Surprise! E-Cigs Do More Good than Harm

This article was originally posted on RealClearScience.

Some things in life are so indisputably true that it is a surprise that anyone disagrees. The safety and efficacy of vaccines, the benefits of GMOs, and the inability of Nicolas Cage to convincingly perform a single role all would be at the top of Captain Obvious’s list. Now, the list has a new entry: Electronic cigarettes produce far more good than harm.

The idea behind e-cigarettes is straightforward. Tobacco cigarettes are bad for you, mostly because of the tar and other toxic chemicals that can lead to cancer or chronic obstructive pulmonary disease (COPD). The addictive component is nicotine, a nervous system stimulant that mimics the neurotransmitter acetylcholine. That is why smokers keep coming back for more; they need the “high” that nicotine delivers.

Though it is a powerful drug, nicotine does not cause cancer or COPD. It is widely assumed that, similar to nicotine patches or other forms of nicotine replacement therapy, e-cigarettes will give smokers an innovative (and fun) way to quit tobacco.

But there are naysayers. Some studies have shown that e-cigs produce carcinogens, and long-term biological effects are unknown. UCSF researchers insist that e-cigs do not help smokers quit, but merely lead to “dual use of e-cigarettes with conventional cigarettes.” Still others claim that e-cigs may serve as a gateway to regular cigarettes, particularly among children. Thus, some adversaries have concluded that e-cigs are no good and, in fact, may be worse than regular cigarettes.

Such logic beggars belief. The worst part of a tobacco cigarette is the tar; e-cigs contain none of that, which means they will produce fewer carcinogens. It is true that long-term biological effects are unknown, but a reasonable hypothesis is that e-cigs will prove to be a much safer alternative. “Dual use” is a rather strange complaint; time spent vaping an e-cig is certainly better than inhaling tobacco smoke. And since the notion that marijuana serves as a gateway to harder drugs is a dubious one at best, why should we believe that e-cigs will serve as a gateway to real cigarettes?

Indeed, a new literature review in the journal Addiction analyzing the safety and use of e-cigs should quell some of those fears. The authors write:

“EC [E-cigarette] aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower. Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders. EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children. EC enable some users to reduce or quit smoking.”

They conclude:

“Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality. Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence. Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.” (Emphasis added.)

Based on current data, the authors see no reason to regulate e-cigs as strictly as the real thing. Many e-cig opponents will balk at that, claiming that e-cigs have no business being in the hands of children or other non-smokers. Indeed, they could be right. But there is a simple fix: Regulate them so they are sold only to people over the age of 18 or, alternatively, as a prescription drug.

Source: Peter Hajek, Jean-Franc╠žois Etter, Neal Benowitz, Thomas Eissenberg & Hayden McRobbie. “Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit.” Addiction. Published online before print. DOI: 10.1111/add.12659