Does vaping save smokers or create new nicotine addicts?
This report is part of a special collaboration with PBS NewsHour Weekend and WNET.
GWEN IFILL: Depending on who you talk to, e-cigarettes are either an answer for millions trying to stop smoking or the dawn of a new era of nicotine addiction. They are either a big threat to big tobacco or they may save it.
As special correspondent John Larson reports, for good or ill, e-cigarettes remain completely unregulated by the federal government. That is about to change.
CRAIG MAJORS, Liquid Vapor Lounge: How long have you guys been vaping?
JOHN LARSON: When Craig Majors was thinking about opening the Liquid Vapor Lounge a few years back, the e-cigarette industry had not yet caught fire.
You cashed out your 401(k), took a loan out on your car, took all your savings.
CRAIG MAJORS: Went all in.
JOHN LARSON: All in, selling a selection of products for vaporizing liquid nicotine. There was only a handful of so-called vape shops in Oklahoma City at the time, but that changed almost overnight.
CRAIG MAJORS: Three years ago, 10 shops, two years ago, 15, now 200.
JOHN LARSON: In less than five years, vapor products and e-cigarettes have become the fastest growing sector of the $100 billion American tobacco industry, with Hollywood pitch women.
JENNY MCCARTHY: I'm Jenny McCarthy and I finally found a smarter alternative to cigarettes.
JOHN LARSON: Appearing in local Super Bowl ads.
MAN: Friends don't let friends smoke.
JOHN LARSON: And even in HBO's "Veep."
ACTRESS: Catherine, you are smoking?
ACTRESS: I am vaping.
JOHN LARSON: In fact, an estimated 20 million Americans have taken up e-cigarettes and vaporizers, many motivated by the same thing.
MAN: It helped me not want to go back to cigarettes.
MAN: It worked. Three years, no cigarettes.
MITCH ZELLER, Director, FDA Center for Tobacco Products: It looks like we may have a product that could deliver nicotine to the lungs without combustion. So, for some currently addicted adult smokers, if they could completely switch to e-cigarettes, this could conceivably help.
JOHN LARSON: And it's that message that the FDA and big tobacco agree on, that e-cigs may be a safer alternative for cigarette smokers.
NARRATOR: We know what smokers want.
JOHN LARSON: And why Robert Dunham of Reynolds American calls e-cigs the industry's Holy Grail.
ROBERT DUNHAM, Executive Vice President, Reynolds American: If you can deliver satisfaction to adult tobacco consumers in a way that poses far less risk, let's go. I mean, this has got to be the billion-dollar idea, right?
JOHN LARSON: But, despite the industry's runaway success, there has been little research and no federal regulation. Two years ago, researchers at the University of California, Riverside, discovered some vaporizing systems exposed users to heavy metals.
Another study revealed vaporizing liquids at high temperatures, while uncommon, could expose users to high levels of formaldehyde, a known carcinogen.
THOMAS SUSSAN, Researcher, Johns Hopkins University: If you think that you're picking these up because they're glamorous and that you're not going to have any downstream or long-term effects as a result of this, I think you kidding yourself.
JOHN LARSON: Dr. Thomas Sussan at Johns Hopkins university found in a recent study of mice that while healthy lung tissue looked like this, the lungs of mice exposed to e-cig vapor looked like this, showing evidence they were less capable of fighting infection. He also discovered free radicals, the same dangerous chemicals found in tobacco smoke.
THOMAS SUSSAN: It wasn't to the level that — what we see in conventional cigarettes, but the number of free radicals that we detected was seven-times-10-to-the-11th, which is a huge number. So, it's very likely that those free radicals are going to inflict some level of damage in the lungs.
MATTHEWS MYERS, President, Campaign for Tobacco-Free Kids: The FDA has failed to recognize the impact of the advertising of this product towards young people.
JOHN LARSON: Matt Myers of the Campaign for Tobacco-Free Kids says, according to the Centers for Disease Control, e-cigarette use has tripled in middle and high school students in just one year, an estimated two million kids exposed to nicotine.
MATTHEWS MYERS: It's the way to be cool, it's the way to be sexy, it's the way to be independent, it's the way to be rebellious, and it's the way to be just like everybody else. And it's no surprise it is appealing to millions of kids.
JOHN LARSON: Nicotine has been proven addictive harmful to teenagers, threatening normal brain development.
I imagine a parent of a teenager, saying, what's it going to take to shut down this marketing?
MITCH ZELLER: Well, we share the concern. E-cigarettes shouldn't be used by kids. And we were on the record last year as saying to get the proposed rule out took us longer than it should have.
JOHN LARSON: Longer because the courts overruled the FDA's first effort. The FDA now is trying again, proposing new regulations, which surprisingly do not address targeting teenagers with sweet flavors or advertising.
MITCH ZELLER: I understand the frustration that it's taking FDA so long. There needs to be a little patience. We need answers to the questions that have been fielded in the many studies that we have put out there to have the full regulatory framework in place for e-cigarettes.
CRAIG MAJORS: Have you ever had Suicide Bunny's Mother's Milk?
JOHN LARSON: Visit any vape shop and you will find hundreds of flavors, called e-liquids, or e-juice. Some do appear to target the young, with sweet flavors like Strawberry Shortcake, or Captain Crunch, or Gummy Bears.
SEAN GORE, Chairman, Oklahoma Vapor Advocacy League: The industry is not targeting children. Just because you're adult doesn't mean that you don't like Gummy Bears.
JOHN LARSON: A former rodeo rider and recovering addict, Sean Gore is an advocate for Oklahoma's vaping industry.
SEAN GORE: You know, I see adults buying, you know, packs of Gummy Bears all the time. Just because you're an adult doesn't mean that you don't like good flavors.
JOHN LARSON: And it is the growing abundance of flavors, variable nicotine strengths, and customizable equipment that Gore says is so popular. Vape shops offer what's called open systems, so customers can pour e-liquids into open vaporizers.
Big tobacco, on the other hand, offers what's called closed systems. The nicotine liquid is already enclosed within the e-cig, which turns out to be a huge point, because even as the FDA is writing its proposed regulations, big tobacco is lobbying to outlaw the increasingly successful open systems offered by its competitors.
ROBERT DUNHAM: We do have and we have heard legitimate concerns from others, about the dangers of exposed nicotine. And that's one that we believe ought to be addressed.
JOHN LARSON: Liquid nicotine is highly toxic. Too much can be lethal. Many of the new vapor entrepreneurs are small business. The owners of The Vapor Hut in Oklahoma City, for example, used to sell snow cones out of this truck. They now have six vape shops and a multimillion-dollar online business selling 140 flavors, which, even in absence of regulation, they are mixing in what they describe as clean rooms.
And they're just one of thousands of new small businesses now competing with big tobacco.
It feels like a million small businesses are crawling in over the walls into a business that you guys traditionally have relatively owned. I mean, are they a threat? Or, should I say, how much of a threat are they to you?
ROBERT DUNHAM: If we get our act together, the these guys are going to be our — our future customers. There's no reason that those things don't want to come together.
SEAN GORE: And we're just going to hand the industry straight back to them, while driving small business owners out? It makes no sense.
JOHN LARSON: Gore fears the pending federal regulations may force every small flavor manufacturer to spend tens of thousand of dollars proving the safety of every flavor at every strength.
SEAN GORE: If that happens, you will end up seeing probably five flavors. And, really, the only individuals that will be able to afford the testing and getting the approval for those flavors would be big tobacco.
MATTHEWS MYERS: The notion that people who have no chemical training, no safety training are mixing concoctions in the back room or their bathtub and giving it to the consumer means we're doing a human guinea pig experiment on literally millions of Americans without any knowledge of what the consequences are.
If you're too small a manufacturer in order to be able to assure the public about what's in your product, then you shouldn't be selling it to the public.
JOHN LARSON: Which brings us back to the public and these folks back in Oklahoma who volunteered for some closing portraits. All told us, vaping saved them from cigarettes.
The government promises it will try to balance this with the still unknown risks of e-cigs. Big tobacco hopes regulators will keep the health benefits in mind. Small business fears that big tobacco may be trying to put them out of business.
And as for the vapors themselves? They do love the abundance of flavors, but want to know, what's really in this stuff? And how safe is it?
For the PBS NewsHour, I'm John Larson in Oklahoma City.