Heartland Health Monitor
5:00 am
Tue August 19, 2014

Missouri Veto Lays Bare Growing Debate Over Electronic Cigarettes

E-cigarette retailer Aaron Todd says "vaping" helped him quit smoking.
E-cigarette retailer Aaron Todd says "vaping" helped him quit smoking.
Credit Alex Smith / KCUR

Carlo Cavallaro pours a brown liquid into a device that looks a little like a Star Trek phaser. When it hits battery-heated coils, the liquid sizzles and turns into vapor. He takes a big draw and exhales a sugary-smelling cloud.

Cavallaro makes his own custom nicotine-infused e-cigarette juice.

“This one that I have here is a fudge brownie,” he says.

E-cigarettes have only been around the United States for about seven years, and during that time they have been left largely unregulated by the federal government or most state governments, including Missouri.

The independent e-cigarette makers, as well as enthusiasts like Cavallaro, have reveled in the freedom to experiment with devices and flavors, making the vaping industry pretty much whatever they want it to be. So it might seem surprising that e-cigarette advocacy groups have been pushing for one regulation.

“We want to make sure that minors don’t get these products in their hands,” says A.J. Moll of  the Bistate Regional Advocates for Vaping Education, or BRAVE, which works in Missouri and Illinois.

With support from e-cigarette companies and retailers, Missouri lawmakers overwhelming passed a bill last session that would have banned the sale of e-cigarettes to minors. Moll was irate when Gov. Jay Nixon vetoed it in July.  

“He could’ve insured the safety of Missouri’s children by simply signing what we feel is a common sense bill,” he says.

To regulate or not to regulate

But Nixon said the issue wasn’t quite that simple. In a letter to the secretary of state, the governor said he would support a straight ban for minors but could not accept parts of the bill that would have prevented e-cigarettes from being regulated like tobacco products.

Nixon explained that the products contain nicotine, which is addictive and dangerous, particularly for adolescents and pregnant woman. And some studies have shown e-cigarette vapor contains carcinogens and heavy metal particles. In a nutshell, there are still lots of questions about e-cigarettes’ safety.

“There’s certainly not an extensive array of evidence related to e-cigarettes as there is with traditional cigarettes,” says Dr. Brian King, a senior scientific advisor with the Centers for Disease Control and Prevention.

King notes that e-cigarettes have been sold in the U.S. only since 2007 and studied only since 2010. Decades of research have shown traditional tobacco cigarettes contain thousands of chemicals and as many as 70 carcinogens, but there just aren’t enough studies to prove the dangers, if any, of e-cigarettes. Complicating the picture is that e-liquids and devices are made in different ways by lots of different producers.

King thinks the many unanswered questions about e-cigarettes should make the public cautious. Moll, on the other hand, believes those unknowns are precisely why health agencies should not jump into tobacco-style regulation.

“They just don’t know enough about e-cigarettes, so I don’t know how they can form regulations,” Moll says.

A healthier alternative? 

“I quit in May two years ago, and I haven’t had a cigarette since. All my family and friends I’ve gotten off cigarettes, and it was with the help of electronic cigarettes,” says Aaron Todd, owner of Vapur, an e-cigarette chain in the Kansas City area.

Todd and many e-cigarette users see the devices and juices as a healthier alternative to tobacco and a good way to quit tobacco smoking. In fact, modern e-cigarettes were invented in China in the early 2000’s as a smoking cessation device.

King, however, is skeptical.

“The plural of ‘anecdote’ is not ‘data,’” he says. “So although some people are saying they are using them to quit, the data we have currently does not show that these products are effective for long-term cessation.”

While most e-cigarettes have been produced by small, independent companies, their sales are expected to reach $1.5 billion this year, and that growth has attracted the attention of some big-time players. In the last two years, major tobacco companies such as Reynolds American Inc., Altria Group Inc., British American Tobacco and Lorillard Inc. have bought or introduced their own e-cigarette brands under names like Vuse, MarkTen, Green Smoke, and Blu.

While Nixon vetoed the Missouri bill, many other states have passed similar legislation banning sales to minors but preventing e-cigarettes from being regulated like tobacco.

To Tracey Kennedy of Tobacco Free Missouri, that seems very similar to the tobacco industry’s strategy of voluntarily adopting “anti-youth access” programs to avoid further regulation. Kennedy is one of many observers who suspect big tobacco companies are pushing for the new state laws. Her group has closely monitored the legislation.

“We were able to highlight some comparisons to other states that had very similar language that could be directly related back to the tobacco industry,” she says.

FDA rule

Recently, the debate at the state level has been overshadowed by federal action. In April, the Food and Drug Administration proposed a rule barring e-cigarette sales to minors, requiring health warnings and disclosure of ingredients, and banning free samples, among other things. If the rule is adopted, it could conflict with the anti-regulation-friendly state laws.

Kennedy, for one, doesn’t think the FDA rule goes far enough.

“What’s really a key thing that’s missing,” she says, “is there’s no marketing restrictions on e-cigarettes, so things like celebrity endorsements and television ads and things that really appeal to youth aren’t a part of this rule.”

By contrast, Moll sees the FDA rule as potentially ruining a growing independent industry built on a safer alternative to tobacco.

“What they’re really going to do is close all these businesses down, and you’re not going to be able to get product, and there’s going to be a huge black market,” he says.

As e-cigarette proponents anxiously await the FDA’s decision, many like Moll will also be pushing Missouri legislators to override the governor’s veto of the state bill at the veto session in September.

Amid all the debate and clamor, at least one thing is clear. The 21st-century answer to cigarettes is unquestionably gaining in popularity. And with that popularity, increased scrutiny from politicians and health advocates — scrutiny that could radically change the industry — is all but inevitable.

How that plays out remains shrouded in smoke.

Correction: An earlier version of this story incorrectly spelled A. J. Moll's surname.