The debate regarding the perceived benefits of e-cigarettes smoulders on. Opinions remain divided as to whether the unknown and potentially harmful side-effects of this unregulated product outweigh the argument that e-cigarettes are a safer alternative to smoking. A recent review (the Cochrane Review) provides a cautious boost to the e-cigarettes camp.

The Cochrane Review was published on 17 December 2014. The aim of the review was to understand whether e-cigarettes help smokers stop or cut down on their smoking, and whether it is safe to use e-cigarettes to achieve this. The review considered 13 trials published up to July 2014. Two of the trials (conducted in New Zealand and Italy), with a combined sample size of 662  participants, were helpful in that they compared e-cigarettes both with and without nicotine, and also compared e-cigarettes directly to nicotine patches.

Whilst the quality of the evidence overall is considered to be low because it is based only on a small number of studies, the preliminary findings are promising. The findings reveal that e-cigarettes containing nicotine increased the chances of stopping smoking long-term compared to the use of e-cigarettes without nicotine (placebo devices). Approximately 9% of participants using e-cigarettes abstained from smoking for at least six months, compared to 4% who used the placebo device.

The use of e-cigarettes containing nicotine also helped more smokers reduce the amount they smoked by at least half (36%), compared to those using nicotine-free e-cigarettes (27%). It was not possible to determine whether e-cigarettes are more successful than a nicotine patch in helping people stop smoking, due to the small sample size.

None of the studies found that smokers who used e-cigarettes in the short-term (for two years or less) were exposed to an increased health risk compared to smokers who did not use e-cigarettes.

Notwithstanding the encouraging results of the studies, the use of e-cigarettes remains controversial. Fears remain that the use of e-cigarettes in public places will “re-normalise”  smoking and reverse declining smoking rates. The impact that e-cigarettes may have on a person’s health, to include bystanders, remains unknown. The World Health Organisation has recently suggested that e-cigarettes pose a risk to bystanders through emissions of “toxicant” substances, and has also warned of limited evidence that they help people quit smoking. More recent reviews have suggested harmful effects of e-cigarettes to the lungs and immune system, as well as a potential link to cancer.

Some countries have banned the use of e-cigarettes altogether, such as Cambodia and Jordan. Others have imposed a total ban on the sale, importation and distribution of e-cigarettes, given their potential harmful effects.

Clearly, until the potential health implications associated with the use of e-cigarettes are fully established, the debate and controversy surrounding their use is unlikely to subside. E-cigarettes are not currently regulated in the UK, and will not become regulated until 2016, which heightens the uncertainty regarding the risks surrounding e-cigarette use. This will clearly impact on the insurance industry. Insurers are likely to remain cautious, and indeed reluctant, to embrace the potential opportunities that this growing market brings, until such time as there is tighter regulation and the risks become more clearly defined.