Issue 22 / 23 June 2014

THE role of e-cigarettes in smoking cessation has split Australian experts, with the battlelines drawn between harm minimisation and tougher regulation.

Leading public health advocates on both sides of the debate have urgently petitioned the WHO with their cases, ahead of a major meeting to determine global tobacco policy in October. (1)

Professor Wayne Hall, chair of the Centre for Youth Substance Abuse Research at the University of Queensland, said those supporting a ban on e-cigarettes had “lost sight of the possible gains to smokers because their thoughts are dominated by the fear of what big tobacco is up to”.

He called for the battery-powered devices and the “e-juices” they vaporise to be “made legally available in Australia”, to ensure their safety and quality.

Currently it is illegal to sell or supply nicotine-containing e-cigarettes and e-juices in Australia, but experts agree the products are being widely purchased over the internet.

Professor Hall said the e-cigarettes can contain highly variable amounts of nicotine, ranging from none at all to 20 times the content of an ordinary cigarette.

“Only products that have passed some quality control should be sold, including having dependable nicotine delivery, maximum levels of particulate matter and childproof nicotine containers”, he said.

Professor Hall was one of almost 60 doctors who petitioned the WHO in May not to class e-cigarettes in the same category as tobacco cigarettes. (2)

The letter stated that it was “hard to imagine major reductions in tobacco-related [non-communicable diseases] without the contribution of tobacco harm reduction”.

“Even though most of us would prefer people to quit smoking and using nicotine altogether, experience suggests that many smokers cannot or choose not to give up nicotine and will continue to smoke if there is no safer alternative available that is acceptable to them”, the petition said.

Although no randomised controlled trials have proved e-cigarettes are superior to conventional quitting aids, Professor Hall told MJA InSight the devices could increase rates of quitting if more smokers were prepared to use them than had been the case for nicotine replacement therapy.

However, Professor Simon Chapman, professor of public health at the University of Sydney, argues the devices are more likely to prolong smoking addictions and renormalise smoking culture.

In a separate petition to the WHO, Professor Chapman and 128 other health professionals warned that the tobacco industry was behind a disingenuous push to have e-cigarettes seen as smoking cessation aids. (3)

They drew parallels to the mistakes of history, saying public health experts had mistakenly embraced cigarette filters and “low tar” cigarettes as “harm reduction” strategies in the past, which were actually “designed to promote cigarette sales by reassuring a concerned public that the new products were safer”.

The letter cited evidence that most e-cigarette users continued to smoke tobacco cigarettes, albeit fewer, and were less likely to stop smoking than non-users.

“The available epidemiology doesn’t show that just cutting back on the number of cigarettes translates into reduced harm. It’s the duration of smoking that matters most for lung cancer”, Professor Chapman told MJA InSight.

Professor Stephen Leeder, another signatory to the letter and editor-in-chief of the MJA, told MJA InSight that the enthusiasm of the tobacco companies for e-cigarettes immediately aroused his suspicion.

“The safety studies have not been done, but previous work on ‘safe cigarettes’ (so-called) has shown them not to be safe”, Professor Leeder said. “Precautionary principles suggest we should be vigilant and skeptical about e-cigs.”

Both Professors Hall and Chapman agreed GPs were likely to face questions from patients about e-cigarettes. They agreed that while any quit attempt should be encouraged, patients should be informed of the limited evidence to support e-cigarette use in smoking cessation.

Professor Hall told MJA InSight: “To receive a health benefit, patients should aim to stop all smoking rather than just using e-cigarettes to replace some cigarettes”.

The debate comes as new research shows more than 460 brands of e-cigarettes and more than 7000 unique flavours of e-juice are being marketed online. According to the study in a special supplement in Tobacco Control, co-edited by Professor Hall, the market is growing at a rate of 10 new brands and 242 new flavours a month. (4)

The study identified a potent shift in the marketing messages about e-cigarettes in the past 2 years, away from advertising them as an alternative to cigarettes towards painting them as product in their own right called an “eGO” or a “mod”.

Professor Chapman seized on the findings as evidence that sellers are appealing to a younger generation of non-smokers as part of a growing youth culture of “vaping”.

However, the authors of the study said that was just one possible interpretation of the data. “Is it possible that the newer products, which continue to move away from being cigarette-like, will actually render conventional cigarettes unattractive to youth?” they wrote.

A second study in Tobacco Control found 20% of current smokers, 5% of ex-smokers and 1% of never-smokers in the EU had ever used an e-cigarette. (5)

 

1. WHO Framework Convention on Tobacco Control
2. Statement from specialists in nicotine science and public health policy, 26 May 2014
3. Center for Tobacco Control Research & Education: Letter to Dr Margaret Chan, 16 June 2014
4. Tob Control 2014; 23: iii3-iii9
5. Tob Control 2014; Online 16 June


Poll

Should e-cigarettes be made legally available in Australia?
  • Yes - so they are regulated (81%, 429 Votes)
  • Maybe - more evidence needed (11%, 58 Votes)
  • No (8%, 43 Votes)

Total Voters: 530

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23 thoughts on “Battlelines on role of e-cigs

  1. Don Cook says:

     I was in France last October, E-cigarettes were sold widely and there were stores that sold only E-cigarettes and the various accessories. Not sure the French smoking rate has declined much. My feeling was that it was a trendy gimmick and the young people used both cigarettes and E-cigarettes. To suggest that Australia cannot further reduce smoking rates without E-cigarettes is a rather strange view.

    The dramatic reduction in our smoking has come about by good policy often driven by non government bodies.

    Most people quit smoking without any aids, lotions or potions they just give up because of the effects of many different policies. Also the smoking rate amongst young people is at all time  low, most of those will not go onto smoke. We do not need E-cigarettes here what we we do need is better enforcement of our ban on them. nearly all the capsules being sold in retailers contain nicotine in widely differing strengths yet there is not a body that has the power to stop the sales. Some of the liquids come in flavours such a chocolate and strawberry, do we really want this stuff allowed?

     

     

     

  2. Monash University Publisher Packages says:

    What we don’t know about e-cigarettes is what else (other than nicotine) the solutions contain…..it’s a no brainer to not inhale something if we are not sure of the contents. I see this as an option that some smokers may want to consider (just like low tar cigarettes, or lower strength cigarettes); so never legalise it……

  3. Daragh Weldon says:

    As Aristotle said ,”the perfect is the enemy of the good”.

    The relevant question is not whether ecigs are completely harmless ,they aren’t ,but then again neither is sunlight or excessive water,but whether they are less harmful than regular cigarettes, and all the available evidence says that they are by several orders of magnitude.

    Speaking as a smoker ( yes I know ,I know) who has tried patches,gum and champix I have found ecigs to be absolutely the best form of harm reduction (reduction not elimination) and it is the only replacement  that is actually pleasurable to partake in,which matters , because, and this may come as a surprise to non smokers ,smoking can actually be pleasurable.

    Yes , in a perfect world we would all have the will power to abstain from things that are harmful to us ,like nicotine ,caffeine and alcohol but we don’t live in a perfect world and those of us who are adults would probably like the choice to imbibe nicotine in a less harmful and actually more enjoyable form than regular cigarettes.

    As for what else eliquid contains apart from nicotine ,the main constituents are proylene glycol (not ethylene glycol ) vegetable glycerin and FDA approved food flavourings ( which are obviously tested for ingestion rather than inhalation) and as of now you cannot purchase nicotine containing eliquid in Australia but you can import it from abroad and yes they are available in all manner of flavours such as strawberry and banana which adults also enjoy.

    Coffee also comes in vanilla and chocolate flavours but I don’t see too many children gulping down grande frappucinos .

    Anyone wishing to reduce smoking related illness should welcome ecigs not puritanically prohibit them

  4. Dave Jenkins says:

    But we do know what is in them. Propylene Glycol (PG), Vegetable Glycerin (VG), Nicotine and Flavours. That is it. Nothing else.

    Basically , take the contents of a Quickmist Spray NRT product and remove all the nasty extras. You are left with what we vape.

    I know that PVs (E-cigs) work. 37 years a heavy smoker. NRT didn’t work. But the day I started vaping was the day I had my last cigarette. That was 9 months ago. Yes, they work – without question.

  5. Tomasz Tomicki says:

    Using quality e-liquids from reputable vendors is not much worse to your health than drinking coffee.  This is also about living in the 21st century and having the freedom of choice.  Just have a look at how much damage alcohol causes but people are not exactly debating whether or not it should be banned…

    We all realise the dangers of smoking and our society has become so afraid of anything even remotely associated with it.  But using e-cigarettes (or vaping) is NOT smoking.  There is no smoke only vapour.

  6. Dr Ewa Huebner says:

     To suggest that Australia cannot further reduce smoking rates without E-cigarettes is a rather strange view.

    It is not a strange view, it is supported by many studies. Except for Sweden, where there is access to smokeless tobacco banned elsewhere, the smoking rates remained at 15-20% at all developed countries.

    Most people quit smoking without any aids, lotions or potions they just give up because of the effects of many different policies.

    New studies show that people using e-cigs are more successful (by about 20%) than those quitting “cold turkey”. This is a very modest estimate. With support by those who quit using e-cigs (as opposed to researchers who don’t know much about how to use them) and with a free choice of devices and flavours the success rate is much higher. BTW that’s why we need strawberry and chocolate flavours – although it is not my personal choice.

     We do not need E-cigarettes here what we we do need is better enforcement of our ban on them.

    Not sure who are the royal “we”, but I and thousands of ex-smoking vapers do need them to keep away from harm caused by smoking. Not to mention about 1.5 millions of smokers in Australia who should have a fair go to try.

    …nearly all the capsules being sold in retailers contain nicotine in widely differing strengths yet there is not a body that has the power to stop the sales.

    I don’t know about any retailers openly selling nicotine in Australia. It is (rightly or wrongly) illegal. We have law enforcement agencies who have all necessary powers.

  7. Joe Avsenik says:

    I have absolutely no financial interest in the vape industry.  I started smoking at the age of 18 and continued to do so for the ensuing 31 years. I had been trying to quit for most of those years; by going ‘cold turkey, with nicotine patches, Nicorette gum and Zyban, to no avail. 

    Last year, on June 15th, my father passed away suddenly.  After going through that devastating time, at the age of 49, I resolved to quit smoking as a tribute to my father.  I bought my first e-cig kit last year, on July 26. I have not had a cigarette since that day; nor have I even craved one. My family, friends and I have all noticed a marked improvement in my health. I no longer cough, wheeze or stink of cigarettes and I no longer suffer from guilt or feel like a pariah.

    I will forever be grateful to e-cigarettes for allowing me to quit my debilitating, self-destructive and noxious addiction.  Without them, I would undoubtedly still be smoking myself to death.  My only regret, other than starting smoking in the first place, is that I hadn’t found e-cigs 20 years earlier.

    Before you dismiss my testimonial as anecdotal, I can assure you that my story is not unique and is very ‘ordinary’ within the vape community. There are tens of thousands, just like me. Please do not support the effort to prevent the millions of remaining smokers from being ‘saved’ from the evil, poisonous clutches of cigarettes.

    In fact, if you or a loved one currently smokes, I would implore you to investigate the miraculous assistance which e-cigarettes can provide to end the destructive and costly addiction.

  8. ed west says:

    They wanted us to quit smoking. We did with e-cigs! Now you want to move the goal? Nicotine is no more harmful than coffee or tea. Maybe Aussies should ban them too? http://www.bbc.com/news/health-27485954

  9. Dr Attila Danko says:

    Ok, let’s enforce the ban strictly, use more scarce customs resources to intercept nicotine imports, and what will we achieve?  The thousands of Australian’s who have successfully quit smoking with vaping, who have been unable to do so with any other method, will mostly go back to smoking.  Well done Prohibitionists!  You are doing dirty Big Tobacco’s work, and they will welcome back the ex smokers with open arms.

  10. BRUCE ROGERS says:

    You have to ask yourself why some so called health professionals are concerned with personal vaporisers.Not really much to them and the atomisers contain nicotine (not all the time) PG and VG and flavors.When you look at what is in Quikmist these same ingrediants are there plus a hell of a lot of nasty items.No one is going on about what is in Quikmist and this stuff is legal.

    Personal Vaporisers will prove to be the greatest ANTI smoking item that the world has ever seen.But only if people wake up and stop believing the rubbish that is continually being stated by so called health professionals ( some of which have NO health credentials but are shouting the loudest )

    They look like smoking ! Yes they do look like smoking but NO smoke.If you want to ban these then you had better ban kettles and hot showers.

    They renormalise smoking ! No they normalise vaping.

    The flavors are designed for children. So us adults are not allowed to enjoy a multitude of very nice flavors ?No study has found vaping causes children to smoke or vape for that matter.No one that has successfully tried vaping (usually with 2nd or 3rd generation vape gear) wants to go back to foul tasting cigarettes.

    We don’t know the long term effects of PVs. Do you know the long term effects of using Quikmist ? Not saying two wrongs make a right ,but come on people.There has already been a lot of research that favours vaping over smoking by a long long way.

    I could go on and on but feel it is pointless,

     

  11. Dr Ewa Huebner says:

    Your poll doesn’t give a sufficient number of options. Those who do not want vaping banned or believe that there is enough known about them (hundreds of scietific peer reviewed papers) have only one choice. Although no reasonable person would insist on no regulation, it doesn’t mean thay they would agree with ANY regulation. It is enough to look at EU Tobacco Directive to see that some regulation maybe excessive, based on pseudo-science, vested interests, outright ignorance etc. It may in effect be not much different than an outright ban. The only regulation needed is for buyers to be over 18 and for vendors to comply with (mostly already in existence) safety rules.

  12. christa spillane says:

    How about regulating e-cigarettes like champix/zyban? Let them be issued by prescription from a GP.  This allows genuine smokers access to another aid to quitting, and prevents e-cigarettes being marketed to a younger non-smoking population.

  13. Ron Williams says:

    I am another failed Nictine replacement therapies reject who failed many times over 30 odd years using patches, gums, sprays, and cold turkey.. Even tried the easily available no nicotine first generation cigalikes avalable in Queensland. But far too many dangerous side effects for me to even consider trying the government approved champix. All failed,

    But e-cigs work nearly 4 months now since I picked up a 2nd generation e-cig, and haven’t had a smoke since that day. Ecigs work totally and easily, and far cheaper than the government approved methods. Now Why don’t you guys let us buy our nictine eliquid here in Aus’ so we can know whats in them. The government are the ones who are stopping us buying safe e liquid by banning them, forcing consumers to buy from outside the country.

  14. Randal Pittelli says:

    I don’t know why so many medicos are so fond of paternalism. It’s certainly not encouraged by our training.

    Let people smoke them. It’s legal to smoke cigarettes, and smokers pay far more in taxes than their entire cost to the rest of society (Labor’s recent argument to the contrary to justify yet again increasing the tax was circular — it included the cost the smoker pays to buy the cigarettes, among other things).

    I personally have quit smoking by switching to e-cigs. I only smoked cigs after I came to this country and found that I could not purchase smokeless tobacco (snuff, or ‘chew’) — sales of that, too, is arbitrarily banned here. As a former toxicologist, I am convinced that the flavorings used in my e-cigs suspended in water vapor are far more safe than inhaled combusted chemicals in smoke. Even if I’m wrong, that’s my perogative, and I can at least enjoy doing sports again, and I don’t smell of smoke, and I spend far less on my habit.

    Nannies bugger off, I say.

  15. Deb Downes says:

    As a vaper, I detest Big Tobacco, and it’s disappointing that they now own some of the ‘cigalike’ companies and are now producing asinine advertising, I really wish they’d p*** off. I’m equally unhappy with Big P. A nicorette inhaler contains more chemicals than the e-liquid I vape, including hydrochloric acid. No-one ever questions that, do they?

    I’m sick of listening to the likes of Dr Jeanette Young, CHO of Qld Health, get on the radio and tell untruths. Prof. Chapman and Prof. Daube are another pair that get a regular airing, and no-one ever asks them to verify what they’re saying – mostly they ‘cherry pick’ the bits that suit them.

    People with Ice or Crack addictions are physically violent towards their family, nurses and doctors who are trying to care for them, and random people on the street. This is a REAL problem that does require intervention on the behalf of society. If you want to save lives, then spend money on dealing with this issue.

    Vapers want sensible regulation. NO selling to under 18yo, tamper proof containers and clear ingredient lists. 

    Nicotine is legal when bought as tobacco or as an NRT. The only reason that it’s ‘illegal’ outside of this is because is because our  public health ‘experts’  have a ‘quit or die’ mentality. The condemnation of PVs is more about control than health.

    There’s peer reviewed research available, I would urge doctors to seek it out, make up their own minds and treat their patienst as adults.

  16. Peter Kennedy says:

    e-cigarettes are ALREADY regulated exactly the same as Chamoix and Zyban in Australia and always have been. That is, anyone with a product for which he claims a therapeutic benefit has to send the data to the TGA who would then register the product as a prescription medicine. But the e-cig manufacturers, just like all the other purveyors of pseudo-scientific quack cures, refuse to do this because they know they DON’T have scientific evidence of efficacy. But at the same time they try to have the best of both worlds with not so subtle claims that they help you stop smoking. In fact most e-cig users who were smokers, continue smoking – “cutting down” is of no health benefit. These products are made by get-rich-quick cowboys with NO regard for human health.

  17. Dr Ewa Huebner says:

    e-cigarettes are ALREADY regulated exactly the same as Chamoix and Zyban in Australia and always have been.

    Wrong: e-cigarettes are not medicine. Champix (not Chamoix) and Zyban are dangerous medicines with horrific side effects including death.

    That is, anyone with a product for which he claims a therapeutic benefit has to send the data to the TGA who would then register the product as a prescription medicine.

    No reputable vendor makes any therapeutic claims, so they make no attempt to involve TGA. Like tea or coffee, e-cigs are for recreation not curing any illness.

    But the e-cig manufacturers, just like all the other purveyors of pseudo-scientific quack cures, refuse to do this because they know they DON’T have scientific evidence of efficacy. 

    There are hundreds of peer reviewed scientific papers proving efficacy of e-cigs as a substitute for cigarettes. Just use Google Scholar.

    But at the same time they try to have the best of both worlds with not so subtle claims that they help you stop smoking.

    It is not a claim, but a scientifically proven fact (see above).

    In fact most e-cig users who were smokers, continue smoking – “cutting down” is of no health benefit.

    Wrong and wrong: a large proportion of e-cig users do not smoke, and “cutting down” does reduce harm caused by smoking. Remember “every cigarette is doing you damage”, so the ones that are not smoked do not do damage.

    These products are made by get-rich-quick cowboys with NO regard for human health.

    People run businesses to make money. In this particular case they happen to sell a product which benefits health.

  18. Monash University Publisher Packages says:

    I disagree with the comments made on this forum by some readers about the ingredients of e-cigarettes. It is not as simple as what they think or what is claimed by the manufacturers. Please read the recent systematic review of 14 studies and 16 patent applications at: http://www.ncbi.nlm.nih.gov/pubmed/24732162      It states that “Materials in e-cigarettes may include metals, rubber and ceramics. Some materials may be aerosolised and have adverse health effects.” It is great to have anecdotal evidence, but we need evidence from large studies of long-term safety and efficacy. Otherwise, health professionals will be blamed for recommending something that is not safe/efficacious and could even be sued down the track. Anyone with solid data on safety and efficacy should be able to register their product after convinving regulatory bodies/agencies. Why are they not doing it? Pharmaceutical companies and device companies get approval for their products by submitting solid safety and efficacy data. e-cigarette manufactures will need to do that to convince many health professionals/researchers including myself.

  19. Dr Ewa Huebner says:

    In reply to Johnson George (the previous poster): The fundamental logical error you make is that you demand a proof of absolute safety. Actually, it is not possible to prove absolute safety of anything, lack of harm cannot be proven, only the existence of harm can.

    Nobody claims that e-cigarettes are absolutely safe, but the great many claim that they are significantly safer than burning tobacco. They are a harm reduction device, not harm elimination device. Therefore, they should be compared with smoking cigarettes, This is where the paper you quote fails. Additionally, it brings up concerns, which relate to many other devices, for example safety of batteries in e-cigs is no different than safety of batteries in mobile phones. Are you suggesting that we wait for a proof of absolute safety before using mobile phones?

    I’m sure long term studies will eventually emerge after sufficient time. In the meantime, well informed people should be able to make a choice how they want to reduce harm to themselves. Medical professionals offer those who wish to quit Zyban and Champix, known to cause serious side effects including death. After about 10 years of e-cigs being available no report of death or serious health damage has been made.

    Having said all that some regulation in this area would be useful, but not the kind which would constitute a virtual ban or gives advantage on the market to tobacco companies who buy into some inferior types of e-cigs.

  20. Peter Kennedy says:

    EwaZofia, as the e-cigarette purveyor which you obviously are, your spiel, among its other blatant untruths, perfectly illustrates my point. You claim that e-cigs are not medicines but “recreational” then in the same breath you claim that e-cigs “help you stop smoking” i,.e you are claiming that they ARE a medicine. (Addiction to smoking is an illness, and the TGA declares explicitly that any product which is claimed to help quit, reduce, or substitute for smoking, is a medicine.) Like the rest of the cowboys you try to have your cake and eat it too. First make up your mind whether you are going to promote your product as a medicine OR as a recreation, and then you can take steps to try to get your product made legal.

    I repeat, as numerous scientific studies have shown. “cutting down” is of no health benefit. You are misrepresenting the meaning of the slogan “every cigarette is doing you damage”. It’s the duration of smoking that causes cancer, not the absolute amount smoked (once past a certain minimum which virtually every smoker exceeds.)

  21. Dr Ewa Huebner says:

    as the e-cigarette purveyor which you obviously are, your spiel, among its other blatant untruths

    Wrong. I am not “the e-cigarette purveyor”. And be specific if you accuse me of not telling the truth.

    You claim that e-cigs are not medicines but “recreational” then in the same breath you claim that e-cigs “help you stop smoking” i,.e you are claiming that they ARE a medicine.

    Smoking is not an illness, it may cause an illnness.

    (Addiction to smoking is an illness, and the TGA declares explicitly that any product which is claimed to help quit, reduce, or substitute for smoking, is a medicine.)

    Addiction is to nicotine. TGA declaration (if your quote is correct) doesn’t make smoking an illness.

    Like the rest of the cowboys you try to have your cake and eat it too. First make up your mind whether you are going to promote your product as a medicine OR as a recreation, and then you can take steps to try to get your product made legal.

    I do not promote my product, I don’t have any product to promote. E-cigs are legal already. The only illegal thing in Australia is selling nicotine.

    I repeat, as numerous scientific studies have shown. “cutting down” is of no health benefit. (…)

    All this is about smoking, it has nothing to do with e-cigs. And science is never that simple. Some studies show one thing and some other show something else.

  22. Peter Kennedy says:

    “be specific if you accuse me of not telling the truth.”

    Sure. It’s actually easier to list what appears to be the only statement which you have made here which is NOT a blatant untruth, viz. “People run businesses to make money.” Evrything else is empty sales spiel, or to be charitable, in some cases possibly just ignorance.  

  23. Myra Neumann says:

    Everyone I know who has used e cigs still goes back to smoking,none have given up.young non smokers will be introduced to and start smoking once they use a e cigarette.if people genuinely want to give up we already have genuine medicinal smoking aids. The marketing of e cigs is specifically the multinational tobacco companies devising new ways to control mass populations of people to be addicted to nicotine. Thus making mass money.

     

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