The debate about electronic cigarettes continues. In February 2018, the American Cancer Society (ACS), in a policy shift, gave a qualified endorsement to e-cigarettes as a quit-smoking aid. I think this is a mistake because there’s still so much we don’t know about these devices, which are largely unregulated and are increasingly marketed by—surprise, surprise—the big tobacco companies. Meanwhile, millions of Americans are becoming hooked on nicotine via e-cigarettes, including many teenagers, who are now more than twice as likely to vape (that is, inhale e-cigarette vapor, which is often candy-flavored) as to smoke tobacco. In effect, they’re becoming guinea pigs in a giant unguided experiment on vaping.
The ACS included a lot of caveats in its support of e-cigarettes, which work by heating a liquid (called e-juice) to produce a vapor that is inhaled. It said that while vaping is less harmful than smoking, its long-term safety is unknown; that FDA-approved quit-smoking methods, such as nicotine patches, are preferable; and that it “strongly discourages” vaping while continuing to smoke (a common practice). It also “strongly recommends that every effort be made to prevent the initiation of e-cigarettes by youth,” since vaping nicotine increases the likelihood of eventually smoking tobacco. And the ACS encouraged the FDA to regulate e-cigarettes (disappointingly, the agency recently postponed full regulation until 2022). That’s a lot of wishful thinking.
One problem in evaluating e-cigarettes is that they can vary greatly in their design, nicotine concentration (ranging from none to relatively high levels), flavorings, and other compounds emitted. In particular, the flavorings, which are not identified on labels, can be a witch’s brew of volatile and potentially toxic chemicals. Presumably the levels emitted are lower than those from tobacco cigarettes, but no one really knows, since there is so much variability.
Here’s some other news about vaping from early 2018:
- An analysis by the National Academy of Sciences, mandated by Congress, concluded that the jury is still out on whether e-cigarettes are harmful or beneficial overall for public health. The report cited evidence that vaping is less hazardous than smoking in some ways, but that it carries its own risks, especially as a gateway to smoking for young people and as a source of toxic compounds from the vaping liquids. It cited many unanswered questions—regarding, for instance, long-term cancer, cardiovascular, and respiratory risk, use during pregnancy, and the efficacy of vaping for smoking cessation. It also said that there can be secondhand exposure to compounds in exhaled e-cigarette vapor, though less than from tobacco smoke.
- In a study in Pediatrics, researchers from UC San Francisco (UCSF) found elevated levels of five carcinogens in the urine of teenage e-cigarette users. Another UCSF study in that journal confirmed that vaping doubles the likelihood that teenagers will eventually become smokers.
- A study in PLOS ONE analyzed existing data and concluded that overall the harms of e-cigarettes are likely to far outweigh the benefit. Its computer model found that while vaping marginally increases long-term quit-smoking rates, it greatly increases smoking initiation in young people. Specifically, it estimated that for each smoker who quits as a result of vaping, over 80 other people would eventually segue from e-cigarettes to real cigarettes.
As someone who cares deeply about public health, I wish e-cigarettes had never been invented. But as a physician, if I had a patient who is a smoker and has tried everything but been unable to quit, and he or she asked me about e-cigarettes, I wouldn’t know what to say. Sure, pretty much anything is better than smoking, so I guess that vaping would be worth a try. But, again, who knows? It certainly would be better if e-cigarettes were well-regulated and standardized.
This article first appeared in the UC Berkeley Wellness Letter.
Also see More Risks from E-Cigarettes.