E-cigs have been on the market for 15 years: If they were really reducing harm it would be obvious by now

Ever since e-cigarettes first came on the market in 2006 the argument has been that it will take time for their health benefits to be manifest. This view was restated again last month in an FDA press release that stated, “Companies who want to continue to market their flavored ENDS products must have robust and reliable evidence showing that their products’ potential benefit for adult smokers outweighs the significant known risk to youth [emphasis added].”

But 2006 was 15 years ago. If e-cigarettes were really reducing harm or individual users it would have been obvious by now.

When people think about smoking the first disease most people think about is cancer. And the risks of cancer evolve over a period of years.

But it is heart and lung disease that kill most smokers and those risks fall much faster. For example, heart attack risk drops by about half in a year as do symptoms of lung disease. Quitting during the first trimester cuts the risk of low birth weight infants a few months later. And 15 is also more than enough time to start detecting a cancer benefit.

These are all changes that should have been detectable in population studies by now if e-cigarettes were substantially less harmful than cigarettes and were replacing them either by promoting smoking cessation (i.e. “switching”) or preventing initiating cigarettes.

But, rather than finding lower risks at a population level the studies are actually finding increased risks of lung (link1, link2, link3) and heart disease (link4, link5, link6).

Of course, the e-cig advocates criticize the studies showing these increased risks. The most common complaint is that many e-cigarette users are former smokers. But, if e-cigs were reducing harms there has been plenty of time for the reduced risks to show up in former smokers. That hasn’t happened.

So, the FDA should really be saying, “Given the lack of robust and reliable evidence of actual benefit for smokers in terms of common diseases, we are not authorizing the sale of any e-cigarettes because of the the significant known risk to youth.”