Smoke Without Fire: How Safe are e-Cigarettes?
By: Nigel Whittle
Head of Medical & Healthcare
30th May 2018
Tradition has it that on 27th July 1586 Sir Walter Raleigh introduced smoking to England, arriving with colonists bringing tobacco, maize and potatoes from Virginia. It is likely however that tobacco had already been smoked by Spanish and Portuguese sailors for many years since its discovery by the native people of Central and South America thousands of years previously.
Fast forward nearly 400 years to 1963, when Herbert A. Gilbert invented and patented the first e-cigarette as an alternative to burning tobacco. His design for a smokeless, non-tobacco cigarette incorporated flavour cartridges, a heating element, and smokeless flavoured air. However in the 60’s there was no pressing demand for a healthier alternative to smoking, and it was not a commercial success. It wasn’t until the 2000s that Hon Lik, a Chinese pharmacist and part-time medical researcher, created the first modern e-cigarette as a practical device containing nicotine dissolved in a solvent. Hon Lik was inspired to develop his concept after witnessing his father’s death from smoking-induced lung cancer.
Nowadays there are many brands of e-cigarette, and all are essentially battery-powered devices, usually cylindrical in shape, containing a solution of liquid nicotine, water, and propylene glycol. When you take a puff on one, a microphone detects a drop in pressure, causing a battery to heat up the solution rapidly and create a vapour that can be inhaled. The action, called “vaping”, is increasingly becoming the preferred way to consume nicotine, with over 3 million people in the UK using e-cigarettes, either as a tobacco substitute or as a means to cut back on smoking.
The technology around vaping continues to advance: the ability to control temperature avoids overheating the carrier liquids, or causing a ‘dry puff’, in which the wick becomes too dry, and burns the ingredients rather than producing vapour. Other enhancements range from improved battery life, to the use of visual displays and Bluetooth connectivity to display and transfer information about vaping parameters and activities.
Safety Pros and Cons
The increase in usage over recent years has been paralleled by a debate about whether vaping can be considered safe, or just safer than smoking cigarettes, and what role it should have in smoking cessation. The active ingredient, nicotine, which is crucial to cigarette addiction is not considered carcinogenic, although it is formally a toxin which in high doses can potentially affect adolescent brain development or cause harm to a developing foetus, so it can never be deemed entirely safe. But importantly e-cigarettes contain far fewer of the harmful substances such as tar or carbon monoxide produced by smoking tobacco, and therefore presumably provides a safer experience.
Because the trend in vaping has developed so fast, clinical research into the practice is struggling to catch up. One approach is to analyse e-cigarette liquids, and the vapour they produce, to demonstrate that they contain lower levels of toxic chemicals than tobacco cigarettes. However, it is more important to show what concentrations of chemicals users are actually exposed to in the real world. Such studies can be difficult and complex to conduct, often involving comparisons between vapers, tobacco smokers, non-smokers, and even to those using nicotine replacement therapy. In general these studies, as summarised in a recent Cochrane Review, have demonstrated that e-cigarettes are far safer than smoking, although the most significant benefits come from stopping smoking altogether.
Regulation of e-Cigarette Use
There is considerable variability of regulation of e-cigarettes in different countries, ranging from no regulation to banning them entirely. The unregulated manufacture of e-liquids in countries such as China has led to legitimate concerns over potential health impacts, and there is mounting pressure for world-wide alignment of regulation as exists with traditional tobacco products. It was not until 2014 that the EU required standardization and quality control of liquids and vaporizers, disclosure of ingredients in liquids, and tamper-proof packaging. Similarly in 2016 the US FDA announced the comprehensive regulation of all electronic nicotine delivery systems.
One result of this regulation is the need for rigorous product development and testing by e-cigarette companies, who are generating increasing amounts of data to demonstrate the integrity of their products. It is inevitable that as the industry matures it will begin to develop its own Quality Standards and operate under specific GxP standards for improved quality control.
Over 100,000 people die each year as a result of smoking-related illnesses in the UK alone. Vaping, on the other hand, has not been linked with a single death in the UK. The advice from Cancer Research UK is that smoking tobacco is the single biggest preventable cause of death in the world, and if you are a smoker, the best thing you can do for your health is to stop. But through 50 years of development, vaping technology has created a significantly safer alternative to traditional smoking and an effective tool for helping people to stop smoking.