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Regulating e-cigarettes requires a balancing act [Commentary]

This year marks the 50th anniversary of the 1964 Surgeon General's report on the harms of smoking, which launched anti-tobacco public health efforts that have saved an estimated 8 million American lives. We are today a far more educated public when it comes to the dangers of cigarette use. Yet a bill in the Maryland House of Delegates that would treat e-cigarettes like normal cigarettes, and thus ban their use in public buildings, was roundly defeated this year. The bill didn't even make it out of committee.

This is happening in the setting of rapid growth in the local e-cigarette and so-called "vaping" markets. As The Sun has reported, vape shops are opening up all over the Baltimore metro area ("Vape enterprises are on the rise," Jan. 5); I pass one of them every day on my morning commute. A wide cast of characters has a stake in e-cigarette regulation — or lack thereof: smokers, small business owners, new vape supply companies, big tobacco companies and government agencies at every level.

So, what is the deal with e-cigarettes, and what should we do about them in Maryland?

Let's talk about the normal kind of cigarettes first. Tobacco, mostly in the form of cigarettes, still kills nearly half of a million Americans each year, making it our No. 1 cause of preventable death. Nearly one in five Americans is a current smoker, and 70 percent of these people want to quit. In the last 50 years, we have figured out a variety of strategies that have helped lower smoking rates, including warning labels, restricting sales to minors, taxes and indoor smoking bans. For individual smokers, there are a few medications and a variety of nicotine replacement products that make quitting a little bit easier — but it's still a struggle for nearly every smoker.

Enter the e-cigarette. Earlier this year, The Sun quoted several smokers who had cut back or quit cigarettes in favor of e-cigarettes or vaping. The Internet is abuzz with similar testimonials, many of them on websites paid for by vape and e-cigarette manufacturers. Even Wikipedia touts their benefits. If e-cigarettes help smokers quit, without getting more people hooked on nicotine or causing major long-term health problems, that's a win for Marylanders' health. But the science about e-cigarettes isn't well known yet.

On the one hand, the studies performed so far — small, short term, preliminary studies — have shown that e-cigarettes are modestly effective at helping smokers quit smoking. Their vapor contains the same cancer causing chemicals as cigarettes, but at much lower levels. Vape solutions contain nicotine along with propylene glycol and food-grade flavorings that, when eaten or drunk in small quantities, are not very toxic. On the other hand, nobody knows the health effects of breathing in these chemicals, especially not if it's done several times a day, for years and decades on end. And nicotine itself is not harmless; it's known to affect brain development in children and adolescents. Cigarettes are rarely seen inside public buildings anymore, but e-cigarette use in bars and clubs is already becoming normal. Maybe because of this, non-smokers are starting to use e-cigarettes. The Centers for Disease Control has reported that the percent of middle and high school students using e-cigarettes doubled from 2011 to 2012; part of this was among kids who also smoked cigarettes, and some among kids who used only e-cigarettes.

In their role as an alternative to smoking, e-cigarettes hold promise to improve American smokers' health. But this promise is not a proven benefit. It will take many years to figure out the full effects of e-cigarettes on users' health and on the population overall. In the meantime, those who can make money by selling e-cigarettes — both local businesses and Big Tobacco — will do their best to increase sales among as many people as possible. They will fight any and all regulations that might reduce their profits. We owe it to smokers not to prevent them from using this possibly life saving alternative to cigarettes. We also owe it to our children not to allow a whole new generation of Americans to get addicted to nicotine.

We need smart regulations to achieve both of these goals. These regulations should keep e-cigarettes cheaper and more convenient than conventional cigarettes, but still expensive and inconvenient enough to deter a new generation of nicotine addicts. Banning e-cigarette use inside public buildings would be a great step toward achieving this.

Dr. Isaac Howley is a resident in preventive medicine and general surgery at Johns Hopkins. His email is

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