E-Cigarettes: Too Good to be True??>
Be Well

E-Cigarettes: Too Good to be True?

by Keng Lam, MD

Have you “smoked” an e-cigarette? According to the Centers for Disease Control and Prevention (CDC), one in five U.S. adults who smoke cigarettes have tried e-cigarettes. Short for electronic cigarettes, these battery-operated devices deliver nicotine in inhaled vapor instead of tobacco smoke. Because there are no human studies showing that nicotine by itself is carcinogenic, the marketed benefit of e-cigarettes is to have users enjoy the effects of nicotine while avoiding the inhalation of many potentially cancer-causing chemicals (and avoiding smoking’s negative effects on respiratory health).

The first generation of e-cigarettes were developed in China by a pharmacist named Hon Lik and hit the market in 2004. Today, these devices are sold in shopping malls and over the internet, even though they have not been evaluated as drugs or drug-delivery devices by the U.S. Food and Drug Administration (FDA).

Sales of these products are climbing fast: The Wall Street Journal recently reported that U.S. retail sales of e-cigarettes could reach $1 billion by the end of 2013. Due to their increasing popularity, investment in e-cigarettes is also rising. For instance, a group that includes Sean Parker, who co-founded Napster and was the first president of Facebook, is putting $75 million into an e-cigarette company called NJOY.

Because the users of e-cigarettes do not consume the putative cancer-causing chemicals in traditional cigarettes, some people claim that they are a healthy alternative to smoking. But are they actually safer? There’s remarkably little data to answer this question, and any studies that have been conducted so far are small and short-term.

One small 2012 published study recruited 20 tobacco smokers to test the e-cigarette’s potential for inducing nicotine addiction. It concluded that the “electronic cigarettes can deliver clinically significant amounts of nicotine and reduce cigarette abstinence symptoms and appear to have lower potential for abuse relative to traditional tobacco cigarettes, at least under certain laboratory conditions.” Researchers from the Onassis Cardiac Surgery Center in Greece recently tested the effect of e-cigarettes on the hearts of those who smoke. With a small sample of 20 healthy young daily smokers, they found that e-cigarettes had no short-term effects on cardiac function.

But other small studies raise some serious concerns about this product category. A Greek study from the University of Athens measured short-term effects of e-cigarettes on respiratory function in 32 people, smokers and non-smokers. After inhaling e-cigarettes for 10 minutes, the subjects demonstrated an immediate increase in resistance of the respiratory tract to airflow, whether or not they were smokers.

A study from the Harvard School of Public Health looked at the airflow effects of e-cigarettes on the lungs of 30 healthy smokers. They concluded that “e-cigarettes assessed in the context of this study were found to have immediate adverse physiologic effects after short-term use that are similar to some of the effects seen with tobacco smoking." In other words, the e-cigarette users had trouble breathing.

Many in the public health and medical community are concerned that e-cigarettes may become a common and widely accepted habit, the way traditional cigarettes were 50 years ago. After all, like cigarettes, e-cigarettes are essentially a nicotine delivery system—and nicotine is one of the most addictive substances known. Will this product create a new generation of addicted people? Worse, will they be a gateway to cigarette smoking? There is no data to answer these questions.

The strongest argument for e-cigarettes, some say, is that they may help people stop smoking. But, this is based upon hope, not data. To date, there are no studies to support this notion. Researchers from New Zealand just finished conducting a randomized clinical trial with 657 people. The study compared e-cigarettes to a nicotine patch, in an effort to determine which was most effective in helping people quit smoking. While the investigators concluded that e-cigarettes were modestly useful, the data showed that they were hardly better than the nicotine patch or even placebo e-cigarettes.

Other ways to deliver nicotine (gum, lozenges and patches) have already been demonstrated to be both safe and effective. If you’re trying to quit cigarettes, until we have more supportive data about e-cigarettes, your best bet is one of these other systems. If you don’t smoke, don’t start using e-cigarettes. At the least, you’re likely to become addicted to nicotine. And you don’t want to find out 20 years from now that they have damaged your lungs.

Originally published August 2013. Updated September 2013.