“E-cigarettes,” or as they are more properly known, “electronic cigarettes,” have been around for well over fifty years, although the modern version has only been on the market for the past dozen years. Since that time, the use of e-cigarettes has increased exponentially. According to figures from the Centers for Disease Control published in October of 2015, 3.7% of all American adults use e-cigarettes and other “vaping” devices on a regular basis – representing 9 million individuals.

Manufacturers of these devices claim that electronic cigarettes are “safer” than standard combustible tobacco cigarettes – but the fact is that the long-term health effects of “vaping” are not fully known or understood. The liquids used for vaping (known as “e-liquids”) contain highly addictive nicotine as well as propylene glycol, an organic chemical used in some brands of “environmentally friendly” antifreeze.

Flavoring for these e-liquids include a chemical called diacetyl, which can result in permanent scarring of the lungs (“popcorn lung,” known by physicians as bronchiolitis obliterans). There is also evidence that e-cigarette users are exposed to heavy metals, including cadmium (used in batteries), manganese (an ingredient in gasoline additives) and chromium (employed in decorative chrome plating) as well as lead and nickel.

Scientific studies also indicate that, despite industry claims to the contrary, e-cigarettes do not discourage young people from taking up regular cigarettes – and in fact, appear to do quite the opposite, according to a study published in the Journal of the American Medical Association in November of 2015.

A 2014 study from the U.K. suggested that e-cigarettes may help adult smokers to quit combustible cigarettes, but this study was later contradicted by another study done at the Center for Tobacco Control Research and Education at the University of California in San Francisco. According to lead author Dr. Pamela Ling, “When used by a broad sample of smokers under ‘real world’ conditions, e-cigarette use did not significantly increase the chances of successfully quitting cigarette smoking.” She adds, “We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not.”

Aside from the risks of lung disease, there have been cases of physical injuries resulting from exploding batteries that are used in e-cigarettes. These lithium-ion batteries have exploded while being used or carried, causing disfiguring injuries, and even while being charged or off. Plaintiffs in lawsuits against e-cigarette manufacturers claim that they knowingly marketed a defective design and failed to warn consumers.

The History of Electronic Cigarettes

The first e-cigarette was designed by a man named Herbert Gilbert in the early 1960s. At that time, information about the connection between cigarette smoking and lung cancer – which the medical community had suspected for 25 years at that point – was beginning to come out to the general public. A heavy cigarette smoker at the time, Gilbert filed for a patent on August 17, 1963 for a “smokeless non-tobacco cigarette…replacing burning tobacco and paper with heated, moist, flavored air.”

Now well into his eighties, Gilbert recently said, “Back then my wish was to have an alternative to the scourge of tobacco cigarettes.”  In fact, his original intention was not to create a cigarette substitute, but rather a medical device. In his patent application, he described a device for “inhaling warm medication into the lungs in case of a respiratory ailment under direction of a physician.”

After Gilbert’s patent was granted over a year and a half later, he began showing his invention to potential investors and companies that might be able to put it into production. His new electronic cigarette was far ahead of its time – and met with considerable resistance from the tobacco industry, which saw it as a threat to its massive profits.

In a 2013 interview, Gilbert recalled:

“I showed it to chemical companies, pharmaceutical companies and tobacco companies and they did what they did to try to protect their markets. I am sure that many great inventions that could have benefited people, in the past and even today, receive the same treatment…I was ahead of my time, and in the midst of what some might say was the most powerful advertising period of big tobacco.”

Forty years after Gilbert filed for his original patent, a pharmacist from China named Hon Lik came up with what is generally acknowledged as the modern electronic cigarette. Himself a heavy smoker whose own father had died of lung disease, Hon Lik originally conceived of the idea not as a way to help people stop smoking, but rather as “a much cleaner, safer way to inhale nicotine.”

Originally patented in 2003, Hon Lik’s new e-cigarette reached market shelves in China the following year. It spawned many imitations and rival products, a few of which made their way to North America through sales on the World Wide Web. Hon’s company, Golden Dragon Holdings, finally registered an international patent for the “Electronic Atomization Cigarette” in November of 2007. The company changed its name to Ruyan (Mandarin Chinese for “Resembling Smoking”) shortly thereafter and began exporting e-cigarettes abroad.

In the beginning, e-cigarettes were not marketed as a smoking cessation device, but rather as a “safer” alternative to combustible cigarettes. In a 2009 article published in the Los Angeles Times, a Canadian businessman named William Taskas, who was among the first e-cigarette distributors in that country, described the device as  “safe smoking –  like smoking with a condom on.”

At first, the new product was well received, not only by consumers, but also by anti-smoking activists and crusaders. At that time, Canadian law professor David Sweanor said, “This is exactly what the tobacco companies have been afraid of all these years, an alternative method of delivering nicotine that is actually enjoyable.” He added, “It took the Chinese, who are very entrepreneurial, and not burdened with all kinds of regulation, to take the risk.”

Nonetheless, health authorities in Australia, Canada and Hong Kong issued bans on e-cigarettes, citing concerns of the lack of safety testing. A Hong Kong health department official pointed out that there were no controls over sales. He said, “A kid could buy it and take too many puffs. You could overdose on nicotine.”

In the U.S., the FDA seized several shipments of e-cigarettes from China when they arrived in October of 2009. Although there were no laws governing their sale at the time, FDA officials stated that manufacturers were making false claims as to the health benefits of e-cigarettes. Nonetheless, the popularity of e-cigarettes among smokers in the U.S. and the U.K. has continued to grow, partially because of the heavy taxes now levied on cigarettes (driving the purchase price of a packet of cigarettes to as much as $14 in some areas) and widespread restrictions on smoking in public places.

Today, there are approximately 500 companies that manufacture and sale electronic cigarettes, which has become a $7 billion industry worldwide.

How Electronic Cigarettes Operate

Today’s e-cigarette is not significantly different from Herbert Gilbert’s original design from 1963. Hon Lik’s initial idea was to use an ultrasound device in order to create vapor, similar to the technology used in home humidifiers. However, the droplets were too large to simulate actual tobacco smoke.

He eventually found “resistance heating” to be a better solution. The majority of e-cigarette devices today employ a heating element, powered by a battery. This element heats the e-liquid, turning it into the vapor inhaled by the user.  Over the years since e-cigarettes have been sold in Western countries, manufacturers and users alike have made modifications to these devices, such as integrating the heating coil into the liquid chamber.  Some of these improve the experience for users, while others – such as the “cig-a-like” – are designed for strictly aesthetic reasons. What has become known as “modding” is now a serious hobby among e-cigarette users.

Health Concerns

There is some disagreement among health authorities and the medical community on whether or not e-cigarette use is a healthier alternative to combustible cigarettes. One of the greatest concerns, particularly with young people, is nicotine.

According to the American Lung Association, all e-cigarette products contain some nicotine – even those that claim to be free of it. Nicotine is highly addictive, and can have devastating consequences on cognitive and behavioral development in young brains. The use of nicotine among pregnant women has also been implicated in premature birth, low birth weight and still birth, and may be a factor in Sudden Infant Death Syndrome (SIDS). In 2014, researchers discovered inconsistencies in the amount of nicotine delivered by electronic cigarettes – even when the liquid is of identical brand and potency. Cartridges of the same batch by the same manufacturer can vary by as much as 12%.

In addition to nicotine, FDA lab tests from 2009 revealed the presence of a number of carcinogens, some of which were mentioned earlier. As is the case with nicotine, the levels of these carcinogens can vary. A later study, published in the New England Journal of Medicine in January 2015 found elevated levels of formaldehyde in the aerosol mists produced by higher voltage e-cigarettes.

Yet another source of concern involves the flavorings used in e-liquids. According to the manufacturers, these substances are listed by the Flavor and Extract Manufacturers Association (FEMA) as “Generally Recognized As Safe” (GRAS). However, there are two reasons why such claims are suspect. First, FEMA is not a government regulatory agency (although its website states that all determinations made under the FEMA-GRAS^TMprogram are submitted to the FDA and records are made available to the public). Secondly, simply because such substances are safe to eat does not mean they are safe to breathe.

For example, simple black tea is a common drink, ingested daily by people all over the world, with no harmful effects. It even confers some health benefits. However, when smoked and taken into the lungs on a regular basis, black tea leaves can cause a host of respiratory disorders – including cancer. Another example, is diacetyl, an ingredient in artificial butter flavoring. Often added to e-liquids as a flavoring agent, this chemical can cause “popcorn lung” as mentioned earlier.

It is noteworthy that since e-cigarette use became so popular in the U.S., there has been a corresponding increase in the number of calls to poison centers for e-cigarette exposure. A recent study from the Center for Injury Research and Policy of the Research Institute and the Central Ohio Poison showed an increase in such poisonings of 1500% over a period of 40 months.  Most of these cases involve accidental ingestion by young children; other cases resulted from exposure to the skin or eyes. However, nearly 17% of these cases were due to someone inhaling such substances.

There is also the issue of secondhand smoke, also a growing problem as communities continue to restrict tobacco use in public spaces. Secondhand “vape” can be just as much of a health risk as secondhand tobacco smoke, if not more.

Physical Injuries From Explosions

An Internet search for “exploding e-cigarettes” brings up endless stories of devices exploding in users’ faces, in their mouths and even in their pants pockets. One organization, calling itself eCig One maintains an extensive list of incidents involving exploding e-cigarettes. Currently, the organization’s website details a total of 214 incidents – 137 of which resulted in injury or death. According to eCig One, many such incidents go unreported. Their research has also found that e-cigarette explosions today are more likely to result in injuries than in years past.

Dr. Anne Wagner, who treats patients at the University of Colorado Burn Center, describes these explosions as “super hot.” In the first two months of 2016 alone, she treated six patients with serious injuries resulting from such explosions. Speaking to NBC News last year, she said, “We’re seeing deep third-degree burns and almost all of them require skin grafts and these grafts leave a significant scar.”

The reasons for these explosions vary, but the main culprit appears to be the high-powered lithium-ion batteries used to power the devices. These batteries have also exploded in cell phones and laptop computers.

Lithium-ion batteries contain a great deal of power in a small, lightweight package – but they are also fragile, subject to malfunction due to temperature extremes and even puncturing. They can also heat up to the point of “thermal runaway,” in which a feedback loop is created, increasing the battery temperature until it can no longer contain the pressure. The electrolyte within the battery casing itself is highly flammable as well.

Venkat Viswanathan, an assistant professor of mechanical engineering  at Carnegie Mellon University, says this electrolyte is comparable to gasoline. He also points out that while high-quality lithium-ion batteries are generally safe, the cheaper batteries used in many e-cigarettes “have a much greater chance of having a manufacturing defect” – and therefore, a higher chance of exploding and burning.

Conclusion

Even by taking precautions, e-cigarettes put users at risk, both for physical injuries and respiratory disease. Although the FDA has started investigating incidents involving e-cigarettes and some regulations and controls are being enacted at both the federal and local level, it is still largely a matter of caveat emptor (“let the buyer beware”).