ARE E-CIGARETTES LESS HARMFUL THAN CIGARETTES?

 It is generally accepted that e-cigarettes produce fewer of the toxins found in cigarette smoke. However, it is becoming increasingly apparent that this frame is not adequate to tell the entire story regarding individual health impacts. The most recent evidence suggests that e-cigarettes may pose their own unique health harms and that comparison to cigarettes may not be the only relevant question for determining their impact on individual health. Indeed, the growing evidence of potential health risks related to e-cigarette use has led some researchers to question whether e-cigarettes are safer than combustible cigarettes. For more information see “Health Effects”.

 

he recent outbreak of vaping related lung injuries also supports caution with respect to e-cigarettes. While a substantial number of cases in the recent outbreak of vaping related lung illness (see “Health Effects”) appear to be related to THC vaping and the CDC recently identified vitamin E acetate as a chemical of significant concern, the agency has been cautious to say it has not found a single cause and continues to recommend caution with respect to all vaping as the investigation continues. At minimum, this outbreak dramatically demonstrates the dangers of an unregulated market in inhaled substances with no premarket review for consumer safety.

We also note the frequently cited claim from Public Health England that e-cigarettes are definitively — 95% — safer than traditional cigarettes. First, this analysis was originally conducted in 2013, prior to recent research on health effects of vaping. Moreover, further analysis into the original research finds that the evidence for such a statistic remains unclear and not fully comprehensive, among other concerns about author and funding conflicts of interest. The Public Health England claim also fails to acknowledge the reality of the potential for negative net public health impact among a population of users that have otherwise never used tobacco products or the lack of clinical and long-term evidence of these products’ safety in humans, regardless of current smoking status.

While a 2018 National Academies of Sciences, Engineering, and Medicine report found substantial evidence that exposure to toxic substances from e-cigarettes is significantly lower compared to combustible cigarettes, recent studies are showing that is not the end of the story on health impact. It now appears that e-cigarettes may present their own unique health risks, including to the respiratory and cardiovascular systems. Given the products’ relatively recent introduction to the marketplace, further research is needed to evaluate the short and long term health impacts of e-cigarettes.

The evidence for e-cigarettes’ effectiveness as a cessation tool also remains inconclusive and, until an FDA review, the safest, most evidence-based cessation strategy should include a combination of counseling, nicotine replacement therapy, and/ or cessation drugs like varenicline, approved by the FDA. Moreover, while the basic technology behind e-cigarettes is consistent, there is enormous variability within the product category and there is no typical e-cigarette. The products include different ingredients, different hardware and deliver highly variable amounts of nicotine and potentially toxic chemicals, including heavy metals such as cadmium, lead, nickel, tin and copper. This variation makes it difficult to issue overall public health recommendations about the category and demonstrates the huge and long-standing need for pre-market review of these products.

Consumers need to consistently know what they are getting and whether it is safe — particularly from a product designed to deliver chemicals by frequent inhalation. The growing evidence of potential health risks and lung injuries related to e-cigarette use has led researchers to question whether e-cigarettes are safer than combustible cigarettes.

 

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