Saturday, 26 April 2014

E-cigarettes: How harmful are they?

By Lyn Chan, The Straits Times, 25 Apr 2014

E-cigarettes are not just soaring in popularity in Singapore, but also in the rest of the world.

Under the Singapore Tobacco Act, the devices cannot be distributed, sold or imported. In the United States, the Food and Drug Administration (FDA) on Thursday proposed a set of rules to regulate e-cigarettes.

Calls for strict rules have become louder, following data from a new Centers for Disease Control study showing the number of calls to poison centres involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014.

These are alarming numbers. Equally distressing is that worldwide sales of e-cigarettes are expected to top US$10 billion (S$12.59 billion) by 2017, according to Wells Fargo, and will exceed those of traditional cigarettes by 2047, said Bloomberg Industries.

Exactly how dangerous are e-cigarettes to health?

Inadequate studies

Supporters say there is no tobacco in e-cigarettes, so how can they be bad for health? Compared to normal cigarettes, e-cigarettes are definitely an alternative to tobacco. But studies on the side effects of inhaling pure liquid nicotine are inadequate to date, and therefore, unknown, warn health experts.

Nicotine levels

The caution then leads to the next point: Since the jury is still out on the effects of liquid nicotine inhalation, there is an equal chance of it being as harmful as it is safe, and if it is the former, the level of nicotine in an e-cigarette then becomes an issue, especially since users are able to choose cartridges filled with different quantities.

Also, liquid nicotine is just another form of nicotine, and it has long been acknowledged that nicotine is highly addictive.

Quality control

And even if nicotine inhalation is eventually proven safe, there is still the question of quality control. Health experts say that some manufacturers may not list all the chemical ingredients used in e-cigarettes.

Second-hand vapour

As with traditional cigarettes, there is second-hand smoke, or rather, vapour. Proponents protest that it is only water vapour and therefore innocuous - even as some users have complained of vomiting, nausea and eye irritation, from liquid nicotine ingestion - while opponents assert that there can be no certainty until conclusive research is done.

Gateway to tobacco use

Probably the greatest safety concern regarding e-cigarettes is not the physical harm to the user but to youths. In the US, e-cigarettes are marketed to children and teens in fruit and candy flavours - think chocolate, cherry and cotton candy - raising the worry among public health advocates that after e-cigarettes, which may glamourise smoking, come traditional cigarettes.

In March this year, the journal of the American Medical Association, published a study, concluding: "Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents."

With so much unknown surrounding them, e-cigarettes are like the wild, wild west. Perhaps then, the decision to pick up an e-cigarette should be based on what you don't know, instead of what you know.

Number of e-cigarettes seized last year triples
Spike could be due to proliferation of vaporiser companies abroad
By Joyce Lim, The Straits Times, 25 Apr 2014

THE rising demand for electronic cigarettes has led to more seizures of these items, which cannot be sold or imported here.

Last year, the Health Sciences Authority (HSA) confiscated 5,356 e-cigarettes, almost three times the number seized the year before. In 2009, just 10 units were confiscated.

The sharp spike in recent years comes as the alternative smoking product gains popularity here.

Also known as vapers, battery-powered e-cigarettes try to simulate smoking by heating and atomising liquid nicotine stored in a small, replaceable cartridge.

HSA said its Tobacco Regulation Branch carries out regular online surveillance to deter the sale of e-cigarettes locally. But it also noted that the number of such cases remains small.

Instead, the steep rise in the number of e-cigarettes being seized could be due to the "increased number of vaporiser companies sprouting overseas, as well as increased promotion and awareness of vaporisers through overseas media channels".

Checks by The Straits Times show that e-cigarettes are gaining popularity here, evident from the many online forum discussions on where to buy e-cigarettes.

Since the sale of e-cigarettes is illegal here, local users turn to overseas websites or purchase them when abroad.

E-cigarette users The Straits Times spoke to said they believed the product is banned here "just like chewing gum". However, they were unsure if it is an offence to own one.

Under the Tobacco Act, the import, distribution, sale or offer for sale of anything that resembles a tobacco product is prohibited. Since 2011, HSA has prosecuted eight people for selling e-cigarettes. This year, three of them were fined close to $100,000 for peddling the product online.

Buying e-cigarettes from overseas websites or bringing them into the country in hand luggage is also considered importing, which is illegal. Offenders may be fined up to $5,000 for the first time, and up to $10,000 subsequently.

But it is not illegal to own an e-cigarette purchased locally. The Straits Times understands that the law is currently being reviewed.

Ms Felicia Tan, 35, a marketing manager who bought hers during a holiday in Switzerland, said: "I bought it out of curiosity as the tip of the e-cigarette lit up like a real cigarette when I inhaled. But it didn't give me the same experience as smoking a real cigarette. I have since thrown it away."

Another user, who declined to be named, said he uses an e-cigarette as a substitute for cigarettes, and he has since managed to quit smoking.

The 36-year-old sales director had paid US$100 (S$126) for an e-cigarette from the United States, and gets his refills from Johor Baru for RM6 (S$2.30). Each bottle of refill can last for about three months, he said.

However, HSA said there is no conclusive scientific proof to back claims that e-cigarettes are effective in helping smokers quit.

A spokesman said: "We are monitoring the situation, but it will be premature to speculate whether there are any trends at the moment.

"We will continue to conduct surveillance to deter e-cigarette sales and also work closely with the Immigration and Checkpoints Authority to prevent such products from being brought into the country."

E-cigarettes to be regulated under new US plan
Channel NewsAsia, 24 Apr 2014

WASHINGTON: US regulators on Thursday proposed the first restrictions on the soaring $2 billion market in e-cigarettes, but some lawmakers and anti-tobacco advocates said the move falls woefully short.

The new rules would also apply to other, also previously unregulated tobacco products, including cigars, hookahs, nicotine gels, and pipe tobacco, and are aimed in large part at keeping them away from young people.

E-cigarettes are battery-operated devices that deliver vaporised nicotine into an aerosol inhaled by the user.

"This proposed rule is the latest step in our efforts to make the next generation tobacco-free," said Health and Human Services Secretary Kathleen Sebelius.

The new rules would bring e-cigarettes under many of the same rules that already apply to traditional cigarettes, including requiring sellers to enforce a minimum age restriction on those who wish to buy the products.

But the proposals from the US Food and Drug Administration (FDA) would not restrict advertising of e-cigarettes, nor would they ban the special flavours, such as Cherry Crush or Chocolate Treat, that some say are designed to appeal to children.

These gaps prompted strong criticism from lawmakers.

"After years of waiting for the FDA to act, we are extremely disappointed by its failure to take comprehensive action," wrote a group of seven Senate and House Democrats in a statement.

More is needed "to prevent e-cigarette companies from continuing to deploy marketing tactics aimed at luring children and teenagers into a candy-flavoured nicotine addiction," said the group, which includes Senator Dick Durbin.

Durbin spearheaded the restrictions push along with Democratic congressman Henry Waxman, who was more measured in his reaction. Waxman called the FDA proposals "an overdue but important first step."

The "FDA needs to act quickly to finalise this rule," he said, as well as "take additional steps to rein in manufacturers' marketing practices and use of candy flavours that target children and get them hooked on their addictive products."

An industry group for e-cigarette makers, the Smoke Free Alternatives Trade Association, said it supported banning the sale of e-cigarettes to children.

However, it objected to grouping e-cigarettes and related products with traditional cigarettes, arguing "they are technology products, not tobacco products," and therefore "deserve a new and distinct set of regulations."

Roy Herbst, chief of medical oncology at Yale Cancer Centre, said: "We do not know the nature of the long-term health consequences of these devices or what effect they will have on smoking continuation or uptake by adults and youth."

Herbst is chairman of a tobacco and cancer committee at the American Association for Cancer Research, which welcomed the FDA's proposed regulations.

The proposals include barring companies from handing out free samples and would required them to include health warning labels and to seek FDA approval before marketing a new product.

They would also have to register with the FDA and provide details about their ingredients.

And they would be prevented from advertising claims that they pose a lower health risk compared to traditional cigarettes, unless the FDA confirms scientific evidence backing up the claim.

E-cigarette use by young people has been booming. A December study by the US Centres for Disease Control and Prevention (CDC) estimated that 10 per cent of high school students had used them.

In addition to the special flavours seen as targeting youth, most manufacturers have provided free samples at hundreds of events, including youth-oriented concerts, and broadcast TV or radio advertising.

The CDC has also reported a spike in calls to poison control centres about accidents involving the nicotine-filled bottles used to refill e-cigarettes.

More than half the calls involved children under five who had swallowed, inhaled or spilled the liquid on their skin or in their eyes.

The proposals will be open to public comment for 75 days.

Lawmakers as well as anti-tobacco groups are urging US regulators to finalise the rule as quickly as possible and put it into effect within the year.

- AFP/de/fa

* No conclusive evidence that e-cigarettes help smokers quit: WHO report
Citing a World Health Organisation study, Singapore's Ministry of Health says there have been no applications to register electronic nicotine delivery systems as smoking cessation therapy.
Channel NewsAsia, 27 Aug 2014

The Ministry of Health, citing a World Health Organisation (WHO) study, said it would continue to monitor the safety and efficacy of electronic nicotine delivery systems - the most common of which are e-cigarettes - which have not been proven as an effective aid for those try to quit smoking.

Singapore is one of 13 countries worldwide which has banned the sale of ENDS.

The WHO report states that the vapour from ENDS, including e-cigarettes, to users and nearby bystanders), can have the following potential effects:
- An adverse effect on brain development in unborn babies, children and teenagers
- The development of nicotine addiction
- Exposure to toxic and cancer-causing chemicals
- Exposure to PM 2.5 particles.
"The Ministry of Health takes a serious view of the importation of these products into the country, including online purchases and hand-carrying into Singapore. The import, distribution and sale of ENDS, including e-cigarettes are currently prohibited under the Tobacco (Control of Advertisements and Sale) Act," the MOH said.

"ENDS, including e-cigarettes, that claim to be smoking cessation products to help smokers quit tobacco use should demonstrate their safety and effectiveness with the same level of scientific rigour required for approved Nicotine-Replacement Therapies under the Medicines Act.

"As yet, there have been no applications to register ENDS as smoking cessation therapies. As the WHO report indicates, there is as yet no conclusive evidence that supports the registration of ENDS for this purpose."

The ministry added that smokers seeking to quit smoking should use methods that have been proven to be safe and effective. These methods include going cold turkey, undergoing smoking cessation counselling, and undergoing nicotine replacement therapy, which have proven to be effective in helping smokers quit smoking in the long run.

It added that smokers who wish to quit can speak with a Quit Consultant on the toll-free Quitline at 1800-438 2000, or join the iQuit club at In addition, health ambassadors under the Health Promotion Board’s I Quit programme provide peer support to help smokers quit the habit.


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