A new review of medical and public health research on e-cigarettes concludes that tobacco-style regulation is unjustifiably strict, but also suggests that further research is needed on health effects and the relationship of e-cigs to smoking.
Five European and American scientists examined 81 separate papers that contained original evidence on e-cigarettes, published up to February this year, for their article in the journal Addiction.
They conclude that from the perspective of public health and science-based regulation, “the key issue to consider is whether e-cigarette use is likely to increase or decrease smoking-related morbidity and mortality”, and identify several ways in which this could happen.
As possible negative effects of e-cigarettes, they name harm from chemical constituents of e-liquid or aerosol; continuation of smoking through dual use; e-cigs acting as a gateway to smoking for young people; and e-cigarettes re-normalising smoking. They conclude that little or no evidence exists to suggest any of these effects exist.
But importantly, they also say that while e-cigarettes are capable of diminishing smoking-related harm at the individual level through reducing cigarette use, it is not clear whether this positive effects also occurs at a population level – in other words, whether e-cigs are contributing to an overall decline in smoking, or simply aiding a few individuals. “
“The effect of e-cigarette use on cigarette consumption on the population level has not been established so far,” they say, and urge that two questions be given priority by researchers:
- “Ongoing surveillance of the temporal relationship between country-specific markers of e-cigarette use and smoking behaviour”, and
- “Epidemiological studies…that compare health outcomes in cohorts of regular e-cigarette users with matched cohorts of smokers and non-smokers. These need to be supplemented by laboratory and clinical studies of e-cigarette contents and effects on smoking behaviour.”
No such thing as monsters
Their paper, “Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit”, also addresses some specific points often raised by those concerned about the health impacts of e-cigarettes.
On poisoning, it says that “the number of such reports is remarkably low”. On dual use, it suggests that data “show consistently that smokers who use e-cigarettes and smoke at the same time (so-called dual users) reduce their cigarette consumption”. On attractiveness to young people and the supposed gateway-to-tobacco role of e-cigs, it reports: “Experimentation by children is a small fraction of experimentation with cigarettes, and daily use in never-smokers has not been documented so far.”
The paper recommends that “allowing e-cigarettes to compete with cigarettes in the marketplace might decrease smoking-related morbidity and mortality. Regulating e-cigarettes as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence.”
It adds that “health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to e-cigarettes as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use”, although it acknowledges that with fewer than 15% of smokers who try e-cigarettes becoming daily vapers, the products “in their current form are less satisfactory than cigarettes to most users”.
The new article in Addiction was written by Peter Hajek and Hayden McRobbie of the UK Centre for Tobacco and Alcohol Studies and Queen Mary University of London; Jean-François Etter of the University of Geneva; Neal Benowitz of the University of California, San Francisco; and Thomas Eissenberg of Virginia Commonwealth University in Richmond.
Hajek and Etter, in particular, are well-known in public health circles as supporters of e-cigarettes.
What This Means: By its nature, a review like this contains nothing startlingly new. The value it may well have is as an antidote to the drip-feed of research with less optimistic conclusions.
Of course, research that casts doubts on e-cigs’ public health value is no bad thing; all honest study is valuable in a field with so many questions. But particularly on emotive issues like youth vaping, that drip-feed is often turned into a torrent by e-cigs’ opponents and the media.
By contrast, this new paper – which has already received ample media attention itself – provides a coherent overview for those looking to rebut reliance on single studies, and makes useful linkages to practical regulatory and healthcare questions. It will be no surprise to see it quoted widely as the debate continues.
– Barnaby Page ECigIntelligence staff
Photo: Samantha Marx