E-Cigarettes may be Hazardous to Health Nicotine Monkey

Is this the beginning of the end for ENDS?

The acronym – much medical writing is peppered with annoying non-standard abbreviations of this sort – means Electronic Nicotine Delivery Systems. These drug-delivery devices, for that is what they are, were in the spotlight at a conference held in India in 206 of the FCTC (there we go again) which means the Framework Convention on Tobacco Control.

Readers of this blog or of my books will by now be familiar with my views on the Tobacco Controllers.

As part of the agenda for this five-day conference, the delegates considered a report by the WHO on e-cigarettes; it makes for interesting reading. The bottom line is: ‘WHO has now urged restriction of the sale, promotion and use of e-cigarettes.’

Here’s a summary of some of the stated reasons, with emphasis added:

The aerosol produced by e-cigarettes contains glycols, aldehydes, volatile organic compounds, polycyclic aromatic hydrocarbon, tobacco specific nitrosamines, metals including lead chromium and nickel, and silicate particles. Many of these substances are poisonous.

Some of the flavours of e-cigarettes such as cinnamon and cherry pose appreciable health risks
The claim that e-cigarettes are likely to be less harmful than conventional tobacco cannot be quantified due to lack of research.
WHO is sceptical of the claimed ability of e-cigarettes to help tobacco smokers to quit, saying that the scientific evidence is scant and of low certainty, making it difficult to draw credible inferences
Consideration should be given to banning the sale and distribution of e-cigarettes to minors and of banning or restricting the use of flavours that might appeal to minors
Consideration should be given to prohibiting by law the use of e-cigarettes indoors and should require companies manufacturing e-cigarettes to introduce health warnings
The involvement of multinational tobacco firms in the marketing of e-cigarettes poses a major threat to tobacco control, because they are promoting smoking through e-cigarette advertising to adults and children
A review of 105 studies analysing the composition of liquids and emissions from e-cigarettes found that 30 per cent of authors had received funding from e-cigarette interests, including from the tobacco industry

In spite WHO saying it’s sceptical of the claims that e-cigarettes can help smokers quit, it’s reported in the online Vaping Post (where else?) that two Indian scientists have written to the Minister who deals with such matters, requesting him to ‘consider policies that facilitate smoking cessation by providing smokers with safe and regulated tobacco alternatives.’ They also remind us that, ‘The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing around six million people a year.’ Of these, one million are reported to be in India.

To deal with this they call for ‘nicotine replacement therapy supported by advocacy and where possible, psychological support.’ The replacement therapy they have in mind is e-cigarettes, which are supposed to offer ‘a safer and effective way of meeting the physiological demands of nicotine to smokers to help quit or cut down smoking significantly.’ This is the conventional approach, but as I have pointed out before, it’s not noted for its success – 20 per cent at best. Incidentally, the word ‘physiological’ means ‘relating to the normal function of living organisms,’ so here it would be more accurate to talk of the pathological (abnormal) demands of nicotine to smokers.

As I have also pointed out before, the reason for the poor results of the conventional approach is that many smoking cessation advocates seem to have wrong-headed ideas about how to tackle the problem; the comments of the two Indian scientists illustrate several of these.

For a start, the whole idea of replacement therapy is not the best way to go about it. It really means cigarette replacement or nicotine maintenance therapy.

Secondly, although it’s common to talk of an alternative to cigarettes, it needs to be emphasized that you don’t need an alternative to cigarettes. Do you need an alternative for the flu when you’ve recovered?

Thirdly, cutting down cigarettes rather than quitting, does little or nothing for smokers’ health.

The mention of psychological support, however, is at least on the right lines. Smoking is a psychological problem (see my book of this title) for which the right kind of support is of great help for successful quitting. I hasten to say this doesn’t mean the apparent difficulty of quitting is imaginary, but the commonly experienced withdrawal symptoms of nicotine – mainly mild anxiety and nervousness – are mental symptoms. If the smoker can be assisted to demonstrate to himself or herself how these arise it is then usually easy to quit smoking for good.

Finally, lets come back to the notion of ‘meeting the physiological demands of nicotine to smokers to help quit or cut down smoking significantly.’ For the reason stated, we’ll replace the word ‘physiological’ with ‘pathological’.

The only reason smokers have a pathological demand for nicotine is because of nicotine addiction. Non-smokers (and those who don’t use e-cigarettes) have zero demand or need for nicotine. To deal effectively with the smoking problem, therefore, a different mind-set is required. If one goes on meeting or satisfying the pathological demand for nicotine, you are stuck in a self-repeating cycle: each dose of nicotine, whether supplied by ordinary cigarettes or e-cigarettes, creates the demand for the next one.

Therefore, what is needed is to break the cycle – by not putting nicotine into your body ever again – by any means.