Public Health England prematurely endorses e-cigarettes

Abstract

Where there's smoke there's fire -Fire proof our NHS finances! Dear Editor, We read with interest the Public Health England (PHE) commissioned report on e-cigarettes1 highlighted in your news article2 and were struck by its relatively permissive stance on key health issues when compared to the contemporaneous US report3. The PHE review recommends that "e-cigarette use, alone or in combination with licensed medication and behavioural support from a Stop Smoking Service, appear to be helpful in the short term"1. In contrast, the US review has said that "there is insufficient evidence from randomized controlled trials about the effectiveness of e-cigarettes as cessation aids compared with no treatment or… smoking cessation treatments" 3. Furthermore, while the PHE review says that "e-cigarettes are attracting very few young people who have never smoked into regular use"1, the US report concludes that "there is substantial evidence that ecigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults"3. Both reports corroborate the purported overall reduction in harm afforded by e-cigarettes compared to conventional tobacco cigarettes1,3. However, while the US reviewers suggest, with a notable degree of caution, that "there is no available evidence whether or not ecigarette use is associated with clinical cardiovascular outcomes… and respiratory diseases in humans" 3, the UK reviewers confidently conclude, in the absence of long-term follow-up data, that these putative risks are likely to be "substantially below" those of smoking1. Moreover, the US review asserts that "there is no available evidence whether or not ecigarette use is associated with intermediate cancer endpoints in humans"3. Yet the UK reviewers promote the finding that "the cancer potencies of e-cigarettes" are "largely under 0.5% of the risk of smoking"1,4. Who should be believed? We respectfully submit that this disparity of opinion, existing as it does amongst tobacco experts, reflects the wider degree of uncertainty that currently surrounds the long-term health risks of e-cigarettes. We therefore find it astonishing that PHE, a body whose raison d'être is "to protect and improve the nation's health and wellbeing"5, should endorse e-cigarette use at the population level. At a time when 112 out of 135 Acute NHS Trusts are in financial deficit6, a decision for the NHS to invest in ecigarettes on the basis of, at best, an embryonic and inconclusive evidence base appears all the more perplexing. Finally, the UK report repeats the now widely publicised argument that "vaping is at least 95% less harmful than smoking" and includes the caveat that "this does not mean e-cigarettes are safe"1. For the aforementioned reasons, we believe that the PHE report represents an unwarrantedly premature, evidence-deficient endorsement of e-cigarettes to the smoking public.

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“…Some public and private organisations, including Public Health England, have endorsed e-cigarette use, on the basis of the widely accepted standpoint that they could be beneficial for heavy smokers who are not able to quit with standard support 2 3. This endorsement, conflicting with the conclusions of the WHO4 and the US National Academies of Sciences, Engineering, and Medicine,5 has provoked much debate and concern over the spread and use of e-cigarettes 6–8…”

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“…Die Regierungsbehörde "Public Health England", Exekutivagentur des "Department of Health and Social Care" im Vereinigten Königreich, ist dem Konsum der E-Zigarette gegenüber offener eingestellt. Diese Behörde deklariert in einer Stellungnahme, dass der Konsum der E-Zigarette unbedenklich sei und durch die widersprüchlichen Forschungsergebnisse im Vergleich zur konventionellen Tabakzigarette als harmloser gelte [17,25].…”

The impact of Brexit on oral health

“…The Tobacco Products Directive (2014/40/ EU) provides a highly regulated market for tobacco-based products, including on the sale and promotion of e-cigarettes. While the longterm risks of vaping are unknown, there is a growing (although not ubiquitous) 30 consensus that e-cigarettes are less detrimental to health compared to combustible tobacco products and, in certain circumstances, may be used to facilitate smoking cessation. 31 A parliamentary report found opportunities after Brexit to move towards 'risk-based' regulation and taxation of e-cigarettes by: reducing current taxes levied on them; increasing the minimum nicotine content in order to increase use by those with a high nicotine dependency; and allowing marketing claims of reduced harm relative to tobacco products.…”