If Christchurch medical researcher Murray Laugesen has his way, smoking will be banned by the end of the decade.

Instead of puffing on burning tobacco, smokers will be puffing on the vapour of electronic cigarettes, commonly known as e-cigarettes.  

In his vision of the future, it may even be tobacco companies selling them.

E-cigarettes are gaining popularity as an alternative to smoking tobacco. Many smokers believe  they are a safe alternative that feels and tastes like the genuine article.

Dr Laugesen says smoking can’t be banned unless there is a replacement therapy available that smokers actually like.

After conducting some of the world’s most extensive research into e-cigarettes, he believes they provide a safe solution.

E-cigarettes deliver a vaporised nicotine liquid in a way which mimics smoking a regular cigarette.

An element heats the liquid until it produces vapour. The liquid contains a mixture of nicotine and propylene glycol and, sometimes, flavouring. The cigarettes are often powered via a USB cable – hence the “e-” – but most can be detached from their power source once a battery is charged.

Dr Laugesen (left) and his Christchurch-based company, Health New Zealand, have researched the health risks of e-cigarette vapour for users.

Supporters of the e-cigarettes believe its mimicry of the normal cigarette is a major reason it is unique and something to be excited about. The e-cigarette even has an LED which lights up, like the end of a smoke as you inhale. 

E-cigarettes’ design was first patented in China in 2004. Their rise in popularity has been so fast that Action on Smoking and Health (ASH) in the United Kingdom believes that one in 10 British smokers has tried them.

Despite this, governments have been slow to regulate them and little research has been done into safety. This means some health organisations – including the United States Food and Drug Administration (FDA) and the World Health Organization – have warned people not to use them as a replacement for tobacco.

Dr Laugesen says his research of both the nicotine liquid and the vapour shows there is little to worry about.

He concludes that “inhaling mist from the e-cigarette is rated several orders of magnitude (100 to 1000 times) less dangerous than smoking tobacco cigarettes”.

“It is safer because it works at a much lower temperature,” he says. The temperature at the end of a real cigarette is between 800 and 1000 degrees Celsius, while the liquid in an e-cigarette vaporises  at 54 degrees.

“Also, there are only a few chemicals in e-cigarettes compared to the thousands of chemicals in tobacco.”

Dr Laugesen will be celebrating 50 years in the medical profession this year. He says when he goes to the 50th anniversary of his graduation later this year he will be one of the few still working.

“I started off as a surgeon and at the very best I could improve a life once every hour,” he says.

“When I switched to public health, I found that I could improve the health of thousands of people, but if you get into products – say better products to replace cigarettes – eventually worldwide you’re talking about preventing deaths: There are something like eight million [people] a year dying of tobacco-related illness, so the numbers are huge.”  

The FDA is concerned that the safety of e-cigarettes and has tried, so far unsuccessfully, to include them among  nicotine delivery products subject to its approval.

In a challenge by e-cigarette sellers Judge Richard J. Leon ruled against the FDA saying: “This case appears to be yet another example of FDA’s aggressive efforts to regulate recreational tobacco products as drugs or devices.” The FDA has appealed this decision.

The Ministry of Health in New Zealand takes a similar stance to the FDA, but is backed up by stronger legislation, which enables it to classify e-cigarettes containing nicotine as medicine.

The ministry says the nicotine contained in the pads, which is inhaled via an e-cigarette, is classified as a pharmacy-only medicine. “Therefore, the product is regarded as a medicine by the Medicines and Medical Devices Safety Authority (Medsafe).

“The Medicines Act 1981 requires medicines to be assessed and approved by the Minister of Health before they can be distributed. None of the e-cigarette products have submitted data demonstrating their safety, quality or efficacy and none have been approved for sale in New Zealand as medicines.”

This places e-cigarettes in a legal grey area, as e-cigarettes with nicotine are allowed to be imported for personal use but not for sale.

To make matters even more complicated, e-cigarettes can be sold in New Zealand as long as they contain no nicotine. According to ASH New Zealand, some New World supermarkets in Auckland are selling them.

Dr Laugesen agrees that importing e-cigarettes should be controlled, but says regulating e-cigarettes as medicine is too strict. “In New Zealand, for a single strength of medicine it costs around about $100,000 to get registered for one year, and big trials that may cost a million dollars to show a product works as a medicine.”

E-cigarette manufacturers do not have those kinds of resources, he says.

ASH New Zealand director Ben Youden agrees and says the ministry should take a sensible approach to the sale and regulation of e-cigarettes. He sees e-cigarettes is an important step, which could lead to even better replacement therapies. 

“If people are already addicted, it [won't] matter if they keep on using nicotine until the day they die, if it is in a safe form.”

Dr Laugesen says problems for e-cigarette makers include their low profit margins and the fierce competition among them. 

After visiting an e-cigarette factory in North China, he says quality must be upgraded.  “The factory does not have automated filling devices, like you would see in a pharmaceutical company.”

This is where he sees tobacco companies stepping in to standardise, improve and brand the product.

“[E-cigarettes] provide them with a way of providing nicotine without killing people, so it’s a no brainer, you would think. Other people have not got the same know-how to develop such a product.”

Scientists from the tobacco companies have already expressed some interest in the product, he says.

Mr Youden says ASH would rather avoid the moral and ethical dilemmas associated with tobacco companies being part of the solution. Big tobacco would also be unlikely to sell a product which in its current form is nowhere near as efficient at delivering nicotine as cigarettes, he says.

“[The tobacco companies] are selling something that is highly addictive and extremely cheap for them to make, and they don’t lose a lot of customers other than to death. Unless large markets start showing demand for these sorts of products, I can’t see them putting large amounts of resources into them.”

Murray Laugesen has fought against tobacco companies for a large part of his life. His battle began in 1985 when he joined the Department of Health (now the ministry) as principal medical officer.

He played a key role in New Zealand’s smoking policy and successfully advocated  health warnings on cigarette packaging, and for increased taxes on tobacco products. Since leaving the public service in 1995, he has split much of his time between researching nicotine alternatives and advocating the ban of tobacco.

The World Health Organization in 1998 awarded him a medal for “achievements deemed worthy of international recognition in promoting the concept of tobacco-free societies”.

Despite being an advocate of e-cigarettes, he has not settled on them as the perfect replacement therapy.

He is still on the lookout for newer and better smoking alternatives that smokers like.  

Announced in February, one new product that is of interest mimics a cigarette, but is not electronic. It relies on a chemical reaction to deliver nicotine to the user in the form of nicotine pyruvat.

Developed by researchers at Duke University in the US, it is already being hailed as another possible breakthrough and its developers claim it delivers almost as much nicotine as a regular cigarette.

Murray Laugesen and Health New Zealand were the first test it.