e-cigarettes – Debate rages around globe

By Dr. Ananya Mandal, MDDec 12 2010

Following misleading advice that ‘e-cigarettes’ are a “healthy way” to quit smoking, thousands of smokers are switching to these electronic cigarettes. According to the Australian Medical Association (AMA) and anti-smoking groups these smokeless, battery-powered e-cigarettes packed with nicotine have not been tested for safety and could pose a serious health risk. Electronic cigarettes contain an inhaler, an atomiser and nicotine suspended in propylene glycol and water. At present they are banned in NSW and Victoria but overseas suppliers sell them online.

Apart from the health conscious who wish to quit using e-cigarettes there are hose who now take e-cigarettes because of recent tax increases and smoking bans. In some cases, it has helped them give up cigarettes. Paul Medarov, chief executive of New Zealand-based company Elusion, the largest supplier of e-cigarettes in Australia with about 10,000 customers, said sales increased 200 per cent in May after the federal government announced a 25 per cent tax rise on tobacco products. Elusion sells cartridges with high, medium, low or zero nicotine. Health experts say that this method of quitting was crude and could lead to nicotine poisoning or make people return to normal cigarettes.

The AMA has asked the Therapeutic Goods Administration (TGA) and the Australian Competition and Consumer Commission to find out why the products are still available for use. AMA Victorian president Dr Harry Hemley said, “As far as I am aware, there are no warning labels on these products to alert consumers to the risks of use.”

Last week the British Medical Journal published an article that recommended the products be banned, after an analysis of six electronic cigarette brands found nicotine levels were difficult to ascertain and the toxic substance often leaked out, posing a risk to children. In another article that appeared in Tobacco Control last week, researchers recommended banning e-cigarettes.

A spokeswoman for the TGA also said e-cigarettes were not a safe alternative to normal cigarettes and not approved for therapeutic use. She said, “Except in therapeutic preparations [such as] nicotine replacement therapies, nicotine is a schedule 7 poison because it is harmful to human health. Consumers are warned of their danger to health and encouraged not to purchase these harmful cigarette substitutes.” She also said that there were no laws preventing the importation of such products bought over the internet for personal use, unless prohibited by state and territory legislation.

In the United States the Food and Drugs Administration (FDA) lost its appeal a few days ago where they urged the government to treat these e-cigarettes as tobacco products. The ruling is a setback for the FDA and public health organizations that say e-cigarettes may still pose dangers. Campaign for Tobacco-Free Kids added on the court decision, “This decision will allow any manufacturer to put any level of nicotine in any product and sell it to anybody, including children, with no government regulation or oversight at the present time.” Groups such as the American Heart Association also derided the ruling in this week.

Dr. Elizabeth Whelan of the American Council on Science and Health, a New York-based non-profit organization however added, “I can’t believe that so-called anti-smoking groups are saying e-cigarettes are dangerous…What they’re really saying is ‘go back to the real thing,’ which will kill you.” Almost 46 million Americans smoke traditional cigarettes according to the Centers for Disease Control and Prevention. Whelan said, “Most people are not aware that nicotine is not what is dangerous about cigarettes - nicotine is addictive, but it’s not strictly speaking ‘dangerous’… What is dangerous is the products of combustion. And e-cigarettes have none of those.”