The Wild Wild West of e-cigarette manufacturing

Researchers at the University of California, Riverside may as well tell smokers looking to switch to e-cigarettes to keep smoking regular cigarettes based on their study claiming that current versions of the cigarette alternative present a range of issues that pose possible public health risks. Published in today’s online issue of Tobacco Control, the UC Riverside study looked at five brands of e-cigarette — an “electronic nicotine delivery system” — for design features, accuracy and clarity of labelling and the quality of instruction manuals and associated print material supplied by the manufacturers. The study authors said that they uncovered design flaws in some brands of the e-cigarettes, noticed inadequate labelling in the packages and identified quality control issues, including leaky cartridges. This led them to suggest that regulators remove e-cigarettes from the market.

“Some people believe that e-cigarettes are a safe substitute for conventional cigarettes,” said study co-author Dr. Prue Talbot, director of UC Riverside’s Stem Cell Center. “However, there are virtually no scientific studies on e-cigarettes and their safety. Our study — one of the first studies to evaluate e-cigarettes — shows that this product has many flaws, which could cause serious public health problems in the future if the flaws go uncorrected.”

The authors’ failure to mention anything about the use of e-cigarettes as a harm reduction method while discussing the device’s public health impact frustrates ACSH's Dr. Elizabeth Whelan. “What’s missing is whether e-cigararette vapors are safe or not. They only insist that we don’t know and shouldn’t take our chances. The message they send with such articles is: Keep on smoking.”

ACSH's Dr. Gilbert Ross points out that the researchers’ objective was to investigate current manufacturing practices for the product, but that they failed to mention that e-cigarette manufacturing is in its infant stage of development. “If this were about a plant that manufactured Lipitor or asthma inhalers, you’d say ‘How could they get away with that?’ But we’re in the Wild Wild West of e-cigarette manufacturing with very little regulatory oversight as yet. Yes, we need to ensure that e-cigarette makers use good manufacturing practices. Yet, if given the choice, I’d still rather smoke an e-cigarette manufactured now than a traditional cigarette produced under tightly regulated manufacturing practices.”

Passive smoking and children

In 2003, over 11,000 people in the UK are estimated to have died as a result of
passive smoking.* Although regarded for many years as little more than a
nuisance, exposure to ambient tobacco smoke released directly by burning
tobacco and indirectly by exhalation of smoke by smokers (also variously
referred to as environmental tobacco smoke, second-hand smoke, or tobacco
smoke pollution) is now a recognised cause of significant short- and long-term
harm to others. Many of those adverse health effects were summarised,
particularly in relation to adult exposure, in an earlier Royal College of
Physicians report.†
Increasing awareness of these health risks has led the UK and several other
countries to introduce legislation restricting or prohibiting smoking in enclosed
public places. This legislation has typically been justified by the legal and moral
obligation to ensure safe working environments and, in the UK, to prevent the
600 or so deaths previously estimated to be caused each year by passive smoking
at work.* However, these are the minority of deaths caused by passive smoking,
the bulk of which (an estimated 10,700 deaths in adults in 2003)* arise from
exposure to tobacco smoke in the home.
Passive smoking in the home is also a major hazard to the health of the
millions of children in the UK who live with smokers, and the extent of this
health problem has not, to date, been accurately quantified. In this report, we
therefore use established literature and additional analysis to estimate the
prevalence, determinants and trends in passive smoking exposure, present new
systematic reviews and meta-analyses of the magnitude of the effects of passive
smoking on the main recognised health consequences in children, and estimate
the numbers of cases of illness and death arising from these effects. We also
quantify the effect of exposure to smoking behaviour on the risk of children
starting to smoke, and estimate the number of children who do take up smoking
as a consequence. We then consider the financial cost of the disease burden for
the NHS and wider society arising from all of these exposures. The report also
explores ethical issues relating to passive smoking and children, and public
opinion on measures to prevent passive smoking, concluding with policy options
that would reduce exposure of children to this significant health hazard and
negative behavioural model.
Governments, and societies, have a duty to ensure that children grow up in a
safe environment, and are protected from explicit or implicit encouragement to
take up hazardous behaviours such as smoking. This report provides some of the
background and policy measures necessary to ensure that that duty is discharged.
I am personally very grateful to John Britton and the other members of the
RCP’s Tobacco Advisory Group, and the many contributors to this report who
have continued the excellent tradition of the RCP in this important area.