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A response to NHS Choices News: E-Cigarette Decision Imminent

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This post is a response to an article in NHS Choices / News that discusses the MHRA's imminent decision on e-cigarette regulation. This response is too comprehensive to post to the original article comments, here:

Decision over e-cigarettes and 'vaping' imminent

http://www.nhs.uk/news/2013/06June/Pages/e-cigarettes-and-vaping.aspx

 

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Thank you for presenting a balanced article on e-cigarettes.

I agree with you that the cigarette equivalency of an ecig carto is usually overstated by vendors - most expert users put the figure at around 6 cigarettes; it is well-demonstrated that a 20-a-day smoker requires 3 to 4 cartos per day for normal equivalent consumption. The community is well aware of this issue and the consumer association, ECCA UK, will probably take action along with Trading Standards at some point.

To be honest I can see no real route to saving money compared with smoking, by the use of beginner-level devices such as the mini ecigs with prefilled cartos that you describe. Indeed, if a cost comparison is strictly applied, it may even be found to cost more. Savings cannot be made, realistically, until the ecig owner upgrades to a more effective and efficient system.

Sale to minors
Virtually everyone within the e-cigarette community and trade would support a law that prohibits sale to minors. That is a different issue from pharmaceutical regulation, which would (currently) remove all products from the market for at least 3 years, until a product receives an MA, at an estimated cost of £2m per product (as this is what it has cost one company so far in time and money, without yet receiving an MA). Since there are at least 5,000 separate products, and a license can only apply to a single product, this is not a realistic proposition.

It is also worth pointing out that every court in the world where a pharmaceutical license has been applied and then challenged at law has overturned the de facto ban and prohibited the government from taking this route (n = 5).

Inhalation of PG
Discussion of the effects of inhaling PG (propylene glycol), the most common excipent used in ecig refill liquids, should probably also include the fact that it is widely used in multiple pharmaceuticals licensed for inhalation, such as the nebulisers used by lung transplant patients and, more commonly, asthma inhalers (and has been for decades). Presumably the implications for health cannot be too serious if it can be inhaled ad lib by those with the most serious lung conditions and in the most fragile health. There are 70 years of safe use for inhalation of this material, and a considerable amount of research. You might also be interested to learn that if you work in a large building, such as a hospital, you breathe it all day (admittedly in microscopic amounts): it is the bactericide and virucide added to your building's air conditioning plant water cooling system that kills airborne pathogens and prevents you falling victim to Legionnaire's Disease.

Nicotine 'addiction'
As you are a science-based publication, you might want to revisit the statement:
"..... nicotine, which is highly addictive.....". There is no actual evidence for this. There is not a single clinical study of nicotine in humans, i.e. the effects of consumption of pure nicotine in nicotine-naive individuals. All citations on this subject lead to studies on smoking dependence, which an honest scientist would agree is a different matter since cigarette smoke contains 5,300 compounds according to the latest research. There are multiple synergens, additional possible candidates for dependence, and even pyrolysis-created compounds that might be involved in a chemical dependency issue. Since nicotine is a normal dietary ingredient and all test positive for it, calling it 'highly addictive' without a single clinical study seems a little unwise.

It is believed by some experts that after being supplied within tobacco smoke, there is some form of brain chemistry change that increases its potential for dependence; but until there is an actual clinical study of nicotine in humans, it may be wise not to make such definitive statements (it is abundantly clear that animal nicotine models do not apply to humans). We know many (but not all) smokers are dependent on nicotine - but this is a separate issue. After all, you could easily make ketchup dependence-forming by adding another 5,300 carefully-chosen compounds; and since ketchup contains nicotine, this is not a fallacious analogy. Few people are addicted to ketchup or find it difficult to withdraw from.

Cigarettes are a very carefully-engineered product, designed to 'maintain brand loyalty'; thus, smoking creates dependence - but this is a different matter. In addition, many appear dependent on coffee but this is not usually seen as a reason to seek treatment. Since it has clear life-enhancing factors, like dietary nicotine supplementation for some individuals (about 20% of the population, it seems), we should probably not view coffee dependence as anything more than an additional expense in an urban lifestyle. It cannot be harmless, but every urban living decision has a risk/benefit choice to it.

Chris Price

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