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How Many Chambers Full?

Posted by Dr No on 01 June 2014

tobacco.jpgFor richer or poorer, for better or worse, Dr No is a smoker. And like most smokers, he knows he should quit. And – since you ask – no, it isn’t that easy. If it was, Dr No would now be an ex-smoker. Instead, even in the face of all the evidence, the cost, and a family history that includes a father and a grandmother who died from smoking related diseases, will-power time and again fails. He has managed smoking holidays, but sooner or later the nicotine magnet draws Dr No in again. In his orbits of despair, Dr No is as likely to escape the nicotine magnet as the moon is to escape the earth’s gravitational field.

It is with considerable interest then that Dr No has watched the development of electronic cigarettes, and the reaction of his profession to their development. Conventional nicotine replacement therapy – NRT – is at best barely effective, if at all, in helping smokers to quit. The whole NRT enterprise carries a somewhat sordid air, with its products more often than not to be found on the shelves alongside ointments for piles and once-you-pop-you-gotta-stop condoms. Even now, traditional barbers are most likely murmuring the ears of discerning gents, ‘A little patch for the weekend, sir?’ By and large, conventional NRTs do for nicotine addicts what incontinence pads do for sex-addicts: they take the fun out of it.

E-cigs, on the other hand, tick many of the boxes needed to be an effective alternative to smoked tobacco nicotine delivery systems. They provide something tangible to hold, and satisfy the oral need to put one’s lips round something and suck. They deliver something to inhale, and with that the all-important throat hit, not to mention flavour – it is difficult to find a flavour that has not been incorporated into e-liquid, the fluid used to generate the nicotine laden vapour – and a ‘smoke’ – it is actually a vapour, meaning e-cig users are vaping, not smoking – to exhale. Even the non-cigarette-imitative devices – once one has accepted the notion of sticking a Mag-lite pen torch with a nipple on it in one’s mouth – can even, dare one admit it, be made stylish, so long as one does not dangle the device, bookish style, from a lanyard round one’s neck.

As there is no smoke without a fire – e-cigs are no-burners, more kettle than bonfire – there are none (apart from nicotine and even that is optional) of the hundreds of toxic constituents found in tobacco smoke, meaning that, at least in theory, the choice between tobacco cigarette and e-cig should be a no-brainer. If the tobacco cigarette is Russian Roulette with most chambers loaded, then, on the available and admittedly still somewhat limited evidence, e-cigs are Russian Roulette with most, if not all, chambers empty. Dr No knows which game he’d rather play – as do the millions who are switching from most chambers loaded nicotine delivery to most chambers empty delivery.

Such choices are to be welcomed and indeed encouraged. So what do the authorities in general and health experts in particular do? The BMA has as usual tut-tutted, its Kirk chapter calling recently for a wee ban on e-cigs in public, warning they risk glamourising nicotine. NICE currently favours conventional NRT, tagging e-cigs as ‘unlicensed products that are currently being marketed’, which hits all the wrong notes – ‘unlicensed’ (read danger), ‘marketed’ (read profit) - in all the right order to discourage e-cig use for smoking cessation. The MRHA has stuck its oar in, insisting that e-cigs are medicines, and so must be regulated as medicines, guaranteeing e-cigs will get gummed up in a morass of bureaucratic tar. WHO has waded in, describing e-cigs as a ‘threat’, and the European Parliament – no surprises here – wants bigger, better regulation. HMG on the other hand remains coy – possibly because tobacco is treasury-friendly.

The only notable counter-covnterblaste to the manifold abufes of this vile cuftome of vaping (sic) – indeed one might say welcome breath of fresh air – came last week in news of an open letter to WHO written by over 53 ‘leading specialists in nicotine science and public health’ urging it to consider e-cigs to be part of the solution, not part of the problem. Dr No couldn’t agree more. He even wonders whether e-cigs shouldn’t be glamourised, sexed up, and sold in supermarkets alongside the booze. Who knows - but not as yet it seems WHO - we might even save a few lives.


Not sure if your article is entirely serious but, nobody really knows what electronic cigarettes are for. Are they really products designed to help people give smoking or are they;
A) to get smokers to change to e-cigarettes (but not actually give up)
B) to allow smokers who have no intention of giving up to continue their habit in places that don't allow smoking, or
C) to encourage non smokers to take up the habit in a supposedly "safe" way.

I have read two newspaper reports of these things exploding, so not entirely safe.

These devices remind me of miniature narghiles (shisha).

Yoav (glad you are still around - medical blogging ain't what it used to be) - Ever since skool carol services Dr No has been wary of exploding cigars ('We three kings of Orient was loaded and exploded'). Most alternative versions of the carol do however suggest the kings survived the explosion, even if it must have been a most unpleasant experience at the time.

One of the key things about e-cigs is that they are kettles not bonfires ie the 'white stuff' is vapour not smoke. Vapers are not smokers, even if the thing in their hand is called an e-cigarette - all rather confusing.

Dr No cannot speak for others, but for him e-cigs are a (probably much) safer way to get nicotine than tobacco cigarettes, with the advantage that, unlike conventional NRT, they 'satisfy' many of the other characteristics of tobacco cigarettes. Vaping is also significantly less expensive. As yet he does not know whether he will become a 'hard-core' vaper (with or without the occasional tobacco cigarette) or whether, as some appear to have found, changing to vaping does in fact lead to all smoking/vaping cessation. Only time will tell.

It seems not at all unlikely that the e-cig industry will also want to recruit non-smokers/non-vapers. Here the how many chambers loaded in your Russian Roulette revolver do you want argument still applies - only the terminally tonto could argue that on the available evidence it is not safer to vape than smoke. The concern about e-cigs being a gateway to tobacco applies, of course, and no doubt some will pass through that gateway, but still, in term of overall harm reduction, Dr No remains staunchly of the view that e-cigs are a good thing: as the 53 experts who wrote to WHO say, they are part of the solution, not part of the problem.

Debi - correct: if you do an ebay search for e-cig you will find that many of the results include shisha (and variants of) in the item title. Presumably because of e-bay or some other rules many items make a play of being 'no nicotine', when many if not all can be used with nicotine containing e-liquid. As above: all very confusing for the novice. An e-cig that isn't a cigarette, smoking that isn't smoking (it's vaping); no nicotine devices that work perfectly well as nicotine delivery devices. It's all enough to make one reach for a proper old-fashioned gasper.

Still, around, posting occasionally.

I guess that e-cig manufacturers aren't allowed to advertise them as aids to giving up smoking as that would require a licence (which they don't have). On the other hand, I haven't seen any advertising for e-cigs in mainstream media but I don't know if that's because of advertising rules, the cost of advertising or that the makers don't feel they need to advertise to sell their products. Thus, it's difficult to say what exactly are e-cigs for.

On another note, nicotine is a funny drug. It doesn't have particularly strong effects on the nervous system but withdrawal symptoms are quite profound.

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