Electronic cigarettes have been shown to be effective in helping smokers quit and many believe them to be much safer than cigarettes. But the debate rages on.
Today at AAAS, a panel of global advocacy, ethical, policy, health, toxicology and industry experts from Germany, New Zealand, South Africa, the UK and USA debated whether electronic cigarettes killing users softly or our greatest public health opportunity?
E-cigarettes are already used by tens of millions of smokers around the world in local versions. Analysts at Wells Fargo (2013) predict that sales will outstrip classical cigarettes by 2021. These battery-powered devices work by delivering aerosol (‘vapor’) containing nicotine to the user.
The apparent medical advantage is that the vapor produced contains compounds in the tens to hundreds compared with the 8600 or more produced in cigarette smoke that cause life-threatening diseases.
The American Cancer Society estimates that:
- One billion people smoke cigarettes and the number is increasing.
- Half of cigarette users will die early because they smoke.
- Six million people die every year because of tobacco. This figure includes five million smokers, but also about 600,000 non-smokers exposed to second-hand smoke.
- It is expected that, without action, eight million people will die annually of tobacco-related causes, by 2030.
- Over 80% of these deaths will be in low- and middle-income countries.
- Non-communicable diseases (NCDs) kill 35 million people annually, 80% of which are in low- and middle-income countries.
- Tobacco is responsible for 1 out of 6 NCD deaths.
- 100 million people were killed by tobacco in the 20th century and as many as 1 billion are expected to die in the 21st century.
The most recent study undertaken by an independent authority, the Cochrane Collaboration, and published in December 2014 suggests that e-cigarettes have a significant role to play in helping smokers reduce or quit. This independent network includes researchers, health professionals and consumers of healthcare, carers, advocates and people interested in health from 120 countries.
It also backs third-party research meeting the high standards it sets. In this Cochrane Review, two randomized trials were conducted with a total of 662 current smokers. Admittedly, the number of studies included was quite small, so the evidence is not yet strong.
However, it did find that about 9% of smokers who had used electronic cigarettes were able to stop smoking for up to one year. This compares with around 4% of smokers who used nicotine-free placebo electronic cigarettes.
Among smokers who had not quit, researchers found that 36% of electronic cigarette users reduced their consumption of tobacco cigarettes by half. This compared with 28% of users who were given placebos.
Speaker and Chief Executive of Action on Smoking & Health UK (ASH) set up by the Royal College of Physicians, Deborah Arnott, spoke in favor: “Cochrane reviews are world renowned for their systematic analysis of the evidence and our findings at population level are consistent with their conclusions that electronic cigarettes have the potential to help smokers quit.
Research by ASH over the last five years has now been supplemented by official UK government statistics to show that almost no-one who is not a smoker is regularly using e-cigarettes. Neither is there evidence thus far from the UK that the growth in e-cigarette use is leading to an increase in smoking, particularly among young people, in fact smoking rates continue to fall.”
Speaker and Deputy Director of the US National Institute on Drug Abuse (NIDA), Dr. Wilson Compton advocated the middle ground: “Every approach to reducing cigarette smoking should be considered, and e-cigarette use by smokers attempting to quit is promising. Nevertheless, advances in brain and gene research are showing that adolescent exposure needs closer attention. ”
He cited the NIDA-funded Monitoring the Future (MTF) survey that shows daily cigarette smoking by teens has decreased almost 50% over the past 5 years but measuring e-cigarette usage for the first time in 2014, MTF found that over 17% of 12th graders had used them in the past month.
He appealed,”My plea is for an appropriate, rational, scientific appraisal of likely risks and benefits. Above all, we must do more to dispel any youth perception that e-cigarettes cause no harm – they do – while encouraging adults to do everything they can to stop using tobacco products.”
Discussant and Chief Science Adviser to the Prime Minister of New Zealand, Sir Peter Gluckman commented: “What is clear is that unless we obtain robust scientific evidence both as to short and long-term effects, we will remain confused as to whether e-cigarettes can be a positive or negative contribution to public health and whether their use can be regulated in such a way as to promote positive rather than negative outcomes.”
Panel Moderator Professor Julian Kinderlerer, summed up by advocating for great understanding and compassion for the addicted person: “In the case of cigarettes and e-cigarettes, history will judge us harshly as to how we answer this billion person question. It may also look back in anger at policy-making amounting to institutionalized manslaughter”.