e-Cigarettes: how would you advise your nearest and dearest?

There is something seductive about the curl of smoke from a cigarette, and that’s where current NRT options fail.

Enter the e-cigarette.

But should these new products, if they become recognised NRT, be fun or glamorous? Available flavours are said to include strawberry daiquiri and Boston cream pie, celebrities have endorsed them, and consumer testimonials include “Smoking is no longer cool and such a turn off!! Start using VAPESTICK now! All the cool people are ;)”.

Something doesn’t seem to sit comfortably with pharmacy and some of the frivolous marketing is, frankly, disturbing. For example, information about Nicolites (stocked by Tesco Pharmacy and, until recently, Sainsbury’s Pharmacy) states: “It's the tar, carbon monoxide, arsenic and other toxins in tobacco cigarettes that pose the threat, not the nicotine.” Pharmacists will know that nicotine is a relaxant and that it stimulates the release of hormones including acetylcholine and dopamine. The LD50 for adults is 40-60mg, making it highly toxic compared with other alkaloids such as cocaine. Animal studies indicate teratogenicity and suggest carcinogenicity. Nicotine plays a role in the development of cardiovascular disease.  Et cetera.

And what messages do names like “Njoy” and “Smoking everywhere” convey?

Yet I have to be realistic and think about the here and now. Having supported many smokers with quitting, I’ve found (as I’m sure you have) the quit or die approach doesn’t work for all. I understand how hard it can be to stop. Now there’s a product with the potential to be hugely beneficial to these people but it’s unlicensed so we can’t embrace this new technology.

Putting aside the double standards — how the Government allows the sale of tobacco, despite its known harms — and while those in power are making up their minds about classification and the evidence is gathered, I have to decide which poses the least danger to my patients: more months of smoking or switching, now, to a product that they want to try and which is likely to have less potential for harm. Surely the lesser evil is the one to choose.

The story of electronic cigarettes is a good one. It has innovation, ethical dilemmas and even conspiracy theories. And the irony of the whole debate over whether e-cigarettes should be sold in pharmacies is that they were invented by a pharmacist called Hon Lik after his father died of lung cancer.

For me, the question is what I would say to my nearest and dearest. (Shouldn’t we advise our patients in the same way?) Although e-cigarettes cannot be considered safe, I would tell my friends and family to go ahead and give them a try if all else has failed, but with a caveat: take care over your choice of brand.