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Electronic cigarettes should be restricted or even banned, pending better safety data, lung societies urged.

The American Thoracic Society and American College of Chest Physicians joined their counterpart organizations in the Forum of International Respiratory Societies in a position statement taking a skeptical view of the battery-powered nicotine vaporizing devices.

"As a precaution, electronic nicotine delivery devices should be restricted or banned until more information about their safety is available," it said. "If they are allowed, they should be closely regulated as medicines or tobacco products."

The statement was released today at a meeting of the Forum and the Noncommunicable Disease Alliance, coinciding with the United Nations High-Level Review on the Prevention and Control of Noncommunicable Diseases, and will appear online in the American Journal of Respiratory and Critical Care Medicine.

The key cause for concern was safety, noted lead author Dean Schraufnagel, MD, of the University of Chicago and past president of the ATS.

"Nicotine is central to lifelong addiction, and these are nicotine delivery devices," he said in a statement from his organization.

"The gravity of tobacco use on global health and the historical behavior of the tobacco industry that has included deceit about the health effects of tobacco, intentional marketing to children, and manipulating nicotine levels in cigarettes to maintain addiction should prompt us to proceed cautiously."

The position statement acknowledged the common argument that e-cigarettes may be less harmful to health than conventional cigarettes that release tar and carcinogens as they burn.

However, "the potential benefits of electronic cigarettes to an individual smoker should be weighed against potential harm to the population of increased social acceptability of smoking and use of nicotine, the latter of which has addictive power and untoward effects," it said.

Health risks of e-cigarettes haven't been adequately studied; but propylene glycol is, at least, an irritant when inhaled and nicotine has significant effects on the cardiovascular system, neuroregulation, the lung, and possibly peptic ulcers and GI cancer.

What studies there have been on e-cigarettes' impact on smoking cessation have been inconsistent in finding a benefit, the statement argued.

"Many governments have chosen to restrict the sale of nicotine delivery systems, or to ban them entirely," it pointed out.

The U.K. will regulate the devices as medicines starting in 2016, while Brazil, Norway, Singapore, and Indonesia have banned them entirely.

Europe decided to regulate the devices much like conventional cigarettes; the FDA has proposed to go lighter on e-cigarettes, with age restrictions but limited marketing constraints.

In the absence of a ban or regulation as medicine, as the respiratory societies recommended, they said the next best option would be to regulate fully tobacco products.

That should include, it said:

"A ban on all advertising, promotion, and sponsorship

Prohibition of displays in retail stores

Prohibition of sale to minors

Regulation of Internet sales

Taxation at rates similar to combustible cigarettes

Prohibition of sales and refills with flavors that will appeal to children

Requirement that packaging and labeling include a list of all ingredients and the quantity of nicotine

Placement of appropriate warning labels, the same as is required for tobacco products

Prohibition of their use in public places, workplaces, and on public transportation"

Manufacturers should also "adhere to established consumer safety practices that list ingredients and produce consistent products with uniform concentrations and defined maximum doses of nicotine," along with child-proofing containers and other safeguards against inadvertent poisoning, the statement recommended.