01 Jan

Explainer: What Do We Know About E-Cigarettes?

E-cigarettes are increasingly popular in a number of countries including the UK, while in others such as Norway and Brazil they are banned altogether.

So amid all these differences in policy, what do we know and what don’t we know about e-cigarettes? And why, if they have the potential to save many of the lives taken by tobacco smoking each year are e-cigarettes currently one of the most contentious issues in public health research and policy?

Combustible simulation

E-cigarettes are battery operated devices that aim to simulate combustible cigarettes. They don’t contain tobacco but operate by heating nicotine and other chemicals into a vapour that is inhaled. Nicotine is the addictive substance in tobacco but we know that it is the many other chemicals in cigarettes that are responsible for smoking-related diseases.

Because electronic cigarettes deliver nicotine without the vast majority of these other chemicals, organisations such as the Medicines and Healthcare Products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) have indicated that electronic cigarettes are less harmful than tobacco.

Questions, questions

Questions remain about the safety of e-cigarettes despite the fact that any risk that arises from using them is less than the risks of continuing to smoke normal cigarettes – and strong arguments have been made in favour of e-cigarettes from a health perspective because of this lower risk.

The first unanswered question is about the longer-term impact on health of inhaling nicotine and propylene glycol (a substance used in e-cigarettes that is also common in a range of other consumer products) deep into the lungs.

As e-cigarettes are largely unregulated, there are also questions about quality; variation in the chemicals in different cartridges, leaking cartridges and other problems such as the batteries in these devices. In other words, different companies can make very different products. There is some evidence that these technical safety issues are reducing as the quality of products on the market improves.

Another potential safety issue is around the vapour produced by e-cigarettes. There are still relatively few studies that have looked at the effects of exposure to vapour but one study examining vapour from 12 brands of e-cigarettes found a number of toxic substances, but these were at levels between nine to 450 times lower than in cigarette smoke.

Studies of the prevalence of use of e-cigarettes show that these products are being used predominantly by current smokers or recent quitters, either to stop smoking or to cut down. To date, there is limited evidence that people who don’t smoke are using e-cigarettes – just 0.5% of non-smokers in the UK in 2012, for example.

There are also unanswered questions about the extent to which children may be attracted to these products. In studies of e-cigarette use that include adolescents, including one that looked at use in Poland, most of those who had tried e-cigarettes were already current smokers. However, there is little doubt that some of the advertising of e-cigarettes may appeal to children, and recent research has highlighted the need for advertising controls in this area.

Getting the vapours about ‘vapers’

Users of e-cigarettes, particularly those who have successfully stopped smoking, are understandably enthusiastic about these products. There are an increasing number of vocal and well-organised “vaper” groups.

E-cigarette manufacturers are also a growing force in the economy of a number of countries, most notably China. However, health professionals and the public health community in particular have been less enthusiastic. This is due at least in part to some of the unanswered questions about e-cigarettes.

As Sally Davies, Britain’s chief medical officer, put it recently:

We do not yet know the harm that e-cigarettes can cause to adults let alone to children, but we do know they are not risk free.

In addition to the issues above, public health officials and others have argued that e-cigarettes could undermine smoke-free laws, such as bans on indoor smoking. They believe the e-cigarettes could confuse attempts to enforce laws when electronic products look like cigarettes, particularly from a distance.

An additional concern is that the increasing availability and popularity of the products may be driving smokers away from more evidence-based methods of trying to stop (like using a smoking cessation service or licensed stop smoking medication such as Nicotine Replacement Therapy) and that relapse to smoking might be more common as a result.

The tobacco industry

There is also considerable scepticism about the role of the tobacco industry in the e-cigarette market. A number of tobacco companies have now launched their own e-cigarette products (such as RJ Reynold’s VUSE) or have bought into existing e-cigarette companies (such as Lorillard’s purchase of Blu in 2012). New e-cigarette brands manufactured by tobacco companies are expected to continue to emerge in 2014.

This involvement has led some to wonder whether this is about finding safer alternatives to cigarettes or simply about creating a new market of “dual” users of combustible and e-cigarettes. It may also allow the tobacco industry to present a more “acceptable” image in the developed world while it continues to increase its profits from cigarettes in developing countries.

All these considerations mean that the use of e-cigarettes is currently one of the most contentious issues in public health research and policy. All the signs are that they represent a real opportunity to change the stubbornly persistent toll that tobacco takes on society. What the unintended consequences of their use will be, however, remains to be seen.

25 Dec

NSW Greens MP Jeremy Buckingham Lights Up E-Cigarette in Parliament

A New South Wales Greens MP has lit up an e-cigarette in State Parliament to prove a point about legal loopholes around the vapour devices.

Greens health spokesman Jeremy Buckingham caused a stir when he leaned back in his seat and started blowing puffs of vapour from the device during Upper House Question Time.

Government Whip Peter Phelps jumped to his feet to alert the Upper House President to Mr Buckingham’s behaviour.

“Mr Jeremy Buckingham is clearly smoking a vape cigarette in this house, more importantly, he’s done it with clear pre-meditation,” Dr Phelps said.

“It is an outrageous act against the decorum of this house.”

Mr Buckingham replied: “I’m not smoking.”

The President of the Upper House, Don Harwin, reprimanded Mr Buckingham for using props, but he was allowed to remain in the chamber.

Other MPs called out that it was a “stunt” and called Mr Buckingham a “media tart”.

The Government has introduced a bill to Parliament to ban the sale of e-cigarettes to minors, but the Greens and Labor say it does not go far enough.

Mr Buckingham said e-cigarettes should be dealt with under all the same laws covering tobacco and nicotine, including banning their use in non-smoking areas under the Smoke-Free Environment Act.

He said his actions in the house highlighted the double standard applied to e-cigarettes.

“I was trying to make a very important point today that under NSW law and the modest reforms of the Government, it is still legal in this state to vape in a preschool, on a bus, in a public space and even in the Parliament,” he said.

“I was making the point that this is a really serious health issue and the current reforms don’t go far enough in protecting the community.”

18 Dec

E-Cigarettes More Effective Than Patches to Help Quit Smoking

E-cigarettes are more effective than nicotine patches and gum in helping people to quit smoking, according to a study that challenges the negative views of some public health experts.

The issue of e-cigarettes has become a public health battleground, alarming those who think that their marketing and use in public places where smoking is banned risks re-normalising tobacco.

Supporters say the vast majority of smokers are using e-cigarettes to kick their tobacco habit and that the health consequences of nicotine use without the tar from cigarettes appear, as yet, to be far less of a problem.

The study, by a team from University College London, looked at attempts of nearly 6,000 people to stop smoking and found that, while engaging with the NHS smoking cessation services was the most effective way to quit, using e-cigarettes beat nicotine replacement therapy, as well as the efforts of people to stop with no help at all.

Professor Robert West of the department of epidemiology and public health, the senior author of the study, said that it was extremely important to find out how well e-cigarettes worked as a quitting tool. “It really could affect literally millions of lives. We need to know,” he said.

He admitted, however, that it was a controversial area. He also acknowledged opponents’ fears and suspicions about the commercial involvement of scientists. “I don’t and will not take any money from any e-cigarette manufacturer,” he said. His department does take money from pharmaceutical companies that make smoking cessation drugs, but they are rethinking that. “I need to be able to talk about e-cigarettes without even the conception of conflict of interest,” he said.

The study, published in the journal Addictions, was based on surveys of people who had stopped smoking in a 12-month period between July 2009 and February 2014. In recent years, an increasing proportion report using e-cigarettes rather than over-the-counter nicotine replacement therapy such as patches or gum. Many try to quit without support. Those who cut out cigarettes completely do better than those who try to reduce the numbers they smoke. A very small proportion get help from the NHS smoking cessation services.

When the results were adjusted to account for the differences between the smokers in terms of background, age and other variables, those using e-cigarettes were around 60% more likely to quit than those using nicotine replacement therapy or just willpower.

“It is one piece of the jigsaw and not a final answer,” said West. “It may be different in different countries. If it [use of e-cigarettes for quitting] continues to grow, we will expect a public health benefit.”

He said there were misconceptions about e-cigarettes. “Despite what a lot of people think, e-cigarettes are not good news for the tobacco industry and the tobacco industry would like them to go away. They sell tobacco and would like to go on doing that,” he said.

The European Commission has decided that e-cigarettes should be regulated as consumer products below a certain nicotine strength, but that the higher strength versions, which campaigners say those trying to stop smoking need, should be regulated as medicines. In this country that would be the responsibility of the Medicines and Healthcare Products Regulatory Authority (MHRA). Two MHRA licences have so far been applied for, both by tobacco companies. West says that is because only the tobacco industry has the money and the time necessary to go through the licensing process, unlike the small and medium-sized e-cigarette manufacturers, which is a problem.

If e-cigarette use as a smoking cessation tool were to be supported in any way by the NHS, it would have to be via MHRA-licensed products to ensure quality, he said.

“I think it would be perfectly reasonable for people to consider e-cigarettes for use with their patients,” he said. “The NHS would only get involved where the products had that mark of approval. I don’t think the NHS could engage with e-cigarettes outside that process.”

Pharmaceutical companies such as GSK and Pfizer, which make smoking cessation drugs, are among the opponents of e-cigarettes. “They are losing sales hand over fist to e-cigarettes and are incentivised to make it appear they are not effective,” said West.

A section of the public health community is also hostile. “It is related to a broad distaste for large corporations making large amounts of money out of psychoactive drugs,” he said. “You might see some of it as a puritanical ethic, which is a strong driver.”

17 Dec

E-Cigarettes Case Goes up in Smoke Following Landmark Ruling in WA Court

NSW tobacco laws could be amended to specifically outlaw electronic cigarettes after a landmark legal test case in WA led to the criminal prosecution of an online stockist.

”E-cigarettes”, or vapourisers, are battery-powered devices that simulate the effects of smoking by heating a nicotine liquid into vapour, which the user then inhales and exhales.

It has always been illegal to sell e-cigarette liquids that contain nicotine under Australian law but in a big development last week, the Supreme Court of Western Australia effectively banned e-cigarettes outright in the state, prosecuting a company, called HeavenlyVapours, which had been selling the dispensers and nicotine-free ”e-juice” through a website.

The ruling means that anyone over 18 in WA can legally smoke a cigarette containing multiple chemicals and carcinogens, but cannot buy the electronic version which many claim has assisted thousands of smokers to quit worldwide.

Last week, the owner of HeavenlyVapours, Vince van Heerden, said of the ”case law precedent” in an online forum: ”One can only imagine that the other states may now try to follow suit.”

Asked about the case, the NSW Ministry of Health confirmed it was ”continuing to monitor” the case and was waiting to see ”whether the decision may be appealed.”

In the meantime, it confirmed more than a dozen Sydney retailers were facing legal action after being caught selling illegal nicotine-laced e-liquids, late last year.

”Prosecutions are being considered for breaches of the Poisons and Therapeutic Goods Regulation 2008 and evidence has been collected,” a Health Department spokesman confirmed.

Vapourisers range from imitation cigarettes that cost as little as $20, to the Romanian built Wizard Evolved DA20 which sells for $1000.

In 2011, HeavenlyVapours’ premises were raided by the Western Australian Health Department over alleged breaches to section 106a of the Tobacco Products Control Act which prohibits the sale of anything such as food or a toy that mirrors a tobacco product. But in September last year, HeavenlyVapours was acquitted by a magistrate’s court which ruled there was insufficient evidence that the e-cigarettes in question looked anything like traditional cigarettes or cigars, pointing out the devices could just as easily resemble a ”fountain pen”.

But several weeks after the case was dismissed, the WA Health Department lodged an appeal which proved successful last week with the judge determining that any e-cigarette product that involves ”a hand to mouth action” and results in the ”expulsion of vapour” does in fact resemble a tobacco product.

Mr Van Heerden said his legal costs to date were almost $45,000 ”for something no one has ever been charged or prosecuted for before”.

But he has vowed to fight on. ”Common sense and dozens of studies demonstrate that e-juice consumed through e-juice/personal vapourisers do not contain the many thousands of deadly chemicals traditional tobacco cigarettes do,” he said online. ”We deserve the right to choose an alternative.”

15 Dec

Philip Morris Buys E-Cigarette Maker Nicocigs

Philip Morris has snapped up one of Britain’s fastest-growing electronic cigarette-makers, Nicocigs, as it warned profits from its traditional business will be lower than expected.

Nicocigs, was founded in 2008 and is based in Birmingham, is best known for its Nicolites brand.

Philip Morris, the owner of Marlboro, said the acquisition will give it “immediate access to, and a significant presence in, the growing e-vapour category in the UK market, as well as a strong retail presence”.

Nicocigs has about 27 per cent of the UK’s e-cigarette market, which has an estimated total retail value of $350 million (£206 million). The start-up employs 40 sales staff and distributes to 20,000 stores in Britain.

The purchase price for Nicocigs was undisclosed. The company reveals few financial details but it had amassed shareholder funds of £7.7 million by August 2013, according to Companies House. Nishil Nathwani, 27, is the leading shareholder.

The deal comes as Philip Morris, the world’s biggest tobacco firm, cut its profits forecast by about 4 per cent to between $4.87 and $4.97 per share on poor sales and price-cutting in Australia.

The stock fell nearly 2 per cent in trading on the German stock market. Chief executive André Calantzopoulos warned that the firm faces “significant currency headwinds … and known challenges in Asia”.

Calantzopoulos said the advent of e-cigarettes and other “reduced-risk” products means the tobacco industry is at “the early stage of a transformational process”.

Philip Morris reckons it could make $700 million of profit from “reduced-risk” products if it can reach a target of selling 30 billion units. But it also said it will run up $495 million in redundancy costs in September as it stops production in the Netherlands.