eCigarettes: The Real DealSep 25, 2013
Announcer: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
Interviewer: Most of them look like regular cigarettes. Some of them look a little space age. I'm talking about e-cigarettes, electric cigarettes. We're with Dr. Shamus Carr from the Huntsman Cancer Institute. So the way e-cigarettes work, if I understand, is that it's a liquid you put into this e-cigarettes. It vaporizes that liquid, and that liquid is nicotine. Does nicotine cause cancer alone?
Dr. Shamus Carr: Nicotine itself, as far as we know, may not cause cancer. Nicotine has a lot of other effects on cells. They may change things as they go. You know, if you give enough nicotine to a cell, it probably does cause some type of cancer. I don't know that for sure, but, I mean, in general, we don't think of nicotine as the cancer-causing agent in this cigarette.
Interviewer: What about other chemicals in the liquid in e-cigarettes other than nicotine? Do we have any idea of what else is in there?
Dr. Shamus Carr: Yeah. The scariest thing, actually, that has been shown to be in these e-cigarettes is ethylene glycol. You may know it as Antifreeze. What you put in your radiator of your car is in e-cigarettes. So we don't recommend people inhale, drink, or smoke ethylene glycol, yet we're putting it in e-cigarettes. It's not necessarily in all e-cigarettes, but it's one of the major chemicals that's been found. A lot of other chemicals have been found in e-cigarettes, again, because there's no regulation on how the liquids are made. They can put into it whatever they want, and then they're able to market it and it's not listed as a drug. So they don't have to tell you all the chemicals that are going into this. What we researchers have found is that the chemicals that are in this very widely. Some of them have carcinogens and things that are found in cigarettes, but not nearly as much. Sometimes, they are 500 fold less than a regular cigarettes and sometimes only 10 fold less. It varies. There's no regulation on this, so good luck.
Interviewer: It sounds like that, perhaps, nicotine is the potential least of the dangers of this liquid because we just don't know what else is in there. I mean, we know that Antifreeze is in there and some other chemicals.
Dr. Shamus Carr: Don't discount the nicotine. I mean, the cardiovascular effects that nicotine causes.
Interviewer: Let's talk specifically about some specific things that it could cause.
Dr. Shamus Carr: Heart disease and Peripheral Vascular Disease. You can get bad Atherosclerosis disease in the vessels to your legs and you can't walk anymore or you get cramps in your calves because you're walking. Patients who already have poor circulation in their hand from various connective tissue diseases or people who have a disease called Reynaud's, when they smoke nicotine or use nicotine products, their hands go ice cold and white. It's incredibly painful. So, you know, issues with your blood supply to your brain can cause vasospasm on the vessels that go to your brain because of nicotine.
Interviewer: What does that mean, then, at the end of the day?
Dr. Shamus Carr: Strokes.
Interviewer: Strokes? It could cause a stroke? Okay.
Dr. Shamus Carr: It's vasospasm, right? So if you already have a little bit of some Atherosclerosis disease, you're just setting up what's going to be the final piece that pushes you over the edge. The nicotine is not helping.
Interviewer: People say that they're safe because nicotine is not carcinogenic. It's completely false.
Dr. Shamus Carr: Listen. If your separate answer is, like, "Does nicotine absolutely cause cancer?" Probably not. Does it cause a lot of other problems? Absolutely, and that's the bigger issue. So however you want to spin it, feel free. Is it less likely to cause cancer than cigarettes? Yes. Is it just as likely to cause peripheral vascular disease and heart disease? Probably.
Interviewer: What about the amount of nicotine you're getting in, in a regular cigarette versus an e-cigarette? Is it more concentrated in e-cigarettes?
Dr. Shamus Carr: It varies. They're marketing these based on percentages so you can pick up 1.8 percent of nicotine or 1.3 percent of nicotine. You can vary what you perceive as the varying concentration. What we've learned, though, is that when you sample the liquid that's coming out of e-cigarettes, it's all over the place. Since there's no regulation on this and there's nobody standing up and saying, "You need to produce this in a very uniform manner," you turn around and you find that the concentration of nicotine varies widely over what it is saying actually on the package insert.
Interviewer: So just because it says it on the label doesn't make it true?
Dr. Shamus Carr: That's correct.
Interviewer: We don't know what's in the liquid.
Dr. Shamus Carr: Correct.
Interviewer: They could also market and sell liquid without the nicotine in it. That sounds pretty dangerous, too.
Dr. Shamus Carr: You know, it's, like, you're putting something into your body, and you have no idea what it is. That just doesn't sound like a good decision, in my opinion. I mean, do people do it? Sure. Should they? Probably not.
Interviewer: What is an alternative to quitting cigarettes or an alternative to cigarettes?
Dr. Shamus Carr: I think that's actually a great point. Listen. I have prescribed e-cigarettes to patients. That's kind of crazy. I've got patients who are refusing to quit, you know. They've tried gum. They've tried Nicoderm patches. They've tried hypnosis. They've tried Wellbutrin. They've tried Chantix. They've gone through the gimmick, and they have a desire to trick. These e-cigarettes, even though they're dangerous, are a whole lot less dangerous, in my opinion, than a regular cigarette. So, there have been a number of studies that show that patients who are smoking e-cigarettes are smoking a significantly less amount of regular cigarettes. If I can get people off of cigarettes, I'll deal with the nicotine on the side. It's the lesser of two evils, in my opinion, at that point. Use it as a tool. Not every patient should be on an e-cigarette, but not every patient should be on Nicorette gum. It's a tool.
Interviewer: What about secondhand smoke or vapor?
Dr. Shamus Carr: That's the thing. Again, we believe it's a lot less concerning than regular cigarettes. However, there's one study I know of that looked at the air quality in a room with people who were using e-cigarettes, and it's not nearly as bad as regular cigarettes. But it's worse than if there was nothing in the air. So I think time will tell. If it's an exhaled vapor, there's going to be something in it.
Interviewer: At the end of the day, what would you tell a patient that asked you if they were okay to smoke?
Dr. Shamus Carr: We don't know enough, yet, about e-cigarettes. Are they healthy? No. We don't have enough data. There's definitely health effects. It will cause detrimental health effects due to the nicotine that are in this stuff, so they are not safe. Are they slightly safer than cigarettes? The answer is probably yes, but, again, it's not something we should go out and start doing just because it's cool.
Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.