Colin Mendelsohn: The E-cig is safer than tobacco — that’s a fact

UK review of vaping research shows it’s 95 per cent less harmful than smoking cigarettes in the long run, writes Colin Mendelsohn.

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There is overwhelming scientific agreement that electronic cigarettes (e-cigar­ettes) are much less harmful than smoking.

However, the public is confused.

One recent survey reported that only 35 per cent of Australians ­believed that e-cigarettes were a lot less harmful than smoking conventional cigarettes.

Colin Mendelsohn.

Smokers are being bombarded with sensational headlines and conflicting expert opinions.

How do you make sense of this confusing information?

As regular e-cigarette users are ­almost exclusively smokers and ­ex-smokers, any risk from vaping (using an e-cigarette) should ­always be compared with the harm from continuing to smoke.

Current use by adults who have never smoked is rare in the UK and the US (0.3 per cent) and regular use by adolescents who have never smoked is negligible.

E-cigarettes are used as less harmful substitutes for smoking or as short-term quitting aids. After reviewing all of the ­research, the UK Royal ­College of Physicians and Public Health England estimate that using an  e-cigarette  long  term  is at least 95  per cent less harmful than smoking tobacco.

Not everyone agrees on the exact figure, but whether they are 70 per cent, 85 per cent or 99 per cent less harmful doesn’t matter. They are a much safer alternative.

E-cigarettes are less harmful substitutes for smoking, says Professor Mendelsohn.

This safety profile is not surprising as almost all the harm from smoking is from the tar, carbon monoxide and other harmful chemicals caused by burning tobacco.

The vast majority of the 7000 toxins in tobacco smoke are absent from e-cigarette vapour or are only present at trace levels.

Contrary to popular belief, nicotine is not the villain! Although ­addictive it has only relatively minor health effects except in pregnancy and perhaps in adolescence.

Nicotine does not cause cancer or lung disease and plays only a minor role in heart disease.

However, e-cigarettes are not completely safe.

A number of potentially harmful toxins are present in vapour, but at much lower levels than in cigarette smoke and in most cases below the levels known to cause harm.

The levels of these toxins in the saliva and urine of vapers are also substantially lower than those found in smokers.

A recent study identified  all  the known can­cer-causing agents in e-cigarette vapour.

Based on the levels and potency of the chemicals, the overall cancer risk from vaping was cal­culated as less than 1 per cent that of smoking.

Furthermore, health improves when smokers switch to vaping, ­including improved asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and reduced pneumonia risk. The levels of chemicals in ­second-hand vapour are even lower and are unlikely to pose any significant health risk to bystanders.

Health improvements have been linked to switching from real tobacco to vaping. Picture: Mark Cranitch.

Although science is clear, there is no shortage of sensational and misleading headlines.

Stories often exaggerate small or potential risks, quote poor quality ­science and draw false conclusions from their research findings.

One example is the “popcorn lung” myth. Diacetyl is a butter-flavoured chemical known to cause a “popcorn lung” (bronchiolitis obliterans), a serious lung condition found in popcorn factory workers. When this chemical was discovered in e-cigarette vapour, a public panic followed with one media story scarier than the next.

However, later analysis found that exposure to diacetyl from vaping was hundreds of times less than from smoking, which has never been associated with “popcorn lung”.

Then there was the formaldehyde scare. Formaldehyde is a cancer-causing agent found in cigarette smoke. A flawed laboratory study in 2015 used unrealistic procedures that no human could tolerate, generating high levels of formaldehyde.

Resulting headlines absurdly claimed that vaping had a higher cancer risk than smoking. Subsequent testing confirmed the flaw but by then the damage was done.

Another area of misleading ­research has come from studies in rats and laboratory tests which expose cells to e-cigarette liquid or vapour. These studies do not replicate normal conditions of use and are not directly applicable to humans. They often use excessive doses, longer exposure and unrealistic testing conditions.

E-cigarette opponents often raise the fear of unknown future risks and argue that we should wait until long-term safety data is available.

However, by this impossible standard, no new drug or treatment would ever be allowed until 20 or 30 years of continuous testing.

There are a lot of half and mis-truths about ‘vaping’. Picture: Tom Lee

Nor is it needed in the case of e-cig­arettes. Ten years of research and international experience give us a high level of confidence that the risk is very small.

There is high price for unnecessary delays. While we wait, paralysed by unrealistic and overcautious standards, up to two out of three smokers will continue to die prematurely from their addiction.

The available evidence is incomplete, but it is more than enough to move forward cautiously.

E-cigarettes have helped millions of smokers to quit overseas. Misleading or exaggerated information about harm will discourage smokers from switching to this much safer and potentially lifesaving alternative.

Smokers have the right to ­evidence-based and accurate information so they can make informed choices. Spreading misinformation and scaremongering about e-­cigar­ettes costs lives and must stop.

Disclosure: I have no past or present commercial or financial relationship with any tobacco or e-cigarette company.

Colin Mendelsohn is an Associate Professor at the University of New South Wales School of Public Health and Community Medicine