What are e-cigarettes?

Electronic cigarettes, known as E-cigarettes, are non-flammable devices that deliver synthetic or tobacco-derived nicotine; they are similar in size, shape, and usage to their leaf tobacco counterparts. They are available worldwide through the Internet or increasingly in retail outlets.

However, due to the lack of rigorous chemical and animal studies, as well as clinical trials on commercially available e-cigarettes, neither their value as therapeutic aids for smoking cessation nor their  “safety” as cigarette replacements is established and remains speculative.

E-cigarettes consist of three integrated parts contained in a stainless steel shell: the mouthpiece (or nicotine cartridge), the atomizer chamber (or  vaporizer), and a smart chip lithium ion battery.  Typically, a disposable filter holds a cartridge containing synthetic nicotine dissolved in propylene glycol, water, and flavorings.

When the entire unit is assembled, the user creates an inhaling motion which activates the battery via pressure sensors. The battery powers the vaporizer, and the vaporizer heats the liquid housed in the mouthpiece. As such, the electronic cigarette is a delivery device for the addictive substance nicotine. The vapor released is polyethylene glycol (PG), which looks like cigarette smoke (also used for theatrical smoke) and is also an FDA-approved food additive. The volume released varies by brand, but when inhaled feels like cigarette smoke to users. Unlike tobacco smoke, the vapor quickly evaporates, leaves no remaining odor, but the secondhand smoke may still be irritating.  Compared with conventional cigarettes, which last for about fifteen puffs, e-cigarettes can sustain 150 to 300 puffs, the equivalent of one-half to one pack of cigarettes. The cartridges vary in nicotine strength, being characterized as “zero,” low, medium, or high. Disposable, non-refillable versions, equivalent to one or two packs of cigarettes, also are available.

In tests conducted by the FDA’s Division of Pharmaceutical Analysis on two brands of e-cigarettes, additional ingredients were detected including diethylene glycol in one cartridge (a component of antifreeze and toxic to humans) and tobacco-specific nitrosamines (a known carcinogen) in half of the samples. This is very concerning and adds to the premise that such items should be closely regulated.

E-cigarettes were invented by an employee (Hon Lik) of a Chinese electronics company (Ruyan) headquartered in Beijing, which began marketing e-cigarettes in 2004. The Ruyan Group remains the leading manufacturer of e-cigarettes (sold as Ruyan® e-cigarettes), but additional manufacturers using similar devices have subsequently entered the market, offering their products worldwide via the Internet, in shopping malls, and other distributors. Prices for the devices (a charger, rechargeable battery, and five nicotine cartridges) range from about $80 to $150 with packages of replaceable cartridges, each good for several uses, costing $10 to $15 or the equivalent of 1 to 1.5 packs of cigarettes.

Per the CSAPH report, manufacturers of e-cigarettes have not submitted the requisite applications for FDA approval of these products for smoking cessation. And the Food and Drug Administration (FDA) has warned the public against e-cigarettes, saying they cannot be considered legitimate therapy for smokers to quit and that they could turn children into smokers.

Questions answered by Russell W.H. Kridel, M.D. as a public service to patients concerned about current health issues. All of the facts are gathered from published reports of AMA Council on Science and Public Health and approved by the AMA House of Delegates.

Read the AMA Council on Science and Public Health Report on “Use of Electronic Cigarettes in Smoking Cessation.”

Russell W.H. Kridel, M.D.

Does bottled water have fluoride in it?

Most bottled water is low in fluoride and lacks sufficient fluoride levels to prevent tooth decay.

However, most municipal drinking water sources do include fluoridation to reduce dental caries.

Drink tap water.  Your dentist and your bank account will be happier.

Read the AMA Council on Science and Public Health Report on “Safety of Bottled Water”.

Russell W.H. Kridel, M.D.

Why is salt the new target in the media?

You may have seen or read about a subway ad campaign that kicked off this week in NYC by the city’s Department of Health that urged consumers to reduce salt consumption.

NYC Subway Campaign

The concern over public salt consumption and salt levels in common food products is not really new news. In a 2006 Report on the Promotion of Healthy Lifestyles, the AMA Council on Science and Public Health addressed the issue of reducing the population burden of cardiovascular disease by reducing sodium intake. You can read a summary of the report here.

The CSAPH stated the public health advice to reduce sodium intake, such as that recently in NYC, is intended to influence the overall distribution of sodium intakes and, thereby, the incidence of hypertension in the population. With an appropriate food industry response, combined with consumer education and knowledgeable use of food labels, the average consumer should be able to choose a lower sodium diet without an inordinate level of dietary restriction, inconvenience, or loss of food enjoyment.

If we could change what the food companies and restaurants do, we can change the consumer’s mindset. And the result will be less cardiovascular disease and improved health overall for our population.

Russell Kridel, MD


Are flu vaccinations just for high-risk groups, like the elderly?

No. Flu vaccinations are not just for high-risk groups. The current policy states that routine annual influenza vaccinations are recommended for all adolescents and adults age 6 months and older.

Optimally, vaccination should occur before the onset of influenza in the community. Therefore, vaccinations are offered as soon as a vaccine is available to the public.  In addition, vaccinations are made available throughout the flu season as long influenza viruses are circulating in your community.

Previously, it was recommended that persons at high risk for complications from influenza should be the priority.  But, that is no longer the case.

Read the AMA Council on Science and Public Health Report on Influenza and Influenza Vaccine.

Russell Kridel, MD