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 Weinstein, 58, has gone from a pack a day nine months ago to the
equivalent in nicotine of four or five cigarettes. The e-cigs have a
familiar look and feel, and quench his desire to hold on to a
cigarette and puff.
"I fully understand I'm still addicted to nicotine," said Weinstein,
a Connecticut taxi driver who had smoked for more than 20 years.
"But I'm now so much healthier."
E-cigarettes, metal tubes that heat liquids typically laced with
nicotine and deliver vapor when sucked, are transforming the market
for smoking cessation products and slowing the $2.4 billion in
global sales of long-standing aids such as nicotine patches and
gums. But their impact on health remains unclear, experts say,
raising difficult questions for regulators who are starting to
impose limits on e-cigarette use.
E-cigarette makers in the United States are barred from explicitly
marketing the products as smoking cessation devices, but have found
ways to appeal legally to smokers who are thinking of quitting.
“You never say 'quit' because it’s not approved by the FDA as a
smoking cessation device,” said Jose Castro, the chief executive of
A1 Vapors in Miami, referring to the U.S. Food and Drug
Administration.
A1 Vapors runs an ad on its website urging customers to "kiss
tobacco goodbye" and give themselves the "gift of your life.
literally", adding a disclaimer that e-cigs are not a smoking
cessation product.
E-cigarettes, or e-cigs, have only come into widespread use in the
past few years, but have already made inroads into traditional
quitting therapies.
About a third of British smokers trying to quit were using
e-cigarettes, according to a University College London survey in
January of 1,800 people, including 450 smokers.
E-cigs are used by almost twice as many people as
government-approved nicotine gums, lozenges and patches, according
to the survey. That was a reversal from 2011, when only about 5
percent of people were using e-cigarettes and more than 30 percent
used over-the-counter products.
Similar data is not yet publicly available for the United States.
Worldwide sales of all nicotine replacement therapies grew just 1.2
percent last year, to almost $2.4 billion, according to data from
commercial researcher Euromonitor. U.S. sales, at $900 million, grew
0.2 percent, and are expected by Euromonitor to drop this year by
that amount.
Big tobacco companies like Altria, Lorillard and Reynolds American
have rushed into the e-cig market. The entire U.S. market for "vapor
devices" such as e-cigs grew in 2014 by 40-50 percent to $2.5
billion to $3 billion, Euromonitor said. The global market is worth
$5 billion.
RULES ON E-CIGS TIGHTENING
Mark Strobel, a consumer health analyst at Euromonitor, said
e-cigarettes have slowed nicotine replacement therapy sales, along
with relatively high prices and a shrinking population of smokers,
especially in the United States.
"For some consumers it has been a direct substitution."
GlaxoSmithKline (GSK) and Johnson & Johnson don't break out the data
on their smoking cessation products, which are relatively small
parts of their sales, but the companies have noted the change.
"It's definitely taken a bit of our market, no question at all - but
there's a lot of competition in that space," GSK chief executive
Andrew Witty told Reuters in an interview this month.
GSK's nicotine replacement therapies and smoking cessation products
include the brands Nicorette, NicoDermCQ and the medicine Zyban.
There is little long-term safety data on e-cigarettes, although some
healthcare professionals say they may be better for consumers than
tobacco cigarettes because they have no carbon monoxide and fewer
cancer-causing chemicals.
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A growing number of states, cities and countries - including Israel
and Australia - are considering or have approved legislation to ban
or limit the devices or the liquids, which come in exotic flavors
from bacon to bubble gum.
California's top public health official on Wednesday slammed e-cigs
as addictive, saying they were leading to nicotine poisoning among
children and threatened to unravel the state's decades-long effort
to reduce tobacco use.
Earlier this week, California introduced a bill that would ban the
devices in public places, and New York Gov. Andrew Cuomo proposed a
similar ban earlier this month.
Last year, the World Health Organization recommended that smokers
should be encouraged to try already approved treatments rather than
e-cigarettes. The FDA last April proposed rules for electronic
cigarettes that would, among other things, ban sales to those under
18, but not restrict flavored products, online sales or advertising.
MAKING SMOKING COOL AGAIN?
Many health experts worry that e-cigarettes will become established
as smoking cessation aids before enough research is done to
determine their health impact. Another concern is that they may stop
people from quitting tobacco completely and deter people from trying
potentially more effective methods.
Dr. Albert Rizzo, senior medical advisor for the American Lung
Association, said that when patients ask about the products, he
tells them it's good that they are trying to quit but: "We don't
know enough to recommend them."
Some healthcare professionals said that even if they are not opposed
to e-cigarettes, they are concerned about their marketing,
especially to young people.
The Federal Trade Commission declined to comment on specific e-cig
ads but said “advertising must be truthful, non-deceptive and
supported by competent and reliable scientific evidence."
E-cigs risk bringing the "cool" back to smoking, reversing the
progress over decades in which smoking has become less socially
acceptable, said Dr. Robert K. Jackler, a professor at Stanford
University School of Medicine.
"A lot of us are very concerned about the renormalization
phenomenon," he said. "These glamorize smoking behavior."
Still, some doctors point to the low efficacy of traditional ways to
quit smoking.
"They have better results than placebos, but their rates of success
are quite low," said Dr. Michael Siegel, a professor at the Boston
University School of Public Health, who said e-cigarettes are an
alternative, especially for people who have tried the conventional
therapies and failed.
(Additional reporting by Kate C. Kelland and Ben Hirschler in
London; editing by Peter Henderson and Stuart Grudgings)
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