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Updated 08 October 2015

The fight for the right to smoke e-cigarettes

While the World Health Organization says legislation is needed until we fully understand the potential harm of e-cigarettes, researchers are saying we already know they are safer and legislation could do more harm than good.

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There still is huge excitement about e-cigarettes/electronic cigarettes or ENDS (electronic nicotine delivery systems) as a new smoking cessation tool.

According to the World Health Organization, global use of e-cigarettes is booming, with more than half of the world’s population living in countries where the devices are available.

Global sales of e-cigarettes reached $3 billion in 2013 and are expected to grow to $10 billion by 2017, the WHO projects.

The product delivers nicotine and other chemicals in a vaporised form to the lungs and the assumption is that, although the user remains addicted to nicotine, this is less damaging than inhaling tobacco smoke, which has known health risks.

This may well be so, but neither the safety of delivering nicotine to the lungs in this way, nor the efficacy of e-cigarettes in helping smokers quit, has been scientifically demonstrated.

Also, the amount of nicotine and other chemicals in e-cigarettes varies, and is not always fully disclosed by the manufacturers.

Benefits outweigh the risks, so far

However, two new studies from the King's College London's Institute of Psychiatry, Psychology and Neurosciences show that, while there is still no proof that e-cigarettes help people to stop smoking, they do show evidence that using e-cigarettes may help those who are trying to quit.

The first study, published in the journal Addiction, found that 65% of those who were using an e-cigarette daily tried to give up smoking within the year, compared to 44% of smokers who weren't using e-cigarettes.

They also reported that up to 14% of people who used an e-cigarette had reduced their tobacco consumption by at least half.

The second study, published in Nicotine and Tobacco Research found people who were trying to quit smoking did better when they used refillable tank models of e-cigarettes. These allowed them to change the nicotine content and flavours of the liquid in the tanks to suit their preference, thereby allowing for personal preferences.

These studies show that using an e-cigarette not only reduced the numbers of lethal cigarettes smoked, it also shows increased attempts to quit smoking.

What researchers do need to study is the toxicity of long-term inhalation of nicotine and the flavourings in the e-cigarettes. Not all e-cigarettes are made equal and many smokers desperate to quit, especially those in the developing countries, could opt for cheaper versions of e-cigarettes that have not undergone any safety trails by their manufacturers or their country's government health bodies.

The WHO maintains that while additional research is needed on multiple areas of e-cigarette use, regulations are required now to address health concerns, in particular for:

- Advertising: An appropriate government body must restrict e-cigarette advertising, promotion and sponsorship, to ensure that it does not target youth and non-smokers or people who do not currently use nicotine.

  • - Indoor use: legal steps should be taken to end use of e-cigarettes indoors in public and work places. Evidence suggests that exhaled e-cigarette aerosol increases the background air level of some toxicants, nicotine and particles.


    The body recommends that consumers rather use other reputable smoking cessation methods such as prescription medication and nicotine replacement therapy until e-cigarettes have been better studied.

  • Not so, say some researchers

  • In a statement regarding the WHO-commissioned report on e-cigarettes, posted on the King's College London website, Professor Peter Hajek, co-author from the Tobacco Dependence Research Unit at Queen Mary University of London, says:

    “There are currently two products competing for smokers’ custom. One, the conventional cigarette, endangers users and bystanders and recruits new customers from among non-smoking children who try it. The other, e-cigarette, is orders of magnitude safer, poses no risk to bystanders, and generates negligible rates of regular use among non-smoking children who try it.

    The WHO recommendations blur these differences and if followed, will cripple the competitiveness of e-cigarettes and help to maintain the market monopoly of conventional cigarettes.”

    They will inhibit innovation and put off smokers from using e-cigarettes, putting us in danger of foregoing the public health benefits these products could have.

    The article by McNeill and colleagues takes nine key statements in the WHO-commissioned review and provides an alternative conclusion and a commentary.

    Highlights include:

     -  The review implies that e-cigarette use in youth is a major problem and could be acting as a gateway to smoking when in fact current use by non-smokers is extremely rare and youth smoking rates are declining.

    - The review fails to acknowledge that e-cigarettes are not just less harmful than tobacco cigarettes but that the concentrations of toxins are mostly a tiny fraction of what is found in cigarette smoke

    - The review infers that bystanders can inhale significant levels of toxins from the vapour when the concentrations are too low to present a significant health risk

    - The review gives the impression that evidence suggests that e-cigarettes inhibit smoking cessation when the opposite is true

    Protect the developing world

    In August 2015 two researchers from the Stanford University School of Medicine co-authored of a commentary on e-cigarettes that was published in the August 2015 issue of the Journal of the American Medical Association where ing they cautioned against the marketing of e-cigarettes in developing countries where big tobacco could recruit new and never users into smoking.

    Researchers Dr Andrew Chang and Dr Michele Barry urge developing countries to exert greater regulatory control over d-cigarettes where exposure may exacerbate lung problems, such as tuberculosis or lower respiratory infections, two diseases that are highly prevalent in the developing world.

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