E-cigs are the new kid on the block as far as nicotine products go leaving many unanswered questions, says Dr James Cant
Whenever I’m talking to people in my role as Head of British Lung Foundation Scotland, there’s one topic that always comes up. Electronic cigarettes. They’re on everybody’s lips, often literally. And there are so many questions. Are they safe? What’s in them? Do they help you quit smoking? Are they attracting children to start using tobacco?
These products are very new, so we don’t have solid answers to all those questions. E-cigs were only invented in 2004 and although they’ve take the market by storm in recent years the evidence base about their effectiveness and potential risks is still comparatively small. What we can say is that, if you’re using a reputable and well-made brand, “vaping” an e-cigarette is almost certainly a lot safer than smoking a tobacco cigarette. Tobacco kills one of every two regular users. There is no evidence that e-cigarettes are anything like as harmful. But we can’t say that they’re totally harmless. And it will be years before we can accurately assess the long-term impact of their use. A more immediate safety concern can be found from the many press stories about chargers melting, going on fire or even blowing up. Sadly this is an inevitable outcome of what has until now been an unregulated market. The result has been that there are hundreds of different brands available, many of them made with little quality control. That not only means you might get a substandard charger, but research has found that many e-cigs that claim not to contain nicotine actually do, and that many that claim to have certain concentrations of nicotine in fact have drastically more or drastically less. This is unlikely to be harmful – nicotine by itself, though very addictive, isn’t poisonous in the quantities you might be able to vape. But more alarming reports have come in of low-quality e-cigarettes giving off nano-particles of tin from where different elements have been soldered together. That doesn’t fill you with confidence.
There are also the associated risks of exposure to large quantities of nicotine. Many e-cig devices have a refillable tank, which allows users to top the device up with “e-liquid” containing their preferred strength of nicotine and any flavours they like. That’s fine, but the e-liquid bottle can contain a dangerous quantity of nicotine, particularly if a child or a pet were to get hold of it.
These issues, serious though they may be, shouldn’t mask the main point – if you take sensible precautions, using an e-cigarette is almost certainly much safer than smoking tobacco.
Do they help you quit smoking? For thousands of people in the UK, the answer has been a definite yes. A lot of those people have become enthusiastic advocates of the device. But there’s still an open question as to how effective quitting using an e-cig can be. The evidence that we have at the moment says that they’re about as helpful as using nicotine replacement therapy – gum, patches, lozenges or sprays. That’s definitely good, and better than going cold turkey. But there are other therapies and medicines available on the NHS which are more effective.
That said, many people find that e-cigarettes do work for them. And if they work for you, that’s good. If you smoke, the most important thing you can do for your health is quit, so anything that helps you is a good thing. But e-cigs aren’t a panacea, and they aren’t the right answer for everyone.
So we know that e-cigarettes help some people stop smoking. But do they convince others to start? There’s a lot of concern about a so-called “gateway effect”, where children, attracted by the flavours or marketing of e-cigarettes, start using them only to move on to tobacco later on. And we’re right to be cautious given that so many e-cig firms have been bought up by the tobacco industry. We know the tobacco industry’s principal aim will remain to hook the next generation on to their traditional product – cigarettes. The emergence of a whole host of fruit flavoured e-cigs has strong echoes of the marketing ploys used to promote alcopops some years ago. It’s a worrying trend and we’d be wise to remain cynical about big tobacco’s motives. The good news is that there isn’t yet any real evidence of it happening. A recent major survey of Scottish teenagers showed that less than 5 per cent had tried e-cigs without already being smokers.
So it’s a complicated situation that won’t become completely clear for some years to come. But e-cigs are here and they’ve already made a huge impact on the market. They may well help people reduce their tobacco consumption and even quit and we need to maximise their potential to support this process. But at the same time we need to be aware of the tobacco industry’s ulterior motives and ensure that the sale and use of e-cigs is confined to adults only.
l Dr James Cant, head of British Lung Foundation Scotland