E-cigarettes: Hidden hazard or health breakthrough?

Tokyo drift

Justin McCurry, Tokyo correspondent for The Guardian, recently reported on research conducted by Japan's National Institute for Public Health, which found formaldehyde and acetaldehyde carcinogens in the liquid produced by many e-cigarette products.

The group also found e-cigarettes can fuel potentially life-threatening drug-resistant pathogens. 

Research leader Naoki Kunugita said: "In one brand of e-cigarette, the team found more than 10 times the level of carcinogens contained in one regular cigarette. Especially when the wire (which vaporises the liquid) gets overheated, higher amounts of those harmful substances seemed to be produced."

Earlier in 2015, the WHO advised governments to ban the sale of e-cigarettes to underage people because they posed a serious threat to them. It said that although there is a lack of evidence regarding the damage caused by e-cigarettes, there was still enough evidence to "caution certain groups such as adolescents and pregnant women from using them".

Another WHO study advocated banning the devices indoors over fears they could be at least as toxic to bystanders as regular cigarettes. It also reported most devices had not yet been scientifically tested, warning that nicotine can still contribute to cardiovascular disease, tumour growth and neuro-degeneration. The medical community continues to push for tighter controls on the grounds that the long-term effects of e-cigarettes are not yet known. 

The British Medical Association (BMA) has warned of the lack of reliable studies into e-cigarette safety and concerns remain regarding product information and labelling, the purity of the products' contents and the marked variations from one device to another in the quantity of nicotine delivery. 

The safety of the solution that is vaporised also remains unclear, containing as it does potentially harmful substances that are also used in the production of antifreeze and hydraulic fluid.

Production remains entirely unregulated and lacking quality control measures. The WHO has strongly advised consumers not to use e-cigarettes until national regulatory bodies have declared them both effective and safe, while the BMA continues to recommend other nicotine replacement therapies ahead of them.   

Concerns have also been raised about the creation of an entirely new generation of e-smokers, with teenagers most at risk of getting hooked on nicotine being delivered with novelty flavourings. They are potentially hazardous enough in itself (at least until long-term risks are known), but there is also the possibility of e-cigarettes and the dependence on nicotine creating a gateway to traditional tobacco products. 

As a counterpoint, though, some studies have shown only 0.1% of users are actually non-smokers.

Regulation 

Governments remain uncertain about how to respond. Brazil has simply banned them outright and Australia has banned all sales (although a loophole does exist in their legislation, allowing citizens to import from abroad).

In the US, e-cigs are receiving exactly the same treatment as tobacco products with strict advertising rules and heavy taxation, while some cities have restricted their use in public places. The EU is also proposing controls on ingredients and strength along with the imposition of marketing restrictions. 

So opinion remains divided as to how to treat e-smokers from a life insurance point of view, and as to whether they can be considered to be a major step down the road to smoking cessation.

While some reductions in rates might be available, most insurers are taking the view that e-cigarettes simply have not been around for long enough or subject to an adequate amount of testing to be adopting any radically different pricing approach to users.

Paul Sandilands is managing director of Pulse Insurance 

Special thanks to specialist life underwriter Duncan Mitchell of Tokio Marine Kiln for his advice and assistance in producing this article.