Is Vitamin E Acetate Killing Vapers?

Officials at the U. S. Centers for Disease Control announced Friday that they may have found a cause for the lung injuries and deaths in people who use e-cigarettes.  Since the problem arose last March, a total of 39 people have died from what is now being called "e-cigarette, or vaping, product use associated lung injury," (EVALI for short) and over 2,000 more have become ill or hospitalized.  A report by National Public Radio says that a compound called vitamin E acetate (tocopheryl acetate) has been found in lung-fluid samples from 29 individuals who were hospitalized as a result of vaping.  While the CDC has not reached any definite conclusions that vitamin E acetate is the sole cause of EVALI, the fact that it has been found in all 29 samples is significant.  The compound is known to be used by off-label manufacturers who sell vaping products containing THC—the active ingredient in marijuana.  Most but not all EVALI victims admit using vaping mixtures containing THC.

Vitamin E acetate is a more stable form of pure vitamin E (tocopherol), and the acetate is used in a wide variety of consumer products meant to be applied to the skin or swallowed.  It is an oil-like substance that is innocuous in these applications, but inhaling vaporized oily materials can lead to serious lung problems.  The syndrome called "lipoid pneumonia" can strike people whose job involves breathing vaporized oils.  For example, a performer who "eat sfire" by sticking flaming objects in his mouth will often prepare for his stunt by coating his mouth with a petroleum-jelly-like substance called kerdan.  If the hot object happens to vaporize some of the kerdan and the unfortunate performer breathes the vapor, the oil can coat the inside of his lungs and cause lipoid pneumonia.  A less exotic way of getting the disease is to take a mineral-oil laxative and have it go down your trachea instead of your esophagus (the wrong way.)  So it's entirely reasonable to believe that lipoid pneumonia is what the sick vapers are getting, and that vitamin E acetate may be the cause.

This situation is beginning to resemble another famous incident in which manufacturers involved in making a psychoactive substance turned to what they thought was a harmless chemical in order to cut corners, only to find that it poisoned their customers. 

During Prohibition in the U. S. (1919-1933), it was illegal to sell intoxicating beverages containing more than a few percent of ethyl alcohol.  One of the few exceptions was made for extracts of essential oils such as vanilla and ginger, which were typically 70% alcohol.  When sales of such products boomed and it became clear that people weren't just making lots of vanilla ice cream and gingerbread cookies with the extracts, the Food and Drug Administration required makers of these extracts to adjust their formulas so that they were undrinkable in concentrated form, a process called denaturing.  In particular, makers of Jamaica ginger had to add bitter-tasting substances like castor oil that would not interfere with the intended use for ginger flavoring, but would discourage would-be alcohol consumers from drinking the stuff just to get a buzz.  In order to enforce these rules, the FDA would audit samples of Jamaica ginger to make sure that when the alcohol boiled off, the remaining solids were heavy enough to satisfy the auditors that the makers were still denaturing their product properly.

Thus the matter stood until the price of castor oil went up in the late 1920s.  One Jamaica-ginger maker named Harry Gross looked around for a substitute chemical and found one called tri-ortho cresyl phosphate (TOCP for short).  He asked the manufacturer, Celluloid Corporation, if the chemical was toxic, and they told him they didn't think so.  But this was simply based on the fact that no one involved in the making of the chemical had become seriously ill, not that any tests on animals or humans had been made.  TOCP had a suitable specific gravity to be substituted for castor oil, so Gross made up a large batch of several barrels and sold it to retailers, who in turn sold it to their mostly poor customers who couldn't afford good bootleg liquor.

In a few months, doctors in the poorer areas of cities, especially in the South, began seeing patients whose legs were not working right.  It turned out that TOCP was a slow-acting neurotoxin that selectively attacked the nerves going to the leg muscles.  Over the next year or so, thousands of victims of what came to be called "jake-leg syndrome" turned up.  Many were permanently paralyzed and spent the rest of their lives in wheelchairs, if they could afford one. 

Gross eventually served a two-year jail sentence for adulterating his product, but there were no other major legal consequences for the manufacturers, or compensation benefits for the thousands of mostly poor victims of the syndrome. 

The parallels to the current vaping crisis may not be as obvious as they seem.  But in both cases, there is a chemical being sold under dubious circumstances by shady operators.  In both cases, the chemical involved was not previously suspected of being harmful.  And in both cases, serious injuries occurred to thousands of people before anything substantial was done to get to the source of the problem.

In contrast to the jake-leg episode, the CDC has been issuing warnings about vaping products almost since the first victims of EVALI were identified.  But the drive that some people feel to get high can overpower caution and common sense, and there will always be those around who are willing to cater to such desires with a potentially dangerous product.

It looks like the CDC may be getting to the bottom of the problem, and if they do, we can expect quick action against anyone selling vaping products that can harm users.  While the free market has its uses, regulations to protect the public typically arise only after serious widespread harm has been done due to lack of regulation, and that may be what happens in this case. 

Sources:  The NPR article "CDC Finds Possible Culprit In Outbreak Of Vaping-Related Lung Injuries" appeared on Nov. 8, 2019 at https://www.npr.org/sections/health-shots/2019/11/08/777646890/cdc-finds-possible-culprit-in-outbreak-of-vaping-related-lung-injuries.  I also used material from the health website Healthline at https://www.healthline.com/health/lipoid-pneumonia#causes.  I blogged on this matter on September 9, 2019 at https://engineeringethicsblog.blogspot.com/2019/09/vaping-turns-deadly.html.  And an excellent longer article detailing the saga of jake-leg syndrome ("Jake Leg" by Dan Baum) appeared in The New Yorker magazine's Sept. 15, 2003 issue beginning on p. 50, to which I referred for some of the information above, as well as Wikipedia articles on Jamaica ginger and vitamin E. 

Vaping Turns Deadly

At this writing, three people have died and hundreds more have become ill from a mysterious lung ailment that is connected with certain types of e-cigarettes.  The victims typically have nausea or vomiting at first, then difficulty breathing.  Many end up in emergency rooms and hospitals because of lung damage.

Most of the sufferers are young people in their teens and twenties, and all were found to have been  using vaping products in the previous three months.  Many but not all were using e-cigarettes laced with THC, the active ingredient in marijuana.  Others were vaping only nicotine, but some early analysis indicates that a substance called vitamin-E acetate was found in many of the users' devices.  It's possible that this oily compound is at fault, but investigators at the U. S. Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) have not reached any conclusions yet. 

In fact, the two agencies have released different recommendations in response to the crisis.  The CDC is warning consumers to stay away from all e-cigarettes, but the FDA is limiting its cautions to those containing THC.  Regardless, it looks like the vaping party has received a damper that may change a lot of things.

So far, vaping and the e-cigarette industry is largely unregulated, unlike the tobacco industry.  It found its first mass market in China in the early 2000s.  The technology was made possible by the development of high-energy-density lithium batteries, among other things.  While vaporizers for medical use have been around since at least the 1920s, it wasn't possible to squeeze everything needed into a cigarette-size package until about fifteen years ago. 

Since then, vaping has taken off among young people.  A recent survey of  U. S. 12th-graders shows that about 20% of them have vaped in the last 30 days, and this is up from only about 11% in 2017, the sharpest two-year increase in the use of any drug that the National Institutes of Health has measured in its forty-some-odd year history of doing such surveys.

The ethical question of the hour is this:  has vaping become popular enough, mature enough, and dangerous enough, that some kind of regulation (either industrial self-policing or governmental oversight) is needed?  The answer doesn't hinge only on technical questions, but on one's political philosophy as well.

Take the extreme libertarian position, for example.  Libertarians start out by opposing all government activity of any kind, and then grudgingly allow certain unavoidable activities that are needed for a nation to be regarded as a nation:  national defense, for instance.  It's not reasonable to expect every household to defend itself against foreign aggression, so most libertarians admit the necessity of maintaining national defense in a collective way. 

           

But on an issue such as a consumer product, the libertarian view is "caveat emptor"—let the buyer beware.  If you choose to buy an off-brand e-cigarette because it promises to have more THC in it than the next guy's does, that's your business.  And if there's risk involved, well, people do all sorts of risky things that the government pays no attention to:  telling your wife "that dress makes you look fat" is one example that comes to mind. 

On the opposite extreme is the nanny-state model, favored generally by left-of-center partisans who see most private enterprises, especially large ones, as the enemy, and feel that government's responsibility is to even out the unfair advantage that huge companies have over the individual consumer.  These folks would regulate almost anything you buy, and have government-paid inspectors constantly checking for quality and value and so on. 

It's impractical to run your own bacteriological lab to inspect your own hamburgers and skim milk, so the government is supposed to do that for you.  Arguably, it's also impractical for vapers to take samples of their e-cigarette's goop and send it to a chemical lab for testing, and then decide on the basis of the results whether it's safe to use that particular product. 

My guess at this point is that sooner or later, probably sooner, the e-cigarette industry is going to find itself subject to government standards for something.  Exactly what isn't clear yet, because we do not yet know what exactly is causing the mysterious vaping illnesses and deaths.  But when we do, you can bet there will be lawsuits, at a minimum, and at least calls for regulation of the industry. 

Whether or not those calls are heeded will depend partly on the way the industry reacts.  Juul, currently the largest maker of vaping products, is one-third owned by the corporate entity formerly known as Philip Morris Companies.  In other words, the tobacco makers have seen the vaping handwriting on the wall, and are moving into the new business as their conventional tobacco product sales flatten or decline. 

The tobacco companies gained a prominent place in the Unethical Hall of Fame when they engaged in a decades-long campaign of disinformation to combat the idea that smoking could hurt or kill you, despite having inside information that it very well could.  In the face of an ongoing disaster such as the vaping illness, this ploy doesn't work so well.  But they could claim that only disreputable firms would sell vaping products that cause immediate harm, and pay for studies that show it's better than smoking and harmless for the vast majority of users.

Sometimes the hardest thing to do is be patient, and that's what we need to do right now, rather than rushing to conclusions that aren't supported by clinical evidence.  Investigators should eventually figure out what exactly is going on with the sick and dying vapers, and once we know that, we'll at least have something to act on.  Until then, if by chance anyone under 30 is reading this blog, take my advice:  leave those e-cigarettes alone. 

Sources: I referred to articles at CNBC.com (https://www.cnbc.com/2019/09/07/cdc-fda-clash-on-warning-consumers-during-lung-disease-outbreak.html) and vox.com (https://www.vox.com/science-and-health/2019/9/3/20847219/vaping-health-risks-2019-lung-damage-death) as well as the Wikipedia article on Juul.

Exploding E-Cigarettes and Ethical Theories

A recent article in the engineering magazine IEEE Spectrum describes how numerous users of e-cigarettes have received injuries ranging from minor to life-threatening when their devices caught fire or exploded.  E-cigarettes work by vaporizing a solution of nicotine and flavoring with a hot wire powered by a high-energy-density lithium-ion battery.  Lithium-ion batteries are in everything from mobile phones to airliners, but the particular design of e-cigarettes makes them especially hazardous in this application.  The high power required by the heater means that the battery is operating perilously near the maximum output current that it can maintain without overheating itself.  And if there are any manufacturing defects in the battery, as can often happen if substandard components are used by a fly-by-night manufacturer with inadequate quality control, the e-cigarette user ends up carrying around what amounts to a small pipe bomb.

The consequences can be dire.  The article tells the story of Otis Gooding, whose e-cigarette went off in his pants pocket, injuring both his thigh and the hand he used to try to get rid of it.  Other users have lost eyes, teeth, and parts of their cheeks to explosions and fires.

Anecdotes, however harrowing, do not constitute numerical evidence that the typical e-cigarette user is taking his or her life in their hands when they light up.  But various sources have estimated that the incidents of e-cigarette explosions or fires is in the dozens if not hundreds a year. 

The e-cigarette market had total sales exceeding $2 billion in 2016, and assuming the average user spends $150 a year on the habit, that means over 10 million people in the U. S. are likely regular users.  Say 100 of these have fireworks-type problems with their devices, and that amounts to an incidence of 1 per 100,000 per year, which is the type of ratio that public-health epidemiologists like to use.  Just to put that in perspective, deaths in the U. S. from lung cancer in the period 2011-2015 averaged about 43 per 100,000.  One of the advantages touted for e-cigarettes is that they don’t produce the tar and other nasty stuff that leads to lung cancer in regular cigarette smokers.  While e-cigarettes haven’t been around long enough for this assertion to be empirically verified—nobody  has been an e-cigarette user for forty years yet—there is probably something to this argument.

And such an argument would appeal to a certain type of ethical theorist called a utilitarian.  Utilitarians decide what the right thing is to do based on the greatest good for the greatest number.  A utilitarian might look at this situation and say, “Okay, we have Case A and Case B.  In Case A, 10 million people satisfy their craving for nicotine with plain old coffin-nails, and as a result a good many more than 43 of them die of lung cancer every year.  In Case B, we have the same 10 million people smoking e-cigarettes.  A lot fewer of them die of lung cancer, at the price of only one unlucky person whose e-cigarette explodes in his face.  Clearly, Case B is better.”

And if you put it that way, it’s hard to argue the point.  But we don’t live idealized lives in which we’re always choosing between two clearly-defined cases.  And if I were an e-cigarette user (which I am not), I would still be concerned about the chances that my device could blow up or catch fire.  But the utilitiarian won’t help me.

So I go looking in the catalog of ethical theories and find something called virtue ethics.  Basically, virtue ethics encourages cultivation of the virtues, of which there are almost as many as there are virtue ethicists.  Of the virtues we could choose from, I’ll pick one that doesn’t have a particularly fancy name, but will work for our purposes:  thoughtfulness. 

If you open a cabinet door while making breakfast one morning, and then think to close it afterwards not because you want to (open cabinet doors don’t bother you at all) but because your wife has a thing about open cabinet doors, you’re being thoughtful.  What does thoughtfulness say about the situation of defective e-cigarettes leading to explosions and fires?

Well, it draws attention to the proximate causes of those explosions and fires, which in most cases prove to be defective lithium-ion batteries supplied by shady manufacturers who are almost exclusively in China, which is where most of the devices and their components are made.  Now there’s over a billion people in China, and probably most of them are doing the best they can in their lives, trying to improve their lot and fulfill their obligations.  China is a haven for entrepreneurs right now, especially in the exploding (so to speak) growth market of e-cigarettes.  And in a world economy where low prices speak louder than almost any other consideration, the organization that can underbid everybody else tends to get the business.  And so probably the management of a shady lithium-ion battery factory feels caught between the rock of maintaining quality and reliability on the one hand, and the hard place of not pricing their product above the minimum needed to get the business. 

The virtue ethicists would tell the makers of e-cigarettes to clean up their act.  “How would you like to be one of the customers whose lips are sent to Kingdom Come by one of your bad batteries?” they might ask.  Of course, if one company spends the money to improve the quality of their batteries, there may be another one around the corner willing to skip quality control and underbid the first company.  The e-cigarette makers who buy batteries also have reputations to uphold, and so they could also pay attention to the sermon of a virtue ethicist and take more responsibility for the quality of their products.  In any event, it’s easy to see that virtue ethics provides you with more reasons to do something about this situation than utilitarianism does.

This is not to say that utilitiarianism is useless.  In situations where there are lots of data to work with, utilitarian analyses can clarify choices between comparable courses of action.  But sooner or later, it always runs up against the questions of how to quantify good, and who to include in the greatest number.  And there are no universally agreed-upon answers to those questions.

Sources:  The print version of IEEE Spectrum carried the article “When E-Cigarettes Go Boom” on pp. 42-45 of the July 2018 issue.  A briefer version appeared on their website in February 2018 at https://spectrum.ieee.org/consumer-electronics/portable-devices/exploding-ecigarettes-are-a-growing-danger-to-public-health.  The statistic about lung cancer was obtained from https://seer.cancer.gov/statfacts/html/lungb.html, and the sales figures for e-cigarettes are from https://www.statista.com/statistics/285143/us-e-cigarettes-dollar-sales/.

Too Much Bang For the Buck: Exploding E-Cigarettes

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Last June, a man named Hamid Sadeghy was installing a car windshield in Austin, Texas when he felt a vibration in his pocket.  Sadeghy, who owns his own auto-glass company, is a responsible person who had been trying to cut back on his cigarette habit for the previous month or so by using electronic cigarettes (also called e-cigs or vapes).  Suddenly, in Sadeghy's words "It was like a firecracker.  It made the same exact noise.  A hissing sound and then burning sensation."  An e-cigarette in his pants pocket had exploded.  He suffered severe burns on his thigh which caused him to have difficulty walking, and was not able to return to work for three weeks following the accident. 

Sadeghy is one of dozens if not hundreds of people who have been affected by e-cigarette explosions.  Ironically, many people use e-cigarettes for the same reason Sadeghy did:  as a less harmful alternative to conventional smoking.  Although the jury is still out on the health hazards of e-cigarettes, there may be something to this idea.  But it changes the picture if every time you light up you're taking a chance that what you're smoking will turn into a pipe bomb.

The phenomenon of e-cigarettes showed up in the U. S. around 2007, and a 2015 poll showed that about 10% of U. S. adults now use the product at least occasionally. Vape shops have sprung up in many places, and most convenience stores carry them.  (Interestingly, the major tobacco companies dominate the convenience-store market channel.)  So if even a few hundred people have had their e-cigarette blow up on them, it is still a very rare occurrence, on the order of one incident per year for every 10,000 to 100,000 users.

Still, the tip of the injury iceberg of e-cigarettes is pretty grim, not to mention the property damage caused by fires.  A recent article on Buzzfeed shows graphic photos of Joseph Cavins, whose exploding e-cigarette destroyed one eye, and Thomas Boes, who lost three teeth in a disfiguring explosion from the same cause.  It's not clear whether such highly publicized stories are responsible for a recent slowdown in the growth of the e-cigarette market, but it's certainly possible.  It's well known that a few really exotic and gruesome accidents can cause more popular fear than a much larger number of less chilling mishaps.  This is why some people will get in a car without thinking but refuse to fly under any circumstances, even though the risk of accidents per mile traveled are much greater in automobiles.

A federal agency called the U. S. Fire Administration (USFA) did a study in 2014 of accidents and fires caused by e-cigarettes, and found that about four out of five happened during charging.  Most of the units use a universal-type USB connector to charge the lithium-ion battery that provides the power to heat the vaporizing element.  Unfortunately, this connector will fit pretty much any USB outlet, including power sources that were not designed to charge the particular battery that the e-cigarette uses.  The USFA thinks that most of the fires happened when the user tried to charge their unit with a power source not designed for it.

Lithium-ion batteries are nasty chemically, even when they are not enclosed in a cylindrical metal structure that unintentionally forms a pipe bomb.  The electrolyte is flammable.  If such a battery is charged too fast, it overheats, the liquid electrolyte vaporizes and breaches the battery case, and the thing catches fire.  The fire raises the pressure inside the metal tube of the e-cigarette, and here's where the pipe-bomb analogy comes in.  Small tubes can contain much higher pressures than other shapes, and so the tube doesn't give out on the sides.  Instead, the end cap or caps blow off, but only after the pressure has built up to an extremely high level.  When a cap lets go, the flaming electrolyte shoots it off with the force of a projectile and sprays itself all over whatever is nearby.  If the unit's being charged, that may be only things like flammable paper or wood. 

But in the fairly rare cases when the battery fails while in use, this sequence of dire events can go off in your face, with tragic and disfiguring results.  Properly designed and manufactured lithium-ion batteries don't explode spontaneously as they are charged or discharged, but the technology is being pushed pretty hard even when an e-cigarette operates normally.  A current of an amp or more is needed to heat the vaporizing element, and some counterfeit or shoddily made batteries can't handle that reliably and end up with an internal short due to overheating.  The result is pretty much the same as with overcharging:  electrolyte vaporizing and an explosion.

The Buzzfeed report says that the U. S. Food and Drug Administration (FDA) is moving to regulate e-cigarettes, bringing them under the same regulatory umbrella as conventional tobacco products.  Their plan is to require sellers to apply for authorization to sell the units, with approval hinging on safety features such as overcharging protection circuitry.  Of course, this would make the units cost more, but the present situation that makes it easy to connect an e-cigarette to the wrong charger is clearly a bad one.

Fire has a way of showing up in the early stages of many electrical products.  For a few years I worked at a division of Motorola which made two-way radios for first responders, and learned something about the history of the company, which goes back to the early days of radios installed in automobiles around 1930.  Back then it seems that the company rushed some auto radios into production that were not sufficiently safety-tested, and the resulting burned-up cars nearly killed Motorola.  Fortunately, they figured out what was wrong and fixed it, and car radios became one of the company's mainstays for many years.

The vaping industry needs to clean up its safety act by changing the charging method so consumers can't accidentally make little time bombs by plugging an e-cigarette into the wrong charger.  This will require coordination among the dozens of largely Chinese e-cigarette makers that up to now are probably engaged in cut-throat competition, and may not happen unless the FDA imposes the requirement on them.  So it will be interesting to see what happens in that regard.  In the meantime, if you happen to be a vape-er (?), be sure to use only the charger that came with the unit.  And it might not be a bad idea to wear safety glasses while you smoke.

Sources:  I thank my wife for pointing out to me the article on Buzzfeed from which I learned of this problem, posted on May 26, 2016 at  

-->https://www.buzzfeed.com/josephbernstein/burned?utm_term=.tbvvL7kEL#.mr0E63qy6.  I also referred to a vaping website called IEC where an (admittedly unscientific) survey of thirty e-cigarette accidents is reported at http://info-electronic-cigarette.com/e-cigarette-explosions-an-in-depth-investigation/.  This site refers to the USFA study, which is available at https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf.  Mr. Sadegh's story was reported by Fox News on June 30, 2015 at http://www.fox7austin.com/news/4664501-story, and the statistic that about 10% of U. S. adults use e-cigarettes is from http://www.reuters.com/article/us-usa-ecigarette-poll-analysis-idUSKBN0OQ0CA20150610.
Note added July 18, 2016:  A reader named Jason Artman read the above post and brought my attention to his website http://ecigone.com/featured/e-cigarette-explosions-comprehensive-list/, where he is maintaining a comprehensive list of over 100 e-cigarette explosion incidents.  

To Vape or Not to Vape?

A year or two ago, the administration at Texas State University, where I teach, passed a regulation that abolished smoking everywhere on campus, inside and out.  I have mixed feelings about this.  Personally, I have never smoked.  Both my parents were moderate to heavy smokers, and my father died of lung cancer at the age of 57.  So I am familiar with the harm smoking can do.  On the other hand,  some see widespread bans on personal habits that have at least some redeeming features as abuse of governmental authority.  Overall, I was mildly pleased by the ban, and so when I walked by a student lounge area in our building the other day and saw what I thought was a puff of cigarette smoke, I was surprised.

But on closer inspection, the student turned out to be "vaping":  smoking (or whatever the appropriate verb is here) an electronic cigarette.  Was that violating the smoking ban or not?  So far, the university hasn't ruled on whether vaping counts as smoking.  Since electronic cigarettes are unquestionably an engineered product, their production, sale, and use fall within the purview of engineering ethics. 

A visit to the website HowStuffWorks.com informed me that a Chinese pharmacist invented e-cigarettes a decade ago.  They depend on small lithium batteries for their energy source, and rechargeable lithium batteries themselves haven't been around for much longer than that.  The power goes through a voltage regulator to a small heating element, where a solution of nicotine in propylene glycol is vaporized and inhaled by the user.  The stuff becomes a finely dispersed mist upon exhaling and looks different than true cigarette smoke, probably because the particles are larger and evaporate rather than dispersing.  The current form of the device was originally marketed as an aid to help people quit smoking, but as with many such aids for addiction, the cure may not be much of an improvement over the disease.

Who is affected by vaping?  Well, there are the manufacturers of the product and its auxiliary apparatus and supplies:  chargers, the nicotine solution, the e-cigarettes themselves.  There are users, many but not all of whom are former smokers of real cigarettes.  There are the makers of conventional tobacco products, who may either feel threatened by the new development or may co-opt it once the market gets large enough, and start selling similar products themselves.  There are various organizational entities ranging from private companies up to things like the European Union, which are now tasked with deciding what if anything to do about vaping.  And last, but hopefully not least, there is the general non-smoking public for whom second-hand-smoke bans were enacted.  But partly because e-cigarettes are so new, nobody has a lot of solid data on their health hazards and whether second-hand nicotine-tinged propylene glycol is something to worry about. 

Hong Kong and Singapore, among other countries, have imposed flat-out bans on e-cigarettes, but most nations either have no laws about them or impose only mild regulation.  Their status in the U. S. has been the subject of numerous court cases, and attempts to get them classified as drug delivery devices have been unsuccessful.  The latest court ruling, which is more definite than logical, says they can be regulated only as tobacco products, which is a little like classifying tires as agricultural products because rubber comes from trees.  But the effect is that governments can't do anything to e-cigarettes that they can't do to regular cigarettes.  Consequently, some state governments have banned sales to minors, but that is about the extent of U. S. regulation so far.

It seems to me that e-cigarettes are all about the nicotine, which has been proved time and again to be addictive.  But so has alcohol, and we all know what a flop Prohibition was.  I confess that I don't relish the idea of attending a party at which I discover several of my friends or students sucking on phony cigarettes, but then again, I don't go to a lot of parties anyway.  In the last couple of decades, the latent puritanical streak in American culture has fastened onto cigarettes, with the result that most people who smoke, as well as most non-smokers, regard the cigarette habit as a disreputable vice.  And this attitude itself will probably keep e-cigarettes from becoming as common as cellphones, for example.

The medical and health evidence on vaping is still largely lacking, so the precautionary principle says to leave it alone until it's been proven to be safe, whatever "safe" means in this context.  The main ingredients of the vapor—nicotine and propylene glycol—are well-understood compounds.  Nicotine use in any form is psychologically addictive, but doesn't itself cause cancer.  Propylene glycol, if pure, is approved for use in foods.  So it's unlikely that their combination in e-cigarettes poses a sinister unknown risk, although one can't be sure without the appropriate long-term studies.

The thing I dislike the most about e-cigarettes is that they present one more opportunity for people, especially young people, to become dependent on a costly habit that otherwise doesn't make the world a better place.  I say that in full knowledge that some of the historical figures I most admire, including G. K. Chesterton and C. S. Lewis, were smokers, not of e-cigarettes but of the original old smelly tobacco products themselves.  E-cigarettes are an addition to a spectrum of products that are potentially habit-forming, products that lie on a spectrum whose mildest end includes coffee and tea, and whose opposite malignant end winds up with heroin and crystal meth.  Some people can choose to stay in one place on the harmless end of that spectrum, while others find that they are drawn through the milder products to take dangerous and illegal risks at the other end.  This is not to say that everyone who tries e-cigarettes will end up hooked on them, or will start smoking real ones.  But some will.  And is the pleasure, or whatever satisfaction that people get from them, worth the risk to those who may find that they are being controlled by their habit, rather than the other way around?  We don't know, but it is a risk both governments and individuals should consider seriously. 

Sources:  HowStuffWorks.com has a good description of e-cigarettes I referred to at http://science.howstuffworks.com/innovation/everyday-innovations/electronic-cigarette1.htm, and I also referred to Wikipedia's articles on electronic cigarettes, nicotine, and propylene glycol.