Dr Martin Juneau, M.D., FRCP

Cardiologue, directeur de l'Observatoire de la prévention de l'Institut de Cardiologie de Montréal. Professeur titulaire de clinique, Faculté de médecine de l'Université de Montréal. / Cardiologist and Director of Prevention Watch, Montreal Heart Institute. Clinical Professor, Faculty of Medicine, University of Montreal.

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9 February 2017
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Electronic cigarettes are actually less harmful than tobacco

An article recently published in the Annals of Internal Medicine confirms that users of nicotine substitutes such as electronic cigarettes are much less exposed to toxic and carcinogenic chemicals than regular smokers. By comparing saliva and urine samples from regular “vapers” and smokers, Dr. Robert West’s team showed that those of vapers contained much smaller amounts of several molecules known to contribute to the damages of smoking, including certain carcinogenic nitrosamines and toxic volatile compounds such as acrolein, acrylamide and acrylonitrile. However, this decrease is not observed in vapers who continue to smoke tobacco occasionally, indicating that the e-cigarette can only truly reduce the exposure to toxic compounds in people who completely stop using combustible tobacco. When this is the case, however, these data clearly show that e-cigarettes are much less toxic than traditional cigarettes and that smokers can significantly reduce their risk of developing smoking-related diseases by adopting this form of nicotine inhalation.

Despite this substantial reduction in harm, several official agencies in Canada and the United States are still fiercely opposed to e-cigarettes because they fear it will “renormalize” smoking and, more importantly, become a gateway to tobacco among young people. I understand these concerns very well: when you’ve been fighting tobacco cigarettes for 50 years, it’s hard to accept anything that seems to resemble it.

On the other hand, one may question the relentlessness of some American researchers to try to demonstrate that the use of the electronic cigarette is really a stepping stone towards tobacco cigarettes. For example, a recent study argues that this is indeed the case, although the authors come to this conclusion based solely on the fact that teenagers who had tried e-cigarettes only once in the past month had also tested a tobacco cigarette during the year. As mentioned by Professor Peter Hajek, who heads the Tobacco Dependence Research Unit at Queen Mary University in London, this result means absolutely nothing, as a young person attracted to tobacco will experiment with several forms available, without it necessarily meaning that testing one leads to trying another.

In fact, there is no data that suggests that the use of e-cigarettes leads to smoking, quite the opposite. The proportion of American teenagers who smoke has been steadily decreasing since the late 1990s: for example the “Monitoring the Future” survey reports that the proportion of teenagers who have smoked in the last 30 days has decreased from 28.3% in 1996 to 5.9% in 2016. In addition, since 2011, when the use of e-cigarettes began to increase rapidly in the United States, the proportion of teenagers who smoke has declined sharply from 11.7% to 5.9%. While it is essential to closely regulate the sale of e-cigarettes to young people, it is high time to admit that “vaping” is not a stepping stone to smoking and can even significantly reduce the catastrophic effects of tobacco on health.

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