E-cigarette warning labels confound health officials

Some offer cautions with more detail than those required on tobacco products

NEW YORK — Tobacco companies, long considered public health enemy number one, have suddenly cloaked themselves as champions of lung health in the digital age.

They are putting out among the strongest health warnings in the fledgling e-cigarette industry, going further even than the familiar ones on actual cigarettes, a leading cause of lung cancer. It has left public health officials scratching their heads and deeply skeptical.

A warning from Altria, maker of Marlboros, reads in part: “Nicotine is addictive and habit forming, and is very toxic by inhalation, in contact with the skin, or if swallowed.”


Another, from Reynolds American, maker of Camels, says the product is not intended for persons “who have an unstable heart condition, high blood pressure, or diabetes; or persons who are at risk for heart disease or are taking medicine for depression or asthma.”

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They appear on packaging for the companies’ e-cigarettes, which are part of a fast-growing industry tobacco companies want to dominate.

The warnings, which are entirely voluntary, generally exceed what amounts to modest cautions, silence, or even positive health claims from smaller e-cigarette makers. The one on a pack of nicotine cartridges for MarkTen e-cigarettes, which Altria is introducing nationwide, runs more than 100 words. People with heart disease, high blood pressure, and diabetes should not use the product, the label says. Neither should children. It goes on to say that nicotine can cause dizziness, nausea, and stomach pains, and may worsen asthma.

“When I saw it, I nearly fell off my chair,” said Dr. Robert K. Jackler, a professor at the Stanford School of Medicine.

MarkTen also warns that e-cigarettes are not a smoking cessation product, a warning that also appears on Vuse from Reynolds.


“Is this part of a noble effort for the betterment of public health, or a cynical business strategy? I suspect the latter,” Jackler said.

Experts suspect several motives, but, chiefly, that e-cigarette warnings are a low-risk way for companies to insulate themselves from lawsuits and, more broadly, appear responsible. By doing so, experts said, Big Tobacco curries favor with consumers and regulators. Plus, they get to appear more responsible than the small e-cigarette companies that seek to unseat them.

But the companies say their reasoning is straightforward. William Phelps, spokesman for Altria, said warnings on MarkTen, made by the subsidiary NuMark, reflect “a goal to openly and honestly communicate about health effects,” based on “scientific research” and “previously developed warnings” on nicotine products. MarkTen is in 60,000 stores in the West and will be nationwide soon.

R.J. Reynolds Vapor Co., which makes Vuse, had less to say about its e-cigarette warnings, which note, among other things, that nicotine is addictive and the product should not be used by people with heart conditions or high blood pressure. A spokesman said the warning reflected the fact Vuse did not contain tobacco leaf and did not undergo “combustion,” as cigarette tobacco does.

Previously, the president of R.J. Reynolds Vapor Co., Stephanie Cordisco, said her division aims to make a break with the negative reputation of the cigarette industry.


“We’re here to make sure we can put this industry on the right side of history,” she said.

Reynolds is one of the companies that sued, successfully, to stop graphic warnings on cigarette packages.

That companies voluntarily warn about e-cigarettes is “totally Orwellian,” said Robert N. Proctor, a Stanford history professor.

“They do everything for legal reasons, otherwise they’d stop making the world’s deadliest consumer products,” he said.

With e-cigarettes, health experts and regulators are struggling with contradictions and questions. The most basic is whether e-cigarettes lure cigarette smokers away from a deadly habit or lead to a new generation of addicts.

Whatever warnings say, they are typically disregarded, said Allan M. Brandt, professor of the history of medicine and science at Harvard University. Tobacco companies “know that even these types of very serious warnings have generally not put significant dents in their sales.”

He said the warnings appear to be part of an age-old practice: creating scientific gray areas. That, he said, lets them forestall decisive action by regulators — “an incredibly effective and duplicitous practice.”