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An e-cigarette

An e-cigarette

Five years ago you’d probably never heard of electronic cigarettes, or e-cigarettes. Now it seems you can’t open a newspaper – or go into a newsagent, supermarket or pharmacist – without seeing them advertised or on sale.

For smokers concerned about the toxic cocktail of cancer-causing substances in tobacco smoke, e-cigarettes – sometimes touted as a safer alternative to smoking – might initially sound like a Holy Grail. We’re determined to reduce the number of smoking-related cancers. If e-cigarettes can help reduce this toll, it’s crucial to public health that this avenue is properly explored to fully understand the benefits and risks of these devices.

There are widely differing responses to the replication of the act of smoking offered by e-cigarettes use, known as vaping. Some people see a unique opportunity to promote a mass switch to vaping that would avoid the massive health toll of smoking tobacco on the 1 in 5 adults smoking in the UK today. Others see e-cigarette as posing a great risk that would keep people too close to their cigarette habit, making a lapse back to smoking more likely.

Currently e-cigarettes are not regulated in the way that approved nicotine replacement therapies (NRT) such as patches and gum are. This means they haven’t undergone all the rigorous tests needed to ensure their safety and effectiveness.

We want to see ‘light touch’ regulation brought in, to ensure the products contents and delivery is monitored and consistent, they are not sold to under 18’s and that their marketing does not promote smoking itself.

The increasing popularity of e-cigarettes makes it crucial to answer questions about their impact – not just on the health of smokers who use them, but on non-smokers, ex-smokers, children and society as a whole.

That’s why we commissioned researchers at the University of Stirling to identify the unanswered questions and concerns around e-cigarettes, and look at the broader issue of tobacco ‘harm reduction’ – measures to reduce illness and death caused by tobacco use.

We’ve just published their report (pdf), and a summary has been published in the journal Tobacco Control). In this post, we’ll look in more detail at the questions and issues it raises.

What are e-cigarettes?

E-cigarettes look like real cigarettes and usually consist of a battery, a cartridge containing nicotine (the addictive ingredient in tobacco), a solution of propylene glycol or glycerine mixed with water, and an atomiser (a device that turns the nicotine solution into a fine mist or vapour).

When someone inhales on the e-cigarette the nicotine solution is heated and evaporates. Research shows the e-cigarette user inhales a ‘hit’ of nicotine as they would when inhaling smoke from a cigarette (although other research has questioned how effective some e-cigarettes are at nicotine delivery).

Cartridges are available in different concentrations of nicotine, and in various flavours such as apple, chocolate, coffee and mint. Most e-cigarettes have an LED at the tip which lights up when someone inhales, in a similar way to the lit tip of a cigarette.

Are they really ‘safer than cigarettes’?

While it’s the highly addictive nicotine that keeps smokers hooked, it’s the toxic cocktail of chemicals in tobacco smoke that kills half of all long-term users. Traditional tobacco cigarettes contain around 4000 different chemicals, including toxins like arsenic and radioactive polonium-210. Tobacco smoke has long been recognised as a carcinogen responsible for more than one in four UK cancer deaths, and the biggest single cause of cancer in the world.

The lack of tobacco in e-cigarettes means they are almost certainly much safer way of getting a nicotine hit than smoking cigarettes.

But there are still some questions about the safety of the chemicals that are in e-cigarettes, and the current lack of regulation means there’s no way of verifying what’s actually in them, especially with so many different companies now entering the market.

For example, we know little about the safety of the propylene glycol in many e-cigarettes. And nicotine itself can be toxic in very high doses. So there are questions about the safety of leakage from cartridges and refill bottles.

Research has found that some e-cigarettes contain chemicals other than nicotine and propylene glycol or glycerin. Tests on some e-cigarettes have found small amounts of nitrosamines, formaldehyde (both cancer-causing chemicals), acetaldehyde and acrolein (toxins) in the vapour or liquid. These are all chemicals found in tobacco smoke, at far higher levels.

Given reports of malfunctions, we‘d like to see these products regulated to help ensure that the mechanical components in the device are safe and reliable, and deliver consistent doses of controlled chemical contents.

Who uses e-cigarettes and why?

E-cigarette manufacturers aren’t yet allowed to market their products as quitting aids, as they haven’t been through the strict tests needed to see how effective they are.

Some research suggests that smokers are already using them to help give up and we want to see much more research to be sure if e-cigarettes could be useful in helping smokers quit (or cut down) smoking.

So we need to know more about how people use e-cigarettes, and why. For example:

  • How many people are using them to cut down their cigarette consumption, or to try to quit entirely?
  • Are people using e-cigarettes in combination with smoking, for example to ‘get round’ smoke free laws?
  • If so, what impact does such ‘dual use’ mean for their future attempts to quit? Are they more or less likely?
  • Are smokers who may have otherwise successfully conquered their nicotine addiction more likely to stay on e-cigarettes (and thus addicted to nicotine) long term, if they start using them?

More research to answer such questions is needed to understand the long-term impacts of using e-cigarettes.

Effects on tobacco smoking?

One of the effects of decades of legislation against tobacco is to make smoking less socially acceptable, as more people are aware of the health risks and it has become more difficult to smoke in public. But the UK’s smoke free legislation doesn’t cover e-cigarettes. So we also need to consider whether using e-cigarettes in places where tobacco smoking is now banned might make smoking more acceptable again.

Likewise, e-cigarettes aren’t covered by the UK’s ban on tobacco advertising. So e-cigarettes are marketed all over the place, and even promoted by celebrities and at celebrity events – techniques barred to the tobacco industry since 2003. It’s important to look at whether e-cigarettes could serve as a ‘gateway’ to smoking traditional cigarettes – by ex-smokers, non-smokers and, most importantly, children.

More than 200,000 under 16s start smoking in the UK every year, so protecting children from the dangers of smoking is a top priority for us. We need to find out more about whether e-cigarettes are attractive to children (particularly given the appealing flavourings and heavy advertising involving celebrities), and whether this will affect the number of children who subsequently take up smoking.

Tobacco industry involvement

Over the last few years, the tobacco industry has become heavily involved in selling e-cigarettes – a move that is seen by some as an ‘insurance policy’ against future potential losses in cigarette sales. This raises many issues around conflicts of interest and the role, if any, of the tobacco industry in public health.

The World Health Organisation’s Framework Convention on Tobacco Control (FCTC) is a global public health treaty set up to provide a united response to the tobacco epidemic. Part of the FCTC aims to prevent tobacco industry interference and there are concerns this will be weakened by the industry’s entry into the e-cigarette market and that this may simply be another tactic to keep profits high.

Next steps

Today’s report by Stirling University will help guide future research and ultimately answer questions about potential benefits and harms of e-cigarettes. A comprehensive report by the French Office for Smoking Prevention (OFT) has also just been published (pdf), which recommends a strict approach to marketing among other proposals.

In 2010, the Medicines and Healthcare Products Regulatory Agency (MHRA), which regulates all medicines and medical devices in the UK, asked for feedback on how to regulate new nicotine-containing products (including e-cigarettes).

We told them (response 1015 in this pdf) that we think such regulation will help address questions around the safety and effectiveness of e-cigarettes. The MHRA response to this consultation is expected imminently, along with results of the research they undertook to inform their decision.

Similarly, the National Institute for Health and Care Excellence (NICE) is due to publish new guidelines on tobacco harm reduction approaches to smoking, which may have implications for e-cigarettes. (Update: these guidelines are now published and do not include e-cigarettes.)

Quitting smoking is still the single most important thing smokers can do to for their health. We hope that the NICE guidance and the upcoming MHRA announcement will help provide smokers with the information and advice that they need to achieve this. And Cancer Research UK looks forward to working with others to deliver the research needed to inform the development of effective policies to support them.

11/06/13: this post was updated in response to the publication of NICE guidelines on tobacco harm reduction

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Comments

Rose Anderson November 24, 2013

I smoked for 40 years and tried inhalors, and patches in an attempt to give smoking up. They did not work for me. Pure desperation, drove me to try vaping 9 weeks ago. I have’nt had the urge to smoke since. My smokers cough and chestiness disappeared in a matter of days. My sense of smell and taste has improved dramatically and I can walk up the hill to my home, without stopping to catch my breath. I feel fitter than I have felt for years and vaping has saved my life. I have gradually lowered the nicotine strenght I’m using and intend to wean myself down to zero nicotine, then hopefully I can give up vaping, before our government tax it beyond my budget, as they are bound to do eventually. I will never go back to smoking as I’m enjoying being healthy for the first time, in a long time. I’m a 60 year old woman who is grateful that vaping has allowed me to get that cigarette monkey off ny back, when other methods failed. If vaping is banned, then many smokers who want to quit, won’t because something that does work, has been taken away from them. Smoking is a legal proven killer, the goverment should be banning them, but they won,t, because they want the huge taxes they pull in from tobacco products. Hippocrites, pure and simole.

troy McGinley November 12, 2013

I ve been a smoker for almost 20 years. Ecig helped me quit. I was able to ween myself off tobacco with the ability to select the nicotine doses . Now I just vape.. I m Nicotine free .
I ve tried to quit smoking many times. Nothing worked. Quiting with Ecig was very easy.

Alan Beard November 9, 2013

Positive news stories and research studies are now quite a common occurrence (although lots of negative press also), what has been absent though has been Parliamentary debate at Westminster . This may be about to change as a number of MP are raising the subject eg Dr Sarah Wollaston in the Plain Packaging debate on 7/9/13 her position is highlighted in this excellent blog http://t.co/OSA0o3qsnZ .CR_UK we have repeatedly asked you to re-examine your position , are you going to attempt to lead or just merely follow ?
I am afraid goodwill towards your organisation has either disappeared or is severely compromised by your illogical stance on e-cigs

Chris Knight November 4, 2013

OK, just read all the posts here and heres my humble and knowledgeable opinion.

I am 71 and started smoking when i was 8 years old. Thats 63 years i have smoked. And yes i am still alive.

One month ago, i tried a e cigarette whilst i was buying my twice weekly packet of 50 gramme rolling tobacco. I still have that packet, unopened and sat on my computer desk. I now only smoke e cigs and what a difference they have made to me. I still cough a little but only a fraction of what i used to. I breath much easier and my very eratic heart beat is rapidly stabalising to a modest 65 beats a minute.

My sense of taste and smell has improved dramatically and i sleep much better. I feel so much better all round and have become more active. AND I NO LONGER CRAVE FOR TOBACCO SMOKE.

Will i give up e cigs. Probably not, because after 63 years my body accepts nicotine. But i have given up smoking tobacco.

So folks, for me E cigs are the bees knees. Hey, the way i am starting to feel health wise now i may even receive the queens ( or kings) telegram in 29 years time.

Mike Waxman (@MikeWaxman1) November 3, 2013

I’ll try again….

I smoked from the age of 13. I am now 51. I have tried periodically over the years to give up, going cold turkey, using patches, hypnotherapy and prescribed zyban among other things. None have significantly worked.

I came across e-cigarettes during an discussion on an online forum in July 2012. Based on the independent, unrequested info, I searched and was surprised to find a huge market out there.

To cut a long story short, I bought a starter kit in August last year and, without putting myself under pressure to give up, started using it. Very quickly I smoked less ordinary cigarettes and in a matter of max 4 weeks, I found my 40-a-day habit cut to 3. In October of that year I smoked my last cigarette. I no longer liked the taste.

It is now just over 12 months since I had a cigarette. And it’s all thanks to an electronic cigarette. My partner who smoked the same, if not more, than me is exactly the same.

Both hardened smokers, I never for one second thought we would stop smoking. How wrong could I be.

We now no longer have night-time or morning coughing fits (there is no doubt it is healthier!), we don’t stink …and we have more money in our pockets.

If we could give up, anyone can. And anybody who tries to put a spoke in the wheels of this phenomenal invention can only have a hidden agenda. Shame on them!