In the past few weeks, a mysterious illness has gripped over 200 people across the United States. The symptoms include breathing difficulties, fatigue, and nausea. Doctors are having a hard time diagnosing – no one can precisely point to its origin.
The only factor that connects all those afflicted is that they are all e-cigarette smokers.
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Since their introduction in 2003, e-cigarette usage has skyrocketed. They are hailed as saviors by users who claim it helps them quit smoking and is significantly safer than traditional cigarettes. Critics liken them to ticking time-bombs, given the lack of evidence regarding their ramifications.
But before delving into the arguments made by these sides, it might be beneficial to understand the origin, structure and regulatory mechanisms behind e-cigarettes.
In the early 1960s, young Herbert Gilbert was working in his father’s scrap yard trying to find a way to deal with the smoke from burning leaves that routinely wafted over to the neighbour’s house. While pondering over ways to channel the smoke elsewhere, he realised that everyday items like leaves and wood posed no harm on their own but when dried and burnt they would emit harmful and unpleasant smoke. His Eureka moment was his realisation that the removal of combustion meant the removal of harm as well.
Gilbert applied the same logic to design a “smokeless, non-tobacco cigarette”. It was an aluminum cylinder that burnt liquid instead of tobacco to emanate vapor for a smoker to inhale. Gilbert patented his invention – the first e-cigarette – and pitched it as a safe and healthy alternative to tobacco. But no company was excited about his idea – it was, after all, the ‘60s and smoking was a cultural norm and not the taboo it is today.
Fast forward six decades: today, e-cigarettes are a c. $11bn industry. Gilbert didn’t make any money off his patent, now long expired. But the industry he indirectly helped found is taking off – it’s expected to double every three years, growing at a CAGR of 24.9% till 2025.
E-cigarettes comprise a few basic structural units. These include a mouthpiece, a cartridge where the liquid is stored (usually contains propylene glycol, glycerin, nicotine, flavours and other additives), a heating element or atomiser, and a battery.
The process begins when the user inhales on the mouthpiece and the flow sensor heats the liquid (this can also be activated through a button). Atomising the liquid solution leads to the creation of an aerosolised vapour, which is what is inhaled by the user.
Around the world, the legal status of vaping (i.e., smoking e-cigarettes) is as diverse as its medical status. In some countries like Brazil and Thailand, they are outright banned. In others like the Philippines and South Africa, they are mostly unregulated. In the UK and the US, they are strictly regulated. The nature of bans also varies: while in some countries like Portugal e-cigarettes containing nicotine are banned, in others like Turkey indoor vaping is prohibited.
Usage tends to vary widely. A few points to note:
In India, definitive numbers are hard to come by. The Indian Vaping Industry Association estimates there are about 450,000 vapers in the country. India is signatory to the WHO’s Framework Convention on Tobacco Control (FCTC), which calls upon countries to regulate the use of e-cigarettes or ban them altogether. And in recent months, the push to ban them has garnered much momentum. 12 states have already banned e-cigarettes and a ministerial panel is currently mulling over a health ministry proposal to implement the ban nation-wide.
A primary concern regarding e-cigarettes is based on the gateway hypothesis. This posits that when people – especially teenagers and kids – are introduced to a drug, it can encourage them to experiment with more dangerous drugs. The fear is that if non-smokers are attracted to try out e-cigarettes, they would be motivated to also try out actual cigarettes – and then other drugs, too.
The gateway hypothesis is particularly associated with students and teens, who are more impressionable and susceptible to peer pressure. (And the fact that many e-cigarette devices are shaped like innocuous pens to make them easier to hide from elders at home or school adds to the fears.)
An extension of the threat of new users getting indoctrinated to smoking is the threat of smokers taking up vaping hoping it would help them quit, but ending up succumbing to both these habits.
A major selling point of e-cigarette brands is their alleged prowess as smoking cessation tools. But evidence for this is conflicting and inconclusive. Studies on the effectiveness of e- cigarettes as an aid to smoking cessation differ from studies that have an endpoint of reducing tobacco use. Besides, there remain many other cessation devices, including patches and medication.
The proponents of vaping point to the customisable nature of e-cigarettes with respect to nicotine content, the absence of obnoxious odours, and – chiefly – that, no matter their danger, vaping is still much safer than smoking. (Tobacco, after all, claims 8 million+ lives every year.) While this may very well be true, it does not discount the fact that e-cigarettes on their own are unsafe devices whose effects of human health remain largely unknown due to the lack of ample data.
When talking of e-cigarettes, the arguments tend to drift to one of the two extremes. One side paints vaping as the panacea that will rid the world of lung diseases and inspire tobacco smokers to quit smoking en masse. The other portrays it as an evil more intolerable than tobacco that should be banned by legislation immediately, even though traditional cigarettes continue to stay in the market. The picture that is closer to reality however is somewhere in between.
The benefits and risks of using e-cigarettes are uncertain and hotly debated. The bottom line is that there still isn’t sufficient evidence to garner a clear picture. While some studies point that e-cigarettes are not as harmful as traditional cigarettes, vaping does not have a spotless record. Many e-cigarettes have nicotine and added flavours that have been known to have detrimental effects over users’ health. The argument that vaping could be adopted as a definitive means to abandon cigarettes is also not backed by solid evidence. That said, the overzealous, albeit often fringe campaigns to ban e-cigarettes often miss the larger point – traditional cigarettes undoubtedly pose a far greater risk to public health.
In the end, the age-old adage “Prevention is Cure” rings ever true. Smoking is conclusively dangerous. Vaping might be safer than smoking, but it is harmful as well. The best thing to do is to give both of them a pass to live a happy, smoke-less, vapor-less, lung disease-less life.
Governments looking to find ways to decrease smoking rates in their countries might want to wait for more data and research before debating about deploying vaping for smoking cessation. In the meantime, accelerating the tried and tested methods of high taxation, curbing smuggling and public education would go a long way in cutting smoking rates.
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