Health & Nutrition

Are Electronic Cigarettes Safe?

One day in 1995, Jeffrey Wigand  received something ominous in his mailbox: a bullet. Though it had no return address, Wigand knew where his special delivery had come from. He had been hired as the vice president of research and development at the tobacco company Brown & Williamson in the late 1980s.

Wigand had initially been working on a reduced-harm cigarette for B&W, but he had quickly grown disillusioned about whether the company really supported his efforts. Wigand was eventually fired, but not before discovering that the company had attempted to manipulate the level of nicotine in its products in an attempt to increase their addictiveness.

Wigand went on to be an expert witness in cases against major cigarette manufacturers like Philip Morris, which revealed that these companies had known about the health risks of smoking for years. He also went on a national television program to share with the public what was happening behind the scenes at his former employer.

The tobacco companies didn’t take the threat lying down. Wigand received a number of death threats. Some were merely hints, like the bullet in his mailbox. Others were explicit, in letters or phone calls, and included threats to the lives of his wife and children.

The threats to Wigand eventually caused his wife to drive him out of his house, and a 500-page dossier of scandalous assertions about him compiled by the tobacco companies was used in an attempt to blacken Wigand’s name. Nonetheless, his testimony helped secure heavy legal judgments against Big Tobacco.

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The secrets that Wigand and other whistleblowers exposed and the threats they received in return are convincing proof that while most conspiracy theories are probably the products of wild imagination, there really were conspiracies, led by the tobacco companies, that harnessed every political, scientific and media force at their disposal—as well as some illegal tactics—to mislead the public about the danger of cigarettes.

There’s little left to deceive the public about now. By 2013, it’s clear to most people that cigarette use has a high probability of serious, often deadly consequences. It’s estimated that over 600,000 people die each year from smoking-related causes, ranging from lung cancer to emphysema to heart disease.

But there are other conspiracy theories to consider in our modern times. These surround not the traditional cigarette, but rather, their electronic counterpart.

Makers of e-cigarettes, as the electronic devices are often called, take just the nicotine from tobacco, leaving behind the tar and other byproducts that have been found to be the most harmful parts of cigarettes. Combining the nicotine with just a couple of other chemicals creates a liquid that can be turned into a vapor through mild heating, rather than the burning that produces cigarette smoke. Those addicted to nicotine can get their fix without getting everything else that’s in a regular cigarette.

E-cigarette vapor is considered much safer than cigarette smoke, even by its most ardent opponents. Yet ordinances, amendments and other laws have sprung up across the US and overseas limiting the use of electronic cigarettes. The UK has passed a law limiting nicotine levels in e-cigarettes to relatively minuscule amounts, low enough that they won’t satisfy most smokers. There have even been bans considered on electronic cigarettes in areas where regular cigarettes would still be available.

A recently leaked draft of a New York City Council bill showed that the Bloomberg administration had advocated for restrictive new measures against electronic cigarettes, after previously telling e-cigarette proponents that they would do no such thing.

Thankfully, the rate of cigarette smoking has dropped in our communities. Recent studies have shown, for example, that the Jewish religious community in Israel has a lower rate of smoking than their secular counterparts. But for those who do smoke, any help in reducing or quitting could be a literal lifesaver. And it’s all too easy to find people to speak to someone in our community—as I did while researching this article—who are still aching over the loss of a family member or friend from a smoking-related illness.

Reputable scientists believe that e-cigarettes could save hundreds of thousands of lives a year in the US, and millions across the globe. What’s the truth about e-cigarettes? And what lies behind all the hatred?

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The long road to e-cigarettes:

The idea for an electronic cigarette is not a new one. The first US patent for such a thing was filed in 1965 by Herbert A. Gilbert. At the time, it had not yet been proven how cigarettes addicted their users, and a prevailing idea was that the habit of smoking created a psychological addiction. So Gilbert’s e-cigarette merely blew moist, warm air into the smoker’s mouth, in an attempt at mimicking the experience of smoking.

Gilbert has become a partner in the Emperor Brands e-cigarette company, which is planning to revive his earlier patents. (They’ve introduced an e-cigarette called the 1963, named after the year that Gilbert first applied for his patent.) He told me that in the 1960s, he had approached companies of all sorts, including some in the tobacco industry, to produce his electronic cigarette. None took him up on the offer.

In the beginning of the 1970s, scientists—particularly the British psychiatrist Michael Russell—proved that it was the nicotine in cigarettes that caused addiction. Russell also recruited Colin Feyerabend, a young biochemist, to develop a test that could measure nicotine levels in the blood and accurately determine how much nicotine smokers were really getting. Scientists would eventually find that the addictive power of nicotine can be stronger than heroin or cocaine. Nicotine binds to receptor sites around the body for the chemical acetylcholine, which is naturally produced by the body.

That ability is what gives nicotine its potent effects. That idea was quickly turned by pharmaceutical companies into products designed to get people to stop smoking. First came nicotine gum, then nicotine nasal sprays and transdermal patches. The closest the pharmaceutical companies got to a cigarette-style device was the nicotine inhaler. But, over time, it became clear that these devices hardly work to keep people off cigarettes. Their rates of success after one year hover at about the five percent mark.

Part of the reason that these methods seem to fail is that addiction to smoking is a complex interplay between the physical addiction to nicotine and the psychological addiction to smoking. Herbert Gilbert’s idea, it turns out, may have been ahead of its time after all.

Interestingly, one reason that the pharmaceutical companies never pursued an e-cigarette device like Gilbert’s may have been because they believed that it would be easier to quit if the nicotine was delivered in a way that did not mimic smoking. Professor Feyerabend explains: “They [the pharmaceutical researchers] were trying to break the habit of smoking. Gilbert himself gave me a speculative reason behind the psychological addiction to nicotine and the failure of other methods: heat, which other methods don’t use. If you start to feel ill, and they want to know if you are ill, they stick a thermometer in your mouth. What a fever shows is that your immune system is fighting an infection. The way it fights it is through heat. Subconsciously, when your immune system needs a boost, and it gets used to having heat come into it through smoke, you get a terrific urge to get a cigarette now.”

In 2002, Hon Lik, a Chinese pharmacist, found a way to reliably deliver nicotine in an electronic cigarette. By putting the nicotine base into a solution of propylene glycol, he could get the liquid to turn to vapor through low-temperature heating, rather than burning. Some e-cigarettes would eventually use vegetable glycerin instead of propylene glycol, because it is less drying to the throat; today, many e-cigarette “juices” contain both.

E-cigarettes now come in basically two forms. There are the cheaper types, sold in gas stations and convenience stores, which generally try to look like cigarettes. They are usually not refillable, but some will plug into a USB port on a computer to charge. The larger types, which resemble metal wands of various widths and lengths, can be refilled with different flavors of e-cigarette fluid (some shops sell more than a hundred varieties) and give what many smokers describe as a much more satisfying “hit” of vapor to the back of the throat, which approximates the feel of a real cigarette. These devices require larger rechargeable batteries, which use a charging station.

Like the product itself, there are also two types of e-cigarette users. There are the casual users, who merely replace their use of cigarettes with e-cigarettes. And then there are the enthusiasts, often referred to as “vapers,” who form a subculture all their own.

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Scientists’ duel:

Because of the small number of ingredients in e-cigarettes, the questions about them are simpler than those about regular cigarettes. Are the ingredients themselves harmful? When you heat them, do they turn into something harmful? And are there impurities in the ingredients that could cause health problems?

Right now, it’s hard to get an absolutely clear answer on those questions. That’s not because there hasn’t been any research, but because the research that’s been done is contested.

For example, Professor Igor Burstyn of Drexel University put out a report this past month that looked at the risks of both the main ingredients of e-cigarettes and contaminants that have been found in e-cigarette vapor. He didn’t study the health effects of the nicotine in the e-cigarettes, because, as he pointed out to me later, the “properties of nicotine and its health effects are well understood,” and people who smoke e-cigarettes are trying to inhale nicotine. He was only looking at things people might not realize they were inhaling in harmful amounts.

Burnstyn’s conclusions were that the main e-cigarette ingredients are inhaled by users at rates that should be studied further, but that contaminants are nothing to worry about. Any studies that have accurately found contaminants, he wrote, have found them at levels that are smaller than would concern environmental scientists. And secondhand vapor was certainly nothing to worry about.

Communicating with Ami via e-mail, Dr. Burstyn was dismissive of health concerns caused by the main ingredients, as well. “I do not think that there is much of a controversy about dangers of propylene glycol: it is mostly benign and may prove to be entirely benign at levels emitted by electronic cigarettes. It is clearly orders of magnitude less hazardous than what one finds in either firsthand or exhaled cigarette smoke.”

But Dr. Burstyn’s research was requested and paid for by an e-cigarette industry group, CASAA (Consumer Advocates for Smokefree Alternatives Association). That may be entirely benign; he told me that “CASAA exercised no editorial control over my writing or analysis,” and that “I did not face any external pressures in my work. It was lovely for me to simply study the numbers and record the conclusions that logically flowed from the calculations.”

Even so, it made some people suspicious. Professor Stanton Glantz is director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. He has been one of the foremost scientific opponents of the tobacco industry for decades and was a critical player in the legal battles against the big tobacco companies and the public exposure of their secret files.

But Glantz is also one of the leading critics of e-cigarettes. He sees Dr. Burstyn’s study as similar to countless studies funded by the tobacco industry that showed, inaccurately, that smoking is harmless. He explained to us why he thought Burstyn’s study was invalid.

“Threshold limit values [the values that Burstyn used to decide what should be considered safe] are a very old, outdated method. And it was a generally not-used method in the first place, even for occupational exposures. It’s an idea that was developed back in the ’60s and has really been superseded by other approaches. The industry likes them because they’re high. The kind of analysis that he did is very reminiscent of other things that tobacco forces have used in the past.

“I feel like I’m playing whack-a-mole with these studies. It’s very frustrating. There was another one published about a year or so ago in a second-rate journal that purported to do a similar risk assessment. They included a risk assessment of smoking regular cigarettes that showed there was no risk to smoke cigarettes, and that the risks of e-cigarettes were even lower, according to their calculations. But these things are just junk from a scientific point of view. This one [Burstyn’s] wasn’t even published. It was just put out on the web.”

So why haven’t there been studies done that he would consider conclusive? Glantz told me that his team at UCSF is working on such a study. But he said that the process of research and peer review means that studies take a long time to complete. “It’s such a new phenomenon, and the legitimate scientific enterprise grinds slowly.”

Glantz agrees that e-cigarettes are not as dangerous as traditional smoking. “That’s obvious. They’re delivering lower levels of a variety of bad things. You can argue about how much lower.

“Even if you look at the levels of the compounds that are emitted, even if the existing e-cigarette levels are off by a factor of two or three, they still will end up lower than what you’d get from a regular cigarette, because when you burn the tobacco you generate a huge amount of toxins. So an e-cigarette will produce fewer toxins than an incredibly toxic thing.”

But he says that fewer doesn’t mean none. “If you look at the very limited data that’s out there, an e-cigarette probably produces 10 to 20 percent of the air pollution as a cigarette. I’m talking about what’s emitted to the surrounding air by the exhale. So you might say that sounds pretty good. Well, if you go into a bar where people are smoking, the air pollution people are emitting is around 800 to 1,000 micrograms per cubic meter. The only way to get the air that polluted outdoors is to be downwind of a forest fire. So even 20 percent of that doesn’t sound so good.”

He claims that the industry is misleading the public. “If you look at their company websites where they say it’s pure nicotine vapor— that’s not true. They say that what the smoker exhales is just water vapor that doesn’t pollute the air—that’s not true. We know the e-cigarettes are exposing both the users and bystanders to a variety of chemicals. What those chemicals are and how much they are is highly variable. It’s not a pure, harmless water vapor. That is already established.”

Part of the problem with e-cigarettes that he sees—and part of the reason research is going slowly—is that the manufacturers of e-cigarettes have no agreed-upon quality standards.

He also says that e-cigarettes don’t help people stop smoking regular cigarettes. “There are two good longitudinal studies—the best kind of study in epidemiology, where you follow the progress of groups of people over time—that have been published. One of them looked at four countries—the US, UK, Canada and Australia—and found that the dominant reason adults were using was to help them quit, but a year later it didn’t help them quit. The people using e-cigarettes were quitting at identical rates of those who weren’t.

“There was another study published a few months ago here in the US that looked at people who were calling quit lines in seven states. There, the people using e-cigarettes actually did a lot worse than the people who weren’t using.

“So the objective data shows they don’t help people quit standard cigarettes or they inhibit quitting. These two studies were quite big and done by good groups who know what they’re doing.”

Dr. Glantz is particularly concerned about secondhand vapor and the use of e-cigarettes indoors. He questioned the safety of every stated ingredient in e-cigarettes and the things that are in them that aren’t listed.

“Even nicotine is a neurotoxin,” he told me. “It used to be used as an insecticide until the EPA banned it. So even if it was true that it’s just nicotine vapor, as they falsely claim, I don’t want people to be exhaling a neurotoxin around me.”

But for every scientist who is opposed to e-cigarettes, there is one who is a proponent of them. Michael Siegel is a professor of community health sciences at the Boston University School of Public Health. He’s done a number of studies on e-cigarettes, but he says that conclusive studies are still waiting because of lack of money.

“One thing holding back research is the fact that this is not a pharmaceutical product made by the large pharmaceutical companies. So most of the companies are very small and don’t have the money to do the type of trials those big drug companies would do with drugs. Those companies spend tens of millions on product testing.”

But what he has seen so far is reassuring. “I think most definitely there is a positive effect of e-cigarettes. There’s a lot of evidence that they are helping literally hundreds of thousands of people either reduce the amount they smoke or get off cigarettes completely. In fact, that’s the main use of these products. The reason people are using them in the first place is because they’re worried about their health and they’re addicted to smoking and want an alternative that will allow them to continue using nicotine but not kill themselves.

“There’s a lot of evidence from surveys and individual testimonials, and most recently from clinical trials, that indicate that these products can be effective in helping people quit or cut down substantially on smoking. I think there’s evidence that these products are as effective or more effective than the other products on the market— such as nicotine replacement therapy—that we’re currently recommending. For people who have tried those products and failed, electronic cigarettes are a great alternative.”

He thinks that concerns about secondhand vapor aren’t well-founded.

“There has so far been no evidence that exposure to the secondhand vapor of electronic cigarettes causes any harm. It is true that there are a small number of chemicals in the vapor—particularly propylene glycol. Theoretically there are concerns, if it’s possible that bystanders could be exposed. But the studies done so far have shown the levels to be very small and probably no risk to bystanders. So there’s no evidence so far that these products are harmful to bystanders in any way.”

Professor Siegel wouldn’t say that e-cigarettes are completely harmless.

“They contain nicotine, which we know isn’t completely safe. We will never say that these are completely safe products. But that’s not the purpose. The purpose is to be safer than cigarettes and allow people who are addicted to a product that will most likely kill them or give them a serious disease to have an alternative that can save their lives.”

Feyerabend, the researcher on nicotine, was much less concerned about its health effects than either Siegel or Glantz. He told me that a drop of pure nicotine on a person’s skin would probably kill them. But the levels of nicotine in cigarette smoke aren’t particularly dangerous, he said, though they have a small cardiovascular effect.

“The reality is that there are so many people out there who want to quit smoking but just are unable to do so because it’s so addictive. The question is what we do for them. Do we just tell them to forget it—they have to just keep smoking because we don’t want them to switch to a safer alternative because it might be slightly harmful? Or do we say that we need to balance risks, and the risks of e-cigarettes are much less than those of cigarettes, so you’re much better off making that switch?”

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The kollel yungerman and the hunt for nicotine:

With experts arguing whether e-cigarettes help smokers quit, anecdotal evidence may be just as good a reference as anything else.

I’ve met several people who reduced or eliminated real cigarettes for themselves because of e-cigarettes. (I recently interviewed both a rav and a financial professional who casually fiddled with e-cigarettes as we spoke.) But I found an even more fascinating bit of anecdotal evidence when I talked to people who own e-cigarette businesses. Almost every single one of them was previously a smoker and had stopped by using the electronic versions. Selling them had just been an outgrowth of their own experiences.

In the Jewish communities in the New York area, one e-cigarette company has been the go-to brand: DropSmoke. (Due to its owners, it is also a brand that can be assumed to be kosher, though a number of e-cigarette companies claim that their ingredients are.) The co-owner, Joe Cwieber, stopped into the Ami offices last week, and he told me that his brother, Eli Cwieber, a kollel yungerman in Lakewood, had researched and developed DropSmoke’s e-cigarettes.

Joe told me that he and his brothers started smoking as bachurim. But when he became a yungerman, Eli found it increasingly difficult to keep up his habit.

“Cigarette prices were going up, and it came to a point that he couldn’t afford it. He started rolling his own cigarettes. But even that became too much. He started trying to find alternatives to smoking, to get the nicotine in a cheaper and healthier manner. He started in his house in 2009 and continued developing a line from there.”

His intensive research made Eli an expert in the subject, Joe told me. “When people in the industry have issues, they call him with questions. It’s a whole sugya. There a lot of factors involved in the juices and the flavors.” Eventually, Joe joined the business to help it grow.

E-cigarette companies are legally unable to claim that their products help stop smoking. Litigation in the mid-2000s kept the FDA from regulating e-cigarettes as medical devices if the companies made no medical claims for them. Instead, they are regulated as tobacco products. That’s kept them from needing extensive product safety testing.

But sitting with me in the office, Joe has a number of success stories to share, including his own and those of his brothers, all of whom use e-cigarettes. But there’s one story in particular that he says that he repeats over and over:

“There’s a fellow who came in on February 3, 2013. He’s 68. He smoked four packs a day since he was 14. He told me, ‘Joe, I want to stop smoking.’ He said he spent $12,000 on treatments to figure out a way. “He bought one device for his car, one for his office, one for his house. He got 10 extra sets of batteries.

He wanted to be prepared and have one wherever he was. He didn’t want to start off by level 24 [24 milligrams of nicotine per milliliter of solution], which is our highest. He started at level 20. A month later, March 3, he went down to 18. Sometime in April he went down to 12. He had charged batteries in every location he could be. He would never come to a point where he might run out and or be stuck without batteries. He’s now smoking level zero—no nicotine. It’s just water vapor and flavor. This guy came down from four packs a day at 68 years old.”

I heard similar stories from Talia Eisenberg, the owner of the Henley brand of e-cigarettes, also based in the New York City area. “I was a smoker and I couldn’t stop smoking. I’m a New Yorker, but I moved out to Boulder for a few years and started getting healthy for a few years—mountain biking and rockclimbing and all that—but I was still smoking cigarettes, and I couldn’t stop. At the time, there was only one e-cigarette brand. I used it to quit smoking, but I didn’t think the product was that amazing and I didn’t think the branding was that great.” So she started her own company.

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The master vaper:

The oldest e-cigarette store in New York is called VapeNY. Its first location opened in Queens; later, another one opened in Manhattan. Astonishingly, while other stores have opened around the city, VapeNY remains the only store in Manhattan dedicated to e-cigarettes.

On a recent afternoon, I headed down to the Lower East Side. VapeNY occupies a small storefront on a narrow side street near a park. When you walk in, the first thing that hits you is a chalky smell. Then the sheer variety of colors and styles of e-cigarette paraphernalia behind the counter catches your eye.

I had come to interview one of the co-owners of the store, Spike Babaian. Ms. Babaian’s name matched her clothing, which included a collar bearing inch-long spikes. But despite her unconventional style, she’s one of the most cogent, articulate and persuasive advocates for the US e-cigarette industry. Besides owning VapeNY, she is also the head of an advocacy group called National Vapers Club.

Babaian, like other company owners, started as a smoker who was looking for a way out. “I smoked two packs of Marlboro Menthols a day for twenty years. I never went a day without at least a pack. Even when I was pretty sick with bronchitis, I still smoked. Once I started using this, it took me a couple of weeks and then I was done.

“In New York, on Long Island, we had the first vaping club in the country. We started having meetings and hanging out and trying different flavors. Back in 2008, 2009, you couldn’t just go to a store, because there were no stores. You had to actually buy your e-cigarette stuff online. Rather than us buying every single thing, we’d each buy a couple of things and then get together and try it. That way we’d know we liked it before we spent thousands of dollars buying something from China that was no good. So we’d get together and try each other’s stuff and decide what we liked and what we wanted to buy. That was in December 2009.

“We started growing a culture in New York slowly. New York Vapers Club had its first meeting in January 2010.”

I asked her why there are still so few e-cigarette stores in New York City, while they have become so much more common in other cities across the country. “We took two years to open a store in Manhattan, and there are no other stores in Manhattan, while there are hundreds in California. It’s because the rent is so high and people are scared of what Bloomberg will do. As soon as Bloomberg is out of office, you’ll see a hundred e-cigarette stores in Manhattan. But we’re not afraid of him. Come get us, Bloomberg.”

We talked for a long time about the research into e-cigarettes; she says there has been more of it than some experts acknowledge. And she told me that the study on indoor air quality that Professor Glantz disparaged was funded by her group.

“We’ve raised a lot of money. We did an indoor air quality study. Of course, Stan Glantz said it doesn’t exist, and then he wrote a blog about how the study doesn’t count because we found that cigarettes weren’t toxic. Certain toxicity levels that we tested were not toxic for cigarettes. Well, cigarettes don’t contain high levels of every toxin we tested for. But we didn’t say cigarettes aren’t toxic. We said they didn’t contain certain toxins.”

Fighting legislation:

Spike Babaian spoke of the campaigns she’s been involved in to stop legislation that would restrict e-cigarettes.

“I was in Camden, Massachusetts, on Monday. They tried to entirely ban the sale of electronic cigarettes, while regular cigarettes would have remained legal. Of course, we fought that, and they realized that was foolish.

“We’ve been fighting indoor bans in New York for some time. And a certain legislator in New York—whom I won’t name—has been trying to entirely ban e-cigarettes for years, by hiding it in a ban on sales to minors. We finally put an end to that because we got a senator to ban [cigarette] sales to minors in New York, which passed. We supported that 100 percent. Once that ban was passed, the representative proposing a [general] ban wasn’t able to hide her bill anymore.”

The draft bill that came out of the New York City Council would prohibit flavored e-juices, apparently out of a concern that children would be attracted by them, which is why flavored tobacco cigarettes are illegal. Professor Glantz had, in fact, mentioned the flavors of e-juice as proof that e-cigarette companies are targeting children.

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Babaian was not impressed:

 “The anti-smoke people want a smoke-free world. Banning flavors won’t make a smokefree world. Our argument to the City Council was: If you don’t smoke anymore and are forced to taste tobacco and menthol only, it will make you want to smoke again. If you can have cherry and raspberry, you won’t want to smoke again.

“I asked some legislators if someone offered them raspberry tea or tobacco flavored tea, which would they rather have? And they said raspberry. And I said that I would, too. It’s not a kid thing. Even adults want that.”

She says that the draft bill came as a surprise to her group. They had testified before the City Council Health Committee on May 2, asking that flavored e-juices not be banned.

“By the time we got to testify, it was toward the end. There were maybe three or four members of the City Council Health Committee left and they all said, ‘Yes, we know. We heard. The last 25 people said the same thing. We assure you e-cigarettes won’t be included in this bill.’

“They all went on and on about how they were sure they would not do it. And then Bloomberg wrote a part of the new version of the bill that specifically banned flavors in e-cigarettes. So they lied to our faces.”

What should be regulated:

E-cigarette manufacturers aren’t entirely against regulation. All three of the New York area company owners I spoke to support a ban on sales to children, though they think that vaping would be safer than smoking for anyone.

Joe Cwieber, in particular, expressed worry about children using e-cigarettes. “If a 15-year-old kid is smoking, it’s tempting to say that it would be good for him to switch to this. But if his friends see him with this and think it’s cool, they might start smoking because of the cool factor, even though they’ve never smoked.”

Professor Siegel told me that, at present, research shows that children aren’t starting to smoke using e-cigarettes. As Spike Babaian put it: “They’re starting with Marlboros.”

Another concern is quality control. Each of the manufacturers I spoke to told me that they personally take special efforts to ensure pure products. But the industry as a whole has no standards. That’s partially because the FDA has been delayed in devising them.

Babaian said, “The FDA has been working on them since 2009, when we told them to start. It’s been four years, and where are they? They don’t know how to regulate them because this is a completely new industry. It’s like when computers first became popular and they didn’t know how to make laws to govern e-mails. It’s never been done before and they don’t know how to do it.”

She said that the industry has been making its own regulations until now. “In 2010, we had an event called Vapefest.

We have had one every six months for the past three years. At the first event, we said you can’t come unless your liquid has a childproof cap, because we don’t want a kid getting hold of it and drinking it and dying. And some vendors freaked out, and were like, ‘Well my bottles are too pretty. I’m not getting childproof tops!’ They wouldn’t listen to us. Three years later, when we tell vendors they can’t come if they don’t have childproof tops, they’re like, ‘Oh, I didn’t realize that. I should get that.’” (The extreme toxicity of nicotine made tragic headlines in the Jewish world earlier this year when a two-year-old in Yerushalayim drank e-juice and died. Those using electronic cigarette juice—especially flavored e-juice—without a childproof lid should be extra careful to keep it away from children, like any dangerous substance that could attract children.)

Babaian said, “The people making their own liquid in their bathtubs don’t know what they’re doing. They’re making it in an unclean, unsanitary environment. They’re making it with flavors that may or may not be safe to inhale. Liquid should be made in a lab, by a chemist trained to work with toxic nicotine in protective gear. There is a Wild West of the e-cig world that is completely unregulated. That’s not safe. You have to ask what’s in it before you put it in your lungs. “So the industry needs to be regulated, but it doesn’t need to be regulated out of existence.”

Who stands to gain?

I’ve never smoked but, like most people, I’ve seen family members and friends suffer and sometimes die from the effects of smoking. After I learned about the existence of e-cigarettes, I’ve often been tempted to go over to people smoking on street corners and suggest that they use e-cigarettes instead. Even if the scientists argue over the safety and efficacy of e-cigarettes, they agree that they’re not as deadly as the regular kind.

So news about restrictive legislation being introduced across the country was confusing. Why would making it harder to get off cigarettes be sensible?

A lack of education on the part of legislators might be the easiest answer. Joe Cwieber told me at our interview that he had just come from speaking to the head of New Jersey’s Essex County Health Department. “At the end of the conversation, I brought up electronic cigarettes.

At first he started telling me that both types of cigarettes are bad. This was an 83-year-old doctor. As I went more into detail, he said, ‘Maybe this is something the county can start putting out for smokers in the area.’ He started understanding what it’s about—how it’s different than cigarettes.”

Robert Heggie of Emperor Brand e-cigarettes also told me that he sees a lack of education, both for the general public and politicians, as the main factor holding back the industry. But while Spike Babaian agreed that many legislators don’t understand e-cigarettes, she sees other forces at work, as well. Some of the push for legislation, she says, has come from the major tobacco companies.

“R.J. Reynolds has tried to propose a bill in 41 states now to modify how e-cigarettes are sold. R.J. Reynolds sells their e-cigarettes in stores. They have a wide distribution ability, because they sell e-cigarettes alongside their regular cigarettes. If the ability to purchase e-cigarettes online was eliminated, they’d have almost 100 percent of the market. So they tried to ban online sales because ‘the children might get them.’ But really they just want to get full control of the market.”

But the forces Babaian really sees as the powers behind pushes to limit e-cigarettes are those that ostensibly combat tobacco addiction: pharmaceutical companies and health advocacy groups.

“We argued for a long time that it was the tobacco companies paying the politicians to make these illegal,” she told me. “But in the end, it has nothing to do with them. They’re going to start selling e-cigarettes. Most already have. What we realized is: Who’s going to lose out on this? The people who make the nicotine gum and patches and lozenges…all the stuff that doesn’t work. The pharmaceutical companies are donating to the politicians’ campaigns and demanding they try to fight e-cigs.

“They also work with the health foundations. I want to tell you a secret: Their whole job and everything they spent years doing is fighting people who smoke cigarettes. This has the potential to eliminate tobacco smoking completely. That puts them out of work.

“The American Lung Association, which fights cancer from smoking; the American Heart Association, which fights heart disease caused by smoking: All these people who are paid because people smoke wouldn’t have anything to do if people didn’t smoke. That’s the dirty little secret.

“We have internal documents of the American Cancer Society, American Lung Association, American Heart Association, saying, ‘We must ban these products because they’ll take our jobs away.’ They essentially said that. And we know that’s true and went to news companies, and they won’t cover that because the pharmaceutical companies are very powerful.

“People say we’re conspiracy theorists and we’re paranoid, but I swear every time I’ve gotten on the phone with someone from a public health group and they were reacting positively, my phone hung up. And it wasn’t once or twice. It was like 75 times over the course of two years. And I was like: They’re cutting off my phone conversations to stop people from hearing the truth. But they couldn’t get my e-mails.”

Is there a conspiracy behind the legislative push? It’s hard to know. As yet, no bullets have shown up in anyone’s mailbox. But what is clear is that e-cigarettes may help smokers dodge a bullet, of the ill health caused by smoking tobacco.

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