The differing medical views on e-cigarettes across the Atlantic

What are e-cigarettes?

E-cigarettes have been around in their modern form since 2003, when they were developed by a Chinese company as a means of capitalising on a trend towards healthier living. The UK has had e-cigarettes since 2006, and the US since 2007. Like other NRT’s (Nicotine Replacement Therapy), they function as a nicotine delivery system. The difference between e-cigarettes and, say, patches and gum is that they better simulate the experience of smoking. The e-cigarette comprises a capsule in which the nicotine is mixed with flavourings and other additives as a liquid solution; a heating device (vaporizer); and a battery. The act of inhaling causes the heating device to vaporize the nicotine solution, creating a smoke-like effect. E-cigarettes are fast becoming the most popular alternative to smoking. According to a 2014 study, over 12% of Americans had used an e-cigarette at least once and the number is expected to rise.

E-cigarettes vs. smoking

In both America and the UK, e-cigarettes are generally considered a much healthier alternative to smoking for the simple fact that they do not burn tobacco, the so-called ‘combusting process’, the smoke from which the user inhales. The smoke itself contains numerous carcinogens and the combustion process also creates additional hazardous chemicals. The total number of chemicals involved in smoking a traditional cigarette hovers around the 4,000 mark — of these around 43 are known to be carcinogenic, and a further 400 are considered toxic. The chemicals in one pack of cigarettes smoked every day for a year trigger around 333 DNA mutations thus increasing exponentially the risk of cancer. In contrast to this complex cocktail, the list of chemicals involved in ‘vaping’ is much simpler and safer. According to one study, endorsed by the Royal College of Physicians, e-cigarettes are 95% safer than their tobacco counterparts. Nicotine itself is relatively harmless, and is comparable to caffeine in its potential threat to health. Since e-cigarettes are merely a nicotine delivery system, they do not produce the harmful smoke which leads to smoker deaths.

But while both sides of the Atlantic accept in general terms that e-cigarettes are somewhat healthier than normal cigarettes, the discussion is framed much differently. In the UK, the benefits of e-cigarettes are the chief focus. Whilst there is some minor debate, for the majority, they are seen as an effective alternative to smoking and as contributing towards an overall decline in the number of smokers. In 2016, the number of smokers in the UK dropped to its all-time lowest level of 7.2 million. While in Britain the potential threat of e-cigarettes is acknowledged and regarded as requiring further research, the benefits are generally believed to outweigh the negatives, and the NHS encourages their use as an aid to cut down on cigarette consumption.

E-cigarettes in America: a different story

In the US, however, reception of e-cigarettes has been much cooler. Their potentially negative effects are emphasised as is the belief that they are not so much an aid to quit smoking as they are a gateway to take up smoking. Figures carried by the American Lung Association show that e-cigarette use by high school students increased by 900% from 2011–15 and were a first step to experimenting with real cigarettes. The American Lung Association takes a severe approach to both e- and traditional cigarettes and sees both as contributing towards lung problems. The negative effects on health of e-cigarettes are not yet fully known, but media reports in the US have focused on them nevertheless. The sharp contrast in strictly medical assessments of e-cigarettes in the UK and the US is not a new phenomenon. In treating addictive conditions, the UK traditionally favours promoting psychological help in conjunction with advocating safer drug practice; the US, however, favours simply withdrawing access to addictive substances as a matter of course. In other words, both countries have a radically different approach to medical matters, and this is manifested in their differing assessments of e-cigarettes.

The different approaches to e-cigarettes is no surprise and is perhaps a consequence of the political and economic environment in both countries. America’s political and economic system runs on donations and the goodwill of powerful lobbyists. It was this system which brought the US a president and cabinet with a net worth of $6 billion, famously “worth more than a third of America”. This wealth-first approach has affected the reception of e-cigarettes too. According to Forbes, the ALA “egged on” America’s Food and Drug Administration (FDA) to adopt a hard-line approach to e-cigarettes by re-classifying them as tobacco products in 2016. The increased regulation makes it much harder for smaller e-cigarette companies to survive and thus favours so-called Big Tobacco. These tobacco giants, like Reynolds and Altria, although themselves investing in e-cigarettes, still make most profit from the sale of tobacco cigarettes. It is therefore somewhat ironic that in so strictly carrying out the war against vaping, American institutions have increased the market share of the biggest tobacco companies and increased the number of potential smokers.

E-cigarettes are regarded very differently in the US and UK. In the UK, they are promoted by the media and the NHS as a viable, comparably healthy alternative to tobacco. In America, their potentially negative effects are emphasised such that they have now been classed as a tobacco product by the FDA. It remains to be seen what effect these contrasting policies will have on the health of their respective populations.