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Tracey Koehlmoos: E-cigarettes still on sale at the shopping mall

22 Sep, 10 | by BMJ

Tracey Koehlmoos

During July 2009 during a brief visit to the US my three sons and I noticed that electronic cigarettes were being sold at kiosks in the mall. It seemed so un-American somehow to have cigarettes being advertised so openly and in such a public venue. Some quick research showed that these devices are actually very dangerous and completely unregulated. I was sure they would be gone within a year.

However, if we flash forward to August 2010, during a brief trip to Boston to resupply for the coming school year in Asia, the boys and I visited an up-scale mall north of town. We were floored to see that “electronic smoking devices” were still being marketed and sold in little kiosks between the major stores. The scenario was exactly the same as during the previous year. Advertised to help people to quit smoking while also enabling people to smoke virtually anywhere, electronic cigarettes continue to skirt around anti-smoking regulation or at the very least “anti-smoking enforcement” in the US.

People who do not go to the malls in the US, may not have encountered the electronic cigarette, which looks like a traditional cigarette but in the “filter” has an atomizer that turns a liquid mix into vapor that the user inhales. The liquid mixture is sold in cartridges of varying nicotine strengths. The body of the cigarette is a lithium battery to power the conversion process and the tip has an LED “ash” so that it glows as if it is burning.

In general the US enforces its policies about anti-smoking so that there is no cigarette advertising on television or in magazines, cigarettes are not sold to children under the age of 18 years, and cigarette packages come with labels that promise grim consequences like, “Smoking Kills.” However, around 19% of high school students have smoked in the past month.

Research shows that teenagers are more susceptible to cigarette advertising and the faux cigarettes which deliver nicotine and other carcinogens including chemicals found in anti-freeze are available for all to see and buy in settings frequented by those under the age of 18.

Since returning home from the US, I learned that the electronic cigarette companies have been warned to stop advertising that they enable smokers to quit. If they wish to advertise themselves in that manner, then they must go through the rigorous Food and Drug Administration approval process.

However, the electronic cigarette qualifies as a drug delivery device and is being advertised and sold without any of the regulations or approvals that such a device should contain. Does this not make them potentially harmful and certainly illegal? Who will stand up to the electronic cigarette? The FDA? The American Public Health Association? The Surgeon General? Or more importantly, where is the conscience of the owners and managers of the malls who are allowing these illegal devices to be marketed in their facilities?

I wonder if the boys and I will encounter electronic cigarettes during our next trip to the US.
On a bright note, I am back in Jakarta and the Marlborough Man is missing from all of the places he was so publicly displayed when I was here in March 2010. Progress?

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University.

Also on electronic cigarettes:  Electronic cigarettes: miracle or menace? (Personal view)

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  • Thelonepeppercorn

    I agree they need to be regulated properly, but they do help a lot of people who have otherwise failed to give up

    'these devices are actually very dangerous'

    I believe there is a risk involved with them as they contain nicotine, but in my opinion I would far rather smoke these than the FDA condoned real cigarettes. I think you need to do a little more research before condemning a product that could potentially save a lot of lives. Your opinion merely seems to be based on a dislike of the look them and no real knowledge of what they actually are, which comes across as very uneducated and narrow minded.

  • Tracey Perez Koehlmoos

    Actually, The Lone Peppercorn, my opinion is based upon science as well as my dislike of cigarettes being advertised and sold where children congregate. Dear Smoker, I strongly recommend you read the second reference for the blog:

    http://www.medpagetoday.com/PublicHealthPolicy/FDAGeneral/22103?utm_content=GroupCL&utm_medium=email&impressionId=1284096689933&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=71791

    Further, you should know that the value of these devices in helping people quit smoking is unproven. There is a process through which these devices can be tested and then certified as smoking cessation aids but we cannot allow those ideas or beliefs that “seem to work” or “seem like a good idea” to outweigh the reality of the product or the health needs of the population. These devices should be rigorously tested through a set of RCTs and then systematically reviewed. Also, we must ask ourselves, what are the long term consequences of use? Of course, we have no idea. It would be great to have one more technique to help those addicted to cigarettes quit–but we must make sure that our techniques are safe–and perhaps it should be marketed in pharmacies rather than between H&M and Abercrombie and Fitch.

  • Davidjk2010

    I completely agree with this blog unlike Peppercorn or whatever his real name is. How does inhaling nicotine save a lot of lives? Nicotine addiction is bad, no matter what form it takes.

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