The e-cigarette: Friend or foe?

Written by Wilma Stassen

Whether it is rising cigarette prices or tightening smoking regulations, more people are turning to electronic cigarettes to kick the habit but the debate about e-cigarettes’ safety and efficacy rages.


A schedule 3 drug, e-cigarettes legally
can only be sold in pharmacies.

Electronic cigarettes, or e-cigarettes, are battery-powered devices that look like conventional cigarettes but contain no tobacco. Instead, the devices are filled with liquid nicotine, which is heated and vaporised before being inhaled.

Worldwide, e-cigarette sales are booming and increased by 240 percent between 2012 and 2013.

In a recent statement, the International Union Against Tuberculosis and Lung Disease warned that the safety of e-cigarettes had not been scientifically proven. The Union also cautioned that e-cigarette vapour could still be cancer-causing while there is limited evidence to support their effectiveness as smoking cessation tools.

The international body advocated restricting the sale and use of the electronic devices by, for instance, banning all advertising, prohibiting their sale to minors and outlawing their use in public places.

In South Africa, the e-cigarette is regulated under the Medicines and Related Substance Act that classifies nicotine as a schedule 3 drug, requiring it to be sold only at pharmacies and with a doctor’s script. The device itself also falls under the Act as it is considered a delivery device for a scheduled drug.

Experts square off

Local experts recently debated the pros and cons of e-cigarettes in the South African Medical Journal where Dr Brian Allwood from the University of Cape Town’s (UCT) Division of Pulmonology argues the tiny machines might be the lesser of two evils for those who cannot kick the smoking habit despite smoking’s obvious dangers.

“It is highly unlikely that e-cigarettes are as toxic to human tissue as conventional cigarettes,” writes Allwood, who adds that e-cigarettes still allow potential quitters to participate in the psychological and social “ritual of smoking.”

He argues there was a also a small but growing body of evidence to support e-cigarettes’ role in quitting smoking. In one clinical trial conducted among 300 hundred people, e-cigarettes helped unmotivated smokers achieve the same levels of cutting down or quitting smoking as a group of smokers who were motivated to quit.

[quote float=”left”]”E-cigarettes may be less dangerous than tobacco, but given that tobacco kills 50 percent of its users, what would not be safer?”

But fellow UCT pulmonologist Dr Richard van Zyl-Smit disagrees and says current research has been limited to a few hundred people and also faults the design of some studies.

“The evidence for their being an effective method for smoking cessation is unconvincing,” he writes. “Safety has not been proven in large studies of long-term use.”

A cause for concern is also the unregulated manufacturing of e-cigarettes, which have been found to contain poisonous and sometimes cancer-causing substances. Although more reputable brands may have stricter manufacturing controls, without  regulation users have no guarantee of what is actually in their e-cigarettes.

Like other nicotine-replacement products, such as patches or chewing gum, e-cigarettes also do not cure nicotine addiction but actually maintain. Nicotine itself is not entirely safe. It is toxic at high doses, increases insulin resistance that can lead to type 2 diabetes, suppresses the immune system and causes mucus to form in the lungs, among others.

“They may even encourage more habitual use of nicotine, which, in time, might encourage a switch to cigarette smoking … or act as gateway devices to cigarette smoking,” writes Van Zyl-Smit. “E-cigarettes may be less dangerous than tobacco, but given that tobacco kills 50 percent of its users, what would not be safer?” – Health-e News Service.

An edited version of this article first appeared in the 26 February edition of the Cape Times.

About the author

Wilma Stassen

Wilma Stassen is a reporter at Health-e News Service. She focuses on non-communicable diseases. Follow her on Twitter @Lawim

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