Electronic cigarettes - miracle or menace?

Electronic cigarettes do not have tar, the harmful part of a normal cigarette

The number of people using e-cigarettes in the UK is expected to reach a million this year but while some believe the electronic alternative to tobacco could help save hundreds of thousands of lives others think they normalise what looks like smoking and may be unsafe

Anyone walking into a busy pub in Manchester may well be confronted with a rather shocking sight.

At one table it looks like a group of friends are smoking, but there is no smell in the air and no ashtrays on the table. What they are using are e-cigarettes.

One of the women, Steph, says the e-cigarette has helped her to stop smoking.

"I've tried patches and inhalator's," she says. "They're a lot better because you feel like you're having a cigarette."

"They're a great idea," says another woman, Lisa. "You've got the health benefits from it and it does taste like a cigarette."

The e-cigarette comes in two parts.

In one end there is liquid nicotine, in the other a rechargeable battery and an atomiser. When the user sucks, the liquid nicotine is vaporised and absorbed through the mouth. What looks like smoke is largely water vapour.Because there is no tobacco in e-cigarettes, there is no tar and it is the tar in ordinary cigarettes that kills.

Safety concerns

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If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths in people who are alive today”

Professor John Britton. Royal College of Physicians The e-cigarette market is growing fast. A survey by the charity Action on Smoking and Health (ASH) suggests 700,000 people in the UK were using e-cigarettes last year. The charity estimates that number will reach a million in 2013 and some medical experts see huge potential benefits.

"Nicotine itself is not a particularly hazardous drug," says Professor John Britton, who leads the tobacco advisory group for the Royal College of Physicians.

"It's something on a par with the effects you get from caffeine. "If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths in people who are alive today. It's a massive potential public health prize." There are however concerns about the safety and regulation of e-cigarettes. They can legally be sold to children. There are few restrictions on advertising. Critics say some of the adverts glamorise something that looks like smoking. Unlike patches and gum, e-cigarettes are not regulated like medicines. It means there are no rules for example about the purity of the nicotine in them.

Regulation call

So are e-cigarettes safe?

"The simple answer is we don't know," says Dr Vivienne Nathanson from the British Medical Association (BMA). "It's going to take some time before we do know because we need to see them in use and study very carefully what the effects of e-cigarettes are."

The BMA is just one of the bodies to respond to a consultation on e-cigarettes by the Medicines and Healthcare products Regulatory Agency. The agency is deciding whether the e-cigarettes should be licensed as a medicine and more tightly regulated. The BMA thinks they should.

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I don't think there's any difference between going for a caffeine break and having a nicotine break”

Lawrence Jones

UK Fast

"I would either take them off the shelves or I would very heavily regulate them so that we know the contents of each e-cigarette were very fixed," says Dr Nathanson. E-cigarettes are currently classed as a general consumer product and regulated by trading standards. It means they cannot contain hazardous chemicals, for example, and that the battery in them must meet EU standards. The trade association for e-cigarettes, the Electronic Cigarette Industry Trade Association, says they make no medicinal claims for their product. It is sold merely as an alternative to ordinary cigarettes.

Attempts to classify e-cigarettes as a medicinal product have been made in Holland and Germany but the industry successfully overturned the decisions in court.

Workplace etiquette

One UK based distributor, called VIP, says over stringent regulation could see them go out of business. Nonetheless Andy Whitmore, the company's marketing director, said it would "welcome regulation that ensures the product can't be sold to anyone under the age of 18".

There are many other questions. For example, should using e-cigarettes be allowed in a public place? At the offices of UK Fast - an internet storage company - employees can use them at their desk.

"It's a tricky one," says the company's chief executive officer, Lawrence Jones.

"It does look like smoking but could you stop someone from chewing a pencil or biting their nails? I don't think there's any difference between going for a caffeine break and having a nicotine break."

Other companies have banned it. But in theory electronic cigarettes can be used anywhere - on planes, trains, in hospitals.

The BMA is worried that the more people start using e-cigarettes the more it will normalise something that looks like smoking. They have called for the ban on smoking in public places to be extended to e-cigarettes.

A decision on whether the regulation of electronic cigarettes should be tightened will be made in a few weeks.

http://www.bbc.co.uk/news/uk-21406540

Electronic cigarettes seem to work

Electronic cigarettes seem to work, psychologically and physically

Since many of my patients have reported using electronic cigarettes to successfully stop smoking, I now recommend the devices to anyone who has tried to quit smoking cold turkey and failed.
And I think it is time that other doctors do, too.
Electronic cigarettes combine a mouthpiece, which contains liquid (including nicotine), an atomizer (which heats the liquid and turns it into vapor), a battery and an LED tip that glows like the tip of a lighted cigarette.
While early versions of the electronic cigarette date back to 1963, with a patent awarded to inventor Herbert Gilbert, the modern versions of electronic cigarettes—the basis for big brands in the industry, such as LOGIC and Blu—were introduced at the beginning of this century.
The reason my patients tell me electronic cigarettes work better than the patch or nicotine gum is that they simulate the act of smoking, but not perfectly.  They are good enough to substitute for real cigarettes, but they aren’t good enough to become an addiction, in and of themselves.  An analogy in the arena of food addiction would be something low calorie that fills you up enough to prevent bingeing on sweets, gives you some distance from that addiction, but then becomes forgettable, because it isn’t really all that compelling.
It is, of course, imperative that the electronic cigarette be a good-enough fake.  And, on this count, LOGIC seems to have a slight psychological advantage, given what patients tell me is a very realistic smoking experience—but not too realistic, as noted above.  Interestingly enough, the LOGIC brand seems to be the best-selling one in New York City, perhaps because of these factors.
There is certainly controversy about whether electronic cigarettes are harmless.  Critics note that they do, of course, contain nicotine (which is the whole idea, after all).  And critics have also found other substances in the vapor released by electronic cigarettes—even cancer-causing substances, but in tiny, tiny amounts that proponents of the devices claim would have no negative effect on well-being at all.
What no one seems to argue about is that electronic cigarettes—from LOGIC or Blu or any leading brand—are not nearly as dangerous as smoking real cigarettes.  LOGIC claims its device avoids 4,000 toxins that are found in cigarettes.
Given my experiences and those of numerous clinicians I have spoken with, it would seem to be a good time to conduct large scale clinical trials in which patients who smoke are given electronic cigarettes by their doctors, encouraged to use them and then quizzed on their use of real tobacco weeks and months and years later.  If the data generated support the product, then it may be wise for medical insurance companies to offer electronic cigarettes to smokers for free.  My bet is they would save lots of money—from the costs of treating heart disease and cancer—down the road.
Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at

http://www.foxnews.com/health/2013/01/30/electronic-cigarettes-seem-to-work-psychologically-and-physically/

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