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The dilemma of e-cigarettes

Are e-cigarettes one of the biggest health risks since traditional cigarettes, or are they the best chance for smokers to quit? Without the research needed to conclusively answer that question, public health officials and regulators are in a difficult position.

At a gas station across the river in Harvard Square, a bright yellow billboard advertises “E-Cig and Vaping Specialists.” Ads for all the major e-cigarette brands are plastered across the walls of the station and even the gas pumps. Prominently displayed behind the counter are Blu and NJOY e-cigarettes, alongside menthol, cherry, and vanilla vapes—overshadowing ads for Marlboros and Newports.

It was only eight years ago that e-cigarettes—electronic devices that heat liquid nicotine into a vapor—were introduced to the U.S. market. Today, annual global sales total $2 billion (though exact figures are hard to come by, in part because online sales aren’t recorded in retail surveys). E-cigarettes are for former smokers, who rely on them to regulate their nicotine intake while avoiding the harmful side effects of cigarette smoke. Online message boards are full of accounts of people who have smoked Marlboros or Camels for decades, finally quitting with the help of e-cigarettes. Vapers have been touring the country to promote the latest e-cigarettes. And e-cigarettes have become more widely known, with appearances in Super Bowl commercials and endorsements from celebrities ranging from Katherine Heigl to Leonardo DiCaprio.

At the time, teens and adults — many of whom had never smoked — were using e-cigarettes. Young people were a prime target for e-cigarette companies, who relied heavily on social media advertising. One e-cigarette company, Blu, created an e-cigarette device with a blue case and an eye-catching image of a vaper vaping.

Together, these trends have created a major public health dilemma.

For decades, tobacco companies have done everything they can to convince smokers that cigarettes don’t kill them, a claim that persists despite dozens of studies showing that cigarettes cause lung disease and cancer. “Doubting our product is the best way to compete with the ‘reasons’ that exist in the public mind,” one tobacco company executive wrote in 1969.

In the case of e-cigarettes, reviews are mixed, of course, with very little scientific research on whether they are a solution for people wanting to quit traditional cigarettes.

That’s why, for public health, the sudden arrival of e-cigarettes into world culture has created a quandary. On the one hand, they represent a potential game changer for those who have been trying unsuccessfully for years to quit smoking. On the other hand, for those who know little about vaping, they introduce an unproven, potentially dangerous product.

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