The e-cigarette prairie fire

Since our last post on the subject of e-cigarettes written by Dr. Jeff Ribordy (, tobacco consumption through these nefarious little tubes continues spreading like a prairie fire. Their use has more than doubled among middle and high school students over the past year. For middle schoolers who start consuming tobacco, one out of five begin with e-cigarettes.

At the time of our last post, it appeared the FDA was prepared to issue regulations on e-cigarettes in October 2013. Well, it is now three months later, and the FDA has still opted for a hands-off approach. They have yet to regulate the advertising, marketing, or production of e-cigarettes. There is still no federal ban on selling e-cigarettes to children. California, along with other states, has outlawed their sale to those under age 18, but kids of all ages can easily buy them over the internet.

Now, don’t get me wrong. I have nothing against North Carolina. Some of my best friends hail from Kentucky. The last time I visited Virginia, the people there seemed downright neighborly. But I do have a problem with the tobacco industry, which is heavily pushing the sale of e-cigarettes. The tobacco mavens promote e-cigarettes as safer than regular cigarettes. They market them in fancy flavors geared specifically towards young people, such as bubble gum, cola, and fruit flavors. Active efforts are underway to allow e-cigarette smoking in restaurants, workplaces, and public buildings, since e-cigarettes are “not cigarettes.” In fact, the tobacco industry is trying to recategorize consumption of e-cigarettes as vaping rather than smoking, in an effort to differentiate the two forms of tobacco use. Even more ironic is that big tobacco promotes e-cigarettes as a safe and effective method to help people stop smoking.

Time for a little reality. Nicotine is very addictive. Like other addictive substances, it increases dopamine levels in the brain. It parallels cocaine in its CNS effects. Big tobacco companies claim vaping has never been proven dangerous and because e-cigs contain no tar, they must be safe. It is true no controlled studies have been done demonstrating vaping is dangerous. It is also true no studies have proven it safe. To obtain meaningful data would take decades. But no additional studies need to be done to confirm the addictiveness of nicotine. E-cigs are not benign. They are not safe. They are hooking our children. And remarkably little public outcry has so far been heard.

After the damaging effects of cigarettes were clearly established, it still took many long years and millions more deaths before this country placed a modest damper on smoking. Even today, restrictions on second-hand tobacco exposure are pretty flimsy in many parts of the country. As physicians concerned with the health of our patients and society at large, we need to step up and make sure vaping is not allowed to spread across the land under the mythology that it is a safer way to consumer tobacco.

Richard Fleming, MD

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