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Unregulated, Addictive, And Enticing: E-Cigarettes Suck In Smokers But Risks Remain

In News on February 9, 2013 at 3:32 PM

NJOY King Launch Event

02/09/2013

At a private party inside The Jane Hotel’s posh nightclub last month, a giddy procession of well-lubricated influencers snapped Instagram photos of themselves clowning around with a giant six-foot replica of an electronic cigarette. Chatty couples on tufted sofas exhaled vaporous plumes between bites of complimentary caviar, endive, and goat cheese. Playboy’s Miss November 2012 floated through the fashionable crowd, which was liberally peppered with representatives from the Finance Set, their wrists bristling with Breitling watches. “They’re trying to capture the essence of being a New York smoker, which is incredibly effective,” one woman said, referring to NJOY, the “#1 electronic cigarette company in America” who sponsored the open bar event. “They’re pushing the benefits of smoking without the health risks.”

At 22, she might have been too young to remember bars before Bloomberg, but what benefits was she referring to? “Being social, being cool,” she said while dragging thoughtfully on her menthol NJOY King, as if Don Draper’s doppelganger might approach at any moment and ask her for a puff. “This is just nicotine, right?”

Though the first e-cigarette patent appeared in 1963, Draper wouldn’t recognize today’s battery-powered robot tube that vaporizes nicotine so it flows neatly into our lungs and bloodstream while staying out of our hair, clothing, and breath. But Draper’s Lucky Strike tantrum aside, he’d certainly love selling it. Marketed as a safer alternative to traditional smokes, 3.5 million Americans spend around $400 million on e-cigs every year, and some analysts predict sales to surpass normal cigarettes in ten years. Better still, e-cigarettes are currently unregulated by the FDA, so they can be hawked on TV, in print, or at an expensive Manhattan hotel, while their essential competitive advantage—selling a drug that many doctors believe is one of the most addictive substances on earth—remains unchanged.

The modern incarnation of the e-cigarette was invented in China in 2003, and the basic structure hasn’t changed much since. E-cigarettes use atomizers powered by rechargeable or disposable lithium batteries to heat up liquid nicotine without combustion. Users inhale that nicotine, along with water, flavorings, and a chemical used in fog machine juice (among other household products), without ingesting the smoke that contains toxic, carcinogenic ingredients the tobacco industry spent decades and billions of dollars denying (then admitting) killed you.

NJOY calls its product the “gold standard” of the field, and it’s easy to see why. One of their disposable NJOY Kings smells sweetly of unlit tobacco, crackles like a lit cigarette when inhaled (think the “engine revving” noise electric cars artificially produce), and has an ashen-colored tip that resembles one of those fake rocks suburbanites hide their spare keys in, which glows bright red during a drag. The resulting cloud of vapor can be convincing enough to have you tossed out of the bar.

“We use a very well-regarded tobacco flavorist from North Carolina, so it has a terrific aroma and flavor to it,” NJOY’s Chief Marketing Executive, Andrew Beaver tells us. “Our proprietary technology is extraordinary. Everything about our product—from how hard you have to draw on it, to how it tastes, to how it feels in your hand, to how you inhale, exhale, is meant to replicate the experience of smoking without all the things you don’t like.” Those features seemingly make them ideal tools for smokers desperate for ways to stop smoking without renouncing a comforting oral fixation and a drug their bodies crave.

Yet despite their proud sales pitch, NJOY sued the FDA to prevent e-cigarettes from being regulated as a smoking cessation device. While e-cigarette manufacturers make dubious claims—both coy and blunt—about their products’ health benefits, the medical and public health community remains deeply conflicted about whether atomized nicotine vapor is the safest or sanest way of addressing a public health crisis that kills 500,000 Americans each year. But if sales are any indication, smokers are rapidly drawing their own conclusions.

Linc Williams may have quit smoking, but not nicotine. “I will never give up nicotine, I enjoy my life with nicotine, and I would like to see its use encouraged long-term,” Williams told the audience at a recent FDA hearing on the regulation of smoking cessation products. Williams, a self-described e-cig activist, said that he had spent nearly $17,000 on patches, gum, and prescriptions that didn’t work, and credited e-cigarettes with helping him kick combustible cigarettes for good, noting that he had run a 5K, and felt his health was improving.

But Williams, who is making a documentary about e-cigarette use called We Are Vapers, continues to use snus and e-cigarettes. “[E-cigarettes] brought the pleasure back…the breathing in and out. That social aspect, the hand-eye-mouth.” The perpetuation of the culture of smoking is one of the major reasons why some public health experts have a hard time endorsing e-cigarettes. They would prefer to see the quitting process be as speedy and unsexy as possible—e-cigarette smokers may not die of lung cancer, but why should they remain physically addicted to a product that has yet to be proven safe? And why would a Hollywood starlet blowing vapor from an e-cigarette look any less cool than a “real” cigarette to an adolescent, future customer watching at home?

“Having this thing people suck on that makes them addicted to nicotine, I don’t think that does the public any good,” Dr. Thomas Novotny, a medical epidemiologist, professor, and former Assistant Surgeon General says. “I really think that we shouldn’t support any new nicotine delivery product—it just won’t change the culture of smoking. If anything, it glorifies it.”

A report published by The Royal College of Physicians [PDF] stated that “Nicotine itself is not especially hazardous,” but many doctors, including those at the Center for Disease Control and the American Medical Association, disagree. Dr. Constantine Vardavas, a senior research scientist at Harvard’s School of Public Health, tells us, “Nicotine is a toxic substance that is seriously harmful to one’s heath, especially due to its effect on the nervous system and this heartbeat and arterial tone, too.”

There is also the matter of what else you are inhaling when you take a drag from an e-cigarette. Manufacturers are not yet required to list their ingredients to consumers, but Thomas Kiklas of the Tobacco Vapor Electronic Cigarette Association, rattled them off as being “Nicotine, water, propylene glycol, glycerol, nicotine flavorings, and that’s it.” Kiklas notes that propylene glycol “has been in the U.S. food supply for generations, they use it for sinus medications.” Dr. Vardavas called it an “irritant,” and noted that while the ingredients themselves may not be harmful, “the synergistic effect of them altogether may be harmful.”

Dr. Vardavas was the lead researcher on a study published last year in Chest medical journal that showed changes in lung function to e-cigarette users in the first five minutes of use. “The Chest study is a small pilot study of limited scope, a fact we acknowledge,” he wrote in an email. “However the significance of this research is that it indicates that e-cigarettes may not be has ‘harmless’ as they are promoted and may indeed impact the pulmonary system, at least in the short term that we assessed.”

Michael Murphy, a 28-year-old who has used e-cigarettes for a year, admits he “can’t really focus without nicotine. For me, I need it to pay attention to what I’m doing. It’s just how I start my day—coffee, and a cigarette.” Murphy, a 28-year-old former smoker who runs an after-school program for students in Queens, said he saves $90 a week on EonSmoke e-cigs compared to buying his former brand, Camels, and has had a mostly positive experience with e-cigarettes: “Before I go to bed, I take the biggest hit I possibly can, and sometimes you just feel a little ill, and your chest hurts, but that goes away in like, a minute.”

In the case of NJOYs, that pain is a selling point: “The kick is out of this world!” one user writes in a review on the company’s website. “Tons of flavor, vapor AND throat hit!!!!!!” another adds. User “mick,” who states that he normally smokes Parliaments, wrote, “I didn’t have great expectations but the hit to the back of the throat was almost too much…this is the real deal. Haha I am hooked.”

Andrew Beaver, NJOY’s spokesman, explains, “That’s the nicotine,” and points out that the effect also happens when you take a sip of a soda after eating spicy food. “That’s just a type of irritation on the back of your throat that can be caused by anything caustic being there.” Asked to comment on the irony of a customer gushing that they are “hooked” on an intrinsically addictive product, Beaver says, “We’re not here to tell you that nicotine is not addictive, we are marketing this product to people who are already addicted to nicotine.”

Dr. Novotny, who has studied the effects of cigarette waste on public health as well as the environment, raises an alarming point in a world that is poised to be saturated with disposable e-cigarettes: “What happens at the end-of-life stage for these products? Cigarette butts are already toxic waste. These have batteries and other toxic materials in them.” He believes their disposal should be “more carefully regulated just like we regulate paints or car batteries or other items we don’t just dispose of in the street. It’s very difficult to get rid of batteries. To think that people could be just tossing these on the ground like normal cigarette butts—I just don’t know.”

Kiklas, the e-cig lobbyist, admitted, “Are there knuckleheads? Of course. But stores have return programs, and we have processes for that.” NJOY, for instance, will send users a free e-cigarette if they send back eight spent ones, and Beaver, the company’s spokesman, claims, “We’re getting a tremendous amount of recycling returns.” NJOYs are also completely recyclable, a feature that eludes most of the 300 and counting brands of e-cigarettes on the market.

After comparing the nicotine in NJOY to the prodigious amount of caffeine the country doesn’t bat an eye at ingesting, Beaver adds, “We are keenly aware that we are not as benign as a piece of chocolate on the checkout counter. There are those who choose to smoke and those who choose to live this very organic, risk adverse life. We do exist somewhere in the middle. Actually,” Beaver pauses and corrects himself, “we’re very far towards the side of being not as consequential as smoking.”

Doctors and scientists who promote a theory of overall harm reduction agree, and say the risks of promoting and using e-cigarettes far outweigh the proven dangers of smoking. They point to the statistics that around half of the country’s 46.6 million smokers try to quit smoking at least one day a year, and that most will fail.

These harm-reduction advocates argue that the FDA should embrace technologies like electronic cigarettes, and even extend the recommended quitting period of 12 weeks that’s currently printed on the packaging for products like Nicorette gum or Nicoderm patches. They argue that this would allow smokers more time to wean themselves off nicotine, perhaps indefinitely.

Doing so would entice a “much larger segment of the smoking population” to use tools to help themselves quit smoking, according to Jonathan Foulds, a public health professor at Penn State University who spoke at the FDA hearing. “Right now [the smokers who are quitting are] primarily…people who are making the decision to quit right now…because that’s what the labeling tells me I must do, and it actually implies that it would be dangerous to do it gradually with this product.”

Perhaps the most compelling argument for embracing new technology like e-cigarettes is that the old technology doesn’t work very well. A recent study published in the medical journal Tobacco Control showed that a large percentage of smokers trying to quit with nicotine replacement products like gum or patches started smoking again after several years. The report echoed what has been found in previous studies: gum and patches may work well in the short-term, but there’s a good chance that ex-smokers using them will return to smoking in the long-run. Chantix, a non-nicotine based prescription drug made by Pfizer, has been linked to an increase in depression and an increased risk of suicide.

And then there is anecdotal evidence from longtime smokers that smoking e-cigarettes for long periods of time helped them quit combustible cigarettes. Brenda Smith had smoked Marlboro Ultra Light 100s for decades until a friend bought her an e-cigarette starter kit 18 months ago: “We were going on a cruise, and you couldn’t smoke on the cruise, but we could smoke e-cigs.” Smith, a 60-year-old registered nurse from Virginia, said that she had tried quitting smoking a few times before, but had never stopped longer than a few months.

“Every time I thought about quitting again,” Smith says, “I knew that I’d just gain 30 pounds while I was trying to quit, then hate myself and start smoking again.” While using e-cigarettes, Smith decreased her cigarette intake from a pack a day, to 10 a day, to exclusively using e-cigarettes. “It’s been a positive experience so far. I definitely feel better now than when I was smoking cigarettes, but it’s been a long process,” she adds. Nowadays she’ll “have a few puffs socially, with a glass of wine in one hand and an e-cigarette in the other,” or take drags after a long day at work. Some days she doesn’t use it at all. “I just needed something in my mouth to smoke to help me to quit, that certainly helps.”

NJOY’s spokesman, Andrew Beaver, calls Big Tobacco “one of the most criminal enterprises that have been out there,” and said his company’s goal is to “be a responsible player in this category, to bring the category into the mainstream, and to allow adults to make the decision to use our products on their own.” Beaver added that the company does not sell to minors, does not sell flavors other than menthol, and engages in “self-regulation.” But NJOY’s rise to becoming the most popular e-cigarette brand in the country stemmed from a lawsuit they filed to prevent their product from strict government oversight, and they continue to reap profits in a vacuum where no regulation currently exists.

In 2010 NJOY sued the FDA to prevent electronic cigarettes from being regulated as a drug device that provided the “therapeutic benefit” of quitting smoking. Nicotine devices must undergo rigorous and costly testing before they can market themselves as products to help smokers quit. NJOY won the lawsuit, and the right to keep selling their product as a type of tobacco product. E-cigarettes were ordered to be regulated under the historic Tobacco Control Act of 2009.

That law, which President Obama called a “extraordinary accomplishment,” prevents tobacco companies from advertising within 1,000 feet of a school, banned cigarette flavors (other than menthol), and for the first time gave the FDA the power to regulate an industry that had regularly been poisoning their customers. But the FDA, an agency that regulates more than $1 trillion in consumer goods—25% of all expenditures in the country—has been slow to respond to the e-cigarette market, and hasn’t yet put any regulation in place.

“We’re moving to release for public comment a proposed rule to regulate additional categories of tobacco products,” said Jennifer Haliski, the spokeswoman for the FDA’s Office for the Center of Tobacco Products. That proposed rule may impose restrictions on e-cigarettes that already exist—new warning labels, a ban on flavors, advertising limitations, additional taxes—and ones that may be specific to e-cigarettes, such as regulating nicotine intake or the ingredients that can be put into e-cigarettes.

The rule is due by April of this year, but once proposed, a lengthy public comment period would ensue, and months would stretch on before the regulations would be enforceable by law.

Until then, electronic cigarette companies can do what tobacco companies can only dream of doing: show celebrities puffing e-cigs on television, sell flavors like chocolate banana or cinnamon apple, and creep into the $1 billion market for smoking cessation products by brazenly touting the supposed health benefits of using e-cigarettes. Company names include SafeCig, and SaveASmoker, while another called E-HealthCigarettes, sold in 7-Eleven stores alongside NJOYs, states on its packaging, “Smoking is harmful for health. E-Cigarette is good for health.”

One of Brooklyn’s homegrown e-cigarette companies, Bedford Slims, sidesteps the stigma by calling their products “vapourettes,” and their cylinders substitute the staid masculinity of traditional tobacco designs with cheery patterns from New York-based artists. Their pitch is more tactful, but clear. After declining to make claims of cessation, the company writes on their website, “a little internet research will tell you what we would LOVE to say.” The company adds, “there are no known negative side effects for vapourettes that could cause damage on the scale that cigarettes do.”

“Compared to the traditional tobacco industry, there are no handcuffs on the e-cigarette industry,” an institutional tobacco investor says. “At this point, the FDA still looks like a paper tiger.” The investor, who would only speak to us anonymously because he is not authorized to comment to the media, stresses how dependent traditional cigarette companies are on “innovation,” or gimmicks, to sell their products, a process that has ground to a halt by the FDA in part by the Tobacco Act’s stipulation that every alteration to their product, however minute, must be FDA-approved.

“The thing about this industry is that they need to keep tweaking their product. That’s how they keep gaining users. But tobacco companies have to get the FDA’s approval if they want to do anything, even if they change the ink on their product,” the investor says. “There’s like 3,000 applications for modifications, and the FDA hasn’t touched one. But the nice thing about e-cigs is that right now, you don’t have to go through all that. There’s a lot of potential.”

Bonnie Herzog, the managing director for Wells Fargo’s Beverage, Tobacco, and Consumer Research division, agrees. “Even when the tobacco industry had none of these new restrictions, it’s not like they had a ton of huge innovations—they couldn’t even advertise. But this is a whole new game. It’s a category where the margins could be quite substantial.” As for NJOY, Herzog believes there is a good chance that one of the major tobacco companies will buy it up. “Keep in mind, Altria doesn’t even have anything in the form of e-cigarettes.”

Altria, Philip Morris’ parent company, makes Marlboro and Parliament cigarettes, and is the largest cigarette manufacturer in the country. Its top two competitors, Reynolds American (Camel, American Spirit, and many others) and Lorillard (Newport) both have their own e-cigarette brands. NJOY’s party at the Jane wasn’t merely to spread the e-cigarette gospel to hip, attractive New Yorkers (although it did plenty of that through the dozens of free e-cigs it doled out) but to flex its muscles for prospective suitors. Another fact not lost on investors: NJOY’s executive vice president, Roy Anise, and its senior VP of sales and distribution, are both Altria alums.

On its website, NJOY states that it is “the only e-cigarette company to have had its marketing practices reviewed by Federal District and Appellate Courts and found to not have made or implied health claims,” and stresses that “NJOY products are not a smoking cessation product and have not been tested as such.” Yet an insert inside a NJOY King reminds us, “Be sure to tell your friends and family about the positive impact NJOY products are having on your life.”

We also received this pitch from NJOY’s PR representative:

Every year at this time, people vow to “quit smoking” (often unsuccessfully) as a New Year’s resolution. Now modern technology has created a ground-breaking new invention designed to help smokers keep that resolution: meet NJOY Kings, a brand-new electronic-cigarette (e-cig) that now gives smokers a new alternative to tobacco cigarette…Whether it’s the vow to “quit smoking” for real this time or you’re at a party where drinks are flowing, even the most casual of smokers enjoys a cig with a drink or two.

Beaver, the NJOY spokesman, said, “We do not market the product as a smoking cessation product. If you look at the Marist polls, quitting smoking has been one of the top New Year’s resolutions for decades, so we believe it’s appropriate to reference that fact.”

Haliski, the FDA spokeswoman, said that the agency does not comment on the claims of specific companies, nor has it released any guidance or regulation on what a “therapeutic claim” is. So who regulates these statements? “It is the manufacturer’s responsibility to review the applicable law.”

“There are a few companies out there making sly claims, but we rigorously go after them,” said Thomas Kiklas, of the TVECA. “We don’t make claims of cessation, we don’t make claims that it’s a less harmful option.” Asked whether NJOY’s insert constituted “sly” marketing, Kiklas replied, “I think it just means if you enjoyed it, spread it around.”

Beaver said that NJOY is working towards submitting itself to the type of regulations necessary to be marketed as a tool to help smokers quit, but declined to say when it would happen. “The thing to keep in mind is that, it’s not like the FDA does this for you, it’s quite costly. But we are in the process of putting together the protocols and the process and the formats to do it.” The company is private, and so are their earnings, but Beaver noted, “Our product is doing extraordinarily well, even beyond our expectations.”

The institutional investor explained the product’s success: “You’re selling this highly addictive substance to the consumer, but you’re not killing them outright. I have to assume this is a product you can have a long runway with.”

Linc Williams, the 40-year-old former smoker who testified at the FDA hearing and has been using e-cigarettes and snus for 30 months, credits the product with saving his life. “I was smoking one day, and had a random trucker come up to me—I had no idea who he was. This guy gave me an e-cigarette, told me to try it, and said ‘It may safe your life.’ He was absolutely right.” Williams says it spurred him to do something about his declining health: he has lost 100 pounds since quitting cigarettes and stresses that he is making his documentary to “pay it forward” and spread the gospel.

“I’m a better person on nicotine,” Williams tells us. “These anti-nicotine zealots who oppose e-cigarettes don’t like us because we’re very vocal about [e-cigs’] success. They don’t like that thousands of us come together online and talk about how using them is a profound, life-changing thing.” When asked what he wants to accomplish as an e-cigarette activist, Williams seems to share NJOY’s stated vision. “My ultimate goal, is for cigarettes to become abnormal, and for e-cigarettes to become the norm.”

Via Gothamist

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