Wednesday June 12 2013
More and more people are using e cigarettes
Electronic cigarettes are to be licensed and regulated as an aid to quit smoking from 2016, it has been announced.
E cigarettes battery operated devices that mimic cigarettes are to be classed as ‘medicines’, which means they will face stringent checks by medicine regulator the MHRA and doctors will be able to prescribe them to smokers to help them cut down or quit.
This move has been widely welcomed by medical experts and officials, as tighter regulation will ensure the products are safe and effective.
Until this happens, e cigarettes are only covered by general product safety legislation, meaning they can legally be promoted and sold to children, and we cannot be sure of their ingredients or how much nicotine they contain. The MHRA will not ban the products entirely during this interim period, but will encourage e cigarette manufacturers to apply for a medicine licence.
Are e cigarettes safe?
We don t really know until they have been thoroughly assessed and monitored in a large population over time. However, compared with regular cigarettes, they are certainly the lesser of two evils.
First, e cigarettes don t contain any tobacco only nicotine, which is highly addictive but much less dangerous. For this reason, smoking e cigarettes (known as vaping ) is generally regarded a safer alternative to smoking for those unable or unwilling to stop using nicotine.
Also, while the US Food and Drug Administration (FDA) found the liquid and vapour to contain traces of toxins (PDF, 237kb), including cancer causing chemicals nitrosamines and formaldehyde, the level of these toxins is about one thousandth of that in cigarette smoke.
We cannot be certain that these traces of toxins are harmless, but tests on animals and a small study of 40 smokers are reassuring, providing some evidence that e cigarettes are well tolerated and only associated with mild adverse effects (slight mouth or throat irritation, a dry cough).
Public health charity Action on Smoking and Health (ASH) is cautiously optimistic, concluding in its January 2013 briefing (PDF, 447kb) that there is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine is suspended.
Others are more wary. Some health professionals do not recommend them because they believe the potential for harm is significant. It is worth bearing in mind that nicotine is not altogether harmless for example, it has been linked to anxiety and research suggests nicotine plays a direct role in the development of blood vessel disease.
E cigarettes are banned by other countries and by some UK schools concerned about their influence on adolescents (see What are the other concerns? ).
What do e cigarettes contain, and how do they work?
Most e cigarettes contain a battery, an atomiser and a replaceable cartridge. The cartridge contains nicotine in a solution of either propylene glycol or glycerine and water, and sometimes also flavourings.
When you suck on the device, a sensor detects the air flow and starts a process to heat the liquid inside the cartridge, so it evaporates to form water vapour. Inhaling this vapour delivers a hit of nicotine straight to your lungs.
Will they help me quit smoking?
We don t yet know. The evidence so far is promising, but not strong enough to draw any firm conclusions.
A 2011 study and a 2013 survey found that e cigarettes decreased the number of cigarettes consumed by smokers, and the survey also suggested they reduce cigarette cravings although participants were recruited from websites of e cigarette manufacturers, so results may not be representative.
It s not certain whether e cigarettes deliver as much nicotine as forms of nicotine replacement therapy such as patches, so they may not be as effective at curbing nicotine cravings.
However, they do have the advantage of looking and feeling like cigarettes they satisfy the same hand to mouth action, give out a smoke like vapour, and some even have an LED light that resembles the burning tip of a cigarette. This could be why a 2010 study found that even placebo e cigarettes (with no nicotine) relieved the desire to smoke within the first 10 minutes of use.
If you want to try a safer alternative to cigarettes but are concerned about the uncertainties surrounding e cigarettes, you may wish to consider a nicotine inhalator. This licensed quit smoking aid, available on the NHS, consists of just a mouthpiece and a plastic cartridge. It s proven to be safe, but the nicotine vapour only reaches the mouth rather than the lungs, so you don t get the quick hit of nicotine that comes with e cigarettes (see box below, which compares e cigarettes with inhalators).
E cigarettes vs nicotine inhalators
Opinion: why cigarettes are here to stay – cnn.com
Why do the filters of european cigarettes have small holes in them
Bloomberg’s proposal, and the case of the ghastly illustrations, both underline America’s bizarrely bifurcated relationship with cigarettes
The country smokers and nonsmokers alike realizes the dangers involved. The Centers for Disease Control and Prevention says that around 443,000 people a year die because of cigarette use.
But the product is as legal as a loaf of bread or a jar of pickles.
So the cigarette manufacturers have a point when they say the government is overstepping by demanding nauseating images on their packages. Free speech does not only refer to our right to say anything we choose it also refers to our protection from having the government force us to say things against our will. Even convicted killers, when speaking in court before sentencing, are not required to say they are guilty. The government has a right to create, publish and broadcast the strongest anti smoking campaigns it can come up with, but the cigarette companies make a compelling case in saying that, as long as their product is legal, they should not be forced to print repellent images on their packages.
(And who knows? the federal government, in deciding not to fight the package illustrations battle in the Supreme Court, may be wary of what could happen there. What if the Supreme Court not only ruled against the proposed graphic illustrations but additionally, on similar grounds, opened up the question of whether the text only warning messages on cigarette packs, the ones that have been there since the 1960s, also are an incursion on free speech?)
In New York, Bloomberg’s heart may be in the right place, but merchants who want to sell cigarettes should be justifiably puzzled If any product is not legal, then they should be barred from stocking it, but as long as it is, how can anyone presume to tell them where to display it or, more to the point, that they can’t display it?
It all comes down to this
While well intentioned attempts to curb smoking may appear bold and decisive, they are in the end timid. The big and most effective step outlawing cigarettes on the grounds that they undeniably, in the long run, sicken and kill the people who smoke them, and those around them is not going to happen.
Politicians would be terrified to do it there are an estimated 45 million smokers in the United States, and no one is going to risk alienating them by completely cutting them off from cigarettes.
In an already shaky economy, the repercussions from shutting down the tobacco industry the jobs suddenly lost would be, to put it mildly, highly problematic from a political and real world standpoint.
The memory of Prohibition would undoubtedly be on lawmakers’ minds. The government once tried to take from people something they had been accustomed to, something that had been legal alcohol. The outcome was anything but pretty.
If there really were the political will to end cigarette use, there are ways. Each state sets its own laws for the minimum age to purchase cigarettes in most states, it’s 18. If states decided to raise the age to, say, 80, that would do it. But the chances are zero.
Like it or not, the country has painted itself into a corner. Cigarettes kill. They will continue to. If they were a new product, they’d never make it to market. Don’t bet against them still being here a century from now.
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The opinions expressed in this commentary are solely those of Bob Greene.