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cigarettes pose a variety of very real dangers The commentary by Corey Whelen ("Safer smoking - the future of e-cigarettes," Dec. 3) might be more appropriately titled "Less-dangerous smoking." The arguments in the case appear to be based on some unsound assumptions. It is noted, for instance, that years of tobacco-control efforts have been unsuccessful in controlling smoking. While it is true that smoking has not been eliminated in our society, the proportion of smokers in our region alone has decreased from 24 per cent in 1995 to 13 per cent in 2013. That decrease translates into hundreds of lives saved, and millions of dollars of savings in direct and indirect health care costs compared to the small investments in public-health tobacco-control efforts. When looking at what control measures should be in place for the new phenomenon of e-cigarettes, the issue is not tobacco per se, but rather the alkaloid chemical nicotine found in the tobacco plant. It is nicotine that is as addictive as heroin, adversely affects fetuses and infants, and negatively influences child and adolescent brain development. Nicotine can be extremely toxic - one teaspoon of liquid nicotine sold for e-devices can kill a small child if swallowed, and even skin contact is to be avoided. Calls to both Canadian and American poison-control centres are on the increase, especially for children under five years of age. And it is nicotine that is most frequently "vaped" by users of e-cigarettes. Thus, it would be an error to assume that the dangers associated with cigarettes would be mitigated simply by the introduction of an electronic delivery system for nicotine. While nicotine itself remains a huge problem, various e-cigarettes have been associated with the production of heavy metals such as chromium and nickel, and carcinogens like formaldehyde at levels that can be even higher than those found in conventional cigarettes. The e-devices can generate large quantities of fine particulate matter that can not only carry toxins deep into the lungs, but can also exacerbate pre-existing lung conditions such as asthma or chronic obstructive pulmonary disease. Other agents used in the e-juice, such as flavourings and propylene glycol, are established irritants to the breathing passages. Despite these concerns, the popularity of e-cigarettes is soaring. Recent sales figures show they are already more than a one-to-one substitute for traditional cigarettes. The sales of e-cigarettes outnumber the decrease in the sales of traditional cigarettes and represent a multibillion-dollar business in North America. They might outsell conventional cigarettes within a decade, according to some market analysts. Tobacco companies are recognizing this huge, lucrative new market share. They are buying up existing producers of e-devices and starting to manufacture their own brands of e-cigarettes. Moreover, the tactics traditionally used by the tobacco industry to maintain acceptability are again being applied to gain sales and social approval for e-cigarettes. While Whelen notes the risks to children, the e-cigarette industry shows no such compunction. The industry is selling allegedly adult flavoured juices such as watermelon, cherry and bubble gum; using celebrity endorsements appealing to youth; and utilizing advertising and sponsorships reminiscent of the imagery and allure once employed to sell conventional cigarettes to young people. The purpose then as now was to hook children and youth on nicotine. And not surprisingly, rates of e-device use by youth are rising markedly. In the past year, one in 10 American high school students has used an e-cigarette and the frequency of middle school students who used e-cigarettes has doubled. In the 21st century, the public has rightly come to expect to be protected from personal practices of others that are potentially harmful to them. Cigarette smoking in an office, hospital, waiting room, classroom or restaurant is no longer accepted behaviour. However, this is becoming an increasingly common sight with e-cigarettes and has the potential to renormalize smoking behaviours. Whelen's argument for accommodation of these devices, rather than confrontation, is a page right out of Big Tobacco's playbook - its main argument to try to fight legislated bans on secondhand smoke in public places 30 years ago. We must ensure that another generation of nicotine dependency is not created. In addition, today's public should expect no less than the provision of clean air free from the emissions of either traditional or e-cigarettes. Encouragingly, many governments across Canada are now moving to regulate these products as just another form of cigarette, deserving of no special status. University of Victoria students Graham Landells and Yasmeen Sadain are co-presidents of the UVic Youth Against Cancer club. Dr. Richard Stanwick is chief medical health officer for Island Health.

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