Are E-Cigarettes a Safer Alternative to Smoking?

The culture of cigarette smoking has never been more ambiguous. There used to be a time where smoking tobacco was a rite of passage. I grew up in an era where smoking acceptance was readily marketed to children: it was an ice-breaker in Tom and Jerry cartoons; big tobacco would use mascots that I could gravitate too; candy cigarettes were a cool imitation. Evil ad men everywhere thought up ingenious ways to train my mushy brain to start smoking as soon as possible -- heck, even in 2013 Don Draper makes it look cool.

Fortunately, there was also a considerable amount smoking education in my middle and high school years. Even though I've puffed my way though a few packs of my own in college, I've never considered myself a 'smoker' and I haven't had even a drag of a cigarette in over six months (I've probably smoked less than 50 cigarettes total). I know how dangerous smoking is so I never smoked enough to become addicted. I've also witnessed my older brother go through a cycle of quitting and starting again a few times.

Thanks to some timeworn innovations that only in the past few years have reached the mainstream marketplace, there may well be hope for me to join the 'cool kids' outside for cigarette breaks. That is, as long as they accept I'm smoking an e-cigarette.

Electronic cigarettes were first introduced in China in 2004, but had been invented nearly 40 years earlier. In 1963, Pennsylvanian Herbert A. Gilbert applied for a patent regarding a battery-powered cigarette which delivered nicotine by atomizing it in water vapor. Tobacco companies appeared interested in further developing and marketing the device, but it [not so] mysteriously got stuck in development hell until the idea was ultimately scrapped.

In 2000, Hon Lik, a Chinese pharmacist, reinvigorated the electronic cigarette by diluting nicotine in propylene glycol (the same stuff used in fog machines) and vaporizing it with a piezoelectric ultrasound-emitting element. When it was introduced in China, and in international markets a year later, it was mainly marketed as a smoking cessation aid, much like nicotine gums and patches. Today, many governments have required companies to remarket e-cigarettes, even though no tobacco is used and no tar is created.

If you'll excuse the annoying soundtrack, the animation at right provides a cross section of how e-cigarettes are assembled and operate. For the video-impaired, a sensor or button relays the signal to a microprocessor to initiate the heating element. A lithium battery supplies power to the element which is wrapped in flavored synthetic nicotine and water/propylene glycol-soaked pads. There is never an ignition in the device and the tip of the e-cigarette lights up to indicate that it is in use. Most e-cigarettes are rechargeable but disposable editions are made, mostly to get novice smokers into the market.

A subject of some controversy would be the safety of e-cigarettes. When originally introduced, they were marketed as a healthy alternative to cigarettes or as a means to quit smoking altogether. Yet notable health agencies, such as the U.S. Food and Drug Administration, the World Health Organization and Health Canada, maintain that there is no conclusive evidence as to whether or not e-cigarettes are indeed a safer alternative to regular cigarettes. While there is no tobacco, no tar and no carbon monoxide in the e-cigarette, there are still high levels of nicotine and a high potential for addiction. The FDA believes that e-cigs can serve as a gateway for people to begin smoking tobacco, and the British Medical Association feels that e-cigs can further strengthen the social acceptance and normalcy of smoking overall. Many government health agencies have classified e-cigarettes as medical products and not as tobacco products; this makes them illegal to use until independent, controlled, peer-reviewed studies have been conducted.

In jurisdictions where this classification has been overturned, such as the U.S., doctors have defended the potential for e-cigs to save millions of lives. Way back in 2007, the Royal College of Physicians stated that, "If nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved. Nicotine itself is not especially hazardous." Even some antismoking organizations have jumped aboard the e-cigarette bandwagon. William T. Godshall, executive director of Smokefree Pennsylvania, has gone on-record stating that, "There is no evidence that e-cigarettes have ever harmed anyone, or that youths or nonsmokers have begun using the products." Both sides agree that significantly more study is needed on the long-term health effects of e-cigarettes, but the latest short-term studies point to a much lower risk-potential. Two Greek studies released late last year concluded that e-cigs posed a much lower risk to the user's heart and lung functions. This study indicates that the largest health risk posed by e-cigarettes would be the additional lung vacuum required to intitiate the device.

Okay. So I'm not going to start e-smoking just to be able to do so-- I lied. I may be fine with a bunch of engineering going into my food, but I don't have any interest in starting to smoke. However, there seems to be a lot of potential behind this technology: the potential to save millions of lives. I think this is another example of misguided abstinence-only social policy. It could be that unless we begin to have a meaningful dialogue about the real health benefits of this smoking alternative, we could lose millions more to lung cancer, emphysema and other diseases while we bicker.

Resources

Wikipedia - Electronic cigarette; Propylene glyocol

NY Times - A Tool to Quit Smoking has Some Unlikely Critics

Royal College of Physicians - Harm reduction in nicotine addiction (.pdf)

Discovery Health - 10 Little-Known Facts about E-Cigarettes