The first thing my mother always did after waking up was grab a cigarette. I’d reach for a different drug: Benadryl. I’d been swigging it since childhood to lessen the coughing and sneezing caused by her chain-smoking.

On the morning of my first trip home from the University of Michigan, I woke with a familiar sore throat and sinus pain and quickly downed two gulps. Perhaps the pristine air of Ann Arbor had turned my 18-year-old lungs and mucous membranes soft, but the cherry-flavored elixir was proving no match for Mom.

By the time I reached the living room, I was coughing and sneezing so hard it felt like a seizure. Then my nose started bleeding. I had a wicked eureka moment. Instead of wadding toilet paper up my nostrils—my standard remedy every time her smoking triggered a nasal hemorrhage—I stripped to my underwear and let the gusher go. Soon my chest was slick with blood, my elbows and wrists as crimson as a suicide victim’s. If finding her son like this didn’t shock her into quitting, I figured, nothing could.

But 10 minutes later, anger gave way to pity and sorrow. The truth is, I loved my mother and wanted to spare her a heart attack, not give her one. I mopped the floor and took a shower that looked like the scene from Psycho.

Three decades later and 6,700 miles from our Pittsburgh home, a pharmaceutical researcher in Beijing was struggling to quit his own pack-a-day habit after watching his father die of lung cancer. To reduce his cravings, Hon Lik, then in his 40s, used a common form of nicotine-replacement therapy: the nicotine patch.

When he sometimes forgot to remove the patch at night, it invariably triggered nightmares. In one dream, now legendary among e-cigarette users worldwide, Hon claims to have seen himself drowning at sea. Then, without warning, the water transformed into harmless clouds of vapor. He woke and jotted down a description of his salvation. A year later, Hon had invented the world’s first commercially viable electronic cigarette.

At first glance, his e-cig looked much like the cancer stick so many of us have grown to know and loathe. But on the inside were no shredded, ammonia-treated tobacco leaves ready to combust into some 7,000 chemical compounds, hundreds of toxins, and at least 69 known carcinogens.

Instead, the first generation of e-cigs spawned by Hon’s novel device contained just three parts: a small lithium battery, a prefilled cartridge containing “e-juice” (that is, nicotine with or without flavorings in a solution of propylene glycol, glycerin, and distilled water), and an “atomizer” to heat the liquid and convert it to a vapor (hence the term “vaping”).

The devices, dubbed “cigalikes” because of their resemblance to traditional cigarettes, reached the United States in 2007. Their hit-and-miss distribution, inconsistent quality, and high cost led many early consumers to shun them as a gimmick.

But as early adopters began swapping success stories about a new high-tech way to quit smoking, annual sales began to increase exponentially.

Soon, armchair tinkerers and independent e-cig companies entered the market with a new array of products. Unlike Hon’s cigalikes, which were meant to be used up and discarded, innovative second-and third-generation devices had rechargeable batteries, replaceable and/or refillable tank-style cartridges, and more powerful atomizers—all to produce more heat, larger vapor clouds, or, for those seeking it, stronger nicotine hits.

By January 2014, some 466 e-cigarette brands and 7,764 flavors—from peach schnapps to kid-friendly “gummy bear”—were available online.

Now addicted smokers can inhale Dr Pepper-flavored puffs of the nicotine they’re jonesing for, and in the same “hand-mouth-cloud” ritualistic manner they’re used to, without worrying about tobacco smoke’s toxins.

It all sounds like Hon’s dream come true. That is, unless you listen to the e-cig critics, who believe vapers need to wake up to the uncertainties of what they’re sucking down.

It’s buyer beware, according to Mitch Zeller, director of the FDA’s Center for Tobacco Products.“We can’t even tell you what compounds are in the vapor,” he said at an April 2014 media briefing. “And in the absence of federal regulation, companies aren’t required to give us any information.”But based on the compounds that have already turned up in some brands, e-cigs are far from harmless, warns Stanton Glantz, Ph.D., director of the Center for Tobacco Control Research and Education at UC San Francisco.“Nobody knows what the long-term impact on health will be, and it’s going to take years to find out,” he says. “My guess is that when the dust settles, e-cigarettes will prove to be about a third as dangerous as cigarettes.”

Aruni Bhatnagar, Ph.D., F.A.H.A., chairman of the American Heart Association panel that’s charged with reviewing e-cigarettes, also points out that even though we don’t know if e-cigs are safe, their cultural acceptance could help revive Big Tobacco.“It’s not clear that smokers are throwing away combustible cigarettes for e-cigarettes,” he argues.Instead, the tobacco industry could be promoting e-cigs to circumvent indoor clean air laws, sustain the addiction of current customers, and recruit new customers to combustible products.“It’s a billion-dollar market,” he says. “The industry isn’t making these investments to prevent addiction.”Those in the “harm reduction” camp, on the other hand, argue that if eradicating a known danger is impractical, then reducing its impact is better than waiting for ideal solutions that may never materialize.

Case in point: giving needles to IV drug addicts to control HIV transmission rates, despite claims that this policy enables drug use.In a viewpoint published last year in the Journal of the American Medical Association, David B. Abrams, Ph.D., a professor at Johns Hopkins Bloomberg School of Public Health, wrote that “independent manufacturers of e-cigarettes could compete with tobacco companies and make the cigarette obsolete, just as digital cameras made film obsolete.”Whether e-cigs turn out to be boon or bane, their impact will disproportionately affect men, especially younger men.In a 2013 survey of 18,406 American students, for instance, male high schoolers were nearly 60 percent more likely to have vaped in the month leading up to the survey than their female peers were.

Another study of 4,444 college students, published in the journal Drug and Alcohol Dependence, suggests that this gender gap persists at least into the early 20s. The study also reports that these numbers are consistent with greater male participation in other unconventional tobacco practices, such as hookah smoking.E-cigs, they speculate, may be especially intriguing to “novelty seekers” with a penchant for risk taking.Or, as we laymen call them, “guys.”

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