Why e-cigarettes are misunderstood

Following the vaping ban in public places by the Welsh government in June and an advertising ban on e-cigarettes in Ireland due this month, it is becoming apparent that officials are not as enlightened about e-cigarettes as we would have hoped. In fact, two of the largest British health charities – Cancer Research UK and British Heart Foundation spoke out in opposition of the ban, claiming there is “insufficient evidence” to support the ban and it cannot “be justified”. Bans like these pose an obvious problem to the vaping movement. With e-cigarettes positioned as a stop-smoking solution, a public place ban forces would-be quitters to vape outside with smokers which would inevitably halt anyone’s quitting ambitions.

In America the FDA have yet to decide how to regulate e-cigarettes. And as there are literally thousands of e-cigarette products and e-liquids already on the market, then an authority to review new products pre-release now seems pointless, regulation needs to be market-wide. However, this is exactly what is being considered in Congress, as a Department of Agriculture appropriations bill has proposed just this.

We checked on the FDA website under e-cigarettes and found that they have not updated crucial information. See the outdated information for yourself below.

Firstly, vapers know exactly how much nicotine is being inhaled during use, that would be the amount stated on the label in accordance with a regular usage rate. Secondly, we do know how many potentially harmful chemicals there are being inhaled, that would be 95% less than regular cigarettes with up to only 25 Volatile Organic Compounds, 11 less than the amount of VOCs recorded in indoor air and 61 less than tobacco cigarette smoke, and not all VOCs are toxic. Interestingly, isoprene, listed as a carcinogenic compound in California Proposition 65 is present only in exhaled breath and not electronic cigarette aerosol. We also know that e-cigarettes have increased the likelihood of smokers quitting for good, over NRT products with 2.6 million e-cigarette users using the devices to quit according to the Public Health England Report. And again with the e-cigarettes ‘gateway’ claim that they encourage young people to try conventional cigarettes has been disproved. Hazel Cheeseman, ASH Director of Policy, reassured us commenting on the PHE report that “These results should reassure the public that electronic cigarettes are not linked with any rise in young people smoking. Although more young people are trying electronic cigarettes and many more young people are aware of them, this has not led to widespread regular use or an increase in smoking.” So we advise the FDA to update their e-cigarettes page with the correct information.

What is interesting is that many governments globally are unsure how to respond to e-cigarettes, and how or whether to regulate them. Norway has recently banned the advertising of e-cigarette products as a senior official claimed “e-cigarettes are a tobacco surrogate and therefore should be included in the ban on advertising.” And New Zealand have prohibited e-cigarettes that deliver nicotine, while keeping cigarettes (with a higher nicotine content) legal. Even so a recent report by the Norwegian Institute found that the benefits of e-cigarettes are not known so far, although, they are far less harmful than smoking tobacco, especially in causing cancer. They warned the long-term health effects are still unknown, showing again a need for further research.

Funny isn’t it, everybody is up in arms about vaping, because the ingredients used in making e-liquids is unregulated and therefore could be ‘unknown’. It should not be forgotten that cigarettes themselves have never been largely unregulated. It seems almost inconceivable that scientists proved smoking tobacco and the chemicals in them directly linked to cases of cancer, illness and death decades ago, yet the ingredients inside them have remained unchanged.

On the 6th August, a Malaysian islamic scholar, Dr. Zulkifli Mohamad al-Bakri ruled e-cigarettes ‘forbidden’ for muslims. He said vaping had imitated non-muslim culture and carried an undignified image. But what underpinned his bold decision was that an e-cigarette “contains tobacco and nicotine, which are substances that can be intoxicating and harmful to human health.” Now, there are a few things wrong with Dr. Zulkifli’s argument. Firstly, e-cigarettes certainly do not contain tobacco, granted some e-liquids are tobacco flavoured but because of the process of atomisation in e-cigarettes, e-liquid cannot contain tobacco. There is of course liquids that contain nicotine, but because of the bad image surrounding cigarettes, nicotine has been lumped in with tobacco throughout the anti-smoking movement as harmful. When, many credible sources in support of Nicotine Replacement Therapies advocate that nicotine itself is not nearly as harmful as smoking with WebMD, an accredited health website, claiming “tars, carbon monoxide, and other toxic chemicals in tobacco cause harmful effects, not the nicotine.” and the NHS say that nicotine will not cause cancer. It seems that when vaping is concerned, nicotine is harmful, but patches and gum containing nicotine are fine. So we struggle to see any substance to the Dr’s claims. In fact, by forbidding muslims from using e-cigarettes to help quit smoking, the mufti may cause more harm than good.

And this is just the issue, it seems people are ill-informed, and the facts about e-cigarettes are limited, and by mass outweighed by bad press. This storm of mixed messages leaves many confused and even medical professionals don’t know what to think.

So to help clear this up, here is what research says. Earlier this year, a study conducted by Dr Konstantinos Farsalinos, a prominent figure in e-cigarette research, found that e-cigarettes are at least 95% safer than smoking with minimum aldehyde levels being detected of up to 250 times lower than cigarette smoke. This was published in the International Journal of Environmental Research and Public Health, and supports e-cigarettes as a safer alternative to smoking. Other research conducted in New Zealand proved e-cigarettes to be as effective at helping smokers quit as nicotine patches. Action on Smoking and Health stated in their November 2014 report on electronic cigarettes that “devices do enable some smokers to reduce or quit smoking and that they offer a route to complete cessation of nicotine use.”

The problem

Is there is not a universal understanding of the benefits of vaping. What everyone may or may not know, but has proven:

1. Second hand vapour is not harmful, being less dangerous than normal exhaled breath (unlike smoking)
2. E-cigarette vapour has no negative effect on airway tissue viability (and we all know the detrimental effects smoking has)
3. Average doses of nicotine are as dangerous as normal caffeine and nicotine does not cause cancer; it is instead the tar from tobacco which contains harmful cancer-causing carcinogens.
4. E-cigarettes are tobacco-free
5. It is illegal for a retailer to sell e-cigarettes to anyone under the age of 18 in the UK as of 1st October 2015 and in the US where this is raised to 21 in some states.

We also know that unfortunately:

1. There are many organisations pushing to prove that vaping may be influential and attractive to those who are underage, when there has been no evidence in studies to substantiate such claims.
2. There has been very little scientific evidence to prove vaping is not harmful outright, although it is known that it cannot be as harmful as cigarette smoke, being 95% less harmful than cigarettes.

With people not fully understanding the benefits of e-cigarettes as well as a recurringly tarnished image presented in the media, the result is mass confusion. Many people do not know what to believe, and can you blame them? There are conflicting messages being delivered constantly.

It is well-documented that there needs to be more research into the health effects of vaping i.e. what continuous intake of vapour will do over a year, 5 years or even 10 years from now. Unfortunately, this kind of information is not available right now. Ultimately, the known risks of smoking far overshadow the unknown risks of vaping, with smoking killing over half of long-term users. And we must remember cigarettes are legal, even in the face of the glaring truth that smoking is the single biggest avoidable risk factor of cancer in the UK.

There is, indeed, a complicated conflict being staged, with growing tensions and an impatience of the public for a resolute verdict on the future of vaping. The perception of e-cigarettes have been dimmed by some companies such as Njoy who paid topless young men to give out free samples. This type of marketing is not designed to persuade smokers to stop smoking but to promote vaping to the wider public and in this case, young women. After all, the goal of e-cigarettes upon invention was to cure the smoking epidemic, not to provide the mass market with a new smoking product.

Smoking levels will continue to drop, as e-cigarette uptake increases. That we can be sure of, but in between we can also be sure that there will be people in opposition, with certain media outlets waiting in the wings ready to spread any shred of defamatory news available. Thankfully, the e-cigarette industry might just be starting to enjoy slight moments of relief as poignant pieces of reputable research come to light and e-cigs may finally gain the recognition they deserve.