Thu April 24, 2014

Despite Popularity, Mysteries Of E-Cigarettes Persist

Originally published on Thu April 24, 2014 7:17 pm

E-cigarettes are not new, but there is still much that's unknown about them. Tom Frieden, director of the Centers for Disease Control and Prevention, explains the latest research on e-cigarettes and offers his take on new regulations proposed by the Food and Drug Administration.




And to talk further about the potential health risks of e-cigarettes, I'm joined by the director of the Centers for Disease Control and Prevention, Dr. Tom Frieden. Dr. Frieden, welcome to the program.

DR. TOM FRIEDEN: Great to be here.

BLOCK: Apart from nicotine, which we know is highly addictive, what components of e-cigarettes are you most concerned about?

FRIEDEN: One of the things we're concerned about is that we don't know what's in them. With no standards and no regulations, there's not one kind of e-cigarette, there's literally hundreds. So one of the things that FDA regulation - when finalized - would do would be to require product disclosure. But the nicotine is concerning enough because it is so addictive and because so many of our children are now experimenting with e-cigarettes.

BLOCK: Do you think that in the public eye the fact that they haven't been regulated means that people think these have to be safe? The FDA hasn't done anything about them.

I know there are an enormous number of misconceptions about e-cigarettes. For example, smokers routinely say, well, I - if I want to quit, maybe I should get an e-cigarette rather than saying I'm going to go get an FDA-approved medicine that will double or triple my likelihood of quitting. So there are certainly many misconceptions around e-cigarettes.

Well, let me ask you about that because there are people - there's a school of thought that says there could be a real health benefit to e-cigarettes if they help people quit smoking conventional-burn cigarettes. Have you seen any persuasive evidence that they actually do help people quit?

FRIEDEN: I certainly see the theory that they could be helpful and I've heard some anecdotes about individuals who say they have helped them quit. But much more importantly is the actuality that right now we're getting millions of kids experimenting with or using regularly e-cigarettes. We're getting smokers who are perhaps using them not to quit but to keep smoking regular cigarettes. We're seeing large numbers of ex-smokers going back to nicotine products for the first time in years using e-cigarettes. We're seeing the re-glamorization of smoking as an act. And we're also seeing potential exposure of nonsmokers, including pregnant women, to the nicotine in e-cigarette products. So I see theoretical potential benefits but definite harms occurring.

BLOCK: Has there been enough research, do you think?

FRIEDEN: I think there's just a lot we don't know and need to know about e-cigarettes. You know, when it comes to tobacco products, we really have to assume they're dangerous until they're proven safe, rather than the other way around.

BLOCK: A lot of the e-cigarettes have flavors - cotton candy, gummy bear, tutti-frutti - flavors that seem to be clearly aimed at kids. And the proposed FDA rules don't address that. How much of a concern is that for you?

FRIEDEN: I think it's shameful behavior by the e-cigarette companies, as is sale over the Internet, as is marketing that appeals to children, as are free samples. These are behaviors that we saw in the tobacco industry in the '50s, and really the e-cigarette industry has been taking pages from that playbook because they've been outside of the regulatory framework until now. This is a first step to try to bring them within that regulatory framework and that's important.

BLOCK: You say it's shameful. But as I mentioned, the new FDA proposed rules wouldn't touch anything about those flavors, at least not now.

FRIEDEN: One of the challenges that the FDA has is the balance between stringent regulation and regulation that will stand up to a court challenge. And, already, the e-cigarette industry has won one court case against the FDA on regulation. Already, the tobacco industry has prevailed in the latest decision on graphic pack warnings. So it is a real balancing act between how effective regulation can be and how sustainable it will be in court.

BLOCK: Dr. Frieden, I do wonder this. I mean, e-cigarettes have been around for maybe five years or so. It's already almost a $2 billion a year industry. And some of the FDA proposals are going to take years to go into effect, if they go into effect. Why has it taken regulators so long to catch up?

FRIEDEN: It's an important step forward to help reverse the epidemic of disease and death caused by tobacco, in particular, to protect our kids from tobacco addiction. But regulations take time and they're not going to immediately prevent tobacco companies from peddling their products to kids. I think all of us wish that regulation could be quicker but we also recognize that there's a balance between quick and stringent regulation on the one hand and regulation that's going to stand up in court on the other.

BLOCK: Dr. Frieden, thanks very much for talking with us.

FRIEDEN: Thank you very much.

BLOCK: That's Dr. Tom Frieden. He directs the Centers for Disease Control and Prevention in Atlanta. Transcript provided by NPR, Copyright NPR.