Is it safe for the NHS to hand out e-cig­a­rettes?

New re­search sug­gests they pro­duce tox­ins that may harm your heart

Scottish Daily Mail - - Good Health - By JOHN NAISH

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.’


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