Public Health England Declares E-Cigarettes A Game Changer August 21 2015

August 19, 2015 | MSN Health & Fitness

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It's official. E-cigarettes are 95% less harmful than smoking and could be available on the NHS according to a comprehensive review by Public Health England (PHE). The PHE review describes smoking cessation using e-cigarettes as a potential "game-changer" that could save 4,000 lives a year. E-cigarettes are to be licensed as a medicine in the UK next year, so it's likely that doctors and stop smoking services will be able to begin prescribing them from 2016.

An estimated 2.6 million people in the UK now use e-cigarettes, according to the charity Action on Smoking and Health (ASH) – and that figure appears to be growing all the time. One of the reasons for this rise in popularity is that the devices are becoming more widely available. Last year, Boots bowed to customer demand and began selling Puritane e-cigarettes to over 18s, while Superdrug and Lloyds Pharmacy already stock the marking-leading brand Nicolites, as well as Vype - and you can even snap up leccy ciggies at your local Tesco.

But not everyone is convinced. The British Medical Association (BMA) has expressed concerns over the safety of e-cigarettes, and although the PHE review didn't find any evidence that e-cigarettes give children a gateway into smoking, the UK government has passed legislation to make it illegal for anyone under 18 to buy e-cigarettes. The ban will come into effect in October. Tighter restrictions on e-cigarettes will come into force next year when they become licensed as a medicine, and the Labour-controlled Welsh government is pushing ahead with a ban on using e-cigarettes in enclosed spaces, despite objections from the Conservative opposition.

A significant number of shops, pubs and restaurants – including McDonald's and Wetherspoon's – have banned the devices from their premises, and several rail companies have followed suit, outlawing e-cigarette smoking on trains and in stations. According to a 2014 YouGov survey, a majority of Brits (52%) think that advertising for e-cigarettes should be banned, while a poll conducted by ITV found that 33% of people believe it is socially unacceptable to use an e-cigarette in public, and 52% reckon it sets a bad example.

What exactly are e-cigarettes?

E-cigarettes are battery-powered devices, usually designed to look like ordinary cigarettes. Their purpose? To simulate the experience of smoking, without many of the harmful effects. The key difference is that they deliver nicotine vapour instead of tobacco smoke. It's the toxins in tobacco smoke that cause many of the health issues associated with smoking.

Each e-cigarette is made up of three components: a battery, an atomizer, and a replaceable cartridge containing nicotine suspended in propylene glycol or glycerine and water. Levels of nicotine may vary. Some brands also contain flavorings. When the user sucks on the e-cigarette, the liquid in the cartridge heats up, which causes some of it to evaporate. This vapour then delivers a hit of nicotine to the lungs.

To make them appear more authentic, some e-cigarettes also feature light at the end, which glows whenever the vapour is inhaled.

Are the chemicals safe?

While experts agree that electronic cigarettes are an infinitely safer option than regular cigarettes, the jury's still out on the extent of any potential threat they pose to public health.

Could the chemicals used cause any problems, for example? Not according to ASH. A recent briefing from the charity concludes: “There is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine is suspended. One study concludes that e-cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects.”

And what about that smoke-like vapour? Research suggests it could cause exceptionally mild irritation to the throat – but beyond that, it is thought to cause no harm whatsoever. However, the BMA is more cautious. "While e-cigarettes have the potential to support tobacco harm reduction, any benefits or disadvantages to public health are not yet well established," says BMA Board of Science deputy chair Ram Moorthy. "This reflects the lack of conclusive evidence of their effectiveness as a smoking cessation aid, concerns regarding the variability of the components of e-cigarette vapour, and the absence of a significant health benefit associated with dual use of e-cigarettes and tobacco cigarettes."

How much do we really know?

Given e-cigarettes are a relatively recent invention, we still don't know what the long-term implications of their usage may be. And it's also important to remember that ingredients vary from brand to brand. For example, there are currently no rules in place surrounding the purity of the nicotine used. Until regulation comes into effect in 2016, this issue won't officially be addressed.

Speaking about the proposed under 18s ban, England's chief medical officer Professor Dame Sally Davies said: “We do not yet know the harm that e-cigarettes can cause to adults, let alone to children, but we do know they are not risk-free. They can produce toxic chemicals and the amount of nicotine and other chemical constituents and contaminants, including vaporized flavorings, varies between products – meaning they could be extremely damaging to young people's health.”

What's more, many critics argue that, far from encouraging smokers to kick the habit, e-cigarettes are helping to 're-normalize smoking. This is essentially the reasoning behind the proposed Welsh ban in enclosed spaces. If it again becomes commonplace to see people in public buildings brandishing cigarette-like devices with 'smoke' apparently coming out of them, will others feel less self-conscious about lighting up for real?

Alison Cox, Cancer Research UK’s head of tobacco policy, says: “Tobacco cigarettes cause one in four cancer deaths. Hundreds of children start smoking every day and we don’t want the marketing of e-cigarettes to confuse the message that smoking kills. We aren’t opposed to e-cigarettes being marketed to adult smokers – and hope that the marketing effort encourages many smokers to give up.”

Can they help you quit?

In the UK, e-cigarettes are mainly marketed as an aid to quit smoking. In this case, their use is only temporary. The theory – as with all forms of nicotine replacement therapy – is that your cravings for nicotine are satisfied without your body being exposed to the other toxins found in tobacco. The dose is gradually reduced until you've stopped completely.

A key potential benefit of e-cigarettes as a smoking cessation aid is that they satisfy the 'hand to mouth' habit while people are in the process of giving up. One New Zealand study found that users experienced reduced cravings, withdrawal symptoms and smoked fewer regular cigarettes a day when given a placebo e-cigarette.

In fact, a study conducted last year by researchers at University College London found that e-cigarettes are more effective than nicotine patches and gum in helping people quit.

However, research suggests that some regular smokers simply use e-cigarettes as an alternative to smoking in places where cigarettes are banned. These people have become known as 'dual users': they've got no intention of giving up, but e-cigarettes provide a fall-back option when tobacco isn't allowed.  Even so, you could argue that by using an e-cigarette indoors – rather than going outside to smoke normally – these people are still benefiting their health by cutting down, albeit unwittingly.

So how widely used are e-cigarettes as an aid to quit smoking? A 2014 survey by ASH found that 52% of ex-smokers had used the devices to help them quit, up from just 9% in 2010.

Ultimately, it seems e-cigarettes can offer a less harmful option for smokers who want to give up or cut down, and both the products themselves and the way in which they are marketed need to be tightly controlled.

For more information and advice on giving up smoking, visit NHS Smokefree