Some Disagreed With WHO Report on E-Cigarettes

Electronic cigarette report misleading, said tobacco experts

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) E-cigarettes are gaining popularity. But whether they are safer than conventional cigarettes is the subject of debate, even among experts.

The World Health Organization (WHO) recently published a report on e-cigs and made recommendations about their use. They recommended that the use of e-cigs be prohibited wherever conventional cigarettes are prohibited. They also called for restricted advertising due to health and safety concerns about e-cigs.

A separate group of scientists felt the WHO report contained errors and statements that could mislead readers. In a new article, these scientists made suggestions for revisions to the report that they felt better presented the data on e-cigs.

Ann McNeill, PhD, of the UK Centre for Tobacco and Alcohol Studies in London, and colleagues wrote the review that criticized the WHO report. The review was published in the September issue of Addiction.

"E-cigarettes potentially offer a much less harmful form of nicotine delivery," Dr. McNeill and team wrote.

The authors of the Addiction article said the public should know the evidence that e-cigs were not as unhealthy as conventional cigarettes and may even help smokers quit.

The critique authors felt that the WHO report should not have presented e-cigs as negatively as it did. They wrote their critique to address ways they felt the WHO review misrepresented or misinterpreted the data.

Dr. McNeill and team noted several statements they felt were incorrect or misleading in the WHO report.

Most e-cigs work by heating a nicotine liquid to create a vapor. The vapor can then be inhaled. This is different from conventional smoking, where tobacco is burned and the smoke is inhaled.

Smoking conventional cigarettes is tied to an increased risk of cancer and heart disease, likely due to the toxins in the smoke.

The WHO report stated that many e-cig users still smoke cigarettes. Because of this, the authors of the WHO report said that there was likely no benefit to heart health and only a slight decrease in cancer risk with e-cigs.

Dr. McNeill and colleagues said this statement from the WHO report was misleading. If people were smoking e-cigs, they likely smoked fewer tobacco cigarettes.

In that case, the amount of time spent smoking and the number of cigarettes smoked would decrease, and that could decrease heart damage and cancer risk, Dr. McNeill and the other authors of the critique wrote.

Another aspect of the report that Dr. McNeill and her review team found misleading was the fact that the WHO report did not explain the difference in the concentrations of toxins between tobacco smoke and e-cig vapor.

Dr. McNeill and team noted that levels of one type of toxin — called nitrosamine — in e-cigs were 76 to 142 times lower than the amount in one conventional cigarette. From one day's use, e-cig users were exposed to nitrosamine at levels 1,800 times lower than a cigarette smoker's daily exposure.

Dr. McNeill and her co-authors said that these facts represented a huge decrease in the number of toxins that e-cig users were exposed to, compared to tobacco smokers.

Dr. McNeill and team pointed out that the levels of toxins in e-cig vapor were similar to those in nicotine inhalers, which the US Food and Drug Administration has already approved for use.

Nicotine inhalers (brand name Nicotrol) are used to help people quit smoking. They deliver a precise dose of nicotine and must be prescribed by a doctor.

The critique by Dr. McNeill and team presented evidence that e-cigs may not be as bad for people's health as the WHO report stated.

"A further study has shown a reduction in asthmatic symptoms in both quitters and [people who smoked tobacco and used e-cigs] suggesting some immediate health benefits for asthmatic smokers of e-cigarette use," Dr. McNeill and the review authors wrote.

The WHO report did not mention the potential benefits of e-cigs to tobacco smokers with asthma, Dr. McNeill and team noted.

The Addiction critique authors said that one interpretation of the data was that nicotine medications have been shown to help people quit smoking, so e-cigs may also help people quit.

Several authors disclosed conflicts of interest. Some authors served as consultants or received funding from e-cig or smoking cessation companies.

Review Date: 
September 18, 2014
Last Updated:
September 25, 2014