Is it safe for the NHS to hand out e-cigarettes?
New research suggests they produce toxins that may harm your heart
ARE electronic cigarettes certified as safe to use? You might think so, given that the Government last week gave the green light for one brand to be prescribed on the NHS to help people to stop smoking.
The drug safety watchdog, the Medicines and Healthcare Product Regulatory Agency (MHRA), has awarded a prescription licence to British American Tobacco for its ‘e-Voke’ device.
This could pave the way for further brands of the nicotine-vaporising gadgets to be prescribed to smokers.
The decision comes in the wake of a review in August by NHS regulator, Public Health England, which declared e-cigarettes to be 95 per cent safer than tobacco and called for them to be prescribed as soon as possible.
However, these positive moves mask growing scientific fears about the safety of the devices. Such concerns have already led to bans on their commercial importation by authorities in Australia, Hong Kong, Brazil and Argentina (though people can still buy them via the internet).
In Britain, disagreements over e-cigarettes’ safety have sparked fierce debate. On one side are scientists who believe the devices could save thousands of lives because they appear to offer a much better level of risk than cigarettes for current smokers.
Supporters argue e-cigarettes help most smokers give up tobacco and it is rare for people who don’t already smoke to take up vaping (as the practice of inhaling from e-cigarettes is known).
However, on the other side are scientists who argue the devices should be shunned because their risks are unknown and they encourage non-smokers to become addicted to nicotine.
E-cigarettes are designed to vaporise a liquid solution containing nicotine, to provide a smoker’s high without tar and cancerous chemicals found in tobacco.
THE amount of nicotine they deliver varies. A test of 16 devices in 2012 by Queen Mary University of London found the top-performing e-cigarettes delivered 15.4mg of nicotine — three times as much as the lowest performers.
But even 15 puffs from those at the top of the scale caused less nicotine to be inhaled than a conventional cigarette, the study in the journal Nicotine & Tobacco Research found.
However, recent research indicates e-cigarettes may themselves bring risks of cancer and other smoking-related harms, such as cardiovascular disease. This month, for example, U.S. scientists claimed the vapour emitted by the devices damages DNA and could cause cancer, which they said could mean they are no safer than tobacco.
The research by the University of San Diego in California was only on human cells in the lab. But the results are disturbing.
The experiment continuously exposed normal cells from the human head and neck to strong e-cigarette vapours for up to eight weeks. Head and neck cancer is a significant risk from smoking conventional cigarettes.
The exposed cells developed pre-cancerous DNA damage and died far sooner than similar cells not exposed to e-cigarette vapour, says the Journal of Oncology.
In December, Spanish scientists warned in the journal Current Environmental Health Reports that a number of e-cigarette brands emit significant levels of a fine chemical soot, called PM2.5.
This is known to cause death through cardiovascular disease.
Meanwhile in September, research chemists from the University of California, Irvine, warned e-cigarettes produce the same amounts of the chemicals acrolein and acetaldehyde as conventional cigarettes. These irritants are known to cause lung damage that may lead to cancer or asthma-type breathing troubles, reported the journal Aerosol Science And Technology.
Furthermore, the process of heating and vaporising the nicotine solution cooks up new chemicals including the carcinogen benzene and lung irritants such as n-butyraldehyde, also found in tobacco smoke, researchers warned in November in the journal Scientific Reports.
Nicotine is increasingly coming under scrutiny. It’s previously been considered biologically harmless, albeit addictive.
But in August, experts at the authoritative U.S. Centres for Disease Control warned how lab experiments show that it can significantly impair the growth of brains and lungs in unborn babies, and affect the development of adolescents’ brains.
In particular, exposure to nicotine can interfere with the normal growth of the hippocampus — an area of the brain that’s associated with learning and memory — in teenagers.
Similarly, Israeli scientists recently warned that nicotine and propylene glycol — a solvent in e-cigarette liquids — can inhibit the growth of nerves and tissues.
This is especially concerning given the reported popularity of e-cigarettes among pregnant women and adolescents.
Last April, a large British study at Liverpool John Moores University revealed one in five teenagers has bought or used e-cigarettes — including many who have never smoked cigarettes. The fear is that once teenagers get a taste for nicotine, they are likely to move on to real cigarettes. Meanwhile, e-cigarettes appear to backfire as a ‘smoking cessation’ tool for many adults, according to Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine.
‘E-cigarettes are commonly used by people who smoke cigarettes as well. Such people are called dual users,’ he says. ‘These devices enable them to maintain their addiction by not having to go outside every time they want a dose of nicotine.’ Professor McKee is concerned about the difficulty of ensuring the safety of all the e-cigarettes on the market. There are nearly 500 brands, in more than 7,000 flavours, and only one product — e-Voke — ‘has gone through the rigorous process to be approved as a medicine’. ‘We really have no idea of what is in many of these things,’ he says of the other products. ‘They also contain substances such as food colourings. While these chemicals have tested OK when swallowed, it may be different when you put them straight into your lungs.’
Indeed, in December, U.S. safety experts warned that e-cigarette users could be at risk of developing a lethal disease, bronchiolitis obliterans, where tiny airways in the lungs become inflamed and scarred, reducing air flow. The only cure is a lung transplant.
Scientists at the National Institute for Occupational Safety and Health lab-tested samples of smoke from 51 flavoured e-cigarettes and found diacetyl in 39. Often used in fruit, sweets and alcohol-flavoured e-cigarettes, diacetyl has been linked to bronchiolitis obliterans. Though safe when eaten, it may be hazardous when inhaled over time.
In September, Professor McKee and Simon Capewell, a professor of public health and policy at Liverpool University, published a critique of the call by Public Health England that e-cigarettes should be prescribed on the NHS as soon as possible.
They argued the committee had been influenced by tobacco companies and the advice was based on ‘weak scientific evidence’.
PROFESSOR Kevin Fenton, the director of health and wellbeing at Public Health England, disputed the accusations, arguing: ‘Nearly 80,000 people a year die of a smoking-related illness and smoking costs the NHS £2 billion a year.
‘By spelling out current evidence — that while e-cigarettes are not risk-free, they carry only a fraction of the harm caused by smoking — we’re fulfilling our national remit.’
Nevertheless, the British Medical Association and the Royal College of General Practitioners, are concerned.
Dr Ram Moorthy, deputy chair of the BMA’s science board, acknowledged the health risks are likely to be ‘significantly lower’ than those associated with smoking tobacco. However, he told Good Health: ‘There is still a lack of robust research and evidence on the long-term safety of e-cigarettes.’
Dr Tim Ballard, vice-chair of the Royal College of GPs, adds: ‘Potentially, there may be a place for the prescription of e-Voke, but GPs would be very wary of prescribing it until there is clear evidence of safety and efficacy.’
British American Tobacco (BAT), whose product is the only one approved for prescription, acknowledges that ‘no product is free from risk’.
A spokesman adds: ‘Questions are being asked about the possible long-term effects of inhaling substances in e-liquids, such as glycerol and propylene glycol.
‘Though these are commonly approved for use in food and medicines, research is needed in relation to their inhalation, so we are planning our own studies.’