The World Health Organization says the word "e-cigarettes" should be banned. The American Heart Association wants to keep the products out of kids' hands. Now, the Centers for Disease Control and Prevention (CDC) have come out firmly against electronic cigarettes in their latest anti-smoking campaign. While the Federal Drug Administration (FDA) continues to mull over regulating e-cigs, the devices keep gaining popularity, and local governments are acting on their own.
For other health issues, taking a harm-reduction approach can be as simple as passing out information or as complicated as setting up safe injection sites for heroin addicts. When it comes to smoking, however, the CDC seems to have taken an all-or-nothing approach, preferring that the only alternative be not smoking at all.
But, the fact is, there are still many things we don't know about e-cigs, and what research we do have can be extremely complex. What's more, "There are big discrepancies between the stories of people quitting on the Internet [with the help of electronic cigarettes] and what’s coming out in the scientific studies," says Daniel Seidman, PhD, director of smoking cessation services at Columbia University Medical Center. So, we wanted to sort through it.
To know how e-cigarettes measure up, we have to first look at the data we've got now. According to the CDC, around 480,000 deaths every year in the U.S. are attributable to smoking. Of those deaths, about 130,000 are due to lung cancer caused by at least 20 of the carcinogens in tobacco cigarettes. So, the rising popularity of smoking alternatives is not surprising.
However, e-cigs aren't risk-free. Although they have significantly fewer known carcinogens than tobacco, they do have their own issues, many stemming from the fact they don't just spew "harmless water vapor." Instead, we know they can deliver more heavy metals into the system than traditional cigarettes, which may cause problems in the delicate lungs, says Dr. Seidman. And, even though the e-liquid solvents propylene glycol and vegetable glycerin are recognized as generally safe, it is possible to ingest too much. This can cause nausea and vomiting, especially in young kids.
When heated up, these chemicals can give way to carcinogenic compounds, such as formaldehyde. But, even here, the studies are contradictory: Some research suggests the amount of formaldehyde inhaled from an e-cig is comparable to or below that of a regular cigarette. Others say the e-cigs deliver much more.
Also, the contents of e-liquid may not always be what's advertised on the bottle. This stuff currently isn't regulated and, in the past, people have found the liquid's actual nicotine content to be at least 20% different from what's on the label. And, even if it's labeled correctly, nicotine is pretty addictive.
So, much of the regulation debate hinges on whether or not e-cigs can actually help people quit smoking for good. And, therefore, whether they should be treated like other FDA-approved quitting techniques. Unfortunately, the evidence here is a little convoluted. One study found that quitline callers who used e-cigarettes were significantly less likely to have quit entirely after seven months than those who had never used e-cigarettes. Another study published last May in JAMA Internal Medicine found that among 949 participants, smoking e-cigarettes had pretty much nothing to do with whether or not they quit after a year.
Yet another study, this one from 2013, compared the devices' effectiveness to another common cessation product: nicotine patches. The researchers found that e-cigarettes (with or without nicotine) were "modestly" helpful for quitting. But, importantly, they were as helpful as the patches.
Still, Dr. Seidman notes that patches were originally designed to be used in conjuction with counseling to help tackle the psychological components of addiction. And, he says that using electronic cigarettes may delay the final quit date.
So, the available evidence suggests they're not a miraculous cure for addiction, but their efficacy may be on par with other products on the market. In general, they're probably better for you than tobacco cigarettes, so it may be worth the switch — even if they aren't going to make you want to stop. But, they aren't as risk-free as patches. And, if you really do want to quit, getting the help of a therapist or addiction counselor could make the difference.
"There’s a way to design e-cigarettes so that there’s enough nicotine to help people quit, but not so much that you addict new people," says Dr. Seidman. "That would be the sweet spot." Unfortunately, there's probably not much room for that on Big (or Electronic) Tobacco's agenda. So, we might be waiting a pretty long time for that sweet spot.
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