28 April 2016
WIDELY AS SUBSTITUTE FOR SMOKING SAYS NEW RCP REPORT
A new report released today from the Royal College
of Physicians, London, Nicotine without smoke:
tobacco harm reduction concludes that e-cigarettes
are likely to be beneficial to UK public health. Smokers
can therefore be reassured and encouraged to use them,
and the public can be reassured that e-cigarettes
are much safer than smoking.
Tobacco smoking is addictive and lethal. Half of
all lifelong smokers die early, losing an average
of about 3 months of life expectancy for every year
smoked after the age of 35, some 10 years of life
in total. Although smoking prevalence in the UK has
reduced to 18%, 8.7 million people still smoke. Harm
reduction provides an additional strategy to protect
this group of smokers from disability and early death.
Since e-cigarettes became available in the UK in
2007, their use has been surrounded by medical and
public controversy. This new 200-page report examines
the science, public policy, regulation and ethics
surrounding e-cigarettes and other non-tobacco sources
of nicotine, and addresses these controversies and
misunderstandings with conclusions based on the latest
- E-cigarettes are not a gateway to smoking
in the UK, use of e-cigarettes is limited almost
entirely to those who are already using, or have used,
- E-cigarettes do not result in normalisation of
smoking there is no evidence that either
nicotine replacement therapy (NRT) or e-cigarette
use has resulted in renormalisation of smoking. None
of these products has to date attracted significant
use among adult never-smokers, or demonstrated evidence
of significant gateway progression into smoking among
- E-cigarettes and quitting smoking - among
smokers, e-cigarette use is likely to lead to quit
attempts that would not otherwise have happened, and
in a proportion of these to successful cessation.
In this way, e-cigarettes can act as a gateway from
- E-cigarettes and long-term harm - the possibility
of some harm from long-term e-cigarette use cannot
be dismissed due to inhalation of the ingredients
other than nicotine, but is likely to be very small,
and substantially smaller than that arising from tobacco
With appropriate product standards to minimise exposure
to the other ingredients, it should be possible to
reduce risks of physical health still further. Although
it is not possible to estimate the long-term health
risks associated with e-cigarettes precisely, the
available data suggest that they are unlikely to exceed
5% of those associated with smoked tobacco products,
and may well be substantially lower than this figure.
The report acknowledges the need for proportionate
regulation, but suggests that regulation should not
be allowed significantly to inhibit the development
and use of harm-reduction products by smokers. A regulatory
strategy should take a balanced approach in seeking
to ensure product safety, enable and encourage smokers
to use the product instead of tobacco, and detect
and prevent effects that counter the overall goals
of tobacco control policy.
Professor John Britton, chair of the RCPs Tobacco
Advisory Group, said:
The growing use of electronic cigarettes as
a substitute for tobacco smoking has been a topic
of great controversy, with much speculation over their
potential risks and benefits. This report lays to
rest almost all of the concerns over these products,
and concludes that, with sensible regulation, electronic
cigarettes have the potential to make a major contribution
towards preventing the premature death, disease and
social inequalities in health that smoking currently
causes in the UK. Smokers should be reassured that
these products can help them quit all tobacco use
RCP president Professor Jane Dacre said:
Since the RCPs first report on tobacco,
Smoking and health, in 1962, we have argued consistently
for more and better policies and services to prevent
people from taking up smoking, and help existing smokers
to quit. This new report builds on that work and concludes
that, for all the potential risks involved, harm reduction
has huge potential to prevent death and disability
from tobacco use, and to hasten our progress to a
tobacco-free society. With careful management and
proportionate regulation, harm reduction provides
an opportunity to improve the lives of millions of
people. It is an opportunity that, with care, we should
Smoking is the biggest avoidable cause of death and
disability, and social inequality in health, in the
Most of the harm to society and to individuals caused
by smoking in the near-term future will occur in people
who are smoking today.
Vigorous pursuit of conventional tobacco control policies
encourages more smokers to quit smoking.
Quitting smoking is very difficult and most adults
who smoke today will continue to smoke for many years.
People smoke because they are addicted to nicotine,
but are harmed by other constituents of tobacco smoke.
Provision of the nicotine that smokers are addicted
to without the harmful components of tobacco smoke
can prevent most of the harm from smoking.
Until recently, nicotine products have been marketed
as medicines to help people to quit.
NRT is most effective in helping people to stop smoking
when used together with health professional input
and support, but much less so when used on its own.
E-cigarettes are marketed as consumer products and
are proving much more popular than NRT as a substitute
and competitor for tobacco cigarettes.
E-cigarettes appear to be effective when used by smokers
as an aid to quitting smoking.
E-cigarettes are not currently made to medicines standards
and are probably more hazardous than NRT.
However, the hazard to health arising from long-term
vapour inhalation from the e-cigarettes available
today is unlikely to exceed 5% of the harm from smoking
"...the hazard to health arising from long-term
vapour inhalation from the e-cigarettes available
today is unlikely to exceed 5% of the harm from smoking
Technological developments and improved production
standards could reduce the long-term hazard of e-cigarettes.
There are concerns that e-cigarettes will increase
tobacco smoking by renormalising the act of smoking,
acting as a gateway to smoking in young people, and
being used for temporary, not permanent, abstinence
To date, there is no evidence that any of these processes
is occurring to any significant degree in the UK.
Rather, the available evidence to date indicates that
e-cigarettes are being used almost exclusively as
safer alternatives to smoked tobacco, by confirmed
smokers who are trying to reduce harm to themselves
or others from smoking, or to quit smoking completely.
There is a need for regulation to reduce direct and
indirect adverse effects of e-cigarette use, but this
regulation should not be allowed significantly to
inhibit the development and use of harm-reduction
products by smokers.
A regulatory strategy should, therefore, take a balanced
approach in seeking to ensure product safety, enable
and encourage smokers to use the product instead of
tobacco, and detect and prevent effects that counter
the overall goals of tobacco control policy.
The tobacco industry has become involved in the e-cigarette
market and can be expected to try to exploit these
products to market tobacco cigarettes, and to undermine
wider tobacco control work.
However, in the interests of public health it is important
to promote the use of e-cigarettes, NRT and other
non-tobacco nicotine products as widely as possible
as a substitute for smoking in the UK.
21 April 2016
New study finds exhaled
e-cigarette vapour particles disappear within seconds
A new study being presented today at the 4th Workplace
and Indoor Aerosols conference in Barcelona shows,
for the first time, that exhaled e-cigarette particles
are liquid droplets that evaporate within seconds.
The research - a collaboration between Kaunas University
of Technology in Lithuania, EMPA Swiss Federal Laboratories
for Materials Science and Technology, ETH Zurich the
Swiss Federal Institute of Technology and Fontem Ventures
- is the first detailed study of its kind conducted
to investigate particles in exhaled e-cigarette vapour.
Speaking from the conference today, Professor Dainius
Martuzevicius, Vice Dean for Research at the Faculty
of Chemical Technology, Kaunas University of Technology
and leading expert on indoor air quality, said: "There
is little data available on the properties of exhaled
e-cigarette 'particles' in the scientific literature
and as a result there is a growing discussion amongst
the public health community as to whether the 'particles'
exhaled following use of vaping products have potential
implications for indoor air quality."
12 April 2006
Are E-Cigarettes a Healthy
Way to Quit Smoking?
Electronic cigarettes have an unparalleled potential
to reduce the public-health impact of smoking, by
allowing smokers to replace the habit and nicotine
of smoking without the toxic effects of combustion.
Dr. Rose is a professor of psychiatry and behavioral
sciences and director of the Duke Center for Smoking
Cessation at Duke University. He can be reached at
City Council to discuss banning smoking and also e-cigarettes
to the Committee: what is the harm of developing dependence
on a low cost non-fatal device?
committee of the Wellington City Council is about
to ban use of e-cigarettes on its properties. The
debate is on 13 April.
to Dr Joe Nitzkin, former chair of tobacco control
for the College of Public Health Medicine in the USA:
bottom lines are these:
restrictions and increasing taxes on cigarettes and
smoking will reduce tobacco-related addiction, illness
these same restrictions and taxes on e-cigs will have
the opposite effect. It will discourage smokers who
would otherwise switch to keepsmoking.
Vaping is not smoking and should not be defined as
exceed $1 per cigarette
from 1 January 2016 the following prices have been
charged, representing a 10.3% in excise and inflation
as well as similar increases in ex-factory price.
Royal $78 for 50 g. ($1.09 per cigarette of 0.7 g).
Mall $21.60 for 20 cigarettes.($1.08 per cigarette).
NHS to give out e-Voke
E-voke has been licensed by Medicines and Healthcare
Regulatory Agency for medicinal use. The aim
is to have these gadgets available for prescription
by GPs in 2016.
E-vokes are not an e-cig. They rely on producing
a powder, like an inhaler.
Vype e-cigarettes have been licensed but will not be
available for some time.
products are produced by BAT.
C. Wheeler. Express. 7 December
and ASH UK 8 December.
1 December 2015
to rise 10.3%
on 1 Jan 2016
According to NZ Customs Service the
new rates will be $668.51 per 1000 cigarettes as from
1 January. Smoking tobacco will cost $666.83 per kg
of tobacco content. This amounts to an increase of
10.3% in tobacco price since 1 January 2015. This
means a cigarette costing $20 in 2015 could cost $22.06
in 2016, assuming tobacco companies also raise their
price by the same percentage.
Is the jury still out on e-cigarettes?
Monday, November 30, 2015
Short of a pill that will magically take addiction
away, are e-cigarettes the best smoking cessation
device since the humble patch? Or are they just another
dangerous addiction,?a gateway device for children
or, worse, a sneaky attempt by Big Tobacco to renormalise
In the May 2012 Viewpoints, Matters of Substance
compared the arguments and decided the jury was still
probably out on e-cigarettes. A recent report by Public
Health England, however, has become the first authoritative
declaration that e-cigarettes are safer than cigarettes
and by a significant margin.
In this edition, we take a look at the English report
and at one of its detractors. Is the jury still out,
and should we bother waiting?
Public Health England
In August 2015, Public Health England (PHE) published
its commissioned report E-cigarettes: an evidence
update, which summarised the findings from two extensive
The reports conclusions were almost startling.
It said the evidence suggests using e-cigarettes is
95 percent safer than smoking and that e-cigarettes
have the potential to make a significant contribution
to the endgame for tobacco. Its policy recommendations
included making e-cigarettes much more prominent in
smoking cessation initiatives and streamlining convoluted
processes for them to be licensed as quit-smoking
Among the reports findings was that e-cigarette
use by people who had never smoked was extremely low,
at around 0.2 percent. Regular use (at least once
weekly) by young people is also very rare at just
2 percent, and while there is some youthful experimentation,
only 0.3 percent of young people who used e-cigarettes
had never smoked tobacco before. It said the most
important reason people use e-cigarettes is to reduce
smoking- related harms and that, while curiosity plays
a role in why some people experiment with them, most
of these experiments did not lead to regular use.
It concluded from this that e-cigarettes are not
undermining, and may even be contributing to, the
long-term decline in cigarette smoking.
The report made much of a September 2014 Cochrane
Review, Electronic cigarettes for smoking cessation
and reduction, featuring New Zealanders Hayden McRobbie
and Chris Bullen amongst its authors. The reviews
meta-analysis of 600 records found that e-cigarettes
can help smokers unable to stop smoking ...
to reduce their cigarette consumption when compared
with placebo e-cigarettes and nicotine patches.
The PHE report also found e-cigarettes do not replicate
the problems of second-?hand smoke. They release negligible
levels of nicotine into ambient air with no identified
health risks to bystanders. No concerns were
found around the labelling of nicotine cartridges
or e-liquids, and when they were poorly
labelled, they mostly contained less nicotine than
declared. While acknowledging nicotine is a poison,
the report found no evidence of nicotine poisoning
to users. The risks of poisoning to others (such as
children) or of evices causing fires were found to
be on a par with other household electrical goods
The reports authors discount recent news headlines
reporting high levels of formaldehyde found in e-cigarettes
as misinterpretations of research findings. They found
no indication electronic cigarette users are exposed
to dangerous levels of aldehydes and said this could
only happen when e-liquid was heated to levels
unpalatable to users. Instead, they assert that
most of the chemicals causing smoking-related diseases
are absent in e-cigarettes and that those that are
present pose limited danger.
PHEs findings have been supported by a number
of high-profile medical experts, including UKs
Chief Medical Officer Dame Sally Davies. A September
2015 British Journal of General Practice editorial
concluded that, for every million smokers who switched
from tobacco to e-cigarettes, more than 6,000 premature
deaths would be prevented in the UK every year. If
all 9 million smokers took up e-cigarettes instead,
54,000 lives could be saved.
Critique of PHE
The PHE research will probably be music to the ears
of the millions of smokers around the world who have
turned to e-cigarettes but who may still have niggling
doubts that their new drug delivery device is really
all that better for their health.
But in one of the greatest parade-raining articles
so far this century, Martin McKee and Simon Capewell,
writing in the British Medical Journal, are scornful
of the research and suggest its foundation is built
First, they say a recent cohort study shows most
smokers who switch to e-cigarettes (80 percent) are
still also smoking cigarettes at 12 months (dual use)
and that reduced smoking may not reduce overall risk
Next, they attack the Cochrane report, on which the
PHE report relies heavily, by pointing out that it
included only two randomised controlled trials and
that, by its own admission, its evidence had limitations
and was of low or very low quality.
The claim that e-cigarettes are 95 percent safer
gets a particular hiding. McKee and Capewell cite
a recent systematic review in Preventative Medicine
that found serious methodological problems in many
of the studies it reviewed and so many conflicts of
interest that no firm conclusions can be drawn
about the safety of e-cigarettes but that they
can hardly be considered harmless. They also
point out the 95 percent figure does not come from
a review of the evidence but from a single meeting
of 12 people convened to synthesise their opinions
on the harms associated with different products containing
nicotine. They point out two of those present had
received tobacco industry funding in the past and
that some other attendees were known e-cigarette champions
McKee and Capewell also dispute the reports
finding that e-cigarettes are not helping to renormalise
smoking. They say a July 2015 survey by the Health
and Social Care Information Centre showed more than
20 percent of 1115-year-olds had used e-cigarettes,
and 73 percent of these were non-smokers. An American
study, published after the PHE report, they say, concluded
that those who had ever used e-cigarettes at
baseline compared with non-users were more likely
to report initiation of combustible tobacco use over
the next year.
The McKee and Capewell rebuttal, which points out
a number of further perceived problems and inconsistencies,
does not claim to prove e-cigarettes are as harmful
as smoking tobacco. Rather,?its contention is that
the PHE report isnt sufficiently evidence based
to underpin changes in public health policy. And therein
lies the rub.
The precautionary principle: for
Many of those opposing e-cigarettes rely pretty heavily
on the precautionary principle. Its a bit like
insisting that policy must be evidence based but goes
a small step further.
The precautionary principle states that, if an action
or policy has a suspected risk of causing harm and
there is no scientific consensus that the action or
policy is not harmful, the burden of proof that it
is not harmful falls on those taking an action. In
other words, it doesnt matter that common sense
suggests breathing in vapour containing a handful
of chemicals is better than breathing in smoke containing
hundreds. Until there is enough evidence to provide
scientific consensus that e-cigarettes are safe, we
cannot endorse them. This is the view taken by the
World Health Organization and by our own Ministry
of Health, which currently refuses to recommend any?use
That sort of scientific consensus is probably a long
way off. There is little available research on the
long-term effects of e-cigarettes because they just
havent been around long enough.
The precautionary principle: against
Massey University Associate Professor Marewa Glover,
who also chairs End Smoking NZ, is less a fan
of the precautionary principle when it comes to public
health policy. She points out the precautionary principle
was used first in the environmental risk arena and
that there arent any real grounds for transferring
it to public health.
Disease and illness are well established areas,
and we have well established practices determining
risks to health so we dont need to rely so heavily
on such a guilty until proven innocent
approach, she says.
In a randomised controlled trial, where the particular
new drug being investigated is clearly working and
alleviating harm for the intervention group receiving
it, a point is reached where it becomes unethical
to continue withholding that drug from the control
group. Glover thinks the situation is very similar
E-cigarettes are clearly working in terms of
helping people stop smoking far more than anything
weve seen so far. We may not have had many randomised
controlled trials yet, but the evidence is definitely
mounting, so why make it difficult for people who
want to use them?
She also points out theres an uncanny
exchange between falls in smoking rates and
rising e-cigarette use in the US and the UK that strongly
suggests e-cigarettes help people quit.
And then theres the anecdotal stories
from millions of people who say their health has improved
or that e-cigarettes have saved their lives.?The precautionary
principle is being used by people who fear another
industry-driven epidemic. But an epidemic of what?
Whats the disease?
Is the jury still out in terms of the safety of e-cigarettes?
Not at all, Glover says.
But the jury is absolutely in on how dangerous
smoking is, and theres ample evidence of its
harm. With e-cigarettes, there is no evidence of acute
or longitudinal harm whatsoever, even though researchers
are looking for it.
You can buy e-cigarette devices in New Zealand, but
nicotine must be ordered in from overseas because
it is not licensed here for non-medicinal sale. The
case is similar in most jurisdictions, and its
a major impediment, especially if youre not
Nevertheless, e-cigarette use is growing just about
everywhere, suggesting a lot of smokers arent
bothering to wait for the jury. The day is probably
coming when stances soften and e-cigarettes become
more officially sanctioned perhaps not because
theres been a rush of irrefutable evidence but
because our government and Ministry of Health suddenly
find themselves woefully behind the times. Theres
little doubt e-cigarettes are here to stay.
cigarette mortality applies to NZ
that smoking kills half of current
but e-cigarettes do not, it can be
that if NZ has 0.6 million smokers
at present, a total switch of those smokers
e-cigarettes would have the eventual effect of saving
of those smokers (300,000) from predictable
due to smoking. If however,
to E-cigarettes, smoking deaths
decrease by 150,000 over the
consumption, NZ 2014
the years 2010-2014 the average drop
in consumption was 6.3% across New Zealand,
the fall was 23%. For 2013-4 the fall was 3.8%.
was the sum of changes in factory-made and
cigarettes. In March 2013 the Census
that a total of 15.1% of adults smoked daily.
2014 a total of 1% of smokers consumed e-cigarettes
nicotine cigarettes reduces nicotine exposure
this 6-week study 780 smokers (unwilling to quit smoking)
of reduced nicotine cigarettes versus standard cigarettes,
reduced their nicotine exposure, and dependence on
nicotine, and number of cigarettes smoked, as well
as craving during abstinence from smoking. Compensation
E. et al. Randomised trial of reduced-nicotine standards
for cigarettes. N. Engl J Med 2015 Oct 1;313:
this study argues that reduced nicotine in the cigarette
means reduced addiction, and increased effect from
19 August 2015
out e-cigarettes free in England, doctors told
should be able to prescribe
says Public Health England,
it tried to debunk the myth that 'vaping'
as bad for health as inhaling tobacco
If all of England's eight million
switched to e-cigarettes overnight,
75,000 lives a year would be saved,
say. Not only are e-cigarettes 20
less dangerous than tobacco, they
also among the most effective quitting
Lay, The Times London.
17 July 2015
know a thing or two about nicotine!
the USA, in 2014, 16.7% of adults smoked.
the USA, 6.3 million smokers used e-cigarettes, and
22% used them daily.
nearly 2 million ex-smokers 63% use e-cigarettes daily,
and obtained their nicotine only from e-cigarettes.
nicotine e-cigarettes is illegal in NZ, but smoking
cigarettes which gives more nicotine is legal!)
B. 30 million US adults have used e-cigarettes, unpublicised
CDC data reveals. Tobacco Truth. 14 July 2015.
(based on the 2014 National Health Interview Survey,
released June 29).
1 Jan 2015
Excise and price up again
Excise up 10% and price of 20 cigarettes reaches
$20, and for 30g RYOs, reaches $30.50. Excise will
increase again on 1 Jan 2016.
2 Jan 2014
Murray Laugesen. Nicotine and Health – American Council on Science and
Health, New York.
special interest to smoking cessation experts and
This world-first publication
(71 pages, 137
1 How nicotine affects your
2 How smokeless affects your
3 Electronic cigarettes.
To view the free copy see http://acsh.org/2014/01/effects-nicotine-human-health/
more details please see