Debate Over E-Cigarettes Lights Up

The debate over the safety of e-cigarettes, and whether they will help smokers to quit, or simply make it easier for them to start or continue lighting up, heated up this week.

On one side of the disagreement are those pushing for regulation. In 2013, the World Health Organization (WHO) began a review of data on e-cigarettes and based on studies conducted so far, last month recommended tighter regulation of the devices to protect consumers’ health. But in a new article published in the journal Addiction, other scientists argue that the WHO misinterpreted the data in a “misleading” way and that the group’s advice for more stringent oversight is problematic.

In the Addiction paper, the authors take issue with nine of WHO’s conclusions, some of which surround the safety of e-cigarettes, their toxin levels, and how likely younger people are to adopt them. They cite some of the same data as the original WHO review did, but interpret it differently, arguing that the benefits of e-cigarettes, especially as an effective tool in helping some smokers to quit, outweigh potential risks from the chemicals and nicotine used in the devices. Therefore, they say, e-cigarettes should be more accessible than the WHO recommendations would allow.

“…The WHO’s approach will make it harder to bring these products to market than tobacco products, inhibit innovation and put off smokers from using e-cigarettes, putting us in danger of foregoing the public health benefits these products could have,” said Ann McNeill, lead author of the paper and professor of tobacco addiction at King’s College London, in a press release. They’re not the only ones who have pushed back against the recommendations. More than 50 experts in public health signed a letter calling for a lighter approach, reported the New York Times.

Why the opposing interpretations of the same data? E-cigarettes are so new that research hasn’t had a chance to catch up with their meteoric rise in popularity. Some of the data based on earlier models of the devices, for example, might not even apply to e-cigs as we know them today, since the product has evolved so rapidly. The body of research is small. And because the devices are so new, much of it is funded by e-cigarette manufacturers.

In the latest paper in Addiction, for example, some of the work by one of the heavily-cited authors of the paper was conducted with funding from the e-cigarette industry.

On the first page in the “competing interests” section, the article discloses the following about Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Greece (click “Get PDF” at the link):

In the paper’s 45 references, Farsalinos is listed as an author in nine of them; it’s unknown which of those studies were conducted with the help of e-cigarette funding.

It’s not uncommon for someone who makes a product to then sponsor research on that product, and it doesn’t mean the findings are worthless, says Steven Schroeder, a professor in the department of medicine and head of the Smoking Cessation Leadership Center at the University of California, San Francisco. (Schroeder does not conduct research on e-cigarettes.) But it also doesn’t mean the results are entirely objective, either. The potential for bias leads journal editors such as those at the peer-reviewed Addiction to require conflict disclosures from both its authors and its senior editorial staff.

It’s not clear yet whether e-cigarettes will turn out to hurt or help smokers. It’s probable that they will contribute to a range of health effects, both positive — as a smoking cessation device — and negative — as a potential gateway to tobacco-based cigarettes or other drugs. The evidence, at the moment, points in both directions.