In developed countries, where the public debate on tobacco consumption has been so widespread that even those who had no desire for it were educated on the negative effects of smoking, the prevalence of this toxic habit dropped so drastically that it caused trouble for cigarette manufacturers.

Sweden, for instance, is the country with the smallest number of smokers in the world. It is part of a number of occidental regions in which the smokers’ rate has been, for some years now, below 14%. Others on this list include California (USA) – 9.8%, New South Wales (Australia) – 13.9%, and British Columbia (Canada) – 11%. In these places, tobacco consumption changed from a signal of high social status into a refuge for the mentally ill, people with problems related to alcohol and drug use, the criminal population, and the homeless.

The new “tobacco-free cigarettes”, the so-called e-cigarettes, which work by steam heating the substances which smokers are so hooked on, have lately been the ace up the big manufacturers’ sleeve, which strive to achieve a “global revolution,” according to their advertisements.

This revolution, however, gets stuck in studies showing that vaping (inhaling aerosols, rather than smoke, obtained by heating a special liquid) might be even more harmful than conventional smoking. The effects of vaping have not been completely clarified by scientific studies. However, the conclusions drawn by scientists are not as ambiguous as producers would like us to believe. Most of them (including a doctor quoted by the BBC) say that if you smoke, vaping could be a useful step, but strictly if you are on your way to total abstinence. If you start vaping as a non-smoker, you are committing a grave mistake.

Possibly more harmful than conventional cigarettes

A recent study carried out by researchers from the Sinai Medical Center in Los Angeles was presented at a scientific conference organised by the American College of Cardiology. The researchers’ message was an extremely serious one: electronic cigarettes might be more harmful to a smoker’s heart than conventional tobacco cigarettes.

The Sinai team compared the developments within three groups: 10 non-smokers, 10 tobacco smokers and 10 electronic cigarette smokers. All the participants in the study were less than 40 years old and were all healthy. Researchers evaluated their blood pressure after a short series of intense physical exercises and observed that, unlike the participants in the other groups, the e-smokers presented no rise in their blood pressure. “This suggests e-cigarettes cause an abnormality that impedes blood flow regulation in the heart”, said Dr. Florian Rader, coauthor of the study and cardiologist at the Cedars-Sinai’s Smidt Heart Institute.

Most of us rightfully associate cigarettes with lung cancer. What we don’t know is that, in reality, heart diseases provoked by smoking kill many more people than lung diseases generated by the same behaviour. Data coming from the US shows that, in 2014, smoking was behind 1 out 4 deaths provoked by cardiovascular diseases, which meant approximately 210 000 deaths that year. Lung cancer, on the other hand, kills approximately 140 000 Americans on a yearly basis. If e-cigarettes prove to be worse for the smoker’s heart than conventional cigarettes, the health implications are huge.

Rader admits that the study he collaborated on is too small to draw unequivocal conclusions, but he is not the only one who observed an association between vaping and an increased risk of heart disease. There are other studies which show that vaping might be the cause of certain serious heart diseases.

Is it worth the risk?

Another study published in the Archives of Disease in Childhood documents the extreme case of a teenager from Great Britain who was one step away from dying after his lungs suffered an allergic reaction to the substances in e-cigarettes.

The doctors were forced to connect Ewan Fisher to an artificial lung to keep him alive after his lungs gave in and he could no longer breathe. The doctors treating him said vaping “is not safe”, although UK health regulators say e-cigarettes are 95% safer than conventional tobacco.

Ewan’s story is worthy of a horror movie. At 16 years old he wanted to quit smoking to improve his boxing performance, so, instead of smoking, he took up vaping. A few months after he started, the teenager began to have more and more difficulty breathing. When he started coughing and suffocating in his sleep, his mother brought him to the emergency room. The doctors concluded his lungs were no longer coping and, in a short time, the young man ended up in the intensive care unit, connected to machines. His condition worsened and not even the ventilator could provide his body with the necessary oxygen. He was transferred to a hospital where he was connected to a device that oxygenated his blood and removed carbon dioxide from his body, after which it was reintroduced back into his body.

After this critical stage, Ewan, who is now 19, entered a long recovery period, which still goes on today. “Vaping has basically ruined me,” said the young man in an interview for the BBC. “I try to tell everyone and they think I’m being stupid, I tell my mates and they don’t listen. They still do it… but they’ve seen what I’ve been through. Is it worth risking your life for smoking e-cigs? I don’t want you to end up like me and I don’t want you to be dead, I wouldn’t wish [that] on anyone.”

Today Ewan is afraid even to stand next to people vaping, aware that even the steam others breathe out might affect his lungs.

Dr. Jayesh Bhatt, consultant at the Nottingham University Hospitals, told the BBC that “the real learning point is vaping is not safe, especially for young people, they should never go near it. We consider e-cigarettes as ‘much safer than tobacco’ at our peril.”

Voices unbiasedly against vaping

A study published in the New England Journal of Medicine concluded that lung inflammation caused by one or more inhaled toxins was the main cause of lung problems identified in several people who got sick in their lungs after vaping. The authors of this study blamed THC or other cannabis derivatives in the e-cigarette liquid.

Representatives of the World Health Organization (WHO) declared that e-cigarettes are “undoubtedly harmful and should therefore be subject to regulation.” Although producers promote e-cigarettes as a cleaner alternative to conventional cigarettes, the WHO warns that there is “insufficient independent evidence to support the use of these products as a population level tobacco cessation intervention to help people quit conventional tobacco use.”

There are three types of e-cigarettes: those that heat the tobacco (heated tobacco products or HTP), those that heat up a liquid which contains nicotine (but no tobacco) and other chemical substances (electronic nicotine delivery systems or ENDS), and versions which heat up solutions with different ingredients, some of which are not even mentioned on the ingredient list, but which do not contain nicotine (Electronic Non-Nicotine Delivery Systems or ENNDS).

Dangerous—especially for teenagers

“Although originally introduced as safer, e-cigarettes are not harmless”, warned Atena Zahedi, who received a PhD in bioengineering after authoring a study which proved that nicotine e-cigarettes damage the brain’s stem cells. “Even short-term exposure can stress cells in a manner that may lead, with chronic use, to cell death or disease. Our observations are likely to pertain to any product containing nicotine.”

Scientists at the University of California named the mechanism of inducing cellular toxicity by using e-cigarettes “stress-induced mitochondrial hyperfusion” (SIMH). Conducting experiments on guinea pigs, they discovered that “exposure of stem cells to e-liquids, aerosols, or nicotine produces a response that leads to SIMH”. Stem cells present in the human body throughout one’s life are cells capable of specialising in various functions, able to become brain, blood or bone cells. They are more sensitive to stress than other cells which are already specialised.

According to the Centers for Disease Control and Prevention (CDC) in the US, the number of American teenagers who admitted to using nicotine products went up by approximately 36% last year. This is attributed to an increase in the use of e-cigarettes. According to federal law, the minimum age to buy tobacco products is 18 years old. However, in California and other states, this has been established at 21 years old. Around 10.8 million American adults currently use e-cigarettes, and over 50% of them are under the age of 35. One in three e-cigarette users vapes daily, according to researchers in a recent study published in Annals of Internal Medicine.

The revolution is delayed

At a global level, over 20.8 million people vape. In Europe, the country with the highest number of people adhering to this habit is Great Britain, with 2.8 million users. In Romania, 27% of the total population smokes, and out of these 8% use e-cigarettes.

Experts say that certain vulnerable categories are more exposed to the risk of using e-cigarettes. Among them, they mention conventional smokers, unemployed adults and persons belonging to the LGBT community. People with chronic medical issues, like heart disease, cancer, asthma and respiratory disorders, are also more prone to using e-cigarettes compared to individuals who do not have these health problems. This is why the authorities in some states, such as San Francisco, have banned the sale of e-cigarettes until their effects on health are clarified.

The revolution announced by tobacco producers must therefore be put on hold. We have numerous reasons to wish it will never materialise and will not hinder the trend that renders smoking obsolete, a trend which was already being observed in most developed countries.

Alina Kartman is a senior editor at ST Network and Semnele timpului.