Electronic cigarettes (e-cigarettes or “vapes”) are at least 95 percent less harmful than conventional cigarettes, can help smokers quit, and provide health benefits.
These were the key messages of Dr. Konstantinos E. Farsalinos during his interview on Radyo Klinika on April 5, 2017. Radyo Klinika is a medical talk show hosted by Ms. Marou Pahati and aired daily from 7 to 8 p.m.on AM radio station DWIZ 882kHz. Dr. Farsalinos was in Manila to speak on tobacco harm reduction and e-cigarettes in a series of media events and a Senate Committee on Health hearing.
Dr. Farsalinos is a research fellow at the Onassis Cardiac Surgery Center in Athens, Greece, and at the Department of Pharmacy, University of Patras, Greece. He has been conducting research on e-cigarettes as principal investigator since 2011. As of 2016, he has published more than 40 studies and articles in international peer-reviewed scientific journals about smoking, tobacco harm reduction, and e-cigarettes.
Key difference between conventional cigarettes and e-cigarettes
Nicotine is the drug in tobacco that causes addiction to smoking, but it is not the cause of heart disease, stroke, lung cancer, and many other life-threatening diseases and conditions linked to tobacco smoking, according to Dr. Farsalinos. Conventional cigarettes produce combustion products through the burning of organic matter, dried tobacco leaf. These combustion products are burned at a temperature of over 800ºC, which produces many poisonous chemicals (carbon monoxide, formaldehyde, ammonia, hydrogen cyanide, arsenic, DDT, etc.) that are subsequently inhaled by the smoker.
While conventional cigarettes and e-cigarettes both contain nicotine, there is one very important difference between them, Dr. Farsalinos explained. “E-cigarettes are much safer than conventional cigarettes because e-cigarettes heat and vaporize liquid at lower temperatures reaching only 180ºC to 250ºC. Unlike tobacco cigarettes, e-cigarettes do not burn organic matter at very high temperatures and therefore do not produce toxic fumes.”
The main components of the liquid used in e-cigarettes (“e-liquid”) are propylene glycol and glycerin, accounting for 95% of the e-liquid. The remaining components are water, nicotine, and food-grade flavorings.
Low efficacy of current smoking cessation methods
“Only 2 out of 100 smokers who stop smoking suddenly and completely—quitting cold turkey—are able to quit for good. At least 8 out of 10 smokers fail to quit with currently approved smoking cessation methods,” said Dr. Farsalinos.
At one year, less than 1 in 10 smokers who use nicotine replacement therapies or NRTs in the form of patches and gums are able to quit successfully. Only 1 in 4 smokers taking oral smoking cessation medications such as varenicline succeed in kicking their smoking addiction, Dr. Farsalinos added.
“E-cigarettes provide an alternative that can address the low success rates with currently available smoking cessation methods,” said Dr. Farsalinos.
E-cigarettes: tobacco harm reduction and alternative quit smoking tool
Dr. Farsalinos said that many people perform harm reduction approaches and behaviors on a daily basis. For example, the use of seatbelts and helmets is a harm reduction approach because it does not eliminate but only reduces a person’s risk of injury or death in the event of an accident.
“Tobacco harm reduction operates on the same principles. It provides smokers who cannot or do not want to quit by themselves or with currently approved methods with safer alternatives that reduce the harmful effects of smoking,” Dr. Farsalinos explained. “Tobacco harm reduction approaches such as e-cigarettes use less harmful products that provide a cleaner, safer form of nicotine intake.”
According to Dr. Farsalinos, e-cigarettes are effective in helping smokers quit because they address the biochemical and behavioral aspects of smoking addiction. E-cigarettes mimic the sensation of smoking and deliver nicotine to users in the form of a vapor—thus the term “vaping”—without the harmful chemicals present in tobacco products. E-cigarettes provide the oral fixation as well as the experience of inhaling, feeling the smoke hit the back of the throat (“throat hit”), and seeing the vapor cloud when exhaling.
Dr. Farsalinos allayed concerns that e-cigarette use can lead people to take up tobacco smoking. “Studies show that regular e-cigarette use among non-smokers is minimal to zero, indicating that e-cigarettes are not a gateway to smoking.”
Switching to e-cigarettes provides significant health benefits
Dr. Farsalinos cited the results of a survey he conducted in 2014 involving more than 19,441 e-cigarette users—by far the largest survey of its kind ever done. The survey found that conventional cigarette users who switched to e-cigarettes experienced significant health benefits. These include less breathlessness with physical activities, such as brisk walking, running and climbing stairs; improved sense of smell and taste; and lower blood pressure and cholesterol levels.
“Smoking tobacco cigarettes is basically long-term poisoning with carbon monoxide,” said Dr. Farsalinos. Carbon monoxide is a toxic gas that reduces oxygen availability in the smoker’s bloodstream—this explains in part the breathlessness with physical activity. The vapor produced by e-cigarettes does not contain any carbon monoxide and has no effect on the user’s blood oxygen availability, Dr. Farsalinos explained.