Can e-cigarettes help smokers quit?

This file photo shows a promoter with a painted face smoking an electronic cigarette during a VapeFair in Kuala Lumpur. (AFP Photo)

E-cigarettes are known by many different names. They are sometimes called e-cigs, vapes, vape pens, tank systems, or mods. In recent years, e-cigarettes have become ubiquitous and can be seen everywhere. It is common to see people vaping in the streets, in their cars and even in some eateries. As the popularity of e-cigarettes and vaping devices (EVC) increase, the debate over its safety has also grown. 

In Southeast Asia, a few ASEAN countries such as Thailand and Singapore have banned EVC. Philippines President, Rodrigo Duterte even took a step further by ordering the arrest of people caught using them after a 16-year-old girl was hospitalised in October 2019 and was diagnosed with e-cigarette-associated lung injury (EVALI) – the first case in the country. Indonesia, which is the world’s second largest tobacco market is also revisiting existing e-cigarette regulations and are in the midst of discussion to ban EVC over health concerns. Anung Sugihantono from Indonesia’s Health Ministry said that “the ministry’s stance is consistent: we want to ban, not limit, vaping and e-cigarettes.” However, Malaysia is looking to regulate the sale and use of EVC despite the country’s ban on vaporiser liquids containing nicotine since 2015. 

Vape companies and manufacturers tend to market e-cigarettes as an alternative to traditional cigarettes and as a smoking cessation tool for smokers, but are they as effective as claimed?

According to the Center On Addiction, an organisation that helps people with drug, cigarettes and alcohol abuse, most researchers and health professionals agree that EVC are less harmful than smoking tobacco cigarettes. The United Kingdom’s (UK) Public Health England even claimed that vaping is 95 percent less harmful than smoking cigarettes because e-cigarettes do not burn tobacco – hence they don’t produce tar or carbon monoxide, which are two of the most harmful chemicals in tobacco smoke. A study published by the New England Journal of Medicine found that e-cigarettes were nearly twice as effective as conventional nicotine replacement products, i.e. patches and nicotine gum, for smoking cessation.

While e-cigarettes might be arguably less harmful than traditional cigarettes, this does not mean that they are completely harmless.

Popcorn lungs

Based on reports, although e-cigarettes generally have fewer chemicals than tobacco cigarettes, they may still contain heavy metals like lead, flavourings linked to lung disease, small particles that can be inhaled deep into the lungs, and carcinogens (substances that cause the formation of cancers). The number of reported e-cigarette-associated lung injury (EVALI) cases have also continued to rise in recent years.

The Canadian Medical Association Journal reported that a 17-year-old boy had signs of “popcorn lung” after using e-cigarettes and vaping large amounts of tetrahydrocannabinol (THC) – a cannabinoid identified in cannabis. The term “popcorn lung” is used for bronchiolitis obliterans, a type of lung disease where the tiniest airways called bronchioles are inflamed. According to the United States’ (US) Centers of Disease Control (CDC), as of 4 February 2020, an estimated 2,758 EVALI cases and deaths have been recorded in the country. The CDC also argued that THC and Vitamin E acetate were strongly linked to the fatalities.

It is unclear how many e-cigarette-related EVALI cases there are in Southeast Asia as there are no official records or data available. 

The Center On Addiction states that although a few studies have found that e-cigarettes can help reduce the smoking habit, most reveal that e-cigarette use does not significantly reduce cigarette use. Several studies also found that people who use e-cigarettes may be less likely to successfully quit smoking. This is largely because e-cigarette use can perpetuate nicotine addiction. Despite the absence of tobacco, one major similarity between traditional cigarettes and e-cigarettes is the use of nicotine – which poses some health risks as well.

Big Tobacco and Big Pharma

Jim Cramer, the host of Mad Money – a popular TV show in the US about investment and speculation particularly in public company stocks – observed “the market’s sudden recognition that the cigarette industry seems to be in serious trouble, disrupted by the rise of vaping.” The increase in popularity of e-cigarettes has raised grave concerns from tobacco makers. In 2018, Philip Morris’ numbers looked worse region to region: the European Union (EU) was down 6.7 percent; Eastern Europe was down 10.4 percent; the Middle East and Africa were down 8.5 percent; East Asia and Australia were down 18.3 percent; and Latin America and Canada were down 1.5 percent. The only positive growth region was Southeast Asia, up 6.1 percent. 

Southeast Asia still holds one of the biggest markets for traditional cigarettes and is highly taxed. “Many of the countries in Asia are struggling to curb their smoking epidemics – and now they are facing an aggressive onslaught of new products,” said Mary Assunta, a policy adviser for the Southeast Asia Tobacco Control Alliance. 

The vape industry is also battling with pharmaceutical companies to win over smokers as they too sell their own quitting alternatives such as nicotine patches. A study of global smoking trends by the Foundation for a Smoke Free World found that in 2017, sales of vapour-based smoking products rose nearly 37 percent, whereas sales of pharmaceutical nicotine products rose by only 2.5 percent. Nevertheless, with the media frenzy surrounding EVALI cases, it is predicted that the pharmaceutical giants could stand to profit from an increase in sales of their nicotine replacement products. An example of this is British GlaxoSmithKline’s new nicotine spray which is already on sale in 45 countries through Johnson & Johnson.

Electronic cigarettes and vape devices are a fairly new product segment that requires further research about their safety and health implications. It took decades for health professionals and scientists to discover the harmful toxins found in traditional cigarettes and it will be the same for EVC. Whether EVC are as effective in helping smokers quit and less harmful as claimed by their manufacturers remains to be seen.

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