There was more evidence this week that the electronic cigarettes used by millions of American teens pose serious health risks. E-cigarettes are battery-powered devices that in most cases heat a flavored nicotine solution, turning it into a vapor that can be inhaled – a practice known as vaping. The e-cigarettes differ in how much nicotine they deliver.

Dr. Scott Gottlieb, who stepped down Friday as Food and Drug Administration commissioner, issued a powerful statement Wednesday revealing that 35 users of e-cigarettes had seizures after vaping between 2010 and this year.

There are many unknowns regarding e-cigarettes. Now we can add a possible association with seizures to the list.


We don’t know how many more seizures experienced by users of the devices were never reported. We don’t know if the process of vaping itself or nicotine from the vapor caused the seizures. We also don’t know how much vaping in a single session would be enough to cause a potential problem.

Recent studies in animals have shown that high amounts of nicotine in the brain can trigger seizures and brain injuries.

There is clearly no free lunch with e-cigarettes. You should not consider them to be harmless devices with no health impacts.

Gottlieb said a recent large toxicology study showed that the impact of vaping on the lungs includes the development of inflammation and pre-malignant changes.

There is clearly no free lunch with e-cigarettes. You should not consider them to be harmless devices with no health impacts.

According to the National Youth Tobacco Survey, more than 3.6 million middle and high school students used e-cigarettes in 2018, making the devices the most commonly used tobacco product among this age group. This turns out to be a stunning 78 percent increase in e-cigarette use among high school students and a 48 percent increase among middle school student use over the previous year.

The increase comes despite the fact that it is illegal to sell e-cigarettes to minors.

Not only is vaping potentially harmful – it is also a gateway drug to tobacco. Studies have shown that teens who vape are nearly four times more likely to start smoking cigarettes than those who don’t.

Gottlieb has been a key player in the fight against the e-cigarette epidemic among teens. I spoke to him in a final interview as FDA commissioner about the new seizure concern.

“It is a very early signal,” Gottlieb told me. “But we are concerned that there are a lot of cases that aren’t being reported to us. By going out with this signal now, if there are other similar experiences we are encouraging other doctors and parents to start reporting them to us.”

Gottlieb called new information coming to light about e-cigarettes “public health 101.” The new report of seizures associated with vaping is a small signal, with no evidence yet of a causal relationship, but raises enough of a concern to prompt additional reporting and study.

In my medical practice, I have developed a somewhat effective approach to recalcitrant smokers. I use a combination of a nicotine patch during the day with e-cigarettes, usually with a tobacco or menthol flavor, for breakthrough urges.

I tell my patients to choose e-cigarettes that look and feel as much like tobacco as possible. Recent studies have confirmed the usefulness of the devices as a smoking cessation tool.

But the problem isn’t with adult smokers using e-cigarettes to help them quit. The problem is with our middle schoolers and high schoolers turning to e-cigarettes.

My 14-year-old tells me that some kids use two or three pods of JUUL (the most popular e-cigarette brand) per day, which is the equivalent – in terms of nicotine – of at least two to three packs of traditional cigarettes per day.

Fighting e-cigarette use and nicotine addiction may end up being Gottlieb’s most important legacy in his two-year stint as FDA commissioner. Unfortunately, despite his best efforts, the problem continues to grow.


A rare association of e-cigarette use with seizures is just the tip of the iceberg. My prediction is that despite the lung-damaging risks of formaldehyde, propylene glycol, silicate particles and metals found in e-cigarette vapor, the biggest risk of all will always be the link to tobacco use, where the tar in cigarettes directly causes emphysema and lung cancer.

A big thanks should go to now-former FDA Commissioner Scott Gottlieb for calling our attention to the dangers of e-cigarettes, along with his many other accomplishments. He has been an important foot soldier in the war for public health.