Earlier this week, the World Health Organization (WHO) has issued a statement claiming “there is no doubt” that e-cigarettes “are harmful to health and are not safe”. This sentiment is shared by the U.S. Centers for Disease Control and Prevention (CDC). In the UK, however, British public health officials have taken the opposite stance, accusing the WHO of spreading “blatant misinformation.”

The lesser of two evils

The WHO and CDC statements come during a time when the United States has gone through a vaping-related lung injury epidemic, which has killed at least 39 people and sickened more than 2,000 others. The culprit seems to have been Vitamin E acetate found in sham e-cigarettes.

Vitamin E is safe to ingest as a vitamin pill or as a lotion, but inhaling it can be harmful. However, because it is so cheap and available, it is often used on the black market of vape cartridge as a thickener in vaping fluid — which was killing and injuring consumers, the CDC believes.

But even with this lung epidemic out of the way, the WHO and CDC are still very skeptical of e-cigarettes. In the opinion of researchers from the two organizations, there are still many hazards and unknown potential long-term effects associated with vaping nicotine. The safest course of action is to simply stay away from them.

E-cigarette devices allow you to inhale nicotine in a vapor form rather than smoke. In a document released on Monday, the WHO claimed that “there is not enough evidence to support the use of these products for smoking cessation.”

In response to the deaths pinned to vaping by the CDC, many US governors suspended or banned the sale of vaping products in their states. These states also experienced a surge in tobacco cigarette sales, seen by some as evidence that legal e-cigarettes like Breazy help people stay away from tobacco.

Meanwhile, in the UK, public health officials have been very critical of the WHO report.

 “The WHO has a history of anti-vaping activism that is damaging their reputation. This document is particularly malign,” Peter Hajek, who directs the Tobacco Dependence Research Unit at Queen Mary University of London, wrote in a statement released today by the U.K. Science Media Centre.

“There is no evidence that vaping is ‘highly addictive,’” he said. “Less than 1% of non-smokers become regular vapers. Vaping does not lead young people to smoking—smoking among young people is at [an] all-time low. … There is clear evidence that e-cigarettes help smokers quit,” Hajek continued.

In the UK, the NHS issued a 2019 report concluding that e-cigs are 95% less harmful than regular cigarettes. This report has since been publicly challenged by a study led by Thomas Eissenberg, who is a psychologist at Virginia Commonwealth University. Eissenberg and colleagues referenced a study of teenage and young adult e-cigarette users which found that 23% of them later started to smoke tobacco products, compared to 7% who had not used e-cigarettes.

Another study performed by researchers at the University of Kansas School of Medicine-Wichita found that e-cig users were 56% more likely to have a heart attack and 30% more likely to have a stroke, compared to non-e-cigarette users. Vapers were also more likely to suffer from mental health issues, being twice as likely to suffer from depression, anxiety, and mood swings.

The mounting evidence suggests that e-cigarettes are definitely not harmless and their use poses certain health risks. But are they worse than tobacco? That’s highly unlikely and perhaps this is the direction that the debate is heading.

This classic story of the “lesser of two evils” won’t likely get a resolution any time soon. And, although it sounds like there’s a lot of confusion on the topic, even among public health experts, evidence-based medicine will no doubt prevail in the end.