E-cig vs. traditional cigarette: why omissions 'harm health'

The position expressed by the 'anti-cancer experts' of the National Medical Association, responding on the possible carcinogenicity of electronic cigarettes, has in fact revived alarmist theses regarding the alleged ability of such devices to cause cancer. In a country where traditional smoking causes tens of thousands of deaths every year, correct information on this issue is indispensable. Therefore, I feel it is my duty to balance a hitherto biased and methodologically flawed narrative.

The scaffolding of these theories rests on a well-known rhetorical device: the scientific community is credited with conferring an absolute 'safety title' on e-cigs, only to be artfully disproved. Yet no doctor can claim that vaping is harmless. Instead, the clinical paradigm of reference is harm reduction. There is ample evidence that those who are unable to quit smoking can reduce their risks by about 95 per cent by switching to e-cigs, as historically evidenced by the British agency Public Health England.

Instead, the alarm over alleged carcinogenicity relies on an Australian review that lacks the very basics of clinical epidemiology. Firstly, it does not analyse human data, but limits itself to monitoring cellular biomarkers and tests on mice subjected to high and unrealistic aerosol exposure scenarios. Furthermore, the authors ignore the basic principle of toxicology that 'it is the dose that makes the poison', presenting any suspected substance as carcinogenic even if present in minute and clinically irrelevant traces. Tobacco smoke releases thousands of chemical agents, at least 158 of which are known to be toxic or carcinogenic. As demonstrated by researchers at King's College London, in e-cig vapour these carcinogens are either totally absent or, if present, are mostly at levels of less than 1% compared to combusted smoke. Thus, the extensive literature demonstrating reduced exposure to carcinogens in smokers who switch to vaping is omitted.

Added to this methodological weakness is the unacceptable selection bias. Research of this type often examines former long-term traditional cigarette smokers, attributing the systemic damage observed to current e-cig use. In doing so, they omit decades of previous exposure to tar and the thousands of toxic substances in combusted smoke. The 'original sin' of pathological damage clearly lies in past combustion, not in the vapour.

To further shore up this shaky thesis, the bogeyman of the 'EVALI' crisis is even dusted off. This is an anachronistic instrumentalisation. The Centers for Disease Control and Prevention (CDC) in Atlanta definitively clarified that those lung lesions did not result from normal e-cig liquids, but from the vitamin E acetate used in illegal THC cartridges sold on the black market. To decontextualise this event is to distort the reality of the facts.