{"id":142,"date":"2018-06-16T14:43:10","date_gmt":"2018-06-16T13:43:10","guid":{"rendered":"\/?page_id=142"},"modified":"2018-06-16T14:43:10","modified_gmt":"2018-06-16T13:43:10","slug":"the-e-cigarette-debate-in-an-historical-context","status":"publish","type":"page","link":"https:\/\/smokingoutthetruth.com\/the-paper\/the-past-the-present-the-future\/the-e-cigarette-debate-in-an-historical-context\/","title":{"rendered":"The e-cigarette debate in an historical context"},"content":{"rendered":"

We tend to become like the worst in those we oppose.<\/em><\/strong>
\nFrank Herbert<\/p>\n

As discussed above, the issue with cigarettes turns on combustion not on nicotine. If it were possible, therefore, to deliver nicotine without combustion there should be a benefit to an individual\u2019s health and therefore to \u201cpublic\u201d health. This is genesis of the concept of the electronic cigarette, the first version of which was patented in the 1960s.<\/p>\n

The debate about the e-cigarette market has been played out in scientific circles, the media and in the investment industry. There are very many, strongly held views on all sides regarding safety, regulation, usage, targeting, product design, the role of the existing tobacco industry and the potential costs and benefits to users and society more generally.<\/p>\n

The UK has been seen as one of the most progressive nations with respect to e-cigarettes with both endorsement from Public Health England<\/a> and a licencing programme<\/a> for Nicotine Containing Products as Medicines. By contrast e-cigarettes are banned in Australia, Argentina, Hong Kong, Mexico and Singapore, for example. How can it be that there are such divergent views?<\/p>\n

The argument in favour of e-cigarettes is fairly straightforward: e-cigarettes do not contain tobacco and do not involve combustion; there are typically only four components to the aerosol inhaled by consumers namely propylene glycol (glycerine), water, flavourings and usually – but by no means always – nicotine; they do not produce smoke.<\/p>\n

There is a weight of scientific evidence<\/a> that e-cigarettes do not expose users to the risks of combustible cigarettes. The veracity of the claim that e-cigarettes are “95% safer” than cigarettes is a different matter, but to be able to say that for those that wish to continue using nicotine but do not want the risks of smoking that e-cigarettes are “a good thing\u201d seems justifiable, and sensible.<\/p>\n

Countering this there are various strands of arguments used against e-cigarettes; that it is too early to tell if harm is genuinely reduced; that there are potential risks from e-cigarettes either from “fine particles” or from certain chemicals contained in vapour; that they \u201crenormalize\u201d smoking; and that they will act as a \u201cgateway\u201d product initiating youth into nicotine addiction which will inevitably lead to cigarette smoking.<\/p>\n

The headlines regarding the potential risks<\/a> of e-cigarettes have received much coverage<\/a> and have resulted in a situation where survey data suggests that uncertainty regarding the relative safety of e-cigarettes has been increasing rapidly.<\/p>\n

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Chart 7: Adult population perception of harm from e-cigarettes relative to smoking (2013-2016)<\/p><\/div>\n

Source: ASH. Unweighted base: All GB adults who have heard of e-cgarettes. 2013 n=8936; 2014 n=11,307; 2015n = 11340; 2016 n=11489<\/div>\n
<\/div>\n
Simplifying the answers into just two views of \u201cNeutral or negative\u201d and \u201cPositive\u201d shows that over the last four years uncertainty has increased to the point where the majority view is now that e-cigarettes are not necessarily safer<\/div>\n
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Chart 8: Positive v Neutral or negative, 2013 (%)<\/p><\/div>\n

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Chart 9: Positive v Neutral or negative, 2016 (%)<\/p><\/div>\n

This level of uncertainty is important for a number of reasons. Firstly for smokers considering vaping as an alternative to smoking, if there is uncertainty of any health benefit the decision to cease smoking may not be made which seems entirely counter to the objective of \u201cpublic health\u201d. Secondly the survey is not of e-cigarette users but of the general population. If the general public is not convinced that vaping is safer than smoking then the same approach of regulating vaping in \u201cpublic places\u201d can be pushed through by playing on the same, engineered, perception of \u201csecond hand\u201d risk.<\/p>\n

Perhaps one of the major stumbling blocks in the growth of the vaping trend has been that the original claims made by many manufacturers that \u201cyou can vape anywhere\u201d have been undone by increasing levels of regulation which precludes vaping in the same places that smoking is already restricted. Vaping bans are already common on airlines, public transport, pubs and at least one major global financial institution which once employed me. In the latter case the arguments against the use of e-cigarettes on company premises included that the FDA had not ruled on them; the American Cancer Society had not ruled on them; they were \u201ca bit smelly\u201d; and that they may present a visual distraction for those trying to quit smoking. On this latter point, those on a diet were not prevented from entering the canteen despite the visual distraction that food might have presented.<\/p>\n

In November of 2016 WHO will hold the 7th \u201cConference of the Parties<\/a>\u201d to the Framework Convention on Tobacco Control. It has released the documents for the five day conference, including one on \u201cElectronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems<\/a>\u201d. The document raises a number of issues pertinent to the debate about e-cigarettes, but also to the debate about tobacco control more generally.<\/p>\n

The document is equivocal on the potential health benefits of vaping relative to smoking and quotes of the risks a number of claims which have been roundly dismissed elsewhere but does state that \u201cit is very likely that ENDS\/ENNDS are less toxic than cigarette smoke<\/em><\/strong>\u201d. It also states that it is \u201creasonable to assume that the increased concentration of toxicants from second hand aerosol (SHA) over background levels poses an increased risk for the health of all bystanders<\/em><\/strong>\u201d. It argues that \u201cgiven the scarcity and low quality of scientific evidence, it cannot be determined whether ENDS may help most smokers to quit or prevent them from doing so<\/em><\/strong>\u201d. It is uncertain that ENDS\/ENNDS use in youth is a precursor to smoking (i.e. \u201cthe gateway effect\u201d) but states that \u201cENDS\/ENNDS use by minors who have never smoked at least doubles their chance of starting to smoke<\/em><\/strong>\u201d. It also finds that \u201cA growing concern is the extent to which research on the topic has links to commercial and other vested interests of the ENDS\/ENNDS industry, including the tobacco industry, and its allies. In a review of 105 studies analysing the composition of liquids and emissions, 30% had authors that had received funding from ENDS\/ENNDS interests – including the tobacco industry<\/em><\/strong>\u201d.<\/p>\n

The paper concludes with four objectives:<\/p>\n