While several heavyweight health organisations including the WHO feel that endorsing e-cigarettes is premature when not enough is known about their effects, some medical experts think the electronic devices are potential life-savers.
One such e-cigarette proponent is Dr Derek Yach, Executive Director of the Vitality Institute and one of the world's leading anti-tobacco advocates.
Speaking at a media lunch hosted by the Electronic-cigarette Association of South Africa (EASA) in Cape Town on 2 June 2015, Yach expressed the view that, given the undisputed ravages of tobacco use on human health, any potential negative impacts of e-cigarettes are likely to pale by comparison, and that doctors should be recommending them to patients as an important smoking cessation tool.
“My concern, when tobacco is claiming 6 million lives a year, is the consequence of not using e-cigarettes,” said Yach, who helped develop the WHO's Framework Convention on Tobacco Control.
Yach also cautioned against regulating the sale and use of e-cigarettes too strictly, for example only allowing the devices to be sold in pharmacies. South Africa may well soon see tighter control of e-cigarettes: Health Minister Aaron Motsoaledi has announced that he intends to include e-cigarettes within the remit of the Tobacco Products Control Amendment Act.
Separating nicotine and tar
Nicotine and tar tend to be linked in public perception (and in that of many doctors), said Yach, but it is important that they be distinguished from each other: while nicotine is the addictive substance in cigarettes, the tar they contain is that which is associated with tobacco's most serious health impacts.
E-cigarettes supply nicotine to the user in vapour form and are thus a form of nicotine replacement therapy (NRT), which also includes nicotine gum and patches. Unlike cigarettes, these products are purported to be much safer because they are free of tar.
“There's a growing group of medical experts who feel that, on balance, a product that takes out the tar must be better,” said Yach.
“Of these products, e-cigarettes are a good choice. Research shows that generally smokers trying to quit prefer their NRT in e-cigarette form. A recent large study also showed that e-cigarettes are probably as good or better than financial incentives for quitting smoking.”
Read: New generation e-cigarettes contain more cancer-causing formaldehyde than regular cigarettes
Legitimate concerns about e-cigarettes
Yach agreed that there are nonetheless legitimate concerns about e-cigarettes.
One of the major criticisms is that e-cigarettes are being overmarketed to youth, using flavouring and other ploys such as trendy pacakaging, which could entice young people to take up smoking too.
Yach asserted, however, that the evidence for e-cigarettes acting as a “gateway” to tobacco use is not very persuasive.
“As e-cigarette use is increasing in the US and UK, tobacco use continues to come down,” he said.
Health authorities are also concerned about e-cigarettes' safety: toxins including carcinogens have been found in the vapour, albeit at far lower levels than in cigarettes, and the liquid refills pose a nicotine poisoning risk to children. Some brands are not subject to sound quality control, and their chemical content is uncertain.
Yach reckons, however, that these issues can be effectively dealt with by applying normal consumer laws to e-cigarette products.
Read: Big tobacco pushes for more control over e-cigarettes
Nicotine carries risks too
Nicotine itself has known risks:  among other possible effects, it elevates heart rate and blood pressure, and, according to Professor Richard van Zyl-Smit of the University of Cape Town's Lung Institute, it may stimulate blood vessels that promote the growth of cancerous tumours.
Dr Yussuf Saloojee, Executive Director of the National Council Against Smoking (NCAS), who worked with Yach in the 1990s to help put South Africa’s progressive anti-tobacco policies in place, does not agree with the latter's view that doctors should be encouraged to recommend e-cigarettes to patients.
“The NCAS stance is that e-cigarettes have some potential but they aren't a panacea and they do carry risk. The evidence is still coming in and we can't endorse them yet, but so far the research on their effectiveness has been rather disappointing. If you do use e-cigarettes, make it exclusive use; in other words, don't use them while you continue smoking,” says Saloojee.
Read: Can nicotine actually be good for you?
Why should we listen to Dr Derek Yach?
Dr Derek Yach, who has focused his career on advancing global health, is Senior Vice President (SVP) of the Vitality Group, part of Discovery Ltd, where he leads the Vitality Institute. Previously he was SVP Global Health and Agriculture Policy at PepsiCo, headed global health at the Rockefeller Foundation, was a Professor of Global Health at Yale University, and is a former Executive Director for Noncommunicable Diseases and Mental Health of the World Health Organization (WHO). At WHO, he served as cabinet director under Director-General Gro Harlem Brundtland where he led the development of WHO’s Framework Convention on Tobacco Control and the Global Strategy on Diet and Physical Activity.
Dr Yach played a key role in the South Africa’s progressive anti-tobacco policies in the mid 1990s and led the development of the WHO’s framework convention on Tobacco Control, recently published an article in Spectator Magazine, titled ‘E-cigarettes save lives’
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Olivia Rose-Innes is Health24’s EnviroHealth Editor. Read more of her columns and articles or post a question to her expert forum.