Updated: To say yesterday’s announcements from WHO were disappointing would rather understate the case. The package of paper, press comment and tweets, looked at in the round was anti-scientific, unethical and harmful. It led directly to a dreadful article in the Telegraph: ‘I thought my e-cigarette was a miracle. Turns out, I was smoking the equivalent of 40-a-day’ as an entirely foreseeable outcome of its onslaught against e-cigarettes. It was made all the more galling by having to listen to WHO spokesman Armando Peruga on the BBC Six O’Clock Radio news talking complete nonsense. Today I decided to write him a letter.
_________________ Letter starts here __________________
To: Armando Peruga, Head of Tobacco Free Initiative, WHODear Dr PerugaOn prime time BBC radio (Six O’Clock News) a clip of you was used saying the following:
There is scientific evidence that proves that the exhaled aerosol increases the level in air of nicotine therefore exposing bystanders to increased concentration of these toxicants.BBC iPlayer at 13 min 20 (package starts at 12 min 00)As I hope you know, this statement says nothing at all about risk to bystanders. What matters is exposure to toxins – and in the case of e-cigarette vapour the exposures will be extremely low if even detectable. However, this will have been perceived by most listeners to mean that vapour exposure is harmful and therefore that WHO’s policy proposal to ban vaping indoors is legitimate.Fortunately, the piece was balanced with sensible comments from Professor John Britton to offset those made by you on behalf of WHO. As Professor Britton put it (13:56):
…the risks to others of electronic cigarette vapour are extremely low. I would rather that someone was using an electronic cigarette than smoking a cigarette, and if use indoors is important to help them stay off smoking, then why not?Before you provide any further statements to the public about risks to bystanders from vapour, may I request that you read carefully the review of vapour toxicology by Professor Igor Burstyn of Drexel University. This remains the best overall assessment though, strangely, is not cited in the paper you have produced for COP-6. Burstyn concludes that risks to active vapers from toxins are very low and exposure to bystanders orders of magnitude lower:Current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients) creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep any adverse health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern. (emphasis added)
Burstyn I. Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks. BMC Public Health 2014;14:18. doi:10.1186/1471-2458-14-18Perhaps you could also consider the risk of vaping bans implicit in Professor Britton’s comment: that banning indoor vaping everywhere will drive people back to smoking or mean they never switch and continue to smoke. Nowhere in your paper for COP-6 do you even recognise this is a risk, let alone attempt to assess it – yet it is one reason why your proposal would do more harm to health than it prevents, if implemented.I hope this will cause you to pause and reflect on what you are doing and to consider your responsibilities as an international civil servant. WHO needs to provide sound proportionate and reasoned analysis, not pseudo-scientific spin. To do otherwise will mean the organisation will lose confidence and trust – not just in its handling of tobacco issues.Yours sincerelyClive Bates