The high-stakes debate over e-cigarettes

Share

Rarely has a single product evoked such diametrically opposed views or such passion as e-cigarettes.

Anti-smoking activists see the electronic nicotine-delivery systems (the formal name) as another evil concoction of Big Tobacco, a devilish way to create new smokers and undermine hard-fought public health measures.

Proponents of e-cigarettes see them as a means of getting what they desperately want – usually nicotine, but sometimes the tactile act of "smoking" – without the carcinogens in tobacco, and as means to gain freedom from the increasingly oppressive measures taken against smokers.

E-cigarettes are canisters used to simulate the act of smoking: Batteries heat up fluid-filled cartridges that contain water, flavouring agents and nicotine (though not always). The act of smoking an e-cigarette is known as vaping because you inhale vapours, not smoke.

Health Canada does not allow the sale of e-cigarettes containing nicotine.It is also illegal in Canada to make any health claims about e-cigarettes, for example suggesting they are a smoking cessation tool.

The United States has, to date, taken a hands-off approach, though the U.S. Food and Drug Administration has served notice that it intends to extend its regulatory control of tobacco to e-cigarettes in the near future.

There is no question that e-cigarettes pose a dilemma for regulators and anti-smoking activists. Devotees – who are an unusually fanatical lot – can trot out amazing anecdotal stories about the power of e-cigarettes and five-pack-a-day smokers who have become healthy vapers. Skeptics feel the arguments are eerily similar to options that have been touted in the past as being "healthier" like "light" cigarettes, cigarellos and chewing tobacco.

Dreams and fears aside, research on e-cigarettes – about their potential harms and potential benefits – is in its infancy. Data on long-term risks and benefits are especially lacking. In other words, the jury is still out, despite the grandiose claims of benefit from proponents and the dire warnings of opponents.

In a world where there are one billion smokers and smoking kills almost six million people a year, this is a high-stakes debate.

The global e-cigarette market is already worth $2-billion (U.S.) a year – with more than half of all sales in the U.S. – and it's expected to surpass $10-billion annually by 2017. And everyone is keeping a close eye on China – where e-cigarettes emerged in 2006 – because, as it pushes to restrict tobacco, it is touting e-cigarettes as an alternative.

Many anti-smoking activists see e-cigarettes as a Trojan horse, a gateway drug that will attract new users to tobacco and discourage current smokers from quitting. It is not clear how many so-called "dual users" (people who alternate vaping and smoking) exist.

Then there is the fear that decades of effort to restrict smoking will be all for naught. At the recent People's Choice Awards, for example, vaping was de rigeur, to the point where it looked like a product placement for the popular brand Blu. The use of aggressive advertising using recognizable Hollywood stars is reminiscent of the old techniques of Big Tobacco.

The point of anti-smoking laws and by-laws is to limit exposure to second-hand smoke, but if vapours are harmless, the argument for restrictions goes up in smoke.

So, do e-cigarettes contain toxic chemicals and carcinogens? That is a point of much contention. Some research says yes, some no. Again, the reality is there is a broad range of products and no standards. But e-cigarettes are principally a nicotine-delivery system. Nicotine is addictive – in fact, it's what makes people addicted to cigarettes. It's not particularly harmful; it's the byproducts of processing and burning tobacco that causes cancer, heart disease, chronic obstructive pulmonary disease and other health woes of smokers. Isn't it preferable to have people addicted to nicotine alone rather than nicotine and a potpourri of toxins?

The answer to that loaded question is "Yes" – if you believe in harm reduction.

Most public health officials strongly favour harm reduction when it comes to "hard" drugs; the supervised injection site Insite, for example, allows intravenous drug users to inject in a controlled setting with clean needles rather than in back alleys with dirty needles. But making that argument for vaping versus smoking doesn't have as much traction. When it comes to tobacco, most public health officials argue for abstinence and oppose e-cigarettes.

The sands are constantly shifting. The Lung Association, for example, went from being an outspoken opponent of e-cigarettes to taking the position that they might be a good smoking cessation tool, a way of weaning people off cigarettes. We don't know yet if e-cigarettes are as effective – or as ineffective – as other forms of nicotine replacement therapy.

Probably the other persuasive argument against electronic cigarettes in 2014 is that they remain an unproven commodity – we shouldn't be rushing headlong to embrace the technology. At the risk of sounding like the conclusion of every research study ever published: More research is needed.

In the meantime though, it seems irrational and counterproductive to ban e-cigarettes in Canada. A more sensible approach would be to regulate and allow nicotine-delivery devices on the market that don't contain carcinogens.

In the war on smoking – which is, after all, a battle to improve the health of individuals and the collectivity – e-cigarettes are not a panacea, but they are a step in the right direction.

Follow me on Twitter: @picardonhealth