Although the first patent for a smokeless non-tobacco cigarette — essentially the world’s first electronic cigarette device — was granted to Korean War veteran Herbert A. Gilbert in 1963, it would take until 2003 and the efforts of Hon Lik, an enterprising Chinese pharmacist who’d lost his father to lung cancer and was himself a smoker, to finally make the e-cigarette a commercial success. These new devices took the smoke out of smoking and have been touted as safer alternatives to burning and smoking traditional tobacco.
Fast forward 15 years and although we still don’t have a conclusive answer to the question of whether e-cigarettes are healthier alternatives to conventional tobacco cigarettes, a new consensus from the National Academies of Science, Engineering and Medicine adds support to the idea that e-cigarettes are a double-edged sword for public health — leading some smokers to quit while encouraging others to take up the habit.
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Although cigarette smoking is down nearly 60 percent from its height in 1965, the Centers for Disease Control and Prevention reports “nearly 40 million U.S. adults still smoke, and about 4.7 million middle and high school students use at least one tobacco product” including e-cigarettes. Cigarette smoking is known to cause more than 480,000 deaths per year from a variety of diseases, including lung cancer, heart disease and chronic obstructive pulmonary disease. So while it’s clear that quitting smoking can improve your health, successfully doing so can be extraordinarily difficult, largely because the nicotine contained in cigarettes is highly addictive.
“Depending on how you define addiction, [nicotine is] probably more addictive than gambling and illicit drugs,” says Samir Soneji, a demographer and associate professor of health policy at the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College in Hanover, New Hampshire. “So although most smokers want to quit,” (the CDC reports 68 percent of smokers want to stop), “they’re in incredibly difficult positions. Most smokers have tried and failed to quit,” he says.
Enter the e-cigarette, which savvy tobacco industry marketers have hyped as a smoking cessation tool since the introduction of these products in the United States in the mid-2000s. These devices can take a variety of forms and offer a range of smoking experiences, but the hallmark is that a liquid — typically consisting of propylene glycol, glycerin, nicotine, water and flavoring — is heated in a tube. (Propylene glycol is found in a range of products from food to antifreeze and is generally recognized as safe by the Food and Drug Administration. Glycerin is a non-toxic, clear liquid used in soaps and perfumes and as a sweetener and moistener in foods and other products.) As this liquid mixture heats up, a vapor is generated that the user inhales into the lungs. The tube simulates the look and feel of a cigarette, right down to a glowing light at the end to mimic the burning end of a traditional cigarette, but because no tobacco is being burned, the theory is the health effects of this habit are reduced. Recent studies suggest this theory is correct — the danger of an e-cigarette is probably less than smoking a traditional cigarette. But vaping isn’t an entirely safe activity either because you’re still inhaling chemicals into the lungs with each drag.
[See: What Not to Say to Someone With Lung Cancer.]
Dr. Humberto K. Choi, a pulmonologist at the Cleveland Clinic in Ohio, says that we still don’t have a full understanding of all the chemicals that may be released when e-cigarette liquids are vaporized, but several that have been detected may pose a threat to the vaper’s lungs. “A lot of chemicals in e-cigarettes are actually carcinogenic, and this is going to cause lung cancer or heart disease or other cancers in the future.”
Dr. Peter Shields, a medical oncologist specializing in the treatment of lung cancer at the Ohio State University Wexner Medical Center, says that when propylene glycol and glycerin are heated, they release other chemicals that may not be as benign as first thought. “These compounds — propylene glycol and glycerin — are ‘generally regarded as safe,’ so they’re in a lot of foods and cosmetics. They’re basically keeping things moist. We eat this stuff all the time. We put them on the skin all the time. And it’s considered safe. But that doesn’t mean it’s safe when it sits in the lungs or how long it sits in the lungs.”
He says studies in animals have shown that inhaling aerosolized propylene glycol and glycerin didn’t have much effect on the animal, “but that’s different from heating this stuff. Depending on how much you heat it, you start to release things like chlorine and formaldehyde and other chemicals that are irritants at least,” and may do even more harm over time by causing inflammation in the lungs that may lead to COPD or heart disease, if not cancer. Beyond these released chemicals, Choi says nicotine itself can harm health. “There are a lot of other health consequences,” that can result from nicotine use over a long period.
And it’s this potential long-term harm that worries many doctors and researchers most. Because these products have only been around for a little over a decade, there’s simply not enough long-range data to show clear effects on the health of users who adopt these devices versus smoking conventional cigarettes. “The really big question is what happens to vapers 20, 30, 40 or 50 years from now?” Soneji says. “Nobody could possibly know until 50 years from now,” because e-cigarettes haven’t been around that long and “the consequences to [the vaper’s] health are pretty slow growing. We don’t have substantial evidence around what happens to that person’s body actually.”
Even so, Soneji says “the e-cigarette industry, which is essentially the tobacco industry, is fighting hard and aggressively against the health claims that e-cigarette vapor causes serious consequences to the vaper’s health,” in a parallel to how the industry fought health claims against traditional cigarettes in the past century. “But the cellular evidence is growing,” that e-cigarette vapors can cause damage at the cellular level, including inflammation and gene expression in lung cells, two pathways known to be involved in the development of lung cancer and COPD.
Still, Soneji says using e-cigarettes to transition off nicotine altogether is “probably better than going cold turkey because cold turkey is a terrible way of quitting. Forty-five percent of the 10 million smokers who tried to quit last year went cold turkey,” and most were unsuccessful.
Shields notes that the nicotine patch, a common tool used to help wean smokers off cigarettes, has a success rate of just 10 percent, which offers a pretty low bar for e-cigarettes to clear if they’re to become a more regular component of smoking cessation efforts. “If these e-cigs are as good as 10 percent, it’d be great to have another tool.”
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But Soneji worries about the effects of these devices and the culture of vaping on kids. The idea that e-cigarettes can be a game-changing cessation tool doesn’t match up with reality. “The reality is that nicotine replacement therapy is still a much safer option because no kid abuses Nicorette gum because it’s not marketed to kids or young adults.” Because of these factors, Soneji and his team determined in a recent study in the journal Plos One that on balance, e-cigarettes confer more harm than benefit.
Still, “despite my work and concerns about the marketing [of e-cigarettes to children and young adults], I still think there’s a window where e-cigarettes could be beneficial,” Soneji says. Because for people who’ve not had success with other smoking cessation tools, “what’s your alternative? Cold turkey? Or continued smoking and losing 10 years of life? Those are terrible alternatives.” He recommends that if you’re planning to use e-cigarettes to quit smoking, try to find a reputable vape shop that can help you gradually step down the nicotine content in the liquid you use to cut your physical dependence and talk to your doctor about all your options for quitting smoking.
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Are E-Cigarettes a Healthier Option Than Tobacco Cigarettes? originally appeared on usnews.com
