E-cigarettes and vaping: good thing or bad thing?

One of our most popular ever topics on Behind the Headlines (apart from advice on how to get Viagra without a prescription!) has been our coverage of e-cigarettes and vaping. See here: nhs.uk/news/2013/06june/pag...

We thought we'd provided a fairly straightforward analysis of the scant existing evidence, but it's received a lot of criticism from vapers and those in the pro-ecig camp.

Personally, if I was a regular smoker I think I'd be convinced to make the switch. What do you think - did we get it right? Is there any evidence that we missed or has emerged since?

And should a logical harm reduction strategy be the order of the day, or should the powers-that-be make darn sure they've got all the safety evidence and regulation they need before making recommendations?

53 Replies

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  • Okay, disclaimer first - I used to smoke up to 60 a day, but gave up 10 years ago before the public smoking ban kicked in (personally I wish the ban had come in 30 years ago - I might have better lungs now.)

    I have a problem with e-cigarettes, but it is not so much about any potential health issues as such or whether they actually help in giving up smoking, but more about how they are being marketed and what that implies to their future.

    I have spent most of my working life in the media producing sound, music, and other audio orientated projects mostly for the advertising industry. This includes making commercials for Rothmans - though I now wish I hadn't.

    The early days of cigarette advertising, mostly aimed at men, was based around the idea that smoking made you look cool, was something that was aspirational, made you sexier to women and generally made you more of a man.

    In the UK, this direction in cigarette advertising was more or less kicked out by the time I started work in the late seventies. The danger of smoking had already been established, as had the lies of the cigarette companies.

    In the 1990s, Rothmans came to our studios to make radio commercials for Africa. They took exactly the same direction as those earlier ads. Their main product was called London Cigarettes, named as such because in parts of Africa London was seen as a really cool place, the place you really wanted to be when you became rich and successful. "Light up a London" was the tag. Looking back, it is pretty horrific to think that 20 years after that sort of advertising was banned in Europe and the US, the cigarette companies should export it to Africa.

    The other day I saw a Television advert for one of the brands of e-cigarettes (sorry, I do not remember which one.)

    The ad took exactly this same approach yet again. It was not about giving up, or being a healthier alternative, it was about looking cool and being trend setting.

    If that is the way the e-cigarette market is going, then any idea that this is a way of giving up will be completely undermined. Instead, it will make itself attractive to people who have never smoked, and may actually lead them on to smoking for real.

    There is something in me, based on 35 years in the advertising industry, which is smelling a con.

  • It looks as if you are not aware of the fact that, in the UK, ecig companies are legally prohibited from advertising that smoking cessation is one goal, and legally prohibited from actually showing the product in TV ads. That leaves glossy celebs as about the best remaining route to increase sales. Don't blame the ecig trade for artificial restrictions imposed by others. Also be aware that such blame is deliberately fostered as a tactic to be used against ecigs, when the blame clearly lies elsewhere.

  • And is if by magic (I swear I didn't know this was out today), the BMJ's news service is flagging up research that has possibly produced evidence of harms: bmj.com/content/348/bmj.g467 (NB. I've not had a chance to examine the research)

  • Oh, doesn't that always happen?

    However, is this the BMJ catching up on the German research from last year?

    ncbi.nlm.nih.gov/pubmed/243...

    And there was one published last June too, I think.

  • Possibly - to give them their due it is from December! Nice dissection of cigarette advertising!

  • You probably need to look at the various studies by independent researchers who are not paid by the pharmaceutical industry to do a hatchet job on ecigs. Perhaps start with Prof Burstyn of Drexel Uni, whose study examined all (not just some) of the current research, including 9,600 separate measurements. He concluded there was no significant risk apparent at this time.

    It would perhaps be wise to keep in mind that since the pharmaceutical industry derives at least 10% and possibly as much as 20% of its total income from smoking, and these income channels will certainly be cut at least 50% by the ecig takeover, and they therefore stand to lose *at least* $100 billion dollars, then the motives of researchers they fund ought perhaps to be taken into account when reading the data reported by the studies. The lurid press releases can be completely ignored since they often present a picture directly opposite to the conclusions a scientist would draw from the actual study (the FDA's 2009 lab analysis of ecigs is the best example of this).

    In the BMJ/German study you quote, carcinogens in 2nd-hand vapour are mentioned. Since the average level is 8ng/gm in the refill (before nebulising and before inhalation and before exhalation), which is the same as in NRT products, then exhaled quantities can hardly be of significant interest. Prof Rodu reports that a level of 8ng in NRTs and ecig refills is "...about a million times lower than conceivably harmful to health". The exhaled quantity would therefore be considerably less, and one might perhaps imagine ten million times lower than conceivably harmful to health. You will note that this is not the position taken by the German researcher and we might perhaps ask why.

  • We're in the process of asking the British Medical Association for the evidence behind their call to ban (e-cigs) in public places. The BMA has advocated a ban at football grounds, and train operating companies have cited their advice in banning e-cigs on trains and stations.

    senseaboutscience.org/blog....

    Coincidentally there is also "The Rise of the E-Cigarette: Tonight" on ITV this evening at 7.30pm. It's certainly a live discussion at the moment.

  • I will be interested in whether they cover the social acceptability of e-cigarettes. I know some people find them a bit of a joke, which is why the companies are trying to make them cool.

    just had a look at your Sense About Science page and the associated ASH survey.

    The one thing that troubles me (and in relation to my longer reply above) is that these surveys do not tell us very much simply because e-cigarettes are so new.

    But I suspect you will find more and more companies will be promoting their products to non-smokers, and that will be to the young, especially on the internet.

    You are already seeing it just in the names. Volcano, Vapor Craze, NicStick, ePuffer (just grabbed these off a list - electroniccigarette-brands....

    These sorts of names are often used for a younger audience.

    Even more so with companies like Totally Wicked

    totallywicked-eliquid.co.uk/

    Lets face it, they are not selling to grissly old guys like me.

    And the number of websites promoting e-cigs is multiplying like mad, many of them running top ten lists with the same brands on them all the time. That means that a lot of money for below the radar advertising is being spent.

    So, I think the entire idea that these are a legitimate way of giving up smoking is about to be totally undermined by the industry, who will just see it as a cash cow.

    In a way, it is almost irrelevant whether these are healthy or not - it is becoming about cashing in on a hole left by tobacco companies.

  • I suggest you look at photos and videos of local vapemeets. The presence of a significant contingent of older people is obvious. Indeed, in some cases they are >90% composed of the older generation.

    Ecig business owners report that that it may be possible to identify the two largest user groups, and they are older people who want to stop smoking because they are becoming personally aware of the health issues, and younger adults who want to save money.

    In any case, when we look at the Swedish experience, where there are many similarities, we see that smoking is being eliminated. Male smoking prevalence in Sweden falls at 1% per year and will be 5% in 2016. With an effect like that, any other hypothetical issues about 'the children' are simply irrelevant. If the UK could achieve anything like the Swedish Miracle then it would be amazing (but a terrible blow for the pharmaceutical industry). People should probably try to decide what the goal is: unique public health statistics like Sweden, which has the lowest smoking-related mortality of any developed country by a wide margin - or supporting the pharmaceutical industry, the cigarette industry, and the taxman. You can't have both.

  • Vapemeets - somehow that reminds me of the old smoking clubs from a different era where people would sit around talking about the world while puffing on pipes and cigarettes and swapping information on the latest flavour of snuff. :)

    I can imagine that these would not be popular with the younger generation.

    At the end of the day, this is such a new industry where the majority of the players are small that it is difficult to really make definite predictions as to where it will be in ten years.

    Only once the really big players (especially tobacco companies) get in there and all but wipe out the small players will you really be able to see what the market truly is.

  • Yes, I'm sure you are right.

    However there will always be a niche market for upgrade/aftermarket products, as the big players never cover this area; and since ecigs almost certainly face unjustified restrictions there will be a huge black market for a time (until there are enough voters to make a difference). The big players will sell the products used in current clinical research on ecigs (mini ecigs with low-strength refills), but these products are of low efficiency compared to products chosen when there is free choice.

  • Just watched the prog on ITV. Like many of the Tonight investigations it was rather thin - they didn't get any reaction from the department of health, for instance.

    Interesting to see that the advertising specialist picking up on the same points as me about the same techniques being used to advertise e-cigs as used to be used for tobacco.

    Plus the fact that the tobacco companies are getting in on the act.

    It will be interesting to see future research and whether e-cigs become popular with young people who have not smoked. That will move the argument into a new area pretty quick.

  • The same thing happened in Sweden as a result of the population-level move to Snus. There has been a 64% fall in male smoking prevalence compared to the UK. They also have the lowest male lung cancer and oral cancer rate in Europe.

    It is a question of protecting cigarette sales or destroying cigarette sales. Which would you prefer?

    Would you prefer people addicted to heroin or dependent on coffee? There is a problem here with straight and crooked thinking, because in an effort to prevent any new recreational use of active alkaloids, the safest methods are banned for moral reasons while the most dangerous methods are protected. Banning harm reduction is an ideological reaction, it is the exact opposite of the best public health direction. After all, the number of smokers in the UK has risen by about 0.5 million over the last 5 years. Many people probably assume, due to all the propaganda, that it has fallen. The number of smokers is rising (measured for the 5 years up to Q1 2013). The only way to fix it it once the 20% Prevalence Rule operates is with harm reduction.

  • Excellent news, it is about time that the BMA justified its stance on e-cigs

  • Thanks Chris. Its almost as if I'm switched on to what's going on in the world instead of having a lucky guess!

  • Why don't they report on the good bits? and is this the first step to banning cigarettes and alcohol. No because despite the large number of deaths related to these they get to much money. ukip here I come. Leave me in peace to vape and save my own life.

  • I smoke for 25 years from the age of 15, for the last decade of my smoking I tried desperately to quit, I used patches, gum, will power, hypnotherapy and the Carr stop smoking book. Every time however I relapsed within a month or so.

    I had got to the stage where I had given up giving up. I bought an early model e-cig about 4 years ago and have never smoked since. I am still a nicotine addict but no longer inhale a burning toxic bonfire of carcinogenic gases and particulates in order to obtain that nicotine. Nicotine has a similar risk profile to caffeine so in terms of long term addiction the risks are relatively small.

    In any discussion about the risks e-cigs pose, it is important to bear in mind that the risks posed by smoking are orders of magnitude higher.

    If every smoker switched to e-cigs we could save the loives of 5 million current smokers, this is once in a generation a public health prize, but sadly vested interests are determined to stop the widespread us of e-cigs.

    As with most things it is wise to follow the money, the pharmaceutical industry earns approximately 20% of it's global income from the treatment of smoking related diseases ( their NRT products are small change ). We are talking about truly vast amounts of money here, enough to mean that industries and governments are determined to lie and strangle e-cigs just to keep people smoking, getting ill and paying up.

  • Hi There

    Janette selwyn here, my son brought home a vapourlite ecig about a month ago and trying to quit myself it was quite revelatory going from a ten a day habit to a couple of puff on an ecig is a massive benefit to me and my family, we save money and it also means i will be there in 20 years to see my youngest son graduate.

    Thank you for reading

    God bless

    Janette

  • I went from 60 a day to a packet of ordinary gum. (I should have gone for sugar free though, silly dolt I am!)

    I am glad you have stopped smoking though - hope you are no longer using the e-cigarette either.

  • We've been looking at the issues as part of the work we do for the Department for Education, providing an information service for schools on drug and alcohol issues, and have produced a briefing paper.

    mentor-adepis.org/e-cigaret...

    I'd welcome any feedback users of this forum would care to give.

  • I'm impressed! It's a fair assessment of the situation, although it should be remembered that the MHRA comments about the test data were based on old studies of now obsolete 1st generation products.

  • Hi Andrew

    This seems a pretty thorough paper and useful to schools.

    However, one thing you may want to add (or point up) is that since e-cigarettes are very new and the huge amount of publicity and promotion around them is only just kicking in, the product awareness amongst children will probably change very rapidly; any assessment they make now may be out of date in months, maybe even weeks.

    The schools should also be made aware that much of the internet promotion for e-cigarettes is aimed at young people, so probably not at smokers (though they pretend otherwise). There is a definite and palpable move by the industry to move these products away from the existing smoker market and create a fresh market. Hence why the newer generations of e-cigarettes no longer look anything like traditional cigarettes. It may be helpful if you put some links to some of the companies manufacturing or selling so that the teachers can get their own sense of this rapidly changing market.

    Oh, one other thought - your introductory photo shows the traditionally shaped e-cigarette. You may want to add one of the new generation ones somewhere.

    Good luck!

  • I'm sorry Joss but I have to disagree with you. The reason that the newer generation products do not look like cigarettes is because the cigalike products are limited by their size and are hence not particularly efficient. The larger products are far better in terms of nicotine delivery, and also in terms of choice (flavour, nicotine strength, power, longevity etc). There are also a large number of people who (like me) want a product which DOES NOT look like a cigarette because I am no longer a smoker.

  • Actually, they are spending an awful lot of money getting the look and style as appealing as possible.

    Websites such as Totally Wicked, have gone for a red and black theme with a cartoon devil to give themselves an "underground" feel and make the entire thing feel that touch naughty.

    That is a style that is known to appeal to the 13 - 28 year old male grouping in particular.

    Plus, many companies offer all kinds of additional flavouring so that you can have lots of variety and to broaden the appeal within the young male and female target markets.

    And with players like British American Tobacco now getting involved in the market, the amount of money thrown at product branding and attractiveness will increase dramatically.

    I saw the same thing with Alcopos many years ago. Officially they were promoting to the existing drinking target market. In reality, the advertising productions briefs we got were saying that production must be kept young and fun to appeal to "emerging" target groups. That translates as young people.

    You have to remember that in the long term, as the number of people who smoke decreases, the biggest target market for this type of product will be amongst people who have never smoked. The companies need to make the product as trendy and attractive as possible and make it socially acceptable. They are unlikely to do that with ageing, cynical and grumpy ex smokers like me, so the 13 plus market is perfect.

    I am just waiting for the first teen pop star to stand up and say "Hey, fans, don't take up smoking and looking uncool .... start Vaping instead!" And holds up the cool product he or she is advertising.

    Sounds like one of those pastiche ads in the film Robocop! :)

  • Please remember that the third generation e-cigs not only look nothing like cigarettes, they also cost a lot more than a simple 20 pack. A latest version 3rd gen e-cig may well set you back £120.

    Also note that alcopops may have been marketed as "cool", but it was aimed at the wanna-be-twenties-again age group. Mostly they are and have historically been bought by the early-thirties.

  • Actually, Alcopops were aimed at teens. Trust me, we made the ads at the studio I worked at. They were seen as the modern version of kids buying Woodpecker Cider, but dragged into the modern market. The main products aimed at the 25-35 yuppy group were the premixed gin and vodka brands.

  • I'm over sixty, and I use TW products. I think if you went to their forum, you would find most of the people on there to be quite mature. Why should the health of millions of vapers and smokers who may become vapers, be of much less importance, than the hypothetical teenager who may or may not use an e cig. Teenagers smoke you know.

  • On a slight tangent, I often wonder whether any particular way is a better way to stop smoking.

    I tried several times over 30 years to stop and when I did it was basically by cold turkey.

    In fact it was surprisingly easy after the first couple of days. But I don't put it down to they way I stopped I put it down to the fact that I had convinced myself at that point that I had no choice - I HAD to stop.

    I think any method I had tried at that point, cold turkey, patches, nicotine gum, hypnotherapy, standing on one leg singing Rule Britannia, would have worked because psychologically I had given up even before I chucked the fags in the bin.

    I am not convinced yet that e-cigarettes will make more people give up more successfully. I think that is happening anyway simply because more people genuinely WANT to give up and would have done one way or another with or without the e-cigarette.

    I think the best smoking cessation aid has been public opinion. Smokers can no longer hide from the fact that most people think smoking is a pretty disgusting habit, for one reason or another. And reducing WHERE you can smoke and constantly having to tell friends and family WHY you smoke is going to help persuade you NOT to smoke.

    The old adage that you cannot preach to a smoker about giving up is a load of rubbish and a last defence. In reality, it does wear away at you till the point where you cannot kid yourself any longer. It worked for me and for a lot of people I know - we just would not admit it till AFTER we stopped! :)

    Isn't the human being wonderfully fickle?

  • Every survey of ex-smokers, without exception, reports that around 70% of successful quitters used self-motivation (aka the 'cold turkey' method), just as you did. You are not an exception, you are part of the overwhelming majority.

    Other successful quit groups that comprise the remaining 30% include small groups each of hypnosis, acupuncture, group sessions, motivational courses, motivational books, pharmaceutical interventions, etc. Plus a new and just emerging group via ecigs.

    Self-motivation is vastly more successful than any other method of quitting, and at least 5 times more successful than other methods such as pharmacotherapy (in the real world, of course).

  • New legislation on the way:

    bbc.co.uk/news/uk-25900542

    However, the real future of these will be online.

  • The issue we face with e-cigs is that they hold out the promise of ending the tobacco epidemic and saving millions of lives each year but we have very little hard evidence and won't get it for some time. Most of us in the public health community accept that they are much safer than smoking and can almost certainly help with stopping smoking. Where there is a legitimate debate is around whether there might be unwanted effects in terms of re-normalising smoking. We don't know the answer to that yet but at the moment the data my team is collecting (www.smokinginengland.info then click on 'latest stats' gives no hint that that is happening. Banning sales to under 18s seems at first sight a reasonable step in preventing it in future, probably together with restrictions on advertising.

  • Hi Robert

    Although I think they can help people stop smoking (in the same way as gum or patches or banging your head against a wall), I think they do not hold any way near the promise you hope. I very much doubt more people will give up smoking because these have been invented - they will just give up by using these instead of the other ways they might have given up.

    The true end to tobacco use will, in the end, be down to a popularity contest - the more unpopular and less acceptable it becomes, the more the number of people smoking will reduce.

    I have been involved in several Give Up Smoking campaigns over the years and am very aware that the "Smoking makes you stink" approach is far more effective with young people than "it will give you cancer." People in the know have been banging on about this for years, but it has fallen on deaf governmental ears who want to see shock and awe advertising because it makes them look good. (COI used to be a client of mine and many of their campaigns were based on what looked good rather than on what worked)

    And young people is where we need to aim - the best way to stop it is to make the next generation hate it.

    So, e-cigs are not a panacea, but they can be used as an aid for those who have already made the decision to cease.

    However, the e-cig market it changing and is nothing like the Patches and Gum market. That market is all about giving up - it is a short term market where you can only sell to someone while they are trying to give up. Once they do they are no longer a customer. Consequently, product development has always been very limited and has attracted only a few players.

    E-cigs, on the other hand, have the potential to open up a whole new, untapped market that is not related to smoking at all. The opportunity is there for manufacturers to get young people hooked onto e-cigs as a long term. social habit and have them as customers for years to come.

    Consequently, the market is attracting thousands of players including the tobacco companies them selves.

    Interestingly, as it develops, I suspect the market and the products will be seen less and less like an alternative to smoking and will be a unique social product in its own right. You will begin to see that some people will both smoke AND use these new products.

    Indeed, the very term "e-cigarette" is beginning to be dropped by sales companies as they do not want the word "cigarette" to tarnish their products. Vaping is very definitely not smoking and they want that to be as clear as possible.

    The current rather cynical TV ad that says "friends do not let friends smoke" is for a product called NJoy. Note, the product is not called Give Up or Stop Smoking, it is called Enjoy - they expect a life for this product long after someone has stopped smoking (or maybe they never did). It wont be long till the ad simply says "friends will always want their friends to NJoy life..."

    It could be that the industry will, in the end, completely undermine your health hopes.

  • Joss, you say that you believe that ecigs do not hold any way near the promise R West hopes for; and that the industry will, in the end, completely undermine his health hopes.

    I wonder if you are aware we already know what happens in this situation? We only have to look at Sweden to see what will happen, as they are the frontrunners in THR (tobacco harm reduction). Male smoking will be 5% there soon and falls at 1% per year. Snus consumption has no clinical significance and there is little reason to think that ecigs will be any different.

    Because (a) an oral tobacco product is eliminating smoking in Sweden (at least among the male population), and it is fairly obvious that ecigs will be vastly more attractive to smokers than Snus; and (b) since Sweden is the world leader in reducing smoking prevalence, the world leader in reducing smoking-related mortality, and the world leader in reducing smoking-related morbidity, and as ecigs appear to have a similar (or even lower) elevation of risk, then we already know what the result will be: smokers will switch en masse to ecigs and smoking-related death and disease will gradually disappear.

    As Prof Britton says, if all smokers switched to an ecig, we'd prevent 5 million deaths just among those alive today.

    Perhaps you think he and Prof West are wrong, or perhaps wrong simply in the scale of the prevention of death and disease?

    I would also like to point out that to enable this effect we should promote ecigs as hard as possible. If/when smoking is virtually eliminated (by free choice) then arguments about 'flavours for children' will seen rather ephemeral. Unless of course we don't believe that Sweden exists or that they have unique public health statistics or that Profs Britton, West and the large number of others with similar views are sane.

    We could ignore all this, hope it goes away, and keeping taking those lovely pharma and cigarette profits.

  • I have no idea where you are heading.

    I have not said that ecigs will not contribute to people giving up smoking - that may well be the case.

    But that does not mean they will also be some magical panacea or will not create harm in some other direction.

    My point all the way along is that ecigs are the perfect product to be exploited by huge companies at the detriment of the consumer - especially the teen market.

    I have teens - they are both health nuts and are quite open about all this stuff. A year ago they had never heard of ecigs (they were another giving up aid that did not apply to them). Now, they are seeing at them at parties being used as fashion accessories and not as giving up aids. In fact, they say that friends do both ecigs and normal smoking as two related occupations.

    As for promotion - that will get millions put behind it. It will be interesting to see what twists and turns it takes and trust me, it will have absolutely no relation to anything any medical professional says or not - it will just be about sales.

  • Of course. And I'm very glad about that - we only need to look at Sweden to see the result.

    It's difficult to describe the Swedish Miracle as a bad thing; equally hard to describe coffee consumption as some sort of evil that needs to be eliminated. These are a function of modern urbanised lifestyles and cannot be removed unless urban life is removed. Actually I don't see that as a bad thing, but accept that I'm probably in a minority :)

  • Albeit informal, the evidence in favour of vaping is overwhelming. Nicotine addicts can easily leave tobacco alone and it's the products of tobacco combustion that cause serious harm, not nicotine.

    In my case, I was an addicted smoker for more than 50 years. I'd tried all the help offered by the NHS but it didn't stop the craving. I once managed to quit by going cold turkey but the result was a dangerous weight-gain followed by a deep depression. About 18 months later, I was smoking again.

    What I've found recently is that vaping enabled me to quit tobacco astonishingly easily and quickly. I did some research, found a large and powerful device (much bigger than a cigarette) and a strong nicotine solution with a tobacco flavour. I never touched tobacco again.

    I'm not the only one who's benefited in this way from vaping and so, surely, it must be a good thing. It may not be perfect and it may be against any health authority's assumed remit to allow smokers to keep taking nicotine, but it's a lot better than leaving addicts with no alternative but to smoke tobacco.

    If health professionals in the know tell me I'm mistaken then I apologise -- but in that case, should I and others like me revert to tobacco smoking?

  • I'll add that I agree with commentators who point out that e-cigarettes are an obvious introduction to nicotine addiction, most especially since the fluids are most commonly sold in sickly sweet, childish flavours. The answer in my mind is obvious: the government should be regulating the sale of nicotine as distinct from the sale of tobacco.

  • When people call for regulation of e cigs, the mean medical regulation. E cigs are already regulated by trading standards and 17 EU regulations as consumer products. They are not medicines, they are a safer alternative to smoking. Wherever this has been tested in court, the courts have decided they are not medicines.

    The fact is nicotine replacement therapies have an over 90% failure rate for smokers. E cigs work because they simulate the act of smoking without the harm. Unfortunately some people haven't caught up and still have the quit or die mindset rather than harm reduction. Ever since e cigs have become popular, they have been under threat from vested interests like the pharmaceuticals and the tobacco companies. They are aimed at smokers. Non smokers are unlikely to be interested in them and as for teenagers, well teenagers do as a matter of fact, start smoking.

  • I have been vaping for 3 and a half years, my chest is better, my health is better and its like I have quit smoking completely. All the vendors I have used have been above and beyond the quality and safety for vaping and if this is taken away from us, the EU and the Government might as well put guns to our heads and pull the trigger. Vaping is safe and already well regulated and saving lives. The real threat is the big tobacco industry and the pharmaceutical companies who are threatened by the ecig and vaping success.

  • Ecigs: the current issue in the EU is the new TPD.

    Pharmaceutical licensing was rejected, which is not really important since it is always and without exception overturned by the courts when challenged - so it wouldn't have lasted long.

    Plan B is tobacco product classification, and the intention of the new TPD rewrite is to allow the total elimination of ecigs by stages (as it has always been). It looks as if the current TPD, if it passes through every stage, will eliminate about 75% of ecig products fairly soon, especially those that work - leaving obsolete products that are inefficient and ineffective for many smokers. It will also prevent any new technology being introduced, so that the current state of the technology will be fossilised.

    However, if interpreted as strictly as possible (as all EU law is in the UK - especially when to do so will massively benefit ecig's commercial rivals such as the cigarette and pharmaceutical industries), then we can expect that all ecig hardware will be prohibited. This is because a requirement of the TPD is that a device must deliver a consistent dose of nicotine. Since this is a medicinal requirement and has nothing whatsoever to do with consumer products, it would probably be difficult to comply with; and when we look closely we find it is impossible to comply with. Thus, all ecigs can be eliminated (which is what the TPD is designed to do in any case).

    My personal belief has always been that a tobacco product classification was the principal aim all along, because medical classification is impossible to maintain at law. This allows a 100% ban just as efficiently, although it cannot be achieved overnight in the same way that a medical classification allows. It will take a year or two after implementation, before the government have received their exact instructions from the pharmaceutical and tobacco industries on how to proceed against the ecig vendors; then the noose can gradually be tightened.

    Of course all this is irrelevant in the long term because the black market will take over for the supply of safe, effective and affordable products. It may be the first time in history that the population will have to go to the black market for safer products to help them stay alive and healthy instead of the opposite. And no doubt eventually there will be a voting bloc of several million people who object to being forced to smoke by the government and object to the incompetence and corruption that rules public health.

    People need to realise that the UK and especially EU governments work for established industries and government revenues, not public health. Your health is utterly irrelevant to them when there is a financial conflict. The Department of Health will always and without exception protect and promote the pharmaceutical industry and its profits, even when there is a massive conflict with public health. The five million preventable deaths Prof Britton talks about are, in the final analysis, a fantasy: each one is worth thousands of pounds to pharma and they will do whatever is necessary to protect that income. Sorry, but your health is not a consideration on pharma's balance sheet.

  • Rob,

    Your statement that there is 'scant existing evidence' on ecigs is not true. In fact it reeks of the propaganda spread by commercially-funded opponents. It is difficult to describe several hundred studies, lab tests, analyses and papers as 'scant'. If you need assistance locating the studies and other resources then no doubt assistance will be offered. Note that Prof Burstyn examined 9,600 separate measurements in his review of the evidence.

    On the other hand if you actually meant long-term evidence as to a reliable determination of the degree of elevation of absolute risk engendered by chronic consumption, then of course you are correct. Unfortunately we won't have the epidemiology for 20 years. Ecigs have been used in the UK since 2005, and in significant quantity since 2009. In 20 years' time we'll have 25 years of good data. Wishing it is is 2034 won't make it so - we have to use what we've got. Perhaps you might ask Profs Britton, West, Hajek, Rodu, Phillips, Siegel, Flahault et al what they think we should do; I believe that they will all tell you that the risk, such as it is, is well worth it.

    Ecigs only have to entail half the risk of tobacco cigarettes to be worth using. Since they would in the worst case have 2 orders of magnitude less risk (100 times), and possibly 3 or even 4 orders of magnitude less risk, this seems a good bet. And it is a bet, not a therapy: this is a consumer product not a medicine. If people want to use seat belts, low-alcohol beer, decaff coffee, condoms and suchlike then it should be their decision, not the state's. Nothing is harmless and no one is saying ecigs are 'safe' - that is not a sane position to take. They only have to be safer than cigarettes; and if they are a lot safer then debate is not really productive. When they appear to be vastly safer, then questions need to be asked: why is there strong resistance? The answer becomes a little clearer when the funding sources of those offering opposing policies are examined: without exception they depend on the smoking economy.

    It's a very simple question, after all: do you want to see 100,000 annual deaths from nicotine-delivery products, or 1,000, or perhaps even as low as 100? This is the coffee consumption area of risk. Are we going to prohibit coffee next?

    If the NHS wishes to support the use of ecigs then presumably the product would need to be a licensed medicine. If an ecig receives an MA then the argument will be over, since the product would be prescribed or offered OTC routinely. (It will also be distributed free and without parental consent to children, as NRTs are currently - but that is another story. At least ecigs do not have the overdose risk that NRTs do for children, resulting in the hospitalisations that have occurred.)

    In NICE PH45 the advice was proffered, a little diffidently but nevertheless substantively: if a patient cannot succeed in quitting smoking by any other means, then medics are permitted to mention ecigs unofficially. I'm not sure how any NHS procedure would differ from this - preventing personnel from doing this would be contrary to current clinical guidance; and advocating ecigs in preference to other solutions is not supported at any level, and risks a reprimand or other action. The NHS policy therefore seems clear, unless it is being suggested that the NHS can ignore NICE and implement whatever policy seems apposite.

  • Chris, you say "Ecigs only have to entail half the risk of tobacco cigarettes to be worth using. "

    Does that apply also to people who have never smoked?

    Having a very non-scientific look through a few forums, it seems to me that the debate is split, not really on medical grounds, but between those who are desperate to protect their wish to use ecigs and those that think they are probably a bad thing.

    Personally, I suspect they are probably a bad thing - mostly on the principle that they are neither necessary as a leisure pursuit or as an aid to giving up. The argument that thousands would not be able to give up without them is rubbished by the statistics of the millions of people who managed to give up smoking before ecigs were invented - I think that applies to patches too, by the way.

    I rather liked a post I found on a forum from a couple of years ago where someone asked about whether any non-smokers taking up ecigs posted on the forum. A "veteran" poster replied:

    "We do get people thinking about it stopping in now and then. We try to discourage them for fear they'll start an addiction they don't need. "

    Quite.

  • Joss,

    "...they are probably a bad thing - mostly on the principle that they are neither necessary as a leisure pursuit or as an aid to giving up. The argument that thousands would not be able to give up without them is rubbished by the statistics of the millions of people who managed to give up smoking before ecigs were invented..."

    This is a valid opinion. However I wonder if you have considered how much being an ex-smoker has affected your opinion? There's nothing worse than an ex-smoker... :)

    There are many people who want to quit and have tried repeatedly but failed. I think you are doing them a disservice by saying, "Just quit". One might also, justifiably, ask if you have also given up coffee, tea, chocolate, wine, sherry, beer, whisky, and so on. Why not? If not - do you really think you have the right to tell others what to consume?

    The 'half the risk' thing applies specifically to smokers, especially those who cannot quit or who don't even want to quit but end up doing so after trying out then repeatedly using an ecig (I'm one of those, by the way: I had absolutely no intention of quitting but ended up doing so). One of the rather useful features of ecigs is that dual-use is an excellent thing: it can gradually convert non-believers. There is no other solution that can do this.

    It is better to discourage people from taking up inhalation of anything, where possible. However I'm one of those who believes that since nicotine is a normal dietary ingredient and everyone tests positive for it, and since it is an active ingredient in the diet, then perhaps what we are actually doing is a form of dietary supplementation. In other words, those that need to supplement their dietary intake do so. As regards new smokers / vapers then it would be preferable for them to use pills for this purpose. In connection with this I think it unlikely that certain populations will ever be able to achieve a lower than 20% nicotine supplementation prevalence - it appears to correct a discrepancy of some kind. I see nicotine consumption (not vaping) as about as relevant as tea consumption, on average.

    In the short term, and in the current climate of taboo especially, it is probably better to discourage non-smokers from vaping. I view vaping as, on average, in the same area of risk as coffee consumption. This cannot be described as significantly harmful, but is an unnecessary additional health burden.

    As regards the long term, we only have one example of population-level THR: Sweden. Smoking prevalence is continually falling there, and they are the only deveoped country that has the remotest chance of reducing smoking to insignificant levels. Male smoking prevalence falls at 1% per year and will be 5% by 2016. It cost the taxpayer zero and has been accomplished entirely by free choice; I think that these factors are important although others may disagree. That Sweden is also the world leader in reducing smoking and the world leader in reducing smoking-related death and disease is critically important.

    Are you aware, for example, that the number of smokers in the UK has risen over the past few years - despite the massive sums paid out to try and do something about it?

    So these are the questions that need to be asked:

    1. If (a) smoking is virtually eliminated by free access to THR products, and if (b) the consumption of such products has no clinical significance, then what precisely is the objection to allowing free access to such products?

    2. If a significant number of THR product consumers are created (as they will be), but (a) consumption has no clinical significance, and (b) it is the only proven way of significantly reducing smoking prevalence in a country where the 20% Prevalence Rule operates (google it), then what are the realistic objections; and indeed what other option is there?

  • @ChrisPrice,

    It was probably a matter of wording - I meant to imply that we found scant evidence on our unsystematic review of readily available sources in the world of peer-reviewed research. If you have a look at the article, you should be able to see the links to the studies we used (including this one that has prompted a parliamentary question palgrave-journals.com/jphp/... )

    You're absolutely right in that the lack of evidence is not, somehow, the fault of e-cig makers or vapers. Nor does the lack of evidence in any way imply that they are harmful or ineffective.

    As I said, I'd take a pragmatic view and give them a try (in fact, I did try a menthol one and was surprised how much more pleasant it was than a cigarette).

  • Rob,

    You may be right that a search of journals is not all that productive, I expect that only around 50 papers can be found this way. However there are some journals that don't show up in these types of searches so it may be useful to also do a reverse-direction search by going to lists of studies (such as those at CASAA) and then checking their relevance/reliability. It is also necessary to have a knowledge of the players in such a field due to the immense commercial rivalry, where researchers are paid by commercial rivals to create studies of rival products that claim to identify potential risks. Press releases especially need to be avoided since a detail investigation of the study data sometimes leads to a conclusion opposite to that claimed in the PR.

    Cahn, Siegel 2010 has been interpreted to indicate that ecigs may have a toxicity level 1,000 times lower than tobacco cigarettes. This sounds about right although it is not necessarily directly transferable to an equivalent level of elevation of risk. That is anyone's guess although it is hard to see any significant disease vectors in ecig ingredients even with common levels of contamination in non-medical products. The principal risks I see are abuse (usage outside of and beyond 'normal' consumption modes or volume or ingredients) and contraindications due to pre-existing morbidities. There are some specific user profiles where use needs very careful monitoring by someone with expert knowledge of product-specific risks, for example emphysema patients. I've tried to list all the health impacts or cautions here (the first post in this thread; my web name on that site is Rolygate):

    e-cigarette-forum.com/forum...

    It is not in the ideal format but this article has several thousand links as it is the only resource of its type, so it is difficult to move or reconstruct - although I will have to find a way of doing so at some stage.

  • Joss S, Some forum posters are not well versed in expressing themselves, as you must have seen when trawling the forums, they are also not devious and answer questions as honestly as they can, not aware that some so-called "noobs" are simply shills either for Big Pharma or Big Tobacco, who will use their words to bolster a case. I would have answered the question differently but, in essence, delivered the same message. Vapers are, on the whole, a bunch of smokers who, for various reasons have switched to the electronic version; maybe it's financial, maybe to beat the smoking ban, or, as in my case forced to abandon smoking after 60+ years by failing health. Most of the vapers I know made the switch because they accept the health risks of smoking and are delighted to find an alternative that is so many orders of magnitude safer. After four years of vaping my health has improved to the point where, at my last asthma clinic, I was told "Whatever you are doing, just keep on doing it" - I had provided the staff with hard-copy of several relevant studies and demonstrated my e-cig. How much "anecdotal" evidence is needed before it becomes fact? On the subject of giving up cigarettes - I'm an expert, I've done it so many times; a year, two years - done that! Have a friend who lapsed after 10 years of abstinence and smoked with renewed vigour; even the BMA have admitted that some just cannot quit. Well, now they don't have to - and the Health Nazis are furious!

  • I was one of the "I will probably never be able to quit" bunch. I smoked up to 60 a day (roll ups and normal) and I started when I was 14.

    Ten years ago I just looked at the price and the looming smoking ban and thought I just cannot justify this on any level at all. So I stopped. I chewed nicotine gum for 3 days thinking it would help, but I hated it and it was a waste of money. So I chewed normal gum. And that was that - it was so easy it was a joke.

    And the reason it was easy was not because I chewed gum, stood on my head, used substitutes or any other clever device, it was because I stopped being an idiot about it. I got myself to a place where smoking simply did not belong any more.

    No one could have done that for me - I needed to get there myself.

    There is one thing that might have made me give up a long a time ago, and that was if the smoking ban had come in earlier. The fact that I wasn't going to be able to smoke at work and there was no workaround (and my job meant that rushing outside every ten minutes was not an option) made a huge difference.

    I am not a "health nazi" as you describe people that probably care about health, but I am honest. And the reason I did not give up for so long was pure, bloody-minded selfishness. Stupid me.

  • I'm going to be honest and hopefully not to harsh. The reality of this situation is just more proof that the powers that be need to stay out of our lives. I don't need my hand held throughout my life and neither does anyone else. By all means do the necessary research and inform the people. However that does not mean make my life any more restricted than it already is. Our civil servants need to do their job and abide to the people not corporations and whiney people who have been accustomed to being told how to think. We need a wakeup call and start thinking for ourselves again.

  • In the end a lot of debate about ecigs comes down to a discussion of the various pros and cons of nicotine. Because there is so much propaganda on this topic, I wrote a couple of articles examining the myths from the perspective of someone searching for indisputable evidence about nicotine and human consumption:

    ecigarette-politics.com/the...

    e-cigarette-forum.com/forum...

    Essentially, it boils down to a simple statement: everything you thought you knew about nicotine is almost certainly wrong. 44% of British doctors were shown to hold views directly contrary to the official guidance given by NICE, for example.

  • Joss S - I'm not describing people who care about health as Health Nazis - I care about my health so much that I have quit almost all prescription drugs which, according to the BMJ are the third biggest killer after cancer and heart disease. I refer to those who allow their "perception" of something to influence their attitude towards it, without taking the trouble to investigate its potential for health, or at the very least, harm reduction. Contraception is a case in point - if it doesn't fit with someone's moralistic outlook it has to be a bad thing. And they will move heaven and earth to prove a point - it's not that long ago that they were blockading Family Planning clinics. That failed, as will all the stupid prohibitions they are trying to impose on what is the only viable alternative to smoking. Some just cannot "give up", some don't want to, and that is their business. Not yours, or mine.

  • Hi everybody,well I just want to give my opinion being a smoker for 35 years,I recently bought an E cig and have not had a real cig since,I suppose the only problem is I seem to be vaping more that I was actually smoking.

    BUT there is no doubt my lungs,coughing and wheezing seems to be much much better.

    My chest is not crackling at night like it used to.So hell that must be a big positive.Im probably not saving any money because I live in Indonesia where the cigs are only a buck a packet.

    Just on the issue of cig companies saying they approve of E cigs,well what else can they do,they couldnt say they were bad now could they? (well not to our face,just pay someone else to do that XD).Plus if they give their support that also makes the E cigs look bad.

    Anyway in a nut shell,the E cig was for sure the only way I was able to give the real cigs the flick.

    Dont even hesitate,if you want to stop smoking real cigs ---- get one today.

  • This is a heavily debated topic right now and there's much confusion due to the product being fairly new to the marketplace and not fully observed or understood in terms of long-term effects on health.

    The EU I understand, is planning to regulate this entire industry very soon and many products will disappear from sale. I think that is needed because at present it's completely unregulated (excluding the industry's self-regulation body) by any outside authority. There's often minimal guidelines on safety in the product packaging, no oversight or safety guidelines on manufacturing, and no clinical safety trials. They're often made by dubious factories in China so heaven knows what's in them. Some e-cigs have even exploded. I'm not trying to scaremonger here or demonise the product, just point out this reality and obvious risky nature of the product and marketplace. If you're going to try e-cigs, at least buy a proper brand and perhaps look at the pure e-cig mixtures without all the additives they put in some (you can make your own mixtures so you know what's going in and from where).

    From what I've read, a general feeling among scientists is that e-cigs are likely to be significantly less risky and harmful to health than normal cigarettes because they produce a relatively harmless vapour compared to cigarette smoke which contains around 3,000 chemicals, many of which are carcgenic. Then there's the obvious problem of tar in cigarette smoke which is linked to lung diseases, high blood pressure, strokes and heart disease.

    E-cigs are also certainly a better option for reducing the known risks associated with passive-smoking and that is often over-looked, so that's a positive I would say.

    Whilst e-cigs don't have toxic chemicals or produce tar, they do have some effect on health and using regularly in place of cigs is bound to have some similar effect on health I would say, beyond just the addictive issues of a nicotine habit.

    There is a social issue concerning children and younger teenagers, who see e-cigs as cool, and perhaps harmless. Getting access to them also is a lot easier for younger people than regular cigarettes due to their wide availability online, so we could end up with a new generation of nicotine addicts unless this industry is properly regulated and this product removed from sale online or restricted in some way (perhaps to credit card holders only).

    I have tried them myself out of curiousity. I was once a 20-a-day smoker who packed the habit in about 8 years ago. I found that the vapour does do something to your throat and lungs and feels similar to cigarette smoke but not as harsh and with no horrible smell. Even after a few puffs for one day, I felt a significant difference in my lungs which lasted several days. Since the vapour comes from glycol which is a type of sugar, my guess is, that you're getting a sticky coating of this in your lungs similar to the tar in cigarettes which can't be healthy and is most likely to produce reduced respiratory function, just as cigarettes do over time. Whether this sticky residue is potentially as dangerous as tar over time in forming plaques in arteries, which could lead to strokes and heart disease, who knows. It may take decades as the product matures in the marketplace before we find that out.

    Not wanting to scare people here, but these plaques in arteries have now been identified as a silent killer and so this potentially causual link to e-cigs/glycol needs to be investigated carefully with people ingesting this stuff daily to see if could form plaques. Plaques form slowly over a decade or so, and someone in their 40's or 50's who seems perfectly healthy, has a stroke or sudden cardiac arrest and dies. Plaques are hard to detect in general health check-ups. Often the warning signs appear late in the disease. The symptoms of someone who has plaques are increased blood pressure, being short of breath, fatique and increased sweating. You can research this diease online. A notable celeb who died from it was the US Wrestler "Ultimate Warrior". As I said, research is still ongoing and these plaques and what causes them is not fully understood.

    The other problem with e-cigs is that they're often marketed or presented by the media as way of giving up smoking or a "nicotine replacement therapy" tool for weening, instead of using patches or gum which don't work for some people. From what I've seen though, they often contain far more nicotine (and you get a far stronger hit of it) than regular cigarettes or even patches/gum, and so they're probably just as addictive, if not more so. You're also still locked into the same social habit of physically smoking which is not the ideal way to give up doing something!

    Summary

    E-cigs should definitely not be considered by anyone planning to give up cigarettes and I think there should be a warning to this effect on the product and some notice saying its potentially more addictive than smoking and carries unknown health risks. At least consumers will be aware of these risks then and can make an informed choice.

    If you're trying to use e-cigs to give up smoking I think you'll end up replacing one bad habit for another. OK, so it probably won't kill you but it certainly won't contribute towards a healthy lifestyle.

    If you choose to use e-cigs as a less harmful option because you don't want to, or can't give up smoking then you have to accept there's likely to be health costs and risks involved, both short and long-term. I would recommend anyone smoking e-cigs daily monitors their health with check-ups and blood pressure checked periodically, just as a regular smoker should.

    These risks are simply unknown until proper longer-term scientific studies are carried out. That aside, I think you'd be a lot better off on e-cigs than if you are trapped smoking normal cigarettes. It's also a lot cheaper as a habit and doesn't seem to be harmful to those around you.

  • articles.mercola.com/sites/...

    articles.mercola.com/sites/...

    Not sensible to swap one vice for another . I understand it may be 100 times better than real cigs, but the end result/aim should be to give up inhaling anything eventually. The gvt will have to treat vaping like normal smoking and keep vapers "ostracised" for their own good and for the good of those around them. Also limit advertising, marketing etc, the same as cigarettes are so as not to prey on young, and those who might perceive it as cool and harmless and therefore start.

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