E-cigarettes: the burning question

Every year, 700,000 people in the European Union die of tobacco-related illnesses. Some experts believe that electronic cigarettes could play a major role in fighting this scourge. “It could eradicate smoking and thus greatly benefit public health,” says Peter Hajek, Professor of Clinical Psychology at the Queen Mary University of London. His review article, published last summer, covered more than 100 studies and emphasized the potential of e-cigarettes to reduce tobacco-induced morbidity and mortality.

Electronic cigarettes deliver vaporised nicotine without burning tobacco, avoiding the production of carcinogens and other substances that harm the lungs and cardiovascular system (see Tobacco-free vapour, at right). They deliver nicotine to the bloodstream more quickly than patches, and users can still employ the gestures that are part of their regular smoking habit. “Vaping” e-cigarettes also helps people reduce their consumption of regular cigarettes. Nicotine-free e-cigarettes, however,are not popular.

Worried authorities

Despite these arguments in their favour, e-cigarettes remain a concern for public health authorities. They fear that e-cigarettes will lure non-smokers, thereby undoing the huge effort that has gone into anti-smoking campaigns. “E-cigarettes renormalise the act of smoking by introducing a new tool that is particularly attractive to young people,” says Hubert Hautmann, a pulmonologist at the Klinikum Rechts der Isar Hospital of the Technische Universität München (TUM). “It’s important to note that the number of cigarettes smoked by young Europeans has been falling consistently since 1965.” This concern seems unwarranted for the moment, since current studies indicate that e-cigarettes are used primarily by smokers. A study of 26,500 adults published by the University of Crete in June 2014 found that nine out of 10 Europeans who tried e-cigarettes in 2012 were ex-smokers or smokers, often heavy ones.

Many institutions nonetheless remain sceptical and concerned. In August 2014 the World Health Organisation (WHO) recommended banning the promotion of e-cigarettes to non-smokers and youth, as well as their use in workplaces and public areas. Hajek disagrees with these recommendations. “This is likely to discourage or even prevent smokers from doing what is right for their health. No study has shown that young people go beyond experimentation and develop a habit of regularly vaping e-cigarettes.”

Prevention or cure

TUM’s Hautmann argues for caution. “The health effects of nanoparticles in the vapour are unknown. It took until the 1950s to establish incontrovertible proof of the link between lung cancer and tobacco. We may need 20 years to understand the danger of e-cigarettes.”

Indeed, e-cigarettes expose the body to compounds whose long-term health effects are still not understood (see Hidden dangers). “Even if they seem to provide a useful way ► ► of breaking the smoking habit, we still need to evaluate the effects of chronic exposure,” adds Maria Rosaria Gualano, a public-health scientist at the University of Turin.

There is also a small risk of second-hand vapour exposure. A 2014 University of Southern California study showed that although exhaled vapour contained 10 times fewer toxic substances than smoke, it contained more chromium and nickel particles (probably emitted from the cartridges). Establishing stricter manufacturing standards should reduce these uncertainties. “Some studies show that very low quantities of toxic substances are present in e-liquids,” says University of Geneva public health expert Jean-François Etter. “But in my estimation the e-cigarette reduces the risks of cigarettes by 99%.”

Some public health experts worry that tobacco companies will take over the market and develop e-cigarettes that will hook users. “This risk must still be weighed against that of tobacco, which kills half of all smokers,” Hajek argues. Compared to the ravages caused by cigarette smoking, e-cigarettes seem like a lesser evil – at least from what science says in 2014.