E-cigs: Boon or bane to public health?

December 6, 2021 Dennis F. Fetalino 161 views

Dennis FetalinoBut believe me, just because the human mind can’t imagine something happening…doesn’t mean it won’t. — Dan Brown, Inferno

Like all other highly debatable issues, there is no absolutely correct or exclusionary answer to the question.

Some ideas or innovations clearly offer relative or even substantial relief from previous processes, but even those who oppose or object cannot even agree among themselves – some would say nothing’s changed while others insist the improvement is not enough.

But what should ultimately matter to both aisles of the debating platform is whether a proposition or an idea would yield a net gain or a net loss to the individual in particular and society in general.

Indeed, even under the most adverse situations, the proverbial silver lining emerges.

In short, it’s how the scales tip in the old cost-benefit equation when you get down to the bottom line.

And in the current scheme of things, collegial state regulatory bodies are aided by independent experts, academe, and “amicus” parties to enlighten their adjudicatory process in arriving at decisions that result in minimum pain or waste and maximum joy or pleasure.

And so it must be asked: Do the potential benefits of electronic cigarettes outweigh the potential risks?

E-cigs are filled with a liquid that typically contains nicotine and flavorings and heated when used. Nicotine is inhaled as vapor, not smoke in a process called “vaping.” Since tobacco is not burned they don’t expose users to the same levels of toxic chemicals as conventional cigarettes.

Two experts — Jonathan Foulds, a professor of public health sciences at Penn State College of Medicinwere, and Brian P. Jenssen – were asked to size up the US Food and Drug Administration’s decision to allow the marketing of some e-cigs.

Their opposing views were featured in the Nov. 19, 2021 issue of The Inquirer. Ped Xing presents pertinent portions of their respective positions.

In the affirmative is Foulds: Yes, FDA was right. Some e-cigs are good for public health. air – 2021 – Highlights _ POLITICO Live

The primary benefit of e-cigs is that they are a way out of cigarettes.

In 2018, the National Academies of Science, Engineering, and Medicine produced a comprehensive report on e-cigs. They concluded that:

“Completely substituting e-cigs for combustible cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in cigarettes,” and that “completely switching from regular use of combustible cigarettes to e-cigs results in reduced short-term adverse health outcomes.”

Shouldn’t nicotine-addicted smokers have the choice to be able to reduce their toxic exposures and health risks by switching to a much less harmful nicotine product?

In 2021, the Cochrane Collaboration published a major review of whether e-cigs can help people quit smoking. It concluded that more people quit smoking using e-cigs than nicotine-replacement therapy (like gums or patches) or behavioral support such as counseling.

Some are concerned that many smokers who try e-cigs continue to smoke. We found that use of e-cigs that deliver high levels of nicotine reduced exposure to a major lung-cancer-causing chemical, even with continued smoking.

We also found that if smokers continued to use an e-cig with high nicotine delivery, a greater proportion quit smoking and completely switched to e-cigs, as compared with a placebo e-cig or no e-cig.

Health policy should be driven by science, not prejudice or dogma.

The FDA should be allowed to do its job without ill-informed pressure. This should lead to more e-cigs being authorized, rather than just one out of thousands of applications.

E-cigs have already provided an effective gateway out of smoking for many, many people — millions, I would wager.

Closing this lifesaving escape route from smoking is a bit like locking the door to the fire escape because the steps may be slippery.

On the rejectionist aisle is Jenssen: No, the risk of hooking young people on nicotine products is too high.

While the FDA has made some progress denying marketing applications for certain flavored e-cigs, it has allowed others to remain in the market, citing that the potential benefits of these products for current smokers outweigh the risks of introducing young people to vaping and lifelong addiction to nicotine.

This is a false choice that overall harms public health.


First, by attracting young people to ingest nicotine, these products may put them on a path to becoming regular smokers.

This is not an idle concern: Tobacco use — the leading preventable cause of disease and death in the US — almost always starts in childhood or adolescence.

Among adults who became daily smokers, nearly 90 percent first started smoking before age 18. While there are several effective, evidence-based treatments to help adult cigarette smokers quit, the most successful has always been prevention or making sure a child never starts in the first place.

Based on my personal clinical experience, once a teenager starts vaping or smoking cigarettes, it’s incredibly challenging to help them quit.

For the past several years, e-cigs have become the most common tobacco product among youth — as many as 11 percent to 20 percent of high school students regularly use them.

Why concerning? E-cigs clearly cause direct harm to youth, including the lung-injury epidemic that dominated the news prior to the Covid-19 pandemic. Furthermore, nicotine is damaging to developing brains.

Younger users of e-cigs are more likely to become addicted, have more difficulty quitting, and may be at increased risk of becoming addicted to other substances. What’s more, young people who use them, compared with those who do not, are four times more likely to become cigarette smokers.

Second, it’s unclear if e-cigs actually help adults quit smoking.

According to multiple, well-respected institutions, including the US Preventive Services Task Force and the surgeon general, there is inadequate evidence to conclude that e-cigs increase smoking cessation, and, because e-cigs and vaping devices are all different, it is difficult to make generalizations about how effective they are at helping people quit based on clinical trials involving a particular e-cig.

No studies to date on the use of e-cigs for tobacco cessation reported health outcomes (measures that include conditions like lung cancer, heart attacks, or death), and few trials reported on the potential adverse events (including a range of potential harms that could be mild, like sore throat, to more severe like hospitalization or death) of e-cig use when used in attempts to quit smoking.

Given the current state of the evidence, for established smokers interested in quitting smoking using e-cigs, public health and clinical efforts should instead guide them toward evidence-based, safe, effective treatments, including nicotine-replacement therapy, behavioral counseling, and additional pharmacotherapy.

Finally, the FDA could embrace a better public health approach to protecting the youth from life-long addictions to tobacco while exploring the role of e-cigs in potentially reducing the harm faced by adults who use cigarettes.

Quite curiously, both experts agreed on one thing: Cigarettes are legal, but they kill.

“(They) remain our most lethal legal product. (They’re only legal because many have been “grandfathered in” by the FDA to stay on the market.) — Foulds

“Cigarettes are the only legal product on the market that, when used as intended, kills the user.” — Jenssen

Behold God’s glory and seek His mercy.

Pause, ponder, act, and pray, people.