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“E-cigarettes 95% safer than cigarettes”: The Public Health England’s report

In August 2015, the PHE’s report elicits the e-cigarette as a safer alternative to smoking tobacco. “E-Cigarettes: An Evidence Update” is a 113 page report that concludes that the best current estimate shows the electronic cigarette is about 95% less harmful than conventional cigarettes and could lead to its  future approval as an alternative drug to tobacco withdrawal such as nicotine patches. Shortly after its release, a few scientists raised concerns about the 95% value and the authors, Ann McNeill and Peter Hajek published a letter to clarify

“We consider the 5% residual risk to be a cautious estimate allowing for this uncertainty”Prof Ann McNeill and Prof Peter Hajek

The report has rapidly been backed by 12 British public health organizations that reiterated their commitment to inform smokers and health professionals about this “popular” tool for smoking cessation.

The Royal College of Physicians of London endorse vaping

As pointed out by Clive Bates, the endorsement of vaping by the Royal College of Physicians London in 2015 has marked a new era in vaping and opened the path to a more liberal approach of vaping in England. The 200 page report released by the College addresses several crucial questions regarding recent controversies and misunderstanding and clarify the situation with regard to e-cigarette and:

  • The gateway to smoking
  • The normalisation of smoking
  • Smoking cessation
  • Long-term harm, probably less than 5% compared to other tobacco products

Cochrane 2016 review: Electronic cigarette for smoking cessation

The 2016 version includes observational data from 24 studies regarding outcomes of vaping and none did find any outcome of vaping for up to two years. The review also concludes that throat and mouth/nose irritation are the most commonly reported side effects in the short-to medium-term(up to two years).

More technical than the rest of the scientific reviews, the Cochrane 2016 update is considered an “independent, rigorous assessment of the best available evidence to date about electronic cigarettes for quitting smoking”.

CARBC’s report “Clearing the air” around e-cigarettes

The University of Victoria’s Centre for Addictions Research of BC (CARBC) released in January 2017 a literature review and a synthesis of scientific research on vaping.  UVic’s researchers found “very encouraging” the conclusions of comparative studies between smoking and vaping in a tobacco harm reduction context. The absence of tar, of carbon monoxide and of 77% of the toxins contained in tobacco smoke are established facts in favor of e-cigarettes.

Experts’ recommendations are that the “best available evidence” be used for regulatory purposes and not “ungrounded fears of a ‘gateway effect’”.

Diacetyl, a matter of concern?

The case of diacetyl is different from that of aldehydes since this chemical belongs to another family, di-ketones and also because the source of diacetyl is generally the flavorings added to the e-liquid and not a reaction that occurs when heating the e-liquid. Described by experts as an avoidable constituent of e-liquids, diacetyl is now part of a list published by the AFNOR for un-wanted products with a threshold that remains at the level of impurity.

Although diacetyl has been associated to “popcorn lung”, no such lung disease has been described among vapers and only a few cases were published in relation to exposure to diacetyl in the food. Hence, it is not likely that diacetyl represent a threat to vapers, at least in Europe, where the norms published by the AFNOR apply to e-liquids

Acetylpropionyl (2,3-pentanedione) is another di-ketone with similar properties as diacetyl, not only from a gustatory point of view but also in terms of risk profile. Unfortunately, it tends to replace diacetyl in buttered e-liquids. Awareness is also raised about other chocolate and nutty flavors, cinnamon but although some compounds in e-liquids deserve particular attention to improve their safety, this shouldn’t push away former smokers to try less harmful alternatives such as e-cigarettes. Especially if they can’t or don’t want to quit tobacco. The experts recommend not to stick to a single taste and to try different flavors.

The benefits of vaping

Although vaping is still presented as a relatively risky behavior for vapers, Prof Riccardo Polosa decided to break with conventions and to present vaping in terms of benefits, in the light of some scientific publications.

The ECLAT study has highlighted some of the benefits of vaping on blood pressure, heart rate but also on weight control and the lung function. Two other study posed e-cigarette as a useful alternative for surgery patients and for patients with lung cancers and all the conclusions converge into a net benefice against combustible tobacco for those who decide to use e-cigarette. Nevertheless, the full spectrum of benefits can only be achieved by exclusive vapers even if a reduction of smoking is already a victory in this fight.

The relative risk of vaping, when presented against smoking is however not the view that is shared by most regulators who rather invoke the precautionary principle to impose a harsh regulation to vaping products.