Evidence about electronic cigarettes: a foundation built on rock or sand?

Abstract

Public Health England recently endorsed the use of e-cigarettes as an aid to quitting smoking. Martin McKee and Simon Capewell question the evidence on safety and efficacy underpinning the recommendations

Acute effects of short term use of e-cigarettes on airways physiology and respiratory symptoms in smokers with and without airways obstructive diseases and in healthy non smokers

“…There is significant debate around the individual and population implications of e-cigarette use [39][40][41][42][43][44][45] . Our study is not without limitations.…”

Untitled

“…Perhaps surprisingly, in the context of lack of robustness from available data, Public Health England reported overwhelmingly in favor of the use of e-cigarettes, citing that they were 95% less harmful than smoking. 21 However, this report has been criticized for the lack of critical appraisal of the empirical evidence, 22,23 and recent systematic reviews and meta-analyses of real-world clinical scenarios are less supportive of the effectiveness of e-cigarettes. 24 We currently have no data on the use of e-cigarettes in the setting of solid-organ transplant, and further clarification is warranted before robust recommendations can be made for the use of safe and effective smoking cessation strategies.…”

Ethical issues raised by tobacco industry‐linked research in the era of e‐cigarettes

“…The author concerned recently co-authored a paper with a company employee [12]. Little is known about the study funder, although other companies registered at the same address are reported to have connections to BAT [11]. Another organization described in the paper as supporting this research, with which an individual with previous tobacco company funding plays a leading role, has also been claimed to be linked to a tobacco company [13].…”

“…A paper by Nutt and colleagues [9] is cited a number of times in the paper by Shaw and colleagues to provide evidence promoting the public health potential of e-cigarettes. This study has been controversial [10,11], partly as no tobacco industry funding was declared, and yet some authors have had financial links with tobacco companies in the past [11].…”

“…A paper by Nutt and colleagues [9] is cited a number of times in the paper by Shaw and colleagues to provide evidence promoting the public health potential of e-cigarettes. This study has been controversial [10,11], partly as no tobacco industry funding was declared, and yet some authors have had financial links with tobacco companies in the past [11].In the case of research funding received some time ago, perhaps the authors did not consider this information relevant to disclose. An editorial note on the same paper indicates awareness of an undeclared association with Nicoventures, the e-cigarette company wholly owned by British American Tobacco (BAT) [9].…”