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Handbook of WMA Policies
World Medical Association ⏐ S-2012-01-2012
WMA STATEMENT
ON
ELECTRONIC CIGARETTES AND
OTHER ELECTRONIC NICOTINE DELIVERY SYSTEMS
Adopted by the 63rd
WMA General Assembly, Bangkok, Thailand, October 2012
INTRODUCTION
Electronic cigarettes (e-cigarettes) are products designed to deliver nicotine to a user in the
form of a vapor. They are usually composed of a rechargeable battery-operated heating
element, a replaceable cartridge that contains nicotine and/or other chemicals, and an
atomizer that, when heated, turns the contents of the cartridge into a vapor (not smoke).
This vapor is then inhaled by the user. These products are often made to look like other
tobacco-derived products like cigarettes, cigars, and pipes. They can also be made to look
like everyday items such as pens and USB memory sticks.
No standard definition of e-cigarettes exists and different manufacturers use different
designs and different ingredients. Quality control processes used to manufacture these
products are substandard or non-existent. Few studies have been done to analyze the level
of nicotine delivered to the user and the composition of the vapor produced.
Manufacturers and marketers of e-cigarettes often claim that use of their products is a safe
alternative to smoking, particularly since they do not produce carcinogenic smoke.
However, no studies have been conducted to determine that the vapor is not carcinogenic,
and there are other potential risks associated with these devices: Appeal to children,
especially when flavors like strawberry or chocolate are added to the cartridges. E-
cigarettes can increase nicotine addiction among young people and their use may lead to
experimenting with other tobacco products.
Manufacturers and distributors mislead people into believing these devices are acceptable
alternatives to scientifically proven cessation techniques, thus delaying actual smoking
cessation. E-cigarettes are not comparable to scientifically-proven methods of smoking
cessation. Their dosage, manufacture, and ingredients are not consistent or clearly la-
belled. Brand stretching by using known cigarette logos is to be deplored.
Unknown amounts of nicotine are delivered to the user, and the level of absorption is
unclear, leading to potentially toxic levels of nicotine in the system. These products may
also contain other ingredients toxic to humans.
High potential of toxic exposure to nicotine by children, either by ingestion or dermal
absorption, because the nicotine cartridges and refill liquid are readily available over the
Internet and are not sold in child resistant packaging.
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Electronic Cigarettes
Due to the lack of rigorous chemical and animal studies, as well as clinical trials on com-
mercially available e-cigarettes, neither their value as therapeutic aids for smoking ces-
sation nor their safety as cigarette replacements is established. Lack of product testing
does not permit the conclusion that e-cigarettes do not produce any harmful products even
if they produce fewer dangerous substances than conventional cigarettes.
Clinical testing, large population studies and full analyses of e-cigarette ingredients and
manufacturing processes need to be conducted before their safety, viability and impacts
can be determined as either clinical tools or as widely available effective alternatives to
tobacco use.
RECOMMENDATIONS
That the manufacture and sale of e-cigarettes and other electronic nicotine delivery sys-
tems be subject to national regulatory bodies prior approval based on testing and research
as either a new form of tobacco product or as a drug delivery device.
That the marketing of e-cigarettes and other electronic nicotine delivery systems as a valid
method for smoking cessation must be based on evidence and must be approved by ap-
propriate regulatory bodies based on safety and efficacy data.
That e-cigarettes and other electronic nicotine delivery systems be included in smoke free
laws.
Physicians should inform their patients of the risks of using e-cigarettes even if regulatory
authorities have not taken a position on the efficacy and safety of these products.
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