Written By: Jenna Birch
The surgeon general
has asked for “clarity” on controversial e-cigarettes. Here, top experts give
some.
“Vape” is the Oxford English Dictionary’s reigning Word of
the Year, and so far, electronic cigarettes are proving themselves one of the
buzziest, most divisive health topics of 2015.
We know tobacco
kills, and e-cigarettes, at least, seem to help people quit.
Research has indicated that e-cigarettes help people slow
their tobacco consumption, an October 2014
study showed that six months of vaping led 21 percent of participants
to quit traditional cigarettes, with an additional 23 percent cutting back by
half.
And according to a new British survey of 1,800 people,
e-cigs are replacing approved aids for quitting tobacco, too. They are now used
roughly twice as often as government-regulated nicotine gums, lozenges, and
patches across the pond. (Similar data does not yet exist for U.S. consumers.)
Meanwhile, the
California Department of Public Health just declared e-cigarettes a public health threat.
The week before last, a study claimed hidden high levels of the carcinogen
formaldehyde were found in e-cigs, potentially increasing lifetime cancer risk
by 5 to 15 percent.
The American Lung Association has also stated its fear of
the “potential health consequences” associated with the use of unregulated
e-cigarettes — with almost 500 different brands, 7,700 different flavors and
wide-ranging nicotine levels. ‘There is much to be concerned about, especially
in the absence of FDA oversight,” the organization said in a statement.
When it comes to e-cigarettes, there are those who argue for
the pros and there are those who voice the cons. There are no clear answers,
leading new U.S. Surgeon General Dr. Vivek Murthy to call for more guidance on
e-cigarettes use as an aid for smoking cessation.
“There’ve been theories and ideas around the fact that
e-cigarettes may be helpful from a harm-reduction perspective in helping people
who are already on cigarettes [and who] have had trouble quitting actually get
off cigarettes,” Murthy said on Tuesday, Jan. 27 in Richmond, Va., as part of a cross-country listening tour. “If the data indeed bears
that out, then I think we should absolutely embrace that and use e-cigarettes
in targeted ways.”
However, don’t mistake Murthy’s words for a wholehearted
endorsement. “I’m concerned about e-cigarettes, and I think this is an area
where we are in desperate need of clarity,” Murthy said. “I think it’s
important for us to understand the impact, particularly on youth, before we
allow the full-fledged spread of these e-cigarettes and then later have
problems that we have to deal with.”
What are those problems? Let’s take a look at the pros, the
cons, and exactly what we do and don’t know.
The Good
As previously mentioned, e-cigarettes aren’t all bad. They
do seem to help people who are trying to quit traditional cigarettes curb their
tobacco addiction, leading the surgeon general to say we could potentially use
these devices in “targeted ways.”
According to a 2013 study of 657 smokers published in theJournal of
the American Medical Association, e-cigarettes were as effective as nicotine
patches in helping people kick their tobacco habit for at least six months.
According to Charles Powell, MD, chief of pulmonary medicine
at Mount Sinai Hospital and a professor of medicine at Mount Sinai Medical
School in New York City. “they are essentially a delivery device for nicotine,”
he tells Yahoo Health. “Just like gum or patches, they have similar replacement
effects, and they’re potentially a more comfortable, attractive way to deliver
the substance.”
And there is some larger-scale research advocating for the
potential gains of e-cigarette use. According to a paper closely reviewing 41
key studies about the short-term health impact and effectiveness of e-cigs
published in the journalTherapeutic Advances in Drug Safety, “currently
available evidence indicates that electronic cigarettes are by far a less
harmful alternative to smoking and significant health benefits are expected in
smokers who switch from tobacco to electronic cigarettes.”
But after the switch from tobacco to e-cigs, what might
happen down the road?
The Risks
While you certainly could wean yourself off these electronic
devices, and therefore off nicotine, often e-cigs are a swap and not a means to
completely stop smoking (or vaping) altogether. “One could devise a strategy to
decrease use — that can be done,” Powell says. “But there’s really no one
marketing that approach, or advocating a plan to make it happen.”
And over time, healthcare providers are concerned about what
the substances in the vapors might do to the body. “We don’t know if the
devices are safe long-term, whether the nicotine amounts are safe, whether the
other additives are safe,” says Powell. “And the problem is that most people
who use these devices are under the impression that they are totally safe.”
For instance, a
study published in the journal Circulationshowed e-cig vapors are
high in nanoparticles that can trigger inflammation leading to health
conditions throughout the body, from asthma to cardiovascular disease, stroke,
and diabetes.
Even in the short term, there isn’t much research on e-cig
use — but they may still present health hazards. A
new studyfrom PLOS One shows the vapors in e-cigarettes may also
leave users vulnerable to viral respiratory infections.
According to Qun Wu, MD, Ph.D, an assistant professor in the
department of medicine at National Jewish Health who also worked on the study,
this effect was seen whether the liquid contained nicotine or not. “Short
exposure to propylene glycol, the primary ingredient in the majority of
e-liquid and e-cigarette cartridges, may cause acute upper airway irritation,”
she tells Yahoo Health. “E-liquids without nicotine and with nicotine inhibit
the lung’s innate immunity, which helps it defend itself against infections.”
Notably, the study also involved the cells of young
adolescents, a key group experts are worried about when it comes to the
long-term health repercussions of e-cigs.
The Youth Factor
The fact of the matter? Kids are getting hooked on e-cigs,
and use is continually on the rise. According to a CDC report late last year, the number of teens using
these devices has tripled over the course of two years — a major concern,
especially since last year’s surgeon general report pointed out the detrimental
effects of nicotine on brain development.
And kids aren’t trading up from the real stuff to a “safer”
alternative, says Powell: “There’s good data showing that young kids are
beginning to smoke e-cigarettes where they never smoked before.”
Not only that, but this group is most vulnerable to the
potential long-term ramifications of vaping — something we don’t know yet,
because e-cigs are so new, they are unregulated, and there is no evidence to
ensure their safety. “It took decades to see how detrimental the effects of
regular smoking were,” Powell says. “We can’t afford to make those mistakes
again here.”
On Vaping Pot
There’s also the issue of vaping pot, which we may know even
less about. While Powell says regulated use of marijuana for medicinal purposes
has its accepted role, there’s little data about the delivery of THC via a pen
or similar device. “Even the impact of marijuana cigarette smoking on lung
health and cancer risk is an unanswered question that requires further
research,” he says. “Oil is frequently used to deliver cannabinoids through
pens, and the health effects are unknown. They have not been shown to be safe.”
The little existing research is mixed, but benefits do seem
to be there. One study conducted in 2004, for instance, found vaping cannabis
may deliver fewer other potentially-damaging compounds when compared with
smoking it. However, that said, it’s possible vaping the oil is a shockingly
potent way to get high. According to a CNBC report, hash oil can contain up to 80 to 90 percent
THC, the main mind-altering chemical from the cannabis plant, versus 15 to 18
percent for traditional pot smoking.
The pot-vaping trend even seemed to worry Allen St. Pierre,
executive director of the National Organization to Reform Marijuana Laws, which
is a nonprofit advocating for the broader legalization of marijuana. “Between
the fact that you can potentially pass out with a single inhalation, or you can
have such property damage and potential bodily harm just producing it … these
[issues of the vape pen] definitely need to be addressed,” he told NPR. “This is a screaming call for regulation if there
ever was one.”
This is also a concern, because young people could
potentially use this method of delivery to get high in secret, at anytime.
Although she has a prescription, the NPR report used 19-year-old Nikki Esquibel
as an example. Virtually odorless and colorless, it could allow Esquibel to get
“stoned” without anyone knowing: “I use it mostly around my neighborhood,” she
said. “It’s easy to hide.” And with vaping picking up among teens, even in
classrooms, it’s an issue on some experts’ radar.
Why the Intense
Debate?
Check Google. Run a quick search of e-cigarettes. You’ll
find a slew of scary studies about vaping, coupled with a ton of advocacy
websites for their effectiveness.
Why can’t anyone seem to agree, yea or nay? Well, simply
put, there are two sides to every story. For instance, The New York Times ran a counterpoint to all the fear-inducing news
surrounding the recent formaldehyde study, noting the issues with the hubbub.
First and foremost, e-cigs aren’t vaped at high voltage (because of a nasty
taste), which is when those damaging levels of the carcinogen were produced in
the study.
After talking to the study author David Peyton, and
mentioning a tweet from the New England Journal of Journal of Medicine
indicating vaping carried a higher risk that smoking, writer Joe Nocera reports
Peyton was shocked. “I regret that,” he told him. “That is not my opinion.” The
aim of his study, he said, was simply to highlight there’s so much that we don’t
yet know about e-cigs.
Which is true. Medical professionals often cite the lack of
research and carcinogens in e-cigs as reason for caution — but e-cig users note
that they’ve kicked their tobacco habit by vaping instead. Ultimately, as the
surgeon general says, we are in major need of more scientific evidence to fill
in the gaps on long-term effectiveness or harm before rendering a final verdict
on vaping. And this takes time.
Powell does point out, however, that there are other
regulated ways to kick smoking habits that aren’t e-cigs. If you’re a smoker
who wants to quit, you may want to consider trying those first.
The Bottom Line
While we can’t snap our fingers and make evidence for or
against vaping appear, or get e-cigs FDA-regulated in one big leap, there is
one thing we can do: stop the bleed. As Powell says, many marketing campaigns
are not aimed at using e-cigs as devices to quit smoking tobacco.
One thing we know for sure is that we have to prevent
groups, like teenagers, getting hooked on e-cigarettes that were never tobacco
users in the first place. There’s no reason to risk long-term damage —that may
be forever.
“The health consequences of lung damage and injury, in
particular, tend not to be reversible,” says Powell. “We can treat the symptoms
and make things more comfortable — but it’s so hard to turn back time.”
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