Swedish researchers want to ban flavours in e-juice

Despite the intense international research on vejping and health risks in recent years, two Swedish researchers say Sweden should try to ban flavours in e-juice.

In a article in Svenska Dagbladet Dr Magnus Lundbäck of Danderyd Hospital says that researchers are lagging behind in the development of e-cigarettes.

"We know too little about e-cigarettes today," he told the magazine.

Since 2011, the UK Department of Health (PHE) has conducted intensive research on e-cigarettes and their health effects. This has resulted in the report "E-cigarettes - an evidence update" which summarises over 2,000 studies on e-cigarettes from around the world. The first report was published in 2015 and each year it is supplemented with the latest year's studies, most recently this year highlighting an analysis of youth use of e-cigarettes. PHE concludes that e-cigarettes would reduce the harm from tobacco smoking for a smoker by 97%.

But Magnus Lundbäck has studied cultured cell samples that he has exposed to nicotine vapour and nicotine liquid and believes that the samples show cell damage.

'It showed DNA damage and the cells have impaired function' says Magnus Lundbäck to SVD.

"Does not prove health effects"

However, cell studies to determine risks have been heavily criticised by the scientific community. Especially when it comes to e-cigarettes.

"Cellular studies to prove something become more politics than science," says Mr Perez. Konstantinos Farsalinos, Greek cardiologist who has studied e-cigarettes for over a decade and published several studies on the subject. "Cell studies are often conducted under unrealistic conditions and exaggerated to get a result. They have value, of course, but not as evidence of the health effects of, for example, the vapour from e-cigarettes," he writes on his website, commenting on cellular studies in general.

Most effective method in studies

Linnea Hedman, a public health scientist at Umeå University, is also concerned about the growing use of e-cigarettes. According to a study on lung health published in 2018, involving 30 000 Swedes, e-cigarette use is linked to coughing and mucus formation in the airways. She adds that many users also smoke regular cigarettes.

"It doesn't look like e-cigarettes work for smoking cessation, as the manufacturers claim," she tells SVD.

But according to a study published by Cancer research UK earlier this year, e-cigarettes are the most effective method of quitting smoking. At least compared to traditional over-the-counter methods. The study involved 1000 smokers who were offered help to quit in two ways: with over-the-counter products such as gum and patches. or with e-cigarettes (and e-juice with nicotine). Participants were divided into two equal groups. All were offered counselling during the year of the study.

According to the study, 9% of the first group (classic stop-smoking products) had quit smoking at the one-year follow-up. However, a majority expressed that they did not 'like' the products and were unlikely to continue using either gum or patches after the study.

Among e-cigarette users, the picture was different. 18 per cent had quit smoking. Twice as many. But the big difference, according to the researchers, was that e-cigarette users (80 per cent) liked their e-cigarettes and were happy to continue using them, which the researchers say makes the risk of relapse much lower. Tastes and satisfaction were cited by participants as the main reasons for staying away from smoking.

Want to ban flavours

Both Magnus Lundbäck and Linnea Hedman however, tells SVD that it would be reasonable for Sweden to try to ban "flavoured e-cigarettes", referring to Finland which only allows the sale of tobacco flavours in the e-juice.

E-cigarettes and e-juice are regulated under the "The law on e-cigarettes" since 2017 in Sweden. The law is based on the EU Tobacco Directive and regulates, in addition to requirements for warning labels and registration of products 6 months before sale, the size of the bottles that can be sold (10ml if the juice contains nicotine) and the maximum nicotine content (20mg/ml). Sweden also taxes nicotine-containing e-juice, regardless of nicotine content, per millilitre. However, there are no regulations on the flavours themselves.

"If it turns out that some flavourings are harmful, it may be necessary to ban them". Josefin Jonsson, Head of Tobacco Prevention at the Public Health Agency of Sweden said earlier.