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To vape or not to vape?

To vape or not to vape?


Anyone looking through the various media reports on e-cigarettes recently may understandably be left confused. While some warn that they are a dangerous product destined to lead to widespread addiction, others highlight the testimony of the many people who say they were the only thing that helped them quit tobacco. So what are the facts?

E-cigarettes certainly seem useful for many people who want to quit smoking, with clinical trials showing them to give significantly higher quit success rates than placebo (McRobbie et al. 2014).

But are e-cigarettes safe? While we can‘t say with 100% confidence right now that e-cigarettes are completely safe, there is also a lack of evidence to suggest they are harmful. So then, what should we conclude? How do we balance the risks and make a decision on whether e-cigarettes should be seen in a positive light?

Well, how do we make a decision on whether anything is good or bad for our health? Generally, we compare it to the other choices available. For example, playing sport or exercising three times a week may not be completely safe, but it’s a lot safer than the alternative, which is an inactive lifestyle and all the problems that this brings to our health.

So what about e-cigarettes? Recent studies show that the overwhelming majority of people who use e-cigarettes are smokers or ex-smokers – substituting e-cigarettes for traditional tobacco products like cigarettes or cigars (West et al 2015). So, given this context, are e-cigarettes a safe choice? Are they safer than tobacco?

The answer is unquestionably yes – much safer. This is unanimously agreed upon by all healthcare agencies, including both the National Institute for Health and Clinical Excellence (NICE) and the Medicines Healthcare Regulatory Association (MHRA). As Prof Linda Bauld (2015) says “Smoked tobacco is a lethal product that kills one in two of its regular users, who lose on average 10 years of life. Smokers die from the tar particles and toxic gases drawn into the body from smoking rather than from the nicotine.” As e-cigarettes don’t contain tobacco – there can be little doubt that they represent a much safer alternative.

In addition, the substitution of tobacco for e-cigarettes isn’t just safer for those using them. They are also much safer for those nearby. Studies have found that e-cigarette use in indoor environments does not expose others to toxic tobacco-specific combustion products (Czogala et al., 2014). Therefore, including the use of e-cigarettes within smoke free policies really doesn’t make much sense, especially if it hinders the efforts of people to use e-cigarettes to quit smoking.

But are e-cigarettes a threat to young people? Some have argued that e-cigarettes may act as a ‘gateway’ to tobacco smoking to young people and therefore be a harmful influence. However, the surveys conducted (such as those by Action on Smoking & Health) show that the vast majority of young people who report using both e-cigarettes and tobacco have tried tobacco first. So in fact, rather than e-cigarettes acting as a gateway to tobacco, the opposite is likely to be true. Therefore, while we should certainly discourage the use of e-cigarettes by young people, and restrict their sale to just adults, any concerns over them bringing extra dangers to that already posed by tobacco are likely to be unfounded.

In conclusion, while more research is certainly needed, on balance it seems we should view e-cigarettes in a positive light and be keen to lean more about their potential to benefit health. To reject them as a threat is simply not backed by the evidence and, ironically, may result in more tobacco related harm in the long run.

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