The industry markets e-cigarettes as a safer alternative to conventional cigarettes, but this may be a misleading branding. In September, the Government of India decided to ban the manufacture and sale of e-cigarettes.1 This decision follows an appeal by the WHO to all member states.
Although the health risks posed by e-cigarettes and vaporizers have been increasingly widespread in the media and scientific research platforms, the message does not seem to have reached many consumers.
In some forums, many opinions read like the following: "... despite the media propaganda against the e-cigarette, more and more people are switching to the e-[vaporizer] and so far I have not heard of anyone who has fallen seriously ill because of vaping. I myself have also been steaming for half a year now, and I must honestly admit that I have felt much better since I stopped smoking the cigarettes and shifted to vaping".2
Another forum participant has written that "e-cigarettes are fine to quit. You can continue puffing and break the habit of buying and smoking cigarettes."3 The vaping user can calm their conscience, can maintain the rituals of smoking and arguably also no longer have to tackle the physical dependence on nicotine. Yet, few quitters use the nicotine-free liquids and even these are not harmless.
In contrast to the scientifically proven nicotine-containing and nicotine-free therapeutical approaches, which are exempt from the risks posed by e-cigarettes (and can help smokers to quit), the WHO does not advocate e-cigarettes as smoke-quitting aids. A press release from the Government of India states: "The likelihood of interference by the tobacco industry in tobacco cessation efforts through misinformation about the potential benefits of these products, which are presented as alternatives but in many cases are complementary to the use of conventional tobacco products, is an actual and real possibility"4.
E-cigarette critics are sometimes lumped together with lobbyists. The pharmaceutical industry is a thorn in the side of the e-cigarette-based smoking cessation, and as the tobacco industry is losing profits, the state is missing out on the millions in tobacco tax revenue due to vaping.3 But all this misses the core of the problem. The danger lies in the marketing of e-cigarettes as a "much healthier alternative". Even cigarettes without filters or chemical additives do not deserve the term "healthier".
Regardless of whether e-cigarettes are worse than conventional cigarettes, the best strategy is simply to keep your hands off both. Why is it better to think about how to substitute smoking instead of how to stop it? Many teenagers are being socialized within a new wave of social norms that sees the smoking of traditional cigarettes negatively. But such norms are becoming more lenient on vaping, coupled with a rise in offers, designs, flavors, and marketing strategies that see vaping as a "real option" to cigarettes.
At present, it is simply far too early to assess the actual extent of the higher risk for diseases with long latency periods posed by the vaping wave. It took years before there was a robust body of evidence on the health consequences of smoking regular cigarettes, and then again years before this evidence arrived loud and clear in people's everyday lives.
E-cigarettes give somewhat pleasant (but chemically based) aromas and rid us of the classic, acrid cigarette smoke, giving the habit a veneer that promotes the subjective feeling that no harmful compounds are produced at all. This makes it justifiable for some, to pull out the e-cigarette near children, at the cinema or in public transportation, because it is "not really" tobacco or a burning smoke after all. The perception that it is harmless is simply wrong. Liquids for e-cigarettes contain various chemicals and contaminants that are harmful to our health. Many lung diseases have been linked to e-cigarette smoke in scientific studies, among these alveolar hemorrhages, acute interstitial pneumonia, bronchiolitis, and pneumonitis.5 The association between many of these diseases and the future development of lung cancer is also well documented.
A study6 published in the New England Journal of Medicine in September 2019 reported on 53 patients who were part of a study on lung diseases in two US states. All participants were vapers with a median age of 19 years. 50 had to be hospitalized, 48 had a conspicuous thoracic x-ray finding (with complications such as pneumomediastinum, pleural effusion, pneumothorax). Common symptoms in first medical consultations included shortness of breath, cough, chest pain and gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain). The majority of patients were admitted to intensive care because of respiratory insufficiency (9 of them with acute respiratory distress syndrome or ARDS). Since June 2019, over 200 such cases have been described in 25 US states. The increasing frequency of pulmonary diseases associated with vaping must attract more attention from legislators. Already in 2018, and in October 20195, the Lancet Oncology published extensive editorial pieces on the need for vaping regulatory frameworks.
Unfortunately, the prevalence of vaping is highest among young people, especially teenagers. In American high schools, the popularity of e-cigarettes has doubled from 2017 to 2018.
Following an investigation on advertisement practices, the U.S. Food and Drug Administration issued a warning to the manufacturer 'Juul'. The company had illegally advertised its e-cigarettes as less harmful than regular cigarettes and used a targeted campaign to children and teenagers, by deploying advertisements in places such as schools and summer camps.5 Similar methods were used by the tobacco industry for a long time until stricter laws were introduced.
References:
1. Changes in e-cigarette policies worldwide. The Lancet Oncology 20, 1487 (2019).
2. (In German only): Was ist eure Meinung zu E-Zigaretten? GameStar-Pinboard https://www.gamestar.de/xenforo/threads/was-ist-eure-meinung-zu-e-zigaretten.460621/.
3. (In German only): Stöver, H. & Jazbinsek, D. Weltnichtrauchertrag: Was Lobbyisten gegen E-Zigaretten haben. Die Zeit (2018).
4. Press Information Bureau. https://pib.gov.in/PressReleseDetail.aspx?PRID=1585437.
5. Oncology, T. L. Vaping-related lung illnesses: time to act. The Lancet Oncology 20, 1327 (2019).
6. Layden, J. E. et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report. New England Journal of Medicine 0, null (2019).