So how’s your New Year resolution coming along? Probably not too well if you’ve chosen to quit smoking.
Research suggests around 60 per cent of those who resolved to stop on January 1 will have started again by the end of the month, with barely one in 10 remaining smoke-free by the end of the year.
And small wonder. The nicotine in cigarettes is chemically addictive, driving smokers to persist despite the proven health threat.
Clearly anyone battling the habit needs all the help they can get. The doubling in price of cigarettes following last year’s excise tax is certainly an incentive.
Yet in the UAE there’s one form of help that’s off the table, despite its reputation as the most effective of all: e-cigarettes.
By giving a nicotine hit without the lethal chemicals created by real smoking, these battery-operated devices are now front and centre in the global fight against tobacco-related illnesses.
With more than one in 10 deaths in the UAE being linked to smoking, the potential benefits of “vaping” would seem obvious.
But anyone selling or bringing e-cigarettes into the country faces confiscation orders and fines.
And the UAE is not alone. Many countries restrict or ban vaping, including Australia, Austria, Belgium, Japan and Singapore.
Tourists caught with e-cigarettes in Thailand face up to 10 years in prison.
Yet at the same time, many countries have no problem with vaping. Smokers in the UK are positively encouraged to take it up by official bodies like the Royal College of General Practitioners and Public Health England.
The differences in policy reflects the contrasting views of health officials world-wide on whether vaping is both safe and effective.
And that reflects the fact that the supposedly objective scientific evidence is mired in controversy.
Take safety. By eliminating the burning of tobacco, e-cigarettes are undoubtedly free of the same deadly mix of chemicals.
But they still contain nicotine, which has been linked to a host of health effects, ranging from heart and respiratory problems to impaired brain function.
There is also concern about the substances used to create the smoke-like vapour, which have been linked to cancer-causing compounds.
Only long-term studies can put these risks into proper perspective, and they’re still ongoing or have yet to even begin.
On top of this is the problem that e-cigarettes are constantly evolving.
An international team of researchers recently reported finding toxic metals like nickel in vaping liquids. But the team’s results only apply to older-style e-cigarettes, so it’s not clear whether they’re relevant to newer models.
Even so, it’s fair to say few researchers think e-cigarettes will prove to be at least as harmful as tobacco smoking.
As such, making them available to smokers is like offering them a powerful drug. Yes, they may have side-effects but compared to the “illness” they’re being used to treat, these are a price worth paying.
But the main debate over the safety of e-cigarettes has now focused on a wider issue: the “gateway effect”.
That is, while e-cigarettes may be appropriate for smokers trying to stop, they may also lead non-smokers to go the other way, and start a deadly habit.
Over the last few years, some studies have led to claims that young non-smokers who try e-cigarettes are more likely to take up the real thing.
In October a study involving over 44,000 students in Canada found that those who had “vaped” in the 30 days prior to being asked were more likely to have started smoking a year on.
But the interpretation of such studies has provoked huge controversy. As the researchers of the Canadian study point out, it’s possible that those who became smokers were always going to do so, and may simply have taken up e-cigarettes as part of their journey.
It’s an argument backed by the fact that if e-cigarettes do turn non-smokers into smokers, the huge popularity of vaping should have led to a surge in the prevalence of smoking. Official statistics show no such effect.
In fact, vaping doesn’t seem very popular among children. Last August, the largest study yet of the phenomenon, involving more than 60,000 young people in the UK, found while more are experimenting with it, barely one per cent become regular users.
Any lingering concerns that e-cigarettes may be a gateway can be dealt with easily enough by controlling access by young people – which is exactly what many countries already do.
All this would be rendered academic if e-cigarettes don’t actually help smokers give up smoking.
And the evidence on this key question is the most controversial and equivocal of all. A review of dozens of studies published in the journal Lancet Respiratory Medicine in 2016 claimed to show that those using e-cigarettes were 28 per cent less likely to quit smoking than those who did not.
The claim sparked a storm of protest – not least from researchers whose studies had been included in the review, who claimed their findings had been misrepresented. While the claim is now widely regarded with suspicion, the evidence for the effectiveness of e-cigarettes remains surprisingly weak.
The most recent study by the Cochrane organisation, which produces well-respected reviews of health interventions, found just two relatively small randomised controlled trials (RCTs) of the use of e-cigarettes.
Widely regarded as the gold standard in establishing effectiveness, both these RCTs suggested e-cigarettes are effective, but the evidence was far from compelling.
More research is needed – and more is on its way, in the form of over a dozen more RCTs.
For the 1 in 5 of the adult population of the UAE still smoking, these findings cannot come soon enough. If – as many expect – they’re positive, e-cigarettes may be freed to help those making perhaps the toughest New Year resolution of them all.
Robert Matthews is Visiting Professor of Science at Aston University, Birmingham, UK