Ever since news of the harmful effects of tobacco smoke hit the public consciousess around the middle of the 20th century the tobacco industry and others have been looking for a “healthy” alternative. Are e-cigarettes just latest in a list of failed attempts to make smoking safe?

In case you are a new visitor to our planet (welcome) using tobacco products has been determined to be a significant risk factor in developing certain kinds of lung cancer and vascular disease, including strokes and heart attacks (the top three killers).  The tobacco industry initially tried desperately to deny or downplay the scientific evidence for the health risks of smoking, engaging in a campaign of doubt and confusion, but those efforts ultimately failed.

Some companies marketed light, low tar, and filtered cigarettes with the claim, direct or implied, that they were a more healthful alternative to regular cigarettes. However, there has never been convincing evidence that such cigarettes are less of a health risk. Still, the marketing stuck and now 90% of all cigarettes sold are filtered.

Another alternative marketed as less of a health risk is Asian herbal cigarettes – marketed mainly in Asia where smoking is on the rise. However, here too evidence is lacking for reduced risk compared to tobacco. Smokers may just be trading one set of carcinogens for another.

All of these products raise concerns that they will keep people smoking under the false hope that they are at less risk of adverse health consequences. The optimal outcome for public health is to reduce the number of people smoking at all.

The latest player in this game of “safe smoking” is the e-cigarette. This is a battery operated cigarette-shaped tube that provides a nicotine vapor when inhaled. The goal is provide smokers with their nicotine fix (nicotine is the primary addictive substance in tobacco) without all the carcinogens and carbon monoxide in tobacco smoke.

The problem, again, is that the marketing may be getting ahead of the evidence. The British Medical Journal recently reported that there is insufficient evidence to justify any claims for reduced risk from e-cigarettes.

The concept itself is plausible – e-cigarettes may be considered just another nicotine delivery system, no different than nicotine gum or the patch. But it is a unique delivery system that needs to be investigated. For example, the BMJ reports that there may be chemical contaminants in the vapor that contain some fo the same carcinogens as in tobacco smoke, although in lower amounts. Also the dose and route of entry of nicotine may have unanticipated health risks.

There are two claims for e-cigarettes that need to be investigated: do they help people quit smoking, and what is their overall health risk. Neither question has been adequately answered with scientific research.

Regulators in different countries are taking slightly different approaches to the problem. Some feel that e-cigarettes are probably safer than smoking tobacco, and therefore should not be discouraged as an alternative. Others simply choose to warn the public that the data is not in, so consumers should exercise caution.

But once again there is the fear that belief in the safety (relative or absolute) of e-cigarettes may keep people consuming nicotine and even smoking longer.

Only one thing is clear at this point – rational public policy on such issues needs to be informed by scientific evidence, which is currently lacking.


Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also has produced two courses with The Great Courses, and published a book on critical thinking - also called The Skeptics Guide to the Universe.