A major medical group just threw its weight behind E-cigs

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E-cigs are helping people more than hurting them.

At least that's the conclusion of a new report released Thursday by the Royal College of Physicians, the medical organization that sets standards for UK doctors.

Their finding runs counter to what the vast majority of American policy makers have been saying for years, which is that there simply isn't have enough evidence to say for sure if the benefits of e-cigarettes outweigh their potential harms.

Some have suggested that the sticks, which can look a lot like regular cigarettes, will make smoking look cool again, citing full-page magazine spreads featuring polished celebrities like Jenny McCarthy, iridescent e-cig in hand.

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Others say the byproducts of the devices, which include particulate matter (tiny, often toxic particles that can irritate and inflame the lungs and may be linked to diseases like asthma, diabetes, heart disease and even cancer according to a paper from the American Heart Association), could be just as harmful as the disease-causing tobacco sticks they were intended to replace.

What the research says

These concerns mean very little, of course, if the research doesn't back them up. Here are the biggest research-supported problems with e-cigarettes:

• Formaldehyde: At lower voltages, e-cigs produce up to 800 times less formaldehyde (a substance that's been linked with cancer) than conventional cigarettes. (That's a good thing!) But, because early e-cig models didn't deliver the same powerful nicotine hit as conventional ones, some manufacturers figured out a way to allow users to ramp up the voltage and temperature on their e-cigs — giving them more nicotine with every puff. One study found that those higher temperatures can be dangerous, even producing the same levels of formaldehyde as traditional cigs.
• Particulate matter: The particles inhaled when you smoke an e-cig tend to be smaller than those in regular cigarettes (0.18-0.27 microns compared with 0.3-0.5 microns). Some studies suggest that this can be a problem, since the smaller they are, the deeper they may travel into the lungs.
• Trendy advertising: Many of the advertising campaigns e-cig companies were using when the devices came out creepily resembled traditional cigarette ads from the 1950s and 1960s, as the New York Times pointed out in 2013.
• Lack of strict regulation: E-cigarettes are a booming, multibillion-dollar market, but according to the Times, the FDA still has yet to publish final rules that would bring e-cigs under federal oversight. That means they're less regulated than traditional cigs, which could put vulnerable populations like kids at risk.

Reducing harm

The Royal College of Physicians set out to weigh these concerns against e-cigarettes' potential benefits with a focus on people who want to use e-cigarettes to quit. If regular British smokers were to swap their traditional cigarettes for electronic ones, they'd probably end up healthier, the group finds. This is based on a strategy known as "harm reduction," a set of principles first introduced as a theory in the 1980s in Britain.

Harm reduction acknowledges that the vast majority of people will probably engage in so-called "risky" behavior — things like doing drugs and having sex — at some point, and instead of trying to stop it from happening, we should enact policies that make it safer. If you've ever had a friend who agreed to not drink alcohol and be the "designated driver" to or from a party where other people were drinking, you've used the theory of harm reduction.

Some policies grounded in the principles of harm reduction have had huge successes: For example, the introduction of clean needle exchanges, which allow IV drug users to access sterile needles for free, in cities like Philadelphia were linked with a drastic reduction in HIV/AIDS rates.

In its report, the RCP says the same types of principles could be applied to tobacco. And in regular smokers, swapping e-cigarettes for traditional cigarettes would do more good than harm, they say.

"... current policy levers have proved more effective in preventing uptake of smoking than in helping established smokers to quit," they write in their report. "It is primarily for this reason that the RCP has advocated policies that encourage and enable smokers to switch to less harmful sources of nicotine."

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