Electronic Cigarettes: Miracle or Public Health Danger?


Editor’s note: This blog post was adapted with permission from the American Cancer Society’s Expert Voices blog.

The U.S. Food and Drug Administration (FDA) recently announced that it is taking steps to regulate electronic cigarettes (e-cigarettes) as tobacco products. Regulatory agencies in a number of other countries have taken similar steps.

E-cigarettes resemble a standard cigarette, but use a battery and an atomizer to heat a solution that, when inhaled, delivers vaporized nicotine to the user. They have been described as both a miracle answer to the devastating effects of cigarette smoking and as a grave danger to public health.

As with so many highly celebrated — or reviled — products, the true nature of e-cigarettes likely lies somewhere in between.

Conflicting viewpoints

Benefits cited by people who favor e-cigarettes include their:

  • Ability to deliver nicotine without many of the more than 7,000 other chemicals in a regular, burned cigarette
  • Absence of secondhand cigarette smoke
  • Resemblance to regular cigarettes, which provide the tactile and visual sensations — holding them in a certain way, a glowing tip, blowing smoke and so on — that many cigarette smokers have become used to (or even psychologically dependent upon)
  • Potential for aiding cigarette smokers who wish to quit

Those with concerns about e-cigarettes warn of the lack of scientific data about:

  • Their safety — users cannot be sure of what they are inhaling, since e-cigarettes have not been subjected to thorough, independent testing. And as many different companies manufacture them, there are no quality assurances in their production processes.
  • Their effectiveness as smoking cessation aids.
  • Their ability to deliver enough nicotine to satisfy withdrawal effects.
  • The effect of secondhand vapor.
  • Whether their use encourages those who might have otherwise quit to continue smoking — and only use e-cigarettes when they are in nonsmoking environments.
  • Whether youth may use them as an introduction to smoking regular cigarettes.

In looking at these lists, it is easy to see how e-cigarettes are a source of controversy.

The bottom line

There is only one solution to resolving this controversy and ultimately improving public health. That solution, as we’ve learned from more than two centuries of public health advances, is to put science to work.

Only after obtaining solid, independent data can and should we make evidence-based decisions and recommendations. An international group of respected scientists recently recommended this course of action and outlined a clear research agenda for helping determine the safety and effectiveness of these devices (1).

To do otherwise — to develop public health policy on the basis of opinions and anecdotes — will not serve the public well and will ultimately undermine both points of view.

E-cigarettes may have the potential to make an important contribution to public health by helping some smokers quit, but they are not likely to be a “magic bullet” any more than other smoking cessation tools have been to date.

Hopefully, the research and regulatory processes will move forward quickly. After all, if e-cigarettes are shown to be unsafe and ineffective, we want to move on to other approaches that can lower the appalling burden attributable to cigarette smoking. If they are shown to be both safe and effective, smokers can add them to the menu of approaches that may end their habit and extend their lives.

Etter JF, et al. Electronic nicotine delivery systems: A research agenda. Tobacco Control. 2011;20:243.