Debunking misleading statements from the e-cigarette and ENDS industry
Many e-cigarette and ENDS vendors have promoted their products as a “healthy” alternative. Their marketing messages mislead consumers to believe that these products have been proven to be safe, both for users and for people who would be exposed to second-hand smoke. The Union’s review of the available evidence shows:
- the safety of these products has not been scientifically demonstrated
- scientific testing indicates that the products vary widely in the amount of nicotine and other chemicals they deliver
- the current lack of regulation or monitoring means that there is no way for consumers to find out what is actually delivered by the product they have purchased
- the chemicals used in electronic cigarettes have not been fully disclosed, and there are no adequate data on their emissions
- adverse health effects for third parties exposed (second-hand exposure) cannot be excluded because the use of electronic cigarettes leads to the emission of fine and ultrafine inhalable liquid particles, nicotine and cancer-causing substances into indoor air.
Concern over impact on youth
There are particular concerns surrounding the use of e-cigarettes and ENDS by youth. These include the potential negative impact of nicotine on adolescent brain development, as well as the risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products. A recent study by the US Centers for Disease Control and Prevention showed that e-cigarette experimentation and recent use doubled among US middle and high school students during 2011–2012, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012.
Rapid growth in awareness and uptake requires urgent action
A significant and rapidly growing number of people are aware of or are using e-cigarettes and ENDS. Use of these products amongst current and former tobacco users in 2010-11 was estimated at 6 per cent for the USA, 4 per cent for the UK, 1 per cent for both Canada and Australia and 0.5 per cent among Indonesian men. However, a recent report by the UK Medicines and Healthcare Products Regulatory Agency found that one-tenth of UK smokers now use e-cigarettes, and the number of UK users has risen to around 1.3 million in 2013, up from 700, 000 in the previous year.
E-cigarettes and ENDS are not yet proven cessation aids
To date, few studies have assessed e-cigarettes/ENDS as a harm reduction or cessation aid and with conflicting findings. The largest study to date was based on a sample of 5,939 current and former smokers across four countries. It found that ENDS users were not more likely to quit smoking than non-users.
“E-cigarette and ENDS manufacturers and vendors have been vocal about the supposed benefits of their products and quick to shout down calls for regulation or questions about their contents”, says José Luis Castro, Interim Executive Director of The Union. “Today, the Union makes its position clear. Based on our review of the available evidence, we strongly support the regulation of the manufacture, marketing and sale of electronic cigarettes or electronic nicotine delivery systems; and our preferred option is to regulate these products as medicines”.
“Right now, significant numbers of people around the globe are using these products”, says Castro, “and they just don’t know what they are ingesting, what that might mean for their health in the long term or what their use of e-cigarettes and ENDS means for the people around them. It is an echo of the traditional cigarette industry in the 20th century, which created the current global epidemic of tobacco-related harm and mortality. To avoid repeating the same mistakes, we need to act now to regulate e-cigarettes and protect consumers around the world”.
According to The Union, if regulation as medicines is not feasible, the following measures should be considered, pending the availability of reliable evidence:
i. A comprehensive ban on all advertising, promotion and sponsorship
ii. Promotion of ECs/ENDS for tobacco cessation to be prohibited
iii. Display of ECs/ENDS in retail stores to be prohibited
iv. Sale to minors to be prohibited
v. ECs/ENDS and their refills should not be sold in flavours that are appealing to children
vi. Packaging and labelling of EC/ENDS cartridges and disposable ECs/ENDS to include a list of all ingredients, stipulate the quantity of nicotine and include appropriate warning labels
vii. ECs/ENDS should not be used in public places, workplaces or on public transportation
viii. Consumer safety standards for EC cartridges should be established, including ensuring manufacturing consistency and regulating the maximum quantity/dosage of nicotine they may contain.
The 44th Union World Conference on Lung Health began on 30 October and ends today (3 November) at the Palais des Congrès in Paris. Details of the scientific programme and web casts of sessions can be found at http://www.worldlunghealth.org/conf2013/