Electronic cigarettes: Help or hazard?

Kicking the cigarette habit is one of the best things that smokers can do for themselves. Nicotine replacement products, prescription medications, and counseling can all help. What about the newest tobacco substitute, the electronic cigarette? Despite the appeal of so-called e-cigarettes, we don’t know enough about their safety or effectiveness to give them the green light.

Electronic cigarettes come in a variety of shapes. Some look like cigarettes, pipes, or cigars, while others are disguised as pens or other more socially acceptable items. Whatever their shape, they all are built around a battery-operated heating element, a replaceable cartridge that contains nicotine and other chemicals, and an atomizer that converts the chemicals into an inhalable vapor.

A study published this spring in the American Journal of Preventive Medicine concluded that electronic cigarettes may help smokers quit. Whether they are a safe way to quit is another question—preliminary studies from the FDA, New Zealand, and Greece raise some concerns.

There are three reasons to worry about electronic cigarettes. First, the dose of nicotine delivered with each puff may vary substantially. An FDA analysis recorded nicotine doses between 26.8 and 43.2 micrograms per puff. It also detected nicotine in products labeled as nicotine free.

Second, electronic cigarettes deliver an array of other chemicals, including diethylene glycol (a highly toxic substance), various nitrosamines (powerful carcinogens found in tobacco), and at least four other chemicals suspected of being harmful to humans. To be sure, the dose of these compounds is generally smaller than found in “real” cigarette smoke. But it isn’t zero.

Third, by simulating the cigarette experience, electronic cigarettes might reactivate the habit in ex-smokers. They could also be a gateway into tobacco abuse for young people who are not yet hooked.

We need scientific studies of e-cigarettes. Until then, it’s caveat emptor, buyer beware. And be aware that there are better and safer ways to quit. The most effective strategy involves using nicotine replacement or a medication along with some sort of counseling or support, either in person, by telephone, or even by text message.

If you want to quit, solid information and advice are available at www.smokefree.gov, a Web site developed by the National Cancer Institute. Any of the approved methods are vastly preferable to smoking—and to electronic cigarettes.

Dr. Harvey Simon is Editor of the Harvard Men’s Health Watch, a monthly newsletter written to help men lead healthier, longer lives.