Are E-Cigarettes Safer or Not?

On July 26, 2014, a vapor blowing competition was held in a bar in downtown Manhattan, New York, where participants blew various smoke shapes, resembling clouds.

Electronic cigarettes allow you to enjoy the pleasure of nicotine while avoiding inhaling dozens of carcinogens and other toxic substances. However, some researchers believe that electronic cigarettes are harmful and should be regulated like traditional cigarettes. Currently, there is a significant divide in the scientific community regarding electronic cigarettes, with opposing sides seemingly unable to convince each other.

The inventor of the electronic cigarette is Chinese. Ten years ago, Han Li, one of the founders of the company Ruyan, invented the modern electronic cigarette. Since then, this "cigarette" that does not require a lighter and does not contain over sixty carcinogens has become popular worldwide.

In a 2013 interview with French media, Han Li stated that although he is the inventor of the electronic cigarette, he has not made much money due to the large number of knockoffs and similar products on the market.

In the past decade, the variety of electronic cigarette products available has been astonishing. According to a study published in July 2014 by researchers including Shu-Hong Zhu from the University of California, San Diego, as of January 2014, there were 466 electronic cigarette brands sold online globally, with 7,764 different flavors, and these numbers continue to rise. In the 17 months leading up to January 2014, the number of electronic cigarette brands increased at an average rate of 10.5% per month, while the number of flavors increased by 242 each month.

In August 2014, Daniel Sarewitz, a technology policy researcher at Arizona State University, published a commentary in the journal Nature proposing a thought experiment related to electronic cigarettes.

Sarewitz hypothesized, what would happen if every smoker in the U.S. switched to electronic cigarettes? He pointed out that electronic cigarettes allow you to continue enjoying the pleasure of nicotine while avoiding inhaling dozens of carcinogens and hundreds of other toxic substances produced by burning tobacco leaves. "If all smokers in the U.S. used electronic cigarettes, the 480,000 annual deaths caused by smoking would ultimately be avoided," he wrote.

Sarewitz clearly supports electronic cigarettes, believing that the causal relationship between traditional cigarettes and disease is well established, and that electronic cigarettes are currently the best alternative. "Make smoking look uncool, expensive, and stupid, and make using electronic cigarettes look cool and smart. If people must be addicted to something, let them be addicted to something that won't bring cancer to themselves and their families," is his viewpoint.

However, Sarewitz's perspective does not represent the majority of researchers. In fact, there is a significant divide among scientists regarding how to view this new phenomenon, with opposing sides unable to convince each other.

Creating more smokers?

Although businesses often claim in advertisements that electronic cigarettes help with quitting smoking, some scientists are quite skeptical. This year, new data has led some researchers to believe that electronic cigarettes should be regulated like traditional cigarettes.

In July 2014, Jennifer Duke and colleagues from RTI International published a study reporting on the exposure of American youth to electronic cigarette television advertisements.

According to Duke's research, electronic cigarette companies' television ads reached 24 million teenage viewers in the U.S. The frequency with which teenagers saw electronic cigarette ads on television more than doubled from 2011 to 2013, while young adults saw them three times more often.

Other recent studies have also found that electronic cigarettes are mentioned frequently on social networks. In just May and June 2012, over 23,000 different users on Twitter posted more than 70,000 tweets related to electronic cigarettes. Nearly 90% of these tweets were commercial in nature.

Researchers are unclear about the proportion of teenagers among Twitter users, but those aged 18 to 29 account for 26%, which is twice the proportion of users aged 30 to 49.

Researchers have also found that the advertising techniques used for electronic cigarettes and their allure are increasing.

These latest research findings have led Stanton Glantz from the Tobacco Control and Education Center at the University of California, San Francisco, to believe that controlling electronic cigarettes is imperative. In August 2014, he submitted a comment to the U.S. Food and Drug Administration (FDA) stating, "The FDA should prohibit advertisements and promotions that claim or imply that electronic cigarettes are safer than traditional cigarettes or effective smoking cessation tools until manufacturers can provide sufficient evidence to the FDA that these claims are true."

Glantz has been calling for controlling smoking imagery among youth for several years. During the release of Transformers: Age of Extinction, he criticized the smoking scenes in the film for endangering American youth, noting that there are even more young viewers in China than in the U.S.

In March 2014, Glantz and colleagues published a paper stating that their findings show that electronic cigarettes do not encourage teenagers to stay away from traditional cigarettes; rather, they may encourage teenagers to become users of traditional cigarettes. They found that teenagers who use electronic cigarettes are more likely to use traditional cigarettes compared to their peers who do not use electronic cigarettes.

This conclusion sparked intense debate among his peers, and the journal that published Glantz's paper subsequently published a series of critical responses. The questioning researchers argued that the data provided by Glantz does not support his conclusion, and that he confused correlation with causation: while there may be overlap between the populations using traditional cigarettes and electronic cigarettes, this does not determine whether electronic cigarettes induce people to use traditional cigarettes or vice versa.

In an interview with Nature, Glantz later stated that those questioning his research did not accurately understand his paper, and he still insists that his conclusion is supported by the data. He believes that electronic cigarettes are leading more children to use nicotine and more children to start smoking traditional cigarettes.

In a set of data published in 2013, the Centers for Disease Control and Prevention (CDC) stated that from 2011 to 2012, the proportion of high school students in the U.S. who had tried electronic cigarettes rose from 4.7% to 10%.

As a result, CDC Director Tom Frieden publicly stated, "The rise in electronic cigarette use among youth is deeply concerning." He also said, "Nicotine is a highly addictive drug. Many youths who start with electronic cigarettes may face a lifetime of addiction to nicotine and traditional cigarettes."

However, researchers with opposing views argue that teenagers enjoy trying new things—this is what the data reveals. They believe that the current data is insufficient to support Frieden's claims. In response, Nature wrote: "If they (electronic cigarettes) lead to the use of traditional cigarettes, then smoking rates should have already risen... This does not seem to have happened—smoking rates are generally declining in developed countries."

Is it harmful?

Another core issue of heated debate among tobacco and health researchers is whether electronic cigarettes are safe, or whether they pose certain threats to human health.

The American Cancer Society's stance on electronic cigarettes is: "Until electronic cigarettes are scientifically proven to be safe and effective, the American Cancer Society supports regulating them like traditional cigarettes." In July 2014, the American Thoracic Society issued a statement saying, "The safety of electronic cigarettes has not been adequately proven... The addictive effects of nicotine and its abnormal effects should not be underestimated." A large number of lawyers have also jointly written to the FDA, further stating that "electronic cigarettes should be considered harmful and addictive."

These statements were dismissed by Sarewitz as "nonsense." In his thought experiment, replacing traditional cigarettes with electronic cigarettes clearly has more benefits than drawbacks.

Regarding the safety of electronic cigarettes, there are indeed some concerns in the scientific community, but current research results make it difficult for experts to determine how safe they really are.

For example, aside from the health effects of nicotine, researchers are concerned about another substance: propylene glycol. This substance is key to the vapor produced by electronic cigarettes, and it is actually the same as the smoke-producing substance used on stage. Propylene glycol is generally considered safe in most cases, but at high concentrations, such as on stage, it may irritate the respiratory system. The scientific community lacks research on the long-term effects of inhaling propylene glycol.

In April 2014, at the American Association for Cancer Research annual meeting, a group of researchers from Boston University reported that they found that the gene expression of bronchial cells exposed to medium concentrations of electronic cigarette vapor in the laboratory was similar to that of cells exposed to tobacco smoke. In this regard, there was no difference between the two.

However, since this is an early study, researchers cannot conclude whether electronic cigarettes will cause cancer. "They may be relatively safe, but our preliminary results show they are not mild either," the researchers said at the time.

Nature also mentioned in a recent report that a study published this year found that using electronic cigarettes, like using traditional cigarettes, reduces the amount of carbon monoxide exhaled by users, which may indicate changes in lung function.

These are early studies on electronic cigarettes. The commonality among these studies is that they seem to show that electronic cigarettes are not as safe as people think, but the research results are not conclusive.

Many scientists do not believe that current scientific research can provide answers to the dilemma of electronic cigarettes. Amid the debate, restrictions on electronic cigarettes have already begun.

Several leading scientists in electronic cigarette research wrote to the World Health Organization (WHO) in May 2014, stating that restricting electronic cigarettes would be counterproductive, effectively protecting the traditional cigarette market. However, in August, the WHO still published a report recommending limiting the use of electronic cigarettes indoors, banning the production of certain flavors, and restricting sales of electronic cigarettes to adults over 18 years old.

Earlier, the European Union modified its cigarette product policies, imposing restrictions on the production standards and advertising of electronic cigarettes. Singapore and Brazil have fully banned electronic cigarettes. The U.S. FDA is attempting to regulate electronic cigarettes like traditional cigarettes.