Tech + Health

01.31.13

My (Electronic) Cigarette Addiction

I thought I’d found a way to cheat death and still get my nicotine fix. I should have known it was too good to be true. By Eli Lake.

I enjoyed my last real cigarette on August 1, 2008. I was just outside Washington’s Union Station, about to board a train to Philadelphia. I inhaled deeply, stubbed out the butt on the side of a trash can, then threw it (a Marlboro Light) and the lighter I’d used to ignite it into the trash. I was free—unless you count the pack of Nicorette gum in my bag and a bundle of cinnamon sticks, which I’d heard could help with cravings. 

Three days before my farewell to tobacco, my doctor, a rail-thin Hindu named Patel, told me my habit would probably lead to a debilitating stroke. I suspected as much. Leaving aside the warnings on the packs themselves, the medical literature, the court-ordered ad campaigns, the concern from friends and family, every smoker knows he’s killing himself.

My smoking was manic and perpetual. I would smoke before and after brushing my teeth. I would smoke while drinking coffee, after dessert, during dinner, on the phone, waiting in line. I suffered intense sinus flare-ups, headaches, high blood pressure, wheezes, and coughs. If I was sick, usually from some respiratory ailment brought on by smoking, I would smoke nonetheless.

But there’s a difference between knowing the bitter truth and hearing it straight from your doctor. So when Patel delivered his diagnosis, it was the catalyst I needed to quit. My mom was waiting at the train station in Philadelphia that summer day, and I finally had some good news for her on a topic she had been nagging me about for years.

At this point in the story, you’re supposed to congratulate me for my courage in overcoming addiction. I am supposed to tell you that although it was hard to give up my gradual suicide, it was all worth it, as I now run marathons for children’s cancer research.

But that would be a lie. Ending my dependence on Marlboro Lights was cruel deprivation. It’s not just that smoking is awesome, it’s that there is no better addiction for a working journalist. So much of what reporters do is wait around for press conferences, for important people to leave meetings, for sources to show up at cafés, for hearings to reconvene. Smoking is something to do with your hands and mouth in the long stretches of inactivity that fill a working hack’s day. Then there is the nicotine: a stimulant that for the addict also has the added effect of calming the nerves. In other words, a perfect drug for anyone who writes on deadline.

I am supposed to tell you that although it was hard to give up my gradual suicide, it was all worth it, as I now run marathons for children’s cancer research.

But the best thing about smoking is that it goes so well with alcohol. There is something about that mixture of martinis and cigarettes that improves the evening over time.

In the first months after quitting, I was desperate for nicotine. At first I tried the gum, then the lozenges. I tried the patch for about an hour. But in the end, the buzz wasn’t worth it. Try mixing cabernet with Nicorette sometime if you don’t believe me.

Then one evening, more than two years after I’d quit the habit, I was saved by a new one.

I was at a dinner for a good friend who had just returned from the Middle East. As he sipped a drink, he pulled out what looked to be a cross between a pen and a cigarette holder, and he took a puff. It was an electronic cigarette—and it was miraculous in so many ways. He could smoke it indoors, with no fear of violating city ordinance. He wasn’t inhaling chemically treated tobacco into his lungs. He was simply inhaling a vapor, one tinged with a touch of nicotine.

I had to try it. It was wonderful. I could smoke when I wanted, and I didn’t have to destroy my lungs, sinuses, and circulatory system in the process. My clothes wouldn’t smell like a dive bar. I found the loophole, cheated cancer, and rediscovered the pleasure of martinis. The added bonus with electronic cigarettes was that I could smoke them anywhere. On freezing days, there was no need to huddle outside the office for four minutes to suck down my dose. I smoked on airplanes, in meetings, and at restaurants. It was like a time machine to the golden age of smoking, when there were ashtrays on elevators and in movie theaters.

Over time, I have come to depend on them just as I once depended on the authentic article. I don’t smoke as manically or perpetually as I used to, but I don’t leave home without my disposable e-cigarette, either. I don’t need to inhale first thing in the morning, but I usually enjoy a few puffs over coffee.

Occasionally, I get a quizzical look. I tell people, “It’s just harmless vapor.” If only that were true.

The thing is, after years of telling myself I’d found the perfect loophole, I thought it might be wise to check my facts. The consensus medical research today is that while electronic cigarettes are healthier than tobacco cigarettes, and a good way to end dependency on tobacco, they are not without health risks. Besides the nicotine, the other active ingredient in my cigarettes is propylene glycol, a substance the FDA classifies as GRAS, or “generally recognized as safe.” But there’s a catch. Most research about propylene glycol is about its effect when it’s ingested as an additive in food. Less is known about the effects of inhaling it as a vapor—dozens and dozens of times a day.

“The safety and efficacy of e-cigarettes have not been fully studied,” says the FDA on its website, and consumers “have no way of knowing ... how much nicotine or other potentially harmful chemicals are being inhaled during use.”

Krave, the Miami-based company that makes my e-cigarettes, doesn’t go into much detail on its website about the health effects of its products, except to say they contain nicotine (“a chemical known to the State of California to cause birth defects or other reproductive harm”) and propylene glycol (“on the safe elements list of the Food and Drug Administration”) and are “not an aid for smoking cessation.” Krave does stress that the e-cigarettes are “revolutionary” and “innovative.” That much I can agree with.

Dr. Lowell Dale, the medical director of the Mayo Clinic’s Tobacco Quitline, was far more incendiary. Propylene glycol as a liquid, he told me, is “similar to antifreeze.”

“I think the potential is that they are harmful,” Dale says. “I think there is less nicotine in those products, and they are not combustible, so you are not getting all the particulate matter you get from cigarettes.” But, he adds, “we are just being very cautious about the long-term consequences of its use. It comes out of China. It’s unregulated. There is a lot of evidence the products vary from cartridge to cartridge.”

Wonderful. Here I was thinking I was cheating death when I was more likely inhaling Chinese-made antifreeze. I guess there’s always cinnamon sticks.

Letter to the Editor:

Daily Beast Homeland Security reporter Eli Lake recently stepped outside of his area of expertise to pen a column entitled “My (Electronic) Cigarette Addiction.” In the article, Lake explains how the use of smoke-free electronic cigarettes (e-cigarettes) allowed him to achieve something that, for him and so many others, was ever-elusive—abstinence from smoking.

This kind of inspirational story is typical of e-cigarette users, many of whom were inveterate smokers who had tried and failed to quit repeatedly with cessation aids such as the nicotine patch, gum, and lozenge, as well as pharmaceutical products like Chantix.

Unfortunately, Lake did not apply the same journalistic vigor to this article that he does to his homeland security pieces. In order to learn more about e-cigarettes, Lake sought the opinion of Dr. Lowell Dale of the Mayo Clinic’s Tobacco Quitline. Dale, who has never published on the topic of e-cigarettes and appears to have no expertise in the area, told Lake that propylene glycol—the main ingredient in some brands of e-cigarettes—is “like antifreeze.” Lake accepted the comment as fact, and even concluded his article with the grim realization that he had probably been inhaling “Chinese-made antifreeze.”

Even ignoring the somewhat xenophobic subtext, Lake’s characterization of e-cigarettes is grossly misleading. Ethylene glycol is the poisonous substance responsible for the death and illness in humans and animals from the ingestion of antifreeze. Propylene glycol, on the other hand, is used to reduce the toxicity of antifreeze. In fact, despite its use in antifreeze, the CDC’s Agency for Toxic Substances & Disease Regulation describes propylene glycol toxicity as unusual and rare.

The silly equivocation led Clive Bates, former head of the largest anti-smoking organization in the U.K., Action of Smoking and Health (ASH), to comment accurately that “if propylene glycol is ‘anti-freeze,’ water is ‘engine coolant.’”

The inhalation of propylene glycol is hardly unheard of. Propylene glycol has been used as the base for fog machine liquids and in nebulizers for decades. It is even used as the main ingredient for a smoking cessation aid, Nicorette Quickmist, which has already gained regulatory approval in Canada and the United Kingdom. QuickMist users not only inhale the propylene glycol mist, but are instructed to spray the mist away from their mouth—potentially exposing bystanders—several times prior to usage. If propylene glycol toxicity is in any way as toxic as antifreeze, why would the health authorities in the U.K. and Canada give their stamp of approval to this product? That’s not to even mention the numerous cough syrups, nasal sprays, and injectable pharmaceuticals that contain propylene glycol.

Yes, there are unanswered questions about the long-term inhalation of propylene glycol, but these are hypothetical risks that must be compared to the very well known risks posed by the inhalation of burning tobacco smoke. Besides, the science on e-cigarette inhalation is progressing rapidly. Over just the past year, two studies have been published demonstrating that e-cigarettes do not impair acute lung function and release far less volatile organic compounds than cigarettes.

By giving readers the false impression that the toxicity of the carrier ingredient used in some e-cigarettes is somehow comparable antifreeze, Lake has potentially warned off hundreds or thousands of smokers from a method that has been estimated by the real experts to be about 100 time less harmful than smoking.

Of course, we wish the best of luck to Lake in breaking his e-cigarette addiction with cinnamon sticks. But for those addicted to actual cigarettes—the kind responsible for hundreds of thousands of deaths each year—please don’t let Lake’s misinformed reporting keep you from giving e-cigarettes a try.

Gregory Conley, J.D. / M.B.A., is Legislative Director for the Consumer Advocates for Smoke-free Alternatives Association

Jeff Stier is Director of the Risk Analysis Division, of the National Center for Public Policy Research.

Response from Eli Lake:

The Agency for Toxic Substances & Disease Registry classifies propylene glycol as a substance “used by the chemical, food, and pharmaceutical industries as an antifreeze when leakage might lead to contact with food.” That said, propylene glycol is different from the antifreeze used in cars, which is considered more toxic and not safe. The FDA has classified propylene glycol as “generally recognized as safe.”

However, as my article makes clear, very little research has been done on the effects of inhaling, as opposed to ingesting, propylene glycol. Rachel Grana, a behavioral scientist at the Center for Tobacco Control Research and Education at the University of California, San Francisco, says, “The issue with propylene glycol is that it is generally recognized as safe in food and other applications but it has not been proven as safe for inhalation. This is the question: is it safe to inhale it in these quantities?”

Dow Chemical, a company the makes propylene glycol, says in its product safety guide: “Inhalation of the PG vapors appears to present no significant hazard in ordinary applications. However, limited human experience indicates that inhalation of PG mists may be irritating to some individuals.” The company recommends against using it in a mist form such as in fog machines or in eye-washes.

Dr. Lowell Dale of the Mayo Clinic stands by his initial quote where he said propylene glycol was similar to anti-freeze in liquid form. “There are similarities between propylene glycol and ethylene glycol, the anti-freeze used in automobiles,” Dale said. “The major point is that we have no studies that show the safety of propylene glycol when inhaled over the long term.”

Also, a representative of VaporCorp., the company that makes my brand of disposable e-cigarette, confirmed that it is indeed made in China.