E-cigarettes could now be prescribed by doctors as a way of giving up smoking, after regulators granted one such product a drug licence for the first time. This marks a significant point in the growing popularity of vaping, which has created a global market for e-cigarettes now worth over US$6 billion. Yet the technology remains highly controversial.
Proponents of e-cigarettes argue that they have helped increase the rate at which people are quitting smoking. But sceptics fear that vaping might make smoking a more socially acceptable habit again, that it could become popular among children who may then move on to conventional cigarettes, and that it even poses a possible direct health risk due to the chemicals it involves.
One important area identified for further research by academics, organisations and government is the nature and impact of the dual-use of electronic and conventional cigarettes. Instead of simply assuming that vaping is a way for all people to cut down on smoking for health reasons, we should consider that they may be complementary activities for some. Regular smokers are often subject to regulation and social pressure. For example, they may no longer be able to smoke in their workplace or in places where they meet with friends or family.
Substituters vs complementers
E-cigarette use, on the other hand, is often unregulated and provides both the nicotine fix associated with cigarette use and some of the social element. So smokers now have the option to smoke regular cigarettes where they can and complement this with the use of e-cigarettes where it is not possible or appropriate to smoke tobacco.
If e-cigarettes were only adopted as substitutes and helped more people to quit smoking, they could increase the associated health and financial benefits that come with this by cutting tobacco use. But where e-cigarettes act as a complementary product, they could instead blunt regular anti-smoking regulation and keep more people smoking for longer.
We conducted an online survey of 2,406 people in the US and found that 37 per cent of smokers who use e-cigarettes view them primarily as a complementary product to traditional cigarettes, rather than a substitute. We also found that while 55 per cent of “substituters” were trying to quit, only 40% of “complementers” were.
Together with publicly available data from US and UK sources, this research allowed us to calculate a new measure of how financially beneficial e-cigarettes are in terms of public health savings. If 37 per cent of dual-users are taken to be “complementers”, the estimated benefits of e-cigarettes drop by as much as 57 per cent in the US – the equivalent of US$3.3 billion to US$4.9 billion a year in health-cost savings.
We also found that this problem is likely not to receive the attention it deserves because non-smokers underestimate the extent to which e-cigarettes act as a complementary product. While 37 per cent of dual-users in our sample viewed vaping primarily as a complementary activity, only 27 per cent of non-smokers thought e-cigarettes would be used in this way rather than as a substitute. This perception gap suggests some people overestimate the benefits of e-cigarettes. This is especially worrying because non-smokers make up the majority of the general population, which likely includes many policy-makers and health experts.
The difference in perceptions may be due to the early success stories of those smokers who used e-cigarettes to quit smoking. In line with this, our research found that ex-smokers who successfully quit were the least likely to have used e-cigarettes primarily as complements (20 per cent). This was followed by dual-users who were trying to quit (30 per cent), and finally by those with no intention of quitting (44 per cent).
Health news in pictures
Health news in pictures
1/25 Most child antidepressants are ineffective and can lead to suicidal thoughts
The majority of antidepressants are ineffective and may be unsafe, for children and teenager with major depression, experts have warned. In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide
2/25 'Universal cancer vaccine’ breakthrough claimed by experts
Scientists have taken a “very positive step” towards creating a universal vaccine against cancer that makes the body’s immune system attack tumours as if they were a virus, experts have said. Writing in Nature, an international team of researchers described how they had taken pieces of cancer’s genetic RNA code, put them into tiny nanoparticles of fat and then injected the mixture into the bloodstreams of three patients in the advanced stages of the disease. The patients' immune systems responded by producing "killer" T-cells designed to attack cancer. The vaccine was also found to be effective in fighting “aggressively growing” tumours in mice, according to researchers, who were led by Professor Ugur Sahin from Johannes Gutenberg University in Germany
3/25 Green tea could be used to treat brain issues caused by Down’s Syndrome
A compound found in green tea could improve the cognitive abilities of those with Down’s syndrome, a team of scientists has discovered. Researchers found epigallocatechin gallate – which is especially present in green tea but can also be found in white and black teas – combined with cognitive stimulation, improved visual memory and led to more adaptive behaviour. Dr Rafael de la Torre, who led the year-long clinical trial along with Dr Mara Dierrssen, said: “The results suggest that individuals who received treatment with the green tea compound, together with the cognitive stimulation protocol, had better scores in their cognitive capacities”
4/25 New online test predicts skin cancer risk
Health experts have created a new online tool which can predict a person’s risk of developing a common form of skin cancer. The tool uses the results of a 10-question-quiz to estimate the chance of a person aged 40 or over of having non-melanoma skin cancers within three years. Factors including the age, gender, smoking status, skin colour, tanning ability, freckling tendency, and other aspects of medical history are covered by the quiz
5/25 Multiple Sclerosis stem cell treatment 'helps patients walk again'
A new treatment for multiple sclerosis (MS) has enabled some patients to walk again by “rebooting” their immune systems. As part of a clinical trial at Sheffield's Royal Hallamshire Hospital involving around 20 patients, scientists used stem cells to carry out a bone marrow transplant. The method known as an autologous haematopoietic stem cell transplant (HSCT) works by using chemotherapy to destroy the area of the immune system which causes MS
6/25 Dementia patients left without painkillers and handcuffed to bed
Dementia patients experience a ‘shocking’ variation in the quality of hospital care they receive across England, a charity has warned. Staff using excessive force and not giving dementia patients the correct pain medication were among the findings outlined in a new report by The Alzheimer’s Society, to coincide with the launch of Fix Dementia Care campaign
7/25 Cancer risk 'increased' by drinking more than one glass of wine or pint of beer per day
Drinking more than one glass of wine or pint of beer a day increases the risk of developing cancer, according to medical experts. New guidelines for alcohol consumption by the UK published by chief medical officers warn that drinking any level of alcohol has been linked to a range of different cancers. The evidence from the Committee on Carcinogenicity (COC) overturns the oft-held view that a glass of red wine can have significant medical benefits for both men and women
8/25 Vaping 'no better' than smoking regular cigarettes
Vaping could be “no better” than smoking regular cigarettes and may be linked to cancer, scientists have found. The study which showed that vapour from e-cigarettes can damage or kill human cells was publsihed as the devices are to be rolled out by UK public health officials as an aid to quit smoking from 2016. An estimated 2.6 million people in the UK currently use e-cigarettes
9/25 Rat-bite fever
A teenager was hospitalised and left unable to move after she developed the rare rat-bite fever disease from her pet rodents which lived in her bedroom. The teenager, who has not been named, was taken to hospital after she complained of a pain in her right hip and lower back which later made her immobile, according to the online medical journal BMJ Case Reports. She suffered for two weeks with an intermittent fever, nausea and vomiting and had a pink rash on her hands and feet. The teenager, who had numerous pets including a dog, cat, horse and three pet rats, has since made a full recovery after undergoing a course of antibiotics. Blood tests showed that she was infected with for streptobacillus moniliformis – the most common cause of rat-bite fever. One of her three pet rats lay dead in her room for three weeks before her symptoms showed
10/25 Taking antidepressants in pregnancy ‘could double the risk of autism in toddlers’
Taking antidepressants during pregnancy could almost double the risk of a child being diagnosed with autism in the first years of life, a major study of nearly 150,000 pregnancies has suggested. Researchers have found a link between women in the later stages of pregnancy who were prescribed one of the most common types of antidepressant drugs, and autism diagnosed in children under seven years of age
11/25 Warning over Calpol
Parents have been warned that giving children paracetamol-based medicines such as Calpol and Disprol too often could lead to serious health issues later in life. Leading paediatrician and professor of general paediatrics at University College London, Alastair Sutcliffe, said parents were overusing paracetamol to treat mild fevers. As a result, the risk of developing asthma, as well as kidney, heart and liver damage is heightened
12/25 Fat loss from pancreas 'can reverse' effects of type-2 diabetes
Less than half a teaspoon of fat is all that it takes to turn someone into a type-2 diabetic according to a study that could overturn conventional wisdom on a disease affecting nearly 3 million people in Britain. Researchers have found it is not so much the overall body fat that is important in determining the onset of type-2 diabetes but the small amount of fat deposited in the pancreas, the endocrine organ responsible for insulin production
13/25 Potatoes reduce risk of stomach cancer
Scientists have found people who eat large amounts of white vegetables were a third less likely to contract stomach cancer. The study, undertaken by Chinese scientists at Zhejiang University, found eating cauliflower, potatoes and onions reduces the chance of contracting stomach cancer but that beer, spirits, salt and preserved foods increased a person’s risk of the cancer
14/25 Connections between brain cells destroyed in early stages of Alzheimer’s disease
Scientists have pinpointed how connections in the brain are destroyed in the early stages of Alzheimer’s disease, in a study which it is hoped will help in the development of treatments for the debilitating condition. At the early stages of the development of Alzheimer’s disease the synapses – which connect the neurons in the brain – are destroyed, according to researchers at the University of New South Wales, Australia. The synapses are vital for brain function, particularly learning and forming memories
15/25 Sugar tax
The Government should introduce a sugar tax to prevent an “obesity crisis” from crippling the NHS, a senior Conservative MP and former health minister has said. Dr Dan Poulter believes that the case for increased taxes on unhealthy sugary products was “increasingly compelling”
16/25 Cancer breakthrough offers new hope for survivors rendered infertile by chemotherapy
A potentially “phenomenal” scientific breakthrough has offered fresh hope to cancer patients rendered infertile by chemotherapy. For the first time, researchers managed to restore ovaries in mice affected by chemotherapy so that they were able to have offspring. The scientists now plan to begin clinical trials to see if the technique, which involves the use of stem cells, will also work in humans by using umbilical cord material and possibly stem cells taken from human embryos, if regulators agree
17/25 Take this NHS test to find out if you have a cancerous mole
An interactive test could help flag up whether you should seek advice from a health professional for one of the most common types of cancer. The test is available on the NHS Choices website and reveals whether you are at risk from the disease and recommends if you should seek help. The mole self-assessment factors in elements such as complexion, the number of times you have been severely sunburnt and whether skin cancer runs in your family. It also quizzes you on the number of moles you have and whether there have been any changes in appearance regarding size, shape and colour
18/25 Health apps approved by NHS 'may put users at risk of identity theft'
Experts have warned that some apps do not adequately protect personal information
19/25 A watchdog has said that care visits must last longer
The National Institute for Health and Care Excellence (Nice) said home help visits of less than 30 minutes were not acceptable unless part of a wider package of support
20/25 Pendle in Lancashire tops list of five most anxious places to live in the UK
Pendle in Lancashire has been named the most anxious place to live in the UK, while people living in Fermanagh and Omagh in Northern Ireland have been found to be the happiest
21/25 Ketamine could be used as anti-depressant
Researchers at the University of Auckland said monitoring the effects of the drug on the brain has revealed neural pathways that could aid the development of fast-acting medications. Ketamine is a synthetic compound used as an off anaesthetic and analgesic drug, but is commonly used illegally as a hallucinogenic party drug. Dr Suresh Muthukumaraswamy, a senior researcher at the university and a member of the institution’s Centre for Brain Research, used the latest technology in brain imaging to investigate what mechanisms ketamine uses to be active in the human brain
22/25 A prosthetic hand that lets people actually feel through
The technology lets paralysed people feel actual sensations when touching objects — including light taps on the mechanical finger — and could be a huge breakthrough for prosthetics, according to its makers. The tool was used to let a 28-year-old man who has been paralysed for more than a decade. While prosthetics have previously been able to be controlled directly from the brain, it is the first time that signals have been successfully sent the other way
23/25 The biggest cause of early death in the world is what you eat
Unhealthy eating has been named as the most common cause of premature death around the globe, new data has revealed. A poor diet – which involves eating too few vegetables, fruits, nuts and grains and too much red meat, salt and sugar - was shown to be a bigger killer than smoking and alcohol
24/25 Scientists develop blood test that estimates how quickly people age
Scientists believe it could be used to predict a person’s risk of developing Alzheimer’s disease as well as the “youthfulness” of donated organs for transplant operations. The test measures the vitality of certain genes which the researchers believe is an accurate indication of a person’s “biological age”, which may be younger or older than their actual chronological age
25/25 Aspirin could help boost therapies that fight cancer
The latest therapies that fight cancer could work better when combined with aspirin, research has suggested. Scientists from the Francis Crick Institute in London say the anti-inflammatory pain killer suppresses a cancer molecule that allows tumours to evade the body’s immune defences. Laboratory tests have shown that skin, breast and bowel cancer cells often generate large amounts of this molecule, called prostaglandin E2 (PGE2). But Aspirin is one of a family of drugs that sends messages to the brain to block production of PGE2 and this means cancer cells can be attacked by the body’s natural defences
Bigger than you think
If the public is focused on the success stories of those who have used e-cigarettes and ceased smoking, they will underestimate the extent of complementary vaping. It is likely that the early years of e-cigarette use will have been dominated by those wanting to substitute them for tobacco in order to quit. But as those quitters succeed, the proportion of complementary users will rise.
However, just because some people use e-cigarettes as a complement to tobacco doesn’t mean they don’t want to quit. Our research actually found that complementary users were more likely to be using another quitting method or product, such as nicotine gum or patches, in addition to e-cigarettes. This suggests that for some trying to quit, their progress may be hindered by e-cigarettes.
But because complementary use can significantly dampen the health benefits of cigarettes and may make some smokers worse off if they prolong their habit, the product could undermine regulation that aims to help reduce smoking. What’s more, increasing regulation of regular cigarettes will have a knock-on effect on cigarette use but also could encourage more people to take up complementary vaping, increasing the impact of the problem. Health authorities such as the NHS should take the issue of complementary use into consideration when designing policy. Making e-cigarettes available on prescription, for example, may well help some smokers, but harm others.
David Ronayne, Teaching Fellow and PhD Candidate in Economics, University of Warwick; Chris Doyle, Principal Teaching Fellow, University of Warwick, and Daniel Sgroi, Associate professor, University of WarwickReuse content