From the BMA document:
A 2008 review by the World Health Organization (WHO) does not exclude the possibility that the ecigarette
could be useful as a smoking cessation aid, but concluded that no rigorous, peer-reviewed
studies have been conducted showing that the e-cigarette is a safe and effective nicotine replacement
therapy.16 There is evidence that e-cigarette products are highly variable in the efficacy of their
vaporisation of nicotine,b,17 and that the labelling of nicotine levels may be inconsistent and misleading.18
An analysis of the total level of nicotine generated by e-cigarettes which vaporise nicotine effectively
found that the amount inhaled from 15 puffs was lower compared with smoking a conventional
cigarette.b In 2009, the United States Food and Drug Administration (FDA) released results of an analysis
of some e-cigarette products.18 The analysis found that the e-cigarette cartridges contained carcinogens
and toxic chemicals.
The tests also suggested that quality control was inconsistent or non-existent:
• cartridges with the same label emitted a markedly different amount of nicotine with each puff
• one high-nicotine cartridge delivered twice the amount of nicotine compared to a nicotine
inhalation product approved by the FDA.18
They conclude:
Stronger controls are needed on where e-cigarettes can be used in order to:
• protect others from being exposed to e-cigarette vapours. While the concentrations of the
constituents of these vapours (propylene glycol, glycerine, flavouring substances, and nicotine)
are lower than with smoked cigarettes, 'passive vaping' has been found to occur with the use of
e-cigarettes.20,21,22
• ensure their use does not undermine existing restrictions on smokefree public places and
workplaces, by leading people to believe it is acceptable to smoke. Of particular concern to BMA
members is their use by patients, visitors and staff in hospitals and other healthcare settings.
Exposure to nicotine from e-cigarettes (either directly through their use by an individual or
indirectly from the vapours they produce) may adversely impact on patients, such as those with
heart or circulatory conditions, and their use may also become a source of conflict between staff
and patients. Similar concerns exist in other settings, such as the use of e-cigarettes on airplanes.
• ensure their use does not undermine the success of conventional tobacco control measures by
reinforcing the normalcy of smoking behaviour in a way that other nicotine containing products
do not.23 This specifically relates to the way these devices commonly resemble tobacco cigarettes,
in terms of appearance, nomenclature and the way they are used, as well as features such as
flavouring and styling that are potentially highly attractive to children, and may include cigarette
brand reinforcement.
And I agree.