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I'll be the last pharmacy on the planet not selling e-cigarettes. I am passionate about stopping people from smoking €“ but I am also utterly convinced that e-cigarettes are bad for public health...

ADMITTEDLY it seems like I am fighting a losing battle against e-cigarettes as both Boots and Lloyds are now stocking these products, but I'll explain my reasoning.

Smoking kills. You don't have to tell me that or the members of my family who've been its victims. So are e-cigarettes better than smoking? You could make that argument, but they are not an alternative to breaking the dependence on nicotine, while at the same time potentially undoing decades of public health progress in making smoking socially unacceptable.

Helping people to stop smoking is without doubt one of the most rewarding professional achievements, as well as being both a cost-effective and impactful healthcare intervention for quality and quantity of life. Nobody has yet examined what effect e-cigarettes have on long-term smoking rates. Do people keep using them indefinitely? Do users revert to cigarettes after a period of time? Or do they just stop all forms of nicotine? These are some of the many unanswered questions, answers to which might help inform the debate.

Well funded lobby

The well funded e-cigarette lobby argues that its products are a safe alternative to smoking. Is this completely true? They do, after all, contain nicotine, which is a drug, and there is no such thing as a completely safe drug. When we use NRT as part of a smoking cessation programme it is always for a limited period of time and it is used as part of a structured withdrawal programme. We have no idea what the long-term safety of electronic cigarettes looks like. Yes, we could use NRT as a starting point, but e-cigarettes are different €“ they are not manufactured to a uniform standard, for starters.

A MHRA report in 2011 that looked at e-cigarettes found that some contained formaldehyde and other known toxins, which are also found in cigarettes. While present at lower levels than in cigarettes these toxins are not complet ely risk-free. In addition there are fears about exploding e-cigarettes or ones that have caught fire. These are unlicensed products, so pharmacists should be acutely aware that they may bear some liability for faulty or malfunctioning products.

Users of e-cigarettes can get around the ban

Backward step

Since the ban on smoking in enclosed public spaces in July 2007, smoking has become very anti-social. This has led to a lot of people giving up smoking and has safeguarded even more from the dangers of passive smoking. E-cigarettes threaten to undermine this progress as, currently, users are able to exploit the new technology to get around the ban.

As a non-smoker I really object to this backward step, firstly because it potentially re-introduces the hazy atmosphere of some pre-2007 public spaces, but also that it once again normalises the image of smoking, reintroducing e-cigarette users to the social herd rather than leaving them isolated and battling force nine gales outside the pub.

In January this year, for the first time in more than 50 years, British American Tobacco advertised on TV in the UK. What could they possibly be advertising? Yes, the e-cigarette €“ yet another backward step. While I am no expert on advertising, I can see there is definite potential that e-cigarettes might appeal to a young person who has never smoked because they are concerned about the health effects, but might consider this 'completely safe alternative' as it looks like a way to rebel.

MHRA figures show that while the passive effects of e-cigarettes are nowhere near as dangerous as smoking, they do pose some risk. This takes us back to the central argument of the e-cigarette lobby: e-cigarettes are better than smoking.

Now, to say something is safer than something else is called relative risk, which is not the same as saying that something is safe €“ that is absolute risk. An example could be that cars are safer than motor-bikes (which may or may not be true), but that is not the same as saying that driving is completely safe. E-cigarettes may be safer than smoking, but they are not safer than giving up altogether and are not completely risk-free. I can safely say that I will not stock them, even after they are licensed.