Although the Health Ministry s bill to bar tobacco advertising in the print media failed to pass in the Knesset a few months ago due to vigorous lobbying by cigarette companies, public health head Prof. Itamar Grotto hopes its initiative to prevent the sales of electronic cigarettes does not share the same fate.

After four months preparation of a draft to prohibit the sale of both e cigarettes and the chemicals that fill them, the document has been issued for the perusal of the public.

Grotto hopes the document will reach the Knesset and be passed in another half year, he said on Monday.

But as e cigs are a growing business here, legislation to protect public health could easily have trouble overcoming the vested interests.

Most but not all e cigs contain concentrated nicotine, an addictive drug and “medical poison,” according to the document. This quickly causes smokers to become dependent on tobacco and goes straight from the lungs into the bloodstream and the brain.

As increasingly stringent legislation has limited smoking in public places in Israel and abroad, causing tobacco companies to be worried about their income and addicted users to worry about when and where they can get their “fix,” companies have increasingly developed and put on the market electronic cigarettes that give users the feeling of smoking without polluting their environment.

These, said the ministry, can be “even more dangerous” than smoking nicotine.

Consisting of a battery, a device that heats the chemical and a container to store it, an electronic cigarette vaporizes the powder or liquid into synthetic smoke.

Although Israeli law bars smoking in public places, it has not yet set down any rules regarding the use of e cigs in public places or their advertisement and marketing.

A bill to include e cigs in existing prohibitions has been tabled in the Knesset.

The ministry stated that e cigs and related products “pose a severe health danger to the public.”

When the chemical is nicotine, it is a psychoactive stimulant, a poison and addictive, and it releases adrenaline and dopamine. It is also used as an agricultural insecticide. As the nicotine in e cigs is much more concentrated 24 mgs. during seven minutes of “smoking” compared to 1 mg. in tobacco it is more poisonous, the ministry document stated.

Smoking e cig chemicals also lasts longer than smoking a cigarette.

These chemicals and others in e cigs are not uniform or standardized among products.

Leaks from cartridges have also been reported, posing a “serious toxic risk” from exposure in the air and by being swallowed, including by children, the ministry continued. In 2012, a baby died after swallowing the content of an e cig cartridge.

Propylene glycol contained in cartridges can result in poisoning, the draft document said, and can cause respiratory problems through inflammation of the vocal cords.

Inhaling another chemical, diethylene glycol, can cause damage to the kidneys and nervous system and has reportedly killed over 600 people in various countries. It can also cause harm when swallowed.

Tobacco specific nitrosamines are carcinogenic.

As a result of e cig dangers, the US Food and Drug Administration has barred the sale of e cigs, while the World Health Organization has advised countries to warn its residents of exposure to e cigs, whose claims of reducing tobacco smoking “have not been proven.”

Thus the ministry document calls for the prohibition of the manufacture, storage or marketing of e cigs and their products.

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“The big question, and why we’re here, is whether that goal can be realised and how best to do it… and what kind of cultural, regulatory environment can be put in place to make sure that’s achieved.

“I think it can be achieved but that’s a hope, a promise, not a reality,” he said.

A revolution

This view was echoed by Dr Jacques Le Houezec, a private consultant who has been researching the effects of nicotine and tobacco.

He said that because the harmful effects of its main comparator, tobacco, e cigarette use should not be over regulated.

“We’ve been in the field for very long, this for us is a revolution.

There is concern over the lack of regulation of e cigarettes

“Every adolescent tries something new, many try smoking. I would prefer they try e cigarettes to regular cigarettes.” Dr Le Houezec added.

Many are now calling for the industry to be regulated.

Konstantinos Farsalinos, from the University Hospital Gathuisberg, Belgium, said it was important for some light regulation to be put in place “as soon as possible”.

“Companies are all hiding behind the lack of regulation and are not performing any tests on their products, this is a big problem.”

Prof Farsalinos studies the health impacts of e cigarette vapour. Despite the lack of regulation, he remained positive about the health risks associated with inhaling it.

An EU proposal to regulate e cigarettes as a medicine was recently rejected, but in the UK e cigarettes will be licensed as a medicine from 2016.

Healthy rats

E cigarettes are still relatively new, so there is little in the way of long term studies looking at their overall health impacts.

In order to have valid clinical data, a large group of e cigarette users would need to be followed for many years.

Seeing as many users aim to stop smoking, following a large group of e smokers for a long period could be difficult.

But in rats at least, a study showed that after they inhaled nicotine for two years, there were no harmful effects. This was found in a 1996 study before e cigarettes were on the market, a study Dr Le Houezec said was reassuring.

Concern about the increase in e cigarette use remains.

The World Health Organization advised that consumers should not use e cigarettes until they are deemed safe. They said the potential risks “remain undetermined” and that the contents of the vapour emissions had not been thoroughly studied

E cigarettes still divide opinion

The British Medical Association has called for a ban on public vaping in the same way that public smoking was banned.

They stated that a strong regulatory framework was needed to “restrict their marketing, sale and promotion so that it is only targeted at smokers as a way of cutting down and quitting, and does not appeal to non smokers, in particular children and young people”.

Ram Moorthy, from the British Medical Association, said that their use normalises smoking behaviour.

“We don’t want that behaviour to be considered normal again and that e cigarettes are used as an alternative for the areas that people cannot smoke,” he told BBC News.

But Lynne Dawkins, from the University of East London, said that while light touch regulation was important, it must be treated with caution.

She said that e cigarettes presented a “viable safer alternative” to offer to smokers.

“We don’t want to spoil this great opportunity we have for overseeing this unprecedented growth and evolving technology that has not been seen before, We have to be careful not to stump that.”