To #Vape or not to Vape? That is the question

Despite decades of efforts to counter the problem, smoking remains a major public health risk for Europeans as the number of smokers in the world has increased rather than fallen, writes Martin Banks.

But what is perhaps less well known is that tens of thousands of people have been helped to quit smoking - by using e-cigarettes.

Some, including no less a body than the World Health Organisation, still remain sceptical of the potential for new technologies, including electronic cigarettes, to reduce smoking-related harm.

The scepticism can be traced back to the organization’s Framework Convention on Tobacco Control (FCTC), which has been pressuring policymakers to employ strict regulations and treat e-cigarettes like tobacco.

The FCTC, which operates in secrecy and bars journalists from attending its meetings, has militated in favour of a “quit or die” approach of reducing demand by raising taxes and has repeatedly stymied initiatives aimed at harm reduction. The upcoming meeting, the 7^th Conference of Parties (COP7) to be held in November in India, is expected to deliver new recommendations to policymakers to that effect.

But is such pessimism misplaced?  Do e-cigarettes really have the potential to help smokers quit and, in doing so, curb the ever-rising death toll of smoking-related death and disease?

Alison Cox, director of prevention at Cancer Research UK, believes so.

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She is among those firmly in the camp that insists e-cigarettes can play a key role in helping smokers to quit, suggesting that the evidence so far shows e-cigarettes are much safer than tobacco.

Indeed, Cox says e-cigarettes may help some smokers move away from tobacco entirely.

The authorities in the UK are not alone in generally supporting this relatively new product.

France recently became the latest country to come out in favour of e-cigarettes, suggesting they are an effective tool for smokers who are looking to reduce or replace tobacco.

Tabac Info Service, run by government body Public Health France, said “according to the latest work of the High Council on Public Health (Haut Conseil de la Santé Publique), electronic cigarettes can constitute a tool to help stop or reduce consumption of tobacco” and also “reduce the risk of developing serious illnesses such as cancer”.

And in neighbouring Belgium, the country’s public health minister Maggie De Block recently enthusiastically approved the sale of e-cigarettes containing nicotine.  Previously, it was only possible to purchase nicotine-free e-cigarettes. Vaping, said De Block, can help people stop smoking because e-cigarettes contain 95% less nicotine than regular cigarettes.

The overall consensus appears to be that electronic cigarettes can help smokers kick the habit and do not pose serious side-effects in the short-to mid-term.

This is evidenced by the findings of the Cochrane Collaboration, a respected medical research group which examined the best available evidence on the devices.

It estimates that in 2015 e-cigarettes alone may have helped about 18,000 smokers in the UK to quit who would not otherwise have stopped.

According to its findings, published recently in the British Medical Journal, the devices appear to be linked to a decrease in the use of nicotine replacement therapies on prescription.

While many agree on the benefits of vaping, the issue becomes ignited because of legislation, on both sides of the Atlantic that places such devices in the same category as tobacco.

This has happened in Hungary, a country of heavy smokers, where a new bill tabled earlier this year in parliament seeks to regulate electronic cigarettes and related products, treating them the same as regular tobacco products.

At the EU level, the debate on e-cigarettes is intensifying with British MEPs taking steps against what they have branded ‘restrictive’ new EU rules covering the sale of e-cigarettes.

They include UK MEP Julie Girling who has spoken of the “potential public health benefits of e-cigarettes”.

She and Tory party colleague Vicky Ford have now written to Research, Science and Innovation Commissioner Carlos Moedas asking him to examine the latest evidence on the health effects of vaping and whether it can help long term smokers give up traditional cigarettes.

Last month, Public Health England published a review, described by Cancer Research UK as a “robust piece of work”, which concluded that e-cigarettes are 95 per cent less harmful than tobacco.

Cancer Research UK says that such evidence points to e-cigarettes being “far safer” than tobacco cigarettes – a toxic product which kills up to two thirds of its long-term users.

Girling and Ford hope that if Moedas comes to a similar conclusion, the European Commission will look again at the controversial EU Tobacco Products Directive.

 Article 20 of the directive, which is currently being implemented by EU member states, will force e-cigarette manufacturers to either classify their products as cigarettes or face tight rules on advertising, or as medicinal products and sell them only in pharmacies. The EU directive also restricts the amount of nicotine cartridges can contain and introduces what some label burdensome new manufacturing standards.

Under the draft legislation, e-cigarettes will not only be regulated - having to meet certain quality and safety standards - but if companies claim e-cigarettes help smokers quit they will have to seek a medicines license.

Girling, the Conservative environment co-ordinator, told this website: "There is great concern that the new regulations will dissuade smokers from switching to e-cigarettes. There was little scientific input when this part of the directive was drawn up and further evidence has subsequently highlighted the potential public health benefits of e-cigarettes. We believe it is time some facts were introduced into this debate and hope Moedas will agree to our request.”

Her endorsement of the potential benefits of e-cigarettes is echoed by Ford, the Conservative spokesman on the Internal Market, who told EU Reporter: “The EU restrictions on electronic cigarettes were swept into the new tobacco laws without the chance to take into account expert evidence.

"We all received thousands of emails and letters from users who argue that the products have enabled them to give up traditional smoking. The EU commissioner has now appointed a group of scientific experts and it would be useful to hear their advice on whether the restrictions are appropriate."

The EU plans would also mean e-cigarettes being placed under the same tax arrangements as cigarettes and cigars and this has sparked concerns that that could damage public health.

Deborah Arnott, of the health charity ASH, believes so, saying: “If the EU were to require states to tax electronic cigarettes like tobacco products it would be detrimental to public health. It would discourage smokers from switching.”

Jamie Hartmann-Boyce, author and editor of the Cochrane Tobacco Addiction Group, said: “Fundamentally, tobacco researchers on both sides of the argument want the same thing – to reduce death and disease. We’re in the same boat.”

Cigarettes are uniquely deadly. They kill two in three people who use them regularly. E-cigarettes are said to be safer than traditional smoking. What’s not to like?

If you’re asking whether e-cigarettes are safer than regular cigarettes, most experts certainly lean on the side of “yes”. The message is: simply because e-cigarettes are new to the scene is no reason to seek to extinguish their growth.

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