Are e-cigarettes safer?

If you don't smoke, don't start. If you smoke, quit. If you don't quit, change.

That is the message of Philip Morris International (PMI), the company that brings cigarette brands such as L&M and Marlboro to TT. It has committed to eventually stop selling cigarettes and deliver a smoke-free future.

In addition to cigarettes, PMI produces smoke-free products including heated tobacco, e-cigarettes or vapes and nicotine pouches for oral use, namely the IQOS, Veev and ZYN brands respectively.

Speaking at PMI's Techovation media event in Neuchâtel, Switzerland on October 9, CEO of PMI Jacek Olcza admitted nicotine was addictive.

So the company markets its products exclusively to adult smokers and nicotine users.

Nicotine occurs naturally in the tobacco plant. When tobacco is burned, nicotine is transferred to the smoke.

According to Medical News Today's website, nicotine affects the central nervous, cardiovascular, respiratory, muscular and gastrointestinal systems. It causes bronchospasms, indigestion or heartburn, changes in blood flow, increased risk of blood clotting, changes in heart rhythm and rate, increased risk of conditions such as chronic obstructive pulmonary disease (COPD) and more.

It said nicotine can be toxic when ingested or absorbed and a lethal dose depends on a person’s weight and overall health. Therefore, it's important not to use modified vaping devices or black-market modified e-liquids.

But, Olczak stressed, research showed nicotine did not cause cancer: it was other substances in cigarettes that, when burned, caused the disease.

No country in the world, he said, had banned cigarettes, even though there were years of research saying they were harmful. And while people debated whether or not to use cigarette alternatives, nine out of ten smokers do not stop.

He said we lived in a society that continuously denied innovation instead of looking at the positives. He compared it to when seatbelts were created for the everyday vehicle and people said they would promote faster driving.

More research was always necessary, he admitted, but a lot wasavailable today. He asked who would take responsibility for the lives lost if people wasted another ten or 20 years ignoring the research and the benefits.

He and PMI believed nicotine alternatives were a much better choice, which was why PMI was putting millions of dollars into researching and developing its smoke-free products.

Smoking vs vaping; comparing the risks

The Mayo Clinic website says tobacco smoke contained over 60 known cancer-causing chemicals and thousands of other harmful substances.

It causes lung cancer, several lung diseases and made asthma worse. It increases the risk of other types of cancer including mouth, throat, bladder, pancreas, kidney and cervical cancers, as well as some types of leukaemia.

It also causes heart and circulatory system problems and increases the risks of diabetes, eye problems, complications during pregnancy, respiratory infections such as colds, the flu and bronchitis, and tooth and gum disease.

And those who frequently inhale secondhand smoke have a higher risk of lung cancer and heart disease, worsening asthma, ear infections and colds.

According to the American Lung Association, e-cigarettes produce a number of dangerous chemicals including acetaldehyde, formaldehyde and acrolein – a herbicide used to kill weeds. They may also cause lung disease, cardiovascular (heart) disease, chronic obstructive pulmonary disease, asthma and lung cancer.

“In 2016, the US Surgeon General concluded that secondhand emissions contain, ‘nicotine; ultrafine particles; flavourings such as diacetyl, a chemical linked to serious lung disease; volatile organic compounds such as benzene, which is found in car exhaust; and heavy metals, such as nickel, tin, and lead.’”

On the Johns Hopkins Medicine website, lung cancer surgeon Stephen Broderick is quotes as saying vaping was associated with several lung diseases but not cancer, yet.

“Cancer is definitely a concern, given that vaping introduces a host of chemicals into the lungs. But vaping products haven’t been around long enough for us to learn whether or not they cause cancer.”

Philip Morris findings

PMI’s research into smoke-free products began over a decade ago.

In its May 2024 scientific booklet See the Science for Yourself, it said experts, including the US Surgeon General and the UK Royal College of Physicians, agreed that while nicotine was addictive and not risk-free, it was not the primary cause of smoking-related diseases.

“Smoking-related diseases, such as COPD, CVD (cardiovascular disease) and lung cancer, are caused primarily by inhaling HPHCs (harmful and potentially harmful constituents) largely formed when tobacco is burned, not by nicotine alone.”

The company also used simulated residential conditions to measure 24 air quality markers in accordance with international guidelines to assess the quality of indoor air while using its tobacco-heating systems (THS).

“When using THS, the levels of 21 of these compounds did not increase beyond the levels already present as background in our dedicated indoor air quality room. Only the nicotine, acetaldehyde, and glycerin were measurably higher than the background, although well below the exposure limits established in air quality guidelines.”

According to the booklet, only a few of the compounds in THS aerosol exceeded the concentrations in cigarette smoke. Three of the compounds found to be significantly higher in THS aerosol were unique to THS aerosol. And four compounds were highlighted to be of potential toxicological concern.

The US Food and Drug Administration concludes, “Although some of the chemicals are genotoxic or cytotoxic, these chemicals are present in very low levels and potential effects are outweighed by the substantial decrease in the number and levels of HPHCs found in combusted cigarettes.”

Just don’t

Dr Maria Clapperton, director of the NCD Unit at the Ministry of Health, said the health risks of vaping were similar to those of regular cigarettes because they both had the same component – nicotine – which was addictive.

“That chemical is still present, so it continues to have persons hooked," she awarned, pointing out that it's known from past and current research into the habit of smoking, "There is no health benefit whatsoever related to cigarette smoking.

“This is why all healthcare professionals encourage members of the public to cease.”

She said in addition to providing the addictive nicotine, the act of vaping encourages the habit, so, although it was marketed as an alternative to help people quit smoking, it wasn't one.

And, she said, there were still many emissions from vaping that were harmful, which was why a lot of developed countries were banning vaping in public in addition to cigarettes.

She reiterated that smoking cigarettes increased risk of lung and throat cancer, damaged blood vessels and increased the risk of developing cardiovascular diseases leading to heart attack and stroke. It also increased the risk of developingblood clots in the legs and lungs.

Smoking by pregnant women could inhibit the proper development of a foetus and lead to babies with low birth weight. And it affected the brain development of babies and people under 25.

“A lot of the time, when you come to the doctor, as a screening question we ask, ‘Do you smoke? Yes or no?’ Because we are aware that the risk of cardiovascular diseases in somebody who smokes is significantly higher than that of somebody who does not.”

Clapperton added that diabetes, high blood pressure and elevated cholesterol levels were all risk factors for cardiovascular disease. Smoking in addition to those risk factors significantly increased the risk of heart attack and stroke.

She said it was the same with vaping.