E-cigarettes: The great unknowns

Electronic cigarettes have been quietly growing in popularity in the United States over the past six years, but they made national headlines last week when a Florida man had one explode in his mouth, knocking out his teeth, damaging his tongue and setting a room on fire.

Tom Holloway, 57, of Niceville, Fla., was smoking the e-cigarette on Feb. 13 when his wife heard an explosion that sounded like a firecracker.

Like many, Holloway turned to e-cigarettes two years ago in an attempt to quit smoking.

E-cigarettes are battery-powered devices shaped like cigarettes that deliver nicotine through an inhaled, smokeless vapor. While various incarnations have been around for 50 years, the modern version was invented by a Chinese pharmacist in 2003. Exports started about two years later.

Locally, e-cigarettes are available in a variety of forms at convenience stores, mall kiosks and tanning salons.

A 'tobacco product'?

In 2008, the Food and Drug Administration tried to block e-cigarette shipments by using its authority to regulate it as a drug-delivery device. E-cigarette manufacturers sued, saying the devices are "tobacco products," and won.

The FDA did not appeal the decision to the Supreme Court and last year announced plans to regulate e-cigarettes as a tobacco product.

Dr. Michael Cummings, a tobacco researcher at the Medical University of South Carolina Hollings Cancer Center, says the e-cigarette is nothing like a tobacco product. E-cigarettes have a battery and contain no tobacco.

Cummings says e-cigarettes could be an effective product to help people quit smoking, but the research hasn't proven the product's safety or efficacy. E-cigarettes' current status as a tobacco product may hinder that research, which so far has been mixed.

"It could absolutely be a tool (to quit), but I think we need good studies to evaluate the claims," says Cummings, noting that current products such as nicotine patches, gums and lozenges have relatively low quit rates.

Cummings adds that the effectiveness of e-cigarettes is inhalation -- the most efficient form of delivering a drug to the brain. It's the same reason smoking is so addictive, whether it's nicotine or other drugs.

Cummings and other health advocates are worried about the unknowns of e-cigarettes. Earlier tests by the FDA, he says, found chemicals similar to those used in car washes. He also is worried about the metal tubings, which potentially could contain lead. The metal could leach into the inhaled vapor and be dangerous for the smoker and bystanders.

"Is it safe and effective? That's the criteria used by the FDA," says Cummings. "It's hard to know. Today, it's human experimentation without consent."

No plans to quit

James Michael Abercrombie, 44, of Summerville started using e-cigarettes about six months ago.

The former collegiate runner at Baptist College, now Charleston Southern University, got hooked on smoking after being married to a smoker.

Though he had stopped for years, a divorce started him back smoking about a pack of cigarettes a day, which became a problem for him personally and professionally. As a car salesman, customers and managers said the smell of smoke turned people off.

While he had tried to quit, he failed. His breakthrough came with e-cigarettes, which he sees as nothing more than water vapor and flavoring.

"I know there's a big debate about it (e-cigarette use), but I can tell a huge difference personally as far as breathing. ... I don't cough at night or in the morning. I don't wheeze. I can even go out and run," says Abercrombie.

His girlfriend, Amy Davies, a former smoker and current health enthusiast, doesn't have a problem with Abercrombie using the e-cigarette but has no plans to join him.

Other benefits of e-cigarettes for Abercrombie, he says, are being able to inhale virtually anywhere and saving money. His e-cigarette kit, which includes the tube, battery and charger, cost $50. Bottles of flavored liquid are $10 each and last about a week. A pack of five filters, which cost $10, lasts about five weeks. By contrast, cigarettes cost $5-$6 a pack.

Despite the unknowns, Abercrombie says he likes using e-cigarettes so much that he has no plans to quit and wants nothing to do with tobacco cigarettes anymore.

Still better than tobacco

Cummings, who is a national-level expert on to-bacco use and addiction, says cigarettes remain the biggest threat in terms of deaths due to cancer and heart disease.

He called the e-cigarette "a sideshow" to the greater evils of smoking tobacco.

"You can hardly get worse than cigarettes. Anything that substitutes for a cigarette is a good idea. I'm not opposed to people making choices, but people need to make informed choices," he says.

Cummings added that consumers are taking a risk by choosing a product that is available "primarily at the shopping mall or online."

Reach David Quick at 937-5516.