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E-cigs ‘significantly less harmful than smoking’ insist leading health bodies

Joint statement comes as further attack launched on safety and effectiveness

Caroline White

Wednesday, 16 September 2015

E-cigarettes are “significantly less harmful than smoking,” emphasise Public Health England (PHE) along with several other leading health bodies, in a joint consensus statement.

The statement, whose signatories include the Royal College of Physicians, Cancer Research UK, and the Faculty of Public Health, comes in the wake of persistent criticism of PHE for its stance on the use of e-cigarettes.

In August, PHE published an independent evidence review, in which it said that the current best estimate is that e-cigarettes are around 95% safer than smoking, and endorsed their potential to help smokers quit.

But the BMA, the US Centers for Disease Control and Prevention, and the World Health Organization are not so sure.

And in the latest salvo in a series of public skirmishes over e-cigarettes, experts once again question the evidence on the safety and effectiveness underpinning the review’s recommendations in The BMJ* today.

Professor Martin McKee of the London School of Hygiene & Tropical Medicine and Professor Simon Capewell of the University of Liverpool, argue that the available evidence about e-cigarettes “suggests that the debate is far from over and questions remain about their benefits and harms.”

They go on to say that a recent Cochrane review, which was widely cited in the PHE report, concluded that the available evidence was of “low or very low quality” by recognised standards.

And they point out that the 95% safer figures comes from one meeting of 12 people, which included several known e-cigarette champions and was sponsored by companies with links to the tobacco industry.

They describe the report’s dismissal of the possibility that e-cigarettes may be a gateway to smoking as “premature.” And they argue that the report has many other omissions, such as concerns about product safety, and the lack of evidence of risks from long-term dual use with conventional cigarettes.

The joint statement says that all the signatories agree that “e-cigarettes are significantly less harmful than smoking,” and that all the evidence “suggests that the health risks posed by e-cigarettes are relatively small by comparison but we must continue to study the long-term effects.”

In a bid to dispel the impression that e-cigarettes are at least as harmful as tobacco, the statement insists: “we have a responsibility to provide clear information on the facts as we know them to be. It is our duty to provide reassurance for the 1.1 million e-cigarette users who have completely stopped smoking, to prevent their relapse.”

It continues: “To be clear, the public health opportunity is in helping smokers to quit, so we may encourage smokers to try vaping, but we certainly encourage vapers to stop smoking tobacco completely.”

The statement goes on to emphasis that the current national evidence is that in the UK regular e-cigarette use is almost exclusively confined to those young people who smoke, and youth smoking prevalence is continuing to fall.

“The concerns on Public Health England’s evidence review, raised by McKee and Capewell in The BMJ today, are not new and have been covered and fully responded to before,” says the statement.

“We should not forget what is important here. We know that smoking is the number one killer in England and we have a public health responsibility to provide smokers with the information and the tools to help them quit smoking completely and forever,” the statement concludes.

A PHE spokeswoman told OnMedica that all the signatories had felt the need to issue a statement following the criticisms, “to draw a line in the sand,” under the current debate, and to make clear that the review was about saying “this is what we know so far.”

* Martin McKee and Simon Capewell. Evidence about electronic cigarettes: a foundation built on rock or sand? BMJ 2015;351:h4863. doi: 10.1136/bmj.h4863

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