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Cole-Bishop Bill Reintroduced in Congress

http://tobaccobusiness.com/cole-bishop-bill-reintroduced-congress/

By Tobacco Business –

FDA Congress

U.S. Representatives Tom Cole (R-Oklahoma) and Cole Bishop (D-Georgia) reintroduced legislation in Congress in an effort to change the FDA predicate date under the FDA tobacco regulations. Known as the FDA Deeming Clarification Act of 2017 (HR 1136), this legislation would also adopt new regulations relating to e-cigarette and vapor products. HR 1136 is an updated version of HR 2058 and the Cole/Bishop amendment.

The re-introduced bill would change the predicate date from Feb. 15, 2007 to Aug. 8, 2016, the date when the FDA deeming regulations took effect.

This move would allow newly deemed tobacco products that were on the market as of Aug. 8, 2016-including e-cigarettes, vapor, cigars, pipe tobacco, hookah tobacco, nicotine gels and dissolvable nicotine products-would not need a special Substantial Equivalency Application or Pre-Market Tobacco Application to be filed with the FDA in order to remain on store shelves and in the market. These products would still be required to comply with the other FDA tobacco regulations, however.

Specifically for vapor products, the bill would also establish a product standard for vapor product batteries. The product standard would include technical characteristics that batteries for vapor products would need to meet in order to be used in an e-cigarette or vapor product. Vapor product manufacturers, wholesalers, and retailers would not be allowed to advertise a vapor product in a newspaper, magazine, periodical or other publication except an adult publication whose readers younger than 18 years old constitute no more than 15 percent of the total readership and fewer than 2 million people younger than 18 years older.

This bill would have a major impact on various part of the tobacco industry. First, it would relieve some of the burden placed on manufacturers of varying ages and sizes. Companies founded after Feb. 15, 2007 would be able to continue operating with their products readily available in the market. As is, compliance costs could drive many newer manufacturers out of business. Second, changing the predicate date would give many manufacturers more product on the market. This also could drastically change the course of the vapor industry, much of which was established long after 2007. The vapor industry is also greatly founded in technology and the ongoing improvement and development of said technology. Anything that was on the market prior to the 2007 predicate date, which is very little, would likely not be promoted or used by vapor consumers today. There are also a great deal of questions and concerns regarding the FDA approval process for tobacco products like cigars, pipe tobacco and vapor products, which is likely to be a very long, costly and confusing process.

Many in the vapor industry view HR 1136 as the first necessary step in developing appropriate regulation for the vapor industry. On its website, the Consumer Advocates for Smoke Free Alternative Association (CASAA) commented, “Different efforts and strategies are required to keep moving the ball forward. Looking to the future, fair regulatory treatment of vapor products is part of the larger campaign to change the tobacco control culture int he United States. Ultimately, policy makers, regulators, and public health advocates must change their abstinence-only approach to one of the comprehensive harm reduction in order to humanely reduce the morbidity and mortality associated with smoking cigarettes.”

The passing of HR 1136 would be a major breakthrough for those hit by the FDA deeming ruling. You are encouraged to reach out to your state representatives and voice your support for the bill, either through email, phone or attending a town hall meeting.

Clean Indoor Air Act – Use of Electronic Cigarette Devices – Prohibition

Download (PDF, 393KB)

Alert: Just 10 Puffs Of an E-Cigarette As Deadly As a Regular Fag

“Quitting smoking is the easiest thing in the world. I know it because I’ve done it thousands of times. Mark Twain

https://www.thequint.com/fitness/2016/12/21/just-10-puffs-of-e-cigarette-are-as-deadly-as-regular-cigarette-vaping-is-not-safer-than-smoking-quit-smoking-2017

Bang on! Science says that 9 out of 10 people who try to kick the butt fail miserably. Perhaps that is why, practically overnight, e-cigarettes have come into their own as the new in thing.

And now an independent study done by USA’s biggest child health body, the American Academy of Pediatrics, finds that e-cigarettes could be the gateway to lifelong nicotine addiction, hinder brain development, give you ‘popcorn lungs’ (an irreversible and fatal condition where the airways are narrowed and weakened) – and all this combined can threaten decades of anti-smoking gains.

If you think that e-cigarettes are an American phenomenon, smoke on this: In the last 3 years, the e-cigarette market has shot up to a $3-4 billion industry and the US contributes to only a quarter of it. In 2014, ITC started manufacturing e-cigarettes in India when most of the Chinese e-cigarette brands were readily available, and obviously, the cigarette giant will not invest millions in a tobacco cessation tool.

Before You Start Vaping, Here’s What You Need To Know

An alarming new study by Swedish scientists found that just 10 puffs of an e-fag can set the heart disease ball rolling, just like a regular cigarette.

It increases the risk of high blood pressure, hardens arteries and makes it harder for people to quit smoking. All this for the popular perception that e-cigarettes are a smoking cessation tool, but contrary to popular perception, it does contain nicotine.

Nicotine is as addictive as heroin, precisely why these vaping devices will never help anyone wean themselves off smoking.

An e-cigarette is a terrible alternative to smoking. In fact, they are much more sinister than tobacco cigarettes – even the World Health Organisation doesn’t buy it.

Nicotine poses several health hazards of varying severity and promotes the growth of tumours.

Dr Pankaj Chaturvedi, Senior Oncologist Surgeon, Head and Neck Cancer Surgery, Tata Memorial Hospital

According to Dr Chaturvedi, e-cigarettes also pose the threat of nicotine poisoning – if you inhale three cartridges in a row, you can die. One cartridge has roughly 11 milligrams of nicotine, three would be over 30, which is a fatal dose. The World Health Organisation says reports of nicotine poisoning have increased manyfold in the US and UK where the popularity of e-cigarettes is soaring.

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Where Does India Stand On E-Cigarette Regulations?

Like with most subjects to do with ‘health’, India does not have a national policy on e-cigarettes yet.

The problem is that e-cigarettes are not mandated by law, and they don’t come under the jurisdiction of the Drugs and Cosmetics Act or fall in the Cigarette and Other Tobacco Products Act. Companies can openly flout the tobacco control provisions, which means they can sell it to kids under the age of 18, skip the gory pictorial warnings on packaging, and openly advertise it.

In 2013, the then Union Health Minister Dr Harsh Vardhan called a closed door meeting of public health activists and FDA officials to completely ban the sale and supply of e-cigarettes in the country.

He was motivated by the news that 13 of the 59 countries that regulate e-cigarettes banned them after compelling scientific evidence that these sticks do more harm than good. But since then, the Health Minister changed and the issue has been put on the back-burner.

A new drug is being freely and openly being sold to people and that drug is nicotine. We don’t know how healthy or unhealthy these are over the long term. But the question is this: if in the next 5 years, we find out these are as deadly as cigarettes for your health, what happens then?

Dr Pankaj Chaturvedi, Senior Oncologist Surgeon, Head and Neck Cancer Surgery, Tata Memorial Hospital

The problem is that Big Tobacco has not revealed exactly what kinds of chemicals there are in the vapour liquid.

And that is concerning.

Health experts don’t trust them. Nobody should trust them. Their only motive is profit. Will you be naive enough to think that big tobacco firms want to help smokers quit?

Standardised Packaging and Tobacco Products Directive

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Call to ban sweet-flavoured e-cigarettes in Wales

Health officials are calling for a ban on the sale of confectionary-like flavours in e-cigarettes over concerns they appeal to children.

http://www.bbc.com/news/uk-wales-38756717

Public Health Wales said it could potentially lead to nicotine addiction in adult life.

It recommends restrictions on advertising e-cigarettes in all media regularly viewed by children.

A vaping company said it should be able to market itself as an “alternative to smoking”.

There are also calls for restrictions on the use of e-cigarettes in and around school grounds and a register of retailers to be set up to prevent their sale to under 18s.

E-cigarettes deliver nicotine within an inhalable aerosol by heating a solution that typically contains nicotine, propylene glycol and or glycerol, and are available in a variety of flavours.

Ashley Gould from Public Health Wales (PHW) said: “You can buy bubblegum, candyfloss, jam doughnut flavour e-cigarettes and they are only aimed at one audience – and that’s about recruiting children.”

PHW said while the health risks associated with e-cigarettes were significantly lower than cigarettes “they are not without risk.”

It said the potential risks were:

Mimicking smoking a cigarette, which could play a role in normalising smoking behaviour
May reduce the likelihood of smokers quitting by displacing proven methods
Potentially acting as a gateway to tobacco use

The potential benefits e-cigarettes can have on smokers were also identified.

The UK’s Royal College of Physicians previously said they should be offered to smokers to help them quit.

Mr Gould said for people who are smoking and want to continue to do so, they would “100% advocate making the switch to e-cigarettes because it’s less harmful than continuing to smoke”.

Joe Bevan, director at Celtic Vapours, said he would like to be able to market his product “as an alternative to smoking.”

“We’re not nicotine replacement therapy and we’re not smoking,” he added.

He said the vapour e-cigarettes give off is “no more dangerous than the actual air we breathe on a daily basis.

“Our emissions tests have shown if you stand by a busy road you will inhale more toxins.”

Vapers beware: 10 things to know about e-cigarettes

With catchy names like Smurf Cake and Unicorn Puke and sweet flavors like bubble gum and strawberry, electronic cigarettes may have special appeal to young people, but that doesn’t mean they are safe.

https://www.universityofcalifornia.edu/news/vapers-beware-ten-things-know-about-e-cigarettes

Evidence is mounting that e-cigarettes are exposing a new generation to nicotine addiction and may be leading users toward a cigarette habit. As a result, the U.S. surgeon general last month issued a report declaring youth e-cigarette use “a major public health concern.”

“All Americans need to know that e-cigarettes are dangerous to youth and young adults,” said Surgeon General Vivek Murthy, in releasing the report. “Any tobacco use, including e-cigarettes, is a health threat, particularly to young people.”

The battery-powered devices heat a liquid typically containing nicotine mixed with the chemicals propylene glycol and glycerin as well as flavorings to deliver an aerosol inhaled by the user. While e-cigarettes deliver nicotine without the tar and smoke of traditional tobacco cigarettes, they still are considered tobacco products.

But their healthy halo has helped propel their popularity: E-cigarettes are now so popular that more American youth vape than smoke cigarettes. In just a decade, e-cigarettes have become a multibillion-dollar business led by multinational tobacco companies with outlets not just online but everywhere from vape shops to convenience stores and retail giants like Wal-Mart.

Ads tout them as a cool, harmless alternative to cigarettes. E-cigarette users, or vapers, have contests to see who can blow the largest cloud of vapor.

But there’s more to e-cigarettes than meets the eye. The surgeon general’s report aligns with increasing scrutiny of e-cigarettes, from new regulations to a growing body of research into health effects.

Here are 10 things to know about e-cigarettes:

E-cigarettes contain nicotine

E-cigarettes contain nicotine, which is addictive and can harm the developing adolescent brain, said UC San Francisco professor of medicine Stanton Glantz.

A lot of the kids who take up vaping are at low risk for smoking, but once they start using e-cigarettes, they are three to four times more likely to start using cigarettes, Glantz said.

“The biggest health concern with e-cigarettes is they are prolonging and expanding the tobacco industry,” Glantz said.

Glantz, director of UCSF’s Center for Tobacco Control Research and Education, said he was initially neutral on e-cigarettes, but now finds them concerning. Among other hazards, e-cigarettes produce ultrafine particles than can trigger inflammatory problems and lead to heart and lung disease.

“The data is just becoming overwhelming,” Glantz said.

E-cigarettes expose people to more than ‘harmless water vapor’

E-cigarettes are billed as producing “harmless water vapor,” but, strictly speaking, the vapor produced when users exhale is actually an aerosol that contains a mixture of nicotine, flavorings and other ingredients that can be toxic.

Stanford University pediatrics professor Bonnie Halpern-Felsher has studied young people’s perceptions of e-cigarettes. In September, she launched a free, downloadable youth tobacco prevention toolkit with an e-cigarette module, funded by the UC Tobacco-Related Disease Research Program (TRDRP) and the California Department of Education.

“Youth are definitely using e-cigarettes because they think they are cool,” Halpern-Felsher said. “Adolescents and young adults don’t know a lot about e-cigarettes. They think it’s just water or water vapor. They don’t understand it’s an aerosol. They don’t understand that e-cigarettes can have nicotine. They don’t understand that flavorants themselves can be harmful.”

The flavors can be toxic

More than 7,000 varieties of flavored e-cigarettes are on the market.

UC Riverside professor of cell biology Prue Talbot screened the cytotoxicity (quality of being toxic to cells) of 36 refill fluids and found that some were highly toxic. The most cytotoxic flavor, Cinnamon Ceylon, contained a chemical called cinnamaldehyde, which gives cinnamon its flavor and whose side effects may include coughing and sore throats. Talbot has been studying more flavors and is building a database to help determine the most dangerous ones.

“Flavors are something that could be potentially regulated,” Talbot said.

Vaping has secondhand and thirdhand effects

Unlike cigarettes, which emit smoke from the lit end, e-cigarettes don’t produce sidestream emissions between puffs, but they still generate secondhand and thirdhand effects when users exhale the mainstream vapor.

In a TRDRP-funded study, Berkeley Lab researcher Hugo Destaillats led a team that found 31 chemicals that include several toxicants at significant levels in e-cigarette vapor. The most toxic chemicals included acrolein, a severe eye and respiratory irritant; and formaldehyde, an irritant and probable carcinogen.

Emissions varied by type of device and voltage.

“The way you heat the liquid drastically determines if you produce a lot of compounds or just a few,” Destaillats said. “As you increase the voltage, toxic byproduct concentrations increase exponentially.”

The batteries can explode

There were 134 reports of e-cigarette batteries overheating, catching fire or exploding between 2009 and January 2016, according to the Food and Drug Administration, which will host a public workshop in April to gather information about e-cigarette battery safety concerns.

E-cigarette batteries “can explode without notice,” Talbot said. “People can be quite severely injured.”

E-liquids are poisonous if swallowed

Calls to poison control centers about e-cigarette exposure in young children have skyrocketed nationally in recent years. In California, the number of calls involving e-cigarettes increased from 19 in 2012 to 243 in 2014, according to the UC-administered California Poison Control System. More than 60 percent of those e-cigarette calls were related to nicotine poisoning in children 5 and under.

E-cigarettes show mixed results in helping smokers quit

While some people have quit smoking with e-cigarettes, on average, adult smokers who use e-cigarettes are about 30 percent less likely to stop smoking cigarettes, Glantz said. Also, e-cigarettes are associated with more, not less, cigarette smoking among adolescents.

“If you are a middle-aged person who has been smoking for 20 years, maybe it is good to switch to e-cigarettes,” Destaillats said. “But if you are a teenager and never have smoked, then it is not a good idea to use e-cigarettes.”

The minimum age has risen

In June, California became the nation’s second state, following Hawaii, to raise the minimum age for tobacco sales to 21, and for the first time added e-cigarettes to the definition of tobacco products. In August, the FDA extended its tobacco oversight to e-cigarettes, banning sales to those under 18.

“It sends a message to youth that e-cigarettes are in the same category of all tobacco products,” Halpern-Felsher said.

E-cigarettes will be taxed

Under Proposition 56, the tobacco tax passed by California voters in November, the state will tax e-cigarettes for the first time, starting April 1. It’s estimated that the price of a typical 30-milliliter bottle of e-liquid could increase to about $30 from $20.

“Anytime you increase the price, people buy less,” Glantz said.

The tax revenue will enhance education efforts by boosting funding for the state Tobacco Control Program. The surgeon general’s report also will make it easier for states to integrate e-cigarettes into tobacco education campaigns and could lead to more regulations, Glantz said.

E-cigarettes may be safer than cigarettes, but unknown risks remain

Expect more information to emerge about e-cigarettes as studies examine long-term effects.

“It’s often assumed that e-cigarettes are safer than cigarettes, but that could be an incorrect assumption,” Talbot said. “We don’t yet know the long-term health effects of e-cigarettes.”

Decades of research have helped scientists determine that cigarette smoke creates more than 7,000 chemicals, at least 69 of which are known to cause cancer and many of which are poisonous.

So, while e-cigarettes deliver fewer cancer-causing chemicals than cigarettes, research has yet to reveal how e-cigarettes fully impact heart and lung health and their cancer-causing potential, Glantz said.

He estimates that e-cigarettes are about one-third to one-half as dangerous as cigarettes.

In other words, they are still plenty dangerous.

“Regular cigarettes are super unhealthy,” Destaillats said. “E-cigarettes are just unhealthy.”

Leading U.S. websites stay in front despite slowing of traffic

Convenience and lower prices make the internet one of the most important distribution channels for e-cigarettes in the U.S., according to a new ECigIntelligence market report which estimates that the country has 180 vendors selling vaping products online.

Most traffic is concentrated among the top online vendors, although their web rankings declined during 2016.

Most of the leading websites receive more than half their visits from the U.S., although traffic from countries such as the UK, Canada and Turkey is increasing.

The leading source of visits is organic search, primarily from Google, followed by direct traffic – consumers who go directly to the vendor’s website. The impact of other channels such as email or social media is very low, according to ECigIntelligence data.

The study reveals that most of the leading online distributors in the U.S. have multi-brand websites, and the presence of corporate websites with single-brand is very low.

The report reveals a large variation in pricing between the leading websites. On the other hand, there is little average difference between prices among the top ten ranked online retailers and the next ten.

What This Means: Despite a downward trend in web ranking and visitor numbers for the leading online brands, the internet still provided one of the most important distribution channels for e-cig products in the U.S. in 2016, with about 15% of vapers regularly making their purchases online. The percentage is higher among hobbyists, of whom approximately 50% prefer to buy online.

The most popular vendors don’t necessarily have the cheapest products available – and though the leading websites’ statistics appears to have declined, they still account for the lion’s share of the traffic. There is no necessary correlation, however, between website visits or engagement and revenues.

– David Palacios ECigIntelligence staff

Minister Litzman, The Tobacco Companies And Cash Envelopes Episode 2

http://www.theyeshivaworld.com/news/headlines-breaking-stories/511229/minister-litzman-the-tobacco-companies-and-cash-envelopes-episode-2.html

On Tuesday 12 Teves, YWN-ISRAEL reported on a Channel 2 sting investigation in which persons affiliated with the Hamodia newspaper, which is tied to Health Minister Litzman, accepted cash to arrange meetings with the minister via is closest confidants. The report also shows how members of the senior ministry staff, physicians, were willing to turn a blind eye to importing electronic cigarettes, which reports show are harmful to the tzibur’s health, all to accommodate the e-cigarette company representatives, who were distributing cash envelopes.

As explained in the first report, the undercover reporters established a fictitious company, SEC (Smoke Electric Cigarettes) and approached ‘macherim’ in Hamodia, primarily Yaakov Reinitz, who in exchange for cash, arranged meetings with senior ministry officials and with Minister Litzman himself. The first meeting was arranged during Chanukah, less than two weeks before they first met with officials in the Hamodia office in Jerusalem. The SEC representatives were seeking approval from the Health Ministry, or at least to refrain from interfering with importing their e-cigarettes to Israel.

It was also explained that Channel 2 has documented Litzman has met with heads of international tobacco companies, which he is prohibited from doing as per the FCTC (WHO Framework Convention on Tobacco Control) Agreement that was signed by many countries, including Israel. If the Health Minister does meet with such persons, the public must be advised, which did not happen here.

Channel 2 also points out that Litzman, to the surprise of all, has been a lone vote objection to legislation to get tougher against the tobacco industry, hinting that he may have been bought out by persons representing the tobacco companies’ interests.

In the final chapter of the report, Reinitz is recorded telling SEC folks “I am sitting in the minister’s office and I am told representatives of Phillip Morris were already here and they are supposed to meet with the minister.

The SEC representatives (Channel 2 reporters) entered Litzman’s office with their hidden video cameras and met with the minister along with personal aide and confidant to the minister, Moti Bobchik and of course, Reinitz.

They get right to the point, telling Litzman they wish to import electronic cigarettes in the coming weeks and seek the ministry’s assistance, adding “we already met with Prof. Itamar Grutto who said ‘at the moment it cannot be authorized’, but added you, the minister has the ultimate say in the matter”.

Litzman explains the matter is still being debated and at first, the thought was to prohibit the e-cigarettes, then instruction the SEC officials to continue to remain in contact with Prof. Grutto. He added “Whatever Itamar decides is what will be. I am not getting involved with this. At present I am dealing with junk food, not this”.

It is pointed out during this tenure, Litzman has not moved ahead any legislation seeking to curtail smoking and tobacco. The minister has also blocked legislation that seeks to limit or prohibit electronic cigarettes. Litzman advises them to remain in touch with Reinitz, who will be updated by him. The meeting lasted for seven minutes, during which they learned Litzman has given Phillip Morris permission to go ahead advertising a new product.

In a subsequent call with Reinitz, he promises SEC officials “A client of mine will not be …… and they needn’t worry”.

Once again Litzman’s office insists it has no knowledge of anyone asking for money or persons paying to see him. He insists his office is open to all and accepting money for such meetings is illegal and unacceptable. Regarding electronic cigarettes, Litzman’s office reports it is working to advance bills seeking to limit them in Israel. However, the minister’s voting record and ministry actions in recent months tell a different story, that the minister is not working against tobacco companies. In addition, Phillip Morris has invested “billions” in a new electronic smoking product and appears to have received a green light in Israel.

 

Not much proof that e-cigarettes can help people stop smoking

http://www.nst.com.my/news/2017/01/203391/not-much-proof-e-cigarettes-can-help-people-stop-smoking

As people become more aware of the dangers of smoking, many have taken steps to reduce the number of cigarettes smoked or to stop the bad habit. Public and private health centres and pharmacies provide smoking- cessation services, which include evidence-based treatment. These studies were based on large-scale population with medication that has been proven to be safe and effective. Nicotine replacement therapy (Nicorette) and Varenicline (Champix) have been used by those who wanted to quit smoking, and they have done so.

Interestingly, there is not much evidence supporting e-cigarette use as an alternative method for smoking cessation.

Recently, the Institute of Public Health, Health Ministry, conducted a survey on the use of e-cigarettes among adolescents and adults in Malaysia (The Tobacco and E-cigarette Survey among Malaysia Adolescents and The National E-Cigarette Survey 2016).

The results were disturbing. The majority of those who use e-cigarette are dual users. This means that they smoke cigarettes and e-cigarette. This is hazardous as it may result in nicotine overdose, which can lead to death. This can strengthen their addiction to nicotine, which hooked them to cigarettes in the first place.

Almost 70 per cent of the dual users stopped e-cigarette but continued smoking conventional cigarettes.

Most school children and adolescents started using e-cigarettes out of curiosity.

The main pull factors were the flavours and smell of e-liquids.

Many other dangerous substances can be introduced by drug pushers and dealers by just lacing the liquids.

Nearly 75 per cent of the study population felt that e-cigarettes were not useful to stop smoking and more than half wanted these to be banned.

DR RASHIDI MOHAMED PAKRI MOHAMED Nicotine Addiction Research Group, Universiti Malaya

The Surgeon General’s Report on E-Cigarettes: Quitters & Starters

By Dr. Sudip Bose, MD

http://www.huffingtonpost.com/dr-sudip-bose/the-surgeon-generals-repo_b_14046964.html

Jan. 7, 2016 — A report on e-cigarettes released at the end of last year by the US Surgeon General’s office shows a number of risks related to the popular product — particularly regarding young people — that should make them a lot less popular, but likely won’t. The act of “vaping” is often thought of as a safer alternative to smoking, but that’s not necessarily the case. Here are the dangers and potential dangers people should be paying attention to related to e-cigarettes:

The Debate

E-cigs are at the center of one of the most contentious debates in public health. The availability and appeal of using e-cigs as an alternative to smoking cigarettes has been growing quickly over the years for both those who are new to smoking, as an introductory product, and to those who are trying to quit smoking, who see it as a more “healthful” way of trying to kick the smoking habit.

However, e-cigs don’t solve the nicotine problem at all. Yes, e-cigs eliminate tar, and yes, e-cigs eliminate the tobacco — both dangerous elements to one’s health. And that’s definitely good. But what they do not eliminate is the critical element of nicotine. Nicotine is one of the most highly addictive substances on earth. It’s presented in a liquid and then vaporized form in an e-cig; you inhale through the e-cig, and as you inhale, the nicotine and other substances in the liquid are atomized and absorbed into your lungs. The nicotine in an e-cig is a lot more concentrated and potent.

New Users

For those who have never smoked and who are interested in the experience, e-cigs are an entry-level product that have been promoted and marketed as being safe. They’re not. They may be “safer” than cigarettes, but that’s only by degree.

While a new “vaper” isn’t exposed to the other substances of tar and tobacco such as are found in a normal cigarette, he or she is getting concentrated and more potent doses of nicotine. That’s not good. And we’re seeing younger and younger people trying these. Also not good. The e-cig “e-liquid,” which is what produces the vapor that users inhale and exhale, are marketed in an array of flavors that appeal to younger users — junior high and high school age kids — they’re available for order online, and you’re getting addicted right away to the habit of using nicotine. The flavors available boggle the imagination: bubble gum, banana, “Mother’s MIlk,” blueberry-lemon, banana cinnamon nutbread, pomegranate, strawberry — it goes on endlessly. These teenagers — and even younger children — are getting addicted early, which could lead to smoking, and e-cigs can easily become a gateway to trying and developing an addiction to more serious drugs. Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction. Ultimately they make some very poor choices and place themselves in very dangerous situations.

We may see less cancer as a result of e-cig use, because the tobacco and tar are gone. But we won’t be able to tell that for years or decades to come. Remember there are other chemicals mixed in with the nicotine in the solution that also could cause cancer down the road. The liquid that becomes vaporized in e-cigs, which you inhale and exhale in a cloud of vapor, contains not only nicotine but an array of other substances, such as propylene glycol, glycerine, flavorings and sometimes components like diacetyl, acetyl propionyl, benzaldehyde and the less-threatening sounding vanillin. We know that when inhaled, diacetyl causes a type of bronchitis known as “popcorn lung” — a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways. It may sound benign to a degree, but according to the American Lung Association, “it’s a serious disease that causes wheezing and shortness of breath, similar to the symptoms of chronic obstructive pulmonary disease (COPD).”

Quitting Smoking

If you’re trying to quit smoking, remember the key drug, nicotine, is still very much available through an e-cig and at much higher, concentrated doses. So while you will be eliminating the tar and tobacco of a cigarette, you’re amping up the accessibility of nicotine. That’s not exactly a great way to wean yourself from something harmful — to add more of it to your system.

We’re seeing a lot more nicotine toxicity. For example, little babies we see in the emergency room — sometimes they get a hold of a cigarette and they chew on it, which is usually not that harmful. But if they get a hold of an e-cigarette and ingest some of that liquid nicotine, which again is so concentrated in an e-cig form, we see nausea, vomiting seizures, paralysis — bad things.

Being that the nicotine is one of the most addictive substances, it’s not really helping you quit your addiction, it’s not the path to accomplishing that. And we’re seeing younger and younger people getting into it.

An Alternative to Smoking

There is a rising “connoisseur-ship” that’s evolved in the world of vaping in which vapers discuss vaping in the same way that wine aficionados discuss the nuances of whatever wine they are drinking. That’s great, but that doesn’t lessen the dangers outlined above.

Are vapers listening? Not really. In 2013, e-cigarette-related sales were $1.7 billion, which was double what they were in 2012. In 2015, those sales had risen to $2.9 billion. Many tobacco manufacturers also are in the e-cigarette game. More than 250 e-cig brands are on the market.

Perhaps this Surgeon General’s report will help refocus attention on the dangers of e-cigarettes and give people enough of a reason to take a pass at the growing trend of vaping.

For more about Dr. Sudip Bose, MD, please go to SudipBose.com and visit his nonprofit TheBattleContinues.org where 100% of donations go directly to injured veterans

Follow Dr. Sudip Bose on Twitter: www.twitter.com/docbose