The e-cig emperor is naked – or, at the very least, 95% naked

Thomas Eissenberg, Aruni Bhatnagar, Simon Chapman, Sven-Eric Jordt, Alan Shihadeh, and Eric. Soule just published an excellent commentary in American Journal of Public Health, “Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes” that shows, once and for all, how silly the claim – which is still being promoted by Public Health England and others – that e-cigarettes are “95% safer” than conventional cigarettes.

They note that the original 95% estimate was not based on any actual evidence and summarize some of the evidence that e-cigarette damage cells, harm users, and have a gateway effect on youth.  They have a nice online appendix that lists some of the relevant research to back up these conclusions.  (A full list would likely include hundreds, if not thousands, of studies.)

Eissenberg and colleagues also treated the original Nutt et al paper gently; they did not talk about all the industry ties and conflicts of interest among the people who came up with the 95% number.

They sum their paper up, saying:

The “95% safer” estimate is a “factoid”: unreliable information repeated so often that it becomes accepted as fact. Public health practitioners, scientists, and physicians should expose the fragile status of the factoid emphatically by highlighting its unreliable provenance and its lack of validity today, noting the many changes in e-cigarette devices and liquids, the accumulation of evidence of potential harm, the increased prevalence of use, and the growing evidence that e-cigarette use is associated with subsequent cigarette smoking.

As the authors note, the evidence is continue to build rapidly and we are learning more.  For example, they say “There is little doubt that exclusive e-cigarette users are unlikely to die from lung cancer that is caused by carcinogenic tobacco-specific nitrosamines or polycyclic aromatic hydrocarbons, toxicants largely absent from e-cigarette aerosols.”  But, on October 22, 2019, a little over two weeks after their paper was accepted for publication, the first experimental study was published showing that it was possible to induce lung and bladder cancer in mice exposed to e-cigarette aerosol.  The investigators attributed this effect, in part, to nitrosamines. 

The trajectory of the evidence is clear: E-cigarettes are dangerous and the more we learn the more dangerous they look.

The full citation is Thomas Eissenberg, Aruni Bhatnagar, Simon Chapman, Sven-Eric Jordt, Alan Shihadeh, and Eric K. Soule,   Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.  American Journal of Public Health 2020; 110: 161-162, https://doi.org/10.2105/AJPH.2019.305424.  It is available here.