Swedish researchers want to ban flavors in e-juice

Despite intense international research in recent years on vejpning and health risks, two Swedish researchers now believe that Sweden should try to ban flavors in e-juice.

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

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

Since 2011, the UK Department of Health, PHE, has been conducting intensive research on e-cigarettes and their health effects. This has resulted in the report "E-cigarettes - an evidence update" which summarizes over 2000 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 e-cigarette use by young people. In summary, 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 exposed to nicotine vapor and nicotine liquid and believes that the samples show cell damage.

"It showed DNA damage and the cells get impaired function" says Magnus Lundbäck to SVD.

"Does not prove health effects"

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

"Cell studies to prove something are more politics than science," says Konstantinos Farsalinos, Greek cardiologist who has been studying 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, e-cigarette vapor," he writes on his website in a comment to cell 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 build-up in the airways. She also says that many users also smoke regular cigarettes.

"It doesn't look like e-cigarettes work to quit smoking, 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 to quit smoking. At least compared to traditional over-the-counter methods. The study involved 1,000 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 counseling 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 that they would probably not continue using either gum or patches after the study.

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

Want to ban flavors

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

E-cigarettes and e-juice are regulated under "The law on e-cigarettes" since 2017 in Sweden. The law is based on the EU Tobacco Products Directive and regulates, in addition to requirements for warning labels and registration of products 6 months before sale, the size of 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 milliliter. However, there are no regulations on the flavors themselves.

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