E-cigarettes: Good news, bad news

John Ross, MD, FIDSA

Contributing Editor

Follow me at @JohnRossMD

Americans are confused about electronic cigarettes. A recent poll showed that the public was about evenly split between those who thought that electronic cigarettes, or e-cigarettes, were less harmful than conventional cigarettes, and those who believed that e-cigarettes were as bad as or worse than regular cigarettes.

Unfortunately, there is no long-term safety data about electronic cigarettes. What information we do have suggests that e-cigarettes have a complex mix of potential harms and benefits.

Electronic-cigarettes: Less deadly than regular cigarettes

First, the good news: electronic cigarettes are almost certainly less lethal than conventional cigarettes. Cigarette smoking is a uniquely dangerous addiction. In fact, cigarettes might be the only consumer product that kills when used as directed. Cigarettes are the number one cause of preventable death in the United States, killing 480,000 people every year. That’s more deaths than HIV, heroin, methamphetamine, cocaine, alcohol, motor vehicle accidents, and firearms combined. Smoking increases the risk of stroke, heart attack, COPD, asthma, diabetes, and most cancers. The free radicals in cigarette smoke physically age the human body. On average, smoking reduces your life span by at least 10 years. Tobacco could not possibly be approved for sale in the United States today if it was a new product coming on the market.

A burning cigarette gives off noxious gases, such as carbon monoxide and hydrogen cyanide. Cigarette smoke also contains an ultrafine suspension of gummy residue, known as tar. Most of the carcinogens in cigarette smoke are found in the tar. The major benefit of e-cigarettes, compared to regular cigarettes, is that they do not produce the tar or the toxic gases found in cigarette smoke. An electronic cigarette contains a cartridge of fluid, popularly known as e-liquid. E-liquid is made up of nicotine and flavorings dissolved in propylene glycol and glycerol. The e-liquid is superheated by a battery-powered vaporizer, converting it into a mist which is inhaled, or “vaped.”

Studies about e-cigarettes and smoking behavior show conflicting results. Electronic cigarettes were mildly helpful in kicking the habit in one clinical trial. In other studies, e-cigarette use did not increase quit rates, or was even associated with a higher risk of continuing to smoke. One review concluded that real-world use of e-cigarettes is associated with lower quit rates.

The downside of e-cigarettes

Now the bad news. Nicotine in e-cigarettes may have several negative health effects. Chronic nicotine exposure may lead to insulin resistance and type 2 diabetes, although this risk may be offset by the well-known appetite suppressant effects of nicotine. Inhaled nicotine increases heart rate and blood pressure. Nicotine is highly addictive in its own right, and it may lead to changes in the brain that increase the risk of addiction to other drugs, especially in young people. Nicotine may also impair brain development in adolescents, leading to attention deficit disorder and poor impulse control. These potential harms of nicotine are particularly worrisome in view of soaring rates of e-cigarette use in U.S. teenagers.

The nicotine in e-liquid may also be a household hazard. Many e-liquids have candy and fruit flavoring and packaging that makes them attractive to children. Cases of nicotine poisoning from e-liquid have skyrocketed, with accidental ingestions of e-liquid by kids rising by more than 1,000%.

Flavored e-cigarettes may pose another health threat. They often contain a chemical compound called diacetyl, which is associated with a rare lung disease called bronchiolitis obliterans that causes permanent damage to the bronchioles (the tiniest airways in the lungs).

Propylene glycol and glycerol, the major components of e-liquids, are not thought to be dangerous on their own. However, they may decompose when heated by the vaporizer, and be transformed into toxic compounds such as formaldehyde. This is more common with newer vaporizers that use high wattages.

What you need to know about electronic cigarettes

  • For people who are currently addicted to cigarettes, e-cigarettes provide a less dangerous nicotine source, without exposure to tar or most of the poisonous gases in cigarette smoke. However, it is unclear whether e-cigarettes actually help significant numbers of people to quit smoking.
  • People who do not already smoke should avoid electronic cigarettes.. E-liquids contain nicotine, which increases the risk of high blood pressure and diabetes, as well as flavoring agents that may cause a chronic lung disease called bronchiolitis obliterans. High-wattage vaporizers may also generate significant amounts of formaldehyde and other toxins.
  • E-cigarette use is soaring in young people. This is of particular concern, as exposure of the developing brain to nicotine may impair brain development and predispose teenagers to addiction to other drugs.

Related Information: Harvard Men’s Health Watch


  1. Angelique

    I smoked anywhere from 1-2 packs a day for nearly 50 years. I quit tobacco over a weekend with my e-cig. I have not smoked a cigarette in over 5 years now and even smelling one someone else is smoking doesn’t interest me. And there is still 3/4 of a carton sitting in the back of my fridge. My health is better and my doctor is pleased. I am still working part time, doing my own yard work (on 2 acres), and generally have a busy and active life – at 71 years young. E-cigs are a boon and without them I would no doubt still be smoking tobacco (I really enjoyed them until I got my first e-cig.)

  2. A Wilson

    Dealing with an addiction to cigarettes can be a case that is more mental and emotional than most people think it is. Like many other addictions, switching to e-cigarettes is just a sedative that is now being proven to not work as well as intended. Instead of replacing a cigarette with an electronic form of the device, the addicted individual should seek counseling to resolve the issues of why this person started to smoke, why they continued to smoke and why they cannot kick the habit. Harbor Village Detox offers great counseling sessions to help decide how to help people get rid of their addiction.

    • JohnW

      I smoked a pack a day for over 30 years. I started vaping on 9/11/2014 and by 9/25/14 I had quit smoking completely. The patches, gums, hypnosis, … didn’t work for me. My friend who also smoked about as much as I did had a heart attack and his doctor told him to quit smoking or die. He started vaping and it let him quit too. I started with a high nicotine vape (24mg) and as my equipment got better and my lungs started to feel better, I have dropped down to either a 3 or 6 mg vape. Coming up on 2 years cigarette free and it was easy to do. My lungs feel better, I sleep better, food and drinks taste better. I don’t believe that I would have been able to quit by just going to a detox facility. But having the choice of different flavors, something to do with the hands, and satisfying the oral fixation let me quit easily.

  3. ke1255

    “E-cigarette use is soaring in young people” – it’s really not if you look at recent surveys. Prevalence in young people is, and has remained, low and is constrained mainly to those already smoking / ex-smokers.

  4. Carol Thompson

    Those phony “480,000” deaths are the product of deliberate scientific fraud. Anti-smokers falsely blame smoking for heart disease and COPD that’s really caused by cytomegalovirus, and they ignore or use crappy studies that miss most cases to falsely blame smoking for cancers that are really caused by infection. And HARVARD IS THE MOTHER SHIP OF THIS CHARLATANISM, because Harvard is filthy rich and corrupt and controls all the politicians.

  5. J.C.

    The Royal College of Physicians is a British professional body dedicated to improving the practice of medicine. Founded in 1518, it set the first international standard in the classification of diseases. To this day, it remains the most respected medical group in the world. The RCP was the first group to identify tobacco as harmful in the 1962. It took the U.S. seven years to come to the same conclusion. When the world’s most prestigious group of doctors, representing more than 32,000 physicians worldwide, states that electronic cigarettes are orders of magnitude less harmful than cigarettes, then that’s it. The debate is over. Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including nearly 42,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day. Finally there is a technology that can end the scourge of tobacco on public health. Enough is enough. There is no debate. Stop the lies.

    • Carol Thompson

      You stop the lies. The anti-smokers commit flagrant scientific fraud by falsely blaming smoking for diseases that are really caused by infections. Smokers are more likely to have been exposed to those infections, for socioeconomic reasons, so their bogus studies based on lifestyle questionnaires are cynically designed to cast false blame. Every Surgeon General report is proof of this fraud.

  6. Cathy Ball

    Both cigarette smoke and e-cig vapour harm my breathing if I am anywhere near. It is difficult to keep crossing the road/missing buses/walking out of non smoking areas to avoid smoke and vappur and then having to attend A&E as has happened on several occasions. If you dont care about your own lungs thats sick but my lungs matter to me.

  7. C. B. Dion

    Can’t you people ever tell the truth about ecigs when you post these ridiculous stories? All this does is serve to keep the public misinformed about nicotine and the alleged harms from it and ecigs. If nicotine is so damaging to adults and especially children then why are the FDA touted NRT’S made to be given to those 12 yrs old and up? All the studies you claimed showed harms were long ago discredited and debunked.
    I wonder if you could do your job if you had to have absolute transparency and ethics?
    C. B.

  8. Matri Harmony

    Nice blog. I will bookmark this page for future reference. Thank you so much for this wonderful article.

  9. R.C.

    I’ll be 24 months smoke/nicotine free August 1st. E-Cigs solved the Pavlovian response to smoking for thirty five years. I did use nicotine for the first sixty days after that I just did not need it.

    Age restrict access to nicotine. Temperature Control your Mod and don’t use Diacetyl in your E-Juice. Simple straight forward solutions!

    After that get out of the way. Yes there will be a loss of tax revenue. The Health Care Savings will offset the lost tax revenue TEN FOLD.

    Regretfully “Professional Politicians” have sold their souls to special interest (IE: Big Tobacco, Big Pharma). They are loath to give up revenue and will try to crush the E-Cig industry.

    You should plan accordingly!

  10. wakas

    Electronic Cigarettes or E-Cigarettes are equally harmful to me. even though people recommend it to quit regular smoking but still it’s dangerous.

  11. Charlie in Michigan

    Medicine is not science. Doctors are not scientists. I’m not a doctor or a scientist but I think I have a better grasp of the issues than you do. Vaping is lower risk than smoking, probably a lot lower. There’s no such thing as zero risk.

    We’re supposed to be so worried about the kids. I was a kid once. As it happens that’s when I started smoking, 50 years ago. I wish ecigs had been around back then. So called pubic health can’t keep kids away from tobacco but they are determined to keep them away from vaping? Why?

    The day I started vaping 20 months ago my daily cigs went from 25 to 5 with no effort. It wasn’t science or medicine. It must have been magic? 6 weeks later I stopped smoking. Since then I’ve smoked a couple of cigarettes to prove to some friends who still smoke that I’m immune to relapse. They tasted terrible, I didn’t want another, but it demonstrated the reward for making the effort. No relapse, ever. That’s huge. Medicine nor science can offer that.

    Most cigarette revenue goes for taxes. It’s a government business and substantially funds so-called public health. Governments have a conflict of interest. They need to shut up and butt out. Smokers and former smokers will end the Tobacco Age if the rest of you just get the hell out of the way.

    • Clancy

      Very similar to my experience. My health improved dramatically and after more than two years, I have no urge to go back to cigs. Still vase my own liquid which is 95% glycerin and the remainder glycerin with nicotine.

  12. joseph

    E cigarettes contain at least 100 times less diacetyl than normal cigarettes.

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