Should Ireland ban the advertising of e-cigarettes?

This issue will not go away until more reliable research is performed. Governments and Industry need to invest now.

The Minister for Health has just announced (June 2014) that Ireland will become the first European country to order a ban on branded cigarette packets. But what about e-cigarettes? In contrast to smoking we know virtually nothing about the form, nature and contents of the aerosols that expel from our mouths because of “vaping” an e-cigarette. So why is there silence on this issue?

To date there has been some restraint in advertising e-cigarettes in Ireland. It has not been like the UK where the most complained about TV ad campaign in 2013 was one in which the e-cigarette brand, VIP, featured a sultry-looking woman saying: “I want you to get it out. I want to see it. Feel it. Hold it. Put it in my mouth. I want to see how great it tastes”. Not surprisingly the Advertising Standards Authority (ASA) ruled the ad could only be aired after 11pm. Even more recently a press campaign promoting Vype e-cigarettes with claims such as – “pure satisfaction for smokers” and “experience the breakthrough” – were thought by the ASA to be interpretable as meaning that smokers could achieve satisfaction from e-cigarettes instead of cigarettes. The ads were banned.
(http://www.theguardian.com/media/2014/may/29/ecigarette-advert-sex-smoking-complained-marmite)
(http://www.theguardian.com/media/2014/jun/11/vype-e-cigarette-tv-campaign-banned-advertising)

Three questions are often posed about e-cigarettes: What are the possible health problems associated with them? Are they safer than cigarettes? Will using them help me with my addiction to cigarettes? To answer these questions the differences between “smoking” and “vaping” need to be outlined.

We often read and hear that e-cigarettes emit smoke; they do not. Smoke contains solid particulates that are formed when a material is burnt. We are also told that they emit water vapour; well they certainly involve vapourizing or “vaping” a liquid mixture that contains water….but it is not just water. If it was that pure and simple then there would be no problem because water vapour is a natural part of life. It’s always around us in the air and represents the reason why, on some days, we might feel “sticky”. Actually the most scientifically accurate word to describe what comes out of an e-“smokers” mouth on exhaling is an aerosol (very small droplet) spray.
We encounter aerosols every day in the form of clouds and boiling kettles. Most people are also familiar with aerosol spray cans used at home, from fly killers to hair products, because they are a handy type of dispensing system that creates a fine mist of liquid droplets to deliver a chemical product where it’s needed.

“Vaping” is the new sneezing

We are all certainly accustomed to sneezes. These are explosive expulsions of air and droplets from the lungs exiting through the nose and mouth. We know a lot about sneezes. For example 40,000 droplets can be produced by a single sneeze. The aerosol droplet sizes range from 0.5 to 5 µm (microns), dimensions that are about 1/10th to 1/1000th less than the width of a human hair. Finally, sneezes spread diseases by launching so-called “disease vectors” (germs) into the air and into or onto other people.
However the area of science that mainly deals with aerosols is focussed on monitoring the contents of our atmosphere.

From those studies, including ours at CRACLab in University College Cork, we know that airborne aerosols can carry even smaller chemical particles and/or Primary Biological Aerosol Particles (PBAP) such as bacteria. For air-quality purposes, the aerosols with most health risk are often referred to as PM2.5, which means all particulate matter with diameters 2.5 µm (microns) or less. People and animals inhale such aerosols in the air they breathe and the smaller they are the easier they can enter the lungs and cause serious harm to our well-being.
(http://crac.ucc.ie/)

In contrast we know virtually nothing about the form, nature and contents of the aerosols that expel from our mouths because of “smoking” or “vaping” an e-cigarette. Two fundamental questions need answering. What germs (like the flu virus) or chemicals (like nicotine and its vapourized products) do the aerosols transport with both healthy people and those who are ill? Over what distance do the aerosols remain airborne indoors? And so until we do the necessary research associated with the “vapour” aerosols that are generated from e-smoking the health risk assessment must remain unknown.

Perhaps you should think about it like this. What would you do if somebody sneezed straight into your face in a confined space? Are the potential outcomes really much different from breathing in second-hand aerosol from an e-cigarette? We need to find out.

Innocent until proven guilty?

We can only determine the health effects of e-cigarettes on both young and old if more research is performed. Some worrying results have appeared recently regarding their effects promoting the growth of drug-resistant bacteria like MRSA and also by direct particulate matter ingestion but the studies need to be confirmed. Perhaps the Irish government should sponsor the Health Research Board (HRB) and the Environmental Protection Agency (EPA) to find out some further scientific facts. One of their State Agencies did, after all, invest €5M recently into the building of an e-cigarette manufacturing factory in Connemara.

Research into whether e-cigarettes reduce dependency on conventional smoking (like methadone can do to heroin) or promote a degree of addiction toward tobacco in young adults and children should begin now in Ireland. After all we do not want to replace an atomic bomb with a hydrogen bomb.

But before all of that we must decide if we should consider e-cigarettes to be innocent until proven guilty (Common Law) or, as I believe, guilty until proven innocent (Napoleonic Code). We certainly waited a long time to legislate against tobacco smoking…..a habit that has been around for some 5000 years.

In the most recent years of that period it is more than likely that many people reading (most certainly writing) these words have lost loved ones to lung cancer or other smoking-related disease. Modern e-cigarettes have only been around for about 10 years; we should not have to wait until 7014 AD before governments begin to act.

We cannot prevent tobacco companies investing in the manufacture of a new product to fill the gap caused by smoking bans. But national governments do have a duty to fund research in order to protect the general public when too little is known about the alternatives to declare them safe. Until we know more we could, at least, put a ban on the advertising of e-cigarettes.

Professor John Sodeau; crac.ucc.ie; @johnsodeau

Director of Centre for Research into Atmospheric Chemistry (CRACLab)
Environmental Research Institute, University College Cork