ECD: The reaction in the UK seems to be that these devices might help, but that more research is needed. Should more research be done into electronic cigarettes before we allow them to be used by smokers?
Adrian: Well, it’s certainly good that some commentators think that E-cigarettes might help; current smoking prevalence rates are proving surprisingly stubborn to conventional public health interventions. Apart from the reduced harm aspect, E-cigarettes do offer that touchy-feely behavioural aspect of cigarettes that for the most part other alternative products don’t. When it comes to the need for more research, I agree with this, but it should not be at the expense of taking the products of the market in the meantime. If this were to be the case, it really would be a cruel irony if smokers who had switched to E-cigarettes were, as a result, forced to revert to smoking regular cigarettes.
ECD: Should health groups help to fund this expense, as they should also be un-biased. Also, should the e cigarette be taxed by the government to compensate for potential loss in revenue?
Adrian: At a time of economic crisis when many health groups are under financial pressure, the funding may have to come from elsewhere. But it would be entirely appropriate, if not essential, for health groups to be involved in the design of protocols and the undertaking and review of research to evaluate more fully the long-term potential of E-cigarettes as less harmful alternatives to cigarettes. Yes there might be a revenue loss from fewer cigarettes being smoked if E-cigarettes took off in a big way. But I’d hope that governments would use tax policy to steer smokers towards safer products rather than drive them away from them.
ECD: The current advice for smokers from bodies like ASH UK is that nicotine replacement aids should be used by smokers instead of electronic cigarettes. How effective are these aids in helping smokers give up over the long term?
Adrian: Nicotine replacement aids clearly work for some people, but overall these aids are much less effective than one might anticipate, especially over the long–term. For example, in a recent study they were found to be effective in only 1.6% of users, although this admittedly this was better than the 0.4% achieved with placebo treatment.
It’s of course feasible that the development of newer nicotine replacement aids that more closely reproduce the pharmacokinetic profile of the intake of nicotine from cigarettes might improve on this, and currently there is a lot of interest in testing this concept. But at the end of the day it seems the most important thing that helps smokers to give up is having the willpower to do so. If E-cigarettes prove over time to be an effective transition tool in enabling smokers thinking about quitting to develop and build on the willpower to help them do so, then it would be an obvious benefit. I’d hope that if this is the case, bodies like ASH UK would recognise it as such and respond positively by revising their advice accordingly.
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