In an era where tobacco is one of the biggest public health threats, many smokers have embraced electronic cigarettes as a less harmful alternative to tobacco products. Some of these battery-powered devices look like traditional cigarettes and cigars, and all of them produce flavoured steam that not only simulate tobacco smoke, but also deliver a smaller amount of toxin-containing nicotine.
Since their introduction to the mainstream market in 2004, e-cigarettes have experienced a worldwide upsurge in the number of users. In the UK alone, an estimated 2.6 million adults were consuming e-cigarettes in 2015, according to a survey by the Action on Smoking and Health (ASH). The study also found the majority of current ‘vapers’ (as they’re colloquially called) use e-cigarettes to either reduce the amount of tobacco they smoke or to stop smoking altogether.
Despite their favourable reception among regular smokers, medical professionals are yet to reach consensus on the potential long-term health implications of e-cigarettes. Are they really safer and more effective than their filtered counterparts as so many smokers believe? Hippo.co.za asked experts and thought leaders for their opinion on e-cigarettes.
Traditional vs e-cigarettes - the potential health risks
Contributed by Associate Professor Richard van Zyl-Smit of The Lung Institute
Q: Several medical bodies, including South Africa’s Medical Journal (SAMJ) and The World Health Organisation (WHO) have said that too little is known about e-cigarettes to declare them better than traditional cigarettes, but other medical experts disagree and support ‘vaping’. How should we be measuring what makes one healthier than the other?
A: “There is no question that tobacco cigarettes are deadly – 50% of smokers will die prematurely from a tobacco-related illness. This not only includes cancer but also emphysema, stroke, heart attacks, etc. The debate around e-cigarettes is a hotly contested one with very passionate arguments from both sides. The reason that many groups are calling for a cautious approach to e-cigarettes is that we do not know how much safer they are than tobacco. Recently, a UK group has said they are 95% less harmful than tobacco. There is, however, very little data to support that claim. If only a quarter (25%) of people using an e-cigarette die as a result would it be considered ‘safer’. But what is safe enough? Only 20%? 10%? 5%?”
Q: Are there any risks unique to either method of smoking that the public should consider?
A: “The risks of tobacco cigarettes are extensive – from wrinkles around the mouth, throat and lung cancer, stroke, and miscarriage, among others. As e-cigarettes are relatively new, we have not seen any significant ‘short term risks’ but it took nearly 50 years to show that tobacco caused cancer, so we cannot conclusively say they are safe in the long-term.”
Q: Considering your response to the above questions, where do you stand in this debate and why?
A: “I spend a large proportion of my time as a lung specialist treating patients with emphysema, as well as running the smoking cessation clinic at Groote Schuur Hospital. Based on my reading of the literature, my own laboratory experiments and my clinical practice, I have taken a cautious approach. If you smoke e-cigarettes, they may be a way to quit smoking traditional cigarettes. Some will say it worked (just read any blog on quitting smoking) but just as many will tell you it doesn’t – so they’re worth a try, but not guaranteed to get you to quit. Ultimately you should aim to stop all forms of smoking, not just switch to a potentially safer option. As a non-smoker – why bother trying something that may prove to be harmful in the long-term?”
Q: Is there not a way to make cigarettes truly healthy or health neutral?
A: “Nicotine is the chemical that keeps you coming back for another cigarette and why smoking is so addictive. Without it, there would be no point in smoking. If you took the nicotine out of an e-cigarette there would be no ‘pleasurable’ response. Nicotine is not a chemically neutral substance as it affects your immune system as well as mucus production and blood vessel growth. At very high doses it is used as an insecticide. The lungs can also only ‘cope’ with a certain amount of ‘air pollution’, be it chemicals or particles such as dust, before becoming injured. So regularly inhaling anything more than the purest air really should be avoided – we can’t avoid outdoor air pollution if we live in a big city but why add to the burden on your lungs?”
Although health concerns are probably the most hotly debated, there are more comparisons one can make between traditional and new smoking methods.
Contributed by Tech Girl
“You need two purchases when you start vaping. The first is the actual electronic cigarette and the other component is the flavour for the e-cigarette. For a decent e-cigarette, you can expect to spend around R800.That's for the actual gadget. The various liquid flavours cost around R160 to R200 and they last for a long time.
Currently, there is no research to show vapers smoke less. However, if someone smokes a box of cigarettes every three days (and a box is costed at R38), they'll be spending R380 a month on cigarettes. The liquid flavours for e-cigarettes cost less than half of that and can easily last a month for a heavy vaper. So despite the initial cost, you'll definitely save money long-term.
Some vaping liquids have no nicotine, which is great because a lot of the time the smoker is far more addicted to the habit of smoking than the actual nicotine. The nicotine delivery of e-cigarettes vs normal cigarettes is very different.
So, for most people, it seems that e-cigarettes would work out cheaper in the long run.”
Cigarette marketing - then vs now
Contributed by Adiv Maimon of DragonFly Marketing
“Easily the biggest challenge of marketing e-cigarettes is overcoming public perceptions. The correlation in people’s minds between normal cigarettes and e-cigarettes is difficult to overcome and most people view the product as an alternative to smoking, rather than a separate product in itself. The damage done by normal cigarettes is something that e-cigarettes would never be able to overcome completely.
In some ways, e-cigarette marketing definitely emphasises the ‘cool factor’ similar to traditional tobacco adverts back in the day. But, they’re steering clear of the outright fabricated messages that were used before the advertising industry was as regulated as it is now. They’re only barely starting to touch the surface of traditional advertising, and making little-to-no use of modern techniques such as digital advertising, particularly in South Africa. The first to create a fun, engaging ad campaign across media using professional services could easily take an extra chunk of the market. Social media ad campaigns are showing strong results for many brands, particularly with millennials.
With a new product such as this, the research is often contradictory and therefore under-publicised. As long as the marketing message stays away from outright claims that could be easily refuted, it will take a while before that message needs to change. In my opinion, the message should be less ‘e-cigarettes are healthy’, which creates disbelief, and more ‘e-cigarettes are enjoyable’, which is easy to hold on to for a long time.”
Gateway vs quitting mechanism
Contributed by Allen Carr’s Easyway
Q: Some e-cigarette manufacturers point to the product as a way to cut down or ween off of traditional smoking, but is this happening?
A: “A recent survey on the habits of e-cigarette users commissioned by Allen Carr’s Easyway, found that, even though half of the participants (47%) indicated they started using e-cigarettes as a way to stop smoking entirely, 84% of e-cigarette users regularly continue to smoke cigarettes as well as use e-cigarettes.”
Q: Some reports claim that the marketing of e-cigarettes may in fact act as a gateway to nicotine addiction in young people who otherwise may never have smoked. What are your thoughts?
A: “When looking at current e-cigarette advertising being broadcast on South African television, the ‘coolness’ of using e-cigarettes looks disappointingly familiar to previous cigarette advertising that was banned for obvious reasons. If ‘smoking cigarettes is cool’ advertising has been banned because of the risk of youngsters being lured into trying it and becoming addicted to nicotine, only someone who ignores the scientifically established addictive capabilities of nicotine completely, would think that consuming nicotine in any form (including e-cigarettes) would not carry the same risk.
We should rebel against the idea that nicotine addiction (irrespective of how it is introduced into a person’s body), like caffeine addiction, is something we should just accept. We should rather try to eradicate nicotine addiction completely, irrespective of the fact that it will undermine the profits of the industries that depend on it.”
If you compare an e-cigarette to fresh air, the risks could be substantial. If you compare them to smoking a regular tobacco cigarette, the benefits (cancer-risk reduction) could be substantial. So where does that leave the public? If you smoke, e-cigarettes could be a safer alternative. We have very little long-term data to show this to be true but given what we know about nicotine, the less you consume the better - with zero consumption obviously being the goal.
Keep in mind that smoking is a lifestyle choice that may increase your Life Insurance premium. If you switch to e-cigarettes, your insurance provider may still consider you as a high-risk profile, therefore it’s unlikely you’ll receive a discount on your payments.
The views expressed here are solely those of the authors in their private capacity and do not in any way represent the views of Hippo.co.za. We do not necessarily endorse the products and processes mentioned in this article and accept no responsibility for damages that may arise as a result of this article.