For many smokers, his discovery was a revelation. Invented in 2003 by Chinese pharmacist Hon Lik, the electronic cigarette (vaporette) became popular with the creation of the first flavors and liquids in 2013. Today, 5.4% of French people vape daily and 43% of French people have quit altogether with smoking. But should we really be happy about it? At the scale of public health research, a decade does not provide the perspective needed for perfect health assessment. Nevertheless, scientific studies are accumulating and allow us to identify some certainties. In particular: vaping is certainly less toxic than cigarettes. “Vapers need to understand this so they don’t start smoking again,” warns Professor Daniel Thomas, cardiologist and member of the Alliance Against Tobacco (ACT), the two main anti-tobacco organizations in France.
The reason is obvious. “The combustion of cigarettes produces tar, responsible for cancer – lungs, larynx, bladder, etc. -, and carbon monoxide, linked to various cardiovascular diseases, including heart attacks,” summarizes Professor Gérard Dubois, member of the National Academy of Medicine and emeritus professor of public health. This is not the case with the vaporette, which simply heats a dilution medium (propylene glycol and/or vegetable glycerin), nicotine and various aromas. “Propylene glycol is considered so safe that it is permitted to produce smoke and fog during shows,” explains Professor Dubois. Then there are the flavors and nicotine, which, while extremely addictive, are not carcinogenic in themselves, contrary to what 80% of French people think. Therefore, the fumes released by vapers do not seem to pose a major problem. “They are infinitely less toxic than those of cigarettes and even if these vapors remain more toxic than pure air, they have a composition comparable to those accepted for classic air quality standards,” says tobacco specialist Bertrand Dautzenberg.
“But we should also not believe that the vaporette is harmless or that non-smokers can try it without risk,” says Professor Thomas. Studies have shown that certain toxic and carcinogenic chemicals present in cigarette smoke are also present in vaporizer smoke, albeit at much lower concentrations. “This includes nicotine breakdown products, especially nitrosamines, but because the liquids are 99.6% purified, there are 200 times less of them than in a cigarette,” explains Bertrand Dautzenberg. As for formaldehyde, we detect 0.03 to 0.05 mg – compared to 0.1 mg in a cigarette -, except when the liquid is burning [en cas de mauvais réglage de la résistance, ou quand il n’y a presque plus de liquide, NDLR]In this case, the levels are close to those of cigarettes”. Therefore, the tobacco specialist recommends regularly replacing the coils and always refilling your reservoir. On the other hand, when the liquids are replaced by oils, vitamin E, THC or CBD, there may be tragedies occur, as was the case in the United States in 2019. “There were about fifty deaths, but it was an abuse that had nothing to do with vaporettes,” Professor Dubois brushes off. The doctor also uses “heated tobacco devices, similar to vaping, but which are actually much closer to real cigarettes in terms of health risks.
However, is the vaporette “95% less harmful than cigarettes,” as vaping advocates claim? “This figure came out of nowhere and has no scientific basis to date. It comes from an August 2015 report that cites an expert estimate based on another March 2015 report, itself “based on a November 2015 study 2014 that… Never mentions this 95%! All this is based on nothing other than an irreproducible estimate,” brushes off Professor Loïc Josseran, president of ACT and medical researcher in public health at the University of Versailles Saint-Quentin-en-Yvelines. To claim that vaping 95 % less harmful than cigarettes, scientists should follow vapers who have never used cigarettes for forty years and compare them with non-smokers or smokers who have never vaped. On the one hand, however, the product has only been in mass use for ten years. On the other hand, 55.5% of vapers today still smoke cigarettes, while the remaining 45% are ex-smokers. It is therefore difficult to distinguish the effects of vaping from those of cigarettes. Not to mention from the fact that the vaping device is not a unique or standardized object. Some are disposable, others have different tensile strengths and resistances. There are also many flavors. “Such research is complex to set up, would be very expensive and difficult to finance ”, adds Professor Thomas. An investment that the health authorities are not always ready for.
Experimental studies to find weak signals
Meanwhile, scientists try to discover weak signals by conducting experimental research, in the laboratory, on cells or animals. Sometimes they have to force the line. For example, a study published in the Journal of Proceedings of the American Academy of Sciences in 2018 confirmed that exposure to vapor smoke could damage the DNA of cells in the heart, lungs and bladder of mice. However, the small 20-gram mammals were literally gassed, as they were exposed to 1,920 milligrams of nicotine in just three months. That’s equivalent to ten years of vaping. The results of this work were strongly criticized at the time.
In turn, a team from the Keck School of Medicine published a more serious study in the journal in 2021 Scientific reports. This work suggests that vaping can cause unwanted biological changes and lead to the development of various heart and respiratory diseases, and even cancer. Their latest experiment, published in 2023 in Nicotine and tobacco research, suggests that vaping is associated with damage to the DNA of cells in the mouth. “Users of electronic cigarettes (such as Juul) and sweeter products had the highest levels of DNA damage compared to non-users,” said Ahmad Besaratinia, professor of public health at the Keck School of Medicine. The concentration of nicotine smoked had no influence on the results.
“Some will tell you that these experiments, which look for weak signals, are carried out in an anomalous way. This is sometimes the case in studies where e-liquids are heated until they burn and inevitably release toxins,” notes Professor Daniel Thomas op. them and the anti-vapes who emphasize the worst results without distinguishing between what is permissible and what is not, there may be bad faith on both sides. Even if we want to be as objective as possible, it is not always easy to know which research is credible.”
Do you require the purchase of vaporettes in pharmacies?
According to Loïc Josseran, one of the outstanding questions concerns aromas, of which there are thousands. “Research shows that they can cause neurological damage and cardiac arrhythmias, or even thickening of the respiratory tract,” he underlines, citing a scientific study published in 2021 in Pharmacology & Therapeutics. This work points to “at least 65 aromatic ingredients”, of which the most concerning is cinnamaldehyde (cinnamon flavor), followed by vanillin and ethyl vanillin (vanilla), menthol (mint), ethyl maltol (candy, popcorn or cotton candy), benzaldehyde (almond) and linalool (fresh scent of mint aroma). In a press release published in February 2023, the CNCT also spoke out in favor of a ban on perfumes. “There are indeed some aromas for which toxicity at the cellular level has been demonstrated,” confirms Daniel Thomas. “But it’s not so much their toxicity as their ability to ensnare adolescents that concerns me.” He is simply campaigning for the abolition of confectionery flavors with childish names and sugary flavors. In the crosshairs, like those of the CNCT, the ACT and the Academy of Medicine: puffs, these disposable electronic cigarettes aimed at the youngest.
It remains to be seen whether the vaporette can make it possible to give up tobacco. There the searches are more precise. Two studies from the review Cochrane, the reference in the field shows that this is the most effective means of quitting smoking. For both Bertrand Dautzenberg and Professor Dubois, the debate has been settled, mainly because these studies provide a ‘high’ level of evidence, in other words, a result that is almost certain. “The vaping debate pits two camps against each other: one sees the vaporette as a weapon to help smokers quit smoking, the other faces fears that it could convert young non-smokers to nicotine. However, these two positions could can be combined intelligently.”, summarizes Daniel Thomas. To reconcile them, one of the solutions could be to assimilate vaporettes with medical devices – as in Austria and Norway – and make them accessible only in pharmacies, and no longer in tobacco shops or “vapo stores”, which do not or insufficiently apply the ban on sales to minors. “Because the best cigarette is the one you don’t smoke, whatever it is,” recalls Professor Dubois.