MPs in the UK have called for a more ‘risk-proportionate’ approach to the regulation of e-cigarettes, where advertising rules and tax duties reflect “evidence of the relative harms of the various e-cigarette and tobacco products available”.
In its final report on e-cigarettes The House of Commons Science and Technology Committee, chaired by Norman Lamb, stated that e-cigarettes were ‘substantially less harmful—estimated by Public Health England to be around 95%—than conventional cigarettes’ but conceded that the evidence currently available did not allow a precise figure to be determined.
It also called for e-cigarettes to be medically licensed in order to encourage more people to quit conventional cigarettes.
“A licensed product could also provide the basis for a doctor-patient relationship that could extend over the period needed to give up smoking, and help overcome some smokers’ reluctance to swap to e-cigarettes because of cost considerations,” the report said.
The committee recommended the Government review with the e-cigarette industry how its systems for approving stop smoking therapies could be streamlined to be able to respond appropriately should e-cigarette manufacturers put forward a product for licensing.
Meanwhile, a report from the CSIRO on the use and health impacts of e-cigarettes concluded that “the evidence available suggests that regular use of e-cigarettes is likely to have adverse health consequences.”
The view is backed up by the recent publication of a study in Thorax by Dr Aaron Scott from the University of Birmingham’s Institute of Inflammation and Ageing and colleagues, which observed that alveolar macrophages release potential tissue damaging compounds when exposed to sub-lethal concentrations of e-cigarette vapour condensate.
According to Professor Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine at Queen Mary University of London, the study challenged the view that vaping presents only minimal risks.
“The argument that, since vaping is better than smoking cigarettes any effects of vape on lung cells are not important – is increasingly becoming a specious one. First, because airway cells lining the lower airway are exposed to much lower concentrations of nicotine if it absorbed at sites other than the lower airway such as the gut and skin.
Second, this study, and other studies using human airway cells and animal models, have shown that non-nicotine constituents of EC vapor also have adverse effects on lower lung cells. By contrast, other methods of smoking cessation will not expose lower airway cells to this complex mix of putative toxins.”
Professor John Britton, Director of the UK Centre for Tobacco & Alcohol Studies at the University of Nottingham, said that given that electronic cigarette vapour contains oxidant and other pro-inflammatory constituents the findings of the study were to be expected.
“This indicates that long-term use of electronic cigarettes is likely to have adverse effects, as is widely recognised by leading health authorities in the UK including the Royal College of Physicians and Public Health England,” he said.
However, he noted that since e-cigarettes were used almost exclusively by former smokers it was unclear how the adverse effects seen by the authors compared with that of exposure to cigarette smoke.
“The current study does not address that question, but given the much lower levels and range of toxins in electronic cigarette vapour relative to cigarette smoke, the answer is likely to be substantially less. The harsh truth is that smoking kills, and smokers who switch completely to electronic cigarettes are likely substantially to reduce the likelihood of premature death and disability,” he said.