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By Jilian Mincer
NEW YORK, Jan 29 (Reuters) - When Marty Weinstein decided toquit smoking, he took a friend's advice and tried electroniccigarettes rather than government-approved nicotine replacementproducts.
Weinstein, 58, has gone from a pack a day nine months ago tothe equivalent in nicotine of four or five cigarettes. Thee-cigs have a familiar look and feel, and quench his desire tohold on to a cigarette and puff.
"I fully understand I'm still addicted to nicotine," saidWeinstein, a Connecticut taxi driver who had smoked for morethan 20 years. "But I'm now so much healthier."
E-cigarettes, metal tubes that heat liquids typically lacedwith nicotine and deliver vapor when sucked, are transformingthe market for smoking cessation products and slowing the $2.4billion in global sales of long-standing aids such as nicotinepatches and gums. But their impact on health remains unclear,experts say, raising difficult questions for regulators who arestarting to impose limits on e-cigarette use.
E-cigarette makers in the United States are barred fromexplicitly marketing the products as smoking cessation devices,but have found ways to appeal legally to smokers who arethinking of quitting.
"You never say 'quit' because it's not approved by the FDAas a smoking cessation device," said Jose Castro, the chiefexecutive of A1 Vapors in Miami, referring to the U.S. Food andDrug Administration.
A1 Vapors runs an ad on its website urging customers to"kiss tobacco goodbye" and give themselves the "gift of yourlife. literally", adding a disclaimer that e-cigs are not asmoking cessation product.
E-cigarettes, or e-cigs, have only come into widespread usein the past few years, but have already made inroads intotraditional quitting therapies.
About a third of British smokers trying to quit were usinge-cigarettes, according to a University College London survey inJanuary of 1,800 people, including 450 smokers.
E-cigs are used by almost twice as many people asgovernment-approved nicotine gums, lozenges and patches,according to the survey. That was a reversal from 2011, whenonly about 5 percent of people were using e-cigarettes and morethan 30 percent used over-the-counter products.
Similar data is not yet publicly available for the UnitedStates.
Worldwide sales of all nicotine replacement therapies grewjust 1.2 percent last year, to almost $2.4 billion, according todata from commercial researcher Euromonitor. U.S. sales, at $900million, grew 0.2 percent, and are expected by Euromonitor todrop this year by that amount.
Big tobacco companies like Altria, Lorillard and Reynolds American have rushed into the e-cig market.The entire U.S. market for "vapor devices" such as e-cigs grewin 2014 by 40-50 percent to $2.5 billion to $3 billion,Euromonitor said. The global market is worth $5 billion.
RULES ON E-CIGS TIGHTENING
Mark Strobel, a consumer health analyst at Euromonitor, saide-cigarettes have slowed nicotine replacement therapy sales,along with relatively high prices and a shrinking population ofsmokers, especially in the United States.
"For some consumers it has been a direct substitution."
GlaxoSmithKline (GSK) and Johnson & Johnson don't break out the data on their smoking cessation products,which are relatively small parts of their sales, but thecompanies have noted the change.
"It's definitely taken a bit of our market, no question atall - but there's a lot of competition in that space," GSK chiefexecutive Andrew Witty told Reuters in an interview this month.
GSK's nicotine replacement therapies and smoking cessationproducts include the brands Nicorette, NicoDermCQ and themedicine Zyban.
There is little long-term safety data on e-cigarettes,although some healthcare professionals say they may be betterfor consumers than tobacco cigarettes because they have nocarbon monoxide and fewer cancer-causing chemicals.
A growing number of states, cities and countries - includingIsrael and Australia - are considering or have approvedlegislation to ban or limit the devices or the liquids, whichcome in exotic flavors from bacon to bubble gum.
California's top public health official on Wednesday slammede-cigs as addictive, saying they were leading to nicotinepoisoning among children and threatened to unravel the state'sdecades-long effort to reduce tobacco use.
Earlier this week, California introduced a bill that wouldban the devices in public places, and New York Gov. Andrew Cuomoproposed a similar ban earlier this month.
Last year, the World Health Organization recommended thatsmokers should be encouraged to try already approved treatmentsrather than e-cigarettes. The FDA last April proposed rules forelectronic cigarettes that would, among other things, ban salesto those under 18, but not restrict flavored products, onlinesales or advertising.
MAKING SMOKING COOL AGAIN?
Many health experts worry that e-cigarettes will becomeestablished as smoking cessation aids before enough research isdone to determine their health impact. Another concern is thatthey may stop people from quitting tobacco completely and deterpeople from trying potentially more effective methods.
Dr. Albert Rizzo, senior medical advisor for the AmericanLung Association, said that when patients ask about theproducts, he tells them it's good that they are trying to quitbut: "We don't know enough to recommend them."
Some healthcare professionals said that even if they are notopposed to e-cigarettes, they are concerned about theirmarketing, especially to young people.
The Federal Trade Commission declined to comment on specifice-cig ads but said "advertising must be truthful, non-deceptiveand supported by competent and reliable scientific evidence."
E-cigs risk bringing the "cool" back to smoking, reversingthe progress over decades in which smoking has become lesssocially acceptable, said Dr. Robert K. Jackler, a professor atStanford University School of Medicine.
"A lot of us are very concerned about the renormalizationphenomenon," he said. "These glamorize smoking behavior."
Still, some doctors point to the low efficacy of traditionalways to quit smoking.
"They have better results than placebos, but their rates ofsuccess are quite low," said Dr. Michael Siegel, a professor atthe Boston University School of Public Health, who saide-cigarettes are an alternative, especially for people who havetried the conventional therapies and failed. (Additional reporting by Kate C. Kelland and Ben Hirschler inLondon; editing by Peter Henderson and Stuart Grudgings)
Glaxosmithkline (GSK)