“The big question, and why we’re here, is whether that goal can be realised and how best to do it… and what kind of cultural, regulatory environment can be put in place to make sure that’s achieved.

“I think it can be achieved but that’s a hope, a promise, not a reality,” he said.

A revolution

This view was echoed by Dr Jacques Le Houezec, a private consultant who has been researching the effects of nicotine and tobacco.

He said that because the harmful effects of its main comparator, tobacco, e cigarette use should not be over regulated.

“We’ve been in the field for very long, this for us is a revolution.

There is concern over the lack of regulation of e cigarettes

“Every adolescent tries something new, many try smoking. I would prefer they try e cigarettes to regular cigarettes.” Dr Le Houezec added.

Many are now calling for the industry to be regulated.

Konstantinos Farsalinos, from the University Hospital Gathuisberg, Belgium, said it was important for some light regulation to be put in place “as soon as possible”.

“Companies are all hiding behind the lack of regulation and are not performing any tests on their products, this is a big problem.”

Prof Farsalinos studies the health impacts of e cigarette vapour. Despite the lack of regulation, he remained positive about the health risks associated with inhaling it.

An EU proposal to regulate e cigarettes as a medicine was recently rejected, but in the UK e cigarettes will be licensed as a medicine from 2016.

Healthy rats

E cigarettes are still relatively new, so there is little in the way of long term studies looking at their overall health impacts.

In order to have valid clinical data, a large group of e cigarette users would need to be followed for many years.

Seeing as many users aim to stop smoking, following a large group of e smokers for a long period could be difficult.

But in rats at least, a study showed that after they inhaled nicotine for two years, there were no harmful effects. This was found in a 1996 study before e cigarettes were on the market, a study Dr Le Houezec said was reassuring.

Concern about the increase in e cigarette use remains.

The World Health Organization advised that consumers should not use e cigarettes until they are deemed safe. They said the potential risks “remain undetermined” and that the contents of the vapour emissions had not been thoroughly studied

E cigarettes still divide opinion

The British Medical Association has called for a ban on public vaping in the same way that public smoking was banned.

They stated that a strong regulatory framework was needed to “restrict their marketing, sale and promotion so that it is only targeted at smokers as a way of cutting down and quitting, and does not appeal to non smokers, in particular children and young people”.

Ram Moorthy, from the British Medical Association, said that their use normalises smoking behaviour.

“We don’t want that behaviour to be considered normal again and that e cigarettes are used as an alternative for the areas that people cannot smoke,” he told BBC News.

But Lynne Dawkins, from the University of East London, said that while light touch regulation was important, it must be treated with caution.

She said that e cigarettes presented a “viable safer alternative” to offer to smokers.

“We don’t want to spoil this great opportunity we have for overseeing this unprecedented growth and evolving technology that has not been seen before, We have to be careful not to stump that.”

The high-stakes debate over e-cigarettes – the globe and mail

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Rarely has a single product evoked such diametrically opposed views or such passion as e cigarettes.

Anti smoking activists see the electronic nicotine delivery systems (the formal name) as another evil concoction of Big Tobacco, a devilish way to create new smokers and undermine hard fought public health measures.

Proponents of e cigarettes see them as a means of getting what they desperately want usually nicotine, but sometimes the tactile act of smoking without the carcinogens in tobacco, and as means to gain freedom from the increasingly oppressive measures taken against smokers.

E cigarettes are canisters used to simulate the act of smoking Batteries heat up fluid filled cartridges that contain water, flavouring agents and nicotine (though not always). The act of smoking an e cigarette is known as vaping because you inhale vapours, not smoke.

Health Canada does not allow the sale of e cigarettes containing is also illegal in Canada to make any health claims about e cigarettes, for example suggesting they are a smoking cessation tool.

The United States has, to date, taken a hands off approach, though the U.S. Food and Drug Administration has served notice that it intends to extend its regulatory control of tobacco to e cigarettes in the near future.

There is no question that e cigarettes pose a dilemma for regulators and anti smoking activists. Devotees who are an unusually fanatical lot can trot out amazing anecdotal stories about the power of e cigarettes and five pack a day smokers who have become healthy vapers. Skeptics feel the arguments are eerily similar to options that have been touted in the past as being healthier like light cigarettes, cigarellos and chewing tobacco.

Dreams and fears aside, research on e cigarettes about their potential harms and potential benefits is in its infancy. Data on long term risks and benefits are especially lacking. In other words, the jury is still out, despite the grandiose claims of benefit from proponents and the dire warnings of opponents.

In a world where there are one billion smokers and smoking kills almost six million people a year, this is a high stakes debate.

The global e cigarette market is already worth $2 billion (U.S.) a year with more than half of all sales in the U.S. and it s expected to surpass $10 billion annually by 2017. And everyone is keeping a close eye on China where e cigarettes emerged in 2006 because, as it pushes to restrict tobacco, it is touting e cigarettes as an alternative.

Many anti smoking activists see e cigarettes as a Trojan horse, a gateway drug that will attract new users to tobacco and discourage current smokers from quitting. It is not clear how many so called dual users (people who alternate vaping and smoking) exist.

Then there is the fear that decades of effort to restrict smoking will be all for naught. At the recent People s Choice Awards, for example, vaping was de rigeur, to the point where it looked like a product placement for the popular brand Blu. The use of aggressive advertising using recognizable Hollywood stars is reminiscent of the old techniques of Big Tobacco.

The point of anti smoking laws and by laws is to limit exposure to second hand smoke, but if vapours are harmless, the argument for restrictions goes up in smoke.

So, do e cigarettes contain toxic chemicals and carcinogens? That is a point of much contention. Some research says yes, some no. Again, the reality is there is a broad range of products and no standards. But e cigarettes are principally a nicotine delivery system. Nicotine is addictive in fact, it s what makes people addicted to cigarettes. It s not particularly harmful it s the byproducts of processing and burning tobacco that causes cancer, heart disease, chronic obstructive pulmonary disease and other health woes of smokers. Isn t it preferable to have people addicted to nicotine alone rather than nicotine and a potpourri of toxins?

The answer to that loaded question is Yes if you believe in harm reduction.

Most public health officials strongly favour harm reduction when it comes to hard drugs the supervised injection site Insite, for example, allows intravenous drug users to inject in a controlled setting with clean needles rather than in back alleys with dirty needles. But making that argument for vaping versus smoking doesn t have as much traction. When it comes to tobacco, most public health officials argue for abstinence and oppose e cigarettes.

The sands are constantly shifting. The Lung Association, for example, went from being an outspoken opponent of e cigarettes to taking the position that they might be a good smoking cessation tool, a way of weaning people off cigarettes. We don t know yet if e cigarettes are as effective or as ineffective as other forms of nicotine replacement therapy.

Probably the other persuasive argument against electronic cigarettes in 2014 is that they remain an unproven commodity we shouldn t be rushing headlong to embrace the technology. At the risk of sounding like the conclusion of every research study ever published More research is needed.

In the meantime though, it seems irrational and counterproductive to ban e cigarettes in Canada. A more sensible approach would be to regulate and allow nicotine delivery devices on the market that don t contain carcinogens.

In the war on smoking which is, after all, a battle to improve the health of individuals and the collectivity e cigarettes are not a panacea, but they are a step in the right direction.

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