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E-cigarette

Electronic cigarettes are to be regulated as medicines

It’s been an interesting few days for smokers intent on stopping their habit.

Last week saw welcome new guidance from the National Institute for Health and Care Excellence (NICE) – the first to recommend that licensed nicotine-containing products (NCPs) can be used to help people cut down on the amount they smoke (as well as to help them stop entirely).

Today the Medicines and Healthcare Products Regulatory Agency (MHRA) has made its long-awaited announcement of its intention to license NCPs such as e-cigarettes, which have – until now – fallen outside both medical regulation and NICE’s guidance for quitting and cutting down.

This is good news. We’ve wanted to see e-cigarettes come under “light touch” regulation for some time – as it could ensure their safety, quality and effectiveness, restrict marketing that risks cross-promoting tobacco smoking, and stop them being sold to under-18s.

So we think it’s a great idea to bring e-cigarettes within MHRA licensing.

The ideal solution?

One thing everyone interested in reducing the toll of tobacco can agree on is that e-cigarettes are a controversial issue. Our recent blog article on the topic covered some of the unanswered questions about e-cigarettes, and generated a lively discussion in the comments section.

In the article, we raised issues about the contents of e-cigarettes, their safety and their long-term use.

But it’s important to get the balance right: it would be wrong to give the impression that there are no risks at all – hence the call for light-touch regulation and monitoring. Yet it’s important to remember that using these products is almost certainly safer by far than smoking tobacco.

In the debate about e-cigarettes it’s not the product safety that’s most hotly disputed, but their potential impact on a smoker’s motivation to quit, and on the progress made so far in reducing the UK’s smoking rates.

Tobacco is by far the most important preventable cause of cancer in the world. Smoking accounts for one in four UK cancer deaths, and nearly a fifth of all cancer cases – including those caused by exposure to second-hand smoke.

The good news is that quitting smoking significantly reduces the chances of developing one of the fourteen cancers related to tobacco use. The sooner you quit the better, but it’s never too late. But nicotine is highly addictive and many attempts to quit smoking fail.

Some argue that e-cigarettes are a huge opportunity to wean smokers off a deadly product by offering a nicotine “hit” without them having to inhale tobacco smoke.

The argument goes that, in a free market, consumers will always choose a safer product over a more dangerous one – so the better e-cigarettes can replicate cigarettes, the more they will spur a mass move away from tobacco smoking with little need for further public health interventions.

This is after all what we all want – an end to the death and disease caused by smoking.

Fatal attraction

But as well as this promise, e-cigarettes have several potential theoretical downsides:

  • what makes e-cigarettes beautiful could also make them dangerous – their replication of the act of smoking could be too close to the ‘real thing’ to allow smokers to ever effectively escape their tobacco habits and potentially to revert back to smoking tobacco;
  • using e-cigarettes in smoke-free areas could potentially give smokers less motivation to quit smoking the rest of the time;
  • and their use in smoke-free places and in marketing images could have a knock on effect of ‘renormalising’ smoking, by confusing or contradicting the messages about the harms of smoking. This could undermine public health efforts to deter young people from taking up smoking.

At this stage we simply don’t have the necessary evidence to be able to say with any confidence which of these arguments – if any – is correct. But we have plenty of experience to warrant some caution.

A market flaw?

Sitting above these opportunities and risks is something we’re extremely wary of: the fact that the big tobacco companies are investing in NCPs.

For example Nicoventures – the company that owns one of the first of these types of products to be put forward for MHRA licensing – is owned by British American Tobacco, one of the four companies that control over 90 per cent of all global tobacco sales.

In a future post, we’ll be exploring the issues of conflicting interests that arise from this dual corporate ownership of cigarettes and their potential nemesis.

But for now, we’re remaining mindful of the first principles of internationally agreed public health guidelines: “there is a fundamental and irreconcilable conflict of interest between the tobacco industry’s interests and public health policy interest”.

Watch this space.

Alison Cox, Tobacco Control Lead

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Comments

Susan Brew November 30, 2013

There is NO evidence that e-cigs are proving attractive to young people who would not otherwise try tobacco cigarettes.
There is now substantial evidence that e-cigs are effective at helping long-term smokers to quit smoking.
There is NO evidence that e-cig users who have quit smoking are even tempted to revert to smoking – let alone that any have done so.
Yes there should be regulation to prevent young people buying e-cigs, but there is substantial evidence to show that any regulation that goes further than that will damage the progress made by the e-cig industry.
Further regulation is not necessary, as the trading standards act and other consumer protection legislation already in place will be sufficient to ensure that e-cig construction, as well as cartomiser and e-liquid contents are as stated on the packaging. Nicotine may be a dangerous substance, but we don’t insist on further legislation for other dangerous substances such as bleach and alcohol. Warnings are already on all e-cig and e-liquid packaging.
Why is the tobacco industry investing in e-cigs? Because they can see the writing on the wall for tobacco. Already a 1% decrease in cigarette sales in the USA because of e-cigs. That is HUGE!!!
Stop opposing e-cigs and start getting behind them.
Please stop talking as though vaping were as bad as smoking – it is orders of magnitude less dangerous to both the user and the bystander.

Change photo randy cox November 29, 2013

Very nice blog. Its interesting to read. And my opinion, Electronic Cigarette is a good alternative choice for the smokers to quit off from their health defects.

brainyfurball November 13, 2013

I think I got my hopes up too soon with regard to ASH. Yes, they are acknowledging that young people are not being attracted to e cigs and yes they are hinting that e cigarettes are not a gateway to cigarette smoking – I am afraid that they are playing clever in that they recognise that the arguments being presented for medical and/or tobacco regulation are lost. So they say that the above are not happening, BUT, they now argue that we are unaware of the unseen dangers so e cigarettes must still be regulated.

Well, yes they must, but not under the banner of medicines and not as tobacco products. There is a need for regulation – e cigarette regulation. There is a precedent for this type of situation and that was with the advent of the motor car, where, in trying to regulate them, the powers that were, did so under horse and cart legislation.

RobbieW November 4, 2013

Will CRUK ever engage with users?

e-cigs could be greatest public health prize in a generation, why on earth do CRUK support a de facto ban.

The only logical reason is to support the profits of their major benefactors – shame on you CRUK, is there no one within CRUK with the moral courage to make a stand against this?

brainyfurball November 2, 2013

More good news. ASH have just said that, “Among children regular use of e-cigarettes is extremely rare. Children who
had heard of e-cigarettes were asked about their use and knowledge of them. What little use that is reported is confined almost entirely to children who currently smoke or used to smoke.”

And a great deal more. Has ASH realigned itself? Has the tide begun to turn?

http://www.ash.org.uk/files/documents/ASH_891.pdf

Robert Innes October 25, 2013

Thanks for the link Alan. I m copying your comment onto my fb page. Hope you don’t mind. Good point Brian.

Brian Nightingale October 14, 2013

When they bang on about, “think of the children”, what about the children of smokers. These parents could be vaping instead of smoking. Poorer parents who smoke, would have more money to spend on their children. It seems that CRUK and other anti-smoking groups and charities like to pick and choose which particular children they will think of.

Most of us have children and grandchildren, whether we’re smokers or vapers, we want what’s best for them. Should my grandchildren ever start smoking which I hope they don’t, I would hope that e cigs would be freely available to them so they could switch to a safer alternative. I’m sure any caring parent or grandparent would want that.

Alan Beard October 13, 2013

Recent smoking rate statistics have recently been updated to the end of September .

Shows a number of things
1 e-cigs useage in cessation attempts increasing at an ever faster rate (exponential)

2 Traditional NRT products reducing at about the same rate

3 E-Cigs now overtaken NRT overall in smoking cessation

see http://www.smokinginengland.info/latest-statistics/

People are choosing what they think is effective without any assistance from CRUK, NHS UKGovt Public Health .

change your standpoint CRUK

Alan Beard October 13, 2013

sorry bad link … its in Letters The Editor … 3 rd letter down entitled Better Than Tobacco

http://www.economist.com/news/letters/21587764-armenia-ecuador-e-cigarettes-azerbaijan-3d-printing-germany-machiavelli-bon-jovi

Alan Beard October 13, 2013

ASH and CRUK seem to believe this point of view as put forward by Ms Arnott (ASH) see http://www.economist.com/news/letters/21587764-armenia-ecuador-e-cigarettes-azerbaijan-3d-printing-germany-machiavelli-bon-jovi–(scroll down to 3rd letter)

This is a tissue of half truths and disinformation of which Ms Arnott has expertise

“Investment Analysts” believe costs will be” minor”- to whom? this simply reinforces that only big players will remain and only in a medicinal market SME would disappear. This would be a far simpler option for Govt to regulate BUT is it in the Public interest? , will it genuinely promote an increased move away from tobacco cigarettes ? The answer to both of these Q is a resounding NO

One area where I could agree with is for there to be a 2 tier Licensed and Non-Licensed approach . Licensed e-cigs could be promoted and advocated by NICE ,NHS etc this would benefit current smokers . However unlicensed ( but regulated) should remain for those who wish to continue their relatively harmless (to them or others ) activity .

Do the typical arguments about glamourising,re-normalising,encouraging children,gateway effects etc etc which have zero factual evidence disappear with medicinal approval ?

I really do wish that CR UK will revisit their position and use scientific not ideological argument over this

brainyfurball October 8, 2013

Just read this on Yahoo News:

Cancer Research UK said it is the toxic cocktail of chemicals in tobacco smoke that kills half of all long-term smokers.
The lack of tobacco in e-cigarettes means they are “almost certainly” a much safer way of getting a nicotine hit than smoking cigarettes.

Do you think the message has got through, or is it just egg dripping off their faces.

Thank you! Thank you everyone who has contributed here… Now a new battle begins against the tobacco companies.. And hopefully CRUK will be on our side this time.

John October 8, 2013

HOORAY ! Thanks Robert for the info.

Elaine Keller October 7, 2013

But I’ll bet you make an adorable and cuddly brainyfurball (at least in your daughter’s eyes.)