Electronic cigarettes: Do we know enough?

20th January 2010 - With smokers banned from lighting up in public places and left shivering outside pubs and offices, the interest in alternative ways to get a nicotine fix has boomed. One of these is the “electronic cigarette”, or e-cigarette.

However, two researchers are asking: do we know enough about this method of nicotine delivery?

E-cigarettes are battery operated devices that allow users to inhale nicotine vapour. They resemble ordinary cigarettes and, for added authenticity, some of them “light up” at the end. Users are assured they can “puff” away over a drink in a bar because the e-cigarette doesn’t emit smoke.

E-cigarettes are easily bought in the UK, with a number of companies offering them over the internet.

No human trials

Writing in bmj online, Andreas Flouris and Dimitris Oikonomou, from the Institute of Human Performance and Rehabilitation in Greece, say that “our knowledge on the acute and long term effects of e-cigarette use is, at best, very limited”. They pose the question: are these devices a miracle or a menace?

The authors say that, to date, there are no human or animal studies of the effects of smoking e-cigarettes. Neither, they say, is there any data on the effects of passively breathing in the invisible vapour.

Limited number of studies

In July 2009, The US Food and Drug Administration (FDA) announced that a laboratory analysis of e-cigarette samples found that they contained carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze. It noted that in the US they were sold in shops and online without any health warnings about nicotine.

Dr Margaret Hamburg, the commissioner of food and drugs, said in a press release accompanying the findings that “The FDA is concerned about the safety of these products and how they are marketed to the public.”

The authors of the bmj online article say there have been two other studies into e-cigarettes, including one by Health New Zealand, which recommended e-cigarettes as being safer than normal tobacco products. The third study, by Demokritos, a publicly-funded Greek research institute, took a neutral position on the devices.

Unregulated

Andreas Flouris and Dimitris Oikonomou write that “to the best of our knowledge e-cigarettes are not regulated in the European Union, and the European Centre for Disease Prevention and Control has not released any germane reports”.

Action on Smoking and Health (ASH) says the absence of any clinical trials to establish whether e-cigarettes can help people to stop smoking is a principle problem with the products. In a briefing document, ASH says it has some safety concerns because e-cigarettes are unregulated and manufacturers rarely disclose the ingredients.

The authors of the BMJ Online article conclude that more research is required in order to inform consumers about the safety of e-cigarettes.