Are e-cigarettes harmful to health, and is there evidence of the harm?

Are e-cigarettes harmful to health, and is there evidence of the harm? The debate over e-cigarettes continues. This year, the 315 event exposed e-cigarettes again, promoting the idea that they are harmful to health. Not long ago, Luo Yonghao began to vigorously promote the Flow e-cigarette, and Fang Zhouzi subsequently published an article pointing out the harms of e-cigarettes, sparking further discussions on the topic. The recent 3.15 gala has brought widespread attention to e-cigarettes. So, do e-cigarettes really pose a risk? The smoke is thick with uncertainty.

The harm of e-cigarettes has not been clearly defined.

The stakeholders in the production and sale of e-cigarettes have put forth many supporting arguments. For example, when using e-cigarettes, nicotine is vaporized and absorbed, and since they do not require combustion, they do not produce carcinogens and have no secondhand smoke issues. They can also help smokers quit. Among the most frequently cited evidence is a report from Public Health England, which states that "the harm of e-cigarettes is 95% lower than that of traditional cigarettes," leading these stakeholders to conclude that the harm of e-cigarettes is almost negligible.

Serious scientists, however, tend to be more cautious in their wording. Without more research conclusions, scientists can only qualitatively point out that e-cigarettes contain fewer types and lower quantities of toxic substances compared to traditional cigarettes, thus posing far less health risk than traditional cigarettes.

For instance, David Eaton, the associate dean of the University of Washington's graduate school, stated in his investigative report: "It's hard to simply say whether e-cigarettes are good or bad. In some cases, they can help adults with a smoking habit quit, which is beneficial for reducing the risk of smoking-related diseases; but in other cases, they may induce non-smokers, especially teenagers, to try them, which is concerning." On one hand, some assert confidently that "e-cigarettes can reduce harm by 95% compared to tobacco and can help with quitting, clearly a health product," while on the other hand, it is "hard to simply say whether e-cigarettes are good or bad." This creates a misleading impression among the public that the harm of e-cigarettes may not be that serious.

Researching the potential health hazards of a product often takes a considerable amount of time to determine, and such research can be obstructed by vested interests. So how should the public face these disputes? The conclusion that cigarettes are harmful to health has now become a basic consensus. We might as well look into the history of the discoveries regarding the harms of cigarettes to understand the public health issue of e-cigarettes.

Tobacco originated in the Americas in the 9th century.

Tobacco was first discovered in Central and South America in the 9th century, where local Indians used it in religious ceremonies. In ancient times, shamans were also physicians, and the sacred tobacco used in rituals was naturally believed to be able to treat various diseases, thus becoming an important economic crop in the region.

In the early 17th century, tobacco was used as a form of currency for trade between Indians and colonizers, and it was "as good as gold!" Its importance is evident.

I personally prefer to anchor the origin of tobacco to 1528, when the Spanish introduced tobacco to Europe during the Age of Exploration. In 1560, the French ambassador to Portugal, Jean Nicot, gifted tobacco seeds to the French king, claiming it had miraculous effects. People began to believe that smoking could prevent diseases—especially plagues. The nicotine we know today is named after him.

During the same period as Li Shizhen, the famous Spanish physician and botanist Nicolás Monardes wrote a book as legendary as the "Compendium of Materia Medica," titled "Medicinal Plants of the New World (referring to present-day Americas and Australia)." In this book, he claimed that tobacco could be used to treat over twenty diseases.

Later, Europeans continued to embellish tobacco, and by the Elizabethan era, the famous Sir Walter Raleigh firmly believed and promoted the various miraculous health benefits of tobacco.

Sound familiar? History is astonishingly similar.

Tobacco expanded globally with the tide of industrialization.

As an important economic crop, tobacco expanded worldwide, entering its heyday after the invention of the first cigarette machine in 1847.

The industrial age not only greatly improved the efficiency of spinning but also of cigarette production. At that time, the production of cigarettes by tobacco companies surged from 40,000 per day in the handmade era to 4 million per day. From then on, cigarettes swept the globe due to their easy availability, maintaining significant growth.

Before the emergence of tobacco, lung cancer was rare; until 1761, people did not even consider lung cancer a distinct disease. Detailed records of lung cancer only began in 1810. In 1878, malignant lung tumors accounted for only 1% of cancers found during autopsies, but by the early 20th century, this proportion had risen to 10%-15%.
Despite some questioning voices during this period, no one believed there was any connection between these diseases and tobacco. This situation continued until 1929, when a German internist, Fritz Lickint, recognized the direct link between smoking and lung cancer, which drew the attention of the medical community. In the following decades, as research deepened, new evidence of the health hazards of smoking emerged continuously.

Finding evidence of tobacco's harm to health took a long time.

In response to these new developments, tobacco companies were also active. In 1958, American tobacco manufacturers established the "Tobacco Industry Research Committee," later renamed the Tobacco Research Council. Each member company contributed based on sales ratios, aiming to protect the interests of tobacco companies, attack scientific research, and lobby the government and Congress to safeguard the interests of tobacco manufacturers.

This association represented the interests of the tobacco industry, influencing American politics and economics in various ways: first, influencing American legislation; second, affecting American administrative agencies; third, impacting tobacco farmers; fourth, the American Tobacco Association's influence on society and the economy; fifth, the impact of tobacco advertising on society; sixth, the struggle between the tobacco industry and anti-smoking organizations; seventh, the influence of the tobacco industry on smokers in litigation.

The powerful weapon of this Tobacco Research Committee to question scientific research was "correlation does not imply causation." The aforementioned evidence was based on epidemiological surveys, which, while proving a strong correlation between smoking and lung cancer, could not conclude that smoking causes lung cancer. Due to ethical constraints, scientists could not conduct experiments on humans to find evidence. Therefore, this causal relationship was only confirmed after the maturation of genetic technology.

In 1996, a potent carcinogen found in cigarette smoke—benzo[a]pyrene—was discovered. Scientists found that this substance not only causes mutations in the p53 gene but is also a major risk factor for K-ras mutations, and the p53 gene is crucial for regulating cell division.

Further research has also found that, in addition to lung cancer, smoking increases the risk of head and neck cancer, pancreatic cancer, bladder cancer, and several other cancers. The discovery of benzo[a]pyrene is regarded as the "final evidence" that smoking leads to lung cancer, after which tobacco companies could no longer use "correlation does not imply causation" as a shield.

Science will ultimately provide us with the answer.

Today, looking back at this history, we find that the truth is hard-won. Not only is benzo[a]pyrene in tobacco like this, but so is aristolochic acid in plants. Finding evidence of tobacco's harm to health took more than half a century; with current technological means, finding the harm of e-cigarettes may not take as long, but it will still require a significant investment of time and funding. The truth never falls from the sky.

History also reminds us that before making a new factual judgment, learning from similar histories can provide multidimensional understanding and serve as an anchor for self-identity. Tracing history should follow scientific principles, and if we use metaphysics or other means as this anchor, these pursuits that begin with misunderstandings and deceptions, despite having divergences in the development process, will ultimately be denied.

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