National Academy of Sciences Report on E-Cigarettes Confirms that Vaping is Much Safer than Smoking and Has No Known Long-Term Health Effects

A report released this morning by the National Academy of Sciences confirms that despite the demonization of vaping by many anti-tobacco groups and health departments, use of these products is much safer than smoking, and there are no known long-term health effects associated with vaping.

This does not mean, of course, that vaping is safe. It just means that we don't know what the long-term effects may be. But it is important to stress that at this time, we don't know of any long-term adverse health effects.

The report also concludes that the "second-hand" aerosol produced by vaping is safer than secondhand tobacco smoke, that vaping is less addictive than smoking, that switching from smoking to vaping can improve respiratory function and symptoms in people who have asthma or COPD, and that switching from smoking to vaping reduces health risks across the board.

Finally, the report concludes that experimentation with e-cigarettes is a risk factor for experimentation with tobacco cigarettes and subsequent smoking. 

The key findings of the report are:

1. "There is substantial evidence that except for nicotine, under typical conditions of use, exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes."

2. "There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes."

3. "There is moderate evidence that risk and severity of dependence are lower for e-cigarettes than combustible tobacco cigarettes."

4. "There is moderate evidence that second-hand exposure to nicotine and particulates is lower from e-cigarettes compared with combustible tobacco cigarettes."

5. "There is no available evidence whether or not e-cigarette use is associated with clinical cardiovascular outcomes (coronary heart disease, stroke, and peripheral artery disease) and subclinical atherosclerosis (carotid intima media-thickness and coronary artery calcification)."

6. "There is insufficient evidence that e-cigarette use is associated with long-term changes in heart rate, blood pressure, and cardiac geometry and function."

7. "There is no available evidence whether or not e-cigarette use is associated with intermediate cancer endpoints in humans. This holds true for comparisons of e-cigarette use compared with combustible tobacco cigarettes and e-cigarette use compared with no use of tobacco products."

8. "There is no available evidence whether or not e-cigarettes cause respiratory diseases in humans."

9. "There is limited evidence for improvement in lung function and respiratory symptoms among adult smokers with asthma who switch to e-cigarettes completely or in part (dual use)."

10. "There is limited evidence for reduction of chronic obstructive pulmonary disease (COPD) exacerbations among adult smokers with COPD who switch to e-cigarettes completely or in part (dual use)."

11. "While the overall evidence from observational trials is mixed, there is moderate evidence from observational studies that more frequent use of e-cigarettes is associated with increased likelihood of cessation."

12. "There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults."

13. "There is conclusive evidence that, other than nicotine, the number, quantity, and characteristics of potentially toxic substances emitted from e-cigarettes is highly variable and depends on product characteristics (including device and e-liquid characteristics) and how the device is operated."

The Rest of the Story

There are several very important implications of the report's conclusions. For what it is worth, I agree with all of these conclusions except #12, although it depends on how one interprets that statement. But setting aside that single possible disagreement, here are the major implications of these conclusions taken as they are:

First, these conclusions mean that all the anti-tobacco groups and state health departments that have been telling the public that vaping is just as bad (or worse) than smoking have been spreading serious misinformation.

Second, these conclusions mean that all the groups and agencies that have been telling people that vaping is just as addictive as smoking have been spreading serious misinformation.

Third, these conclusions mean that all the groups and agencies that have been telling people that vaping is associated with an increased risk of cancer, heart disease, or lung disease have been making completely unsubstantiated claims.

Fourth, these conclusions mean that all the anti-tobacco groups and state health departments that have been telling people that there is no evidence that vaping can help smokers quit have also been spreading serious misinformation.

Fifth, the overall conclusions of the report mean that the FDA has done an extreme disservice to the protection of the public's health by implementing a pre-market approval requirement for electronic cigarettes rather than simply promulgating safety standards for these products.

The conclusions of the report lend strong support to the legislation being considered by Congress which would scrap the FDA's de facto ban on most e-cigarettes (i.e., the expensive and burdensome pre-market applications) and instead, force the agency to promulgate safety regulations for all vaping products.

The bottom line is that it is possible to make e-cigarettes that pose little health risk but because the FDA has dragged its feet and chosen to take a prohibitionist approach rather than to do its actual job (protecting the public's health), there continue to be products on the market that are exposing users to unnecessary potential risks, including battery explosions and unwanted chemicals produced by overheating of the e-liquid.

From extensive testing of products like Vuse, Mark Ten, and blu e-cigarettes, we know that it is possible to manufacture e-cigarettes that control temperature well enough to avoid the degradation products that result from overheating. We also know that it is possible to manufacture safe batteries that will not explode. But rather than implement such standards, the FDA has instead blocked manufacturers from making their products safer, because any change in their products would require them to take the product off the market until they get an application approved, which could take years.

It is ridiculous that if a company knows its batteries are exploding and causing serious injuries, it cannot fix that problem. Its choices are to either continue marketing defective products or to go out of business. Of course those companies are going to choose to continue marketing the unsafe batteries.

As I have been arguing for months, the report agrees that there is no evidence to support the conclusion that vaping increases the risk of heart disease, lung disease, or cancer, despite the many anti-tobacco groups and state health departments (and even researchers) which have made such claims. The report concludes that there is no evidence that vaping is associated with heart disease, lung disease, or cancer. Groups that have been telling the public about all sorts of risks associated with vaping, such as "popcorn lung" and increased risk of cancer, have been making unsupported claims.

It will take many years before we will know whether vaping is associated with long-term health risks because it would take perhaps decades of vaping before these diseases would develop (note that even in heavy smokers, we typically do not see heart disease, COPD, or cancer until at least two decades of use). However, we can't wait for two decades before we make decisions on how to regulate these products. Thus, we have to use the best available evidence to decide the best approach to protecting the public's health.

I believe that the best approach is to allow e-cigarettes to remain on the market (i.e., scrap the pre-market application requirement), but to set safety standards to prevent battery explosions and overheating of the e-liquid. I don't think this is very complicated, and organizations like AEMSA have already developed manufacturing standards that would go a long way toward maximizing the safety of vaping products.

Finally, let me say a few words about conclusion #11 above ("There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults"). It is true that youth who experiment with e-cigarettes are more likely to also experiment with tobacco cigarettes and therefore, to become smokers. It would be shocking if this were not the case because we know that youth who experiment with one risky behavior are more likely to experiment with other risky behaviors. But this doesn't necessarily mean that the experimentation with e-cigarettes is causing the youth to start smoking.

For example, there probably are not many kids who use heroin who have never taken a sip of alcohol. If you did a study, you would find that alcohol use is associated with later use of heroin. But this doesn't support the conclusion that experimenting with alcohol causes kids to become heroin junkies. It simply reflects the fact that kids who take huge health risks are more likely to already have taken smaller health risks. A youth is not going to decide to rebel one day by injecting a drug into their veins. The rebellion process would likely start with a less hazardous behavior, such as taking a toke on a cigarette and then for a very small number of kids, they would end up progressing to hard drug use.

So the important question is not whether youth who experiment with e-cigarettes are more likely to end up smoking (of course they are!), but instead, whether youth who experiment with e-cigarettes are more likely to become addicted to vaping and then be led to smoking addiction, such that without having become addicted to vaping, they unlikely would have become smokers. So far, the evidence suggests that this is not the case: very few youth have been identified who started as nonsmokers, became regular vapers, and then progressed to smoking.

The rest of the story is clear. Tobacco control groups and public health agencies who are truly concerned about protecting the public's health should rally behind the use of vaping products for adult smokers as a harm reduction strategy and should channel their concerns about the health risks of vaping among both smokers and nonsmokers by demanding that Congress require the FDA to take immediate action to rescind its pre-market application requirement for vaping products and instead, to promulgate safety and quality control standards for all electronic cigarettes and vaping products.
National Academy of Sciences Report on E-Cigarettes Confirms that Vaping is Much Safer than Smoking and Has No Known Long-Term Health Effects was originally posted by E-Sigaret Nieuws