E-cigarettes are one of America’s latest trends. Since entering the United States over the last ten years, they have taken the smoking community by storm. To many of us however, they are still somewhat of a mystery. Generally, we have a sense that they are less harmful than cigarettes, but how much less harmful exactly? With any new product, it is hard to foresee long-term health effects. But what do we know so far? Should e-cigarettes and their advertisements be regulated similarly to conventional cigarettes? Read on for a breakdown on what e-cigarettes are, the debates over them, and what regulation is being discussed.

What are electronic cigarettes?

E-cigarettes, also known as e-cigs and vaporizer cigarettes, are used as an alternate method to smoking tobacco via cigarettes, pipes, or cigars. They are battery operated and don’t involve smoke inhalation. The idea is that they bypass tobacco smoke, which can include more than 7,000 different harmful chemicals, many of which are known to cause cancer, heart disease, and lung disease. Some of the more well-known poisonous chemicals are cyanide, methanol, and ammonia. In addition, tobacco smoke includes tar, carbon monoxide, and nitrogen oxide.

Many e-cigs are designed to look like cigarettes and create a similar experience for those who are smoking them. A Chinese pharmacist perfected them in 2003-2004 and they were quickly brought to the international market in 2005-2006. In the current, automatic versions, a user sucks on an end piece to activate a sensor that allows a heating element to vaporize a liquid solution held in the mouthpiece.

Components

E-cigarettes are generally reusable and come in three parts: the Mouthpiece, the Atomizer, and the Battery.

• Mouthpiece (Cartridge): The mouthpiece holds the liquid solution, also known as e-liquid and e-juice. This solution can contain different grades of nicotine and come in a variety of flavors. Some are meant to imitate established cigarette brands, while others are more exotic. The nicotine is most often dissolved in propylene glycol, a food additive. The FDA has labeled propylene glycol as a “Generally Recognized as Safe” (GRAS) substance.
• Atomizer: This is the heating element that allows for vaporization. It requires replacement every three to six months.
• Battery: The battery is the largest piece of the e-cigarette. It is usually lithium-ion and rechargeable. It catalyzes the heating element and often contains an LED light to showcase activation.

Nicotine 

This product eliminates the inhalation of tobacco smoke, however it is important to note that nicotine itself isn’t very healthy. Although it is not the element of cigarettes that causes cancer, the U.S. Surgeon General has linked nicotine to negative impacts on fetal and adolescent brain development, premature birth, and low birth weight. In rare cases, nicotine can even cause abnormal heart rhythm and atrial fibrillation. It is also known to cause mouth irritation, mouth and throat pain, high blood pressure, and canker sores.

In 2014, a study found that “e-cigarettes with a higher voltage level have higher amounts of formaldehyde, a carcinogen.” This is under debate however due to the methods and nature of the study.

How are conventional cigarettes regulated?

We already know that smoking tobacco is awful for your health. It is to blame for 30 percent of all cancer deaths in the U.S., and accounts for 87 percent of lung cancer deaths in men and 70 percent in women. As a result of these health concerns, cigarettes and their advertisements are heavily controlled. To ascertain whether e-cigarettes should be similarly regulated, we need to understand established cigarette regulations. Here are some recent highlights.

The Family Smoking Prevention and Tobacco Control Act

The Family Smoking Prevention and Tobacco Control Act, passed in 2009, authorized the FDC to regulate the manufacture, distribution, and marketing of tobacco products. It requires prominent warning graphic labels for cigarettes and larger text warnings on smokeless tobacco products. It regulates describing tobacco products as “light, low, or mild.” Tobacco companies must yield research on health, toxicological, behavioral, or physiologic effects of tobacco use. The FDA can conduct compliance check inspections of any establishment selling tobacco products and fine any establishments not adhering to set regulations. It also requires tobacco manufactures to receive an order or exemption from the FDA before it can introduce new tobacco products.

Other parts of the law are focused on preventing advertisements aimed at America’s youth. Cigarettes cannot be flavored. The packaging design and color must be muted. It prohibits tobacco brands from sponsoring “sporting, entertainment, or other cultural events.” It prohibits free samples of cigarettes. And lastly, it prohibits tobacco branding on non-tobacco products.

E-Cigarette Regulation

Currently, there aren’t any regulations concerning the manufacture, distribution, and marketing of e-cigarettes. The only type of e-cigarettes subject to regulation are those designed for therapeutic purposes, as the FDA has authority to oversee those.

Only three states in the U.S. ban e-cigarettes in designated 100 percent smoke-free venues: Utah, New Jersey, and North Dakota. Only 15 states restrict the use of e-cigarettes in other venues. There are 162 local laws that restrict e-cigarettes in various venues, but those appear to be few and far between.

Are e-cigarettes dangerous?

The question remains: should we be worried about e-cigarettes? That’s a debate that’s happening across the country. They do eliminate deadly smoke inhalation, the most detrimental part of smoking cigarettes. However, there are still concerning aspects of e-cigarettes that need to be taken into account.

E-Cigs as a Gateway to Smoking for Young Adults

The Journal of the American Medical Association (JAMA) published a 2014 study entitled, “Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents.” The study was conducted out of a concern over the increasing use of unregulated e-cigarettes by today’s youth. The results came from a sample of U.S. middle and high school students who participated in the 2011 and 212 National Youth Tobacco Survey. It found:

Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.

In accordance, a 2013 study published by the Centers for Disease Control and Prevention (CDC) concluded that:

Youth who had never smoked conventional cigarettes but who used e-cigarettes were almost twice as likely to have intentions to smoke conventional cigarettes as those who had never used e-cigarettes.  Among non-smoking youth who had ever used e-cigarettes, 43.9 percent said they have intentions* to smoke conventional cigarettes within the next year, compared with 21.5 percent of those who had never used e-cigarettes.

Additionally, the CDC found that more than 250,000 young adults who have never smoked a cigarette have tried an e-cigarette. That is a triple increase from 2011.

Targeting youth?

If these studies are indicative of reality, then it’s scary to think of how e-cigarette companies are targeting the youth demographic. According to a study published in Pediatrics, “electronic cigarette advertisements increased by 256 percent from 2011 to 2013 and young adult exposure to e-cigarette ads jumped 321 percent in the same time period.“ It found that 75 percent of youth exposure to e-cigarette ads happened through the medium of cable networks like AMC, Comedy Central, and VH1. E-cigarette ads appear on programs like “The Bachelor,” “Big Brother,” and “Survivor,” which were rated amid the 100 highest-rated youth programs in 2012-13.

Other tactics accused of being aimed at young adults include free giveaway samples at music and sporting events, candy flavors, and the glamorization of packaging. All of these actions have been banned for traditional cigarettes companies because of their appeal to the youth.

 Do e-cigs help people quit smoking?

It’s difficult to determine. Studies indicate that they don’t necessarily help stop smoking.

JAMA Study Findings

As previously discussed, the 2014 study published by JAMA found that e-cigarettes do not help smokers quit. Specifically with regard to quitting smoking, 88 (out of 949) smokers claimed to start using e-cigarettes at the beginning of the study. In the next year, 13.5 percent of those 88 quit smoking traditional cigarettes. Almost equal percentages of e-cigarette users and solely traditional smokers quit smoking traditional cigarettes within the year. The difference was so slight, it fell within the study’s margin of error.

There are also testimonials, easily found online, that share success stories of smokers that quit with the help of e-cigarettes. These findings and interviews are not to say that it never happens, but it does not seem to be the norm.

Discussions for Future Regulation

The FDA has the authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. The FDA proposed the “deeming rule” on April 24, 2014 to extend tobacco products to include e-cigarettes. If approved, e-cigarettes would be regulated in the same manner as traditional cigarettes. This includes federal prohibition on free sampling, federal warning label requirements, and age verification requirements for retailers. It is still uncertain when and to what extent the FDA will be empowered to regulate e-cigarettes.

Conclusion

Studies looking into e-cigarette health concerns and their position as a gateway product for America’s youth are still new. The product only reached the U.S. in the last ten years and nothing is 100 percent conclusive. On one hand, smoking an e-cigarette is less harmful to your health than smoking a traditional cigarette. If a traditional smoker quits cigarettes and manages to only smoke e-cigarettes for the rest of his or her lifetime, that is a good thing. In the same respect, if a young adult who would have developed a smoking habit only ever uses e-cigarettes because of their availability, that is also a good thing. On the other hand, e-cigarettes aren’t necessarily safe for your health just because they are safer than cigarettes. And we could eventually find that they definitively promote cigarette smoking. The government and FDA can revisit the subject when there is more conclusive information available.

Resources

Primary

JAMA Pediatrics: Electronic Cigarette and Conventional Cigarette Use Among U.S. Adolescents

FDA: Deeming Tobacco Products to Be Subject to the Food, Drug, and Cosmetic Act

FDA: E-Cigarettes

Additional

BeTobaccoFree.gov: Law/Policies

American Cancer Society: Tobacco-Related Cancers Fact Sheet

American Lung Association: General Smoking Facts

American Nonsmokers’ Rights Foundation: U.S. State and Local Laws Regulating Use of Electronic Cigarettes

E-Cigarette Research: The Deception of Measuring Formaldehyde in E-Cigarette Aerosol

American Lung Association: Statement on E-Cigarettes

Medical News Today: What Are E-cigarettes?

RTI International: E-Cigarette TV Ads Targeting Youth Increased 256 Percent in Past Two Years

Science News: E-Cigarettes Don’t Help Smokers Quit

Jessica McLaughlin

Jessica McLaughlin is a graduate of the University of Maryland with a degree in English Literature and Spanish. She works in the publishing industry and recently moved back to the DC area after living in NYC. Contact Jessica at staff@LawStreetMedia.com.

The post E-Cigarettes: Should We Treat Them Like Traditional Cigarettes? appeared first on Law Street.

Cancer. Just one little word that sets hypochondriacs everywhere on edge. To some, the word means nothing but certain death. If that seems a little dramatic to you, guess what’s the second most common cause of death in the United States? That’s right, cancer.

What about the word “virus”? Scary…but not nearly as scary as cancer. It’s certainly not a word that evokes hope. But that may change as medical breakthroughs present a compelling question: can we use viruses to treat cancer?

How could we use viruses to cure cancer?

I know what you’re thinking. How can two negatives combine to achieve something as positive as a cure for cancer? The answer lies in your immune system.

Your immune system pinpoints a virus as a foreign invader, and works to eliminate it. Kind of like how our government would react to an alien spaceship entering Earth’s atmosphere.

On the other hand, your immune system has a harder time detecting cancer. Cancer cells share more characteristics with your own harmless cells than viruses. After all, cancer does originate from your own cells. It’s not in your body’s best interest to attack its own cells, so your immune system may overlook cancer as a threat. Kind of like how the government would react to a standard American aircraft filled with aliens. Seeing the aircraft as one if its own, they would leave it alone, and we’d have an invasion.

In summary, your immune system recognizes and fights viruses, but often not cancer.

So where does the cancer treatment part come in?

Our bodies can fight off viruses efficiently. What if we could hijack that fighting spirit and direct it towards cancer cells? What if we could manipulate our marvelous immune systems to fight off cancer?

That is the basis for how we may use viruses to treat cancer in a process known as oncolytic virotherapy.

Let’s go back to our surreptitious alien friends (cancer). They’ve made it into our atmosphere in their inconspicuous plane and are having a lovely joy ride when that alien spaceship (virus) joins them to transfer some of its passengers. Someone is bound to notice this suspicious activity and alert the authorities. Now the government (immune system), is wise to the presence of foreign invaders in both aircrafts and prepares for attack.

In oncolytic virotherapy, a virus infects a cancer cell. Distressed by this turn of events, the tumor cell releases cytokines which are really just messenger proteins. The cytokines raise the inflammation red flag and the immune system dispatches its sniper-like white blood cells to eliminate the source of inflammation–the infected tumor cell.

That was just one cell. What about an entire cancerous tumor? That’s where a virus’s prodigious replicating power is actually a good thing. Viruses don’t reproduce per se, but inject their own genetic material to commandeer host cells and replicate with their help. Replicating is a virus’s raison d’etre, host cells beware. After one cancer cell is successfully infected, the virus uses it as its replication puppet, consequentially infecting more cancer cells. So one transmission of a virus to a patient could cause destruction of many cancer cells and possibly an entire tumor.

To truly understand this process, take a moment to brush up on your viral replication knowledge. This video will help you out:

Will any virus work?

Any virus can infect and destroy a cancer cell, but it can also infect and destroy healthy cells. Successful oncolytic virotherapy requires a more selective virus–an oncolytic virus. The word oncolytic stems from oncolysis, which means the destruction of tumor cells. Oncolytic viruses are specifically attracted to tumor cells and leave your normal, healthy cells alone. This type of virus combats cancer cells without making patients sick.

That’s a new thing, right?

Yes and no. The concepts underlying virotherapy have been recognized for years. Doctors have pondered the use of viruses to treat cancer for more than a century as they discovered tumor remissions after viral episodes. As early as 1904, researchers noted a remission of cervical cancer in a woman given the rabies vaccination. But while early observations were strong, patient tests yielded erratic results. Then, technological breakthroughs took off in the 1940s and transformed oncolytic virotherapy from dream to possibility.

Scientists began studying genetic material in vitro by the 1970s, opening doors for new experiments and tests. The discovery of recombinant DNA technologies in the 1990s sparked an explosion of breakthroughs in genetic engineering. Genetic engineering took oncolytic virotherapy to new levels.

Genetically Engineering a Cancer-Killing Virus

Genetic engineering empowered scientists to devise oncolytic viruses with certain ideal characteristics for safer, more specific, and more effective oncolytic virotherapy. Scientists created viral vectors that target tumors in the body even more specifically than naturally occurring oncolytic viruses by isolating the human genes that code for tumor antigens. This heightened specificity diminished risk of infection in healthy cells and the toxicity witnessed in early murine (family of rats and mice) and human experiments was mitigated.

With engineered super viruses in tow, interest in oncolytic virotherapy soared.

Fear of engineered viruses  

Many find the concept of engineering viruses a bit on the scary side. I Am Legend, both the book and the movie, epitomizes distrust of viral engineering. The story features some possible side effects of tinkering with nature. Spoiler alert: it doesn’t go well for the people in this story.

But fear not, scientists aren’t cooking up a myriad of franken viruses in their labs unchecked. The field is regulated by the Food and Drug Administration with detailed oversight from the Recombinant DNA Advisory Committee reporting through the Office of Biotechnology Activities. To conduct a human study, researchers have to file an investigational new drug application with the FDA. They must provide ample evidence of human safety from prerequisite lab and animal tests. Rest assured they are working hard to prevent a virus induced apocalypse.

Other than oversight…

What other government activities could possibly affect the future on oncolytic virotherapy? Well, if there’s one thing cancer research requires other than brilliant brains, it’s money. In that vein, organizations like the American Society of Clinical Oncology find the stagnant growth in federal funding for cancer research disheartening.

In fact, 75 percent of oncologists in the United States say that current funding slumps impact their ability to conduct cancer research. Check out this infographic from the American Society of Clinical Oncology that sums up the situation.

Even so, proposed legislation to invest in biomedical research, encourage innovation in biotechnology, and fight off the deadliest cancers proves confronting cancer remains a priority for representatives. It looks like the War on Cancer started by the Nixon administration in 1971 is still going strong today.

Does oncolytic virotherapy work?

Mayo Clinic announced a great success in oncolytic virotherapy last May. One nearly hopeless woman saw complete remission of her multiple myeloma after injection with the measles virus – enough to vaccinate 100 million people. Speaking of vaccines, Dr. Mark Federspiel actually came up with the proper concentration of the virus by building up a strain of the measles virus used safely in vaccines. Watch to find out how this success is giving doctors hope for a one-shot cure for cancer:

Hungry for more evidence? Check out Table 1 of this article for a list of published clinical trials in the field of oncolytic virotherapy. One major critique of the therapy is that lab successes often don’t translate to human trials.

What are we waiting for?

There are a few kinks to work out in the field of oncolytic virotherapy before the procedure gains mainstream acceptance.

Here are a few key hurdles:

• The explosion of engineered viruses created by pharmaceutical and biotech companies have presented scientists with more options than they have time or money to test. Furthermore, modifications come so fast, a state of the art engineered virus can quickly become obsolete.
• Treatment toxicities are always possible when using a virus to treat a disease. Healthy cells risk infection as even meticulously engineered viruses have the ability to mutate.
• Finding the right balance of immune suppression and aggression is difficult. The immune system must be weak enough to allow the virus to get to the host, yet also strong enough to combat the infected tumor once the virus has reached it.

Conclusion

A one-shot cure for cancer? Who wouldn’t love that? While it seems like a fairy tale, recent successes are creating buzz that we may be getting closer. Even if one shot doesn’t do it, many believe oncolytic virotherapy can be used synergistically with other cancer therapies to induce tumor remission.

Hope is the most important part of our War on Cancer. Hope drives us to continue fighting in the face of a daunting adversary. Is there reason to hope viruses may be used to treat cancer? Absolutely. Is further research and testing needed? Again, absolutely. The field of oncolytic virotherapy has made incredible progress since the first whispers began over 100 years ago. Surely the next century will bring more advancements than we can possibly imagine today.

Resources

Primary 

Cancer Research Institute: Cancer and the Immune System: The Vital Connection

Journal of Vascular and Interventional Radiology: Oncolytic Virotherapy

Additional

American Cancer Society: Cancer Facts & Figures 2014

Genelux: What is Oncolytic Virotherapy?

BBC: How Does the Body Fight Off a Virus?

American Cancer Society: Immunotherapy

The New York Times: Viruses Recruited as Killers of Tumors

UC San Francisco: Killing Cancer Through the Immune System

Clinical and Translational Oncology: Viruses in Cancer Treatment

Mayo Clinic: Harnessing Viruses to Treat Cancer

Dove Press: Applications of Coxsackievirus A21 in Oncology

Dove Press: Reovirus in Cancer Therapy: an Evidence-Based Review

NIH: Oncolytic virotherapy

Multidisciplinary Digital Publishing Institute: Oncolytic Viruses for Cancer Therapy: Overcoming the Obstacles

BMJ: Fighting Cancer With Oncolytic Viruses

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Fighting Fire With Fire: Can Viruses Cure Cancer? appeared first on Law Street.

It seems as though the fake tanning trend is finally nearing its expiration date. Or at the very least, its legal limits. In recent months, multiple states have moved to restrict the ability of minors to access tanning beds. Teens under 18 in the states that have moved to legislate may need parents’ permission before indulging in the fake-UV rays, or be banned altogether.

Just a few years ago, tanning beds seemed ubiquitous for high school students looking to get a little more orange, despite that the dangers of tanning beds have been well known for years. Laws have always varied, but more states are moving toward banning minors outright, or requiring parental consent for those under 18. The American Cancer Society (ACS) tends to recommend the latter, highlighting the danger of tanning beds for young people. ACS South Dakota’s grassroots manager Carmyn Egge recently pointed out, “what we have found is that a person under the age of 35, who uses an indoor tanning device, their likelihood of getting a melanoma diagnosis [increases] by 59 percent.” Cindy Caneveri, of the American Cancer Society’s Cancer Action Network has cited similar statistics to the press, explaining:

Melanoma is now the second most common cancer for ages 15 to 29, and most common for ages 25 to 29. Melanoma is cumulative, so if you start out using a tanning bed [in your teens], you’re not seeing cancer until your late 20s.

States that have banned tanning completely for those under 18 include: California, Texas, Vermont, Illinois, Oregon, Nevada, Washington, Minnesota, Hawaii, and Louisiana. Delaware just recently passed a bill as well, although it won’t go into effect until 2015.

While the states above have banned teen tanning outright, some states are settling for restricting the ways in which teens can tan. This summer, a new law went into effect in Pennsylvania making tanning tougher on minors. The Indoor Tanning Regulation Act took place last month, and banned anyone under 16 years old from using a tanning bed. It also required that 17 year olds have parental consent. A recently passed Missouri law is also cracking down on the ways in which teenagers can tan indoors. The state now requires that anyone under the age of 17 provide written permission from a parent before using tanning facilities.

The Indoor Tanning Association disagrees with the bans on younger people, pointing out that 16 year olds can drive, own guns, and in certain cases get married, so they should not be limited in their choices to engage in indoor tanning.

The laws, however, do make a lot of sense. Tanning can be a harmful alteration to your body, and it’s logical to leave the ability to consent up to adults. Cigarettes, for example, are illegal until an individual turns 18 and is no longer a minor. Skin cancer is actually more frequent at this point than lung cancer. Each year in the United States, approximately 420,000 new cases of skin cancer are diagnosed that can be traced back to indoor tanning. In comparison, a total of about 225,000 new lung cancer diagnoses were expected in the U.S. in 2014. While cigarettes and tanning beds carry very different types of carcinogens, the move toward restricting harmful activities for those underage is a traditional practice.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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