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How harmful are e-cigarettes?

Inspired by an interesting blog article by Carl Phillips, I want the harmfulness
Of e-cigarettes compared to tobacco cigarettes. Link to the detailed,
English-language contribution: https: // antithrl ies.com/2017 / 06/20 / time-to-stop-
measuring ring-risk
As-fraction-of-risk-from-smoky ng /
The famous estimate of Public Health England (95% less harmful)
Experts worldwide agree that the inhalation of an aerosol of e-cigarettes
Is less harmful than the inhalation of tobacco smoke. There is, however, a
disagreement in the
Question about how much less damaging the steam is. A well-known opponent of
steam has
An analogy tries, according to which the consequences of falls from the 5th floor of a
high-rise building
Were as fatal as those from the 15th floor. Even if this analogy is highly
Misleading - not to say nonsensical - is, it would be for the information of the
population
It is desirable to be able to provide a quantitative measure for the lower level of
harmfulness.
Based on one of the British drug expert David Nutt together with one
Panel of international experts published risk analysis has Public Health England
Is considered to be at least 95% lower, resulting in a residual risk of a maximum of
5%. This value has now reached the status of a fact and has been incorporated into
Countless media reports, contributions to internet forums and various discussions
Prayer-mill-like. The words "at least" or "maximum" are unfortunately lost
Mostly under the table. Despite the weaknesses and faulty outlined below
Interpretations of the risk assessment of PHE, I also often refer to the 95% because
A concrete number for the explanation of the advantages of steaming helpful and
impress
Is a simple "much less harmful".
How were the 95% determined?
Only a few people read Unfortunately, the original literature, so that the origin
of 95% hardly
Is known. The risk analysis of David Nutt is based on so-called multiple-criteria
Decision analysis (MCDA), whereby 14 criteria for harmfulness are estimated and
weighted
were. The criteria for risk analysis of nicotine - containing products are given in Fig.
1 of the
(Nutt et al., 2014, https://www.karger.com/Article/Pdf/360220). As shown in Fig.
2, the calculated residual risk of e-cigarettes is mainly based on their risk
Dependence potential. Accordingly, the risk of medical nicotine products of
The authors were much lower than those of e-cigarettes. The ethical /
Ideological question whether dependency should be assessed as harmful in the
absence of other effects
Is, I would not discuss here.
Is a quantitative measure of harmfulness useful?
No, because there are different kinds of harmfulness. I would like to explain the
"Harmful" of cycling with that of driving. If you have skin
Abrasions, sunglasses, muscle soreness and the like, cycling is more important
More harmful. However, according to published statistics, the risk of fatal accidents
is
Driving is many times higher than cycling. One can weight it and one
Theoretical total risk of cycling compared to driving, but

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This number is pointless because apples are compared with pears. Most of us suffer
Rather to die from a sunglasses than from a traffic accident. If you can
Aspects such as physical training, environmental pollution, consumption of fossil
fuels
Etc., it becomes increasingly difficult. The advantages of cycling
As a "negative risk" against the "positive risk" (disadvantages such as skin abrasion)
The calculation.
Health advantages and disadvantages of nicotine consumption by means of e-
cigarettes
Socioeconomic and ecological aspects are disregarded here
Limit me to the health aspects. When considering the harmfulness
Of e-cigarettes - as exemplarily exemplified in the example of cycling -
Different forms of harmfulness and also possible advantages of the
Steaming. In the following list I have documented
And especially plausible facts. Absurd injuries such as impotence, blindness or
I ignore brain shrinking as well as the various "cocoon studies" in which over
Formation of (allegedly) carcinogenic aldehydes.
Health benefits of smoking compared to smoking
- improvement of the lung function of healthy persons and asthmatics;
- decreased progress of COPD (less oxidative stress, no particles);
- Improve physical performance (especially by improved bleeding
And elimination of inhalation of carbon monoxide);
- decreased incidence of upper respiratory infections (colds, colds);
- elimination of the harmful effects of toxic combustion products (cancer risk,
Circulatory disorders, stroke, myocardial infarction, etc.).
Health benefits of steaming compared to non-steaming
- improvement of cognitive functions by nicotine (concentration, attention);
- protection against Parkinson's disease, Alzheimer's disease and ulcerative colitis by
nicotine;
- lower weight gain during smoking stop caused by nicotine and thus reduced
Risk of complications of overweight;
- possibly antibacterial effect of inhaled propylene glycol.
Health-related disadvantages of steam compared to non-steam
- allergic potential of propylene glycol and aromatics (relevant to atopic)
- irritation of the respiratory tract (presumably desired by smokers "throat hit")
- irritation of the nasal mucosa (local inflammation, nose bleeds)
- maintenance of dependence (nicotine, behavior)
- short-term increase of heart rate and blood pressure
- possibly accelerated tumor growth, impairment of chemotherapy
(Pro-angiogenic effect of nicotine)

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This list illustrates the problem of the reduction of harmfulness to one
Percentage. If one - of Nutt et al. Relatively high - weighted dependency potential
Ignoring the advantages of steaming against the harmful effects,
One would presumably have a "negative risk" compared to the non-vaporization, ie
the Kon
Sum nicotine-containing e-cigarettes would have health effects for most people
Against abstinence. However, in individuals with severe heart disease
Or a malignant tumor are the most harmful. It is advantageous
Or harmful is therefore individually different. Similar to increasing the motility of the
Intestine is advantageous in the case of constipation but is undesirable in the case of
diarrhea.
Comparison of mortality rates
According to WHO, around 6 million people die every year from the effects of
tobacco
consumption. Due to the published by David Nutt and employees of Public Health
England widespread residual risk of 5% could come to the conclusion that
While switching all smokers to steaming 300,000 people a year on the consequences
Of the steam. The reduction from 6 million to 300,000 is impressive,
But also 300,000 dead would be happy for the willing introduction of a new
technology
Hardly acceptable. From the above, it should be apparent that these conclusions
Is absurd. There is no reason to believe that people are affected by the consequences
of the
Inhalation of the aerosol of e-cigarettes. The residual risk of mortality
By steaming it is 0%, or at least very close to 0%. Possible deaths
Outgassing batteries or mistakenly swallowed devices are not excluded
But by the elimination of death-sacrifices by burning cigarettes by far
Siert. Abusive use, such as intentional or accidental nicotine poisoning
Is irrelevant, because the misuse of knives, ropes or toilet cleaners is lethal
can be.
Conclusion
The lump-sum statement that E-cigarettes are 95% less harmful than tobacco
Cigarettes is meaningless without explaining the underlying assumptions, but may be
Nevertheless be helpful to the population, the media and decision-makers before
Eyes to lead that e-cigarettes not just a little but around magnitudes
Less harmful. If possible, it should be noted that in the case of the harmful
Consequences of smoking about lung cancer, COPD and myocardial infarction, in the
case of damage
Of steam, on the other hand, via respiratory irritation, allergies and dependency.
Ultimately, one should clarify that people die from the consequences of smoking
But not the consequences of steaming.
Dr. Bernhard-Michael Mayer
Graz, July 7, 2017
Professor of Pharmacology and Toxicology