The e-cigarette business is booming, and the tobaccoless nicotine product that is considered a safe alternative to conventional smoking is set to take the world by storm – in fact, that storm has already started.  Global sales in tobaccoless smoking products has grown to nearly $3 billion and around one in five smokers have tried e-cigarettes in an attempt to quit smoking [1] .  So just what is it about these little devices that is so popular, and are they really as safe as they seem?

 

Best Thing since Sliced Bread

                  The product was initially developed in China, after a failed North Korean start all the way back in the 1960s.  It was brought to the US market in 2007 and the FDA, America’s regulatory body for food and drugs, are yet to get it under their control – despite attempts to try.  The small devices have numerous designs and can look like a standard cigarette or vastly different.  They run on a small lithium battery that heats up a liquid found within a (disposable or refillable) cartridge.  The heat turns the liquid into vapor that is inhaled (or ‘vaped’), whilst any remaining vapor simply evaporates away.  The devices produce no smoke, no carbon monoxide, and no odor [2]{C} .  E-cigarettes mainly consist of propylene glycol (an FDA approved food ingredient), nicotine (of varying degrees, depending on user selection), and flavouring [3] .  Compare this to conventional cigarettes’ 7,000 chemical and around 70 known carcinogens [4] , it is easy to see why these tobacco-alternatives seem like a miracle cure to smoking and all the ills that it causes.  It’s cheaper too – whilst smoking a pack-a-day costs around $1,000 per year, ‘vaping’ the equivalent costs only $600.  But surely the old adage still stands – if it seems too good to be true, it probably is. 

 

It’s not what it Seems

                  Whilst the FDA acknowledges that e-cigarettes may help to reduce tobacco-related disease by offering less-hazardous alternatives to smoking, they also admit that there is simply not enough data to determine the full effects of these devices on public health.  Priscilla Callahan-Lyon from the Office of Science at the FDA’s Center for Tobacco Products argues that “while e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful then cigarettes are inconclusive” [5]{C} .  Likewise, the US Federal Centers for Disease Control (CDC) suggest that whilst there may be enough evidence to suggest that e-cigarettes are healthier than smoking, they will not go so far as to say that they are ‘safe’ until significantly more research has gone underway [6] . 

What’s more, as research results begin to trickle in, it is becoming apparent that the miracle cure may not be so much of a miracle or even a cure after all.  The World Health Organization (WHO) claims that the safety of e-cigarettes is ‘illusive’, as many contain chemicals that are not disclosed on ingredients list, and that have not been properly tested [7] .  Of those that have been tested, the results generally do not favor the e-cigarette industry. 

 

The Dangers of Liquid Nicotine

                  One of the main products found within e-cigarette cartridges is liquid nicotine which, unlike tobacco leaves, can be – and has been – lethal.  Only a tablespoon of liquid nicotine is enough to kill an adult when ingested and it takes as little as a teaspoon to kill a child.  Of course, these cartridges are not designed to be ingested but rather, ‘vaped’, which is significantly safer than ingestion but when they are loaded with flavors and odors of fruits and other sweet goodies, it’s easy to imagine a child ‘treating’ themselves when their parents aren’t looking. 

Of course, it could be said that only irresponsible adults would leave the cartridges around for children to find and that may, in part, be true but accidents do happen.  Since e-cigarettes have become popular, calls to poison control centers regarding liquid nicotine incidents has risen from 0.3% to nearly 50% - and of those, 51.1% involved the accidental poisoning of children under the age of five, whilst 42% of calls were relating to incidents with adults over the age of 20.  So it’s not just the children of irresponsible parents, and it’s not a problem to ignore. [8]

 

Unknown Ingredients

                  Of course, users could opt for the non-nicotine cartridges – those apparently filled with only flavored liquid design to give the feel and experience of smoking without the addictive affects.  These may even escape the dangers above, but lab tests have shown that even the nicotine-free cartridges still contain low-doses.  These unknown ingredients are a further worry when it comes to these apparently wonderful smoking alternatives.  As the WHO claimed, many companies are yet to disclose their ingredients lists. 

In a 2009 study, the FDA found some cartridges containing 1% diethylene glycol, a toxic chemical found in anti-freeze.  Further tests showed that whilst inhaling vapors, metals from the device could also be inhaled – including tin and other metals known to have toxic and carcinogenic effects.  Until further tests are completed, and the FDA begins to regulate the industry, who knows what else might be lurking in these seemingly innocent cartridges [9] . 

But they still can’t be as bad as conventional smoking, surely, with its propensity towards lung cancer and similar diseases, right?  Wrong.  Park et al. recently published their study in the journal Clinical Cancer Research, stating that in actual fact e-cigarette users experience diminished lung function and airway resistance – even if they do not, or have never smoked traditional cigarettes, and even if they are using the nicotine-free variety of e-cigarette cartridges.  What’s more, Park et al. discovered that smoking e-cigarettes, regardless of variety or previous smoking history, often created similar cellular changes as conventional smoking.  Whether these cellular changes will lead to cancer in the same way as the smoking changes do remains to be seen but it is certainly a warning [10] .  

 

Fashion                  

                  However, even if all this wasn’t true, and even if e-cigarettes turn out to be perfectly safe, there is a group of people who claim that the product is still dangerous.  Perhaps, it is argued, that the increasing use of e-cigarettes will re-normalize smoking [11] , after many years of making it an unsociable and dislikeable habit in order to encourage people to give up.  Thus, by making it a socially acceptable thing once more, the industry is encouraging further smoking. 

Whilst claims that it’s all a ploy by the industry to increase their turnover and profits may seem to be edging on conspiracy, this group of opponents do actually have a point.  The development of e-cigarettes has been a godsend to the slowly dying tobacco industry, with all the industry’s main players investing in tobaccoless smoking and ‘vaping’ brands of their own.  What’s more, evidence suggest that e-cigarettes actually haven’t reduced conventional smoking, or helped people to ‘give up’, with most people now part-taking in a dual activity – sometimes smoking, sometimes ‘vaping’.  Studies even suggest that e-cigarettes could be a ‘nicotine gateway’ among the young, as Lauren Dutra of the UC San Francisco Center for Tobacco Control Research and Education claims.  This USCF study of almost 40,000 adolescents found that e-cigarettes actually lead to more smoking amongst young people rather than less, and that people are less likely to give up completely given the option of e-cigarettes [12] . 

 

The Future

So whether it is physical or social, the side effects of these devices are darker than they first appear.  Most of all, what’s interesting is that with support for the safety of these products coming from the tobacco and e-cigarette industry whilst the rest of the world sit in wonder at just how serious the effects can be, and the ironically similar methods of advertising employed by the e-cigarette industry to that of the tobacco moguls of the past, the campaign for the recognition of ‘safe’ e-cigarettes is frightening similar to the tobacco campaign of old. 

 

The fact that anyone could claim that smoking tobacco is safe with no ill side-effects seems ridiculous to us now, a poorly veiled attempt at keeping profits high founded by ruling tobacco companies.  It will be interesting to see whether we, in the future, will look at this advocacy towards e-cigarettes in much the same light.  For now, we don’t know.  They may certainly seem better than smoking conventional cigarettes and they may certainly seem like a useful tool for ‘quitting’ but until there is more research done and until we know for sure, it’s probably best to stay away from them and quit the old-fashioned way. 

 

[1]{C} Maria Trimarchi and Susan Cassidy, 2014, 10 Little-Known Facts About E-Cigarettes [online].  Available at: health.howstuffworks.com/wellness/smoking-cessation/10-facts-about-e-cigarettes.htm [accessed 05/27/2014]

[2]{C} Ibid.

[3]{C} Jacob Sullum, 2014, Will FDA Regulation Preserve or Destroy the E-Cigarette Industry? [online].  Available at: www.forbes.com/sites/jacobsullum/2014/05/01/will-fda-regulation-preserve-or-destroy-the-e-cigarette-industry [accessed 05/27/2014]

[4]{C} Maria Trimarchi and Susan Cassidy, 2014

[5]{C} Jacob Sullum, 2014

[6]{C} Jon Henley, 2014, E-Cigarettes: Miracle or Health Risk? [online].  Available at: www.theguardian.com/society/2014/may/05/rise-of-e-cigarettes-miracle-or-health-risk [accessed 05/27/2014]

[7]{C} Ibid. 

[8]{C} Maria Trimarchi and Susan Cassidy, 2014

[9]{C} Ibid. 

[10]{C} Ibid.

[11]{C} Jon Henley, 2014

[12]{C} Elizabeth Fernandez, 2014, E-Cigarettes: Gateway to Nicotine Addiction for US Teens, Says UCSF Study [online].  Available at http://www.ucsf.edu/news/2014/03/112316/e-cigarettes-gateway-nicotine-addiction-us-teens-says-ucsf-study [accessed 05/27/2014]