Majority of Doctors Opine that E-Cigarettes Should not be Available on Prescription

An online survey conducted by GPonline has found that a significant majority of GPs do not believe that e-cigarettes should be prescribed for those attempting to quit smoking.

Nearly 70% of doctors surveyed on the subject rejected this idea, while only 17% explicitly backed the existing Public Health England policy.

14% of the 448 doctors who responded were undecided, but recent evidence from a study in the United States could sway many doctors against the prescription of e-cigarettes, considering that the technology clearly emits numerous harmful chemicals.

The collective wisdom of the doctors goes against advice provided by the health authorities.

A report from the Royal College of Physicians, published earlier this year, advised GPs to promote e-cigarettes “as widely as possible as a substitute for smoking”.

It had been asserted by the report that e-cigarettes represent a viable harm reduction strategy, and the conventional wisdom on the subject initially was that e-cigarettes significantly less harmful than traditional tobacco products.

But this viewpoint is being increasingly challenged as research becomes available, despite the apparent enthusiasm for the technology from health authorities.

After its publication, the RCGP called on NICE to investigate whether e-cigarettes should be prescribed to patients.

However, despite the views of doctors, there is still a significant groundswell of clinicians willing to prescribe the technology.

37% of GPs said that they were likely or very likely to recommend e-cigarettes to patients who are trying to give up smoking, compared with just 28% who said they were either unlikely or very unlikely to recommend them.

The consensus of opinion from doctors is that there is currently insufficient information available, particularly on the long-term consequences of e-cigarettes, in order to provide advice to patients.

This is something that surely must be addressed if voting is to be recommended as a serious medicinal contributor to the cessation of smoking.

At present, the existing health authorities’ policy seems to be rather uninformed and misguided, and evidence is accumulating all the time that e-cigarette smoking could in fact have very serious consequences.

Responding to potential criticisms, a spokeswoman for NICE indicated that its public health guidance on reducing harm from smoking recommends licensed nicotine-containing products.

“We haven’t produced guidance that looks at e-cigarettes specifically. As is usual process, the DH or Public Health England would have to officially refer the products to us before we can appraise them.”

 
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Scottish Government to Deny Under-18s Access to E-Cigarettes

As the debate over e-cigarettes intensifies, the Scottish government is expected to pass new legislation banning under-18s from purchasing the devices in question.

The Scottish Government’s Health Bill will also limit the advertising of vaping paraphernalia, as an increasing body of research suggests that the technology can be just as harmful as traditional smoking products.

Vaping technology is now available via prescription in England, but there is controversy about this decision for a couple of reasons.

Not only is it suggested that e-cigarettes are perhaps carcinogenic, but there is also criticism of the suggestion that they actually contribute to people ceasing smoking completely.

In many cases, smokers merely migrate from the conventional tobacco products to smoking e-cigarettes on a permanent basis.

Aside from the legislation related to vaping technology, the bill will also contain other provisions as well.

It will create specific criminal offences for health and social care workers who are found to be deliberately mistreating those in their care.

The legislation will also require health and social care organisations to be open when a patient has suffered unintended harm during treatment or care, through a statutory duty of candour.

And the Scottish government also amended the bill at the eleventh hour in order to create a duty for the NHS to provide equipment and support people who lose voices as the result of health conditions after input from MND Scotland.

Public health minister Maureen Watt commented on the bill, outlining the reasons for removing access to the cigarettes for those aged under 18.

“This is a wide-ranging bill. If passed this afternoon it will mean the introduction of regulation of e-cigarettes for the first time. While they are almost certainly safer than cigarettes, and have a role to help people quit smoking, we don’t want children to take them up, and that’s why we are proposing these age restrictions.”

Watt also spoke about the decision to ensure that people will no longer smoke in the vicinity of hospital property.

“Making it an offence to smoke near hospital buildings is common sense, and it will help NHS boards to enforce their existing smoke-free policies. Hospitals are places people go to recover from illness, and they shouldn’t have to walk through clouds of smoke.”

In addition, Watt welcomed some of the additional provisions contained in the bill, and suggested that it would be a worthy addition to health legislation in Scotland.

“This is also a Bill that seeks to improve patient safety and rights. Our proposals on duty of candour will ensure that health and social care providers are fully open when a patient has suffered unintentional harm. They will improve transparency, raise standards and help us to learn from past mistakes. We also hope to create a new criminal offence for wilful neglect. Thankfully these cases are very rare, but when they do happen it will give our courts the power to deal with the worst cases of neglect and ill-treatment.”

The bill will be debated in Parliament before members of Holyrood vote on its adoption.

 
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Research Questions the Value of Vaping and Other Technology in Stopping Smoking

A survey published in an authoritative journal suggests that vaping technology may actually be ineffective in assisting people with quitting smoking.

In fact, simply going cold turkey tends to be more successful.

The study in the Annals of Internal Medicine indicated that volunteers who used this approach were 25% more likely to remain abstinent half a year from the date that they give up than smokers who tried to gradually wean themselves off instead.

This goes against the idea that offering e-cigarettes to patients – now available via NHS prescription – can be an effective form of treatment.

Instead, it seems that willpower will ultimately decide whether or not an individual is able to stop smoking.

In accordance with this research, the NHS suggests that selecting a convenient date to quit is extremely important in the process.

“Whenever you find yourself in difficulty say to yourself, ‘I will not have even a single drag’ and stick with this until the cravings pass,” the health service suggests.

Additionally, seeking professional support from a GP is considered particularly important in ultimately successfully quitting smoking.

In the British Heart Foundation-funded study, nearly 700 UK volunteers were randomly assigned to one of two groups – a gradual quit group or an immediate quit group.

With all participants also offered advice and support, along with access to nicotine patches and replacement therapy, it was notable that the abrupt-cessation group of the two was significantly more successful.

After six months, 15.5% of the participants in the gradual-cessation group were abstinent compared with 22% in the abrupt-cessation group.

Commenting on the study, lead researcher Dr Nicola Lindson-Hawley, from Oxford University, observed that the results somewhat clashed with conventional wisdom.

“The difference in quit attempts seemed to arise because people struggled to cut down. It provided them with an extra thing to do, which may have put them off quitting altogether.”

Even though more people in the study said they preferred the idea of quitting gradually than abruptly, individuals were still more likely to stop for good in the abrupt group.

Dr Lindson-Hawley asserted that it was still better to cut down on cigarettes than do nothing at all.

There are about 10 million adults who smoke cigarettes in Great Britain, smoking rates have more than halved since 1974.

Surveys show that about two-thirds of current smokers would like to stop smoking, but only about 30%-40% make a quit attempt in a given year.

 
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E-Cigarettes Growing as NHS Prescriptions Kick In

As prescriptions for vaping technology begin to kick in, the latest evidence suggests that in the region of one-million smokers in England are utilising e-cigarette with the intention of ceasing nicotine addiction.

However, it is interesting to note that the number of people using these devices in order to stop is actually less than the total number of e-cigarette smokers.

A separate study by the Office for National Statistics indicated that 2.2 million people in the UK use e-cigarettes.

Researchers at University College London believe that 891,000 people have utilised e-cigarettes in an attempt to stop smoking during 2014.

This was opposed to using prescription medicine or receiving behavioural support.

The figures acquired by the university would seem to be approximately 10% of the total number of the cigarette smokers in Britain, with this figure thought to be around 8.5 million.

This latest piece of research follows on the back of another study which suggested that the chance of quitting is increased significantly by using vaping technology.

A previous study suggests that the chances of quitting smoking rises by 50% when e-cigarettes are utilised in comparison to traditional products such as nicotine gum and patches.

The long-term rate of quitting smoking cigarettes rises from around 5 per cent to 7.5 per cent when e-cigarettes are used – amounting to around 22,000 people, according to the new study published in the journal ‘Addiction.’

Professor Robert West, who led the research team, believes that the study does indicate that e-cigarette technology is helpful in aiding smokers to stop the habit.

On the other hand, West also asserted that the numbers are not as high as some e-cigarette manufacturers claim.

West also believes that the research is contrary to the concept that e-cigarettes undermine quitting if smokers use them to cut down slowly, and it also disproved the idea that they could be a gateway into smoking conventional tobacco products.

“These claims stem from a misunderstanding of what the evidence can tell us at this stage, but this is clearly something we need to watch carefully,” West asserted.

Professor Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary University of London, commented that the devices could be an effective tool in reducing the number of deaths from smoking.

Hajek seemed to support the concept of e-cigarettes being made available to the general public via prescriptions.

“This is unfortunate, as it is likely that even more smokers would switch to vaping successfully if e-cigarettes were combined with behavioural support that the services provide. Hopefully, findings like this will encourage the services to start offering e-cigarettes as a part of their overall toolkit.”

The data was compiled since the second quarter of 2011, by The Smoking Toolkit Study backed by organisations including the Department of Health and Cancer Research UK.

 
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Smoking Ban Having Positive Impact on Cancer Deaths According to Study

Evidence suggests that the public ban on smoking indoors has helped save the lives of many passive smokers.

A study assessed the effects of smoking bans across 21 countries, including England and Scotland, and found fewer admissions to hospital for heart attacks and strokes following smoking bans.

On the other hand, it was notable that the bans in question didn’t result in many people stopping smoking.

The assertion is based on the fact that the study included in the review found a larger reduction in heart attacks and strokes among non-smokers.

It thus concluded that the fact that people who do not smoke are no longer exposed to passive smoking is having a positive influence over the health of the population as a whole.

The problem with the research in question is that carrying out a randomised controlled trial of any merit over such a complicated subject is simply impossible.

Although the observational evidence in this particular case has some credibility, it is difficult to entirely cite causality considering that this is based on data alone.

There could be numerous factors contributing to this phenomenon, but it is nonetheless encouraging, and it seems reasonable to assert that the smoking ban has indeed had some influence.

Research was carried out by researchers from the Cochrane Tobacco Addiction Group, which is part of the Cochrane Collaboration of international healthcare researchers, and funded by the Health Research Board Ireland and University College Dublin.

The study was published in the peer-reviewed Cochrane Database of Systematic Reviews on an open-access basis, so it is free to read online.

Researchers found 77 studies and looked at the effects of a smoking ban on:

– cardiovascular health (mainly heart attacks and strokes)

– respiratory health (mainly asthma and chronic obstructive pulmonary disease, or COPD)

– the health of newborn babies

– numbers of deaths from smoking-related diseases

– numbers of people who smoked, plus quit rates and tobacco consumption

In 33 out of the 43 studies included in the research, there was persuasive evidence that fewer people were admitted to hospital with heart attacks and unstable angina.

However, the evidence was unclear about the effect smoking bans had on how much people smoked, and how many smoked.

While some studies showed a dip in smoking and an increase in attempts to quit just before and shortly after a smoking ban was introduced, these reductions didn’t last.

What can be reasonably concluded from the evidence is that the smoking ban is having influence in some areas of public health, but not significantly impacting upon the tendency of people to stop smoking.

 
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E-Cigarettes Available on Prescription Amid Controversy

Electronic cigarettes are now available for free on the NHS, despite an ongoing debate about the safety of the technology.

Research last week suggested that e-cigarettes are in fact no safer than traditional tobacco products, despite the fact that some health experts have recommended smokers switching to the new vaping technology.

Under the new regulations, it will be possible for e-cigarettes to be prescribed by doctors, alongside other traditional aids to help smokers such as nicotine patches and chewing gum.

The technology is intended to be an aid to ultimately quitting smoking and cutting one’s dependence on nicotine, rather than a replacement for the traditional tobacco product.

But Scottish GPs said more research into their long-term effects is needed and public health minister Maureen Watt warned that they are “not risk-free”.

An American study has already asserted that electronic cigarettes may be as harmful as smoking.

The e-Voke, made by British American Tobacco, is the first e-cigarette to be licensed by the UK’s Medicines and Healthcare Products Regulatory Agency, and will now be available via traditional prescription.

This technology would otherwise cost £20, with replacement cartridges retailing at £10 per week.

By comparison, a week’s supply of nicotine patches and chewing gum costs in the region of £10.

Already, 5 per cent of the Scottish population uses e-cigarettes, yet BMA Scotland has banned them in public places, also outlawing their sales of people aged under 18.

There is still considerable concerns that e-cigarettes may not offer a legitimate alternative to traditional tobacco products, and also that they may not even be an effective way of quitting smoking in the longer term.

Dr Andrew Thomson, a GP in Tayside and a member of the BMA’s Scottish Council, commented on the decision, striking a note of caution about the impact of e-cigarette technology.

“Further research is needed to learn more about the long-term effects of electronic cigarettes to uncover whether they are an effective and safe way of reducing tobacco harm.”

BMA Scotland stated that it was up to individual GPs to decide whether to prescribe e-cigarettes to patients.

On the other hand, some general practitioners have indicated that they would be willing to prescribe the technology if required.

Dr Jean Turner, a patron of the Scotland Patients Association, commented that “if you spend money now helping people getting off cigarettes, it will save them a lot of misery in the long term and save the NHS money treating people with vascular and lung disease.”

Scottish MSPs have recently that a lot to restrict the advertising of te-cigarettes.

 
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E-Cigarette Study Suggests Technology Just as Damaging as Tobacco

Research into e-cigarettes suggests that the vaping technology may not be any safer than conventional tobacco products.

Researchers at the University of California found that e-cigarette vapour may damage DNA in a similar fashion to that of traditional cigarettes.

Scientists believe that the form of DNA damage caused could equally lead to cancer.

Cells exposed to e-cigarettes developed DNA damage and died far sooner than those left untreated.

Nicotine-free e-cigarettes caused 50 per cent more DNA strand breaks, while for those containing nicotine, the damage rose three fold over eight weeks.

“Based on the evidence to date I believe they are no better than smoking regular cigarettes,” commented Professor Jessica Wang-Rodriquez of the University of California and one of the leaders of the study.

“There haven’t been many good lab studies on the effects of these products on actual human cell. Our study strongly suggests that electronic cigarettes are not as safe as their marketing makes them appear to the public. We were able to identify that e-cigarettes on the whole have something to do with increased cell death. We hope to identify the individual components that are contributing to the effect,” Wang-Rodriquez continued.

Debate on this new smoking technology has been fierce. Many health campaigners have suggested that e-cigarettes are superior, at least in health terms, to traditional cigarettes.

Public Health England had indeed advocated smokers switching to vaping, suggesting that e-cigarettes are significantly safer than conventional tobacco products.

It was also reported back in August that the NHS would begin offering e-cigarettes on prescription, in order to diminish the chances of smokers contracting cancer.

But this latest research suggests that vaping technology could be a forlorn attempt to reduce the dangers of smoking.

Indeed, both the World Health Organisation and scientists from the London School of Hygiene and Tropical Medicine and the University of Liverpool remain concerned about their safety.

Researchers from the University of California utilised epithelial cells Iin their experiment, and found that cells exposed to vaping vapour displayed several forms of damage.

DNA strand breaks, apoptosis and necrosis were all found to be common in cells directly treated by the vaping technology.

Wang-Rodriguez Remains convinced that e-cigarettes are just as dangerous as traditional tobacco products.

“There have been many studies showing that nicotine can damage cells. But we found that other variables can do damage as well. It’s not that the nicotine is completely innocent in the mix, but it looks like the amount of nicotine that the cells are exposed to by e-cigarettes is not sufficient by itself to cause these changes. There must be other components in the e-cigarettes that are doing this damage. So we may be identifying other carcinogenic components that are previously undescribed.”

An estimated 2.6 million adults in Great Britain currently use electronic cigarettes. Nearly two out of five users are ex-smokers and three out of five are current smokers.

 
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E-Cigarettes to Become Prescription Item Amid Ongoing Debate

E-cigarettes are to be prescribed on the NHS for the first time in the New Year, but the health service still has to face logistical issues about introducing this policy.

It has been stated that there are fears that GPs could be overrun by people demanding this prescription.

It will soon be possible for doctors to hand the device to smokers who intend to quit the habit, a move that will reportedly cost the NHS in the region of £20 per person.

In addition, each e-cigarette prescription will cost £10 per week for the supply of patients cartridges.

The government believes that the technology is significantly less harmful than smoking, and that the government believes that this medicinal license application will have a significantly positive influence on public health.

It is predicted that this new prescription move will ultimately lead to long-term health budget savings.

And the decision has already been welcomed by the anti-smoking organisation Action on Smoking and Health.

It is already estimated that in excess of 2.5 million people utilise E-cigarettes, with the technology believed to be 95 per cent safer than tobacco.

Cartridges used in the rechargeable devices contain ‘pharmaceutical grade nicotine’, according to British American Tobacco.

While the public smoking policies introduced by the government previously have had a significant influence on the habit, around one in three people in the UK continued to smoke E-cigarettes.

At least 76,000 lives could be saved every year if all smokers switched to electronic cigarettes, according to Public Health England .

Numerous studies have been carried out on the effects of E-cigarettes, but owing to the short lifespan of the technology thus far, it is impossible to explore the long-term influence on health.

While E-cigarettes contain carcinogens and other toxic chemicals contained in tar from tobacco, e-cigarettes do not burn tobacco and so avoid delivering these substances.

Thus, the general consensus of opinion is that E-cigarettes are significantly safer than tobacco, even if there are no studies to back this up over anything other than a short-term timeframe.

However, there are also concerns about the normalisation of smoking E-cigarettes.

The emergence of e-cigarettes has led to fears that they will act as a gateway to smoking conventional cigarettes among those who have never smoked.

There is no evidence of this having occurred as of yet, but as the phenomenon becomes more popular it is possible that E-cigarettes could lead to more young people taking up the habit of smoking conventional cigarettes.

Nonetheless, the NHS has decided to reveal this policy in order to attempt to address the existing health situation.

But Professor Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary, University of London, suggests that there is a possibility that E-cigarettes could become a new gateway drug.

“People who are attracted to e-cigarettes are the same people who are attracted to smoking. People who drink white wine are more likely to try red wine than people who do not drink alcohol.”

 
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Study Finds Link Between Marijuana and Prediabetes

New research suggests that people who use marijuana may be more likely to develop prediabetes than those who have never smoked the substance.

A paper published in Diabetologia (the journal of the European Association for the Study of Diabetes) assesses a sample of 3,000 people across the United States.

And the findings of the study were that adults currently using marijuana work 65 per cent more likely to suffer from the form of poor sugar control that can lead to Type II diabetes.

Those involved in the study who no longer smoked cannabis, but had used it 100 times or more in their lifetime, also have a significantly higher chance of developing their condition.

This was found to be around 50 per cent greater than those who have never consumed marijuana in any form.

The study ultimately found that “marijuana use was associated with the development and prevalence of prediabetes after adjustment. Specifically, occurrence of prediabetes in middle adulthood was significantly elevated for individuals who reported using marijuana in excess of 100 times by young adulthood.”

However, although there was a high incidence of prediabetes indicated by the study, the research failed to establish a direct link between Type 2 diabetes and marijuana usage.

The authors, led by the University of Minnesota School of Public Health’s Mike Bancks, said: “It is unclear how marijuana use could place an individual at increased risk for prediabetes yet not diabetes.”

Thus, some confusion still reigns over the result of the study.

Data was gleaned from a group of more than 3,000 US citizens, all of whom are collectively participating in a study called the Coronary Artery Risk Development in Young Adults.

Each of these individuals were aged between 18 and 30 when they were recruited in 1985-86, and have now been participating for 30 years straight.

The percentage of those reporting use of marijuana among the group has declined significantly over the decades in which they have been involved in this huge piece of research.

Although there seems to be little understanding regarding how marijuana could be linked with prediabetes and not tied to diabetes, authors of the paper did at least suggest some possible reasons for this.

The paper proposes that the lack of a link to type 2 diabetes could be because individuals excluded from the study had higher levels of marijuana use and greater potential for development of diabetes.

Additionally, it is possible that marijuana usage may have a larger affect on blood-sugar control in the prediabetic range than for full, type 2 diabetes.

3.2 million UK adults have been diagnosed as being diabetic, with this figure expected to increase to 5 million by 2025.

But Europe’s EMCDDA drug agency suggested in its annual report on drug use in the continent, published in June 2015, that cannabis use among 15 to 34 year olds has halved in the UK over the last 15 years.

It is thought that this could be due to smoking-related legislation.

 
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