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Thursday, June 05, 2014

No evidence that e-cigarettes are gateway to smoking

Further to my previous articles here on e-cigarettes today's Western Mail carries news of further claims by Professor Peter Hajek, the director of the Tobacco Dependence Research Unit at Queen Mary University of London, who says that  “virtually nobody” who is a non-smoker experimenting with e-cigarettes would move on to daily smoking:

Prof Hajek, who is speaking at Wales’ first summit on electronic cigarettes in Swansea today, said: “If my children were to try a nicotine product, I would prefer this to be an e-cigarette rather than a conventional cigarette.

“The concern that e-cigarettes would lure young people to smoking has not been supported by evidence. About half of non-smokers who experiment with cigarettes progress to daily smoking. In a striking contrast to this alarming effect, among non-smokers experimenting with e-cigarettes, virtually nobody progresses to daily use.”

It comes as a survey by Action on Smoking and Health (ASH) Wales found very few young people between 13 and 18 who have never smoked have tried e-cigarettes.

Less than 3% of ‘never-smokers’ who responded to the survey reported having tried an e-cigarette.

The survey also suggested that, of the young people who had tried e-cigarettes, a quarter had done so to help them stop smoking or cut down on the number of cigarettes they smoked.

This further contradicts the Welsh Government's contention that e-cigarettes should be banned in public places because they normalise smoking.

Not only do the Welsh government not have any evidence to support that position but they are increasingly swimming against the tide of academic opinion.

It seems that the only support for that position is coming from those who do not believe that people should be able to make their own lifestyle choices.
What is the evidence, though, on whether smokers move on to e-cigarettes as an easier alternative to giving up?
I think the gateway concern expressed by ASH is misleading - the real gateway concern is that tobacco cigarettes appear to be a gateway to regular recreational use of harder drugs (eg. heroin...), and that the widespread availability of e-cigarettes will have a similar effect.

Another concern is that nicotine is believed to promote cancer tumour development via a number of mechanisms (e.g. encouraging blood vessel development, inhibiting programmed cell death, activating signalling mechanisms etc.)?

So, switching from inhaling nicotine through tobacco smoke to inhaling nicotine in an e-cigarette vapour will surely continue to bathe the toxic carcinogenic residue that will remain in the lungs of a former smoker with nicotine – a cancer promoter.

Therefore switching to nicotine inhalation via e-cigarettes would likely accelerate the development of any cancerous growth ?

Given that apparently more than 50% of lung cancer is detected in former smokers, who last smoked 10 or more years previously, surely this is a concern, and, for example, could hypothetically lead to a situation whereby a smoker switches to vaping and as a result is diagnosed with lung cancer 8 years after switching – whereas if they had instead stopped smoking/vaping completely that lung cancer might never have been diagnosed until, say, 15 years after stopping smoking (and they might expire, through ‘natural causes’, before that occurs…)?

It is of course very likely that any such deaths arising after switching to e-cigarettes will be attributed by the industry to other factors – in particular, the person’s previous smoking history – and the fact that their death may well have been accelerated by using e-cigarettes that they have been told by the e-cigarette industry are safe (a ‘harmless water vapour’) will doubtless be covered up.
Ash London covers that point and others April 2014 Fact Sheet "Use of electronic cigarettes in Great Britain"
"The main reason given by current smokers for using the products is to reduce the
amount they smoke while ex-smokers report using electronic cigarettes to help them
stop smoking"
In general, there is no disagreement about there being a dose-response relationship between the amount smoked and risk of disease - the worst risk applies to people who start smoking early, smoke for a long time and smoke heavily. So it sounds reasonable to assume that people who cut down the number of cigarettes they smoke each day reverse that risk and reduce harm.

But studies that follow large groups of smokers over many years have found that to not be the case.

A 30-year Norwegian study of 51,210 adults, for example, found “Long term follow-up provides no evidence that smokers who cut down their daily cigarette consumption by more than 50% reduce their risk of premature death significantly.”


A Danish study of 19,737 people with 15 years follow-up concluded “smoking reduction is not associated with a decrease in mortality from tobacco-caused diseases.”


The stop smoking guru Allen Carr smoked something like 60 to 100 cigarettes a day for 33 years. He stopped smoking after seeing a hypnotherapist, and sadly died of lung cancer 23 years after stopping smoking. If, instead of stopping smoking, he had switched to e-cigarette nicotine it is very likely that his lung cancer diagnosis would have been made sooner and he would have died earlier – because of the continued interaction between the e-cig nicotine and the smoke tar residue that remained in his lungs.

Ash London ‘Fact sheets’ do not address any of these concerns.

Surprisingly Ash say that NICE recommends that smokers should cut down – despite the conclusions of studies, such as those above, that say cutting down doesn’t help.

The quote just reports some user survey data of reasons given by users - other reasons in the ‘Fact Sheet’ include that e-cigarettes are cheaper than tobacco.

Interestingly a recent study showed that 80% of smokers who tried using e-cigs to quit smoking failed to quit and returned to smoking. So presumably e-cigs are not as ‘satisfying’ as smoking.
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