If all smokers in the world switched from cigarettes to electronic cigarettes, it could save millions of lives, maybe even almost all the five million who die every year from smoking. That's because there is no tobacco in e-cigarettes, no tar and no real smoke, all of which in ordinary cigarettes can kill. E-cigarettes work by vaporizing liquid nicotine. They are consequently a substitute for cigarettes, great for people who are trying to give up smoking. Or so it seems. While it is clear e-cigarettes are less harmful by several magnitudes than smoking, the debate around e-cigarettes somehow continues, sharply dividing medical and public opinion. Healthwise, e-cigarettes are still relatively new so there is little in the way of long-term studies looking at their overall health impact. But the World Health Organization is not taking any chances, advising that consumers should not use e-cigarettes until they are deemed safe. The WHO says the potential risks "remain undetermined" and that the contents of the vapor emissions have not been thoroughly studied. In order to have valid clinical data on safety in the long term, a large group of e-cigarette users would need to be followed for many years. Until this is done, it should not be taken for granted that e-smoking is absolutely and positively safe. Then there is the psychological factor - that something that looks like smoking is glamorous and may be attractive to certain vulnerable groups. E-cigarettes could normalize behavior that has become socially unacceptable. What is needed in this regard is a marketing and sales strategy that is only targeted at smokers as a way of cutting down and quitting, one that does not appeal to non-smokers, in particular children and young people. The promotional campaign should try to ensure that non-smokers and children do not end up using e-cigarettes. Another e-smoking problem is that it is not yet regulated in the same way as medicine. Regulations around the world should be catching up with the surge in the popularity of e-cigarettes, but some companies seem to be hiding behind the lack of regulation in addition to not performing the required tests on e-cigarettes. There is also the endless debate about where to smoke e-cigarettes. A smoking ban might not apply to e-cigarettes because there's no smoke. It means, in theory, they can be used anywhere - trains, planes, even hospitals. However, the fact is that in the West, many institutions, offices and restaurants allow e-cigarettes but some don't. So while it's up to individual companies to determine their own policy, the result of different rules in different places can be somewhat confusing. E-cigarettes should be meant primarily as smoking cessation aids. In this they do help. As well as giving the feeling or illusion of smoking with a nicotine hit, e-cigarettes also mimic the sensory sensations of smoking, leading to speculation that they may be a useful tool for people trying to quit. E-cigarettes have also recently been found to be just as effective as nicotine patches in helping smokers to kick the habit. Given the increasing popularity of these devices in many countries and the accompanying regulatory uncertainty and inconsistency, e-cigarettes will continue to divide opinion. They can normalize smoking – which can be good and bad - and at the same time may help people to give up tobacco. They are definitely a huge potential public health bonanza that could save millions of lives. But there also has to be concern about the effects of their long-term use, their regulation and their safety.
