E-cigarettes should be banned indoors, says WHO
UN health agency recommends tighter controls on e-cigarettes, but some experts say bans 'could cost countless lives'
A new report from the World Health Organization has warned that e-cigarettes could be more toxic than many people currently believe and recommended that the devices should be banned indoors. But some experts say the UN agency's advice is an "overreaction" that could cost lives.
Contrary to the claims of some manufacturers who argue that e-cigarettes are a comparatively safe alternative to smoking, the WHO's report said that e-cigarettes expose smokers and non-smokers alike to harmful chemicals.
The report urged tougher controls, arguing that the "smoke" emitted by e-cigarettes "is not merely water vapour as is often claimed in the marketing for these products", but often contains harmful pollutants. The WHO also warned that using e-cigarettes, or "vaping," could lead to a "renormalisation" of smoking.
The WHO added: "The fact that ENDS (electronic nicotine delivery systems) exhaled aerosol contains on average lower levels of toxicants than the emissions from combusted tobacco does not mean that these levels are acceptable to involuntarily exposed bystanders."
The report was welcomed by many UK health officials, the Daily Telegraph reports. Professor John Ashton of the Faculty of Public Health told the paper: "Most adult smokers start smoking before the age of 18. That's why many public health experts are concerned that the advertising of electronic cigarettes could make it seem normal again to think smoking is glamorous, when it is anything but.
"We also don't know enough yet about the harms and side effects of electronic cigarettes, and it will take years before we can be sure what they are."
However some experts believe that strict regulation could mean fewer people giving up conventional cigarettes in exchange for their electronic counterparts, which could lead to more smoking-related deaths.
Gerry Stimson, from Imperial College London, told The Times: "What is needed is light-touch regulation and a proper appreciation of trade-offs between regulation to protect consumers whilst not destroying the value these products offer to smokers who want to quit smoking".
He added: "The WHO position paper appears to have cherry-picked the science, used unnecessary scaremongering and misleading language about the effects of nicotine."
E-CIGARETTES: Safer than tobacco, say researchers
Electronic cigarettes are "less harmful" than traditional cigarettes, new analysis of recent studies has shown.
An international group of scientists analysed data from over 80 studies conducted on the use and sale of e-cigarettes. According to the BBC, it focused on safety concerns, the toxicity of the chemicals present in both the liquid and the vapour and analysed the rate of use among non-smokers as well as smokers.
The analysis also showed that e-cigarettes are not regularly being used by non-smokers or those under the age of 18. It said that there was no evidence that the products encouraged young people to start smoking.
Most significantly, scientists showed that e-cigarettes can help smokers cut down their cigarette intake and even help them quit entirely. And they warned that tough regulation of the new industry could "damage public health on a big scale".
"Regulators need to be mindful of crippling the e-cigarette market and by doing so failing to give smokers access to these safer products that could save their lives", said Professor Peter Hajek, one of the authors of the paper.
However, Prof Martin McKee, of the London School of Hygiene and Tropical Medicine pointed out that despite the research, health professionals remain "deeply divided" on the issue.
So what do we know about e-cigarettes, and should they be regulated?
What are e-cigarettes?
E-cigarettes come in a range of shapes and sizes, but common to all of them is the way they work. A built-in battery powers a small electronic heating element located in the "atomiser", which draws liquid up from a cartridge and onto the element. The solution, usually a mixture of propylene, glycol, glycerine, flavourings, and – critically – nicotine, turns to vapour and is inhaled through the mouthpiece.
Some e-cigarettes look like a regular tobacco cigarette, others look more like the top of a hookah pipe. Others still have been made to look like a traditional pipe – the kind that Sherlock Holmes smoked.
Are they dangerous?
Anna Gilmore, director of the Tobacco Control Research Group at the University of Bath told The Guardian: "E-cigarettes are certain to be way less harmful than cigarettes. Common sense would dictate that". But their long-term effects still remain unknown.
The WHO says that their safety is "illusive", noting that it is impossible to know what effect they may have on the body because "the chemicals used in electronic cigarettes have not been fully disclosed, and there are no adequate data on their emissions".
The British Medical Association (BMA) has also expressed concerns about the lack of adequate testing or controls. "The real truth," says Gilmore, "is that we just do not know. We cannot say e-cigarettes are risk-free. We cannot yet be sure what impact they will have on smoking rates or population health, whether they'll be the miracle product or not."
Should they be regulated?
Professor Robert West, of University College London told the BBC that e-cigarettes should be "regulated appropriate to what they are" and that they are "orders of magnitude safer" than tobacco cigarettes
He suggested "bespoke regulation" including banning sales for under-18s and controls on how the devices are advertised.
Dr Vivienne Nathanson, the British Medical Association's director of professional activities, told the BBC that there was evidence that children were beginning to use e-cigarettes as a direct result of marketing campaigns.
"Rather like cigarettes in the 50s and 60s, we really need to look at [advertising] and, I believe, ban it, to stop them advertising in a way that attracts children," she said.
Professor John Ashton, president of the UK's Faculty of Public Health, agreed that the possibility that advertising might impact on children was a cause for concern.
E-cigarettes are currently not regulated as medicines in the UK, the Daily Telegraph notes, but Britain's drug watchdog the MHRA wants to introduce new controls by 2016.
Are e-cigarettes bad for you? Doctors urge new controls
More research into the potential risks of e-cigarettes is needed, experts have said, after a new study found that nearly 30 million people across Europe now use the battery-powered nicotine products.
A survey of 26,500 people across 27 European countries suggested that e-cigarettes have been tried by 20.3 per cent of current smokers, 4.7 per cent of ex-smokers and 1.2 per cent of people who never smoked. The study concludes that more than 29 million European adults have tried the products.
The rise in e-cigarette use has led to a "staggering" growth in new products; around ten new brands come to market every month, Reuters reports.
The study, published in the journal Tobacco Control, emphasised the need for more research into the effects of using electronic cigarettes.
"These findings underscore the need to evaluate the potential long-term impact of e-cigarette use on consumer health, cessation and nicotine addiction and formulate a European framework for e-cigarette regulation," the report concluded.
The study was published as a group of doctors and health experts from around the globe urged the World Health Organisation (WHO) to enact new controls on e-cigarettes.
A letter to the director general of the WHO, Margaret Chan, recommended the same kind of regulation as tobacco products, with specific bans on how the devices are promoted and advertised.
The group wrote: "By moving to the e-cigarette market, the tobacco industry is only maintaining its predatory practices and increasing profits.
"Manufacturers of electronic nicotine delivery systems are making a range of false and unproven claims, misleading the public into thinking these products are harmless (they are not) and effective cessation aids (unknown)".
But the issue of how e-cigarettes should be regulated remains contentious. Last month 53 scientists urged the WHO not to impose bans on the new devices, suggesting that they may actually be beneficial to people's health.
"These products could be among the most significant health innovations of the 21st century – perhaps saving hundreds of millions of lives," they wrote. "The urge to control and suppress them as tobacco products should be resisted". ·