The surgeon general has asked for “clarity” on controversial e-cigarettes. Here, top experts give some. (Photo: Getty Images)
“Vape” is the Oxford English Dictionary’s reigning Word of the Year, and so far, electronic cigarettes are proving themselves one of the buzziest, most divisive health topics of 2015.
We know tobacco kills, and e-cigarettes, at least, seem to help people quit.
Research has indicated that e-cigarettes help people slow their tobacco consumption, an October 2014 study showed that six months of vaping led 21 percent of participants to quit traditional cigarettes, with an additional 23 percent cutting back by half.
And according to a new British survey of 1,800 people, e-cigs are replacing approved aids for quitting tobacco, too. They are now used roughly twice as often as government-regulated nicotine gums, lozenges, and patches across the pond. (Similar data does not yet exist for U.S. consumers.)
The week before last, a study claimed hidden high levels of the carcinogen formaldehyde were found in e-cigs, potentially increasing lifetime cancer risk by 5 to 15 percent.
The American Lung Association has also stated its fear of the “potential health consequences” associated with the use of unregulated e-cigarettes — with almost 500 different brands, 7,700 different flavors and wide-ranging nicotine levels. ‘There is much to be concerned about, especially in the absence of FDA oversight,” the organization said in a statement.
When it comes to e-cigarettes, there are those who argue for the pros and there are those who voice the cons. There are no clear answers, leading new U.S. Surgeon General Dr. Vivek Murthy to call for more guidance on e-cigarettes use as an aid for smoking cessation.
“There’ve been theories and ideas around the fact that e-cigarettes may be helpful from a harm-reduction perspective in helping people who are already on cigarettes [and who] have had trouble quitting actually get off cigarettes,” Murthy said on Tuesday, Jan. 27 in Richmond, Va., as part of a cross-country listening tour. “If the data indeed bears that out, then I think we should absolutely embrace that and use e-cigarettes in targeted ways.”
However, don’t mistake Murthy’s words for a wholehearted endorsement. “I’m concerned about e-cigarettes, and I think this is an area where we are in desperate need of clarity,” Murthy said. “I think it’s important for us to understand the impact, particularly on youth, before we allow the full-fledged spread of these e-cigarettes and then later have problems that we have to deal with.”
What are those problems? Let’s take a look at the pros, the cons, and exactly what we do and don’t know.
As previously mentioned, e-cigarettes aren’t all bad. They do seem to help people who are trying to quit traditional cigarettes curb their tobacco addiction, leading the surgeon general to say we could potentially use these devices in “targeted ways.”
According to a 2013 study of 657 smokers published in the Journal of the American Medical Association, e-cigarettes were as effective as nicotine patches in helping people kick their tobacco habit for at least six months.
According to Charles Powell, MD, chief of pulmonary medicine at Mount Sinai Hospital and a professor of medicine at Mount Sinai Medical School in New York City. “they are essentially a delivery device for nicotine,” he tells Yahoo Health. “Just like gum or patches, they have similar replacement effects, and they’re potentially a more comfortable, attractive way to deliver the substance.”
And there is some larger-scale research advocating for the potential gains of e-cigarette use. According to a paper closely reviewing 41 key studies about the short-term health impact and effectiveness of e-cigs published in the journal Therapeutic Advances in Drug Safety, “currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes.”
But after the switch from tobacco to e-cigs, what might happen down the road?
While you certainly could wean yourself off these electronic devices, and therefore off nicotine, often e-cigs are a swap and not a means to completely stop smoking (or vaping) altogether. “One could devise a strategy to decrease use — that can be done,” Powell says. “But there’s really no one marketing that approach, or advocating a plan to make it happen.”
And over time, healthcare providers are concerned about what the substances in the vapors might do to the body. “We don’t know if the devices are safe long-term, whether the nicotine amounts are safe, whether the other additives are safe,” says Powell. “And the problem is that most people who use these devices are under the impression that they are totally safe.”
For instance, a study published in the journal Circulation showed e-cig vapors are high in nanoparticles that can trigger inflammation leading to health conditions throughout the body, from asthma to cardiovascular disease, stroke, and diabetes.
Even in the short term, there isn’t much research on e-cig use — but they may still present health hazards. A new study from PLOS One shows the vapors in e-cigarettes may also leave users vulnerable to viral respiratory infections.
According to Qun Wu, MD, Ph.D, an assistant professor in the department of medicine at National Jewish Health who also worked on the study, this effect was seen whether the liquid contained nicotine or not. “Short exposure to propylene glycol, the primary ingredient in the majority of e-liquid and e-cigarette cartridges, may cause acute upper airway irritation,” she tells Yahoo Health. “E-liquids without nicotine and with nicotine inhibit the lung’s innate immunity, which helps it defend itself against infections.”
Notably, the study also involved the cells of young adolescents, a key group experts are worried about when it comes to the long-term health repercussions of e-cigs.
The Youth Factor
The fact of the matter? Kids are getting hooked on e-cigs, and use is continually on the rise. According to a CDC report late last year, the number of teens using these devices has tripled over the course of two years — a major concern, especially since last year’s surgeon general report pointed out the detrimental effects of nicotine on brain development.
And kids aren’t trading up from the real stuff to a “safer” alternative, says Powell: “There’s good data showing that young kids are beginning to smoke e-cigarettes where they never smoked before.”
Not only that, but this group is most vulnerable to the potential long-term ramifications of vaping — something we don’t know yet, because e-cigs are so new, they are unregulated, and there is no evidence to ensure their safety. “It took decades to see how detrimental the effects of regular smoking were,” Powell says. “We can’t afford to make those mistakes again here.”
On Vaping Pot
There’s also the issue of vaping pot, which we may know even less about. While Powell says regulated use of marijuana for medicinal purposes has its accepted role, there’s little data about the delivery of THC via a pen or similar device. “Even the impact of marijuana cigarette smoking on lung health and cancer risk is an unanswered question that requires further research,” he says. “Oil is frequently used to deliver cannabinoids through pens, and the health effects are unknown. They have not been shown to be safe.”
The little existing research is mixed, but benefits do seem to be there. One study conducted in 2004, for instance, found vaping cannabis may deliver fewer other potentially-damaging compounds when compared with smoking it. However, that said, it’s possible vaping the oil is a shockingly potent way to get high. According to a CNBC report, hash oil can contain up to 80 to 90 percent THC, the main mind-altering chemical from the cannabis plant, versus 15 to 18 percent for traditional pot smoking.
The pot-vaping trend even seemed to worry Allen St. Pierre, executive director of the National Organization to Reform Marijuana Laws, which is a nonprofit advocating for the broader legalization of marijuana. “Between the fact that you can potentially pass out with a single inhalation, or you can have such property damage and potential bodily harm just producing it … these [issues of the vape pen] definitely need to be addressed,” he told NPR. “This is a screaming call for regulation if there ever was one.”
This is also a concern, because young people could potentially use this method of delivery to get high in secret, at anytime. Although she has a prescription, the NPR report used 19-year-old Nikki Esquibel as an example. Virtually odorless and colorless, it could allow Esquibel to get “stoned” without anyone knowing: “I use it mostly around my neighborhood,” she said. “It’s easy to hide.” And with vaping picking up among teens, even in classrooms, it’s an issue on some experts’ radar.
Why the Intense Debate?
Check Google. Run a quick search of e-cigarettes. You’ll find a slew of scary studies about vaping, coupled with a ton of advocacy websites for their effectiveness.
Why can’t anyone seem to agree, yea or nay? Well, simply put, there are two sides to every story. For instance, The New York Times ran a counterpoint to all the fear-inducing news surrounding the recent formaldehyde study, noting the issues with the hubbub. First and foremost, e-cigs aren’t vaped at high voltage (because of a nasty taste), which is when those damaging levels of the carcinogen were produced in the study.
After talking to the study author David Peyton, and mentioning a tweet from the New England Journal of Journal of Medicine indicating vaping carried a higher risk that smoking, writer Joe Nocera reports Peyton was shocked. “I regret that,” he told him. “That is not my opinion.” The aim of his study, he said, was simply to highlight there’s so much that we don’t yet know about e-cigs.
Which is true. Medical professionals often cite the lack of research and carcinogens in e-cigs as reason for caution — but e-cig users note that they’ve kicked their tobacco habit by vaping instead. Ultimately, as the surgeon general says, we are in major need of more scientific evidence to fill in the gaps on long-term effectiveness or harm before rendering a final verdict on vaping. And this takes time.
Powell does point out, however, that there are other regulated ways to kick smoking habits that aren’t e-cigs. If you’re a smoker who wants to quit, you may want to consider trying those first.
The Bottom Line
While we can’t snap our fingers and make evidence for or against vaping appear, or get e-cigs FDA-regulated in one big leap, there is one thing we can do: stop the bleed. As Powell says, many marketing campaigns are not aimed at using e-cigs as devices to quit smoking tobacco.
One thing we know for sure is that we have to prevent groups, like teenagers, getting hooked on e-cigarettes that were never tobacco users in the first place. There’s no reason to risk long-term damage —that may be forever.
“The health consequences of lung damage and injury, in particular, tend not to be reversible,” says Powell. “We can treat the symptoms and make things more comfortable — but it’s so hard to turn back time.”