Electronic cigarettes are certainly less harmful than smoking. But “better than smoking” does not necessarily mean that they are “good for you”
For decades, doctors and governments have been trying to get rid of smokers from their harmful habit, but it has proven to be a very difficult task because nicotine is addictive as quickly as heroin or cocaine. Fortunately, there are a lot of officially approved methods to quit smoking. People can try inhalers, gums, pills, patches, nasal sprays and prescription drugs. Everything can help, but few of these methods successfully replicate the ritual surrounding cigarettes, and this limits the attraction in front of the poorest of smokers.
Given these problems, e-cigarettes came about a decade ago. Unlike ordinary cigarette burning cigarettes, electronic cigarettes use an electric charge to vaporize a dose of nicotine (often accompanied by various flavoring chemicals). These have proved extremely popular, especially in America, the United Kingdom and Japan, where health officials have quickly come to the conclusion that they are much better than smoking. Consumers, says Robert West, a professor of health psychology at University College London, “vote with their lungs.”
However, not everyone is happy. E-cigarettes are relatively new, so information on side effects is still scarce. Others worry about who is using them. The Food and Drug Administration (FDA) says it has data that it will release in the coming months and shows an “epidemic” of vaping among adolescents. Recently, the FDA has announced to the vaping companies (starting with Juul) that they must do everything possible to combat young people’s vaping, or they will face sanctions. How worried should the rogues – or their parents, be?
Chemistry is the best place to start. Cigarette smoke is a really nasty thing. It contains about 70 carcinogens, such as carbon monoxide (poison), particles, toxic heavy metals such as cadmium and arsenic, oxidizing chemicals and other assorted organic compounds.
The composition of electronic cigarette vapors varies between brands. A good estimate suggests that instead of thousands of different compounds in cigarette smoke, they contain only hundreds. Its main ingredients – propylene glycol and glycerol – are considered harmless when inhaled. But it is not 100% sure. People with chronic exposure to steam clouds used on stage for special effects (containing propylene glycol) have reported respiratory problems. Nitrosamines, a family carcinogen of chemical substances, were found in electronic cigarette vapors, but at a very low level, considered insignificant. The metal particles in the heating elements of the device, such as nickel and cadmium, are also a concern.
Some studies have found that e-cigarette vapors may contain high levels of non-friendly chemicals, such as formaldehyde, acetaldehyde and acrolein, all derived from other ingredients exposed to high temperatures. Vapors also contain free radicals – highly oxidizing substances that can damage tissues or DNA and are considered to be largely aromatic. According to works published in January, flavors such as cinnamon, vanilla and butter generate the majority of this type of substance.
Several studies on mice have confirmed that vapors can induce an inflammatory effect on the lungs. In June, for example, Laura Crotty Alexander of the University of California, San Diego, published with her colleagues results that show that electronic cigarette vapors have a variety of unpleasant effects, which can cause kidney dysfunction and thickening and scarring of connective tissue from around the heart – fibrosis. Their data suggest that vapors may also disrupt the epithelial barrier that lines the lungs, triggering inflammation. They speculate that this could facilitate the agglomeration of bacteria. This information coincides with the recent work of Lisa Miyashita of Queen Mary University in London, who found that vaping makes cells cover the airways and is more susceptible to bacterial colonization.
All this information sounds very worrying, but it must be treated with a certain dose of skepticism. An alarming August study showed that electronic cigarette users are more likely to be diagnosed with cardiovascular disease. But many sailors have smoked in the past, or still do. It is possible that these studies interpret the old habits of smoking cigarettes instead of those caused by vaping. Many believe that the toxic nature of electronic cigarette vapors is exaggerated by unrealistic laboratory conditions. Overheating the liquid creates an unpleasant taste that users actively avoid. Laboratory tests can heat the fluid more energetically than it does under real conditions, for example.
The last piece of the puzzle is nicotine. In addition to causing addiction, it is known to have an adverse effect on the whole body. But the current source of concern is the adverse effects on children. For example, animal studies suggest that nicotine exposure may influence the brains of adolescents, making users later in life predisposed to other addictive substances. This could be one of the reasons why young people who start smoking are more likely to become addicted to adulthood. It may also mean that those who start vaping at a very young age are likely to remain long-term nicotine addicts and even quit smoking. However, says Dr. West, these issues have not been confirmed by epidemiological studies.
Smoking during adolescence has also been associated with long-term cognitive and behavioral disorders, including memory and attention. Animal tests suggest that exposure to nicotine could specifically explain at least some of these effects. All of these form the scientific context of FDA concerns about the effects of vaping among young people.
Unfortunately, getting definitive answers takes time. Epidemiology is a very difficult field, and the multitude of factors included as well as past connections can lead to unintended conclusions. Traditional smoking has been noted in medical history as a fun as unhealthy as there are no doubts about the effects caused by them. As for electronic cigarettes, it will take longer until we really know if and what the side effects are.
While all this information is often frustratingly vague, they do indicate at least one clear conclusion – whether it is completely harmless or just moderately bad for you, vaping is definitely healthier than smoking. This is the message that must be spread, especially when one third of smokers say they have not tried electronic cigarettes because they are concerned about their safety and dependence. This attachment to an evil habit is self-destructive. At least for the moment, despite all the obstacles and influences generated by the tobacco industry giants, electronic cigarettes have proven to be innovative and beneficial to public health.
Vaping, smoking, driving, voting – when you are an adult?
At the level of the United States, one of the most recent government regulatory acts aimed at saving us from ourselves is the growing number of states that have a minimum age of up to 21 years to buy tobacco or vaping devices. As CBS News reports, Illinois is among the latest states to watch this movement.
It is a national impulse. More and more states are increasing the legal age to buy tobacco and vaping products from 18 to 21 years old. This measure responds to what some officials call a public health crisis. Illinois has joined New Jersey and six other states in raising the age limit. While statistics show that tobacco continues to lose popularity among young people, vaping is likely to increase in popularity among students in general and high schools.
Now comes the interesting part. Congressman Robert Adelhort of District 4 in Alabama introduced legislation that could make 21 the legal age for tobacco or vaping products throughout the United States. As a first impression, you might find this idea appealing. Ultimately, no one wants more young people to smoke or become addicted to nicotine. What could go wrong?
However, there were two questions that we must ask here. First of all, is this really a federal issue? Where does the federal government get the power to push this level of regulation over all states? Each state sets, as their citizens consider, the minimum age for other things, especially for marriage. The same applies to driving licenses and other government permits.
But there is an even more important question that relates to all these regulations, including the purchase of alcohol or tobacco. It is known that there is an understanding in America that under a certain age you are considered a child and you are not entirely responsible for all your actions and their consequences. Beyond this limit, without any serious deviation, you are considered an adult and responsible for the decisions you make, as well as being assigned all the rights that come with maturity.
With this in mind, the following hypothesis must be considered: if you are not mature enough to buy alcohol, tobacco or vaping products, you are not an adult who can be entrusted with making such decisions. And if you are not old enough to be considered an adult, then how can you have the right to fight and die for your country, to vote or to drive a car !?
In response to the first question above, it should be noted that these are issues that are solved at the level of each state (there is an argument that the minimum age for military service or voting in national elections is a federal issue). Although it is possible that at the end there are 50 different minimum ages that define maturity, as we justify and say that you are “adult” at sixteen when you want to drive a car, but you are a child up to 18 years old if you want to get married or vote? And then you go back to being a child for another three years if you want to drink a beer or light a cigarette?
The idea is that little consistency would not spoil from one state to another, the current system being devoid of any logical trace.
The relationship between the developed world and nicotine is changing. Between 2000 and 2015, the number of smokers decreased by 29 million. This decline has not been evenly spread around the world – China now accounts for 44% of all cigarettes that are smoked every year, for example. But in many western countries the most popular addiction on the planet is rapidly becoming obsolete.
But some are afraid that we are just replacing one addiction with another. Vapor is booming worldwide, and the US federal drug administration wants to oppose the use of e-cigarettes. San Francisco officials are even thinking of the total ban on e-cigarette sales, pending the review of their impact.
Why have anti-smoking measures been so successful in some Western countries? And should the same tools be directed against electronic cigarettes?
The World Health Organization (WHO) is pursuing, by 2020, a 30% decrease in the prevalence of smoking among those over 15 years. Very few countries are on track to achieve this, with the UK being one of them.
“The UK had one of the most comprehensive approaches in the world, but there was nothing unique or particular about what we did,” said Marcus Munafo, a professor of biological psychology at the University of Bristol, an addiction specialist.
“All British tobacco control policies – which were the world’s leaders at the time – have been implemented in other corners of the world, but the UK is one of the few countries that implements them all,” Munafo said.
Britain began to face smoking as a public health epidemic in 1962, when a report from the Royal College of Physicians described the countless harms of the habit.
The paper recommended restricting tobacco advertising, raising taxes, banning cigarette sales to children, and disseminating more information on the tar and nicotine content of cigarettes. Three years later, tobacco ads were banned on television.
The response of civil society in the early days has been limited by education, said Deborah Arnott, Executive Director of Action on Smoking and Health (ASH), one of the largest charities in the UK that has been fighting against the big corporations in the industry. tobacco. “There have been advertising campaigns and public awareness efforts, but there have not been many political measures that could have had a significant impact on the health of the population.”
In the decades that followed, ASH and other activists made the government devise a number of measures: to increase the number of smoke-free areas, to increase taxation, and to restrict advertising on multiple media channels.
The crucial fight, according to Arnott, came at the end of the twentieth century. The government has now expressed an increased interest in controlling the tobacco industry, but has not offered too many policy measures globally.
ASH and others have started lobbying for a complete ban on smoking in public places, based on a central idea: the legislation does not interfere with smokers ‘rights, but instead fights for citizens’ rights to live in a deprived environment. cigarette smoke. The focus on the damage done to others has opened the door to substantial changes.
After years of resistance, a multilateral campaign forced the government to act: in 2007, smoking was banned in all workplaces and in closed public places.
“There is no better way for young people to adopt something new than to be told that they should not do so.”
“It was a real turning point,” Arnott said. The difference from smoking bans was the common commitment of competing rights of smokers and non-smokers: before these measures, interfering with smokers’ rights was considered taboo.
Following the ban, other innovative solutions have cemented the success of the campaign: in 2015, smoking in cars with children under the age of 18 was banned. In 2016, a high-level battle concluded that large tobacco corporations would give up and ban all colored packaging, which was replaced by a simple brown-green package, with scary images about the effects of smoking.
Today, about 16% of the British population smokes, compared to 46% in 1974. “An important aspect in tobacco control is that there is no universal measure, but a number of policies are needed, each with a small effect, but whose compound effect becomes significant, “said Munafo.
“The impact is attributed to individual policies, but there is a reference point where tobacco consumption becomes much less visible. Compared to 20 years ago, tobacco products are much less present in the UK: there is no ads, no tobacco product listings, no vending machines – fewer people smoke. ”
In the US, media institutions and government bodies have reacted strongly to figures showing a 78% increase in adolescents from 2017-2018, reports Scott Gottlieb, FDA director until very recently, calling this phenomenon an “epidemic.”
The UK, on the other hand, has encouraged smoking as a tool to give up cigarettes, including on NHS sites. A large clinical study, published this year, found that when combining electronic devices with face-to-face support, people quit smoking with a double success rate compared to nicotine or gum patches.
“The British approach to vaping was unique: I considered boating to be a good tool for people to stop smoking and should be encouraged in this context,” Munafo said.
As a consequence, Munafo added, boating in the UK is often considered a conservative measure of middle-aged people trying to quit their habit of smoking once and for all, not as a rebellious act generated by a new generation of people. adolescents.
“The American approach seems to be the glamorization of young people,” Arnott said. Munafo emphasized the point: “There is no better way to get people to start smoking, especially young people, than if you tell them they shouldn’t do it.”
Arnott expressed particular concern about how American statistics place smoking and smoking under the same tobacco category, equating the dangers of the two – while science suggests they are incomparable. A study by the UK Ministry of Health has shown that smoking is about 95% less harmful than smoking.
“Nobody is saying that we should have a free market approach,” Munafo said. In the UK, there are age restrictions, health warnings directly on e-cigarette liquid bottles, restrictions on liquid formulas and ads that are banned on TV before 9pm.
“There is a middle way in which we can encourage smoking as a method of quitting cigarettes, while trying to minimize the use of electronic devices,” he added.
It should be understood that public health institutions and researchers have an obligation to tell the truth. In principle, there are not many stakeholders in e-cigarette research who would argue otherwise. But questions about and how information about e-cigarettes should be communicated have been extremely controversial.
Much of the confusion is due to the fact that electronic cigarettes do not exist for a long time, and longitudinal studies require time.
But, although various studies and debates on US e-cigarettes have increasingly acknowledged that smoking is less harmful than traditional cigarettes, the American public has increasingly believed the opposite. It is unlikely that these results are due to isolated negative cases or hasty conclusions, it is certain that people have been flooded with different messages about electronic cigarettes, and this message is false.
Many of the young shipmates interviewed expressed their disappointment and confusion about “propaganda” with electronic cigarettes. They want public health messages to be “more rational” about the vat, so they can rely on news to inform their own decisions. Instead, they felt that many public health campaigns are using fear to mistakenly suggest that electronic cigarettes are at least as harmful as normal cigarettes. Such campaigns not only were perceived as sensational and insecure, but they also did not present relevant information that outlined vaping as a way to quit or reduce smoking damage:
They are trying to say that vaping is not better … Example: “Of course, electronic cigarettes are healthier … if inhaling toxic chemicals sounds healthy to you …” This type of information is simply misleading. It does not really educate the public about the reality of the situation.
While science cannot represent static and absolute truth (as Karl Popper very well notes: “scientific truth is different from certainty”), knowledge about a body of scientific evidence at all times is “there” and well-known. In the case of electronic cigarettes, some claims are better supported by evidence than others.
Institutional trust does not depend on the particular understanding of an institution of “absolute truth” as much as it is based on pure truth. In biomedical ethics, the truth refers to an active process of informing patients about a state of health. If withholding information from patients with terminal illnesses was once accepted in the US, they must now tell patients what they want to know. Exchanging information based solely on what is supposed to be “one’s own good” is not the truth; to tell someone the truth must correspond to their concerns.
Obviously, there are divergences in the field of public health regarding the ethics and implications of nicotine products. But public health institutions do not have to agree on these issues to practice the truth and to respond to the people they serve. Even the most reserved conclusion about e-cigarettes has an impact on trust. As Americans view the withholding of information about a medical condition as condescending and harmful, the study participants did not want to be protected:
“You could say that vaping is less harmful, right? But then they reduced it again … And so it is, we all know. But it’s still healthier than cigarettes. What I mean is: quit -make my decision. Give me all the facts, but all the facts and I will make a decision myself. “
What would a potential ban on e-cigarettes mean for large tobacco corporations?
According to a report by The Washington Post, the US Food and Drug Administration (FDA) is in the process of blocking gas stations and conventional stores from selling electronic cigarettes with flavors, easily accessible to children. The ban comes as a measure to combat what the FDA calls a “young people’s vaping epidemic.” But depending on how the ban goes, it could be a big win for Big Tobacco.
This is not a total ban on vaporizers, according to a publication citing an anonymous FDA official. Petrol stations and recreational stores may continue to sell peppermint or menthol cartridges (pods), but not those such as mango or nectar (it is unclear if tobacco flavorings will be allowed). Sales of flavored products will, however, be permitted in profile and tobacco retailers, as well as in online stores with strict age verification settings. The restrictive measures do not target open atomizers, reports Post.
We do not yet know exactly how the ban will work or if there will be one. (FDA refrains from any kind of comments). However, if the ban described by the Washington Post goes further, it will generally affect closed-bridge devices. This will affect those at Juul the most, says Jidong Huang, associate professor at Georgia State University, a specialist in tobacco economics. Some of Juul’s popularity is based on his aromas, he says. Since Juul has more than 70% of the US e-cigarette market, their cutting in front comes as positive news for other tobacco companies whose cartridge systems (pods) are not as competitive.
In addition, traditional smoking is at an all-time low. Public health experts say that we cannot attribute the decrease in smokers by increasing the popularity of electronic cigarettes. But most adults who use e-cigarettes also use cigarettes, which means that large tobacco companies are losing out on the tobacco delivery market. Analysts say that what is bad for Juul is good for tobacco companies, including those who have re-profiled electronic cigarettes. “We continue to believe that any FDA action to restrict e-cigarette sales to minors will benefit tobacco producers,” says Bonnie Herzog, chief executive officer of Wells Fargo Securities LLC.
Juul works independently of the big tobacco companies, as opposed to brands such as Blu, Vuse and MarkTen. Removing flavored cartridges from store shelves is unlikely to hit Big Tobacco in your pocket, says Huang. Ultimately, tobacco giant Altria has decided to withdraw its flavored products just before the FDA warnings “This measure does not come with a public-health justification; rather, it does not affect the bottom line,” says Huang. “It is very likely that this ban will generally benefit the large tobacco industry.”
James Campbell, spokesman for Fontem Ventures, the company behind Blu e-cigs and a subsidiary of the tobacco brand company Imperial Brands PLC, believes this ban may be good for business. “A significant proportion of our sales are tobacco, menthol and peppermint and we have several types of products,” Campbell says in an email to The Verge. “Following these measures we will be more competitive than before.”
Spokesmen for British American Tobacco (the company behind the Vuse device line) and JT International (the company behind Logic) are waiting to see the official FDA plan and not speculate on its effects. Altria did not respond, as did Juul who declined to comment – although The Wall Street Journal claims that Juul is already making moves to get its popular young flavors off the shelves of retailers. It seems that the e-cigarette giant could comply with the FDA measure without any fight.
It is estimated that the effects of such a ban will be different: it is expected that restricting sales in retail stores will reduce smoking among young people, but could make it harder for adults to move from combustible to electronic cigarettes.
It is not yet clear what the ban entails, as the FDA declined to comment. The Washington Post did not say, for example, whether the FDA also plans to stop the sale of flavored cigars and cigarettes, which Desmond Jenson, a lawyer at the Mitchell Hamline School of Law’s Center for Public Health, says would be very important. to be included.
When it comes to cigars, people imagine Winston Churchill with a big cigar in his mouth, but that’s not what it is, “says Jenson. he says. “Everyone universally agrees that fuel products are the most dangerous.”
The fact that they could be omitted due to a flavor ban is worrying Huang, based on past experiences. When the FDA banned sales of flavored cigarettes, for example, several people gravitated toward menthol cigarettes as well as flavored cigarettes. “In fact, we see an increase in sales of cigarettes and smoked cigars after the Tobacco Control Act of 2009,” says Huang.
This is why it is speculated that the FDA ban on e-cigarettes in conventional gas stations and stores should go further. “It should also ban sales of all fuel tobacco products in addition to flavored electronic cigarettes,” he says. This would discourage children from flogging, he adds. It also provides incentives for adult smokers to switch from combustible cigarettes to electronic cigarettes. Jenson agrees that a flavor ban that only affects e-cigarettes is not enough. “If we’re just talking about electronic cigarettes without any other kind of combustion cigarette,” he says, “we’re talking about a missed opportunity for the FDA.”
Conclusion
There are no longitudinal studies and the long-term effects of vomiting are not yet known, but research in this direction remains vital.
In the absence of this evidence, it seems that discussions about vaping in public health debates are going in a more political direction than based on scientific information.
“People tend to do things that are harmful or have a potential risk all the time, such as mountaineering or skiing: there is a certain dose of risk and harm that we accept as a society. we accept it is a philosophical problem. We cannot rely solely on science to solve this moral panic. ” -Edward Siddons