Electronic cigarettes are causing a lot of medical and political controversy right now, as the powers that be struggle to come to grips with a highly disruptive new technology.
There’s a lot of uncertainty about the place of vaping in society; are electronic cigarettes a threat to public and individual health, or a fantastic new tobacco harm reduction tool that will help millions of smokers quit?
Opinion is split into two passionate camps, with vapers and many public health experts arguing that this is a life-saving innovation while opponents of nicotine use claim e-cigarettes are a danger, especially to young people.
One common argument from opponents is that e-cigarettes are too new and that we don’t know enough about them to be sure of their safety or effectiveness.
In reality scientists have been studying them for several years and there’s a surprising amount of research available.
Here’s an outline of what we know……
The potential health effects of electronic cigarettes have been widely studied and the results are quite positive.
It’s likely there’s some potential for health risks; the main ingredient of most liquids, propylene glycol (PG) causes allergic reactions in a small percentage of people. It can also cause coughing and a dry mouth.
Obviously these are minor issues compared with the dangers of smoking, but some research has claimed to find more serious risks.
For example a widely publicised study in January 2015 claimed that formaldehyde electronic cigarettes could expose users to a higher cancer risk than smoking.
Less than two weeks later another study claimed that mice exposed to electronic cigarette vapour were more likely to suffer compromised immune systems and become infected with bacteria and viruses.
There are serious questions about both of these studies, however.
The first one, carried out at Portland State University and described in a letter to the New England Journal of Medicine, used a small atomiser of an old design on a modern e-cigarette capable of generating high voltages.
When run at normal power levels it produced no formaldehyde at all, but when the power was increased high levels – much higher than from an actual cigarette – were detected.
There are a couple of points to note, though.
Firstly, what was detected wasn’t free formaldehyde; it was formaldehyde hemiacetyls, and there’s no evidence these are actually carcinogenic.
Secondly, the high power levels that produced the hemiacetyls were completely unrealistic.
No actual vaper would have run the device at those settings because the resulting vapour would have been foul-tasting and burnt.
The thing to take away from this study is not the exaggerated cancer risk of burned liquid – formaldehyde is far from the only carcinogen in cigarette smoke, and isn’t even the most significant – but the fact that, when used correctly, the chemical was completely absent.
As for the mouse study there are even more questions. The researchers noted that e-cigarette vapour contained free radicals, and also speculated that the chemical composition of the vapour was damaging the lungs of the mice and weakening their immune systems.
What’s much more likely, though, is that this effect was simply caused by nicotine.
It’s well known that nicotine suppresses the immune systems of murids – rats and mice – but not of humans.
It’s also been pointed out that the level of vapour the mice were exposed to was totally unrealistic; it was equivalent to a human vaping almost every time they take a breath.
No Evidence of Harm
There’s no evidence that electronic cigarettes harm the immune system in humans, and in fact propylene glycol may protect against infection – hospitals often add it to the air supply because it kills viruses and bacteria.
A claim that’s been made by Stanton Glantz (Pictured) is that vapour contains similar levels of ultrafine particles to cigarette smoke, and may have similar health effects.
What Glantz, who has no medical training – his qualifications are in aeronautical engineering – overlooks is that the research he uses to support his theory is based on cigarette smoke and vehicle exhaust, which contain solid particles of burned toxic material that are small enough to penetrate deep into the lungs.
The “particles” in vapour are actually liquid droplets, they’re much larger and they’re either much less toxic – for example nicotine – or not toxic at all.
A new study has found that the levels of toxins in the vapour from a properly used e-cigarette are about the same as you would find in normal air.
Gateway to smoking
Another common argument is that electronic cigarettes could act as a gateway to tobacco use – that non-smokers, especially young people – could start vaping then move on to smoking.
Several studies – again mostly from Stanton Glantz – claim to have discovered this effect, but there is a major flaw with the work that some experts have said is so bad it might actually be deliberately misleading.
To find a gateway effect it’s necessary to use a longitudinal study – one that follows a group of people over time.
Glantz used snapshot studies, which only measure statistics at one point in time. Basically he was using statistics in a way they can’t actually be used.
Meanwhile the CDC has found that as e-cigarette use in teens and young adults rises, the rate of smoking is falling faster than ever.
That suggests very strongly that there is no gateway effect.
Help with Quitting
Opponents of vaping claim there’s no evidence e-cigarettes are an effective way to quit smoking. Actually it’s this claim that has no evidence.
The UK is probably the country with the best data on smoking and vaping, thanks to the Smoking Toolkit Study run by Smoking in England.
In Britain alone there are more than 2 million vapers and a third of them have quit smoking completely.
There’s no evidence to prove a link but it certainly suggests one. In December 2014 a review by the Cochrane Collaboration found that e-cigarettes actually did help smokers quit, and in fact seemed to be more effective than licensed medication like nicotine patches.
They’ve been available in the west for more than eight years, and long-term trials for medications usually take five years – seven at the most. That means electronic cigarettes have been around more than long enough for a lot of research to be done, and it has been.
It’s always good to know more but we know enough right now to say they’re much safer than smoking. That’s enough to be going on with.