American public health experts, led by the Centers for Disease Control and Prevention, have long been suspicious of e-cigarettes. The possible risks of vaping are vast, officials warn, including the potential to open a dangerous new door to addiction for youth. Scientists will not know the full effect for years, so for now, they caution, be wary.
But mounting evidence suggests vaping is far less dangerous than smoking, a fact that is rarely pointed out to the American public. Britain, a country with about the same share of smokers, has come to the opposite conclusion from the United States. This year, a prestigious doctors’ organization told the public that e-cigarettes were 95 percent less harmful than cigarettes. British health officials are encouraging smokers to switch.
The American approach “is the same as asking, ‘What are the relative risks of jumping out a fourth story window versus taking the stairs?’” said David Sweanor, a lawyer with the Center for Health Law, Policy and Ethics at the University of Ottawa. “These guys are saying: ‘Look, these stairs, people could slip, they could get mugged. We just don’t know yet.’”
E-cigarettes are much less harmful because they do not have the deadly tar found in regular cigarettes. They instead provide the nicotine fix smokers crave through a liquid that is heated into vapor and inhaled. There is no long-term data yet, but evidence does not show the vapor to be particularly harmful in the short term.
That e-cigarettes are less harmful is a message American smokers rarely hear, partly because American regulation prevents it. Companies are banned from making such claims unless they go through a long process to prove it, and so far, no e-cigarette maker has done so. More states are also passing laws that lump e-cigarettes in with traditional cigarettes, levying taxes on them and banning their use as part of local smoke-free rules.
“When they are regulated just like tobacco, people draw the conclusion that they are just as dangerous,” said Daniel I. Wikler, an ethicist at the Harvard School of Public Health. “You didn’t say it, but you didn’t have to. People make that assumption and you don’t try to disabuse them of it.”
Last week, Georgia State University published a report finding that the percentage of Americans who thought e-cigarettes were as bad as cigarettes or worse than them had tripled, to 40 percent in 2015 from 13 percent in 2012.
If smokers have tried everything else, and use an e-cigarette to quit completely, “that’s a good thing,” said Dr. Thomas R. Frieden, the director of the C.D.C. He has heard anecdotes about that happening, he added.
“But the plural of anecdote is not data,” he said. “And counterbalancing that good trend, there are at least three negative things that might be happening,” like people who have never smoked using them, children picking them up as a path to smoking, or smokers using them to perpetuate their habit.
But smoking has been declining. The 2015 adult smoking rate dropped by more than 10 percent from the previous year, the biggest decline since the government began tracking the measure in 1965, said Kenneth E. Warner, a professor of public health at the University of Michigan, citing the government’s National Health Interview Survey. Past dips have always been linked to some event, he said, like a tax. But there was no single event to explain this one, and some suspect e-cigarettes may have played a role.
Terry F. Pechacek, a professor of public health at Georgia State University, estimated that in 2015, more than four million Americans reported that e-cigarettes had helped them quit smoking over the past five years, up from about 2.4 million in 2014.
Youth cigarette smoking has gone down, too — by about half since 2007, around the time e-cigarettes started to be sold in the United States. In fact, youth smoking had its biggest-ever drop in 2015, Professor Warner said, citing Monitoring the Future, a federally funded survey. The rate is now 7 percent, a historical low. (Dr. Frieden noted that hookah use had been rising, as had the share of young people using e-cigarettes.)
Science is filling in the blanks, said Dr. Thomas Glynn, a consulting professor at Stanford University and the former director of cancer science and trends at the American Cancer Society. “We’ve been wringing our hands for years, saying we don’t have enough research, but we’re getting to the point where we can’t say that anymore,” he said.
British policy makers say that they were also skeptical of the devices at first, but that they have become more convinced of their benefit as data has accumulated. Rates of successful quitting are up. The smoking rate is down. Surveys by Action on Smoking and Health, a British antismoking group, have found that half of Britain’s 2.8 million e-cigarette users no longer smoke real cigarettes. Among people who are trying to quit smoking, e-cigarette users are 60 percent more likely to succeed than those who use over-the-counter nicotine therapies like gum and patches, a British study found.
Americans tend to value abstinence above all else, an all-or-nothing approach that British advocates see as rooted in the United States’ Puritan culture, said Deborah Arnott, the chief executive of Action on Smoking and Health.
“It’s a bit fundamentalist in the U.S.,” Ms. Arnott said, adding that the intense focus on children missed the potential utility of e-cigarettes for current smokers, often some of the poorest and least educated members of society. “What about the smokers? What about the people who are dying now as a result of this habit?”
Dr. Glynn said the American approach was well meaning, and had in the past achieved spectacular success. But it comes with a deep suspicion of the tobacco industry that goes back decades, he added.
“We know there’s a big, bad tobacco industry, and that’s the enemy,” he said. “But e-cigarettes do not fit that narrative. We are fighting a 2016 insurgency with nuclear weapons from the 1980s.”
Some researchers think they cannot speak openly, and in many organizations, “advocacy is leading the charge, as opposed to science,” Dr. Glynn said. “Public health is suffering as a result.”
Professor Wikler said, “You want to be married to the science, but in this case, I think there’s been a kind of unmooring, and that’s a somewhat dangerous game.”