Daily Mail By SARAH HARTLEY
The Royal College of Physicians and a number of GPs now back them as a safer alternative to smoking. Small studies suggest they help smokers quit the real thing. Yet legislators have been less than welcoming. In Australia it is difficult to buy e-cigarettes, while the devices have encountered similar problems in Brazil, Mexico and Hong Kong. And earlier this year, New York City banned them in public places. The then Mayor Michael Bloomberg was said to believe public use of e-cigarettes threatened to undermine enforcement of anti-smoking laws.
£1.3bn GLOBAL SENSATION
Unlike tobacco, e-cigarettes can be freely advertised in Britain on TV, billboards and online, and there are millions of users here. Last year, global sales reached £1.3 billion.
E-cigarettes are battery-operated, usually rechargeable devices. As the user sucks on the gadget, an element is activated which heats a replaceable cartridge filled with liquid containing nicotine, turning it into a vapour that can be inhaled. There is no tobacco and no smoke, but a visible vapour is exhaled.
The astonishing popularity - there was an 800 per cent increase in 2013 in smokers using e-cigarettes to kick their habit - is agitating the tobacco industry (its sales fell eight per cent last year), pharmaceutical firms that manufacture nicotine-replacement therapies, and medical bodies concerned about safety.
The European Union wants the products banned for 'normalising the action of smoking', but some British doctors view e-cigarettes as essential for smokers wanting to cut down or quit.
E-cigarettes will be at the centre of one of the hottest health debates this year. Are they a medical or a lifestyle product? Do you want to sit in a bar as someone blows vapour in your face? Do you care that your eight-year-old child can legally buy e-cigarettes when they cannot buy tobacco? Or, given that one person dies of tobacco-related disease every five minutes in the UK, do you want to encourage the use of a product that potentially may save the lives of millions of smokers?
You may already have an opinion without knowing exactly how an e-cigarette works. In fact, in the absence of any significant studies, bodies such as the British Medical Association have erred on the side of caution and deemed them unsafe.
Dr Vivienne Nathanson, the BMA's head of science and ethics, says: 'What they do is normalise the concept of smoking when we've all got used to the fact that smoking in public places isn't allowed.'
Indeed, current legislation remains confusing. If you want to use an e-cigarette in the office you would be within your rights - the 2006 Health Act only bans smoking in public places. Yet some employers have already barred such devices - for instance, MPs are not allowed to light up an e-cigar (yes, they make these too) in the Commons.
The NHS has taken an upbeat stance: 'Compared with regular cigarettes they are certainly the lesser of two evils,' its website states. 'Smoking e-cigarettes is generally regarded as a safer alternative to smoking for those unable or unwilling to stop using nicotine.'
The US Food and Drug Administration found toxins in the vapour include cancer-causing chemicals nitrosamines and formaldehyde, but the NHS says: 'Levels are 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 such as a dry cough.'
While the endorsement is not ringing, the NHS is desperate to reduce the nation's love of tobacco which currently costs the NHS £2.7 billion in treatment a year. The taxpayer spent £88.2 million on 'stop smoking' services in 2012 and £63.4 million for cessation aids in 2011-12.
Perhaps an unlikely supporter of e-cigarettes is public health charity Action on Smoking and Health (ASH), established by the Royal College of Physicians (RCP). It believes 'there is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine [in e-cigarette cartridges] is suspended'.
Arguably the UK's leading champion of e-cigarettes is ASH board member Professor John Britton. He leads the tobacco advisory group for the RCP, and is director of the UK Centre for Tobacco Control Studies at Nottingham University. He says: 'There are ten million smokers alive today who will eventually be killed by smoking. If they had used e-cigarettes, those deaths could be avoided. It's a massive potential public health prize. Successive governments have failed to tackle tobacco smoking, watching as millions die in an entirely preventable epidemic.
'It is vital to do all we can to help people to quit smoking tobacco, and prevent young people from starting to smoke. Given the right controls, e-cigarettes could make a huge contribution to that.'
TOUGHENING UP THE RULES
With an estimated five per cent of the NHS budget spent on the treatment of smoking-related illness, Prof Britton argues that investment should be spent on smoking prevention and the education about the risks of nicotine so that moving on to an alternative such as e-cigarettes makes sense, with a view to eradicating smoking completely.
He also remains a staunch supporter of the regulation of e-cigarettes in the UK through the Medicines and Healthcare Products Regulatory Agency (MHRA).
The problem is, as Prof Britton explains: 'Some e-cigarettes contain a range of pollutants that do not need to be there. The risk may be trivial in relation to smoking, but could still be important if these products are used in the long term.
'So we need to know the solutions are clean, we need to know the devices work and deliver nicotine effectively. Many smokers have said to me e-cigarettes didn't work for them and have resorted to smoking again; this could be because the product didn't deliver enough nicotine. We also need to make sure companies are promoting the health gains as an alternative to tobacco rather than advertising to children or as a lifestyle accessory.'
This is exactly the gripe of Cancer Research UK, which is concerned that celebrity endorsements encourage children to use e-cigarettes - at present there is no age restriction on buying them. Alison Cox, Cancer Research UK's head of tobacco policy, says: 'Tobacco causes one in four cancer deaths. Hundreds of children start smoking every day and we don't want the marketing of e-cigarettes to confuse the message that smoking kills. We aren't opposed to them being marketed to adults and hope the effort encourages many smokers to give up.'
DR SMOKELESS'S PLAN
One GP who has triumphed in converting smokers to e-cigarettes is Dr John Ashcroft, based in a deprived area of Ilkeston, Derbyshire. Last year he turned an empty office near his surgery into Dr Smokeless, a store selling e-cigarettes to patients. 'I've always had a number of patients who I've unsuccessfully tried to help stop smoking, and suddenly they've stopped by using e-cigarettes,' he says.
Some swap for their health or they want to carry on and “smoke” in the pub. Large numbers of my patients use rolled tobacco which costs £16 a week. But e-cigarettes are even cheaper - 20 a week costs £2.50.
'The public health gain is going to be very, very large - the biggest we're likely to see this century. We could ban cigarettes in a few years' time and tens of thousands of lives would be saved. Are e-cigarettes totally safe? The answer is probably, but we don't really know. I'd like to see funding for proper research.'
Dr Ashcroft has recently managed to have a code put on the national GP system so that doctors are now able to record patients using e-cigarettes. 'We need to start recording figures of patients using e-cigarettes and health changes as they swap over. The health gains are immense.
'When the smoking ban came in we saw a huge reduction in heart disease. It is likely that figure will drop further thanks to e-cigarettes, although it will take longer to see changes from lung disease.'
Has Dr Ashcroft ever smoked? 'No, but I keep a few e-cigarettes in my pocket to show patients. I passed them around at a medical conference recently. While doctors recognise the size of the health gain, most don't know a lot about them.'
One can only hope the policy-makers are quicker to catch up.
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