Effectiveness may be little more than a smokescreen
The electronic cigarette, or e-cigarette, was invented as a way for smokers to satisfy their nicotine cravings without inhaling the harmful ingredients found in ordinary cigarettes. But their effectiveness and safety have been heavily debated among researchers, clinicians and policymakers.
The e-cigarette was invented in 2003. It consists of a cartridge filled with 'e-liquid' containing nicotine in varying concentrations, an atomiser to vaporise the liquid into mist, and a rechargeable battery.
E-liquids are flavoured with either traditional flavours, such as tobacco and menthol, or something sweet and fruity. They are formulated to produce a throat hit - the sensation a smoker gets when nicotine hits the back of the throat while inhaling - as well as vapour that mimics smoke produced by normal cigarettes.
A 35-year-old graphic artist, who wishes to be known only as Mech, used to smoke 20 cigarettes a day. Nine months ago, Mech started puffing, or 'vaping', on e-cigarettes.
'I had been trying to quit for many years. I'd tried everything from laser acupuncture and nicotine replacement therapy, to going cold turkey. I decided to try e-cigarettes as a last resort,' he says. Mech says he feels healthier after making the switch. 'I breathe more normally and I no longer have that dreaded smoker's cough. I'm also more active in sports, which makes me feel healthier overall.'
Governments have moved to ban e-cigarettes because of concerns that minors may be attracted to them. They have also not been tested and lack any form of regulation or standardisation. Quality control is a problem, as e-liquids are typically produced by small-scale manufacturers. Some cut corners by using cheaper but more toxic ingredients.
Nicotine content in e-liquids also varies widely. 'The content of nicotine in e-cigarettes is unregulated and inconsistent, unlike proper nicotine replacement therapy,' says Professor Philip Eng, a senior consultant respiratory physician at Mount Elizabeth Hospital in Singapore.
The US Food and Drug Administration notes that e-liquid 'may contain ingredients that are known to be toxic to humans, and may contain other [unsafe] ingredients.' These include cancer-causing chemical compounds called nitrosamines.
Even so, e-cigarettes are less toxic than ordinary cigarettes, which contain about 5,000 known chemicals and many more unknown ones. In a review of 16 studies that analysed the contents of e-cigarettes, researchers at Boston University found that the levels of certain harmful chemicals in e-cigarettes were comparable to levels found in nicotine patches, and hundreds of times lower than in normal cigarettes.
In Hong Kong, e-cigarettes containing nicotine and marketed as a nicotine replacement therapy are considered pharmaceutical products under the Pharmacy and Poisons Ordinance and must be registered before sale, according to the Tobacco Control Office. The possession and sale of unregistered e-cigarettes is prohibited, and the devices cannot be used in designated no-smoking areas.
Mech's attempts to quit failed before he discovered e-cigarettes. Smokers have a strong attachment to the physical act of smoking. Researchers have found that cigarette cravings can be relieved with cigarettes without nicotine. This suggests that smokers crave the physical stimuli associated with smoking, as well as nicotine.
'It is definitely the mental aspect of the habit that is difficult to overcome,' says Mech. 'The reason I have managed to stop smoking easily is because e-cigarettes do not remove the habits that smokers enjoy.' A study published last October in the BMC Public Health journal found that among 40 regular smokers who were given e-cigarettes over six months, 22.5 per cent quit smoking altogether. Another 32.5 per cent cut their consumption by 50 per cent.
But Eng notes that the hand-mouth movement of e-cigarette smoking is 'a significant act that reinforces the smoking habit'. He therefore advises would-be quitters to learn diversionary tactics, such as chewing gum or taking up a sport.
'Quitting smoking is a very complicated process. It depends on both pharmacotherapy and behaviour therapy to identify the various reasons why a person continues to smoke despite recognising the perils of the habit. As such, I cannot believe that e-cigarettes can be an effective modality to quit smoking,' says Eng.
Dr Michael Siegel, a Boston University tobacco control expert, disagrees. 'If a smoker is choosing between active smoking and electronic cigarette use, the use of the electronic cigarette is clearly the wiser choice.'
Siegel cites a study which found the majority of participants successfully cut down or quit smoking by using e-cigarettes.
'Research is needed to study the effectiveness of e-cigarettes. But there is no question that these products can be effective, and are effective, for thousands of users.'