In the US e-cigarettes are to be banned with sweet liquids, India wants to completely ban e-cigarettes. Where is the problem?
The concerns about e-cigarettes have two causes: the protection of minors and mysterious cases. Above all, the manufacturer of the e-cigarette Juul has managed to lure millions of young people with flavors such as "Cool Cucumber", "Crème Brulée" or "Stoned Smurf" in the USA. "Juulen", in German "inhalieren", is today a fixed term in schoolyards.
The problem: The liquids of the e-cigarette contain up to five percent nicotine, in Germany are generally allowed a maximum of two percent. The substance reaches the brain within a few seconds, where it increases, among other things, the production of the happiness hormone dopamine, but also makes it dependent.
According to a survey of 42,000 high school students recently published in the New England Journal of Medicine, one in four 12th graders used an e-cigarette containing nicotine last month. US studies indicate that the adolescents are more likely to use tobacco cigarettes.
In addition, there is another problem: Over the past few weeks, more than 500 e-cigarette users in the United States have developed severe lung complaints, with eight dying. There are also many young people among those affected.
Which prohibitions are specifically planned in the US and other countries?
The governor of New York decided last weekend to ban flavored liquids for e-cigarettes in a rush. Next to be distributed only liquids with tobacco or mint flavor. US President Donald Trump announced that it would enforce a similar ban across the country.
Until more is known about the illnesses, the US health authorities also recommend to refrain from e-cigarettes. If you still want to continue steaming, you should buy the liquids only in designated shops and do not pan yourself.
India goes much further. There, according to the Reuters news agency, Juul and Philip Morris had planned to launch e-cigarettes. The government came before them. The country warned of an "epidemic" among young people and banned sales, application, import and production of vaporizers on Wednesday.
However, India is also one of the world's largest producers of tobacco, so e-cigarettes are a threat to many farmers in the country.
The diseases in the US are considered mysterious and puzzling. What is known about them?
Not much yet. The authorities are working according to their own statements to clarify the cause. For many sufferers, the symptoms start with breathing problems, shortness of breath and chest pain. Within the following days or weeks, they may deteriorate to such an extent that the patients have to be artificially ventilated. In part, gastrointestinal problems such as nausea, diarrhea or fever are added.
The US Food and Drug Administration (FDA) is currently investigating samples from those affected by e-cigarettes for a variety of ingredients, including pesticide, opioid and heavy metal contaminants. It is quite possible that there are several triggers, writes the FDA. Thus, no substance has been discovered in all samples tested so far.
What is striking is that many sufferers have consumed THC, the psychoactive ingredient in marijuana. In addition, vitamin E acetate was frequently found in the affected THC liquids. Both - the addition of vitamin E and cannabis oil - is banned in Germany.
What explanations are there for the cases of illness?
Robert Loddenkemper, a professor of lung medicine, believes that the lungs respond to chemical stimuli. "I think it's possible that it's an allergic reaction to the inhalation of organic substances," he says. "The US colleagues have evidence that fats or oils could have caused lung damage." (Read the complete interview here on SPIEGEL Plus.)
How do the authorities even want to know that the e-cigarettes have led to the problems?
As long as no explanation is found, this can not be proven to 100 percent. But it is impossible that infections lead to the problems. In addition, the health authorities have established criteria for the diagnosis of the disease:
- Those affected must have used e-cigarettes or other vaporizers in the past 90 days before the onset of complaints,
- X-rays have to show certain abnormalities in the lungs,
- Tests for various bacteria and viruses, including the flu, must be negative, and
- it must be ruled out that a cardiological or rheumatic disease is the cause of the discomfort.
Are there still new cases reported in the US?
The number of those affected increased significantly last week, to a total of 530 (as of 20 September 2019). In addition, eight deaths have been confirmed in several states, the CDC said. More than 300 of those affected have now evaluated data. Two thirds (67 percent) are therefore 18 to 34 years old, 16 percent even younger than 18.
Is there an acute danger for e-cigarette users in Germany as well?
In Germany, no similar increase in lung diseases is known, nor is there any oil in common liquids.
"The fact that the problems should occur within a relatively short period of time and that young people in particular are affected, indicates that this is an acute problem in the US and not about the long-term effects of e-cigarettes," says Frank Henkler-Stephani from the Federal Institute for Risk Assessment (BfR).
According to the current state of knowledge, no increased risks for users of e-cigarettes in Germany are to be expected if they use products that comply with European and German regulations. Overall, consumers in this country are better protected than in the US. For example, manufacturers of liquids in Germany must report their formulations, and the use of certain health-hazardous ingredients has been banned.
However, Henkler-Stephani warns against unregistered self-mixing products that often contain no nicotine and are often marketed online. Since nicotine-free liquids are not covered by tobacco law, the corresponding provisions also do not have to be complied with. Absurdly, this might make liquids with nicotine safer in some cases.
Apart from that, there is no comparable youth problem in Germany: Although many young people try e-cigarettes here as well. However, regular consumption is very rare among adolescents, writes the German Cancer Research Center (DKFZ) on the basis of a survey conducted in 2018. According to this opinion, mainly adults who have previously smoked are vaping in this country.
Although Juul was prohibited in Germany on Friday by injunction to distribute his cartridges for e-cigarettes. However, this has only indirectly to do with the health debate. The Juul competitor Niko Liquids had objected to false labeling. As a consequence, Juul is no longer allowed to sell his e-cigarette cartridges if their nicotine content deviates from the nicotine content stated on the packaging, or if the cartouche lacks the crossed-out wheelie bin symbol to dispose of electronic waste.
Many people in Germany try to get away from traditional cigarettes with e-cigarettes. Is that still a good idea?
Yes, it is. "According to current studies, e-cigarettes are significantly less harmful than conventional cigarettes," says Ute Mons of the German Cancer Research Center (DKFZ). For example, studies on short-term effects have shown that the condition of patients with the COPD lung disease improved after switching to e-cigarettes. In addition, it is proven that e-cigarettes can help with smoking cessation.
Although e-cigarettes would not bring everyone away from smoking, says Mons. But for long-time smokers who do not get rid of their addictions, they could be an alternative. "Ideally, of course, is to stop completely and not even begin." However, it is not yet clear how e-cigarettes will have a long-term effect, as they have not been on the market for so long.