All new behaviours raise complex questions of etiquette. The sudden ubiquity of e-cigarettes – electronic substitutes for the cancer sticks of old – is challenging our assumptions about where it is appropriate to “smoke”.
More than a million people are using them in the UK and, according to Bloomberg, on present trends they will outsell conventional cigarettes by 2047. So is it OK to “fire up” in an office? In a restaurant? In a hospital bed?
Heathrow has just opened the world’s first airport “vaping” zone, sponsored by a manufacturer of the devices, in the Terminal 4 international departure lounge. It stressed that all forms of smoking remained forbidden elsewhere – but the move underscored the need for clarity on the matter. Is “vaping” smoking? Or not?
Airlines aren’t keen on the practice, not for health reasons but because they fear it could trigger disputes between passengers. Yet there is no law preventing it. One e-cigarette manufacturer, Vapestick, has gone as far as publishing guidance on how to get away with vaping during flights (the vapour is unlikely to set off the smoke alarm in the toilet).
The pace of change is illustrated by the story of the hapless e-cigarette user travelling by coach down the M6 from Preston to London last year who found himself the focus of a full-scale terrorist alert. Passengers on the Megabus noticed smoke coming from his bag and thought they saw him pouring liquid into it. They alerted the driver who made an emergency call, armed police swooped, closing the motorway and causing a tailback that stretched for miles on one of Britain’s busiest roads.
Eighteen months on, that incident feels like ancient history. Could anyone mistake an e-cigarette for a bomb today? They are everywhere – touted by street salespeople, promoted on the web, sold from specialist shops and advertised on house-sized posters.
For a product invented in 1963, just as the harm caused by tobacco was starting to become widely known, the recent surge in their popularity has been astonishing. Early versions were unwieldy, delivered an inadequate “hit” of nicotine and suffered from what was unkindly described as a “hernia effect” – users had to suck hard to get anything at all.
Tobacco companies were suspected of trying to undermine the new devices which threatened to encroach on their lucrative markets. If that was so then, it has dramatically changed today. The major companies including British American Tobacco and the US cigarette giant Philip Morris, makers of Marlboro, are piling into the new market – re-awakened when a Chinese pharmacist reportedly discovered a way of vaporising nicotine more effectively using lithium batteries in 2007.
E-cigarettes, as almost everyone must know by now, look and feel like real cigarettes and are designed to mimic the experience of smoking without the harmful consequences. They consist of a battery, an atomiser, a heating coil and a cartridge of liquids used for creating the inhaled mist which reproduces some of the effects of smoking minus the cancer-causing chemicals caused by burning tobacco.
Product labelling is inexact but most contain nicotine in a solution of either propylene glycol or glycerine and water, and sometimes flavours such as vanilla and apple. The atomised mist resembles smoke when exhaled but research to date has not shown the vapour to be harmful.
Tobacco smoke contains 4,000 chemicals, in addition to the nicotine that smokers want, which form the sticky residue in the lungs known as tar. The cigarette has been compared to a dirty syringe for taking nicotine – and the e-cigarette as its pin-clean substitute.
But conventional cigarettes are very efficient vehicles for the delivery of nicotine – deep into the lungs where smokers want it – and this has proved difficult to reproduce. E-cigarettes are not as effective as the real thing – but now come acceptably close to satisfy many smokers. And they are more satisfying than nicotine patches and gum which do not deliver the craved “hit”.
Does that make them safe? It certainly makes them safer. Nicotine is the closest we are likely to get to the perfect drug. Its effects are diverse; it stimulates, calms and enhances feelings of pleasure, but has few side effects. Its great advantage over other drugs is that its effects are mild. It is pleasurable only within a narrow range of concentrations in the blood. It is the instrument of its delivery – the cigarette – that is lethal.
That is what led the Royal College of Physicians (RCP) to call in 2007 for e-cigarettes and other forms of nicotine delivery to be made more widely available, on the “harm reduction” principle. Even if they are little more effective at helping smokers to quit than nicotine patches and gum, as evidence shows, there is an immediate and substantial health gain merely by moving smokers on to safer substitutes.
Critics who dismiss e-cigarettes because they do not significantly increase the chances of quitting over existing methods are missing the point – by several tens of thousands of lives a year.
But there are some tricky issues to be resolved. The booming e-cigarette market raises questions about etiquette, children, eating out, health, tax, the law and language.
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