I’ve spent the past week immersed in the literature about e-cigarettes. The debate is amazingly polarised, from those who fear e-cigarettes will perpetuate the tobacco epidemic to those who think they could save millions of lives.
There is no doubt that smoking tobacco is hugely harmful and e-cigarettes are considerably less toxic to human health. E-cigarettes also seem to be more attractive to smokers than conventional smoking cessation aids such as nicotine replacement therapy patches and gum.
Yet the industry is at present unregulated, meaning a wide variation and uncertainty about manufacturing standards, the amount and strength of nicotine in each e-cigarette capsule and the flavourings used to make them more palatable. Different regulatory authorities are taking different approaches to the problem, meaning that what’s regulated as a tobacco product in one country may be considered a medical device in another, or a food product in a third.
In addition, there’s fear that e-cigarettes will ‘re-normalise’ smoking. I’m sure I wasn’t alone to double-take the first time I saw an e-cigarette advert on the side of a London bus. It brought back memories of the days when cigarettes were freely advertised and the upper desks of buses were a fog of tobacco smoke. In the interim, smoking has become anti-social. Will e-cigarettes make smoking seem glamorous again?
But the key unanswered question is whether they actually help people stop smoking tobacco. Perhaps surprisingly, there has only been one randomised controlled trial in smokers wishing to stop smoking, which compared e-cigarettes both with and without nicotine to NRT patches. The study was inconclusive, with disappointing tobacco quit rates for all three treatment groups.
E-cigarettes are perceived to be a less harmful alternative to smoking, which can help wean people off tobacco. Yet the research base to recommend them simply isn’t there. People can’t make informed decisions about how to stop smoking until big, good-quality studies are complete.
Image of vintage anti-tobacco campaign materials: from Wellcome Images with thanks.