Are E-Cigarettes Safe?

What are you comparing them with? For smokers the yardstick is switching from tobacco. For vapers who have never used any form of nicotine the contrast is with inhaling Alpine air.

The Tobacco Comparison: 

Nicotine Users Killed Over Past 10 Years: Smoking tobacco = 60 million vs Vaping e-cigarettes = Zero

The vast majority of e-cigarette users are switching from tobacco smoking which kills one in every two of its users – they typically lose 10 years of life along with a big impact on their health while they are alive – from taste buds, to lung capacity and sexual ability. The World Health Organization estimates that during this century 1,000,000,000 people will be killed by smoking. That’s one every three seconds. Since e-cigarettes were invented 10 years ago the number killed by vaping has been zero.

Why is vaping failing to kill? Because vaping produces none of the lung clogging tar or suffocating carbon monoxide that tobacco smoking produces. And in terms of toxins including carcinogens e-cigarettes produce only trace amounts similar to those produced by medicinally licensed nicotine gum and patches.

“The risk is negligible, and compared with smoking there is no contest” Professor Robert West, University College London, July 2013

“The chemicals that make cigarettes dangerous are either absent in electronic cigarettes or present only in trace concentrations” Lancet, July 2013

“If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths” Professor John Britton, Royal College of Physicians, February 2013

The Alpine Air Comparison

If you are going to have a vice then vape

There are some people using e-cigarettes who have never smoked tobacco. Later we look at whether that is becoming a stepping stone into tobacco smoking for them. But can we be utterly relaxed their using e-cigarettes even if they never moved onto tobacco? Would a life of vaping have long-term physical impacts? What about the ethical issues of people being addicted to ? As we will see there are some impurities in e-cigarettes and there are risks in misuse. And of course they contain nicotine. But while there are many good questions to ask about vaping the overall safety of e-cigarette vapor doesn’t bamboozle scientists:

The toxicity of vapour in e-cigarettes is “one thousandth of that in cigarette smoke” NHS Website

“There is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns  Drexel University Study, January 2014

“It’s not dangerous to be near someone who is using an e-cigarette.” BBC News 28 April 2014

How Safe Is Nicotine?

Is nicotine a deadly killer? Or is it just tobacco smoke we should worry about?

The health effects of nicotine on its own are “very similar to drinking coffee” Professor Peter Hayek. ( BBC News 28 April 2014. ) It is very difficult to inhale dangerous amounts of e-cigarettes – both smokers and vapers will feel nausea long before they were harming their bodies. They decide how much nicotine they inhale with the depth of each breath. Breathing in nicotine is a very fast way to get the drug into your bloodstream when you want. That’s one reason a lot of smokers struggle with ‘medicinal’ sources of nicotine. With gum the nicotine peaks in the blood long after they put the patch on. So it’s not just that the gum fails to produce instant satisfaction, it can create nausea when too much nicotine has been absorbed.

Why do many people worry about nicotine as a drug:

i) ignorance: doctors saying it’s a carcinogen

ii) bad science: The first is a discredited research project published in 1858. Recent studies have indicated that the human body is much more tolerant to nicotine than thought. Yet the European Unions e-cigarette policy is still based on a reliance on this 164 year old discredited experiment. The EU will in two years ban e-cigarettes containing more than 20mg of nicotine. Yet scientists have demonstrated that this produces only one-third of the nicotine that a tobacco cigarette produces. So the typical vaper is inhaling much less nicotine than a smoker.

iv) the gateway fear

So there’s an interesting debate not just about how much safer it is to consume nicotine through vaping than smoking – but also about what, if any, restrictions are appropriate on vaping.

What About Nicotine Liquid?

I’ve heard that if I touch a drop of nicotine liquid I will turn into warthog.

The potential risks from accidentally drinking nicotine liquid were highlighted by the New York Times. In a front page story the paper said there had been 1,300 reports of accidental poisoning in the United States over the previous year. Yet none of these accidents produced fatalities. The paper failed to mention that there had been 12,000 reports of toothpaste ‘poisoning’ and 70,000 cases of suspected vitamin overdoses. So if any politician wants to ban e-liquid then they have got to answer the toothpaste question first. And definitely ban vitamins.

In the vast majority of cases of ingestion there is no lasting harm as the human body metabolizes the nicotine quickly – half of its is gone within 2 hours. To date the only fatalities have been reported are of an Israeli toddler who was said to have swallowed an e-liquid capsule and an American adult who committed suicide by injecting nicotine liquid. Tragedies – but absolutely no justification for taking away e-cigarettes from millions of smokers who are using to help them switch. Society should ban household bleach and plastic bags long before e-cigarettes. Child proof locks and commonsense are the answer not bans.

How Addictive Is Nicotine?

Why are many vapers able to quit vaping despite the nicotine?

Addiction is really complex. In part it’s because every person has a different physical response to nicotine. Some smokers can ‘just quit’ while other have a very different bodily reaction to going cold turkey. There are others reasons why some fail to give up tobacco. Some use nicotine to mask difficult feelings. For others it has become an ingrained social habit with the familiar ritual of lighting up with friends, holding the cigarette in their hand and having the warm smoke hitting their throats. A fundamental reason for the unprecedented success of e-cigarettes has been the way they mimic these aspects of smoking. But it may not just be psychology which is at work. Some of the other 4,000 chemical in tobacco smoke may also be physically addictive. The absence of those chemicals – and the typically lower levels of nicotine absorbed by vapers over smokers may explain why some e-cigarette users find it easy to also give up vaping once they have left tobacco behind.

Not Just Nicotine In E-Cigarettes?

I’ve heard that propylene glycol is used as fuel for space rockets?

Tobacco smoke has 70 known carcinogens and in sufficient quantities to make lung cancer a very substantial risk for smokers. E-liquid is basically nicotine mixed with propylene glycol. This is the same chemical approved for asthma inhalers (not rocket fuel). So what’s to worry about? We have three main concerns. Firstly because governments are failing to impose basic product regulation on e-cigarettes there is variable quality and no effective testing of batches of e-cigarettes and liquids. With so many small companies importing from China, we don’t have enough confidence in product consistency. The second area is over-heating. Some very cheap devices and some modified ones may be over-heating the e-liquid and some of the components producing dangerous chemicals. The third are the flavors added to e-liquid. Flavors are hugely helpful in helping make e-cigarettes more attractive than smoking tobacco. Many smokers switch to e-cigarettes after finding their perfect flavor and after a short while start to dislike the taste of tobacco smoke. Job done. Yet we are not clear about the long term impact of inhaling flavors which are approved as food flavorings. So far, so much good and no reports of harm. The issue of children and flavors is covered here. 


What About Passive Vaping?

If zero vapers have been killed by vaping, how many non-vapers have been killed by passive vaping?

You’ve guessed it. Zero. It’s ten years since Ireland became the first country in the world to ban tobacco smoking in enclosed spaces. Dozens of countries have followed suit with Russia the latest. Non-smokers didn’t just find the smell of smoke disturbing, they didn’t want to inhale the cocktail of 4,000 chemicals for hours at end. Yet what’s the rationale for banning e-cigarette vaping in public places? The safety argument is hard to make given there is so little toxicity in e-cigarette vapor. Some fantastical arguments have been made about the risks of second vapor – and even third hand vapor (i.e. touching surfaces ‘contaminated’ by nicotine from e-cigarettes.) But they lack credibility for all but the most gullible. A more interesting argument is that smokers and others who watch people using e-cigarettes might break down the hard fought bans on tobacco smoking by ‘normalizing’ smoking. Yet in the six years since e-cigarette use started to take off we’ve seen smoking rates falling (gateway link). So they seem to rather better at normalizing non-smoking. Where are the press reports of armies of smokers using vapers as cover for their activity? Perhaps that’s because as these devices typically have a blue flashing light and don’t smell of smoke, it isn’t that hard to distinguish them from cigarettes. Some vapers are there own worse enemies – being so ostentatious in the vapor clouds they project that they cause offence – and given ignorance about the science – concern. But this is an argument for establishing an e-cigarette etiquette in each venue rather than widespread bans. Such bans really do risk ‘normalizing’ smoking by sending vapers who are struggling to quit outside where tobacco smokers offer them cigarettes.


Dual Use?

I’ve been told by experts that it’s just as dangerous to smoke one cigarette as one hundred a day.

One in three e-cigarette users have permanently quit tobacco. The others are using a mixture of cigarettes and e-cigarettes. On average they have cut down to about four cigarettes a day. Yet some e-cigarettes opponents say that this is just as bad for health as if they continued to smoke the same as before. Their rationale are studies which showed that smokers cutting down do not get anywhere near the same health benefits as smokers who quit. The intellectual black hole in this argument is that, before e-cigarettes came along smokers, who were cutting down on numbers of cigarettes were inhaling much more deeply on each cigarette. In search of their nicotine hit they were inhaling more tar and carcinogens with every breath. Replace the missing cigarettes with e-cigarettes and that problem disappears. 



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