E-cigarette use is rising fast among US smokers, and have passed traditional cigarette smoking among US High Schoolers, according to a recent CDC survey. Among the advantages: e-cigarettes are less regulated and cheaper than regular cigarettes. The vapors smell better. The smoke is supposed to be 95% less unhealthy. And the vape (e-cigarette “smoke”) doesn’t stain teeth like regular cigarettes. Not everyone is thrilled to see a safer cigarette alternative, though. A 2014 Harvard Study, The E-cigarette Quandary, points out that 95% less dangerous is not the same as 100%, that kids might come to smoke who might not otherwise, and that one could still get unwelcome, second-hand nicotine from exhaled vape. To correct these issues, some 200 regulation and prohibition bills have been introduced in 40 states in the past year alone. Among these, prohibitions on selling to minors, prohibitions on vaping where smoking is prohibited, and a National Park Service prohibition on e-cigarette use anywhere in a national park. 

Inside an e-cigarette

My sense is that, for some people, those who already smoke, a 95% less dangerous alternative has got to be a boon, unless (as seems unlikely) people come to smoke twenty times more e-cigarettes than regular. To the contrary, It appears that e-cigarettes seem to help smokers quit tobacco, even with no help from a smoking cessation service. And over time, e-smokers tend to reduce the amount of nicotine in the juice, in that way reducing the toxic burden of the e-cigarette too. This is an option that is not possible with traditional, combustion cigarettes.

The claim that e-cigarettes are 95% less harmful than combustion cigarettes is based on a comparison between the concentrations of poisonous vapors inhaled, as measured for a study published in the journal, Addiction. Sorry to say, you have to pay to read the whole article, but you can read the abstract for free, or read a blog post by the lead author, Dr. Konstantinos Farsalinos. A British study supports this too, as described in a more-recent report by Public Health England. While it is not 100% clear that a 95% reduction in harmful vapor means that e-cigarettes are 95% less dangerous, that would seem to be the conclusion on a puff-per-puff basis, assuming no change in the formulation of e-cigarette “juice”, and only if the smokers don’t end up smoking vastly more.

E-cigarette use among US High School students, 2014. The rise in e-cigarette use parallels a decrease regular smoking; perhaps it’s the cause of the decrease. From “The E-cigarette Quandary.”

For the reasons above, I gave an e-cigarette device to an employee who smokes. So far, it seems he likes it, and I’m happy that he doesn’t have to go outside to smoke. It also seems to have saved him some money and his teeth look a bit whiter as best I can tell. Interestingly, he claims he has less of a desire for regular cigarettes, too matching observations among high school use, and among the population in general. My first impression, the e-cigarette seems to be a boon, a good thing, for him at least.

Despite the sense that e-cigarettes are a boon, that sense is rooted in cæteris paribus, the assumption at all else remains static. Without regulations, I expect some nasty developments — in the content of e-cigarette juice, in the operation of the cigarette, and in the product marketing. Nicotine is a drug, cigarette makers are clever, and there is money to be had. I see regulation being needed over the acceptable composition of the juice, over the operating temperatures and flows of the cigarettes, and over sales and advertising to minors. With these put into place, I see no need for further prohibitions on e-cigarettes in the work-places or the national parks — or so it appears to me today.

Dr. Robert E. Buxbaum, November 8, 2015.