England Is Handing out E-Cigarettes: Is the “Swap to Stop” Tobacco Control Scheme Harm Reduction or Harm Production?

Three Hidden Disagreements over E-Cigarettes

“…The American Lung Association, for example, tells smokers “Don’t just switch; quit tobacco for good” and highlights a number of concerning facts about e-cigarettes, including that they contain toxic ingredients and produce dangerous chemicals such as acetaldehyde, acrolein, and formaldehyde ( 10 ). In a commentary, Lang and colleagues ( 1 ) argued that an influential claim that e-cigarettes are 95% less harmful than combustible cigarettes “has no scientific validity” (p. 1024) and emphasized that the health effects of e-cigarettes are unknown, citing evidence suggesting a link between e-cigarettes and DNA damage and increased risk of cardiopulmonary disease ( 1 ). Similarly, O’Shea and McElvaney ( 11 ) argued that the “swap to stop” program “means swapping one health risk with another,” pointing to evidence that vaping can induce bronchiolitis and cause cellular changes similar to those produced by smoking.…”

“…Cause DNA damage?). Although the respirology community can help inform these debates, respirologists frequently disagree on policy questions ( 1 , 2 ). Here, we identify three underlying, often hidden disagreements over e-cigarettes and offer suggestions to improve the quality of policy debates, building on philosophical literature ( 3 – 8 ) and using a pressing question as an example: Should smokers be encouraged to switch to e-cigarettes?…”

E-Cigarettes as a Smoking Cessation Aid – Toward Common Ground and a Rational Approach

“…In this issue of the Journal , Lang and colleagues, on behalf of the American Thoracic Society Tobacco Action Committee (pp. 1024–1025 ), have set out some objections to this approach, on the basis of concerns around effectiveness, safety, and unintended consequences ( 8 ).…”

The Evidence of Electronic Cigarettes for Harm Reduction Is Not There

“…The ATS Tobacco Action Committee has raised valid concerns about the Swap to Stop program, including concerns about safety and unintended consequences ( 5 ). The Tobacco Action Committee accurately points out that the myth of 95% harm reduction has no evidence to back it up and that there is increasing evidence of significant harms from electronic cigarette use.…”