Scientific Review of Existing Evidence Advocates E-Cigs for Tobacco Harm Reduction

By Lindsay Fox Posted October 17, 2013

Professor Riccardo Polosa
Professor Riccardo Polosa. Photo by:


The misguided claims of anti-vaping zealots are all too familiar. “There is no evidence,” they say, “those things contain carcinogens,” and the oh-so-irritating, “you’re just prolonging your addiction.” We know that these arguments are inherently flawed, downright incorrect or just plain redundant, but one of the many benefits of being right is that you can back yourself up with evidence rather than hollow propaganda and logically-challenged scare-tactics. And here’s a comprehensive review of said evidence, courtesy of Professor Riccardo Polosa and his colleagues Brad Rodu, Pasquale Caponneto, Marilena Maglia and Cirino Raciti. The paper was published in the Harm Reduction Journal, and summarizes the existing evidence into e-cigs, and looks at the potential damage caused by the misinformation surrounding the technology.


The Study


The study opens by addressing the widely-held and downright incorrect belief that nicotine in pure form is a carcinogen or particularly dangerous. Removed from combusted tobacco, the substance doesn’t increase the risk of cancer, and has little, if any, impact on cardiovascular functioning.


After introducing the harm reduction approach to tobacco use, and re-stating its potential to drastically reduce the worldwide death toll associated with smoking, the paper begins to discuss e-cigs. The paper runs through the numerous gas chromatography mass spectrometry studies and re-states the point that e-cigs have considerably smaller quantities of dangerous components than tobacco cigarettes, and that they are comparable in terms of safety to approved smoking cessation products.


Evidence for the effectiveness of e-cigarettes as a smoking cessation method is then provided, with the researchers noting the poor success rates of existing measures. Smokers trying to quit and those with no intention of stopping have both been shown to reduce their cigarette consumption (if not abstain entirely) after being given an e-cigarette. Additionally, Polosa et. al. notes that in one study, 73.1 percent of smokers who switched to e-cigs (with total cigarette abstinence), didn’t even vape by the end of the one year study period.


The overall message of the study can be summed up through the quote, “The available evidence indicates that e-cigarettes do not raise serious health concerns and can be considered a much safer alternative to conventional smoking.”


In the study itself it makes clear, and Professor Polosa also noted this in an interview with James Dunworth, there isn’t enough evidence to say e-cigs are absolutely safe. He commented, “However, this does not imply that we know these products are completely harmless, particularly in case of long term use. Currently, almost no testing is performed on safety or quality of materials. Producers and distributors have to prove, rather than just advertise, that their products are safe and of the highest quality. Moreover, there are no studies on materials, plastics and metals that are more appropriate for use in e-cigarettes, do not interact with e-liquids and do not emit toxic chemicals. […]  This is why I believe that more research is needed. Now more than ever.”


The Swedish Example and Misinformation


The paper makes many references to the story of snus in Sweden, which is a form of smokeless tobacco, and in many ways a similar product (in terms of intention) to e-cigs. Sweden embraced snus, and as a result the proportion of men who smoked in the country dropped from 26 to 10 percent. Surprisingly, the number of people who consumed tobacco in some form (including snus) stayed around the same, showing the effectiveness of alternative forms of nicotine consumption rather than a “quit or die” strategy. Now Sweden is amongst the countries with the lowest rates of tobacco-related mortality in the western world.


Snus Tobacco
Snus – a form of smokeless tobacco


Yet when questioned, smokers from California were not receptive to the idea of snus and were unsure whether they really were (as the evidence clearly suggests they are) safer than cigarettes. Professor Polosa and his colleagues argue that this is due to misinformation provided to the American public by government agencies and health organizations. As we’re all well aware, this is also happening with regards to e-cigs, and according to the researchers, “If the public continues to be misled about the risks of THR products, millions of smokers will be dissuaded from switching to these much less hazardous alternatives.”


Conclusion – A Dangerous Dichotomy


The final important point is the researchers’ allegation that the “quit or die” approach favored by anti-smoking groups is potentially damaging. They comment that “E-cigs represent a middle ground between nicotine maintenance using the most deadly of delivery mechanism, smoking, and the nicotine abstinence demanded by the tobacco control community.” This dangerous dichotomy is neither justified nor beneficial, there is a third option, and it has the potential to save millions of lives around the world.


  • James_673

    The paper is quite interesting. It is true that the negative effects of
    nicotine are much lower than what is portrayed in front of us by the
    anti-smoking lobby. Even though nicotine is kind of a depressant and
    leads to addiction and the like but it has its plus points like improved
    attention, concentration etc. There is also scientific evidence that if
    smokers who are trying to quit and also who have no intention of quitting,
    are given e-cigs, their cigarette dependence reduces significantly. It’s
    encouraging that Sweden’s smoking related mortality rate has gone down
    drastically since the introduction of snus. The wise thing to do will be to
    try to achieve the same thing with e-cigs. E-cigs can justly act as the third
    alternative for the smokers all over the world who do not want to quit or
    die but want a middle path.

  • MacHelen

    The “quit or die” approach is outrageously wrong. What about those who have no intention of quitting but want to get rid of the harmful effects of tobacco? This is where ecigs came along acting like a third option for the smokers. The good thing is people who had no intention of quitting had actually quit.

    No matter how strong the argument against e-cigarettes, you cannot deny the fact that they are better compared to tobacco cigarettes. And you don’t need studies to show that ecigs are harm-reduction device.

    I will say actually it is easy to quit using ecigs, because I quit using the same.

  • Young_Ka

    consider ecig as a safer alternative because ecig fails me whenever I tell
    myself mentally that ‘Now I ‘m on the path of quitting’. BUT if i take a different
    approach like ‘ok, i’m not quitting but choosing a healthier and cheaper
    alternative’ then this works fine with me and I stick to ecig. So I guess it’s
    all about your approach towards ecigs. Like your article says a kind of third