E-cigarettes - a safer alternative or a deadly craze?

There aren't many absolutes in medicine, but here are two - smoking is bad for you and quitting smoking is good. Here at patient.info we go to great lengths to help you along what is often a difficult journey - and make no mistake, difficult is exactly what the journey is. Most smokers who quit successfully have tried three or four times and reverted to the evil weed. So you'd think that any tool we can offer to help people quit has to be good news.

Help comes in many shapes and sizes. Even brief advice from a healthcare professional can increase the chance by a third that this time you'll make it to become a non-smoker (1) and NHS smoking cessation advisors across the country helped 400,000 people quit in 2011-12. (2)

But even with all this help, not everyone manages to quit for ever, and the latest smoking-related guidance from the National Institute for Health and Care Excellence (NICE) (3) looked at whether people would do themselves less harm by using nicotine replacement therapy (NRT) products to cut down the amount they smoked even if they couldn't quit completely. It also weighed up what's known about the harm of using NRT long-term compared to smoking. They concluded that:

  • Most health problems are caused by other components in tobacco smoke, not by the nicotine
  • It's safer to use licensed nicotine-containing products than to smoke
  • There is 'reason to believe that lifetime use of licensed nicotine-containing products will be considerably less harmful than smoking'

But there's a new smoking cessation kid on the block, and it's gaining ground fast. In the USA, use of E-cigarettes has doubled in the space of a year and they're causing more controversy than you might think. On the one hand, a study out this week suggests they're as effective as nicotine patches in helping people quit, and have about the same incidence of side effects (4).

On the other hand, there are concerns about youngsters in particular getting hooked on this 'safer' alternative. There's also concern that at present, there aren't the same regulations covering e-cigarettes as there are for other nicotine replacement products. That means there is the potential for huge variation in what they contain. A recent study looking at a dozen different brands of e-cigarettes confirms the findings of the US Food and Drug Administration, with toxic chemicals including an anti-freeze ingredient and some known cancer-causing chemicals (5,6).

The toxic chemical levels found were much lower than those in cigarettes - but they were still there. Like nicotine replacement products, we just don't know for certain what the long-term risks are. They may be better than smoking - but safe is a relative term.


1) World Health Organisation (WHO). "WHO urges health professionals to engage in tobacco control." 31 May 2005. Accessed online at: http://www.who.int/mediacentre/news/releases/2005/pr22/en/

2) The Health and Social Care Information Centre Statistics on NHS Stop Smoking Services: England, April 2011 - March 2012, 2012

3) National Institute for Health and Care Excellence. Tobacco: harm-reduction approaches to smoking. NICE public health guidance 45, July 2013. www.nice.org.uk/ph45

4) http://download.thelancet.com/flatcontentassets/pdfs/S0140673613618425.pdf

5) Goniewicz ML, Knysak J, Gawron M, et al. Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tob Control. 2013 Mar 6. [Epub ahead of print]

6) Reference Committee D. Use of Electronic Cigarettes in Smoking Cessation Programs. Report of the Council on Science and Public Health. CSAPH Report 6-A-10. http://www.ama-assn.org//resources/doc/csaph/a10csaph6ft.pdf Accessed August 21, 2013.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.