What the science says
The rise in cases of otherwise healthy young adults who have been hospitalized or even died from vaping-associated lung injury is alarming.
Many people don’t know what is contained in these vaping devices, what the reported health effects actually mean, and, most importantly, why all of this developed so quickly, considering that e-cigarettes have only been popular for fewer than 10 years.
Vaping describes the process of inhaling aerosols generated by devices such as e-cigarettes.
When e-cigarettes first came, many smoking cessation experts were optimistic. They viewed the delivery of nicotine through e-cigarettes to be a useful alternative to traditional cigarettes. That is because e-cigarettes did not have all of the other harmful combustion products inhaled through cigarette smoke. Since there is no doubt that smoking traditional cigarettes is harmful to your health -- e-cigarettes were marketed as a “safer” alternative.
As an inhalation toxicologist, I study how inhaled chemicals, particles and other agents affect human health. Since e-cigarettes were introduced, I have been concerned about how the scientific community could possibly know the full spectrum of their dangers. After all, it took decades for epidemiologists to discover that regularly inhaling the smoke from burning plant material, tobacco, caused lung cancer. Why would the scientific community be so quick to assume e-cigarettes would not have hidden dangers that might take years to manifest too?
Do e-cigarettes even work as a cessation tool?
Many smokers have reported that switching from cigarettes to e-cigarettes has helped their physical well-being, including reduced coughing.
But a few randomized clinical trials examining the use of e-cigarettes as a cessation tool have shown mixed results. While some trials demonstrate a significant increase in cessation success (from 9.9% to 18%), people using e-cigarettes were much more likely to remain dependent on nicotine as compared to those randomized for more traditional nicotine replacement products, such as nicotine patch, gum, and nasal spray. Or, they were more likely to relapse to using cigarettes.
In short, whether, how, and to what extent e-cigarettes have potential as a cessation tool is not yet settled, especially considering that more than 80% of smokers randomized to use e-cigarettes continued to smoke after the cessation trial.
Safer than a spitting cobra
Cessation claims aside, the messaging of e-cigarettes as a “safer” alternative may have led many teenagers who use e-cigarettes today to believe these devices are “safe.” “Safer” does not equal “safe,” and the messaging of “safer” was based on comparisons to cigarettes.
This statement did not consider the fact that health effects of inhaling flavoring chemicals contained in popular e-cigarettes are completely unknown, or that heating liquids in these devices cause thermal decomposition of those e-cigarette chemicals that “pose limited danger” into known toxicants. It also did not consider that e-cigarettes are a fast-evolving consumer product with ever-changing devices and chemicals, creating mixtures and exposures of unknown health consequences.
This mistake was further advanced by assessing the adverse health effects caused by using e-cigarettes as a comparison to what occurs when someone smokes cigarettes for several years. It is well-established that smoking cigarettes cause diseases such as chronic obstructive pulmonary disease, chronic bronchitis, emphysema, and cancer. Many of these diseases do not manifest clinically until many years after the first cigarette has been smoked.
No controlled studies were ever conducted assessing whether using e-cigarettes causes any adverse health effects in people who never smoke. To this day, scientists do not know the potential long-term health consequences of using e-cigarettes for decades.
Very different health effects
I think that scientists and policy-makers should completely stop comparing vaping outcomes to smoking outcomes. The now 450-plus confirmed cases of vaping-associated lung injuries prove this point. The clinical manifestations in these patients are not something a doctor would ever see in somebody who has been smoking cigarettes for a few months.
Similarly, these clinical outcomes have not been reported in marijuana users, even though THC, the psychoactive ingredient in marijuana, has now been associated with a large percentage of these cases.
Furthermore, the onset of these significant health problems is much faster than one would anticipate from smoking-related diseases. Since doctors are seeing severe diseases after relatively short exposures, does that make vaping more harmful than cigarettes?
Considering that the compounds inhaled through cigarette smoke are very different from those inhaled through the vast number of different flavored e-cigarettes and vaping devices, wouldn’t that be like comparing apples and oranges? Nobody would consider it reasonable to compare health effects caused by smoking cigarettes to those induced by smoking crack.
While it is too early to say whether or to what extent e-cigarettes can be used to support smoking cessation, one conclusion can already be drawn: Vaping is not without health effects.
Ilona Jaspers is Professor of pediatrics, microbiology, and immunology, and environmental sciences and engineering, University of North Carolina at Chapel Hill. This article previously appeared on The Conversation UK and has been reprinted by special arrangement.