The AAP sees the pros and cons of electronic cigarettes, but mostly the cons:

A rugged actor with a prematurely lined face and raspy voice expounds on the virtues of regaining our freedom. A flaxen-haired actress waxes poetic on the sex appeal of puffing up in a bar. These are not images pulled from the archives of the golden age of television, when advertising tobacco products on the airwaves was unregulated, but rather from a new, and relatively unregulated, chapter in the saga of nicotine-containing products: electronic cigarettes.


Pediatricians Emily Duffy and Brian Jenssen explain in Pediatrics how e-cigarettes work:

In lieu of tobacco, e-cigarettes consist of a liquid cartridge, which typically contains nicotine derived from tobacco, with an atomizer and a rechargeable battery; when the user draws on the device, it atomizes the liquid and delivers a vapor, in lieu of smoke, to the user. E-cigarette users “vape” the atomized contents of the cartridge, which can have flavors ranging from “plain tobacco” to bubble gum or peach schnapps.


The fact that there are still no product and marketing regulations in effect from the FDA has pediatricians, who have the health and well-being of children in mind foremost, worried.  But regulations are also needed to protect the potential medical benefits this technology may hold in weaning smokers from carcinogenic tobacco products:

FDA regulation is necessary to maximize the potential good in these products. E-cigarettes are marketed to current smokers as an aid to reduce or to stop smoking. Although controversial, smoking cessation experts see tremendous potential in these products as a cessation tool, addressing behavioral and sensory needs that other nicotine replacement products, such as transdermal patches and gum, do not. A recent randomized controlled trial published in the Lancet found that e-cigarettes were as effective as nicotine patches at achieving abstinence, with few adverse effects. These products may help smokers quit.


While effective regulations have been passed in Europe, Toni Clarke says forthcoming regulations in the United States will not be as strong:

The U.S. Food and Drug Administration proposed rules on Thursday that would ban the sale of e-cigarettes to anyone under 18, but would not restrict flavored products, online sales or advertising, which public health advocates say attract children.

The long-awaited proposal, which would subject the $2 billion industry to federal regulation for the first time, is not as restrictive as some companies had feared and will likely take years to become fully effective.

Bonnie Herzog, an analyst at Wells Fargo, said the proposal is “positive for industry.”

But public health advocates lamented the fact that the proposal does not take aim at e-cigarette advertising or sweetly-flavored products, which they say risk introducing a new generation of young people to conventional cigarettes when little is known about the long-term health impact of the electronic devices.


While we’re on the subject, Thomas Novotny (head the non-profit Cigarette Butt Pollution Project) opines that cigarette filters — invented not to prevent disease from toxic tobacco but, rather, as a barrier to keep bits of the leaf from smokers’ mouths — are hazardous to the environment and dangerous to human health and should be banned:

For the past two decades, the environmental group Ocean Conservancy has organised the annual International Coastal Cleanup. Hundreds of thousands of volunteers scour beaches all over the world, picking up trash. By far the most common item they pick up is cigarette butts. Last year they removed more than 2 million of them. Cigarette butts are also the most common item collected during urban litter surveys.

By one estimate, around two-thirds of the 6 trillion cigarettes smoked worldwide every year end up being dropped, flicked or dumped into the environment – around 750,000 tonnes in total.

Used cigarette butts are not just pieces of non-biodegradable plastic. They also contain the carcinogens, nicotine and toxins found in all tobacco products.

We have found that one cigarette butt soaked in a litre of water for 96 hours leaches out enough toxins to kill half of the fresh or salt water fish exposed to them. We know that children and animals consume these pieces of toxic trash, that there are costs to the communities that must deal with them, and that there is biological plausibility to the idea that so many cigarette butts tossed into the environment each year may leach out chemicals that could impact human health.


Nicotine is the active and addictive ingredient in tobacco and e-cigarettes.  While nicotine has it’s own very serious negative health effects (and there are plenty of reasons why we should teach our kids to stay away from it), the dangers that come directly from smoking or chewing carcinogenic, cardiotoxic tobacco products compound the dangers of nicotine addiction many, many times over.  All smokers and non-smokers should be hopeful that future studies examining e-cigarette vapors demonstrate safety to smokers and those around them.  Making physical cigarettes obsolete would be a win for everyone.