Department of Health and Human Services Warns Smokers Wishing to Try Quitting Using Electronic Cigarettes to Stick With Regular Cigarettes Because They Don’t Know How Much Nicotine They’ll Get; Department Spreading False Information About the Scientific Evidence

On a new web site devoted to tobacco and smoking cessation, the Department of Health and Human Services (DHHS) warns smokers wishing to try quitting using electronic cigarettes not to do so because they will not know how much nicotine they are getting in each puff. In effect, this amounts to a recommendation that these smokers stick to their regular cigarettes, since many of them have tried unsuccessfully to quit using the other products recommended by DHHS: nicotine replacement products and smoking cessation drugs.

There is a large population of smokers who have tried to quit using traditional NRT or smoking cessation drugs and failed. Having heard from ex-smokers about their success with electronic cigarettes, many of these smokers wish to try quitting using these innovative products, which vaporize nicotine from a glycerin or propylene glycol base and involve no tobacco. The Department of Health and Human Services’ official advice to these smokers: don’t use electronic cigarettes because there is no evidence that they can help you quit and you don’t know how much nicotine you’re getting in each puff.

According to the DHHS information page on electronic cigarettes: “Because clinical studies about the safety of e-cigarettes have not been submitted to the U.S. Food and Drug Administration (FDA), you have no way of knowing:

  • If they are safe
  • Which chemicals they contain
  • How much nicotine you are inhaling

Nicotine is a highly addictive substance. Additionally, these products may be attractive to kids. Using e-cigarettes may lead kids to try other tobacco products—including conventional cigarettes—which are known to cause disease and lead to premature death.

Although e-cigarettes may be marketed as a tool to help smokers quit, they have not been submitted for FDA evaluation or approval and there is no evidence to support those claims. There are, however, a number of FDA-approved quit-aids available to smokers, including:

  • Nicotine gum
  • Nicotine skin patches
  • Nicotine lozenges
  • Nicotine oral inhaled products
  • Nicotine nasal spray
  • Zyban
  • Chantix”

On another of its information pages on electronic cigarettes, DHHS warns that: “When FDA conducted limited laboratory studies of certain samples, FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent. FDA found that cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff. Experts have also raised concerns that the marketing of products such as e-cigarettes can increase nicotine addiction among young people and may lead kids to try other tobacco products.”

The Rest of the Story

The recommendation by DHHS that the many smokers who have failed to quit using NRT or smoking cessation drugs should not try electronic cigarettes in an attempt to quit smoking is tantamount to a recommendation that these smokers continue to smoke rather than risk possibly using a product that delivers markedly different amounts of nicotine in each puff.

What DHHS is actually saying is: “Rather than using electronic cigarettes, a much safer product but one which delivers unknown quantities of nicotine and widely varying amounts of nicotine in each puff, you are better off using regular cigarettes, which are finely tuned – due to years of experience and strict quality control procedures – to deliver precisely the same amount of nicotine in each puff.”

I find this to be irresponsible advice and in a sense, a form of public health malpractice. Any physician who advised a patient unwilling to try NRT or a drug (because they failed in the past) to stay on cigarettes rather than switch to electronic cigarettes would perhaps be subject to a malpractice claim. Is not delivering such advice on a mass level an example of public health malpractice?

The Department’s concern that electronic cigarettes do not deliver known or consistent quantities of nicotine is hardly something that makes the use of these products risky. In fact, it makes them less addictive than regular cigarettes because the consistent delivery of nicotine is one of the factors that makes cigarette smoking so addictive. Ineffective delivery of nicotine actually reduces the addictive potential of electronic cigarettes (which may explain why 2/3 of ex-smokers in my survey of electronic cigarette customers who had quit smoking six months after using these products reported having stopped using electronic cigarettes as well).

If anything, the inconsistent delivery of nicotine is a concern for the effectiveness, not the safety of these products. If electronic cigarette companies can find technology to better regulate the nicotine delivery, they be be more effective for smoking cessation.

Furthermore, consistency of nicotine delivery is not a particular concern of most electronic cigarette companies at the present time because their products are not being marketed with therapeutic claims. They are not being marketed as devices to treat nicotine dependence. Instead, they are being marketed as alternatives to cigarette smoking for smokers concerned about the health damage that is being caused by their smoking.

The Department’s concern that these products may serve as a gateway for youth smoking is a purely hypothetical one, and there is no evidence to support this theory. There is, in fact, no evidence that electronic cigarettes have become popular among youth and there is no evidence that youth are initiating nicotine use with these devices and then progressing to cigarette smoking.

Finally, and perhaps most importantly, DHHS is lying to the public when it asserts that “there is no evidence to support” the claim that electronic cigarettes can help smokers quit. In fact, there is abundant evidence. We know for a fact that there are thousands of ex-smokers who have quit smoking using these devices. Moreover, we know from the first clinical trial of electronic cigarettes that 54% of smokers who were unmotivated to quit at baseline were nevertheless successful in either quitting or cutting down by more than half the amount that they smoke.

So the DHHS’ assertion that there is no evidence that electronic cigarettes can help smokers quit is simply not true.

The rest of the story is that through its dissemination of false and misleading information about electronic cigarettes, the DHHS is not only violating basic principles of truth and honesty, but it is also giving inappropriate medical advice and helping to protect the cigarette companies from what might otherwise be a serious threat to their continued profits from the sale of cigarettes.


#1 Candy Girl on 11.27.12 at 8:45 AM

The DHHS’ misguided position with respect to e-cigarettes is instructive in one key aspect. The Department’s obsession with how much nicotine is being delivered to the user on a “per puff” basis sends a clear message as to what the FDA is likely to establish as a minimum standard for the e-cig going forward- “tell the user exactly what he or she is consuming.” Unfortunately, the current e-cigarette technology is incapable of providing such information to the consumer or to the FDA- who is likely to require such information as part of its inevitable regulatory oversight. E-cigarettes will remain legal in the future- but they won’t look or function like the cheap, silly products that are in the market today.

#2 atobaccoguy on 11.28.12 at 12:21 AM

seriously now what are they looking to do kill more smokers

#3 Panther Fan on 11.29.12 at 1:11 AM

You really have to be kidding! FDA stands for something more than what they state – But this is pretty dumb.

#4 Greg on 11.29.12 at 4:16 AM

how many more lies will the government, big pharma, and tobacco companies tell about e-cigs ?? i dare anyone of em to publish and kind of documentation that proves their statement !! there has already been a study done on the heart and was found in the short run to be little to no effect. also there has been an enclosed room study and was found to be better than to go outside in any major city and breathe the free air !! come on guys get with the program and stop backing the big companies that dont want us to live a healthier life. cause if we dont get sick with canser of something to that effect then they dont make any money and you know they dont want that now !!

#5 Jersey Kid on 12.12.12 at 11:44 PM

Greg what you say is all so true but there is a serious issue with some of the top e-cig companies that are misleading retailers and wholesalers. I saw info regarding two of the leaders over the past week regarding advances made regarding their product so I went and purchased both of them and took them apart and I found nothing different. Just because you package it or change it’s side does not mean you have re-engineered the product. One of these companies say that they consider a soft tip as a technological advancement that they invented. Well to start on that claim I would say soft tips have been around for several years and when you really look at it it’s just a cheap thin plastic tube and when you bite on it really means you are biting on the cartridge. Is this really a advancement in technology. I like my stylish hard tube that has never leaked. Looks to me like manufacturers are just trying reduce their cost at the expense of quality. So when these manufacturers make claims someone needs to challenge them rather than accept their BS. My point is that the industry needs to challeng folks that make these claims as it will cause harm to those that making really good products.

#6 OTP Kid on 12.20.12 at 2:54 PM

The HHS makes an excellent point. E-cigs are currently not regulated, and beside not knowing how much nicotine is being deleivered, other chemicals may be present. The products are made in China, without any regulation or rules, and could be extremely dangerous, no different than lead paint that was being applied to children’s toys. Smokers would be well-advised at this point to use approved methods for quitting, rather than putting their lives at risk with these unknown products.

#7 OTP Kid on 12.26.12 at 6:37 PM

The town of Great Barrington, Massachusetts expanded its anti-smoking ordinance to include electronic cigarettes in its smoke-free law, raise fines for infractions, ban hookah bars and other bars that promote and profit from smoking, and prohibit smoking in parks and cemeteries. (Berkshire Eagle 12/25)

#8 on 12.27.12 at 8:49 PM

@OTP Kid.
A town with a population of 7527 banned e-cigs?
And your point is??????

#9 truth seeker on 12.28.12 at 2:02 AM

I agree with OTP Kid – I mean how do we know and I have heard that propylene glycol long term could be harmful?

#10 OTP Kid on 12.28.12 at 5:15 PM

Ecig sales will start heading downward fairly soon, once they are taxed and restricted as the harmful, untested products they are. Here’s more…

A new law set to take effect on January 1st in New York will ban the sale of electronic cigarettes to anyone aged below 18, with the measure’s sponsor State Sen. Owen Johnson (R-Long Island) saying the ban was needed to protect youth because e-cigarettes “have not been proven to be safe for use at any age.” State law already prohibits underage sales of cigarettes, cigars, herbal cigarettes and smokeless tobacco products, with retailers facing a fine of $300 to $1,000 for the first violation, according to the tax department (AP 12/24).

#11 OTP Kid on 12.31.12 at 12:53 PM

A report published on December 28th by the Italian Ministry of Health warned that young people should not use electronic cigarettes because the device still delivers nicotine to the body and expressed concerns that the use of e-cigarettes could encourage the youth to smoke regular cigarettes. (ABC News 12/30)

#12 Sambo Eciger on 01.01.13 at 2:52 PM

@OTP Kid. Here are excerpts from the same Italian Ministry of Health report that you are refering two.
I guess you should start wearing bifocals so that you can read the entire report.
Excerpts from the Italian Health Ministry report. Read the entire report at :

“Roberta Pacifici, director of Italy Observatory on Smoking, Alcohol and Drug Use at the National Health Institute, who worked on the report, told Italian news agency ANSA, “We can say that the electronic cigarette is less toxic, but we cannot say that it is totally innocuous.”
She conceded that even though there are different strengths of nicotine concentrations in the liquids available the actual amount of nicotine in an electronic cigarette is markedly lower than in a normal cigarette “and a traditional cigarette when smoked produces over 400 substances which are mostly carcinogenic and absolutely toxic.”
Legislation concerning e-cigarette and its liquids use and sales varies throughout the world since the e-cigarette first went on the market less than 10 years ago now. Many countries are awaiting further tests but are reluctant to warn against its use as it is recognized that it can help some smokers to cut their cigarette consumption which could lead to a lower mortality rate from cigarette smoking. A limited amount of scientific tests and controlled studies are available as the product is a relatively new invention.
Ray Story, CEO of The Tobacco Vapor Electronic Cigarette Association, said there was no proof e-cigarettes had ever harmed anyone and that attacks on e-cigarettes were more about protecting revenues than public health.
“In Italy, tobacco is sold through government stores. That old Mafioso-type environment protects its own,” he said.
Story said e-cigarettes don’t claim to help people quit smoking.
“Yes, nicotine is addictive, like caffeine and sugar. We’re not in the non-addictive business. We cater to someone who is already a smoker. Starbucks sells coffee; Coca-Cola sells cola. Both have caffeine. But e-cigarettes deliver nicotine in the cleanest way,” he said.
Regarding the Health Ministry’s recommendation that e-cigarettes not be given to young people, Story said: “Not giving them to young people is common sense. … We have age verification on our products.”
He scoffed at the concern that the use of this gadget could lead young people to graduate from these devices to smoking real cigarettes. “Yeah, and virgin daiquiris make people alcoholics. It’s absolutely inaccurate; there’s no proof,” Story said.

#13 OTP Kid on 01.02.13 at 12:35 PM

Dom’t worry about me Sambo, you’re business model is falling apart once regulation, taxes, and Big Tobacco competition sets in. Go sell something while you still can.

#14 leatherer on 01.02.13 at 4:29 PM

Who are you working for, OTP Kid? You getting a nice fat check from the tobacco companies or the State to spread lies and disinformation? Nice work.

#15 cig city on 01.02.13 at 6:12 PM

@OTP Kid – Why don’t these guys get it that once the taxes and regulations and tobacco companies hit them their biz will be selling used cars again?

#16 OTP Kid on 01.03.13 at 11:16 AM

Cig city,

Because they are living a lie: life is good without taxes and regulations. Soon enough, taxes and regualtions will beset the ecig industry, and smoking restrictions are already being imposed which will decrease opportunity for consumption.

So in the menatime they choose to deny reality and attack me for posting official government declarations found in the media. First it was phone cards, now ecigs, maybe they can tell us what’s next? 🙂

#17 cig city on 01.06.13 at 3:28 AM

OTP Kid – I was watching the business news and there was a segment on how e-cigs were going to end tobacco and in the piece there was reference to these products being a safer alternative – i didn’t think you could say that kind of stuff

#18 Sambo Eciger on 01.07.13 at 2:15 AM

@OTP Kid
Your comments from :
“OTP Kid on 06.11.09 at 10:14 AM
E-cigarettes will either be banned or highly controlled by the FDA. I believe you may be missing the point. While you can argue the benefits of Ecigs all day long, the simple fact is that the product will be portrayed as a smoking placebo to take the place when the smoker cannot smoke; thus, it will encourage continued smoking rather than quitting. Once this argument is publicized, there will be no putting the genie back in the bottle. Because the politicians and beureacrats will ALWAYS err on the side of the safe choice, the products will be doomed. The naivete’ of these boards, this one in particular, is incredible. But it certainly explains why the industry cannot stem the decline, it’s full of idiots.”
Exactly the same comments were repeated in October 2010.
Here it is 2013 and you still have the same animosity towards e-cigarettes.
The restrictions and regulations will come, the industry will grow and keep garnering bigger market share as the alternative way to smoke. And yes even though the product is Safer, that word is off the table for now.
Still predicting their demise?
Some idiots remain idiots forever.

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