Clear The Air News Tobacco Blog Rotating Header Image

Better safe than sorry when it comes to e-cigarettes

Electronic cigarette (e-cigarette) use has spread rapidly within a few years and taken public health professionals in tobacco control, as well as the tobacco industry, by surprise. Most people thought this would be another fad like snus or bidis that would fade away. The use of e-cigarettes varies by country, and the U.S. shows that most teens and adolescents are trying and using them at several folds higher rates than previous years, while in Britain this might not be the case.

When the tobacco industry took notice, it bought some of these small companies or produced its own brands. E-cigarettes have become one of the most controversial public health topics today.

The public health controversy is whether e-cigarettes (also known as Electronic Nicotine Delivery Systems or ENDS) are harmful to public health because they introduce nicotine to nonsmokers or whether they are beneficial because they help smokers of combustion cigarettes quit. The controversy was triggered by some of the public health professionals and organized e-cigarette users (also known as vapers) and sellers who believed that e-cigarettes will completely replace cigarettes among smokers if they are publicized and supported and allowed to be used everywhere, including in smoke-free places. They argue that e-cigarettes are less harmful (and in some cases claim they are completely harmless) than combustion cigarettes. There might be evidence for them being less harmful than cigarettes given e-cigarettes do not have tobacco and the carcinogens it produces, but the claim regarding mass replacement of cigarettes is at best exaggerated and unsubstantiated.

Simply stated, if there was potential for such mass replacement of the more harmful regular cigarette, we would have witnessed this by now since e-cigarette use has been on this rapid rise for some time.

What is happening is that use of e-cigarettes is increasing rapidly among both smokers and nonsmokers, but there is no evidence it is meaningfully helping the smokers who use it to quit, except for anecdotal cases or small studies and experimental controlled settings that do not relate to the general population. However, there is evidence that individuals who never smoked cigarettes but used e-cigarettes are more likely to begin actual cigarette smoking afterward. This is expected given nicotine, delivered by e-cigarettes as vapor, is highly addictive. This is the most serious harm of e-cigarettes that most public health professionals fear will be introduced to teens and young adults who otherwise would not have tried nicotine or got addicted to it. Furthermore, new high-quality evidence is emerging to show that e-cigarettes are more harmful than had been claimed.

There is nothing preventing smokers from trying e-cigarettes instead of the cigarettes they use, but data from many sources show they try them and don’t continue and those who continue on smoke more cigarettes. The U.S. Prevention Task Force and the recent U.S. Surgeon’s General Report did not recommend the use of e-cigarettes for cessation purposes.

The burden of proof is on the producers of such products to show they do not cause harm before making them available to the public. Addiction to nicotine and then reverting to combustion cigarettes, or for smokers to have difficulty in quitting because of higher nicotine from their cigarette and e-cigarettes, is by all means and measures harmful to those individuals and the health of the public. Further, many e-cigarette users want to flout the tobacco smoking bans that were one of the most important among all tobacco control policies to change the social norm of tobacco smoking, protect the public, and also help smokers quit, according to numerous studies.

We have learned from the history of tobacco and its industry that we have to be on the safe side and not overlook or support a product that can cause harm. We are now at a similar stage with e-cigarettes as we were in the early ’70s when supposedly low tar and nicotine cigarettes were glamorized and propagated in the media and by its industry as being a harm reduction approach without substantial independent research to support it, only to find years later they were actually more harmful than regular cigarettes because they made users smoke more.

There is an optimism that the recent decision by the Food and Drug Administration to regulate e-cigarettes will be the first step in controlling the rampage of them in the market with different flavors, concentrations and harm reduction claims. It took many years to take that step, but better late than never.

We have to err on the safe side and protect the future generations from another source of addiction. Better safe than sorry applies to this situation, and safe here means saving thousands of lives who as a result of e-cigarettes become addicted to nicotine and eventually cigarettes.

Al-Delaimy, M.D., Ph.D., has been the director of the California-wide Tobacco Evaluation Surveys for more than 12 years and is associate director of the UC San Diego Institute for Public Health and has authored many reports and peer-reviewed articles regarding tobacco and e-cigarettes.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>