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In 1965, when Herbert Gilbert obtained the first patent on a cigarette without tobacco or smoke, he wrote that the product "would provide a means and method of smoking safe and harmless".
More than 60 years later, however, new versions of Gilbert's invention have sparked debate within the public health community. Electronic cigarettes, which have become increasingly popular over the last five years, have been designed to help people quit smoking – and should significantly reduce lung cancer rates and other diseases. But the question is whether this potential exceeds their potential risks to human health.
No easy answer
Traditional cigarettes work by simple combustion: when the tobacco is lit, it combines with oxygen and creates an inhalable smoke. Electronic cigarettes, sold under brands such as Juul, Blu and Vuse, heat a liquid containing chemicals, usually containing nicotine and often a flavoring agent, creating an aerosol. By delivering nicotine without tar or other harmful combustion by-products, e-cigarettes are supposed to offer smokers a healthier alternative to cigarettes while satisfying their cravings.
This seems to be a win-win situation. But in practice, there is still no consensus on whether e-cigarettes actually help smokers to quit cigarettes. The vapes, as they are called, contain fewer carcinogenic chemicals than found in traditional cigarettes (such as arsenic, benzene and formaldehyde), but there is little long-term data on their health effects – and preliminary research suggests that they could harm the lungs and heart. In addition, e-cigs are designed for adults and are only legally available for adults, but they are very popular among teens. They are potentially worrying new generations.
Although public health officials in some regions, such as the United Kingdom, are strongly in favor of e-cigarettes, the World Health Organization is more cautious. In the United States, Dr. Scott Gottlieb – Commissioner of the Food and Drug Administration (FDA), which regulates devices – says he believes that e-cigarettes are good for public health, despite the unknowns. According to Mr. Gottlieb, e-cigarettes are not "safe", but the opportunities they offer to adult smokers who are trying to quit smoking, such as reducing lung cancer rates and improving respiratory health. general, are important.
"If we could completely switch each adult smoker on an electronic cigarette product, we would have a significant impact on public health in general," Gottlieb said. Tony Abboud, executive director of the Vapor Technology Association e-business group, agrees. He states that e-cigarettes are "among the most promising innovations in public health in the 21st century".
But some researchers who study their effects are not convinced. They believe there is not enough evidence that e-cigarettes help adults quit smoking to counterbalance a growing body of research suggesting that they have harmful health effects, including a higher risk of heart disease and respiratory diseases. "What are the effects of [e-cigarettes] when a user takes 200 puffs a day for 20 years? Says Thomas Eissenberg, director of Virginia Commonwealth University's Center for Tobacco Products. "Anyone who says he knows the answer to this question must submit data."
The long-term effects of e-cigarette use are not the only ones unknown. It is also difficult to know if the vows actually help smokers to quit.
Mixed results
Some studies (supported by numerous anecdotal evidence from users) have shown that e-cigarettes can help stop smoking. But others have found the opposite: they further encourage smokers to continue smoking, probably because they have a habit of consuming nicotine. Electronic cigarettes are not approved by the FDA as anti-smoking devices, and vaping companies can not make a health declaration about their products without this authorization. manufacturers generally call it alternatives to smoking for adult smokers.
Juul is the most popular e-cigarette. According to recent data from the Centers for Disease Control and Prevention (CDC), Juul sold 16.2 million of its stylish flash-like devices in 2017, 641% more than the year before. The company claims to conduct studies on smoking cessation, toxicology, etc. "We want to understand everything and share all this data, because that is ultimately what will advance public health discussions," said Ashley Gould, executive director of the Juul administration. Gould also points out that Juul was founded "to provide a satisfactory alternative to cigarettes, with the aim of completely eliminating cigarettes".
Electronic cigarettes can also have a significant impact on lung cancer. Compared to cigarettes, they contain far fewer ingredients known to cause cancer, and the ones they contain are present at lower levels. There is also no evidence that electronic cigarettes cause cancer. Since smoking is the number one risk factor for lung cancer, it is assumed that if smokers switched from cigarette to vape, lung cancer rates could drop.
But scientists still do not know how the long-term use of electronic cigarettes affects health – partly because the devices are not old enough long enough for the rigorous research needed to be done.
In addition, comparisons with cigarettes are only going so far, because e-cigarettes are a radically different product, says Silvia Balbo, assistant professor of environmental health sciences at the School of Public Health of the United States. University of Minnesota. "When you look at the chemicals in both regular and electronic cigarettes, you can make a comparison," she says. "But if you look at the mix alone and how all the compounds and chemicals interact, that's a different question."
Although studies in this area are preliminary, some research suggests that e-cigs may pose health risks. In a small study conducted this year, Balbo and his colleagues discovered that in 15 minutes of vaping, it was possible to produce compounds that could damage the DNA in the mouths of electronic cigarette consumers . The study only covered five people and did not follow their health over time. But Balbo says the observed DNA changes could be linked to several types of cancer, including cancer of the mouth and lung.
<p class = "canvas-atom-canvas-text Mb (1.0em) Mb (0) – sm Mt (0.8em) – sm" type = "text" content = "Other preliminary studies have come to conclusions One, published this year in the journal PNAS, found that the electronic cigarette aerosol damages the DNA in mice. Another, published in Scientific reports in May, revealed that electronic cigarettes contained more potential carcinogenic formaldehyde than previously expected. "data-reactid =" 41 "> Other preliminary studies have reached similar conclusions.One of them, published this year in the newspaper PNAS, found that the electronic cigarette aerosol damages the DNA in mice. Another, published in Scientific reports in May, found that e-cigarettes contained more potentially carcinogenic formaldehyde than previously estimated.
There are other potential pulmonary problems. Diacetyl, a chemical commonly found in flavored electronic liquids, has been associated with respiratory diseases. A study presented in May at the American Thoracic Society's International Conference revealed that the use of the electronic cigarette could be associated with the development of respiratory diseases such as COPD and bronchitis.
These results are a cause for caution – but letting the unknown health risks eliminate electronic cigarettes would be tantamount to "throwing the baby out of the bath," says Dr. Michael Siegel, a professor of community health at the School of Medicine. Public Health of Boston University. Siegel has dedicated his career to reducing tobacco use – which is why he says he believes e-cigarettes are a good thing. "We know the harm of smoking: when people smoke, it kills them," says Siegel. "We should not let the fact that there are unknown risks blind us to the fact that we know that smoking kills people."
In an ideal world, of course, a smoker who wants to quit smoking would completely quit nicotine. But it's difficult, and according to Siegel, e-cigarettes can be a valuable bridge for smokers who can not or will not quit in other ways. "Anything they can do to reduce smoking is a good thing," he says.
An uncertain future
The biggest concern of the FDA is how to prevent teens from getting out of breath. According to federal government data, the use of electronic cigarettes is increasing sharply. they are now more popular than cigarettes among high school students. In September, the FDA stepped up its efforts to regulate electronic cigarette sales, under the impetus of what Gottlieb called an "epidemic" of youth use that "is simply not tolerable from the point of view of public health ". The agency ordered e-cig companies to figure out how to keep their products safe from underage users – and threatened to ban the sale of some flavored electronic cigarettes if they did not do so. (Flavored products, from candy floss to mint, accounted for about 60% of electronic cigarette sales in 2016, according to CDC data.)
This could be the only way for the FDA to fulfill its mandate, which is to prove that e-cigarettes are good for public health as a whole, Gottlieb said. "To close the children's access ramp, we will unfortunately have to take a step forward to reduce the acceleration output for adults," says Gottlieb. "If we do not reduce the use of these products by adolescents, it will be difficult to assert in a fair way, through a scientific process, that it provides a net benefit to health. public. "
Siegel agrees that reducing teen use should be a priority and believes that this could be achieved by regulating the marketing and sales of electronic cigarettes, as well as the amount of nicotine that makes them addictive. But he added that radical actions such as removing many products from the market would also hurt adult users, many of whom like to use flavored products. Without pleasant e-liquids, he says, convalescent smokers might be attracted to smoking.
"We help at least the tobacco industry because we protect cigarettes from competition and we focus on that other product," says Siegel. "We do what the cigarette industry wants us to do."
Time will tell how the government will tackle the enigma of the electronic cigarette. But as studies continue and youth use increases, one thing is certain: the e-cigarette debate is just beginning to heat up.
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