The E-Cigarette Debate

vape-penProbably the most intense and at times vicious fight within the medical community right now concerns whether e-cigarettes are a net harm or a net benefit to public health. E-cigarettes expel many carcinogens and their use is skyrocketing among the young. On the other hand, traditional tobacco cigarettes are even worse, and if e-cigs drive them out of the market that would benefit population health.

This is an issue where knowledgeable people of good will can disagree, and indeed have. More civil, thoughtful debate is in order and we hope to facilitate that this coming Monday at the Stanford Health Policy Forum. The event is free and open to the public and we hope you can attend (all details here).

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College Lonon. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over ten thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

15 thoughts on “The E-Cigarette Debate”

  1. Under no circumstances do I want to be around anyone who "vapes," and I despise the term "vape." And this was when I thought they were supposed to be safe! So if you're telling me they spit out carcinogens, then there goes a big part of their justification. You say the use is skyrocketing – but is it *replacing* cig smoking that would have happened? If not, maybe they should be banned.

    At a minimum, I want them subject to the same restrictions. Thank heaven I live somewhere where smoking is restricted. I feel guilty for being so annoyed by smokers, but there it is.

  2. May I respectfully suggest that — just as in the debate over fossil fuels — slicing this problem down to the level of its effects on end-users misses a substantial part of the point?

    The tobacco plant is not agriculturally, botanically, or ecologically benign. (Nor is any other agricultural commodity; but that's part of my point.) Indeed, it is a vector for and laboratory for plant diseases (again, like many other agricultural commodities). It seems to me that a debate on "e-cigs" also needs to consider the costs of what it takes to make e-cigs in the first place, both directly and in opportunity-cost terms (for example, hypothetical effect of one-for-one replacement of US tobacco crops with plants comfortable in the same general growing conditions, such as tomatoes). This is parallel to considering the role of, say, ecological contamination that will be an inevitable byproduct of producing Arctic oil (whether from shale or drilling) in the oil-cycle debate.

    Indeed, there may well be something insidious going on (like that would be a surprise from the tobacco industry!) involving what happens to the toxins that DON'T make it into e-cigs. Looking only at the direct effects on end-users, it seems to me, misses the forest for the leaves.

  3. E-cigs deliver nicotine (sort of the whole point, really), which is a major contributor to cardio-vascular disease, and which is how tobacco cigarettes kill most of their victims, if my understanding is correct.

    1. This is a much debated issue. My reading of the evidence is that nicotine does have adverse CV effects, but that it is not the main contributor to CV deaths among smokers.

      1. Really? Well, you're probably in a better position to know than I am, but back when I was still smoking and first having cardiovascular problems (a long time ago, now, praise be), the cardiologists who treated me obviously believed that nicotine was the major culprit in tobacco smoke.

        If not nicotine, what is the main contributor to CV deaths among smokers? Regardless, of course, nicotine intake is a clear negative for human health, so it's not just carcinogens in "vape" that are problematic.

        1. Nicotine is, as I understand it, is an acute vasoconstrictor, which isn't exactly the sort of thing that you want to be exposed to if you have cardiovascular problems. OTOH, it doesn't appear to cause chronic problems. It's roughly, adjusted for dose, about as dangerous as caffiene. I wouldn't recommend drinking too much Mountain Dew if you had a heart condition, either.

          While tobacco is full of a whole host of chemicals, especially when burnt, that damage your lungs and circulatory system, and cumulatively. It even contains very direct carcinogens, even if not burnt. Which is why chewing tobacco is so horrible. It causes cancer, circulatory, and respiratory damage, and cancer, quite independent of whether or not there's any nicotine present.

          So, yes, it actually is a lot better for you to consume your nicotine without any tobacco being involved. And the nicotine, by itself, isn't going to particularly harm you if you don't already have some underlying pathology.

    2. I didn't want to answer this more definitively until after the forum, when I could consult people who had studied this issue for years. Now I know that nicotine is a small part of the CV risk of cigarettes, so much so that people on NRT after smoking have a rate of CV problems only barely different than never smokers.

      1. Thanks for up-ending what I thought I knew about smoking and heart disease. I guess it's still a bad idea to start smoking again (after 15 years).

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  7. While the original cost of a starter kit may be a little bit higher, the month-to-month, or annual, cost of electronic smoking is quite low compared to conventional tobacco smoking.

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