Reducing harm
The complete transition from traditional cigarettes to tobacco heating systems has significantly affected health biomarkers
Daria Gubina, Naked Science
In 1798, the physician Benjamin Rush was one of the first to suggest that tobacco smoking could lead to "incurable diseases" and cancer. Doctors began to pay attention to this, and by the 1920s they had described a thousand cases of lung cancer. At the same time, inventors began to look for ways to reduce the risks from tobacco consumption.
In 1927, the American Joseph Robinson registered an electronic steam generating device, with which he offered to safely inhale steam with "medical compounds" and not get burned. The idea remained on paper, and the popularity of traditional smoking was gaining momentum.
In 1963, a patent for a "smokeless non-tobacco cigarette" from Herbert Gilbert appeared, but he also failed to interest manufacturers. Just in the 60s, ordinary people began to gradually notice that cigarettes are harmful to health. But the analogue of modern electronic cigarettes appeared only in 2003. It was developed by Chinese pharmacist Hong Lik. Since then, the popularity of electronic cigarettes has gradually grown.
Today, lung cancer is the second most common cancer in the world, and tobacco smoking is the main cause of its development (in 85% of cases). In Russia, lung cancer also ranks second in prevalence and first in mortality, annually claiming the lives of 27 thousand people.
Since 2009, the number of smokers in Russia has been gradually decreasing. According to VTsIOM, about a third of the population smokes in cities. Most of them smoke more than a pack a day, getting nicotine by traditional methods: from cigarettes, cigars, hand-rolled cigarettes, hookahs, etc. However, alternatives are rapidly gaining popularity. Electronic cigarettes came to Europe, the USA and Russia around 2007. At that time, there were no studies of the effect of these new products on the body, so health organizations and doctors did not understand how to control their turnover and what to advise people. Today, the global vape market is estimated at more than $ 18 billion.
The popularity of alternatives to traditional cigarettes is growing all over the world. With their help, many people successfully get rid of addiction. For those who are not ready or cannot completely give up tobacco, new systems allow reducing the amount of inhaled toxins. Fortunately, over the past twenty years, enough medical observations and scientific research have accumulated that already allow us to conclude that high—quality, proven alternatives reduce harm to health and help get rid of addiction.
Long-term research in real conditions
One of the ways to monitor the effects of smoking on the body is the control of exposure biomarkers (BoE) and potential harm (BoPH) associated with oxidative stress, cancer, diseases of the cardiovascular system and lungs.
In the UK, scientists decided to test how these biomarkers change over several months in smokers who quit smoking or completely switched to the glo tobacco heating system. According to some of the indicators, the transition to a heating system was comparable to a complete cessation of smoking. The results are published in a peer-reviewed medical publication The Journal of Internal and Emergency Medicine (Gale et al., Changes in biomarkers after 180 days of tobacco heating product use: a randomised trial).
The experiment involved adults aged 23 to 55 years who had been smoking for at least 5 years and at the time of the start of the study smoked 10-30 non-alcoholic (they are more addictive) cigarettes a day. They were all healthy. Participants who wished to continue smoking were randomly assigned to two groups: one group continued to smoke regular cigarettes, the second was given a glo system with a suitable supply of sticks. Those wishing to quit smoking were provided with the help of specialists and nicotine replacement therapy. As a control group, they recruited people who had never smoked, who only took tests.
A total of 332 people took part in the study, which lasted six months at the time of publication of these results: 59 continued to smoke, 127 switched to the glo system, 109 quit smoking and 37 controls. To monitor compliance with the requirements, participants were tested for the CEVal exposure biomarker, which indicates recent smoking of traditional cigarettes.
Note that in the group that switched to glo, the consumption of sticks was slightly higher than the consumption of traditional cigarettes (one stick is considered equivalent to one cigarette) before the experiment, and higher than in the group that continued to smoke cigarettes. But at the same time, it remained stable for all six months.
The results showed that the transition to the glo tobacco heating system led to a statistically significant change in biomarkers, some of which even approached the indicators of the quit smoking group.
The biomarker of systematic oxidative stress (8-Epi-PGF2a type III) significantly decreased and the number of leukocytes decreased (a large number indicates the presence of inflammation). At the same time, the indicator of lung and vascular health increased, as well as the level of HDL cholesterol increased, which indicates a decrease in the risk of cardiovascular diseases. The main thing is that the NNAL indicator, an indicator of lung cancer risk, decreased approximately twice (to 115.7 ng/day) in those who switched to glo. Of course, for those who completely quit smoking, it decreased even more — four times (to 59.09 ng/day) from the indicator of smokers (221.94 ng/day). But in order to reach the level of those who have never smoked, it would have to fall twenty times (to 11.54 ng/day).
Alternatives
Do not forget that there are different alternatives to traditional smoking, which vary greatly among themselves. Tobacco heating systems use tobacco. Electronic cigarettes, or vapes, use a special liquid that provides a thick vapor. Its basic composition contains glycerin or propylene glycol — compounds that are used in smoke generators. Studies have shown that they do not provoke an inflammatory reaction in the lungs, but cause dryness. Vaping liquid can be both with nicotine (in different concentrations) and without.
Nicotine has been proven to be addictive, but the main harm is caused not by it, but by other toxic compounds that are formed when tobacco burns — there are about six thousand of them. Gorenje Some scientists believe that these compounds significantly increase the risk of nicotine addiction.
In this regard, experts distinguish nicotine packs (also known as Modern Oral and as nicpacks) as a method of nicotine consumption that poses the least health risks. The reason for the interest is obvious: in their properties, nikpacks are similar to snus, which is traditionally used in Sweden. This country has the highest level of consumption of such smokeless tobacco per person, but at the same time the lowest mortality from tobacco and the lowest incidence of lung cancer and other "tobacco" diseases. At the moment, these products are prohibited for sale in Russia.
It is noted that even after a short and unsuccessful trial of nicpacks, smokers did not seek to return to smoking cigarettes, but were looking for less toxic alternatives to conventional cigarettes, for example, electronic cigarettes or tobacco heating systems. "The potential of this category is very high. We have lost an effective means for consumers to quit smoking. Therefore, it is worth reviewing the regulation and returning these products to the market," says Alexey Trofimov, Deputy Director for Science, N.M.Emanuel Institute of Biochemical Physics of the Russian Academy of Sciences (IBCF RAS).
Many studies of electronic cigarettes focus on experiments with liquid, although the vapor created should be studied. Studies have shown that vaping smoke contains dangerous compounds like formaldehyde and acetaldehyde, less than 1% of their content in cigarette smoke. Heavy metals were also found in the smoke from electronic cigarettes and tobacco heating systems, but in very small concentrations, often on the verge of being identified in samples. Their long-term effect on the body is unknown, so neither electronic cigarettes (with or without nicotine) nor tobacco heating systems can be considered absolutely safe.
And yet research shows that the devices mentioned above really help to get rid of addiction and reduce the harm caused to human health and those around him. Therefore, electronic cigarettes and tobacco heating systems require separate regulation and control.
Regulation
Controlling the composition of liquids and sticks for electronic tobacco heating systems will avoid the use of dangerous components, as happened in the United States (when a number of illegal manufacturers began mixing cannabis with vitamin E acetate, which is dangerous for inhalation). All ingredients must pass a toxicological safety check for internal use. Including nicotine, because not every nicotine is suitable for domestic consumption.
The Public Health Service of England has officially stated that "e-cigarettes are about 95% less harmful than regular smoking." And English doctors will soon be able to prescribe such nicotine products to those who want to quit smoking.
"The path of regulation is long, but it is more correct than banning the entire category," said Evgenia Gnuchikh, Deputy Director for Research and Innovation at the All—Russian Research Institute of Tobacco, Shag and Tobacco Products, at the First Eurasian Nicotine Forum.
Meanwhile, the issues of regulating alternatives and harm reduction are attracting more and more interest from experts and government agencies. They were the main topics at the First Eurasian Nicotine Forum held in Kazakhstan. Doctors, scientists, representatives of organizations, businesses and states from different countries gathered at the independent site. Together they discussed how to transfer the successful experience of implementing the concept of harm reduction from smoking in the territories of Russia, Kazakhstan, Armenia, Belarus and Kyrgyzstan.
Speaking at the Forum, doctor Alexey Alexandrov, chief narcologist-psychiatrist at the clinical center "Psychiatry-Narcology", identified four cornerstones on which the solution to the problem of substances that cause addiction rests: regulation, information, assistance to addicts and harm reduction. "People should be aware of the risks of nicotine consumption, and they should also be aware of alternative products and the risks associated with them. If we say that nicotine addiction is an addiction, a disease, then there must be support for people who want to give up tobacco consumption," he added.
Note that consumers of electronic cigarettes and tobacco heating systems should be exclusively people who smoke or have smoked traditional cigarettes and their analogues in the past.
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