A call for urgent regulation of e-cigarettes

The International Union Against Tuberculosis and Lung Disease (The Union) issued a position statement at the 44th Union World Conference on Lung Health in Paris, warning about the potential health impact of e-cigarettes (ECs) and electronic nicotine delivery systems (ENDS). The statement which was developed by a panel of health experts, based upon a comprehensive review of all the available scientific evidence on the use of ECs and ENDS, calls for urgent regulation of these products.

There are special concerns around the use of e-cigarettes by youth. These include the potential negative impact of nicotine on adolescent brain development, risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products. A recent study by the US Centres 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. Another recent report by the UK Medicines and Healthcare Products Regulatory Agency found that 10% of UK smokers now use e-cigarettes, and the number of EC/ENDS users in UK has risen to around 1.3 million in 2013, up from 700, 000 in the previous year—an increase of over 85%.

As of now ECs and ENDS are not yet proven cessation aids. Very few studies have assessed them 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.

And yet many EC and ENDS vendors promote 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. However, 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
•    the 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
The Union suggests that if regulation of EC/ENDS as medicines is not feasible, pending the availability of reliable evidence, the following measures should be considered:

* A comprehensive ban on all advertising, promotion and sponsorship of ECs/ENDS and on their use in public/work places

* Package labelling of EC/ENDS to display the amounts of ingredients used, along with appropriate warning labels

* Ban on their sale to minors and a ban on promotion of ECs/ENDS for tobacco cessation

* Establish consumer safety standards for EC cartridges, to ensure manufacturing consistency and to regulate the maximum amount of nicotine they may contain.

“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”, said José Luis Castro, Interim Executive Director of The Union. “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 and they just don’t know what that might mean for their health and 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”.

Shobha Shukla, Citizen News Service - CNS
November 2013
(The author is supported by Lilly MDR TB Partnership to provide conference coverage from the 44th Union World Conference on Lung Health)

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