Jamie Hartmann Boyce, Cochrane Tobacco Addiction group, Joe Allen, Harvard University and Amanda Sandford, ASH
For many smokers across England, this October is... Stoptober! Thatís the campaign urging people to quit smoking this month, and hopefully even kick the habit for life. If youíre one of those brave quitters, you might take inspiration from Public Health Englandís recent announcement that more people are quitting than ever before. Part of this success is thought to be down to the use of quitting aids, and among them, e-cigarettes. But, there have been some confusing reports about whether vaping really does help people kick the habit. To find out more, Laura Brooks sat down with Jamie Hartmann Boyce, researcher with the Cochrane Tobacco Addiction group and lead author of Cochraneís recent review on e-cigarettes....
Jamie - In Cochrane, what we do, where we can, is collect evidence from randomised control trials and, in the case of electronic cigarettes, we found two of these and results showed, when we combined them, that electronic cigarettes with nicotine did appear to help people quit.
Laura - There are growing concerns, aren't there, about the risks associated with vaping? Based on the evidence that youíve seen, how safe are they?
Jamie - Itís a really interesting question. Itís hard to quantify safety for a number of reasons, partly because we donít have long term data. They haven't been around really for all that long and they certainly havenít been in common use for all that long. Another issue with assessing their safety is that the devices are changing all the time. Usually these changes are for the better but that also makes it difficult to assess.
Now, when we think about electronic cigarettes, what we really are comparing them to is regular cigarettes and everything we do know from the evidence suggests that electronic cigarettes are really considerably safer. We didnít find any evidence of any serious side effects that were associated with their use, but the studies we have in our review only went up to two years.
Laura - Right, and thatís an important point, isnít it - does that mean we donít know what the long term effects could be?
Jamie - We havenít seen the data on the long term effects but we know from our studies of cigarettes a lot of the things that happen in your body that mean, in the long term, those cigarettes are likely to cause disease. And when weíve measured those things in users of electronic cigarettes, the studies that we found in our review, found that they appeared much safer than regular cigarettes.
Laura - E-cigarettes might be safer than tobacco, but does that mean they are actually safe? Some scientists have expressed alarm about certain flavourings, because, while these chemicals might be harmless to eat, it doesn't necessarily mean they are also safe to inhale. Harvard Public Health scientist, Joe AllenÖ
Joe - For over a decade we've known about severe lung diseases associated with inhaling flavouring chemicals because of workers in the popcorn packaging industry, many of whom developed severe and irreversible lung disease after inhaling these flavouring chemicals. In particular, one of the chemicals that got the most attention, called diacetyl, and we detected diacetyl in over seventy-five percent of the flavoured e-cigarettes we tested. And this is the chemical that, in the United States, the investigating agency said that itís highly likely that diacetyl contributed to the occurrence of fixed obstructive lung disease, also known as bronchiolitis obliterans, also known as popcorn lung.
So we donít know much at all right now about the hazard associated with these flavoured e-cigarettes and thatís one of the goals of our study is to be sure that when we start talking about e-cigarettes, and safety, and risk, is that flavouring chemicals are part of that conversation.
Laura - Joe Allen, who also believes that e-cigarettes should be regulated as carefully as tobacco cigarettes. But how are e-cigarettes currently regulated? Amanda Sandford works for the charity ASH (Action on Smoking and Health)...
Amanda - Really, virtually all the e-cigarettes that are on the market now in the UK are governed by the European Union Tobacco Products Directive. That means that there are restrictions on limits of the amount of nicotine per product, thereís essentially a ban on the advertising and marketing that crosses borders, so sort of mass media type advertising, and there are other rules such as requiring a health warning on them. But, otherwise they are still classed essentially as consumer products so they are a separate category, theyíre treated differently, from tobacco products.
Laura - And we heard earlier from Jamie that e-cigarettes are thought to be a lot safer than smoking tobacco but, presumably, there is still some level of risk? No-one is recommending that we inhale chemicals into our lungs if we can avoid it.
Amanda - I mean, yes, thatís a fair point. The Public Health England conducted a review of the evidence last year, which complements the Cochrane review, and they found that e-cigarettes were about ninety-five per cent safer than tobacco products. But you're right, there is going to be some small risk from continually inhaling a vapour and we certainly donít know what the long term risks are, particularly to the lungs. But we always come back to the comparative, which is tobacco smoking, because these products are not by and large used by non-smokers, and they are being used by smokers and recent ex-smokers and we know the harm from smoking is so great that, undoubtedly, e-cigarettes are a safer alternative.
Laura - Amanda Sandford. So, where does this leave us? Weíve heard evidence that vaping is much less harmful than tobacco smoke so, if you are a smoker looking to make the switch to e-cigs, the consensus is that itís probably a good move. But consumers should also be aware that there are still some safety concerns, and future trials will be needed so scientists and policy makers can better assess the risks.
But, if youíre quitting this Stop-tober remember, there are many options out there to help you, but the place to start is to get advice from your Doctor or local Stop Smoking service who can help you find the best strategy to go smoke free for life!