E-Cigarette Debate: 7,000 Flavors Of Addiction, But What Health Risks?

I’m not young or edgy enough to hang out with anyone who smokes e-cigarettes, but I’ve been vaguely aware that they’re a big and growing thing, and the focus of a big and growing controversy. To wit: Do they end up a net positive, because they help people quit the classic “cancer sticks,” or a net negative, because they act as “gateway” cigarettes just when we’ve finally beaten our smoking rates down?

Answer: We don’t know yet. That’s my takeaway from a major multimedia project on electronic cigarettes on Boston University’s new research website. But it’s such an important question that it’s even a source of debate between prominent researchers on campus — though both strongly concur that more research is needed. From “Behind The Vapor:”

At Boston University, Avrum Spira, a pulmonary care physician and School of Medicine associate professor of pathology and laboratory medicine and bioinformatics who studies genomics and lung cancer, was one of the first scientists to receive funding from the FDA to investigate the health effects of e-cigarettes. “In theor y—- and how they’re marketed — e-cigarettes are a safer product because they don’t have tobacco, which has known carcinogens,” Spira says. “The question is: does safer mean safe?”

(From the Boston University video)

(From the Boston University video)

Across BU’s Medical Campus from Spira, Michael Siegel, a physician and professor of community health sciences at the School of Public Health, has emerged as perhaps the country’s most high-profile public health advocate for e-cigarettes. Siegel, who is not currently researching e-cigarettes, says he believes that the device could potentially help large numbers of smokers quit, or drastically decrease, a habit that is the leading cause of preventable deaths in the US. He points out that despite all the existing smoking cessation products on the market, only a small fraction of cigarette smokers manage to quit. Only 4 to 7 percent break the habit without some nicotine replacement or medication, according to the American Cancer Society. At the same time, Siegel says, more research is needed on the health effects of e-cigarettes as well as their effectiveness in helping people quit smoking.

Check out the full project here, including the video above, “7,000 Flavors of Addiction.” And while you’re on the new website, a couple of other particularly grabby features: The Secret’s In The Spit (the gluten-saliva link — who knew?) and The Secret Life of Neutrinos.

Wave Of Praise For CVS Decision To Stop Selling Cigarettes; What’s Next?



From President Obama to the American Medical Association, praise is ringing through the land for CVS Caremark’s announcement today that it will stop selling tobacco products even though that will cost the company some $2 billion in revenue. USA Today reports here that CVS found tobacco sales incompatible with its goal of promoting wellness:

“Selling tobacco is very inconsistent with being in that business,” said Helena Foulkes, CVS’s president. “We really thought about this decision as it relates to the future as a health company — it’s good for customers and our company, in the long run.”

Just to highlight a couple of the positive responses:

The Harvard School of Public Health tweets: “CVS will quit selling tobacco–an important step in fighting smoking and improving health. Bravo!”

A statement from Dr. Ronald Dunlap, president of the Massachusetts Medical Society, reads in part:

The announcement that CVS Caremark will no longer sell tobacco products in its stores is a welcome and exciting step in the continuing campaign against the leading cause of preventable disease and premature death in the United States. Following on the heels of the U.S. Surgeon General’s 50th anniversary report on tobacco issued last month, this decision represents a milestone in tobacco prevention efforts by eliminating the availability of tobacco at more than 7,600 CVS/pharmacy locations nationwide.

It has long been the position of the Massachusetts Medical Society that the sale of such products in health care facilities is inconsistent and contradictory with health and well-being.

As a cardiologist for 34 years, I have seen the devastating effects of tobacco on too many patients for far too long. Heart and respiratory diseases, stroke, and other disorders related to smoking have taken a huge toll. Continue reading

Cigarette Study: Increased Nicotine ‘Yield’ May Make Quitting Even Harder



Fifty years after the U.S. Surgeon General issued the first report on the health hazards of smoking, cigarettes are potentially more addictive than ever, according to a new study that examines so-called “nicotine yields” — essentially the amount of nicotine delivered via smoke.

The study, led by the Massachusetts Department of Public Health and researchers at UMass Medical School, found that nicotine yield “increased sharply from 1998 to 2012 even as the total amount of nicotine in cigarettes has leveled off.”

Public health officials suggest that cigarette makers have cleverly changed the design of their product to increase the amount of nicotine smokers are taking in. (I asked whether the researchers had confronted the tobacco companies directly on these findings. Their response: No, tobacco companies were not directly questioned: “We use the data that they are required to provide to DPH annually,” a UMass Medical School spokesperson emailed.

Here’s more from the news release:

“This study indicates that cigarette manufacturers have recently altered the design of cigarettes. This can significantly increase the amount of nicotine a person receives while smoking,” said Thomas Land, PhD, director of the Office of Health Information Policy and Informatics for the Massachusetts Department of Public Health (MDPH) and principal investigator for the study.

“Cigarettes have a more efficient nicotine delivery system than ever before,” Dr. Land said. “Because smokers have no way of knowing that the level of nicotine they are receiving has increased, they can become more addicted more easily without knowing why.” Continue reading

Mass. Minors Buying E-Cigs? Maybe Not For Long.

(Wikimedia Commons)

(Wikimedia Commons)

I was shocked to find out that minors can buy electronic cigarettes in the state of Massachusetts.

But not for much longer, if a new piece of legislation has its way.

The bill, released today by state Rep. Jeffrey Sánchez, co-chair of the Joint Committee on Public Health, seeks to fix the loophole that allows the free sale of electronic cigarettes and other nicotine delivery products. Though cigarettes are tightly regulated under the Tobacco Control Act of 2009, the FDA and other federal organizations do not currently regulate the sale of alternative nicotine delivery products.

The current state of disarray is caused in part by the development of new tobacco products since the passage of the 2009 act. According to a press release and accompanying fact sheet, Sanchez’s bill would define existing and future tobacco and nicotine delivery products, such as e-cigarettes, ensuring that future products would also be subject to regulation. It would restrict sales of any of these products to minors under the age of 18. And it would prevent the use of electronic cigarettes everywhere that smoking is banned, including in the workplace.

Currently, 12 other states regulate the sale of e-cigarettes: Continue reading

Menthol Perils: ‘Health Enemy #1 For African-Americans’

By Karen Weintraub
Guest Contributor

The FDA this week issued a “preliminary” report after more than two years of study, concluding that menthol isn’t inherently dangerous in cigarettes, but that by masking the harsh flavor, it induces more people to start smoking and makes it harder for them to stop. The report was seen as a step toward an eventual ban on menthol in cigarettes – the one flavoring not already prohibited by federal law.

Now, public health experts say, it’s time to take menthol out of cigarettes.


“It makes smoking a blowtorch taste like rice pudding,” says Harvard School of Public Health Professor Gregory Connolly, director of the school’s Center for Global Tobacco Control. “And unfortunately, what’s in that rice pudding is very heavy toxins that go right to the lungs and you wind up with lung cancer, heart disease, stroke, emphysema, and so forth.”

Connolly, and several other local public health experts, says there’s no scientific doubt that menthol in cigarettes is a problem. And it’s one that disproportionately harms African-Americans and young people – who have a marked preference for menthol.

“If you ask me what is Public Health Enemy #1 for the African-American community in terms cancer: it’s Newport cigarettes – the menthol in cigarettes,” Connolly says. Continue reading

Mass. Blocks Higher Insurance Charges For Most Smokers

You’ve heard all the campaigns and statistics: Smoking Kills. It’s the leading cause of preventable death in the U.S.

And, it’s expensive.


The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. “In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

Continue reading

Health Of The Nation: Obesity Up, But ‘Notable’ Decline In Physical Inactivity

In our house, when there’s good news and bad news, we usually start with the good. So here goes:

According to a new national health statistics report out today analyzing five key health behaviors among U.S. adults — sufficient sleep, smoking, drinking, obesity, and physical activity — there are several bright spots. For instance, the survey found that fewer young people (18-24) are smoking and the number of adults who report they’re completely aerobically inactive showed ‘notable’ declines in recent years, from 39.7% inactive between 2005-2007 to 33.9% in the years 2008-2010.

O.K., now the bad news: Heavy drinking has increased, except among the senior set over 75, smoking prevalence remains virtually unchanged (beyond the youngsters) and obesity is up.


My first reaction is: Huh? Is anyone out there listening to Michelle Obama and all those other Get-Out-There-And-Move and Cut-The-Sugar advocates?

But then I talked to Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine and an assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, who insisted on highlighting the positive.

A little background: Dr. Phillips’ focus is on physical activity, the link between health and exercise and on educating physicians about how to more seamlessly incorporate physical activity into the practice of medicine.

His takeaway from the CDC report is this: “People are starting to move.” Continue reading

Northeastern U. Goes Smoke-Free — Inside And Out

WBUR’s Martha Bebinger reports that starting this fall, Northeastern University will join a growing number of college campuses that are smoke-free, both inside and out.

Northeastern Dean of Health Sciences Terry Fulmer says going smoke-free will save student’s lives.

“If you smoke when you’re younger, you’re more likely to be addicted for life,” Fulmer said. “So now is our opportunity to help them not get in a habit that will potentially be fatal.”

Northeastern will use peer pressure and a campus education campaign — as opposed to penalties — to enforce the new policy. There’s a free smoking cessation program for students and most faculty and staff can enroll through their insurance plan. Dean Fulmer says she does expect the ban on smoking to affect admissions.

(A partial list of Mass. colleges with some type of smoking ban. Source:  The Association of Independent Colleges and Universities of Massachusetts)

(A partial list of Mass. colleges with some type of smoking ban. Source: The Association of Independent Colleges and Universities of Massachusetts)

Here’s more on new smoke-free policy from Northeastern:

The deci­sion to go smoke-​​free dove­tails with Northeastern’s focus on solving global chal­lenges in health. According to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, some 443,000 people die each year from smoking or expo­sure to second-​​hand smoke. What’s more, tobacco use is the single most pre­ventable cause of dis­ease, dis­ability, and death in the United States. Continue reading

When Businesses Refuse To Hire Smokers

A number of employers, both health-related and not, have established policies of not hiring smokers, The New England Journal of Medicine reports today as part of a larger look at the ethics of such controversial measures. These businesses, including the Cleveland Clinic, Geisinger, Baylor and the University of Pennsylvania Health System and the Union Pacific Railroad and Alaska Airlines, have various rationales for their decision to exclude tobacco users. And in an NEJM perspective piece, authors David A. Asch, M.D., M.B.A., Ralph W. Muller, M.A., and Kevin G. Volpp, M.D., Ph.D., all of Philadelphia, lay out several reasons why these policies are taking hold:

Tobacco use is responsible for approximately 440,000 deaths in the United States each year — about one death out of every five. This number is more than the annual number of deaths caused by HIV infection, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined1 and more than the number of American servicemen who died during World War II.

smokerA small but increasing number of employers…have established policies of no longer hiring tobacco users. These employers might justify such hiring policies in many ways — arguing, for instance, that they’re taking a stand against a habit that causes death and disability, that they’re sending an important message to young people and others within their communities about the harms of smoking, or that they’re reducing their future costs, given that smokers, on average, cost employers several thousand dollars more each year than nonsmokers in health care expenses and lost productivity.

But in a companion piece, doctor and health policy expert Ezekiel Emanuel and others write that it’s “paradoxical,” and even wrong to single out smokers by refusing them employment: Continue reading

Why Are There So Many Smokers Among The Mentally Ill?

For years, I’ve been practicing yoga at a studio situated right next to a rehab program for adults with psychiatric illnesses. The harsh irony of so many perky, hard-bodied, coconut-water chugging yogis rushing to their “hour of power” class past the chain-smoking, disheveled mentally ill men and women killing time outside the rehab center always makes me feel sad about the injustices of life. I think about the fact that people with a severe mental illness tend to die, on average, up to 25 years earlier than those in the general population, partly due to smoking-related health problems like lung or heart disease. Sometimes I just want to scream: “Stop smoking and do some yoga!” But of course, things aren’t that simple, and I never say a thing.

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. ZImmerman)

Smoking prevalence is much higher among people with a mental illness, the CDC reports. (Photo: R. Zimmerman)

Today, I went to yoga with Pam Belluck’s excellent The New York Times piece on my mind. The story, about a Louisiana psychiatric hospital considering banning smoking, followed a related story yesterday on new findings that people with mental illness are 70 percent more likely to smoke cigarettes than those without such illnesses.

As I walked to my car after class, I asked a gentleman loitering outside the rehab place how long he’s been smoking. “Forever,” he said, “since birth.” An administrator inside the facility, who didn’t want to be identified, told me “everyone here smokes.” Then, he reconsidered. “Well, almost everybody.”

Indeed the new CDC report paints a grim picture:

Nationally, nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness, and 36% of these people smoke cigarettes. In comparison, 21% of adults without mental illness smoke cigarettes. (Mental illness is defined here as diagnosable mental, behavioral, or emotional conditions and does not include substance abuse.)

There are other troubling statistics from the report:
–31% of all cigarettes are smoked by adults with mental illness.
–40% of men and 34% of women with mental illness smoke.
–48% of people with mental illness who live below the poverty level smoke, compared with 33% of those with mental illness who live above the poverty level.

Here’s a bit of Belluck’s story. Maybe the trend is finally starting to turn? Continue reading