The electronic cigarette came on the market in 2004 as a 'less dangerous' substitute for the tobacco cigarette and a possible aid to quit smoking. The use of smoking materials has increased considerably since then, but there is still much uncertainty about how harmful the e-cigarette actually is. Why do we still know so little about it?
The first three reports of acute, serious lung complaints as a possible consequence of e-cigarettes were reported last week by the Dutch Association of Physicians for Pulmonary Diseases and Tuberculosis (NVALT). The organization based itself on a survey among eleven hundred members.
In the United States, seven people are said to have died and 530 people have developed lung complaints due to e-cigarette fumes.
The US state of New York adopted a law on Tuesday that bans most tastes for e-cigarettes. President Donald Trump announced a week earlier that he wanted to ban flavor liquids for the smokers.
The issue of electronic smoking does not only concern the US and the Netherlands. India not only banned liquids on Wednesday, but also sales, production, import and advertisements.
- E-cigarette has been developed as an aid to quit smoking.
- Little knowledge about what effect is on airways and lungs.
- There have never been acute complaints on such a large scale.
Doctors do not know for sure whether e-cigarettes are the cause
However, doctors cannot yet determine definitively whether the recently reported health problems were actually caused by e-cigarettes, confirms NVALT chairman Leon van den Toorn. When people show certain abnormalities or cough up blood, doctors look for explanations.
"If this person has no other complaints but does smoke electronically, then that can be a logical explanation," says Van den Toorn. In the aforementioned cases, a connection with the smoking of e-cigarettes seemed plausible, but it is therefore not yet possible to prove.
New studies on the consequences of the e-cigarette appear regularly, but precise information is still lacking. "We just have little knowledge about what these smoking products do to the airways and lungs," says the pulmonologist.
"With tobacco it took years before we knew how harmful it was." Doctor Esther Croes
There are various reasons for this lack of knowledge. Firstly, this is because the e-cigarette is still relatively new. The electronic cigarette in its current form was put on the market in 2004 and is therefore only fifteen years old.
"In those fifteen years, many people around the world have used the product, but we have never seen acute complaints on such a large scale as today," says Esther Croes, physician-epidemiologist at the Trimbos Institute. "But we do not yet know what twenty years of vapors affect the body every day. For the tobacco cigarette it also took years before it was determined how harmful the toxins are."
Other ingredients are potentially dangerous
First scientists investigated which harmful substances of tobacco also occur in the liquids of e-cigarettes. There were relatively few. But that does not mean that other components in e-cigarettes are potentially dangerous.
E-cigarette liquid also contains substances with well-known effects, but of which experts do not yet know how they react in the body. "For example, propylene glycol, a substance used in theater fog machines, among other things," says Croes. "A stage technician is probably in those fumes twice a week, but what if you inhale that substance deeply twice a day?"
E-cigarettes are available in many flavors. (Photo: Getty)
Research into the effects of vapors is hampered by the wide variety of devices and liquids on the market. As a result, many different combinations are possible and it is difficult for researchers to determine which chemical reactions are taking place and what effects they have. "A cinnamon flavor is probably good, but it is still unknown what it will do to your body if you evaporate it and inhale it," says Croes.
Electronic smoking to get rid of nicotine addiction
The e-cigarette was developed in China in 2003 as an aid to quitting smoking. The product had the feel and appearance of the old-fashioned cigarette and could contain nicotine, without the other dangerous substances in tobacco.
"Only a limited number of smokers benefit from this," says Croes. Trimbos initially recommends means such as coaching to stop smoking. According to Croes, this is the option with the best chance of success.
"However, if coaching does not work for someone and phasing out through e-cigarettes does, it cannot be otherwise. In the end, there is little more harmful than continuing to smoke tobacco."
Stepping into smoking tobacco
A concern shared by Van den Toorn and Croes is that electronic smoking is a stepping stone for young people to smoke tobacco. "Among young people we see a huge growth in the use of the e-cigarette," says Van den Toorn. "The flavors, scents and colors are simply attractive."
Figures from Trimbos show that many, but fewer, young people between the ages of 12 and 16 still smoke tobacco. But among young people of this age group, the e-cigarette appears to have become more popular. "We work hard for a smoke-free generation," says Croes. "But the e-cigarette cycles right through it."
Although little is known about the potential dangers of electronic smoking, the Trimbos Institute recommends staying away from it. This advice certainly applies to people who have not smoked. "There are indications that it is dangerous and we prefer to choose the least risky option."