In the lead up to the WHO Framework Convention on Tobacco Control Tenth Conference of the Parties that starts today, advocates for e-cigarettes and other “reduced harm” tobacco products have been busy again arguing that delegates should embrace these products. In reviewing some of this material, I have been struck by the fact that their arguments, and the supporting “evidence” hasn’t changed much in the last 10 years. What has changed, however, is the actual evidence, which has been rapidly accumulating.
In particular, as of a few months ago, there were nearly 10,000 peer reviewed papers on the health and behavioral effects of e-cigarettes.
My recent paper, E-cigarettes: Harm enhancement and protection of global tobacco interests, based on a lecture I delivered in Turkey and published at the end of December 2023, summarizes what we now know:
- E-cigarettes mimic cigarettes’ delivery of a nicotine aerosol to the lungs without burning tobacco, which led many to assume they were substantially safer than cigarettes.
- By 2023 there were nearly 10,000 scientific papers on e-cigarettes that revealed higher dangers than assumed, that e-cigarettes as consumer products do not help smokers quit, and that they have addicted millions of youth to nicotine.
- The failure of e-cigarettes as consumer products to help people stop smoking makes their relative toxicity compared to cigarettes a moot point.
- E-cigarettes have attracted millions of youth at low risk of initiating nicotine use of cigarettes, extending and worsening the tobacco epidemic.
- Countries which have prohibited the import and avoided the sale of e-cigarettes have done better overall at controlling the e-cigarette epidemic than countries, including the United States and England, which of adopted a more laissez-faire attitude toward e-cigarettes.
- Electronic cigarettes have also played a role in the multinational tobacco companies’ efforts to reposition themselves as socially responsible, which helps protect their financial and political interests.
Hopefully, delegates at the Conference of the Parties will be making decisions based on the whole body of evidence not just out-of-date and selectively cited material the industry and its allies present.
Here is the abstract of the paper:
Electronic cigarettes mimic cigarettes’ nicotine aerosol without burning tobacco. The assumption has been that electronic cigarettes are substantially safer than cigarettes because they avoid combustion. This assumption, combined with assumptions that electronic cigarettes are effective for cigarette cessation and do not appeal to youth, led many to argue electronic cigarettes are harm reduction. By 2023, evidence revealed higher risks than assumed, that electronic cigarettes as consumer products do not help smokers quit, and that electronic cigarettes have addicted millions of youth to nicotine. Dual use (using both electronic cigarettes and cigarettes) is more harmful than just smoking cigarettes. The failure of electronic cigarettes as consumer products to help people stop smoking makes their relative toxicity compared to cigarettes a moot point. Electronic cigarettes have also played a role in the multinational tobacco companies’ efforts to reposition themselves as socially responsible, which helps protect their financial and political interests. Countries, including Turkey, that have prohibited the import and avoided the sale of electronic cigarettes have done better overall at controlling the electronic cigarette epidemic than countries, including the United States and England, that have adopted more laissez-faire policies toward electronic cigarettes. Turkey should maintain and ensure effective enforcement of its current policies to continue to protect its population from electronic cigarettes.
I delivered a similar presentation in Brazil that covers the same points, including many specific examples of newer studies . You can watch the full lecture (1 hour, in English) followed by a 35 minute Q&A (in Portuguese and English) on YouTube:
The full citation for the paper is: Glantz S. E-cigarettes: Harm enhancement and protection of global tobacco interests. Addicta: Turkish Journal on Addictions 2023;10(3): 194-201. DOI: 10.5152/ADDICTA.2023.23152. It is available for free here.
Stanton Glantz blog 
Hi Stan-
Missing from your summary of accumulating research and data on e-cigarettes is how countries taking a harder line on e-cigarettes have done in regard to reducing smoking versus those taking a more laissez faire approach to e-cigarettes (or whether there is any correlation between e-cigarette policies and smoking levels not explained by differences in smoking-specific policies). Have you (or has anyone) looked into that?
So far, my view has been that the main benefit from the emergence of e-cigarettes is that their availability to smokers and to the industry should make it easier, politically and rhetorically, to implement much stronger anti-smoking laws and taxes . But I don’t think we have seen that to any great extent.
Eric .
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The one country that I have seen data on this question is Brazil, where they have very low smoking rates while prohibiting e-cigarettes.
The reality is uptake of e-cigarettes falls off very quickly as people move past young adulthood and that very few adult smokers “switch completely.” The main effect that e-cigarettes have on older smokers is to promote relapse to nicotine addiction and smoking.
In any event, the tobacco companies that sell e-cigs still vigorously oppose taxes, clean indoor air, and other tobacco control policies.
As the paper argues, the main effect e-cigarettes have had is to expand the tobacco epidemic by recruiting millions of low risk kids to nicotine addiction.
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