If e-cigarettes are supposed to help us quit smoking, why are so many doctors calling for them to be banned or at the very least more closely regulated?
This month 129 public health officials and medical experts from across 31 countries and from institutions as varied as the University of Hawaii to the UK Faculty of Public Health have written to the Director General of the World Health Organization, urging for more evidence-based regulation when it comes to Electronic Nicotine Delivery Systems (ENDS), more commonly known as e-cigarettes.
E-cigarettes aren’t in fact a new technology but have recently become available as a mass market product. While they differ in form, they are usually a battery-powered vaporizer device which, looking like a cigarette, simulates the process of tobacco smoking while producing an aerosol that looks like smoke. They tend to deliver a comparatively small amount of nicotine into the body to stop cravings, and are being marketed at smokers as an intermediary step toward quitting, with the industry telling us they are far more healthy than cigarettes –and that’s where the problem lies.
In particular, the experts writing to WHO are concerned about how tobacco companies appear to have moved to buy up e-cigarette technology and incorporate it into their marketing as a product with a number of health benefits over cigarettes and, apparently, no significant side effects. This, they say, has not been proven and in some cases goes against what scant research we have on ENDS technology.
Says the letter:
It is fundamental that WHO and other public health authorities not buy into the tobacco industry’s well-documented strategy of presenting itself as a “partner.” If the tobacco industry was committed to reducing the harm caused by tobacco use, it would announce target dates to stop manufacturing, marketing and selling its “more harmful” products rather than simply adding e-cigarettes to its product mix and rapidly taking over the e-cigarette market. It would also immediately desist from its aggressive opposition to tobacco control policies such as tax increases, graphic health warnings and plain packaging.
By moving into the e-cigarette market, the tobacco industry is only maintaining its predatory practices and increasing profits. As stated in the guidelines for Article 5.3 of the WHO FCTC, there is a “fundamental and irreconcilable conflict of interest” between the tobacco industry’s interests and public health’s interests.”¯
The letter spells out concerns over how the industry is targeting young people with e-cigarettes, usually under the guise of trying to get people to quit regular cigarettes. If the industry is doing this, it must therefore have proof that e-cigarettes are beneficial in helping young people quit, right?
To the contrary, the letter points to some evidence which suggests far from helping ween teens from cigarettes, ENDS technology may in itself be an attractive prospect for new smokers. Critically, the health experts also take issue with the idea that there is sufficient evidence to say e-cigarettes actually help people quit. In fact, they contend that population studies show that when people use both e-cigarettes as well as standard cigarettes, which constitutes the majority of e-cigarette users, they are in fact less likely to stop smoking altogether.
In addition, what evidence we do have that e-cigarettes can help is very limited. For instance, we don’t know how effective e-cigarettes are compared to conventional nicotine therapies, so we have no real way of knowing whether e-cigarettes have any benefits over standard therapies.
Furthermore, and this is perhaps the most crucial area of the letter, there is reason to be concerned that e-cigarettes may carry potential health consequences:
There is already good evidence that ENDS emissions release several toxic substances into the environment that cause harm to health. These substances include ultrafine particles, propylene glycol, tobacco-specific nitrosamines; nicotine; volatile organic compounds (VOCs), and carcinogens and reproductive toxins, including benzene, lead, nickel, and others. Proposals to allow ENDS use in indoor spaces like workplaces, bars and transportation could see significant exposure to these substances.
The letter also notes that nicotine, which is contained within the ENDS cartridges, can be potentially hazardous and there has been a statistically significant though still relatively low rise in the number of people suffering nicotine poisoning as a result of improperly stored or used cartridges, particularly affecting children and pets like inquisitive dogs.
As such, the medical experts are calling on WHO to consider a regulatory framework that would ban the import and potentially the sale of e-cigarettes until such a time as the industry’s claims have been proven and the product is known to be safe.
It is of course important not to be alarmist. The absolute honest message here is we simply don’t know enough about the e-cigarette technology to understand whether the benefits do outweigh the risks. It is also worth recognizing that there are a number of people who report that e-cigarettes have been the thing to help them quit smoking when nothing else could. That’s wonderful, but it isn’t testable evidence of the e-cigarettes’ wider safety or effectiveness. Until we have that, the tobacco industry in particular should not be allowed to act as if e-cigarettes are a proven technology without potential negative health implications.
You can read the full letter and its citations here.
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