The Truth Behind the Contradictions
The discussion about whether electronic cigarettes are a friend or foe to health has brought forth many conflicting views and perceptions.
While some argue that it is a tool that aids in smoking cessation or is less harmful than regular cigarettes, others warn about the risks associated with its use.
It is important to examine scientific research and the opinions of experts before forming our own opinion.
What is an Electronic Cigarette?
Electronic cigarettes are devices that allow the inhalation of nicotine. Although these products are relatively new, several studies have already been conducted to evaluate their benefits and risks.
This text is a modified version of a briefing from the European Lung Foundation (ELF) and explains what electronic cigarettes are, how they are used, and why there is so much discussion about their use.
Electronic cigarettes have experienced progressively increasing popularity since the 2000s. Despite the potential of electronic cigarettes to reduce smoking-related harm, the majority of scientific studies have not confirmed their safety and usefulness as a smoking cessation aid.
In contrast to other widely available products, medical authorities in Europe have not yet approved electronic cigarettes as a smoking cessation aid.
Extremely Addictive
Since smoking is extremely addictive, quitting this habit is not easy without assistance. Smoking cessation clinics play a crucial role in helping individuals quit smoking by offering the most suitable and scientific method, using a range of products and strategies.
These include prescription medications such as specific pills, nicotine replacement therapies like patches or gums, and counseling services.
Design of Electronic Cigarettes
Electronic cigarettes are designed to have the appearance and feel of traditional cigarettes. They consist of three parts: the battery, the atomizer, and the cartridge.
The device operates by vaporizing the liquid contained in the cartridge. This creates vapor that the user can inhale, giving the impression of smoking.
Unlike regular cigarettes, these devices do not contain smoke but instead contain nicotine in the liquid of the cartridge. The liquid can have various flavors and different nicotine levels that the user can choose.
Why do many smokers choose to use electronic cigarettes?
Electronic cigarettes are advertised as safe substitutes for tobacco, claiming to cause less harm than regular cigarettes, leading some smokers to choose them to continue their habit in a “safer” way.
Many smokers also feel improvement in their breathing and satisfy their need for smoking when they switch from conventional cigarettes to electronic ones. Compared to other cessation methods, few manage to quit.
As products, they are also quite attractive and often incorporate many other electronic functions (USB, mobile chargers, etc.).
But are these enough to make electronic cigarettes acceptable to the scientific community?Why are doctors cautious about using e-cigarettes?
Electronic cigarettes have been the subject of intense debate in the media across Europe as the majority of healthcare providers express reservations about the promotion and use of these products. There may be several reasons why doctors are cautious about the use of e-cigarettes. Some reasons include:
1. There are different regulations for products – they are not controlled for the substances they contain:
Currently, across Europe, there are different regulations for the manufacture and distribution of electronic cigarettes.
This means that there are no restrictions on the chemical substances that can be added to the cartridges.
It also means that they are not subjected to strict quality control, and the products on the market may carry the same labeling but contain different quantities of chemical substances and nicotine, a fact confirmed by studies.
2. An addictive behavior is perpetuated in smokers:
An addictive behavior is perpetuated in smokers: Since electronic cigarettes have the appearance and sensation of regular cigarettes, there is nothing to prompt users to change their behavior.
Their addiction to the physical and emotional elements of smoking continues, perpetuating a harmful behavior.
3. Smoking is normalized, a harmful behavior is accepted mainly by children but also by individuals who have quit or are trying to quit smoking:
The ban on smoking in public places and the continuous awareness about its harmful consequences has contributed to a change in the perception of smoking, making it abnormal and unacceptable.
This anti-smoking campaign has led to a reduction in the percentage of smokers in many countries and has dramatically improved the health level of their citizens. As for electronic cigarettes, until recently, there were no restrictions on their use in offices and other public places where conventional smoking is prohibited.
3. (Continue)
The promotion of electronic cigarettes as a safer alternative to conventional tobacco cigarettes has indeed led to their acceptance by some individuals. However, there are concerns about the impact of e-cigarettes on both current smokers and non-smokers.
Here are some key points to consider:
Re-normalization of Smoking Behavior:
- The visibility of people using e-cigarettes and the messaging that they are safer can inadvertently re-normalize smoking behavior.
- Individuals who have quit smoking or are trying to quit may be tempted to return to the habit due to the perceived safety of e-cigarettes.
Attracting Non-Smokers:
- E-cigarettes may attract non-smokers, especially young people, who might otherwise not have initiated smoking.
- In the United States, between 2011 and 2013, e-cigarette use increased by 230%. Experimentation with e-cigarettes (even just one inhalation) was associated with a sixfold increase in the likelihood of becoming a smoker, while daily e-cigarette users had an eightfold increase in the likelihood of becoming “permanent” smokers.
Youth and Risk:
- The risk is particularly significant among youth. E-cigarettes can serve as a gateway to conventional smoking for adolescents.
- The appeal of flavors and the perception of safety may lead young people to start using e-cigarettes, which could eventually transition to smoking traditional cigarettes.
The Trojan Horse Effect:
- The term “Trojan horse” refers to a seemingly harmless gift or offering that conceals a harmful intention.
- In this context, e-cigarettes could be seen as a Trojan horse for the spread of conventional smoking, especially among young populations.
In summary, while e-cigarettes may have a role in harm reduction for current smokers, their unintended consequences—such as attracting non-smokers and re-normalizing smoking behavior—raise concerns. Balancing harm reduction with potential risks remains a complex challenge, especially when it comes to youth and public health.
4. It is not safe as it contains harmful substances:
A key concern troubling the scientific community at the moment is the lack of data on the possible long-term effects for the user.
Some of the harmful products produced by the electronic cigarette are detected in lower concentrations compared to smoking regular cigarettes, while other chemical substances are produced solely by the electronic cigarette. Many of these substances, regardless of concentration, are carcinogenic.
Until today, there have been no long-term studies on the effects of these products on health, especially concerning the development of cancer and cardiovascular diseases.
Several studies, however, have shown that the use of electronic cigarettes causes alterations in lung function (bronchospasm, reduced elasticity, increased oxidative stress), heart function (increased artery stiffness), and increases the body’s susceptibility to infections.
Therefore, more research is needed on the long-term harmful effects of vapor, flavors, and additives that provide nicotine.
5. They lack clear effectiveness:
Although most smokers use them to quit smoking, they rarely succeed.
Studies have shown that their effectiveness is only comparable to that of nicotine gums, especially when used alone (as monotherapy), a practice that is almost never applied in smoking cessation clinics.
In no way can it be compared to the effectiveness of scientifically proven smoking cessation methods used in our smoking cessation clinics.
Even if the composition of the electronic cigarette is controlled in the future to prevent health damage, it is unlikely to be used alone as a smoking cessation aid.
There is ongoing scientific research on the health effects of using electronic cigarettes, with some studies suggesting they may be a less harmful alternative to traditional cigarettes, while others highlight potential health risks such as respiratory problems and addiction.
Why is regulatory control of the product necessary?
Regulatory control over electronic cigarettes is necessary for several reasons. Firstly, because electronic cigarettes are consumer products, regulating them protects consumers from potential risks to public health and safety.
Protection and Safety
Nicotine substitutes and devices designed to help smokers quit smoking are subject to regulatory rules as pharmaceuticals. This means that the European Medicines Agency ensures the effectiveness and safety of the use of drugs and medical devices.
If regulations are established for the product, the chemical substances contained in electronic cigarettes and the nicotine levels in the devices will be subject to quality control. If these conditions are ensured and their safety is confirmed, with new scientific research, their effectiveness should be proven to be used as a means to quit smoking within organized smoking cessation clinics.
However, even if they are used in smoking cessation clinics in the future, restrictions on their use in public spaces should continue to exist and be implemented as a significant measure to address smoking habits.
The current situation in the world and Europe:
The current situation regarding electronic cigarettes remains controversial and evolving, especially with the increase in their usage and the emergence of new technologies in the field.
Challenges and Prospects
Restrictions and regulations for electronic cigarettes vary worldwide. They are also treated differently across the various EU member states: as tobacco products, medicinal products, or consumer products according to the General Product Safety Directive.
The European Commission has proposed regulations treating them as medicinal products in the revision of the Tobacco Products Directive, while the US Food and Drug Administration recently banned their use in individuals under 18.
In Greece, the use of all tobacco products (including electronic cigarettes) in public places is prohibited.
There is no such thing as less harmful smoking. Smokers should not exchange one carcinogenic product for another.
