Electronic cigarettes could save the lives of millions of
smokers, or they could set millions of non-smokers on the path to nicotine
addiction, revolutionizing the tobacco industry into the bargain. So the
question on the lips of health experts, policy-makers and consumers alike is,
are the devices a health problem that needs tight regulation, or a welcome aid
to smokers trying to quit?
In less than a decade since their first appearance,
electronic or e-cigarettes have become a multibillion-dollar industry. Although
there are scores of different products, most operate on the same principle: a
heating element vaporizes a liquid containing nicotine, which can then be
inhaled as ‘smoke’ (see ‘Smoke without fire’ and Comparison of toxins in
conventional and electronic cigarettes).
However, they are not without their dangers, and, as the
number of users in the United States alone reaches an estimated
2.5 million, regulatory bodies have begun to take an interest. In October,
the US Food and Drug Administration (FDA) is expected to issue a rule that
affirms it has the authority to regulate e-cigarettes, overriding a previous
court decision that e-cigarettes could not be controlled as medical devices.
The European Union is also overhauling its regulation of tobacco with a massive
piece of legislation that, as currently drafted, will regulate most
e-cigarettes as medical devices. A vote on this legislation is due in the
European Parliament on 8 October.
But because little research has been done on the effects of
e-cigarettes, such moves lack a solid scientific grounding. It is generally
accepted that the devices are safer than conventional cigarettes, although
studies by the FDA and Health New Zealand, a research consultancy based in
Christchurch, have shown that some brands contain carcinogens and other toxic
chemicals, including diethylene glycol and N-nitrosamines (A. D. Flouris
and D. N. Oikonomou Br. Med. J. 340, c311; 2010).
If e-cigarettes are used in moderation, the nicotine doses
they provide may be lower than those attained from smoking cigarettes. But
although the devices are smoke-free, nicotine itself causes high blood pressure
and palpitations, and is highly addictive. Little is known about the long-term
effects of e-cigarette vapour.
Some experts think e-cigarettes are a saviour. “They may
kill smoking as we know it,” says Peter Hajek, director of the Tobacco
Dependence Research Unit at Barts and the London School of Medicine and
Dentistry. “That’s the biggest hope we have of ending the tobacco epidemic.”
But as big tobacco companies have piled into a market worth
more than US$2 billion worldwide, regulators have failed to keep up, in part
because the chemicals in e-cigarettes vary so widely. Some countries, such as
Norway and Brazil, have banned the products. But in the United States,
e-cigarettes are currently regulated only if they are marketed as quitting
aids. The United Kingdom has said it will regulate them as medicines — meaning
they will have to meet strict quality standards — but its regulator, the
Medicines and Healthcare Products Regulatory Agency, is holding fire until the
new European rules are in place.
The decisions that regulators make will shape not just the
future of the industry but also the public-health response — and scientists
both for and against e-cigarettes have waded into the debate while regulation
is still up in the air.
“Right now, electronic cigarettes are the triumph of wishful
thinking over data,” says Stanton Glantz, a tobacco-control researcher at the
University of California, San Francisco, who thinks that the products should be
regulated. He points to a report released earlier this month by the US Centers
for Disease Control and Prevention in Atlanta, Georgia, that shows some
children who have never smoked cigarettes are using e-cigarettes, suggesting
that the devices may be a gateway product. And he notes that several surveys
have reported high levels of smokers using both cigarettes and e-cigarettes,
indicating that the products are being used to sustain nicotine addiction. The
use of vapour flavourings, such as vanilla, could also be seen as an attempt to
prolong use and appeal to younger consumers.
Other scientists, such as Hajek, say that regulating
e-cigarettes as medical devices would be a disaster. He believes that the cost
of complying with rules for medical devices would allow big tobacco companies
to dominate the nascent e-cigarette industry, squeezing out innovative new
products.
“To overregulate now could threaten the existence of
e-cigarettes and cut down the options for people who want to quit,” agrees
Christopher Bullen of the National Institute for Health Innovation at the
University of Auckland in New Zealand. He was the lead author on a study
published this month showing that e-cigarettes were as effective as nicotine
patches in helping smokers to quit (C. Bullen et al. Lancet
http://doi.org/nq8; 2013).
Vaughan Rees, a tobacco researcher at Harvard School of
Public Health in Boston, Massachusetts, thinks that e-cigarettes need to
improve before they can replace cigarettes — and that, for now, they should be
regulated as tobacco products. Although they do present an opportunity to
improve public health, he adds, care needs to be taken to ensure that they
don’t flourish alongside conventional cigarettes. “Then we’ve got a double
problem,” he says.
Article Credit: www.scientificamerican.com
No comments:
Post a Comment