E-cigarettes: Is a smoking alternative being choked by regulation?

Dozens of countries are introducing
legislation restricting the use of
electronic cigarettes, but their
proponents say they are harmless and
their use could in fact save millions
of lives. Could they be right?
A group of friends sits around a table in
a pub in south London, exchanging
stories and putting the world to rights in
a cloud of scented vapour.
One of them is 31-year-old Jonny Lavery.
"I had a big problem with death, a really
big problem with dying," he says. "I
wanted to avoid dying at all costs."
But three years ago, Lavery realised that
as a smoker of 15 years, his chance of
doing this was diminishing. Roughly half
the world's smokers die from their habit.
The trouble was Johnny just enjoyed it
too much to quit.
Then he found an alternative - the
electronic cigarette.
These gizmos contain batteries and "e-
liquid" - a solution of propylene glycol
or glycerine - containing a nicotine dose.
A battery inside the e-cigarette heats up
a coil attached to a wick. When the liquid
is presented to the hot wick it produces
vapour which can be inhaled.
They don't quite match the nicotine hit
of a real cigarette, but they come close
enough to have won over 1.3 million
users in the UK alone (compared to nine
million tobacco smokers). In the US, e-
cigarette sales could pass $1bn (£650m)
this year - up from $600m (£390m) in
2012.
Since there is no smoke, puffing on e-
cigarettes is called vaping, not smoking.
The group of men and women sitting in
the pub call themselves vapers - they
meet regularly to vape and to talk about
vaping.
A little nerdy, they resemble a gang of
home-brewing enthusiasts more than a
stop-smoking support group.
They inspect one another's vaporisers -
which come in all manner of shapes and
sizes - and sniff one another's vapour.
"I'm currently vaping toffee popcorn,"
says Shari Levy, emanating sweetness.
"And this one here is coffee. And this
one is tutti frutti - that's nice for the
summer. Amaretto with a morning coffee
is just delicious."
Vaping paraphernalia comes in all shapes
and sizes
Like everyone else in the group, Levy
initially used e-cigarettes to help wean
herself off the real thing. After a while
she realised she no longer really liked the
taste of tobacco.
While e-cigarettes can be used as a
stepping stone to ending nicotine
addiction, some vapers see them as a
way to continue a hobby they enjoy
without the attendant fear of death.
That's because although nicotine is the
addictive ingredient in cigarettes many
experts do not think it is especially
harmful. It's the tar and other nasties in
tobacco that kill.
"Nicotine is not very dangerous, and it's
very unlikely someone will overdose on
the nicotine in electronic cigarettes by
inhaling the vapour," says Maciej
Goniewicz from Roswell Park Cancer
Institute in Buffalo, New York - an
oncologist who has analysed e-cigarettes
and the vapours they produce.
He says that in the absence of research
into the effects of long-term vaping, it is
impossible to say that e-cigarettes are
absolutely safe, but we know enough to
say they are safer than the real thing.
There is no such thing as passive vaping.
Nevertheless, a wave of legislation is
threatening to extinguish e-cigarettes all
over the world.
Brazil, Singapore and Mexico have
banned importing and selling the
devices, even though tobacco is still on
sale in all those countries.
In the US, state-level legislation inhibits
vaping in different ways. Arizona has
banned the sale of the products to
minors. The same rule applies in New
York State, where vaping is also
prohibited within 100m of a school
entrance. In Washington State, all vaping
in public is banned.
Draft legislation in the EU - including a
UK version that will affect the London
vapers - will restrict the sale of e-
cigarettes and bring them within medical
regulation. Manufacturers will need to be
licensed, and the components labelled
clearly with their precise nicotine
content. The products will not be
marketed or sold to young people under
16.
So if e-cigarettes are relatively safe,
what's motivating all this legislation?
One set of concerns has to do with safety
and standardisation. The UK body that
oversees the regulation of medicines, the
MHRA, says e-cigarettes currently
available do not meet appropriate
standards of "safety, quality and
efficacy". Anecdotal reports point to
dangers caused by variations in product
quality, including facial burns after a
vaporiser exploded in a consumer's
mouth. The US Food and Drug
Administration has also found that
nicotine doses vary between devices, and
have been found to vary from the
advertised dose on the label - while the
ingredients in e-liquid are also not listed.
But there are also other concerns:
Some pressure groups fear that
electronic cigarettes may "re-
normalise" smoking, thereby
undermining the smoking bans
which have helped de-glamorise
cigarettes - the British Medical
Association (the UK's trade body for
doctors) cites this concern in
calling for a ban on public vaping.
Others point to the possibility that
the red-glowing tips might prove
enticing to children - New Jersey
assemblywoman Connie Wagner has
also voiced a common fear that
children may enjoy the fruity
flavours.
It's clear that some children have tried
electronic cigarettes, but Prof Robert
West, director of Tobacco Studies at
University College London, says there is
no sign they are becoming popular in
the UK - the only country he knows
where the uptake is monitored closely.
He adds that if and when young people
do start smoking e-cigarettes, public
health experts will have to study the
causes carefully.
"If those young people are people who
would have smoked but instead they're
using e-cigarettes, then that's a huge
public health gain. If they're people who
would never have smoked but they've
taken up e-cigarettes, frankly in public
health terms it's not really an issue - it's
like drinking coffee or something, there's
no real risk associated with it.
"The real risk is if they start using e-
cigarettes and this acts as a gateway into
smoking. Now which of those things
happens none of us knows at the
moment."
As for the idea that e-cigarettes undo the
work to de-glamorise tobacco smoking,
West, who has done consultancy work
for nicotine cessation medication, says
the public health opportunity provided
by e-cigarettes lies in their remaining
trendy.
"The opportunity here is for something
that's seen in a different light," he says.
"We never got communities of people
really enthusing about nicotine patches
or nicotine gum. You didn't get a sort of
nicotine gum users' group, in which
they'd rave about the gum and sort of
say: 'This sort of gum's so much better,
and I make my own gum,' and stuff like
that."
Ninety per cent of e-cigarette users are
also smoking, he says, indicating that the
devices are being used as a quitting aid.
Countries that have banned them are, in
his view, "nuts".
Jonny Lavery and others are planning a
trip to Brussels next week to protest
against the draft European legislation,
which they see as a threat to their
hobby.
The organiser of the London and South-
East Vapers meet-ups, Alan Hodgson, had
tried quitting three times before he
found e-cigarettes. Each time a rough
spell in his personal life sent him back to
the fags.
He would like to stop vaping altogether
or lower the nicotine content of his e-
liquid to zero - but it's not something he
feels he needs to worry about too much.
"My worst-case scenario is really that I
might be vaping for the rest of my life,"
he says, "rather than dying from normal
tobacco cigarettes."