Summary
Introduction:
This text discusses the invalidity of the widely cited estimate that e-cigarettes are 95% less harmful than combustible cigarettes. The authors challenge the accuracy of this claim in light of new evidence and changes in e-cigarette devices and liquids since the estimate was made in 2013.
Key Points:
* The original estimate was made by a group of 12 experts using 14 criteria, but they acknowledged a lack of hard evidence for the harms of most products on most criteria.
* Public Health England and the Royal College of Physicians endorsed the "95% less harmful" claim, despite the lack of evidence.
* Today's e-cigarettes are different from those in 2013, with higher power output, more heating coils, and the use of protonated nicotine, leading to increased potential harms for users and bystanders.
* E-cigarette aerosols contain toxicants that are harmful to living cells in vitro and in vivo, causing cardiorespiratory toxic effects and potentially leading to disease states different from those caused by cigarette smoke.
* Recent evidence shows that e-cigarette users exhibit harm, such as airway epithelial injury, wheezing, increased heart rate, blood pressure, and platelet activation, and decreased heart rate variability.
* E-cigarette use increases the risk of ever using combustible tobacco cigarettes among youth and young adults.
* E-cigarette aerosol is not harmless, and the toxicants in e-cigarette aerosol may cause different diseases than those caused by cigarette smoke.
Main Message:
The text emphasizes that the "95% less harmful" estimate is unreliable and lacks validity due to the many changes in e-cigarette devices and liquids, the accumulation of evidence of potential harm, and the growing evidence that e-cigarette use is associated with subsequent cigarette smoking. Public health practitioners, scientists, and physicians should expose the fragile status of this factoid and highlight its lack of reliability.
Citation
Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK. Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes. American journal of public health. 2020;110(2):161-162. doi:10.2105/AJPH.2019.305424
