Why the hype over electronic cigarettes?


*E-cigarettes have been touted as a safer alternative to smoking conventional cigarettes.  They are seen by some, even in the Public Health community,  as a valuable tool in weaning  America’s 40 million adult smokers off conventional, combustible cigarettes.

Researchers at the University of London are reporting that e-cigarettes were shown to be 60% more effective than other nicotine replacements (nicotine patches and gum) at helping smokers in their cessation efforts.

Lastly, they are being allowed everywhere because they do not give off the malodorous, harmful smoke of combustible conventional cigarettes. Instead, users exhale an odorless or pleasant smelling vapor that quickly evaporates.

Meanwhile, in Taiwan, electronic cigarettes are illegal, and the public has been warned not to use them.  Why?  Should we in the U.S. be concerned?

What are e-cigarettes?

Electronic cigarettes are battery-operated devices designed to deliver nicotine, flavor and other chemicals in an aerosol form inhaled by the user, otherwise known as the “vaper,” during the act of e-cigarette smoking, which is called “vaping.” The aerosol comes from e-cigarette cartridges filled with “e-juice,” or “e-liquid,” placed in the e-cigarettes. When the user inhales, the battery warms the liquid, vaporizing it, giving the user the sensation of inhaling smoke.

What are the dangers of the normal use of e-cigarettes?

The danger lies in the fact that e-cigarettes are not yet fully researched and regulated by the U.S. Food and Drug Administration. This means that neither all the ingredients nor all the possible harmful effects are  known, and that standardized proper handling instructions need not be present on labels.

Thus, the FDA says that so many unknowns remain, including:

1.  The potential risks of e-cigarettes when used as intended.

2.  How much nicotine or other potentially harmful chemicals are being inhaled during use.

3.  Whether there are there any benefits associated with using these products.

For example, I had a patient this weekend admit that he used to sell e-liquid.   I used to, “Import the cheap _____ from China. I sold it by the barrel,” he said.  He admitted he didn’t know all of its ingredients, and did not seem concerned.  What’s interesting is that, in Taiwan, e-cigs are illegal, and the manufacture and sale of e-liquid could result in a 10 year prison sentence.

Have adverse effects of e-cigarette use been reported?

Yes, but the connection between those events and e-cigarettes is not entirely clear.  The FDA receives voluntary reports from consumers and health professionals of adverse events for various substances, including e-cigarettes.  Now while it is unknown whether e-cigs directly caused these events, or if they worsened pre-existing illnesses in the users, the FDA reports that hospitalizations for the following have been associated with normal use of e-cigarettes:

  1. Pneumonia
  2. Congestive Heart Failure
  3. Seizures
  4. Disorientation
  5. Low blood pressures


What is of particular concern to parents?

The Centers for Disease Control reported in a survey that use of e-cigarettes in teens doubled between 2011 and 2012, with 1.78 million U.S. teens reporting that they tried them. What makes this possible is that teen use can often go undetected by parents because of how e-cigarettes may appear.   While conventional cigarettes are easily recognized, and most e-cigarettes come in the form of cigars, pipes and conventional cigarettes, some e-cigarettes also look like pens and even USB memory sticks.

Unintentional exposures are another concern. The American Association of Poison Control Centers and experts at America’s 55 poison centers are urging parents to keep e-liquids out of the reach of children. Toxicologist Ken Kulig says the toxic dose for a child is roughly 6-30 milligrams. Some cartridges contain 500 milligrams. There were 1,414 reported exposures in 2013.  As of March 2014, there were 651. More than half of the poisonings occurred in children under the age of six, with about 42 percent of the poison calls involving people aged 20 and older. Many of the exposures are ingestions, but all sources say to avoid even touching the liquid, which has been called a neurotoxin (toxic to the nervous system). Nausea, vomiting, and eye irritation were the most complaints.


E-cigarettes at the outset appear to be a safer, better smelling alternative to conventional cigarettes for both the “vapers” themselves and others around them.  However, given the lack of regulation and research, including studies of the long-term effects, the jury is still out on its ultimate safety.  Do your own research. Check out the CDC, FDA, and the Poison Control Center first, and consult your physician to learn of all your options for smoking cessation.

To report adverse events with e-cigarettes:

Call 1-800-FDA-1088 or go to:

The HHS Safety Reporting Portal.

Send your information or questions about e-cigarettes to:

1-877-CTP-1373 or [email protected]

If you suspect an exposure to an e-cigarette or liquid nicotine, call:

1-800-222-1222 for your local poison center.

Dr. Kadisha Rapp is a board certified Emergency Medicine physician with over 10 years experience who has practiced in the urban and suburban areas of Washington, D.C., Pittsburgh, Pa., Philadelphia, Pa., and Houston, TX and other cities.

dr. kadisha b. rapp

Dr. Kadisha B. Rapp

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