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Tobacco |
Harm reduction
If electronic cigarettes can
save lives, why are we
jeopardising this public
health breakthrough,
asks
Professor Gerry Stimson
14 |
drinkanddrugsnews
| August 2013
www.drinkanddrugsnews.com
Until recently,
an end to cigarette smoking
looked like a long and slow business. Year on year only small reductions
have been made in reducing smoking prevalence in developed countries.
The arrival of electronic cigarettes (e-cigarettes) and other new
nicotine delivery devices changes that. These new devices are a
disruptive technology, just as the invention of the cigarette-making
machine was in the 1880s. There are now real prospects of helping
smokers shift from smoking tobacco to using nicotine by less
harmful routes.
The Medicines and Healthcare Products Regulatory Agency
(MHRA) and the European Commission (EC) now want to regulate
e-cigarettes as medicines. Will this advance the sale of e-
cigarettes, or push back the progress that has been made?
First introduced to the UK in 2006, uptake of e-cigarettes
has been a relatively quiet consumer-led revolution. There
has been no public health input or encouragement, and no
spending of NHS resources – no taxpayers have been harmed in
this process. There has been little expenditure on marketing. The growth in
popularity has come about by word of mouth and internet advertising. Unlike
many public health measures, there is a population ready and eager to change –
most smokers want to stop smoking. Until e-cigarettes there was no viable option
but to quit smoking altogether or to use nicotine replacement therapy (NRT).
The MHRA estimates that 1.3m people are using e-cigarettes in 2013. The
proportion of smokers using them rose from 3 per cent in 2010 to 11 per cent in
2013. The European market is estimated at around EUR 400-500m, and sales of e-
cigarettes now equal those of NRT. The market has been dominated by mainly
small and medium-sized distributors, but this will change as most major tobacco
companies are already selling or investing in the development of new nicotine
delivery devices.
Most anti-smoking organisations aim for an end of the tobacco industry.
Ironically – for many public health experts – an end to tobacco smoking may be
hastened not though the end of the tobacco industry but through its
transformation. In the next couple of decades, tobacco companies, under pressure
from anti-tobacco legislation, will move towards becoming nicotine companies.
Wells Fargo stock analysts predict that revenue from e-cigarettes will overtake
ordinary cigarettes by 2021.
E-cigarettes v smoking tobacco
E-cigarettes have major advantages over smoking tobacco. More than 4,000
chemical compounds are found in tobacco smoke, and it’s the products of the
burnt organic material that are so harmful to health. Around 80,000 people in
England die every year from smoking-related disease. Smoking is the single most
common cause of preventable illness and death. As Mike Russell noted long ago,
people smoke cigarettes for the nicotine but die from the tars.
E-cigarettes contain nicotine, propylene glycol (a carrier that creates the
vapour when heated) and flavourings. They deliver nicotine but without the
dangerous toxins found when tobacco is burnt. They are used by people who
want to stop smoking but who do not want to or cannot stop using nicotine.
A visit to e-cigarettes and vaping websites indicates extraordinary testimony
of their successful use by long-term smokers. E-cigarettes contain some
potentially harmful constituents but at traces very much lower than found in
regular cigarettes, within the safe limits for consumer products, and indeed at
similar levels to potentially harmful constituents found in NRT. And their
attraction for many users is precisely that they are not medicines.
A CASE