Smoke and mirrors: the truth about vaping


Horizon: E-Cigarettes: Miracle or Menace?

BBC Two – 9.30pm on Sunday 22nd May 2016 

When the editor of the BBC science series Horizon asked me if I fancied making a programme about e-cigarettes that would involve “vaping” (inhaling nicotine-laden vapour) for a month my initial reaction was: “Hell, no.”

Then I thought about it a bit. I was worried that if I took it up I might get addicted (I’d never smoked), but I was also curious. What would it be like? What effect would it have on me? There has been a huge surge in the use of e-cigarettes over the past couple of years, yet very few studies on the effects of vaping on non-smokers. Time, I decided, to do one, with me as the subject.

I hate cigarettes, really hate them. I’ve never smoked, partly because when I was young I didn’t see the point, but mainly because when I was about 12 my dad offered me £100 if I didn’t smoke before the age of 18. I can’t remember if he ever paid me.

If I was even a little tempted to smoke, going to medical school put me off. One of the first patients I saw was Sarah, a 65-year-old woman who was dying of emphysema, a very common disease of the lungs caused by smoking. Even with an oxygen mask she struggled for breath. She’d been smoking 40 a day since she was 15 and she reckoned that she’d spent about £90,000 on cigarettes (at today’s prices it would be more like £290,000).

I also remember a young man called Alex with Buerger’s disease, a relatively rare condition where you get inflammation and clotting in your arteries and veins. Almost everyone who has Buerger’s smokes, and quitting smoking is the only way to stop it progressing. Despite knowing the risks Alex just couldn’t stop. He eventually developed gangrene and had to have a limb amputated.

Fans of e-cigarettes claim that vaping could help people like Alex and Sarah, either by making it easier for them to quit or by providing a safer way for them to get a nicotine hit. It is said that smokers smoke for the nicotine but die from the tar, so why not give them one and not the other?

Critics, however, say that we are gambling with a technology we don’t understand and that there is no convincing evidence that e-cigarettes help people to quit smoking. It may even encourage non-smokers to start.

There is a huge amount at stake. A billion people worldwide spend about £500 billion a year on cigarettes and about half will die of smoking-related diseases. In the UK alone smoking kills about 100,000 a year. If e-cigarettes take even a small fraction of the cigarette market, that is a lot of money and a lot of lives.

Some countries have warily embraced e-cigarettes, while others have effectively banned them. The UK has so far adopted a liberal approach, but in a few days’ time there will come into force European legislation that will limit the size of refills and the nicotine content of the fluids. Vaping will become more restricted.

So who’s right? Are e-cigarettes one of the greatest public health measures invented, with the potential to save millions of lives, or are they just another cunning way to keep us hooked on nicotine? I was keen to find out.

I started by having a range of physical and mental tests, including cognitive tests such as reaction times, then headed for my nearest e-cigarette shop. They come in lots of different shapes and sizes but all work on the same principle: there’s a battery that powers a heating element, a coil. There’s a chamber into which you pour your “e-liquid” which usually, but not always, contains nicotine. The heat from the coil turns the liquid into vapour, which you then inhale. There’s no burning and therefore fewer noxious chemicals involved. The e-liquids come in many flavours, from pina colada to menthol. I went for mint.

I bought a nice, geeky-looking device, with a big, shiny canister and lots of buttons. Then I went home to start vaping. I’d been given a schedule that began gently, then rapidly built to the point where I was taking about 120 puffs a day at a moderately high nicotine dose (the equivalent of a heavy smoker trying to give up). The plan was to do this for a month.

Initially I did a lot of coughing and found the head rush unpleasant, but after a while I started to enjoy the experience. It was a bit like having a very strong cup of coffee, except the effects were almost instantaneous. Blowing smoke was also fun, in an adolescent sort of way, though my friends and family were not impressed.

What was vaping doing to my body, though? According to some scientists, quite a lot of damage. In a recent widely reported study ominously titled Electronic cigarettes induce DNA strand breaks and cell death, researchers found evidence that e-cigarettes are “as harmful as tobacco”.

Addictive or not, it seems nicotine by itself is not that bad for you They took human epithelial cells, the sort that line your mouth, trachea and lungs, and exposed them to vapour from e-cigarettes. Some of this vapour had nicotine in it, some didn’t. When they examined the cells afterwards they found DNA damage and cell death. Although there was more damage in the cells exposed to nicotine-laden vapour, it was still detectable in the nicotine-free vapour. This was the sort of damage that, according to the report, can “set the stage for cancer”. Scary stuff. The lead researcher was quoted as saying that e-cigarettes “are no better than smoking regular cigarettes”.

What the press release that promoted this study didn’t mention, and what most of the headlines missed, was that the researchers had also exposed some cells to tobacco smoke. The results of this were nothing short of cataclysmic. Most of the cells exposed to tobacco smoke died within 24 hours. By contrast, the cells exposed to e-cigarette vapour survived for up to eight weeks.

As a cancer charity researcher quickly tweeted, instead of the headline “Vaping no better than smoking regular cigarettes”, they could have said “Cells can survive for eight weeks in e-cig liquid but only 24 hours in cigarette extract”. Not, perhaps, quite as catchy.

To be honest, when I took up vaping I wasn’t that worried about the short-term health effects. There have been a number of major reports, such as the one from Public Health England, that state that e-cigarrettes are “around 95 per cent safer than tobacco”.

What I was far more concerned about was getting hooked on nicotine. Yet as the weeks went by and I puffed away, nothing happened. When I leapt out of bed I didn’t feel a longing to reach for my machine. If anything I struggled to keep up with my schedule. Once the novelty had worn off it became a bit of a chore.

Chatting to experts, I discovered to my considerable surprise that although cigarettes are highly addictive, nicotine alone may not be. Although no one knows for sure, research in animals suggests that nicotine is far more addictive when delivered in combination with the other chemicals found in regular cigarettes.

Addictive or not, it seems that nicotine by itself is not that bad for you. A report put out by the Royal Society for Public Health last year said that though 90 per cent of the public think that nicotine is harmful, in fact it is “no more harmful to health than caffeine”. And, like caffeine, nicotine has potential health benefits. A natural plant alkaloid, it binds to and stimulates receptors in the brain that are important for thinking and memory. Dr Lynne Dawkins, an addiction expert, tells me: “There is emerging evidence that in certain conditions, such as Alzheimer’s and Parkinson’s disease, nicotine may have a cognitive-enhancing effect.”

To test this claim the National Institute on Aging in the US has funded a trial of 300 patients with mild cognitive impairment (a precursor to Alzheimer’s). The patients, none of whom are smokers, will be randomly allocated to nicotine patches or placebo patches that they will have to wear for 16 hours a day. Over the next few years they will have regular health checks as well as memory and cognition tests. A similar, smaller study, published in 2012, found that non-smokers given nicotine patches saw improvements in memory, attention and reaction times.

Yet before you start slapping on the patches or firing up an e-cig you should be aware that though nicotine may help people who already have impaired memory, there’s no evidence it will help the rest of us. Although I was tested before and after a month of heavy vaping, the nicotine didn’t enhance my brain, apart from a small improvement in my fine motor skills that could apparently make me slightly better at sewing.

The main health justification for e-cigarettes is not that they can help to improve your memory but that they can help those who are keen to quit smoking tobacco — but do they? A recent meta-analysis (comparing lots of different studies) concluded that they don’t. Surprisingly enough this paper concluded that vapers are less likely to give up smoking than those who try other methods. It led to headlines along the lines of “E-cigarettes don’t help smokers quit — they may actually have the opposite effect”.

Like so much of the evidence used to attack or justify vaping, this finding was hugely contentious. Critics, such as Professor Peter Hajek from Queen Mary University of London, described it as “grossly misleading”. Professor Robert West of University College London pointed out that if this were true then quit rates would be falling in countries such as the UK where e-cigarettes are taking off. This isn’t happening. If anything we are seeing the reverse.

When Horizon conducted a small study in which a group of hardcore smokers were randomly allocated e-cigs, nicotine patches or going cold turkey, we found the vapers and those who slapped on the patches were far more successful at abandoning their fags.

E-cigs are not risk-free, and after a month of heavy vaping there were signs of increased inflammation in my lungs (which reversed rapidly when I stopped). Nonetheless I think that e-cigarettes could prove to be a game-changer, one of the great inventions of the age. That said, I have no desire to ever take another puff again.

Horizon: E-Cigarettes: Miracle or Menace? is at 9.30pm on Sunday, BBC Two


E-cigarettes should be offered to smokers, say doctors

man vaping

Smokers should be offered and encouraged to use e-cigarettes to help them quit, says a leading medical body.

The UK’s Royal College of Physicians says there is resounding evidence that e-cigarettes are “much safer” than smoking and aid quitting.

With the right checks and measures, vaping could improve the lives of millions of people, it says in a new, 200-page report.

It says fears that e-cigarettes are a gateway to smoking are unfounded.

But, by and large, people who want to use electronic cigarettes will still need to buy them rather than get them on the NHS.

Do e-cigarettes make it harder to stop smoking?

Are e-cigarettes safe?

Should we switch from tobacco to e-cigarettes?

UK doctors can only prescribe e-cigarettes if they have been licensed as a “quit smoking aid” – something that requires strict regulation.

Few manufacturers go down this route and instead sell products to satisfy users’ desire for nicotine without the harmful chemicals produced by tobacco.

Best way to quit?

Sales of e-cigarettes have been rising steadily since the first went on sale in 2007 in the UK.

Since 2012, they have replaced nicotine patches and gum to become the most popular choice of smoking cessation aid in England.

Around one in 20 adults in England uses e-cigarettes, and nearly all of these are ex-smokers or current smokers who are trying to cut down or quit.

E-cigarettes have remained controversial and this year ministers in Walesattempted to ban them from public places.

The Royal College of Physicians says smokers who use e-cigarettes or prescribed medications – with support from their doctor – are more likely to quit permanently.

Graphic: What's inside an E-cigarette?

1. On some e-cigarettes, inhalation activates the battery-powered atomiser. Other types are manually switched on

2. A heating coil inside the atomiser heats liquid nicotine contained in a cartridge

3. The mixture becomes vapour and is inhaled. Many e-cigarettes have an LED light as a cosmetic feature to simulate traditional cigarette glow.

Different brands of e-cigarettes contain different chemical concentrations.

And in terms of long-term health hazards, e-cigarettes are at least 95% safer than regular cigarettes – something Public Health England has also said.

But that does not mean they are entirely risk-free.

Prof Simon Capewell, of the Faculty of Public Health, said there were still many unknown factors.

“We don’t know enough yet about the long-term effects of vaping on people’s health, which is why we need more research.

“The best thing anyone can do if they want to quit smoking is talk to their GP: there’s solid evidence that NHS quit-smoking services help people kick the habit for good.”

But Prof John Britton, who co-authored the RCP report, says e-cigarettes are extremely positive for public health and should be “encouraged and endorsed”.

He said: “The public need to be reassured this is not a new nicotine epidemic in the making. E-cigarettes have very little downside and a lot of potential benefit.”

According to Public Health England, smokers should consider using e-cigarettes alongside NHS quit-smoking services.

Around a third of UK smokers try to quit each year, but only one in every six of those succeeds.

New EU laws are due to come into force in May that will set safety and quality standards for all e-cigarettes and refills. Manufacturers will be required to disclose the purity of their products to consumers.

Dr Tim Ballard, from the Royal College of GPs, said: “Moving forward we would be looking for clear evidence that making e-cigarettes available on prescription as part of a wider smoking cessation scheme is a wise use of both scant NHS funds and GP practice resources, before the College could get behind it.

“It is not just the cost of the product that needs taking into account, but the time and resources that are involved in assessing patients, and monitoring their progress over a prolonged period of time.

“We reiterate our calls for NICE to take a leading role in establishing whether making e-cigarettes available on prescription is the best way forward.”

A Department of Health spokesperson said: “The best thing a smoker can do for their health is to quit smoking.

“We know that there are now over a million people who have completely replaced smoking with e-cigarettes and that the evidence indicates that they are significantly less harmful to health than smoking tobacco.

“We want to see a wide range of good quality e-cigarettes on the market including licensed products whose safety, quality and effectiveness are independently assured.”

  • 28 April 2016

Dangers Of Vaping Centered On Bad Products

are ecigs bad for you

The news media loves to talk about the dangers of vaping, even the fictional dangers that don’t scientifically exist. This isn’t a surprise, or at least it shouldn’t be. We all know that the media has a much better time with their ratings if they are scaring people. Just imagine you see a teaser for the news. It has ominous music and the narrator says “ecigs are very trendy, but the dangers of vaping are real and we’ll tell you about them tonight on the 10 o’clock news.” Think people are going to tune in to find out?

Of course they are. That’s just how the media game works and it is something you pick up on quite quickly if you just pay a little attention. That’s how the “if it bleeds, it leads” phrase became so well known. When that average American does turn on his or her nightly news broadcast feature about electronic cigarettes, they will undoubtedly be flooded with a bunch of scary threats. Lots of rumor and assumptions will come up and very soon they will end up thinking that the dangers of vaping are terrible. At the least, they’ll think that the benefits are far outweighed by those dangers.

There will obviously be comparisons made the analogue cigarettes, but they’ll stress the similarities. They’ll tell you how you are still ingesting nicotine and they’ll paint it in a way that leads you to believe nicotine is bad for you. In fact, that isn’t really the truth at all. They may tell you that there are dangers of second hand vaping, just like second hand smoke. Once again, that isn’t the truth either and nobody has scientifically proven that it is. All of these claims about the dangers of vaping are made by connecting dots that don’t really connect. But there is one danger that we know exists, and that is the one you should really be focusing on.


Real Dangers Of Vaping Products Exploding

Dangers Of Vaping Bad Products

Batteries are at the heart of the dangers of vaping, but it isn’t as if you should stop vaping (or not start at all). While the dangers of second hand vaping is pretty much a myth, there is real solid proof of this phenomenon of ecig batteries exploding.

We won’t paint a pretty picture here, because the reality is that it is beginning to get out of hand. Just in last week we have seen numerous news reports of people being injured by exploding ecig batteries.

But the news of an explosion that injured a mother of two in England and the one that injured a teenager in Canada are related. Just like they are related to the man in New Hampshire who suffered burns due to an ecig exploding. All of these incidents have to do with the real dangers of vaping; buying bad products.

We don’t mean bad products because they are overpriced. Nor do we mean to say they just don’t taste good or don’t produce the amount of vapor you want. No, we mean bad products because they don’t go through proper quality control. While most electronic cigarettes are made at least partly in China, there is a mammoth difference between purchasing from a reputable brand and something on a non-branded site or simply from ebay. It may be cheaper, but it heightens the dangers of vaping exponentially.

It’s true that sometimes there are faulty products and that can happen in any industry. But there is also a reason we don’t see anything negative like this in the news about any of the top brands we recommend. These are companies that have a reputation to uphold and so they take all the necessary precautions, and even the precautions that aren’t necessary. Whether driven out of a concern for their consumers or a concern for their public image, you’ll be hard-pressed to see anyone working harder to make sure that the product you buy doesn’t fail in such a dramatic way as to explode or otherwise put you in danger.

The other thing that is going on is the serious concern regarding counterfeit ecigs. Fakes are everywhere. The dangers of vaping have been exacerbated by the sheer volume of clone ecigs on the market. You will find cloned ecigs and vaping products all over the internet and sometimes even in vape shops. How bad is the problem? Here are some numbers that will shock most of you.

There are a handful or world-class ecig manufacturers in China. Eight Aspire, Kangertech, Smok, Innokin, Joyetech and a few others are exceptional. They make some of the best vaping products in the world. They have strict quality control and use only the best materials. These companies are located in an industrial area of Shenzhen, China. Within that same are are 600 ecig factories. 600!

Most of those factories are producing terrible knockoffs at rock bottom prices. The fakes look just like the real thing. They are being sold online through a number of retail and wholesale websites. Even vape shop owners are being fooled by some of these products. This is a serious problem and results in a lot of bad press for the industry when one of these clone ecigs is the root cause of some well publicized ecig accident.

If you are interested in a Kanger, Aspire, Joyetch product, you need to buy from a reputable source that knows what they are doing. The vaping business is booming and pretenders and fakes are trying to cash in as are the brands that are just blatantly selling junk! With no regulation in place it is buyer beware.

The real culprit here is greed. The dangers of second hand vaping aren’t real, nor are all these other accusations that just stoke people’s fears. No, the dangers of vaping lie in cheap ecigs. That’s why the FDA should be worried about cheap ecigs instead of fruity ecig flavors. As a consumer, make sure that these harrowing stories in the news don’t put you off from making the switch to vapor. All you have to do is make sure you buy from the right sources and you’ll be well on your way to leaving traditional tobacco cigarettes behind you, as well as ridiculous claims about the dangers of vaping.



A five-year, first-in-Canada study, led by McGill cardiologist Dr. Mark Eisenberg, is exploring whether vaping really is the magic ticket to finally breathing free and easy.

By James Martin

Although the holidays may seem like a distant memory, statistically speaking, most of us are still sticking with our New Year’s resolutions. (For now. Let’s not talk about how many of us last until July.) For many, that means quitting smoking — and they’re hoping that electronic cigarettes will help. According to the U.S. Centers for Disease Control and Prevention, nearly half of all American smokers have tried e-cigarettes to help them kick the habit. But Dr. Mark Eisenberg wants to know: Is vaping really the magic ticket to breathing free and easy?

Dr. Eisenberg is passionate about getting people to butt out. He gives a lot of smoking cessation talks — just last month, he spoke at the Jewish General Hospital, where he is staff cardiologist — and has noticed that, invariably, reformed smokers come up to him afterward to sing the praises of e-cigarettes, those increasingly popular handheld battery-operated vaporizers that mimic conventional cigarettes.

“This is just a first step," says Dr. Mark Eisenberg of his five-year study." But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”

“They say, ‘I smoked for decades and I’ve tried everything — nicotine gum, patches, Zyban, Champix — and I couldn’t stop. Then I picked up an e-cigarette and I never smoked again,’” recalls Eisenberg, who is also a professor in McGill’s Faculty of Medicine and director of the Joint MD/PhD program. “Anecdotally, we have many, many cases like this.”

What doctors don’t have, however, is hard data to back it up. That’s why, this month Eisenberg will start a five-year clinical trial to look at how effective e-cigarettes are at aiding smoking cessation. It’s not just smokers and physicians who are interested in such clarity — so are lawmakers. Under Canada’s Food and Drug Act, e-cigarettes containing nicotine cannot be imported, advertised or sold without Health Canada’s approval; nicotine-free e-cigarettes are not restricted. Although Health Canada has yet to grant such approval, nicotine-loaded e-cigarettes are nevertheless widely and openly available in Canada.

The study, which is funded by the Canadian Institutes of Health Research (CIHR), will follow 486 outpatient smokers at 19 sites across Canada. The smokers will be randomized into three groups. One group will be given e-cigarettes that contain nicotine and counselling. The second group will receive e-cigarettes that do not contain nicotine, and counselling. The third group will only receive counselling. The researchers will supply the smokers with e-cigarettes for 12 weeks, and then follow up with them after six months and a year, observing whether they graduate to total non-smoking, continue with the e-cigarettes, or return to conventional cigarettes. Although some reformed smokers may fall off the wagon after a smoke-free year, Eisenberg clarifies that “statistically significant results at 12 months would still be important evidence” for the efficacy of e-cigarettes as a cessation aid. All 486 patients will not be enrolled simultaneously, with the study expected to roll out over the course of five years.

“The ultimate goal is to use the e-cigarette as a transitional tool in going from smoking conventional cigarettes to not smoking at all,” says Eisenberg. He notes that, at least in the early stages, e-cigarettes are about “transferring the addiction. You’re getting people onto something else that is giving them their nicotine, so they may never quit. E-cigarettes also provide other physical and social aspects because they feel like a cigarette; a pack-a-day smoker makes that hand-to-mouth motion more than 70,000 times a year, for example. That’s a difficult thing to break away from, and a nicotine patch doesn’t provide it.

“We have great hopes that e-cigarettes will be helpful for people trying to quit smoking,” he adds. “Even if they just switch to smoking e-cigarettes that would be better than continuing to smoke conventional cigarettes for decades. I’m not saying that e-cigarettes are safe, but they’re much safer than conventional cigarettes. They’re not going to give you lung cancer. They’re not going to give you heart disease. They’re not going to give you emphysema.

“But what we’re really hoping for is that e-cigarettes lead people to not smoking altogether.”

(This particular study, Eisenberg notes, is not designed to investigate safety concerns, such as whether e-cigarette vapour contains trace elements of harmful substances. Other than their smoking habits, the trial’s participants are healthy, he explains, “so the chances that they’d have adverse effects over a short time like the course of one year are quite low.” The researchers will, however, track whether the smokers are hospitalized for any cardiopulmonary issues. They will also gather data about benign side effects, such as throat irritation.)

E-cigarettes are already big business, ringing up an estimated $500-plus million in sales in the U.S. alone — and that’s without being able to make any claims about helping smokers kick their habits. Eisenberg says that the e-cigarette industry itself isn’t clamouring to make such claims: “They don’t want to be regulated by the Food and Drug Administration [in the U.S.] and Health Canada, so they don’t want to support clinical trials,” he says. “And they don’t need to: Smokers are voting with their feet by buying e-cigarettes to help them quit smoking.” Governments, however, want more than anecdotal evidence.

“This study alone would not be enough for Health Canada to allow companies to market e-cigarettes as smoking cessation aids,” explains Eisenberg. “That said, if this trial shows that there is a substantial reduction in smoking traditional cigarettes, then Health Canada will have to rethink their policy.

“This is just a first step. Then we would need multiple big trials in multiple populations. We would need to use tapering [of nicotine levels] studies, and we would need to use interventions that are longer than 12 weeks. But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”

Posted on Wednesday, February 3, 2016

Do e-cigarettes make it harder to stop smoking?

File picture taken on May 25, 2009 in Beiijng shows the inventor of the electronic cigarette, Hon Lik

People trying to give up smoking often use e-cigarettes to help wean themselves off tobacco. Most experts think they are safer than cigarettes but a surprising paper was published recently – it suggests that people who use e-cigarettes are less successful at giving up smoking than those who don’t.

“E-cigarettes WON’T help you quit,” reported the Daily Mail. “Smokers using vapers are ‘28% less likely to ditch traditional cigarettes,'” read the paper’s headline.

The story was reported on many other websites around the world, including CBS: “Study: E-cigarettes don’t help smokers quit,” it said.

The study causing the fuss was written by researchers at the Center for Tobacco Control Research and Education at the University of California, and published in one of the Lancet’s sister journals, Lancet Respiratory Medicine.

It is a meta-analysis, which means the authors reviewed the academic literature already available on the topic. They sifted out the weaker papers – ones that didn’t have control groups, for example – and were left with 20.

E-cigarettesImage copyrightiStock

The conclusion? Smokers who use e-cigarettes have a 28% lower chance of quitting than smokers who don’t use them, according to Prof Stanton Glantz, one of the authors.

But while the conclusion is surprising, so is the number of academics who have criticised the paper.

One was Ann McNeill, professor of tobacco addiction at Kings College London, whose own research is included in Glantz’s analysis.

“This review is not scientific,” she wrote on theScience Media Centre website.

“The information… about two studies that I co-authored is either inaccurate or misleading… I believe the findings should therefore be dismissed.

“I am concerned at the huge damage this publication may have – many more smokers may continue smoking and die if they take from this piece of work that all evidence suggests e-cigarettes do not help you quit smoking; that is not the case.”

Prof Peter Hajek, director of the Tobacco Dependence Research Unit at the Wolfson Institute also called the findings “grossly misleading”.

e-cigarettesImage copyrightiStock

The critics are making three main points. First, the definition of e-cigarettes is a bit loose. There are many different types – some look like cigarettes, others have tanks for the vaping liquid, some are disposable and other are multi-use. They all deliver different doses of nicotine. Many of the papers included in the analysis don’t specify which type people are using, according to Linda Bauld, professor of health policy at the University of Stirling.

Another point is that the studies vary in the way they measure how often people use e-cigarettes. “Some only assessed whether a person had ever tried an e-cigarette or if they had tried one recently, not whether they were using it regularly or frequently,” Bauld says.

Even the paper’s author admits it’s possible that in some of the studies e-cigarettes may only have been used once, which he says would not be a good predictor of whether they had affected people’s ability to stop smoking.

And there is another problem. You might expect, if you were going to draw conclusions about how useful e-cigarettes are in helping people quit, to focus on studies looking at people who are trying to give up.

Prof Robert West, who heads a team at University College London researching ways to help people stop smoking, says this analysis mashed together some very different studies – only some of which include people using e-cigarettes to help them quit.

Vape Lab employee uses an e-Cigarette while workingImage copyrightGetty Images

“To mix them in with studies where you’ve got people using an e-cigarette and are not particularly trying to stop smoking is mixing apples and oranges,” he says.

Some of the studies track smokers who use e-cigarettes for other reasons – perhaps because smoking a cigarette in a bar or an office is illegal and they want a nicotine hit.

“With the studies where people are using electronic cigarettes specifically in a quit attempt the evidence is consistent,” says West, referring to two randomised control trials.

Both are quite small and one was funded by the e-cigarette industry. They took two groups of smokers, and gave one real e-cigarettes, and the other a placebo. The studies reach a broadly similar conclusion to a large, real-world study called the Smoking Toolkit run by West.

West’s investigation follows people in their daily lives and assesses how successful various methods of giving up smoking are – this includes nicotine patches, medicines and going cold turkey.

These studies suggest that people using e-cigarettes to help them quit are 50% to 100% more successful than those who use no aids at all.

In his paper, Glantz acknowledges there are limitations to the research that he analysed. He agrees there are problems with the way the use of e-cigarettes is measured and accepts it’s not clear which devices people are using. But he is sticking by his analysis because he believes he has taken these factors into account.

The editor of Lancet Respiratory Medicine, Emma Grainger, defends the article too. She says she does not see a problem with the paper and that it has been through the normal peer-review process.

Climb down on proposed e-cigarette public place ban


The ban was announced in April and would have come into force in 2017

The health minister has backed down on plans to ban the use of e-cigarettes in all enclosed public places in Wales.

Instead the Welsh government will change its Public Health Bill so they will only be banned in schools, eating places and on public transport.

In a debate in the Senedd, Mark Drakeford told AMs his personal view had not changed.

But he said he recognised his responsibility as minister to find an agreement.

He said he would bring forward amendments to define more precisely enclosed spaces where e-cigarettes would be prohibited.

He told AMs: “I’m not prepared to do nothing in the hope that harm might not occur”.

Previously the Welsh government said it wanted to restrict the use of e-cigarettes in exactly the same way as tobacco.

It was concerned their use may “normalise” smoking for children and young people while ministers feared they may act as a “gateway” into smoking tobacco.

Graphic: What's inside an E-cigarette?
  • On some, inhalation activates the battery-powered atomiser, others are manually switched on
  • A heating coil inside the atomiser heats liquid nicotine in a cartridge
  • The mixture becomes vapour and is inhaled. Many have an LED light to simulate traditional cigarette glow
  • Different brands contain different chemical concentrations
Line break

The ban, intended to come into force in 2017, would have been a first in the UK.

Ministers pointed to concerns by the World Health Organisation and steps taken in 40 other countries to regulate e-cigarettes, but it divided opinion among health and medical groups.

Some anti-smoking groups including Ash Wales, Cancer Research UK and Tenovus opposed restrictions, saying they helped smokers kick the habit.

A major review by Public Health England found e-cigarettes were 95% less harmful than tobacco and could be prescribed on the NHS in future to help smokers quit.

Before Tuesday’s debate, experts from universities and the National Centre for Smoking Cessation and Training wrote to AMs claiming there was no evidence to justify the legislation.

Media captionMark Drakeford told AMs he was not prepared to do nothing

They claimed it would discourage smokers to switch from smoking to e-cigarettes.

Public Health Wales, local health boards and the BMA supported the curbs while opposition politicians called it a “huge step backwards”.

The proposals also divided the group of AMs which looked in detail at the proposal.

The five Labour members supported curbs on e-cigarettes but they were opposed by four opposition AMs.

Less stringent restrictions on e-cigarettes than those on tobacco were suggested and that appears now to have been accepted by the health minister.

Line break

ANALYSIS by Owain Clarke, BBC Wales health correspondent

The decision this afternoon can be interpreted in two ways.

Some critics will view it an embarrassing climb down – and ask why did the health minister press ahead with the proposed ban in the face of significant opposition and unclear evidence.

Supporters of the Welsh government will say he has acted responsibly, listened to the debate and acted accordingly – an example perhaps of democracy in action.

The watering down of the proposed e-cigarette ban in public places does raise some questions about what exactly the Welsh government’s flagship Public Health Bill will now ultimately achieve.

Previously, a plan to introduce a minimum price for alcohol from the bill was taken out and introduced as separate legislation over fears of legal challenges.

Perhaps the decision today reflects the health minister’s fears that without a majority a political row about the scope of e-cigs ban could scupper the entire legislation.

This whole debate also raises another question about the role of government and the timing of the bill.

In seeking to restrict the use of e-cigarettes, were ministers acting responsibly to protect the public, just in case they were found to act as a gateway to tobacco?

Or was the Welsh government here being premature, too willing without evidence to interfere in people’s lives?


The Secret Bribes of Big Tobacco – BBC News

Published on 30 Nov 2015

A BBC investigation has uncovered evidence of bribery at one of the UK’s biggest companies. Panorama found British American Tobacco (BAT) illegally paid politicians and civil servants in countries in East Africa. The payments were revealed when a whistleblower shared hundreds of secret documents. BAT told the BBC: “The truth is that we do not and will not tolerate corruption, no matter where it takes place.” The bribery was revealed by a former BAT employee, Paul Hopkins.

Panorama: The Secret Bribes of Big Tobacco, is on BBC One at 20:30 GMT on 30 November 2015