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Are e-cigarettes really safe? europe grapples with smoking alternative as pressure to regulate builds

Green smoke review

It is now more than 60 years since the British scientist Richard Doll first proved, beyond doubt, that tobacco kills. Since then, governments and agencies all over the world have attempted to regulate, control, tax and, in a few cases, ban a product that killed more people in the 20th century than all that era s wars combined, and which the World Health Organization predicts will claim the lives of a billion more in the 21st.

Now, regulatory authorities are wrestling with what is, in many ways, more a philosophical than a medical dilemma How do you deal with a new product that is as addictive as cigarettes, and which may do some harm, yet could also free millions of smokers from a far more lethal habit?

Smoking rate edges down to 18% in U.S., but still hovers at 20% for younger adults

Fewer American adults are smoking, a new U.S. government report says.

Last year, about 18% of adults participating in a U.S. national health survey described themselves as current smokers.

The U.S. smoking rate generally has been falling for decades, but had seemed to stall at around 20% to 21% for about seven years. In 2011, the rate fell to 19%, but that might have been a statistical blip.

Health officials are analyzing the 2012 findings and have not yet concluded why the rate dropped, a spokesman for the U.S. Centers for Disease Control and Prevention said. The CDC released its study Tuesday.

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The impasse comes due to a range of products that are flooding the market, all designed to reduce the harm done by nicotine addiction. Some are well established, such as the chewing gums and patches that are sold as quitting aids. But some are new notably electronic cigarettes, which deliver a puff of vaporized nicotine. It is these e cigarettes, used by an estimated 1.3 million Britons, who spend $160 million a year on them, that have sent lawmakers scurrying to catch up with changing technology.

Perhaps inevitably, the bureaucrats appear to be moving in Europe at least in the direction of greater regulation.

A review of the EU Tobacco Products Directive currently under way looks set to reclassify e cigarettes as a “medicinal” product. This would mean that, when it comes into effect in 2016, e cigarettes will effectively be banned across the Continent, since in most countries they will have to jump through the same hoops as any new drug including expensive three stage clinical trials.

European Union rules, however, mean that interpretation and implementation of the policy will be devolved to the governments of the nation states. While countries including France and Germany are set to effectively ban e cigarettes, in the U.K. the Medicines and Healthcare Products Regulatory Agency (MHRA) looks set to impose a more lenient series of controls, which will mean that while some basic safety guidelines for e cigarettes will have to be met after 2016 along the lines of those already in place for other tobacco substitutes such as nicotine patches there will be no ban, and no requirement for full clinical trials.

According to Dr. Chris Proctor, the chief scientific officer of British American Tobacco which, like other tobacco giants, is developing its own cigarette replacement products any move effectively to ban e cigarettes would be madness.

“It is clear that smoking is extraordinarily dangerous it causes heart disease, lung cancer and it needs to be extraordinarily well regulated,” he says. But, he adds, “these replacements are being more strongly regulated than tobacco.”

Proctor points out that in the U.K., about 18% 20% of the population continues to smoke. Public policy should therefore be encouraging them to move to less harmful nicotine products, rather than deterring them.

The scientific evidence is that, compared with normal cigarettes, e cigarettes are pretty benign

So can e cigarettes cause harm? The scientific evidence is that, compared with normal cigarettes, they are pretty benign. Burning dried tobacco leaves releases a toxic combination of more than 100 compounds, including vaporized tars, carbon monoxide and nicotine. These substances can raise blood pressure and, in the case of the tars, may cause genetic changes in the cells lining the lungs and respiratory tract that in turn trigger cancer.

An e cigarette looks like a real cigarette, but instead of tobacco smoke, the user inhales a puff of pure nicotine delivered by heating a capsule. Nicotine the alkaloid “active ingredient” in tobacco acts as a stimulant and is certainly highly addictive. But it is not known to be carcinogenic.

The real fear with e cigarettes is they may also act as a gateway drug to tobacco

Aside from its addictive properties, nicotine can raise blood pressure. There are also some question marks over the long term safety of the chemicals used as solvents, typically propylene glycol although, again, there is no evidence at all of any danger at present.

The real fear with e cigarettes is not to do with their medical properties. It is that because they resemble the “real thing” far more than, say, patches or gum, and are far cheaper than cigarettes, they may also act as a gateway drug to tobacco, encouraging children to take up smoking and adults to continue with a dangerous habit merely switching to e cigarettes in bars and planes, where they are otherwise not allowed to smoke.

However, research carried out by Action on Smoking and Health (ASH), the anti smoking charity, found no evidence that e cigarettes are being used by children. According to the MHRA, the general attitude in Britain is that e cigarettes should be cautiously welcomed.

“We d like them to be better made and to deliver more reliable nicotine doses,” a spokesman says, adding that a requirement for full clinical trials is “not appropriate clearly they are effective”.

Anti smoking campaigners are supportive of any product that may reduce harm even if these products have the backing of the cigarette companies themselves. But according to Martin Dockrell, head of policy at Ash, we need to keep an eye on companies that have a history of “distortions and denial about their products.”

“We are pretty sure that the tobacco industry is not getting into this because they want people to give up smoking,” he says, although he accepts that anything that “reduces harm” will be welcome.


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