E-Cigarettes: Avoiding the Risks

Amidst all the legal arguments and political rhetoric surrounding e-cigarettes and the regulations on where you can use and buy them, lawmakers and e-cig advocates seem to have forgotten that both parties want the same thing: a safer, quality product for a healthier society.

While still new, the e-cigarette industry is no longer in its infancy. The attitude currently surrounding e-cigs might better be described as its teenage years; rebellious, young companies and consumers, fighting with mama-and-papa government over where and when they can go out. All while friends and relatives chime in on social media, and the cool uncle, science, tries to calm everyone down with a little reason and understanding.

“Cool uncle,” and e-cigarette researcher, Dr. Konstantinos Farsalinos, has done one of the largest e-cigarette studies to date, in which he tested 159 different e-liquids for two harmful chemicals commonly used in food and e-cig flavorings called, diacetyl and acetyl propanol.

“We must be sensible, we must be realistic and we must provide some minimal level of regulation, “ Farsalinos said. “But that regulation does not mean restriction. It means making a good quality product.”

Currently, the quality of these products, or what ingredients can be used in them, is completely unregulated.

“We compare it to the Wild West, there are no rules,” said Michael Seilbeck, spokesman for the American Lung Association (ALA). “What is being sold in this store is not necessarily the same as that store.”

Up to now, all proposed e-cigarette legislation has focused on where and when it is acceptable to use them in public, as well as banning sales to minors. There are only three states with statewide restrictions on e-cigs, similar to those on traditional cigarettes; New Jersey, Utah and North Dakota, while 45 states have laws prohibiting sales to minors, with Maine, Texas, New Mexico, Montana and Oregon yet to do so. Additionally, over 300 municipalities across the country have passed their own legislation, restricting e-cig use in public spaces to varying degrees. (For a complete breakdown of state laws, here is an interactive map)

Greg Conley, president of the American Vaping Association (AVA), talked about the e-cig community’s mixed feelings on current and impending regulations.

“Many vapers have supported regulations for banning sales to minors and child resistant packaging, but they want appropriate regulations that don’t impact their ability as adults to access these products,” Conley said. “We have a public health crisis where 450,000 people are dying every year due to smoking related diseases. We have known for 40+ years that smokers smoke for the nicotine but they die from the tar and other toxins. So we need innovative products and the current FDA approved methods are not working for people as well as e-liquids.”

While traditional cigarettes were banned in public places well after science had established the devastating health risks associated with smoking them, e-cigs are not being given the same room to breathe. Instead, lawmakers and tobacco control groups have been lobbying for, and enacting bans on vaping in public spaces well before science has established a firm understanding of all the risks involved.

“If you can smell something, that means the particle is big enough to trigger an asthma attack,” explained Seilbeck. “So should we be exposing the public to something that, not only do we not know what’s in it, but is something that might trigger their asthma? I am not saying it is causing asthma, but that was one of the main reasons the initial laws were passed; for those who are not partaking, why should they be exposed?”

However, sweeping generalizations can be inaccurate.

“I do not want to say they are safe, but e-cigs are much less harmful than traditional cigarettes,” said Farsalinos. “There is nothing that we consume that is entirely safe. Even water has impurities; it contains microbes and bacteria… but that does not mean water is inherently dangerous.”

While, according to the ALA, traditional cigarettes contain about 600 ingredients, 69 of which are known to cause cancer or be poisonous, e-cigs contain a fraction of that. The three primary ingredients in e-cigs, propylene glycol, vegetable glycerin and nicotine, are all well -known and relatively safe chemicals to inhale by ALA standards. However, the chemical flavorings in e-cigs, often designed for ingestion, pose a potential risk when inhaled. Diacetyl and a derivative, acetyl propanol, used in buttery and custard flavors, are the best -known of these potentially harmful chemicals.

Popcorn lung, or to use its real, and much scarier name, Bronchiolitus Obliterans, is an untreatable disease that can result from prolonged inhalation of diacetyl or acetyl propanol. It is a condition in which the tiny air sacs, called alveoli, become scarred and stop working.

Most e-cig advocates are wary of government-imposed regulations of any kind, but none can argue against quality control. Russ Wishtart, an outspoken e-cig advocate who has sued New York City in an attempt to get e-cigarettes removed from the Clean Indoor Air Act, personifies this.

“I am not saying that it [quality control and ingredient disclosure] should be required,” said Wishtart, who also hosts a podcast that devotes a lot of time to e-cigs. “I am not for any kind of restrictions, laws or requirements, but that is something that I would choose to spend my money on.”

But can companies be trusted to regulate themselves without government intervention when profits are at stake?

According to Seilbeck, “In many instances, profit is being put before public health, certainly. It is much easier from a profit perspective, to not look at the health questions.“

But that doesn’t mean they should not be asked.

After seeing Farsalinos’ diacetyl study, Wishtart spent some of his own money to ask his own questions and independently test a popular e-liquid flavor; Mother’s Milk, whose producer, Suicide Bunny, claimed to be diacetyl free. The results came back showing low amounts of Diacetyl and high levels of Acetyl Propanol. In short, the company did not regulate themselves.

“Companies know about these chemicals but customers and users of e-cigs don’t know what they are,” Wishtart said. “Diacetyl exists in traditional cigarettes but the FDA prohibits them from adding more of it. If you think they are going to allow it in E-Cigs, I got a bridge to sell you.”

Cigs Vs. E-cigs
Cigs Vs. E-cigs: A Chemical Comparison

According to Farsalinos, this is an important factor in the e-cig, vape debate.

“That diacetyl [in traditional cigarettes] is produced as a bi-product of combustion and is therefore an unavoidable risk,” he said. “But in e-cigarettes, it is an added ingredient, and is an avoidable risk.“

Isn’t avoiding risks what e-cigarettes are all about in the first place? If smoking cigarettes is a risky behavior, choosing to pick up e-cigarettes is an example of risk- avoiding behavior. Should governing bodies that are tasked with finding public health risks and then mitigating them, take a more proactive role within this nationwide exercise in risk avoidance?

The FDA has proposed a rule that, if approved, would give them authority to regulate e-cigarettes just as it does traditional tobacco products. However, that rule does not include a provision for regulation of the chemical components of e-liquid.

“Finding diacetyl in e-liquids doesn’t mean that, suddenly, vaping is worse than smoking. On the other hand, it also doesn’t mean there is nothing wrong,” Farsalinos said. “The key issue [diacetyl and flavorings] is an avoidable risk and there is no excuse to continually expose people to a risk that can be avoided, especially if it can be avoided for a small cost. It is something every manufacturer should do, regardless of regulations.“

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