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Electronic Cigarettes: An Introduction
This introduction to e-cigarettes has been written by ECCA UK, the
Electronic Cigarette Consumer Association of the UK. It explains what
they are, the medical implications, the legal situation, and other issues.
You can find more detailed information on the ECCA website:
www.eccauk.org
Who invented e-cigarettes ?
The electronic cigarette was invented in China in the mid-90's, by Hon Lik,
an engineer and chemist who had seen his father die of cancer, and being
a smoker himself, wanted to find a way to obtain nicotine but without the
risk to health. He believed that if the smoke could be removed, then so
would most if not all of the risk. He formed a company called Ruyan to
market his invention.
By early 2006 e-cigarettes were available in the UK, and in the USA by
the end of the year. It is thought that by 2007 there were about 1,000 ecigarette
owners in the UK, and the first internet forum on the topic was
started in London. E-cigarette usage growth has been about 500% per
year in the UK, with somewhere between 200,000 and 400,000 owners
there by Q2 2011, the UK market being worth around £5m at this time.
Growth in the US has been much stronger as there are now between 2
and 4 million current users, with the market worth $100m plus. The
original forum now often has over 1,000 people online at any time, more
than 3,500 posts per day, and over 3 million pages on the sitemap.
What is an e-cigarette ?
A standard electronic cigarette has either two or three parts: a battery,
atomizer and cartridge; or a battery and cartomiser, a combined
atomizer-cartridge.
The battery is normally a 3.7 volt rechargeable Li-ion cell, with some
electronics packaged with it to control the recharge and discharge state.
The atomizer is a tiny coil of nichrome wire that heats the liquid and
vaporises it. A simplified description of how it works is that it is a
combination of a toaster and a kettle: the heater coil is exactly the same
as that in a toaster but on a smaller scale; and in use it works like a
kettle, as the coil heats up while immersed in a liquid bath. The result
looks like steam but is well below the temperature needed for that, as it
utilises the same ingredient used in disco fog machines to create visible
vapor - it is mainly water vapor but at far lower temperature than steam.
[1]
The cartridge contains the refill liquid, which is normally held in some sort
of sponge or foam, and gravity-feeds it downward to the heater element.
What is in the liquid ?
Normally, there are less than 10 ingredients in the liquid refill or e-liquid
as it is often termed, and this compares favourably with the 5,300-plus
identified so far in the latest research on cigarette smoke. The vapour is
mainly water vapour, plus flavouring, the visibility component, and
nicotine.
There are various recipes for liquid that are proprietary to each
manufacturer; some are marketed as of the simplest possible make up,
some for their exotic flavours. The liquid normally contains PG and/or VG
[2]
plus flavourings such as coffee or chocolate. Once users' sense of
taste has returned, they tend to prefer sweet flavours over tobacco,
though a combination of the two is popular.
There is no sidestream smoke from an e-cigarette, only what is exhaled
by the user, which is mostly water vapour.
Some owners (about 7% according to polls) use zero-nic liquid, that is,
refill liquid with flavouring but no nicotine.
What are the health issues ?
Death and disease associated with smoking are caused by the smoke and
products of combustion. If the smoke and other combustion products such
as carbon monoxide are removed, there is little if any risk. Nicotine is not
a harmful material, it is similar to caffeine/coffee in many ways. It cannot
cause cancer or any of the other diseases caused by smoking, as it is the
smoke that does this. It is impossible for e-cigarettes to cause lung
cancer.
Because of this, a user's risk drops by several orders of magnitude. Ecigarettes
are extremely unlikely to cause cancer, heart disease, arterial
disease, or COPD as there is nothing in the vapor that can cause this.
There is no smoke.
This is why all the extensive research on e-cigarettes, and all the senior
medical figures who have carried out this research or inspected it and
commented on it, reinforce the fact that e-cigarettes are far safer than
tobacco cigarettes, and that they should be introduced as swiftly as
possible as an alternative to smoking, since hundreds of thousands of
lives will be saved if this is done.
There is a long list of senior medical figures such as professors in charge
of public health departments in hospitals, doctors who are clinical
researchers, and organisations such as the AAPHP, the American
Association of Public Health Physicians, and the ACSH, the American
Council for Science and Health, who have examined the evidence and
pronounced e-cigarettes as safe enough to be used as an alternative
smoking method and ideal for the purpose of saving lives.
No one is suggesting that e-cigarettes are safe in absolute terms - but if
they contain no ingredients that cause harm, and all the ingredients are
already used with no harm recorded, and the ingredient that causes the
vapour to be visible (PG) is licensed for use in nebulisers for lung
transplant patients and has 70 years of documented research proving it is
safe, then we can assume that the risk is orders of magnitude less than
for smoking tobacco. It is expected that some long-term users will prove
intolerant to one or more ingredients, with the result of minor lung issues
- but one thing the doctors are quite clear on is that if smokers switched
to electronic cigarettes en masse then the death rate would fall through
the floor. There cannot be any other possible result.
What is the legal situation ?
Electronic cigarettes are legal to import, own and use in the UK, US, and
Europe. There had been opposition to them by individual government
agencies in both the UK and US, but these objections were quashed by
the courts (in the US) and higher government (in the UK).
It had been claimed that "there was little research", or "we don't know
what's in them", or "we don't know much about them". However, there
was a long list of professors, doctors and epidemiologists who could refute
those statements, and there is an extensive body of research which all
shows harm is very unlikely to be caused. After many years of use by
millions of people all around the world, there is not one single incident of
death or disease linked to e-cigarette use. Since after extensive use there
has been no report of harm, the actions to ban e-cigarettes were
overturned.
Why is there opposition to them ?
It's quite simple: some corporations will lose a fortune if e-cigarettes
become popular. Despite the fact that anyone can see that widespread
use of e-cigarettes will save hundreds of thousands of lives, we are being
asked to give priority to maintaining current income streams instead.
The biggest loser will be the pharmaceutical industry, as their extremely
profitable NRTs (quit-smoking medicines) will not be required. If there is a
safer alternative to smoking, clearly preferred by millions of people (as is
the case now, with e-cigarettes), then people will obviously choose the
better alternative. Why buy drugs that cost the same or more than
smoking? Why take drugs with a substantial risk, such as Chantix?
[3]
Why buy drugs that cost even more than smoking (like the Nicotrol
inhaler)? Why buy drugs that are almost guaranteed to fail?
[4]
As a result the pharma industry will lose hundreds of millions of dollars -
possibly billions - in global sales of NRTs. They are desperate to avoid this
and are fighting hard to have e-cigarettes banned or restricted - and with
some success, as they have millions available for this purpose.
[5]
Wherever you see opposition to e-cigarettes you will find pharma funding.
Why else would anyone object to something that will save hundreds of
thousands of lives?
[6] It does at least allow us to identify the most
corrupt government departments and legislatures - if that is of any
solace.
Why use an e-cigarette and not an NRT ?
E-cigarettes are a replacement for smoking - a better alternative. They
are not for quitting smoking. The vast majority of e-cigarette users don’t
want to stop, they want to continue but with a safer alternative.
E-cigarettes are like Snus, they are a form of smokeless tobacco used as
a better alternative to cigarette smoking. This is called Harm Reduction,
which is a consumer purchasing choice. When people buy low-alcohol
beer, decaff coffee, or low-fat foods, this is termed Harm Reduction - a
consumer choice intended to reduce the risk profile.
Many people have found that they need nicotine in order to function fully
at work and leisure. We don’t know why this is yet, but some factors that
have been mentioned are:
1) Nicotine is a normal ingredient in many vegetables. Aubergines,
tomatoes and tea are said to have the highest content. Since we have
been eating these vegetables for a very long time, it is suggested some
people need more nicotine than most in order to function properly.
2) One form of nicotine is a vitamin: niacin. It is also called Vitamin B3,
nicotinic acid, or nicotinamide. Niacin is a compound word derived from
Nicotinic acid vitamin, and shortage of it causes the disease Pellagra.
Obviously, this group of chemicals is not harmful to us except for a large
overdose (as with other vitamins such as D).
3) Everyone tests positive for nicotine* in the blood (unless they do not
eat vegetables). Therefore, a test for smokers based on a nicotine test
has to have a minimum level quoted - since otherwise everyone would be
classed as a smoker.
* The standard test for nicotine is actually for cotinine, its principal
metabolyte, since nicotine is quickly metabolised (used by the body, and
waste products produced called metabolytes that are eventually
excreted).
Quit - or keep going, but safer ?
People who want to quit smoking are best cared for by their doctor, as
mentoring is a critical part of that process.
However, as little as 2% of people using pharmaceuticals to quit smoking
will succeed. This is the success rate at 20 months shown by independent
research trials on skin patches. The best possible success rate at 20
months has never been shown to be over 10% by independent research.
The overwhelming majority of people who try to quit using
pharmaceuticals will fail.
In contrast, between 30% and 75% of those who try an e-cigarette will
succeed in converting. The difference here is due to whether or not they
are mentored, among other factors. These people will almost certainly
have a similar risk profile as Snus users - i.e. negligible.
From the relative percentages of those trying to quit versus those trying
to convert to a safer alternative, you can see that harm reduction is easily
going to save the most lives. There is just no contest. Even if an ecigarette
user had as much as 10% of the risk of a smoker, it would still
be an easy victory - more than 90% of those who use pharmaceuticals
are at risk of dying, but less than 10% of those who convert to an ecigarette
(and that is a worst-possible-case scenario, since all the medical
experts say the risk is at least 99% less).
This is why the old quit-or-die type of cure, for any form of addiction, is
thoroughly discredited in modern medical practice. It simply doesn’t work,
and most people risk death. All modern treatments for addiction are
based around harm reduction because it saves far more lives. If people
cannot stop, then, if you can, remove most of the risk. Luckily, in ecigarettes,
we have a way to keep smoking without the risk. No one,
anywhere, can show that there is a risk to e-cigarette use; but for the
sake of responsible presentation we will assume that e-cigarette users do
have some risk. Perhaps it is the same as for Snus users, i.e. statistically
insignificant; perhaps it is more.
What does the future hold ?
At some stage, 25% of smokers will be using an e-cigarette. We don't
know when this will be but it is not that far off - perhaps by 2025,
perhaps earlier. If the current rate of growth continued then it would
happen much sooner, but presumably a growth rate of 500%+ per year
cannot be maintained, and the graph will start to get less steep.
It is expected that the pharmaceutical industry will succeed in having ecigarettes
banned in countries where government departments are easiest
to suborn, and restricted in others where they do not succeed in obtaining
a ban. They will be aided by the pharmaceutical licensing aulthorities in
many countries, as those agencies act in effect as the legal arm of the
pharma industry - they never take any action that would severely impact
pharma income, and where possible they assist in removing commercial
competitors. As examples, note their success in having Snus banned
throughout Europe at the cost of many lives [7], and the recent virtual
ban on herbal medicines in the EU in order to restrict sales that compete
with pharma.
As a result, some (or many) e-cigarette users will have resort to black
market supplies of e-cigarettes and materials in order to exercise their
right of choice and their right to live. This may be a historic event when it
occurs, as it might be the first time in history that people have had to go
to the black market for safer materials in order to stay alive, in contrast
to the more usual practice of obtaining dangerous substances.
It will also be most people's first real taste of government corruption and
its direct effect on them.
_______________________________________
Notes
[1] PG, propylene glycol, is the visibility creator and vapor-body
ingredient, and is also used in asthma inhalers and the nebulisers used by
lung transplant patients. It has 70 years of documented research proving
it is safe.
[2] VG, vegetable glycerine, is a popular food additive and skin care
ingredient. It creates more visible vapour than PG but has less TH or
throat hit, the effect that replicates cigarette smoke in the throat.
[3] The quit-smoking drug Chantix/Champix/Varenicline is associated with
hundreds of suicides, and even a case where the recipient killed their
entire family, as it can cause severe depression and psychotic episodes.
Recent evidence also shows it can cause heart attacks.
[4] Independent research shows that NRTs taken without being part of a
mentoring program have a success rate of 7% at best, and some research
shows the success rate as only 2%. Mentored programs can
approximately double this success rate, but the fact remains that the vast
majority of people - at least 90% - taking these medicines will fail to quit
smoking, and everybody knows they will fail. Yes, everybody (except the
patients themselves, as they are not told this).
[5] In 2009 the pharma industry had more lobbyists in Washington, USA
than there were Congressmen. They declared a $267 million spend on
lobbying. The same resources are available in any country that needs
their attention - and those countries will be where NRT sales are highest,
such as in Europe, especially the UK.
[6] Anecdotal evidence shows a success rate of 75% is common when
assisting people to switch to an e-cigarette. Contrast ref#4 with this.
[7] Snus, a Swedish oral tobacco that is processed in a special way to
remove carcinogens, is the best proven alternative to smoking and an
extremely successful tobacco harm reduction product. There are 25 years
of research in Sweden that prove Snus users have virtually the same risk
as non-smokers, and that they are as a consequence not only a safer
alternative to smoking, but safe in absolute terms. For example a Snus
user has the same risk of contracting oral cancer as a non-smoker (and
the same risk of lung cancer, i.e. almost zero, of course).
A Snus user has a risk of 0.3, on the scale 0.001 to 100, where a smoker
has a risk of 100. Sweden has the lowest male cancer death rate of any
developed country.
Despite this, Snus are banned throughout the rest of Europe, as they
would not only compete with NRTs but more or less render them
irrelevant. NRT sales in Sweden are not impressive.