Are e-cigarettes the answer?

Dublin taxi driver Bernard Fitzsimons, who is 56, gave up smoking a year ago, after taking up e-cigarettes. He smoked about 10 packets a week, but went down to three cigarettes a day and then gave them up altogether.

“This is the first time I’ve given them up and I’ve been smoking 40 years,” he says, even though he tried probably 20 times before. His wife, Trish, also smoked for 40 years but had never tried to give up cigarettes before.

“She tried the e-cigarettes about eight months ago and has never looked back since,” says Fitzsimons. Now they tell everyone about them.

However, the medical community is divided about e-cigarettes. Some look on them as positive, and some want to wait and see what evidence emerges, while still others are convinced they will harm the fight against tobacco.

Last month, the first large study, looking at how effective e-cigarettes are in the bid to quit smoking, came out. The study, published in the journal Addiction, found that people trying to quit without medical help are 60 per cent more likely to report success if they use e-cigs. This was compared with relying on willpower alone or shop-bought nicotine-replacement therapies such as patches or gum.

“There has been a huge rise in e-cigarettes,” says study author Prof Robert West of University College London, with one million smokers in England alone trying them in an effort to stop smoking.

The study surveyed 5,863 smokers in England between 2009 and 2014. Some 20 per cent of people trying to quit smoking while using e-cigarettes reported having stopped smoking tobacco. This compared with 15.4 per cent for those relying on willpower and 10.1 per cent for those on nicotine replacements.

Jury is

out The jury is out about any harm e-cigarettes may cause, but they are far less harmful than combusted tobacco, which is loaded with toxins and carcinogens. Nicotine in e-

cigarettes does not cause cancer, West says.

However, it depends on who is buying them, say health professionals. If e-cigarettes are being used by those who never smoked before, they could be a gateway to tobacco use, or they could be used along with cigarettes: so-called dual use.

Prof Luke Clancy, of the Tobacco Free Research Institute Ireland, says e-cigarette supporters believe in harm reduction, but he is against this as a policy for tobacco control at current smoking levels.

“The e-cigarettes may enable a small number to stop, but the cost of that may be to damage the anti-smoking campaign,” he says. Asking if they are less harmful than ordinary cigarettes is the wrong question. “From a tobacco-control point of view, you must ask if, in the long term, e-cigarettes will reduce smoking in Ireland. My belief is that it will not, and I suspect it will make things worse.”

The tobacco industry owns some e-cigarette manufacturers, and health experts still bristle when they recall how “low tar” and “mild” cigarettes were wrongly described as posing less harm in the past. West says e-cigarette users are typically more nicotine-addicted and have tried to give up many times.

He says that “smokers are voting with their feet and using these products anyway. It is our job to find out whether they are likely to help.”

Referring to England, he says quitting attempts are going up, quitting success is going up, and smoking rates are going down. Just 0.2 per cent of people who have never smoked are using e-cigarettes, so he says that, for now, worry about renormalisation of smoking is not borne out by the evidence, though we should be on our guard. Ireland does not collect data in the same way as England does.

Dr Ross Morgan, consultant respiratory physician at Beaumont Hospital, says there has been a lot of head-scratching about e-cigarettes among medical professionals.

“Some people say these are fantastic and are the biggest game-changer in tobacco consumption ever, while others say this is another fad and will renormalise smoking,” says Morgan. “But part of me says, 20 per cent of the planet is addicted to nicotine, and we are not going to make massive inroads just doing what we have been doing so far.

“When patients come into my clinic, as a man did yesterday, who has lung cancer, and tells me he has managed to stop smoking after 50 years with the aid of electronic cigarettes, I tell him I am delighted for him,” says Morgan. However, he notes that 80 per cent of those using e-cigs in the study said they did not quit, which says something about nicotine addiction.

The new study found that over-the-counter nicotine replacements such as gum and patches were worse than going it alone.

West believes this is because, without professional help, smokers tend to under-dose and not use them for long enough.

“It’s a bit like taking an antibiotic for just two days, taking half the dose, and then stopping,” West says, adding he was “surprised and disappointed” with this finding.

However, the NHS service to help smokers quit improved chances of quitting by about 200 per cent, on average. Ireland has the HSE Smoking Cessation Service, provided by specialists. Clancy says people take cessation more seriously when it is done by doctors, and advice from a doctor is more successful than the results reported for e-cigarettes in this study.

However, the advantage of e-cigarettes as consumer products is that many more people will try them and some will succeed in quitting tobacco. Many will not have sought professional help for their addiction before. “There are many who don’t want health products. They don’t even want to stop using nicotine. They just don’t want to die prematurely,” West says.

No-brainer

For Bernard Fitzsimons, the e-cigarettes are a no-brainer. He now spends €9 every three weeks, instead of €100 every week on tobacco. “Only vapour comes out and there is no smell. The kids are delighted and there is no smoke in the house and it is not on your clothes. It’s only afterwards you realise how dirty cigarettes are. Things smell and even taste better now,” he says.

Why are they better than patches and gum, though? “

You are putting something in your mouth. It fools you into thinking you are smoking and the nicotine goes to your brain anyway. You’ve got something in your hand and you are not fiddling around looking for something. It’s like taking a pull out of a cigarette,” he adds.

“Eventually I’ll give them up, but at the moment they are doing the job and stopping me smoking cigarettes.”

To find your local smoking cessation service, see quit.ie, or phone the HSE’s QUITline on 1800-201203.