E-cigarettes not safe, and potential public health disaster

E-cigarettes not safe, and a potential public health disaster if not effectively regulated – says Asthma and Respiratory Foundation NZ
In response to the article ‘Vaping better than smoking, Ministry of Health tells MPs’ published on Newshub on 13 December 2017 stating “It is much safer than smoking, and there is emerging evidence it helps people quit, the Ministry of Health said during a briefing at Parliament on Wednesday.”

Letitia O’Dwyer, Chief Executive of the Asthma and Respiratory Foundation NZ (ARFNZ) says, “The efficacy of e-cigarettes as a cessation tool, along with the known risks of these products is too important to not drill down on the evidence, and we believe the statements issued by the Ministry of Health (MOH) do not stipulate what scientific backing or research is behind them. As far as we’re aware, there is no good evidence demonstrating that using e-cigarettes will reduce the incidence of smoking cigarettes. We fear that the Ministry of Health are providing advice based on one side of the story when it comes to e-cigarette use. Whilst they may be safer than smoking cigarettes, that is not a very hard hurdle to jump. We do however know that there is a growing body of evidence demonstrating that these products do damage in the respiratory tract. We urge the MOH to tread very carefully in considering the appropriate regulatory framework for these products.”

Dr Stuart Jones, Medical Director of ARFNZ says, “The rationale for introducing e-cigarettes is to assist smokers who can’t quit via existing means to do so. However, as a policy response, there needs to be strict regulation of these products to avoid a potential public health disaster in the future. There is no evidence that current smokers in New Zealand are finding it harder to quit than in previous years, so we need to make sure that existing smokers are provided with access to quitting support with a proven track record of effectiveness and safety." (https://www.ncbi.nlm.nih.gov/pubmed/27382047)

Dr Jones says, “We do recognise that for a small number of current smokers, who have tried all other quitting options the use of e-cigarettes may be beneficial, but we need to make sure that we’re targeting that group. The current situation in which e-cigarettes can be marketed including Thomas the Tank shaped vaporisers and fruit loop flavoured liquids is clearly not designed as a marketing strategy for cessation but rather to attract a younger generation of New Zealanders. There is no good reason for children, or indeed non-smokers to use these products as they will cause damage in the lungs. Marketing e-cigarettes as a ‘safer’ alternative to smoking may be interpreted by the general public that they are indeed ‘safe’ and reduce the perceived level of risk taking associated with their use. This is reflected in overseas studies showing an increase in the use of e-cigarettes among adolescents over time.”

If these products are to be made available then we need to weigh up the risks of wide spread access to encourage the small numbers of smokers who can’t quit using existing means against the real harms associated with uptake of these products by children and non-smokers. We also need to consider, that there is significant evidence of smokers using both e-cigarettes and conventional cigarettes and we strongly advise against this dual use.

“We recommend restricting the sale of e-cigarettes to only those people who are smoking and want to use e-cigarettes to give up or reduce harm – this is the only group in our population in which a reduction in harm will occur through the use of e-cigarettes. We also recommend that they are part of a proper smoking cessation programme by the Ministry of Health – a wraparound service involving health professionals at a primary and community care level," says Dr Jones who is also the local branch President of the Thoracic Society.

Being part of a wraparound smoking cessation plan is important, especially if that is in fact the rationale behind their role according to the Ministry of Health, as mentioned in the Newshub article, “vaping could be a tool” in helping to reduce smoking in Māori and Pacific people.

The Newshub article also states, “One of the challenges in developing the law will be allowing vaping products enough visibility to encourage smokers to select them over cigarettes without encouraging young people to take it up.”

We don't want to entice our youth, so to protect them from taking up e-cigarettes or vaping, O’Dywer says “E-cigarettes and vaping products should have the same restricted sale and accessibility placed on them as conventional cigarettes e.g. prohibit sale and supply in public places, not sold to under 18 year olds and no point of sale advertising of e-cigarettes and e-liquids.” This stance is in keeping with the Federation of International Respiratory Societies position paper on e-cigarettes.

O'Dwyer says that several studies are also emerging indicating that e-cigarettes can be a gateway to smoking. A recently published study, ‘Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth’ in the January 2018 edition of Pediatrics (Official Journal of the American Academy of Pediatrics) concludes the following:

E-cigarette use was associated with future cigarette use across 3 longitudinal waves, yet cigarette use was not associated with future e-cigarette use. E-cigarette regulation and prevention programs may help prevent future use of cigarettes among youth.
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Claims about the safety of these products need to be understood in the context of the comparison. Cigarettes are incredibly dangerous so it is not difficult to be safer than cigarettes. The issue is that we do not have enough data about the damage these products cause over long term. Just as the damage from cigarette smoking takes years to manifest, the damage done by e-cigarettes is also likely to be cumulative and take time to develop.

Dr Jones explains, “There is a huge concern around the flavours used in the inhaled products that have had no testing that they are actually safe to inhale. This includes additives of which currently more than 7000 of them are food products. The stomach is very different to the lungs. There are a raft of studies demonstrating many of them are toxic to lung cells especially chocolate and berry. There are also currently no consumer safety requirements for these products.”

The ARFNZ also raises concern that there is significant conflict of interest on the Ministry of Health Electronic Cigarette Technical Expert Advisory Group with three industry representatives (including a buyer for Cosmic retail stores) giving advice on Electronic Cigarette Product Safety.

O'Dwyer says, “It’s greatly concerning that the Ministry of Health does not have a balanced and evidence based Expert Advisory Group. In contrast, many of the people in the group will benefit from the sales of e-cigarettes and vaping products, it doesn’t make sense that these same people are advising us on the safety of these products!”

ENDS

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