A decade ago, e-cigarettes were nothing more than a novelty. The battery-powered devices, which heat up a liquid containing nicotine and flavouring so it can be inhaled as a vapour, were dismissed by many as little more than a passing fad.
Now they are everywhere. Almost three million people use e-cigarettes in Britain today, drawn in by the seductive proposition they can happily puff away without damaging their health. The legion of users here grows daily.
So-called ‘vaping’ is also gaining popularity across the globe, encouraged by doctors who believe it is far safer than smoking real cigarettes.
Not surprisingly, tobacco giants, keen to defend their profits, are getting in on the act by buying up brands and creating their own products. But now a growing number of studies has cast serious doubt on the rosy assumption that e-cigarettes are an almost harmless alternative to smoking. And the latest research is truly worrying.
This study follows others which have found that – just like ‘real’ cigarettes – e-cigs raise blood pressure and promote a hardening of the arteries.
Separate research indicates that the food additives used to flavour the vapour could be dangerous when heated and inhaled.
And another hotly disputed study, published earlier this year, even suggested that those who vape are 28 per cent less likely to quit tobacco than those who do not.
Despite all this, a number of medical organisations in the UK strongly support encouraging smokers to switch from tobacco to e-cigarettes.
Public Health England has issued a statement saying the devices are ‘around 95 per cent less harmful than smoking’. And only last week the Royal College of GPs told its 52,000 members to advise those trying to give up smoking to switch to e-cigarettes.
However, critics of this approach are unconvinced by such enthusiasm.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, said: ‘Many health organisations across the UK have significant concerns about promoting e-cigarettes to smokers.
‘We simply can’t know what their effect will be on health, if used over the long term, because they have not been around long enough.
‘To me, it would be sensible to take a precautionary approach and regulate them as much as possible.’
And Dr Filippos Filippidis, lecturer in public health at Imperial College, London, said: ‘We don’t know whether we may start to see diseases emerge in ten or 20 years’ time associated with some of the ingredients. We urgently need more research into the devices.’ His warning is particularly pertinent because it took decades for the link between tobacco and lung cancer to emerge.
It became clear only thanks to the pioneering work of statistician Sir Richard Doll in the 1950s – work that has saved millions of lives.
In the Karolinska study, published in the journal Atherosclerosis, Swedish researchers took 16 occasional smokers of cigarettes and asked them to each take ten puffs on an e-cigarette.
Within the first hour, there was a ‘rapid rise’ in levels of a type of cell indicating damage to the inner lining of blood vessels, called endothelial progenitor cells or EPCs, said the scientists. This increase, they wrote ‘was of the same magnitude as following smoking of one traditional cigarette’.
This ‘very short exposure to e-cigarette vapour… may indicate an impact on vascular integrity leading to future atherosclerosis’ – better known as hardening of the arteries.
SO IS VAPING THE SAFE ALTERNATIVE?
By Prof John Britton
We should not let studies rightly highlighting the potential dangers of e-cigarettes blind us to the fact that these devices are much, much safer than smoking tobacco.
For a smoker, moving to e-cigarettes brings a huge health benefit. The decision should be a no-brainer. When you smoke a cigarette you inhale not only nicotine but also more than 4,000 highly toxic chemicals, including carcinogens. And you inhale many of them in fairly high concentrations. So there’s nothing better you can do for your health than to quit smoking. Let’s be clear: e-cigarettes are not harmless and we shouldn’t be complacent. E-cigarette vapour contains toxic chemicals, and tiny particles that can harm lungs and blood vessels.
But in terms of the harm they cause, they simply aren’t in the same league as smoked tobacco.
Levels of EPCs only returned to normal 24 hours later.
Professor Joep Perk, a heart specialist and spokesman for the European Society of Cardiology, said: ‘It really surprises me that so little vapour from an e-cigarette is needed to start the heart disease ball rolling.
‘It’s worrying that one e-cigarette can trigger such a response.’
So will long-term use of e-cigs cause heart disease? That remains to be seen. But the Swedish team noted that the average user takes 230 puffs a day – raising the prospect that prolonged use could cause serious damage.
Nor is this study alone. In August, a team at the University of Athens Medical School claimed that puffing on an e-cigarette for half an hour led to similar levels of stiffness in the aorta – the main artery – as smoking a tobacco cigarette. Both activities raised blood pressure, too.
Study leader Professor Charalambos Vlachopulos said at the time: ‘E-cigarettes are less harmful [than smoking tobacco] but they are not harmless.
‘I wouldn’t recommend them as a method of giving up smoking.’
New research is coming thick and fast. Last month, an American study found teenagers who used e-cigarettes were 71 per cent more likely to suffer bronchitis.
On Friday, another study claimed just one puff contained up to 270 times the safe level of toxic chemicals called aldehydes.
But it is a study in the journal Lancet Respiratory Medicine – which found e-cig users were 28 per cent less likely to quit tobacco smoking than those who didn’t vape – that has perhaps caused the most dispute. This finding matters because the vast majority of e-cig users are those trying to quit tobacco.
Co-author Stanton Glantz wrote: ‘While there is no question that a puff on an e-cigarette is less dangerous than a puff on a conventional cigarette, the most dangerous thing about e-cigarettes is that they keep people smoking conventional cigarettes.’
His findings have been leapt on by e-cig sceptics, who frequently quote the headline result.
But e-cig advocates have dismissed it as unscientific and even ‘grossly misleading’.
Peter Hajek, of the Tobacco Dependency Research Unit at Queen Mary, University of London, said it looked only at current smokers who had used e-cigarettes in the past – ignoring ex-smokers who had given up tobacco thanks to the devices.
Advocates of getting smokers to swap tobacco for e-cigarettes now fear their simple message – that switching saves lives – is getting lost in a cloud of confusion.
Smoking claims the lives of 93,000 people in the UK every year – accounting for almost one in every five deaths – as it significantly increases the risk of killer diseases including cancer, heart disease, and a lung condition called chronic obstructive pulmonary disorder.
Professor John Britton, director of the UK Centre for Tobacco and Alcohol Studies at Nottingham University, said: ‘The decision to switch should be a no-brainer… There’s nothing worse you could do for your health than smoke.’
And e-cigarettes did help 18,000 people quit smoking last year, according to research by University College London and Cancer Research UK.
Scientists such as Dr Britton believe that, despite the lurking dangers of e-cigarettes, they could deliver huge benefits to the country’s overall health.
SO IS VAPING THE SAFE ALTERNATIVE?
By Prof Martin McKee
Do we know what the long-term effects of regular e-cigarette use will be on human health? No – because they haven’t been around long enough.
But the evidence that is accumulating causes me very considerable concern.
For a start, nicotine is more dangerous than previously thought. It negatively affects the developing brain, helps cancer spread by encouraging the growth of blood vessels around tumours, and increases the risk of dangerous heart rhythms in those who have just had a heart attack. The flavourings in e-cigs – usually food additives – might have been tested for safety in terms of ingestion though the gut, but taking them in through the lungs after heating is completely different.
Vaping is almost certainly safer than smoking tobacco. But the limited evidence suggests using e-cigs actually reduces the chance of a smoker quitting tobacco.
To that end, a group of 13 health bodies, led by Public Health England and including Cancer Research UK, the Royal College of Physicians and Faculty of Public Health, issued an unprecedented ‘consensus statement’ in July supporting the principle that smokers should be encouraged to switch.
They wrote: ‘We all agree that e-cigarettes are significantly less harmful than smoking.
‘One in two lifelong smokers dies from their addiction.
‘All the evidence suggests that the health risks posed by e-cigarettes are relatively small by comparison, but we must continue to study the long-term effects.’
They concluded: ‘The public health opportunity is in helping smokers to quit, so we may encourage smokers to try vaping.’
Yet this position is ‘out of step’ with opinion in the US and Europe, according to Prof McKee and Dr Filippidis, where health bodies are far more cautious.
Dr Filippidis said: ‘Only time will tell who is right, but my personal opinion is that some more caution would be prudent until the evidence is more clear.
‘Very soon, major tobacco companies will enter the market with their own e-cigarettes or similar products that promise harm reduction.
‘I would feel very uncomfortable promoting products created by companies which have caused so much death and pain.
‘I don’t think we could trust them with our people’s health.
First published in dailymail.co.uk