E-cigarettes: risk mitigation for smokers or a public health disaster?
Abstract
The rapid rise in the use of e-cigarettes concerns pediatricians and public health physicians, especially as it has recently come to light that the origins of e-cigarettes came from the realization by the tobacco industry that the product that they were selling was nicotine, an addictive drug in every format (1). The alternative view point is that e-cigarettes reduce the harm to addicted chronic smokers by substituting a less harmful source of nicotine (2). Oh that is was that simple! Those that see the positive side of e-cigarettes point to risk mitigation as e-cigarettes are not as bad as actual cigarettes (2). There is also the point of view that switching from cigarettes to e-cigarettes as a means of smoking cessation is beneficial and less harmful. However, recent systematic reviews and meta-analyses (3, 4) do not support this concept, partly as the supportive evidence is so weak and inconsistent. The real concern is that e-cigarettes are not harmless (5–10), induce nicotine addiction (11) and lead nonsmoking children to become cigarette smokers (12–14). The evidence of the adverse health effects of e-cigarettes, whether they contain nicotine or not, is mounting, including: inducing oxidative stress; adverse effects of airway epithelial cells; and pulmonary toxicity that includes precancerous DNA damage (2, 3, 5–12, 15). There is no doubt that nicotine-containing e-cigarettes induce nicotine addiction (11). E-cigarettes are also marketed to children, in what seems to be…
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