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The devil you know: Experts discuss the public-health consequences of e-cigarettes

e-cigarettesHow do we reduce health risk in the face of harm that can’t be eradicated completely? That's the question that the medical school’s dean, Lloyd Minor, MD, presented to the audience at Monday’s Health Policy Forum on e-cigarettes — a topic about which he said “intelligent and reasonable people can disagree.”

E-cigarettes are a heavily contested subject in the public-health community. Panelists at this event debated whether the recently developed devices hold promise to help long-time smokers move away from combustible cigarettes, or whether they carry the worrisome potential to re-normalize smoking.

All panelists agreed that those under 21 shouldn't be using any nicotine delivery devices, and they shared a goal of minimizing general use of harmful health products. They disagreed, however, on what the advent of e-cigarettes means to the accomplishment of those goals.

David Abrams, PhD, a Johns Hopkins clinical psychologist specializing in health psychology, addictions, and tobacco-use behavior, described himself as a harm reductionist. He argued that as an alternative mode of nicotine delivery, e-cigarettes pave the way for saving lives by helping addicted smokers not use traditional cigarettes.

“I do think the evidence is very solid that they are dramatically less harmful than cigarettes...because they absolutely have very low, almost undetectable levels or trace amounts of the top eight carcinogens that are found in cigarettes and they have no carbon monoxide,” he explained.

But a lack of extensive research makes Stanford's Robert Jackler, MD, and Bonnie Halpern-Felsher, PhD, question whether vaping is actually safe — and a prevalence of candy-flavored e-liquids leaves them concerned for the potential for harm to youth.

“Let me point out that you can smoke [combustible cigarettes] for many years before you get chronic destructive lung disease,” said Jackler, who leads a Stanford research team studying the impact of tobacco advertising, marketing, and promotion. “So while I agree... that they are safer, the presumption that they are safe for teenagers to adopt as opposed to combustible tobacco, we won't know that for decades.”

In the meantime, he worries that “we’re experimenting with the lungs of teens.”

Jackler and Halpern-Felsher also expressed deep concern about the perception of e-cigarettes in the eyes of young people. They worry that touting e-cigarettes as cessation devices has led to a misconception that e-cigarettes carry no health risks.

“We are now seeing early evidence that those... who never would have used or intended on using a tobacco product, when you ask them about e-cigarettes they do have an intention. They are more susceptible to it,” said Halpern-Felsher, a developmental psychologist who studies health-related decision-making. She explained that when teens see claims about the cessation benefits associated with e-cigarette use, they assume that it’s safe to start using them.

"Kids are seeing tons of advertisements about the benefits, but not about the risks,” she said.

Abrams acknowledged these concerns but countered with an analogy to safe sex: “What we say to kids is that we’d rather you don’t have sex at all, but if you do please use a condom. We don’t go on and on [about the fact] that 2 percent of condoms fail and therefore you shouldn’t use them.”

In the end the three all agreed that marketing plays a huge role in the popularity and social acceptability of smoking. “Brilliant marketing of a lethal product that nobody needed made half the population buy it,” said Abrams in reference to traditional cigarettes.

“And now we're seeing it again with e-cigarettes,” pointed out Halpern-Felsher.

The panel closed on a note of amicable disagreement, leaving the audience with a sense that this may be a topic on which members of the public health community will perpetually agree to disagree.

Lindzi Wessel is a former neuroscience researcher and current student in the UC Santa Cruz Science Communication Program. She is an intern in the medical school’s Office of Communication and Public Affairs.

Previously: Teens confused about harms of marijuana and e-cigarettes, Stanford study findsWith e-cigarettes, tobacco isn’t the only danger, How e-cigarettes are sparking a new wave of tobacco marketing and E-Cigarettes: The explosion of vaping is about to be regulated
Photo by Shutterstock

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