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Electronic Nicotine Delivery Systems in the Era of Information

By September 1, 2018March 1st, 2019No Comments

Nowadays, we are used to having access to all types of information instantly.

Globalisation and the Internet have provided us with the world’s knowledge (often misinformation) within reach inside one’s home (or smart phone) around the clock. Every day we are more and more conscious about what we use, for example, we are bombarded with information stating that it is better to use deodorant without parabens, or drink wine with no sulphites, because they are ‘less harmful to our health’.

Health regulation is essential to have safe products and services on the market. But what happens when there is a new product, a technological innovation for which the information is not yet available? And what if it does not fall within one specific legislative framework? Ignorance and fear take control, there are no instant answers to our concerns, and health professionals and policy makers are not able to legislate properly the product which is not yet fully understood.

Good legislation provides a fair governing framework that protects the public. However, if technological innovation is not understood, or if there is not enough data to support proper legislation for a new product, then the new product becomes a disruption for professionals – moral, legal and scientific concerns are raised. One of the very first questions regulators had to consider after Electronic Nicotine Delivery Systems (ENDS) first entered the market was whether they were consumer, medicinal or tobacco products, and decide whether they were a threat to the public or not. The result, as we all know is quite unimpressive: ENDS can be tobacco related products in the whole of EU after 20 May 2016, but they can also be pharmaceutical products if they obtain a medicinal license, or simply be consumer products if they do not contain nicotine.

Good legislation is a slow process. Regulatory frameworks of well-established and understood products are continuously subject to changes and improvements, because the products either evolve or there is more reliable science available that demands a legislative reform. Regulators have learned from the development of the pharmaceutical regulatory framework: insufficient information has resulted in catastrophic consequences and nobody wishes to repeat similar mistakes. As a result, regulators can be over-cautious with technological innovations that are not fully understood and unwillingly disrupt the development of an industry. In the case of ENDS and the vape industry, professionals do not have enough information to make fully informed decisions, they are continuously learning while trying to regulate properly this new product. And possibly this is one of the reasons why ENDS are victims of an unfit regulation.

A review published by the Cochrane Collaboration identified around 600 records and combined results from two randomized controlled trials that compared ENDS with placebo (nicotine free vape devices). The results showed that vaping nicotine containing e-liquid increases the chances of stopping smoking long-term compared to nicotine free e-liquid, and helps more smokers reduce the amount smoked by at least half compared to nicotine free e-liquid and consumers using a patch. What is more, none of the studies found that smokers using ENDS had an increased health risk. However, “the quality of the evidence overall is low, because it is based only on a small number of studies. More studies of ENDS are needed. Some are already underway.”

It is a fact that once more studies are completed, we will have access to more information concerning ENDS and their health effects. Until then we have to adapt to the unfit legislation and in the meantime, ensure high safety and quality standards through self-regulation and implementing good practices.

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