E-Cigarette Reviews and Rankings

E-Cigarettes Considerably Less Harmful Than Tobacco Cigarettes, Public Health Review Suggests

An annual public health review conducted by researchers from some of the most prestigious universities and institutes in the United States suggests that vaping has the potential to save millions of lives, but warns that a harm reduction approach to public health is required in order for e-cigarettes to reach their full potential.

With so much propaganda around vaping these days, it’s no surprise that only 5.3% of Americans correctly believe that electronic cigarettes are “much less harmful” than tobacco cigarettes, 37% of them believe they are the same or worse than smoking, and 34% simply have no idea. Luckily, from time to time, we get some valuable beads of knowledge from reputed scientists and public health experts. Such is the case with the Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives, a comprehensive review of alternative nicotine delivery systems (ANDS) in general and e-cigarettes in particular, and their potential to save millions of tobacco smokers from an early death.

The review starts off by making it clear that it is “imperative” to come up with ways to accelerate the decline in tobacco smoking around the world, because at the current pace, around 1 billion lives will be lost prematurely because of it by 2100. We already have several alternative means of nicotine delivery, of which e-cigarettes are by far the most popular, but the authors not that in order for them to fulfil their their full potential, a reexamination of nicotine’s role in society and a reevaluation of tobacco control strategies with a focus on harm reduction are required.

“The safest course is to stop smoking or, better, never to start. But a harm minimization approach recognizes that demanding absolute perfection is often counterproductive and that, when a harmful behavior cannot be eliminated, it is necessary to reduce its adverse health consequences,” the review authors wrote. “For those who are smoking and are unwilling or unable to quit nicotine use, moving to cleaner ANDS, including e-cigarettes, NRTs, or low nitrosamine snus, would reduce harm relative to smoking.”

“For most smokers, there is little evidence that nicotine itself causes any of these classes of disease when decoupled from smoke,” the review states. “Although nicotine use poses some risk for vulnerable groups (e.g. pregnant women, heart disease sufferers), this risk is substantially lower than the risk posed by continuing to smoke cigarettes.”

The authors, led by Dr. David Abrams, professor of social and behavioral sciences at New York University’s College of Global Public Health, also emphasize a key point that’s conveniently overlooked by vaping opponents and anti-tobacco activists: “It is not that e-cigarettes are completely safe, or even the safest nicotine-containing product available, but that they are much safer than smoking.” The main principle of harm reduction and harm minimization is that vaping must always be viewed in relation to smoking. We’ve been seeing all these articles in the media warning us that vaping is not harmless, as if someone ever claimed it was. However, the scientific consensus is that e-cigarettes are indeed much less dangerous than tobacco cigarettes. There are few things in this world that are actually harmless, so all we can do is minimize the risk. 

A harm minimization graph of various nicotine delivery products, ranging from exceptionally low harm to exceptionally high harm suggests that not all nicotine-containing products are equally harmful and that authorities have to keep that in mind when regulating them. 

The authors of this detailed annual review also touch on the issue of vaping among youth, stating that, despite what you may read in the media, scientific data shows that “current e-cigarette use by youth consists largely of experimentation, not long-term adoption”. They also point to a study which found that smoking prevalence among youths increased in US jurisdictions that have adopted bans on e-cigarette sales to youths, with the authors stating that this could “illustrate the potential for some well-intentioned precautionary policies to have harmful effects”.

“Overall, the strongest science to date does not support the concerns that e-cigarettes are such a dire threat as to undermine 50 years of tobacco control success, to renormalize smoking, and to set off the addiction cycle for another generation of youth,” the review concludes.

After reviewing a considerable number of scientific studies on whether electronic cigarettes can help smokers quit, or if they actually undermine tobacco control cessation efforts by making it harder for people to quit smoking, the review authors noted:

“Available scientific evidence does not support the contention that e-cigarettes when used daily specifically to quit smoking either inhibit cessation or are undermining historical tobacco control cessation efforts. Much less harmful ANDS products such as e-cigarettes could help displace cigarettes on a larger scale than NRT (nicotine replacement therapies) has because of differential appeal such as the use of flavors while eliminating flavors from smoked products, lower cost due to differential taxation, and differential ease of access relative to smoked tobacco.”

Misinformation and propaganda have played a huge role in the negative way most people view vaping nowadays, and the annual review authors emphasize the need for correct education and communication, warning that exaggerations and misinterpretations risk undermining the potential of electronic cigarettes to render tobacco smoking obsolete.

“Accurate public information is a crucial part of tobacco control policy. The positive impact of e-cigarettes may have been slowed by exaggerated claims of their harms and the harms of nicotine in general. Misperceptions of the harms of nicotine and e-cigarettes have recently increased, undermining their full potential to displace smoking  A misinformed public lacks the information required to take health-protective action. Accurate public education is needed to counteract misperceptions of harm from nicotine and ANDS, to communicate the continuum of risk related to the use of different tobacco and ANDS products,” the review authors wrote.

“If prudently regulated, e-cigarettes and Swedish snus provide a great opportunity to disrupt the US and global smoking-related disease pandemic and offer a proof-of-principle for the potential role of further innovations in ANDS in improving public health,” the researchers concluded. “This opportunity depends on encouraging increased technological innovation and finding the appropriate balance between product safety, consumer appeal, and regulations targeted specifically to decrease the use of conventional, combusted tobacco products.”

The Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives  annual review was published on January 11, 2019, but sadly didn’t get much attention from the media. Meanwhile, articles on the health risks of vaping and the danger they pose to youths make the front news of news sites almost every day. I guess scientific facts aren’t that appealing…

It’s important to not that the findings of this annual review are consistent to the ones published in the prestigious Cochrane review

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