Ask the Doctor: E-cigarettes vs. Real Cigarettes

Carmen McIntyre
Dr. Carmen McIntyre

I received the question, “Are e-cigarettes healthier than real cigarettes?”

First, let me explain what e-cigarettes are. E-cigarettes are electronic devices that mimic cigarettes in appearance and function. They have a mouthpiece or cartridge that hold a liquid solution containing nicotine, which is heated up and vaporized by an atomizer. That vapor is inhaled into the lungs the same way one inhales cigarette smoke. The main difference is that there is no combustion, or burning, hence there is no smoke. Therefore there are no ashes nor butts to be discarded.

They have been around since about 2006, but they are an emerging public health concern, as they are rapidly gaining in popularity. Both current smokers as well as those who have never smoked are using e-cigarettes in increasing numbers. Their sales are set to outpace sales of cigarettes over the next decade. Most concerning is that their use is becoming widespread amongst teenagers. The cartridges are often flavored with sweet or fruity aromas that make them more attractive to children and teens.

According to the U.S. Food and Drug Administration (FDA), e-cigarettes have not been fully studied so consumers currently do not know the potential risks of e-cigarettes or benefits. Another concern is that they may lead young people to try other tobacco products, which cause disease and premature death.

The FDA can only regulate e-cigarettes that are marketed for therapeutic purposes, similar to nicotine replacement products like gums or patches. The FDA has proposed extending their Tobacco Products oversight to include e-cigarettes. The World Health Organization (WHO) has proposed banning them.

Are they safe? They do contain less nicotine than cigarettes, but the user controls how much vapor they inhale, and can mimic the nicotine intake of traditional cigarette smokers. Analysis of e-cigarette vapor has identified chemicals that could be toxic or cause cancer, such as formaldehyde, in the vapor, but at lower levels than cigarette smoke.

Since you don’t light them, they are not a fire risk. Interestingly, although there is no combustion with e-cigarettes, they do contain free radicals also found in cigarette smoke and air pollution, which can damage DNA or other parts of our cells. The Johns Hopkins University study that reported this finding also noted that e-cigarettes impaired the ability of mice to fight off infections as well. Again, as with other toxins, the levels of free radicals are much lower than in cigarette smoke.

Secondhand “smoke” from e-cigarettes, however, is worse than cigarette smoke in the level of harmful particles, according to one study. E-cigarette vapor contains toxic metals, including nickel at four times the level in cigarette smoke, and chromium, which is not even present in traditional cigarettes.

According to the Centers for Disease Control and Prevention (CDC), calls to poison centers in the U.S. related to e-cigarettes rose from 1 call per month in 2010 to 215 calls per month in 2014. Half of those calls related to ingestion of the cartridge liquids by children 5 years old and under. Since most e-cigarettes are not FDA-controlled, they are not required to be child-proof. Regulating manufacturing standards would also allow for control of the harmful metals, as well as limit access to children and teens.

So, are e-cigarettes “safe”? Probably not. Are they safer than traditional cigarettes? Probably. My best recommendation? Avoid cigarettes altogether. They are the number one cause of preventable disease and death. If you are already a smoker, work with a health professional to give them up. It’s never too late to improve your health and the health of those exposed to cigarette smoke and vapor.

Dr. Carmen McIntyre is the Chief Medical Officer at Detroit Wayne Mental Health Authority. If you have a question for Dr. McIntyre, please submit it to

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