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E-cigarettes: Hidden hazard or panacea?

A useful aid to stop smoking or unhealthy as normal cigarettes?

Pulse Insurance director Paul Sandilands explains how the industry needs to treat e-cigarettes for insurance purposes

 It is strange to think that once upon a time, cigarettes were in adverts associated with healthy living.

Recent times have seen such views turned upside down and the emergence of the e-cigarette as a method of combatting smoking addiction.

The publication of a government-backed report calling for e-cigarettes to become available on the NHS has led to increasing calls for life insurers to relax their approach to underwriting and pricing smokers. 

E-cigarettes have been defined, by the US Food and Drug Administration, as a product designed to deliver nicotine or other substances to a user in the form of a vapour.

Typically, they are composed of a rechargeable, battery-operated heating element; a replaceable cartridge that may contain nicotine or other chemicals; and an atomiser that, when heated, converts the contents of the cartridge into a vapour. This vapour can then be inhaled by the user. 

Aesthetically, e-cigarettes are often made to look like cigarettes, cigars and pipes. They are also sometimes made to look like everyday items, such as pens and USB memory sticks, for people who wish to use the product without others noticing.

But diacetyl, a flavouring that is safe to eat but can cause a serious lung condition when inhaled in sufficient quantities, has been found in more than three quarters of a sample of flavoured e-cigarettes.

Scientists at Harvard University who conducted the study said there was an urgent need to assess the safety of the additives in e-cigarettes.

The World Health Organisation (WHO) estimates that tobacco kills half its users and as many as 6 million people worldwide die every year from its direct and indirect effects. 

A report, published by Public Health England (PHE) in August, suggests that 75,000 lives per year could be saved if every one of the 8 million smokers in the UK switched to "vaping”. 

The numbers are striking and certainly support the current underwriting stance whereby smokers are generally charged upwards of 50% more than non-smokers to buy life insurance, while those aged 45 and over are more likely to pay double. 

But can the industry continue to justify charging increased rates for e-cigarette users? Certainly, the PHE study suggests their use could dramatically improve smoking related mortality rates.

Gaining clarity

Brokers and financial advisers have been quick to respond to the latest reports and question the basis for life insurers continuing to charge increased rates for e-cigarette users, of which there are now an estimated 2.6 million in the UK, when vapour inhalation devices contain no tobacco and carry none of the risks of smoking tobacco or smoke inhalation.

In addition, e-cigarettes provide a nicotine fix without the 70-plus known toxic chemicals that go with the real thing. They are tobacco-free and the ‘smoke’ is technically an aerosol vapour that is inhaled by the user.

There seems to be little doubt in some quarters that they are a step in the right direction towards reducing tobacco-related mortality and as an aid to quit smoking. The PHE report suggests the devices are up to 95% less harmful than cigarettes while recognising they are not completely risk-free. 

There are ethical reasons not to promote nicotine use, but many experts believe that e-cigarettes represent a cleaner source of nicotine and that the harm caused purely by nicotine ingestion is by some magnitude lower than the harm caused by cigarette smoke. 

Retailers of vaping devices are reporting that the overwhelming majority of customers are tobacco users who want to quit – yet there are convincing studies that show only 7.3% of e-cigarette users have successfully stopped using traditional tobacco products. 

If more than 90% of e-cigarette converts are ‘dual-user’, one has to wonder at the efficacy of the electronic devices.

Indeed, the WHO said in a report from August 2014 that manufacturers should be prevented from marketing e-cigarettes as smoking cessation aids until they can provide robust scientific evidence to support the claim (which, as yet, has not been forthcoming). 

Equally, there are growing concerns around the lack of scientific testing that vaporisers have been subject to.

The British Lung Foundation has expressed concerns about the long-term health impacts of e-cigarettes and several other studies have demonstrated that the flavours used in e-cigs may cause respiratory problems and damage to the immune system.