EVALI: Will a Vaping Prohibition Combat This New E-Cigarette Illness?
By Glynn Cosker
Managing Editor, EDM Digest
When it first hit the global consumer market in the mid-2000s, the e-cigarette became the Holy Grail for many people who desperately wanted to quit smoking. It was a way to dull nicotine cravings without chewing gum, taking pills, applying patches or breathing in the thousands of harmful chemicals found in a traditional cigarette. The usage of e-cigarettes – or ‘vaping’ – has risen exponentially since its introduction, but a recent mysterious illness is casting an unwanted pall over the practice.
‘EVALI’ Responsible For At Least 26 Deaths in the US
A serious lung ailment, which the CDC has labeled EVALI (E-cigarette or Vaping product use Associated Lung Injury), has affected more than 1,000 people in 49 states and the District of Columbia. EVALI has also resulted in 26 deaths and hundreds of hospitalizations.
EVALI symptoms include coughing, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fatigue and fever. The common link found in all of the lung illness cases is that the sufferers all used e-cigarettes at some point.
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The composition of substances that each person inhaled is unknown. There is no discernible pattern yet, but early investigations point to individuals adding THC to e-liquids purchased at reputable stores throughout the United States. However, numerous EVALI patients flatly deny THC usage or the addition of foreign substances to e-cigarettes.
EVALI has prompted numerous states to ban the sale of flavored e-cigarettes or e-liquids. Additionally, the FDA is currently considering federal legislation that would remove certain vaping products from the U.S. market. These actions demonstrate a reactive approach when a proactive approach was called for years ago.
Behind the current full-throttle cautionary advice and the pending bans on vaping is this fact: America has moved too slowly in developing vaping regulations. Introducing a sweeping “vaping prohibition” might drive some smokers back to deadly cigarettes – or to a vaping black market that is probably causing EVALI in the first place. A better idea is to change nicotine delivery methods in vaping products – as Katherine Ellen Foley explained in her excellent article on Oct. 11.
What Is Vaping?
In basic terms, vaping involves the inhalation of an aerosol by means of a battery-operated device. When a person takes a puff of the e-cigarette, a heating element atomizes an e-liquid solution inside the device’s small tank. The person breathes in – and exhales – the resulting vapor.
The e-liquid solutions are available in various quantities with nicotine levels ranging from zero to 20 or more milligrams per milliliter. For people who want to quit smoking cigarettes but don’t want to give up the associated hand-to-mouth puffing habit or the social aspect of smoking, vaping is a viable alternative to tobacco products, pills and chewing gum.
One such individual is Mike Turbutt, a director at a digital commerce company, who has vaped since 2013 after 30 years of smoking cigarettes. Turbutt, 49, believes that there is no competition: vaping wins over cigarettes by helping him – and many others – to quit smoking and gain a healthier lifestyle.
“I started smoking cigarettes when I was about 12,” said Turbutt, who resides in the U.K. “I tried to quit in the 1990s, but it wasn’t until early 2013 – during a trip to the U.S. – that I decided to try harder. After bringing home a carton of cigarettes from the States, I went into a local shop, and I saw e-cigarettes for sale. I thought to myself, ‘I’ll give them a try,’ and that carton of cigarettes has stayed unopened to this day. I feel much healthier now; I noticed a positive change in my breathing almost immediately when I switched from cigarettes to vaping.”
Turbutt’s story is similar to those of millions of people who have switched from inhaling the 7,000+ chemicals found in an average lit cigarette (and at least 65 of those chemicals are known carcinogens) to inhaling just a few ingredients – primarily nicotine, Propylene Glycol (PG), Vegetable Glycerin (VG) and flavorings. Nicotine is the extremely addictive substance found in cigarettes. While it’s still detrimental to one’s health and certainly not the best thing to breathe in, absorbing nicotine is unquestionably less harmful than inhaling cigarette smoke.
“I always point to this analogy,” stated Turbutt. “I was offered a cigarette by a friend when I was 12 – back in the 1980s – and that basically got me hooked on smoking for 30 years. Today, 12-year-olds are much more likely to be offered a chance to vape by a friend. There was no vaping when I was 12, but I wish that there had been. My lungs would have fared much better.”
Vaping Flavors: Bubble Gum, Milk, Pink Lemonade, PB&J and Ice Cream
The public’s attitude toward cigarettes changed profoundly once Americans heard from reliable sources like the U.S. Surgeon General in 1964 that smoking was bad for you. Prior to the first official warnings against cigarettes, people enjoyed smoking for decades. Consumers constantly heard catchy jingles from tobacco companies as each brand fought passionately for a bigger share of the smoking market.
Additionally, nearly every commercial break in the early days of television featured something akin to a happy couple sitting down for a smoke while opining about the freshness, taste and pleasure of their preferred cigarettes. Famously, a late 1940s TV ad even portrayed a doctor enjoying and promoting one particular brand.
YouTube Video: "The Cigarette Preferred by Doctors" A commercial from the early days of U.S. television.
Is history repeating itself today with vaping? Let’s face it, smoking was considered safe, readily available and enjoyed by more than half of the U.S. population – until it became unsafe. Vaping is seen today by many as safe, readily available and is enjoyed by an ever-increasing population – of high school kids. Therein lies some provocative questions. Why are so many of our children vaping now compared to just a few years ago? Are today’s U.S. e-cigarette companies specifically targeting the younger generation?
The labeling on an e-liquid product – particularly the fruit-flavored options – is definitely similar to what one would see in an average candy shop. The e-liquid bottles and packaging often feature brightly colored and cartoonish artwork and fonts – sometimes with happy faces and beaming smiles.
Furthermore, some of the mainstream flavors of e-liquids include bubble gum, milk, PB&J, pink lemonade and ice cream. Additionally, these e-liquids are referred to as “juice” by most in the e-cigarette industry – yes, juice! There are numerous “Top 10” and “Top 20” juice lists online that rank each e-liquid in various categories like Best Bakery Vape, Best Cereal Vape, Best Dessert Vape and … Best Candy Vape.
These marketing practices need immediate regulation. Imagine packs of ordinary cigarettes with artwork that depicts larger-than-life colorful characters – all smiling and excited about the wonderful taste and enjoyment value of the extremely addictive and harmful ingredients found inside. Obviously, that wouldn’t fly.
The Demographics and Marketing of Vaping
The first rule of marketing is to cater to your target age and gender demographics. This is why shampoo and other hair products are almost exclusively marketed to women and toys are marketed to children. They are the people who will want to buy the products. The top demographic for vaping in the United States is 18- to 24-year-olds.
Most 18-year-olds (and even some older young adults) still love candy and are still as impressionable as younger teens. Therefore, when e-liquid manufacturers aim their products at a person who still mostly reacts positively to candy, ice cream and bubble gum (by offering a highly addictive and harmful substance in flavors like candy, ice cream and bubble gum), it’s easy to see why the vaping industry’s marketing practices are under a microscope.
E-Cigarette Regulations and Promotion Differ Substantially
In the EU, there are strict regulations on who can buy vaping products and how they buy them. There are also regulations on vaping methods, devices and e-liquids.
For example, each container of e-liquid sold in the EU must show a full and specific list of ingredients. You won’t see “and other ingredients,” “a combination of flavorings” or similar wording listed on e-liquid containers in the EU. In the U.S., there is no regulation to list the ingredients of e-liquids on bottles and packaging for consumers to read and compare.
The EU also has regulations enforced by the Tobacco Products Directive (TPD) that caps nicotine strength at 20 mg/ml. These regulations are in place to prevent teens and young adults from adopting a lifelong nicotine addiction, while still helping those who have switched from regular smoking.
However, there are no such regulations in the United States. Indeed, some brands contain 59 mg/ml nicotine and are on sale to anyone 18 or older via websites that verify a purchaser’s age by asking him or her to click on a button that asks them to confirm their age. In the EU, online sales require the person to get their age checked via stringent measures involving third-party background checks. Similar to credit checks, these processes confirm the buyer’s age.
In US, E-Cigarettes Are Classified as Tobacco Products
Confusingly, the U.S. government classifies e-cigarettes as tobacco products even though the devices and e-liquids contain zero tobacco. This means e-cigarette manufacturers cannot advertise or promote their products in any way – even as a less-harmful alternative to actual cigarettes.
Meanwhile, in the U.K. – arguably the vape-friendliest nation in the world – a large sector of the cigarette-smoking population adopted vaping due in part to the U.K.’s advertising and promotion of e-cigarettes by health officials who endorsed e-cigarettes as a less harmful option than cigarettes. In fact, The Royal College of Physicians “explicitly tells doctors to promote e-cigarettes ‘as widely as possible’ to people trying to quit [smoking].”
Conversely, U.S. vaping outlets take a different stance. “Products sold on this site are not smoking cessation products and have not been evaluated by the Food and Drug Administration,” states one online e-liquid store.
So, in the U.K., vaping is promoted as a quit-smoking practice and is endorsed by medical professionals, while in the US, vaping has no specific function and medical officials have no official stance on it.
Whether or not the deadly lung disease EVALI is here to stay – and whether it will ultimately affect millions of American vaping enthusiasts – remains to be seen. So far, though, one statistic is clear and mysterious: There are currently 1,000+ EVALI cases in the United States, while there are zero cases across the EU.
Ultimately, more research, more legislation, more control, less marketing to teens and stemming the flow of the current rush-to-judgement ‘vaping prohibition’ are all necessary to evaluate EVALI and e-cigarettes in general.