Greece Leads World in E-Cig Research But Lags in Legislation
Greek lawmakers have been struggling to curb their country’s tobacco epidemic over the past few years. Higher tobacco taxes have significantly decreased sales, but indoor smoking bans are largely ignored and unenforced. E-cigarettes could have a positive impact on public health by getting more Greeks to give up smoking for a potentially safer alternative, but laws regulating these devices are vague and also unenforced. Nonetheless, Greece has been a world leader in e-cig safety research and product innovation, and some Greek doctors are advocating around the globe for more sensible, science-based regulations to position e-cigs to smokers as a healthier and more attractive alternative to tobacco.
Some health officials have argued that Greek laws regarding marketing restrictions on tobacco should apply to e-cigs as well, but no such restrictions seem to be legally enforced. The Greek National Pharmaceuticals’ Association website has long stated, “Nicotine-containing products should be licensed before being made available to the public, and no such products have been submitted so far,” yet a simple Google search suggests that e-liquids containing nicotine are sold openly in Greece.
Golden Greek is the most internationally well known e-cig brand to come out of Greece. Golden Greek devices are meant to be highly customizable; each individual piece of hardware is easy to remove, service and replace. Esmokeguru, a company in Greece, is one of the leading global distributors of Golden Greek products and also advertises nicotine-containing e-liquids made by German manufactures Happy Liquid and Zazo on their website.
Greek scientists have been just as busy as Greek manufacturers in perfecting e-cig technology. In August of 2012, Reuters reported on a study led by Dr. Konstantinos Farsalinos, a cardiologist from the Onassis Cardiac Surgery Center in Athens. Farsalinos compared the heart functions of 20 smokers and 22 e-cig users before and after consuming the equivalent of one cigarette. While smokers experienced an immediate spike in blood pressure and heart rate, vapers demonstrated only a tiny rise in blood pressure.
Speaking to the European Society of Cardiology in 2012, Farsalinos declared, “Currently available data suggest that electronic cigarettes are far less harmful, and substituting tobacco with electronic cigarettes may be beneficial to health.” In early 2015, Dr. Farsalinos spoke at the World Conference on Tobacco Health in Abu Dhabi to urge government officials in the UAE to lift its ban on e-cigarettes. He equated prohibiting tobacco alternatives with promoting tobacco use.
Dr Farsalinos’s research on e-cigs began in 2012 with an online survey designed to study the habits of e-cig users. The 19,441 respondents who used e-cigs cited wanting to stop smoking as their motivation for initially trying the devices, and a whopping 81 percent of participants said that they successfully beat their tobacco habit thanks to e-cigs. The survey also asked about participants’ experience with tobacco cessation products like nicotine replacement therapies and oral medications; it found that those products had a much lower success rate than e-cigs.
Farsalinos continues to conduct safety research. In 2014, his team at the Onassis Cardiac Surgery Center found two concerning chemicals, the creamy buttery flavorings diacetyl and acetyl propionyl, in a significant percentage of a sample of different e-liquids. The chemicals are commonly found in foods, but preliminary research suggests that inhalation may increase risks of lung disease.
While these findings were disappointing, Farsalinos was quick to implore health officials not to throw the baby out with the bath water. The majority of e-liquids on the market do not contain these chemicals, and other small studies across the globe suggest that the dangers posed by e-cig emissions to vapers and bystanders are negligible. More of such research is needed to help e-cig and e-liquid manufactures make sure their products are safe, and Farsalinos still insists that these products can save lives and lower extraordinary healthcare costs due to smoking-related illnesses.
Farsalinos is especially at odds with many public health officials in one regard: He attributes the fact that e-cigs “not only provide nicotine but simulate smoking behavior” to their success in helping smokers quit using tobacco. Lawmakers in other parts of the world have used this fact to argue that e-cigs normalize smoking behavior and will somehow make regular tobacco cigarettes more attractive to non-smoking youth. Unlike Farsalinos’s findings, such assumptions are based on opinion rather than research.
Greece will have to tighten its tobacco laws once the European Union’s Tobacco Products Directive, or TPD, goes into effect in 2016. Given that the TPD is tied up in European courts due to accusations that it unfairly discriminates against e-cig manufactures, the future seems just as uncertain as the present. Hopefully, more scientists like Dr. Farsalinos will see the value that e-cigs can have in cutting tobacco use and continue advocating for regulations that best benefit public health.