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E-cigarettes, much ado about nothing or a wolf in lamb's clothing?

Are e-cigarettes a safe and healthy way of giving up smoking or is it a wolf in lamb's clothing?   2015-11-15
 

The original version of the electronic cigarette was invented by a Korean War veteran called Herbert Gilbert in 1963 with the patent filed in 1965. He tried to interest the big tobacco and pharmaceutical companies but at the time when the dangers of smoking had not yet filtered down, no one expressed an interest. Nearly half a century later when the realities of smoking were already well known and accepted by the public, a Chinese pharmacist called Hon Lik made his version of the e-cigarette popular and interest in this gadget took off.

According to ASH (Action for Smoking and Health) an estimated 2.6 million people use electronic cigarettes in the UK with nearly 2 out of 5 of them being former smokers and the remaining 3 out of 5 smokers.

Difference between cigs and e-cigs

In a conventional cigarette, tobacco is burned which produces nicotine, tar and more than 7000 chemicals, including more than 70 known to cause cancer and, in some cases, heart and lung disease. In an October 2013 interview Herbert Gilbert describes in a very logical and non-scientific way, why smoking is bad for us:

"the problem, as I concluded, was that when you burned leaves and wood, even if you did it in your back yard, it yielded a result that no one wanted to take into their lungs".

He goes on and brings the examples of lettuce and cinnamon which are both good for us; but if you dry them out, grind them, mix them together, but them in a paper bag and set it on fire "the result would be nothing you would want going into your lungs".

How do they work?

Electronic cigarettes consists of three parts:

  1. The mouthpiece or the cartridge with a liquid solution containing nicotine, flavourings (optional) and a variety of other chemicals. Nicotine free versions are available but according to Public Health England these are not popular amongst users.
  2. A heating element called the vaporizer.
  3. A battery.

The user sucking the mouthpiece activates the heating element which vaporises the liquid solution. This is known as vaping.

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Safer than cigarettes?

As with many of the technological innovations of the past 25 years, opinion on the safety of e-cigarettes is divided. It is this lack of firm guidelines that works in favour of e-cigs. According to Michael Blanding, Boston-based journalist and author, and Madeline Drexler, editor of Harvard Public Health, in the long war to convince the public that smoking kills, tobacco companies did all they could to instill doubt in the mind of smokers that the jury was still out on the killer effects of the cigarette. Blanding and Drexler quote one tobacco executive who wrote in 1969 “Doubt is our product…the best means of competing with the ‘body of fact’ that exists in the minds of the general public.” In the case of e-cigarettes the jury is still out on the potential effects of the e-cigarette. Is it a harmless avenue out of smoking or does it come with its own dangers? In February 2015, the U.S. Surgeon General, Vivek Murthy, warned that health officials are “in desperate need of clarity” on electronic cigarettes to help guide policies.

Helps quit smoking

On the pro side of e-cigs, is the argument that vaping competes with conventional smoking and might cut tobacco related illness. In a study carried out in the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond and published on 30 July 2014 in the journal Addiction, the researchers analysed 81 prior studies on the use and safety of e-cigarette type products. Their conclusion was that e-cigarettes reduce the urge to smoke. Preliminary evidence was also found that e-cigarettes make it easier for smokers to both quit smoking and to reduce cigarette consumption. The researchers found that in England, which has the most detailed data on e-cigarette and cigarette use, the growth in e-cigarette use has been linked to an increase in the number of people who have quit smoking and there has been no increase in the number of smokers.

Researchers in the Center for the Study of Tobacco Products study found that even though the health effects of long-term e-cigarette use are not yet known, based on the data available, the risks of long-term e-cigarette use compared to smoking, are likely to be much less, if at all harmful to users or bystanders. This is because unlike cigarettes, e-cigarettes do not contain the combustion-generated poisons that are linked to cancer, lung disease and cardiovascular disease.

E-cig dangers

In a report commissioned by Public Health England (PHE) and published in May 2014 possible health issues arising out of smoking e-cigarettes are analysed and whilst safer than cigarettes, the long term effects of intensive vaping remain one big unknown.

According to Michael Blanding and Madeline Drexler, there is a growing body of scientific literature which holds that whilst vaping is much less hazardous than smoking, it is definitely not harmless. A 28 January 2015 health advisory from the California Department of Public Health pointed out that “Chemicals in the aerosol are absorbed through the bloodstream and delivered directly to the brain and all body organs.” It adds that typically, e-liquids contain toxic chemicals known to cause cancer, birth defects and other reproductive harm. Whilst the levels of carcinogens in the e-liquid is lower than in cigarettes, both the e-cig aerosol and the emissions, “have been found to contain at least ten chemicals that are on California’s Proposition 65 list of chemicals known to cause cancer, birth defects or other reproductive harm”, including formaldehyde, lead, and nickel. E-cigarette emissions also contain “volatile organic compounds and fine/ultrafine particles. These ultrafine particles can travel deep into the lungs, where they get trapped and may lead to tissue inflammation.”

Nicotine

The principal ingredient of tobacco smoke is nicotine. There are few studies that examine the effects of nicotine addiction independently of cigarette smoking. According to the U.S. Centers for Disease Control and Prevention (CDC) nicotine causes blood vessels to constrict, raises blood pressure, and can trigger abnormal heart rhythms. Just 5 minutes of vaping causes similar lung irritation, inflammation and effect on blood vessels as smoking a traditional cigarette, which may increase the risk of a heart attack.

This is supported by Public Health England, which says that despite the claims that e-cigarettes are harmless, they may contain small amounts of carcinogenic substances such as formaldehyde and acetaldehyde cadmium, nickel and lead. The levels of these toxins are much lower than in conventional cigarettes but we cannot know how they may affect us if inhaled repeatedly over a long time.

In connection with the chemical formaldehyde, a study published in the New England Journal of Medicine in January 2015, claimed that people who smoke high-voltage e-cigarettes have greater exposure to formaldehyde, a suspected carcinogen, than those who keep the voltage low. When formaldehyde is inhaled it has been connected to an increased risk of leukemia and nasopharyngeal cancer. They found no increased risk for people vaping at a low voltage. Critics however say that the study is misleading.

A question that remains to be solved is does nicotine affect the development of the brain during adolescence. According to a CDC study, the number of calls to poison centers nationwide involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014.

Flavours

A simple glance at the wide variety of e-cig flavours reveal a wide range of friendly options, from 'Coconut' to 'Chocolate and Cherry' to 'Apple and Grape'. What can be harmful about chocolate and cherry right?

In a study from Portland State University published in the journal Tobacco Control in April 2015, the researchers reveal that the flavours used in e-cigs may surpass safety levels. These flavours are the same that are used in food but whereas in food they are safe, when inhaled they could be more dangerous. More research is required.

Conclusion

In June 2015 it was announced that the Welsh government was banning the use of e-cigarettes in open spaces. It was reported that organisations such as the British Medical Association and the US based Center for Tobacco Control Research were in favour of the ban but equally influential bodies such as Cancer Research UK and the British Heart Foundation Wales were against. This perhaps underlines the big unknown that e-cigarettes are.

What are the long term effects of vaping? Only time will tell. In the meantime, if you want to be sure to remain healthy, just give it, up vaping and all.