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E-cigarettes have a chance to save millions of lives
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Michael Russell and Murray Jarvik, two pioneers of smoking-cessation research in the 1970s, would probably have welcomed the development of the electronic cigarette or “personal nicotine vaporizer” (PNV).
Beyond serving as a temporary aid for people trying to quit smoking cigarettes, such new nicotine-delivery systems could act as long-term alternatives to tobacco — making it possible to eliminate tobacco consumption almost entirely.
We have long known that people smoke for the nicotine, but die from the smoke. Indeed, the vast majority of cigarette-related diseases and deaths arise from the inhalation of tar particles and toxic gases, including carbon monoxide.
The use of nicotine in non-combustible forms like smokeless tobacco, or PNV, would enable millions of current smokers to reduce considerably the harm that their nicotine consumption is doing to their health. In Sweden, the widespread use of snus, a smokeless tobacco product with a lower concentration of carcinogenic nitrosamines, has contributed to a dramatic decline in the incidence of lung cancer, to the world’s lowest levels.
The benefits of phasing out tobacco consumption could not be more compelling. That is why PNVs should be promoted as an alternative to tobacco products, aided by endorsements from health authorities, tax advantages, and support from the anti-smoking movement.
But, so far, none of this has occurred, largely because nicotine is viewed as a highly addictive and toxic substance. In fact, nicotine has been the primary target of anti-tobacco campaigns for more than three decades.
But nicotine is only partly responsible for tobacco dependence. Other substances from tobacco smoke, such as monoamine oxidase inhibitors that have antidepressant effects, reinforce tobacco dependence, but are absent from vaporized nicotine. That may be why PNV user surveys suggest that nicotine is less addictive in its vaporized form.
In reality, nicotine is a relatively safe drug at dosages that a smoker or “vaper” inhales, with similar effects to caffeine. Moreover, smokers and PNV users control very precisely, on a puff-by-puff basis, the dose of nicotine they consume, virtually eliminating the risk of overdose.
In fact, a lethal dose of nicotine is a lot higher than the 30-60 milligrams that many scientific papers claim. After reviewing case reports of nicotine intoxications and suicide attempts, the pharmacologist Bernd Mayer found that the lethal dose of nicotine in humans must be somewhere between 500-1000 mg of absorbed — not just ingested — nicotine.
Though, in an ideal world, people would simply be able to quit using nicotine altogether, experience suggests that many smokers cannot — or do not want — to give it up. If smokers are willing to accept PNVs as a viable option, high-risk tobacco use could become a thing of the past.
Health authorities and governments have adopted a fear-based approach, scrambling to regulate or even ban PNVs. The European Union’s Tobacco Products Directive and the United Kingdom’s Medicines and Healthcare Products Regulatory Agency plan to introduce strict regulations of PNV sales and use, based on drug legislation. Such opposition is not based on scientific evidence. Indeed, an increasing number of scientific publications show that PNV use is much safer than smoking tobacco.
Russell once declared, “It is nicotine that people cannot easily do without, not tobacco.” He was right. And it is tobacco smoke, not nicotine, that kills.
Jacques Le Houezec is a consultant in public health and tobacco dependence and honorary lecturer at the United Kingdom Center for Tobacco Control Studies at the University of Nottingham. The views are his own. Copyright: Project Syndicate 1995-2014.
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