The European Union has struck a deal which could curb the booming market in electronic cigarettes and lead to an EU wide ban on a popular version of the nicotine device.

In hard fought negotiations between the 28 governments of the EU and the European parliament, both sides agreed on Tuesday that refillable e cigarettes could be banned across Europe if three countries decided on prohibition.

The parliament, under intense lobbying from the tobacco industry, took a more liberal line than the European commission, which proposed that e cigarettes be legislated for in the same way as pharmaceuticals. That was rejected in the compromise, but individual countries were left free to regulate e cigarettes as medicines.

Governments also took a more restrictive position on the issue and could still try to reverse some of the agreed elements. Ambassadors from the 28 countries will meet on Wednesday to decide whether to accept the compromise or return to negotiations.

The issue of e cigarettes quickly became the most contentious aspect of new EU rules on the packaging and sales of tobacco products, although the electronic devices contain no tobacco.

Public health warnings and graphic images of the damage done by smoking are to cover two thirds of cigarette packaging, and cigarette flavourings are to be proscribed, if gradually phased out.

Martin Callanan, leader of the Conservatives in the European parliament, said “This is a perverse decision that risks sending more people back to real, more harmful, cigarettes. Refillable e cigarettes would almost certainly be banned, and only the weakest products will be generally available. As many smokers begin on stronger e cigs and gradually reduce their dosage, making stronger e cigs harder to come across will encourage smokers to stay on tobacco.”

The key question centred on the impact of e cigarettes and whether they encouraged people to start smoking or whether they weaned nicotine addicts off tobacco.

“It’s inhaled. It’s direct inhalation of nicotine into the lungs. That creates an addiction very fast,” said a senior diplomat involved in the negotiations. “It encourages a switch to real cigarettes.”

The European e cigarettes market is currently estimated at 2bn ( 1.7bn), but it is growing fast, with approximately seven million users.

In the UK some 1.3 million of an estimated current 10 million smokers have switched to the electronic devices. Celebrity endorsements and social media are attracting young people to use e cigarettes in large numbers, according to a recent report commissioned by Cancer Research UK.

But public health experts are sharply divided about the devices some argue that they could substantially cut deaths from tobacco currently 100,000 annually in the UK while others warn they will only glamorise smoking, especially among the young.

One study of 657 smokers, published in the Lancet last month, found that e cigarettes worked as well as nicotine patches in helping people stop smoking within six months.

France, which has an estimated 1.5 million e cigarette users, is currently pondering a ban, but a mayor in Normandy has already introduced a local ban.

The EU agreement allows e cigarettes with a nicotine content below 20mg/ml to be regulated for general sale, rather than treating them as medicinal products. Governments had demanded a 3mg/ml limit.

The deal, however, lets individual governments regulate the cigarettes as medicinal products if they choose.

Refillable cartridges became the biggest sticking point, with the parliament threatening to veto the legislation if replacement sales were banned. On refillable e cigarettes, the compromise allows cartridges of 1ml of liquid containing up to 20mg of nicotine. But governments will be able to ban refillable e cigarettes and if three countries do so, then the commission is empowered to impose a blanket prohibition across the EU.

“This will lead to another ridiculous ban from the EU on the majority of e cigarettes which are better for the health of smokers and for British manufacturers of e cigarettes,” said Nigel Farage, the UK Independence party leader and MEP. “The EU should not be putting restrictions on a safer alternative to smoking.”

Carly Schlyter, a Green MEP and public health spokesman, said “Member states will be free to decide whether they want to subject them to authorisation as medicines or apply new rules that should ensure the quality and safety of these products. Either way should ensure that e cigarettes can be used safely to help smokers stop smoking, and not act as a gateway for non smokers.”

Rebecca Taylor, a Lib Dem MEP, said the possible ban on refillable cartridges could push consumers back to tobacco.

“This the exact opposite of what the tobacco directive is supposed to achieve. The fight is now on to show that it would not be justifiable to ban refillable cartridges on health and safety grounds.”

This article was amended on 19 December 2013 to change the word “will” to “could” in the subheading.

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The human body is constantly changing in response to an array of factors stress, medications, what you eat, how you sleep. This is definitely true of blood pressure, particularly the top number in the blood pressure measurement, the systolic blood pressure. In fact, there is a phenomenon called “white coat hypertension,” in which blood pressure goes up when the measurement is taken at the doctor’s office because you’re nervous about having it checked! A friend of mine was recently in the hospital, hooked up to a display that checked his blood pressure every 15 minutes, with tremendous variation. It nearly drove him crazy. n

When to worry If you get a high reading several times in a month, talk to your doctor untreated high blood pressure can lead to heart disease and stroke. Extremely elevated blood pressure (systolic pressure over 180 or diastolic pressure over 110) is a medical emergency. n

27 Mistakes Healthy People Make n

Don’t worry about A blood test result that’s a little high or low n

Even if the lab report says the number is out of normal range, that value is most likely normal for you. For his entire life, my husband has had a slightly low platelet count, but he has never had bleeding problems (platelets help with clot formation). No problem, no disease. Part of the reason a new doctor does routine blood work when you’re feeling good is so that she can learn what is typical for you. n

Don’t worry about Low blood pressure n

You know the saying “You can never be too rich or too thin”? Low blood pressure is kind of like that. It puts less stress on your organs, so it’s generally considered a good thing. n

When to worry If low blood pressure leaves you feeling lightheaded or faint, or if you feel your heart fluttering, then you need to see a doctor. n

Don’t worry about A couple days of nausea, vomiting or diarrhea n

People want to know if it’s food poisoning or a virus, but in terms of healing, it doesn’t really matter. If there is no intense abdominal pain, high fever or blood in your stool, your body will take care of it. The important thing is not to get dehydrated. I prefer that old favorite, flat ginger ale, but any clear liquid, like water or Gatorade, will do. n

When to worry If you feel faint or are vomiting up blood, get to the doctor. n

15 Signs You May Have an Iron Deficiency n

Don’t worry about Painless lumps n

As bodies age, they develop a wide variety of lumps. The overwhelming majority of them are not cancerous. The causes of lumps are so numerous that it is impossible to give a complete list here, but they range from benign cysts to fatty deposits under the skin (called lipomas). Make sure you show them to your doctor on your next visit, but try not to be too alarmed. n

When to worry Some lumps should be evaluated as soon as possible. Breast lumps should never be ignored. Lumps that are tender, warm and red could be from underlying infections that need treatment. Hard or fast growing lumps should also be seen promptly. n

Don’t worry about Bleeding n

In terms of species survival, it’s probably good that the sight of blood provokes panic. But most of us panic more than we should. Cuts on certain parts of the body, like the scalp, can bleed profusely, but that shouldn’t necessarily cause alarm. Put pressure on a cut for 5 to 10 minutes to see if you can get it to stop bleeding. If you can’t, or if the two sides of the slice seem widely separated, you may need stitches to help healing. n

When to worry If you’re not sure whether a cut needs stitches, it’s not wise to wait and see. Wounds need to be stitched within 24 hours or the risk of infection rises markedly. n

Don’t worry about A little rectal bleeding n

The most embarrassed call I receive concerns blood on toilet paper or in the bowl. It is almost always related to hemorrhoids or small cuts in the rectal area rather than a sign of an ulcer or cancer. Try taking a stool softener, or eat more fruits and vegetables to do the same trick. n

When to worry If the bleeding persists for more than two or three days or is painful, head to the doctor. n

18 Reasons Why Your Stomach Hurts n

Don’t worry about Sharp, localized chest pain n

We tend to associate the chest with the heart, but there are lungs, bones, muscles and digestive organs in there, too. Sometimes chest pain that’s worse with a cough, a deep breath or movements of the torso, like lifting or twisting, can be caused by strains or irritation in the small muscles and ligaments that surround the ribs. These can be due to injury or a viral infection and generally resolve themselves a nonsteroidal medicine like ibuprofen may help in the meantime. n

When to worry If you are also short of breath or have a fever, see a doctor. In that case, sharp, localized pain could be a sign of a lung problem. And if you have any doubt about whether you should get medical help for chest pain, it’s always better to err on the side of caution. n

Don’t worry about Rashes n

During my medical training, I had an itchy rash on my arms and legs. It lasted two weeks and went away. I still have no idea what it was. Minor rashes are part of life, and no cause will be found for many of them. Use common sense to treat symptoms u2014taking an antihistamine or applying hydrocortisone cream can help with itching, for example u2014and think about new products or foods you’ve come in contact with so you can try to avoid a recurrence. Have you used any new shampoos? Is the rash only on the legs (in that case, think plant allergy)? Only on areas exposed to the sun? Only on areas under clothing? n

When to worry If an itchy rash comes on suddenly while taking a medicine (particularly an antibiotic) or eating a new food, seek immediate medical attention, especially if you also have shortness of breath or difficulty swallowing. It could be the start of a life threatening allergic reaction. Also, if the itching is unbearable despite over the counter treatment, you might need something stronger, like a short course of steroids. n

19 Signs Your Thyroid Isn u2019t Working Right n

Should you worry more? n

As I said, usually my advice involves calming unneeded anxiety. Most of my friends are worriers. But there is another type of patient u2014the denier u2014and those people should worry more. That group would include my own husband. So if you’re one of them, here are a few things that should always prompt an urgent medical visit chest pain or pressure that you can’t localize with one finger and comes back every time you exercise the worst headache of your life intense abdominal pain, particularly if accompanied by fever and shortness of breath severe enough that you have trouble finishing a sentence. This list is by no means complete, but these symptoms should set off immediate alarms. Put down this magazine and see a real doctor! n

Elisabeth Rosenthal is a correspondent for The New York Times and a graduate of Harvard Medical School. n

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