"E-Cigarettes—Good or Bad" by Allen Weiss, MD, MBA, President & CEO

E-Cigarettes—Good or Bad

May 15, 2014 - In less than a decade since they were introduced on the market, use of electronic cigarettes has taken off in our country; sales for this past year are expected to reach 1.7 billion dollars! The growing controversy about the use of e-cigarettes has also taken off and revolves around three issues. First, are e-cigarettes safe? Second, can this relatively new invention help people stop smoking? And third—on the opposite side—can these devices actually addict people to smoking?

According to a recent Gallop Poll, nearly 90% of U. S. adults who smoke report that if they had it to do over again, they would not have started smoking. About 18% of Americans currently smoke, which is down considerably from decades ago. However, smoking is still the single greatest cause of preventable death, killing an estimated 480,000 people per year. More Americans have died from smoking than were killed in all the wars the United States has ever fought, reported a New York Times editorial.

The Safety Issue: E-cigarettes are battery powered nicotine-delivery devices which vaporize nicotine using propylene glycol or vegetable glycerin. These chemicals, are also used as carriers for cosmetics and in certain foods because they are odorless and tasteless. Propylene glycol is also used for antifreeze in automobiles.

Mayo Clinic experts shared that when the FDA analyzed samples of two popular e-cigarette brands they found variable amounts of nicotine and traces of toxic chemicals, including known cancer-causing substances (carcinogens). This prompted the FDA to issue a warning about potential health risks associated with electronic cigarettes. The FDA is expected to add new warnings shortly, and some states, like New York, have passed laws prohibiting sales of e-cigarettes to anyone under 21 years of age.

Until more is known about the potential risks, the safe play is to say no to electronic cigarettes. If you're looking for help to stop smoking, there are many FDA-approved programs and medications that have been shown to be safe and effective for this purpose.

Smoking cessation: Can e-cigarettes be used to help people stop smoking? This is a question being looked at across the country, in relation to both adults and teenagers. Substituting e-cigarettes for real cigarettes is safer overall, but not nearly as safe as eliminating tobacco products entirely. The amount of nicotine inhaled with these electronic devices is variable and not well controlled. Also, the long term effects of nicotine, which is an artificial stimulant, cannot be good. Nature didn’t include nicotine as an essential element in our diets. Before about 1920 tobacco use in America was relatively uncommon.

Smoking addiction risk: Middle and high school students who use electronic cigarettes are more likely to smoke real cigarettes and less likely to quit, according to a very recent Journal of the American Medical Association Pediatrics. Currently, about three million of the 45 million smokers in America are teenagers, and the overwhelming number of people who use e-cigarettes are also smoking real cigarettes.

Ultimately, the question is whether e-cigarettes will cause more people to stop smoking or start smoking. The jury is still out at the moment but we expect an answer based on real epidemiology studies in the near future. Unfortunately, if the answer is these devices increase the number of smokers—young or old—the damage will already have been done. If these devices are limited to only those who are trying to stop smoking, should we be supportive? Until that is known, stay tuned for—hopefully—objective answers which will help everyone live longer, happier and healthier lives.

Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.