Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique

An empty and feeble critique misses its target and adds nothing

This paper turned up in my weekly search of PubMed.

Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.
Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK.
Am J Public Health. 2020 Feb;110(2):161-162. doi: 10.2105/AJPH.2019.305424.

The commentary claims to show the “invalidity” of the statements made by Public Health England (PHE) and the Royal College of Physicians (RCP) regarding the relative risk of vaping and smoking – in short that vaping is likely to be at least 95% lower risk than smoking.  As this is an important harm-reduction risk communication, it is worth asking: how valid is this critique?

I thought this might be a better critique than it actually is. But somewhat to my surprise, it is very poor indeed.

Short version

At best, the authors try to show the absolute risk of vaping is not zero and that some harm is plausible. In doing so, they are refuting a claim that neither PHE or RCP make and challenging an argument not used by anyone sensible in tobacco harm reduction. However, not a single word of their paper addresses the supposed foundation of their critique – that PHE/RCP are wrong and the risks of vaping are likely to exceed five per cent of those of smoking. As well as a number of baseless assertions that are not even relevant to the “at least 95 per cent lower” relative risk claim (gateway effects, smoking cessation efficacy and second-hand aerosol exposure), there is just nothing in the paper about the relative magnitude of smoking and vaping risks. No analysis, no data, no evidence – nothing that discusses relative risk and why PHE/RCP are supposedly wrong. Niente. Nada. Rien. Nichts. Nothing.

New (20 Jan 2020). See concise comment on PubPeer here: A critique that does not even address its target

Anyway, despite being an empty and feeble piece of work, it does provide an opportunity to discuss some of the issues raised, so I will proceed with a critique.

Longer version

The authors’ supposed refutation of PHE/RCP rests on six propositions.  You can read the article here and I will respond to the authors’ main points in the order they make them. Continue reading “Vaping is still at least 95% lower risk than smoking – debunking a feeble and empty critique”

Is Australia falling behind on tobacco policy?

Sources: Office for National Statistics (UK). Smoking habits in the UK and its constituent countries, 2016.  Australian Institute of Health and Welfare, National Drug Strategy Household Survey, 2016.

Updates: New Zealand moves / Media interviews

Update: two new submissions (available at Committee submissions page #336)


I’m visiting Australia next week and looking forward to some good discussions with people holding any and all points of view on vaping, nicotine and smoking.  My aim is to share experience from the US and UK where we are seeing encouraging uptake of low-risk vaping alongside an unusually rapid decline in smoking. Historically, UK has always had substantially higher levels of smoking than Australia, but in 2016 that gap has finally closed. Both countries have comprehensive tobacco policies – albeit with some differences in the details and Australia generally the first to do new measures, like plain packaging. But there is one major difference. UK (and especially England) now encourages smokers to switch to low-risk alternatives like vaping, while Australia actively prevents it and actually criminalises people who try to protect their own health in this way.

Five talking points inspired by the Royal College of Physicians

The case I want to make is that Australia is missing an opportunity, and there is a human cost for that in terms of cancer, heart and lung disease and premature death. I’ve structured my talking points around five of the key findings of the excellent April 2016 Royal College of Physicians (London) report: see Nicotine without smoke: tobacco harm reduction and press release.  It was, of course, the RCP that first put the dangers of smoking on the public agenda with its groundbreaking 1962 report, Smoking and Health. Continue reading “Is Australia falling behind on tobacco policy?”

Advertising code at fault over e-cigarette public health ad ban

This year’s Stoptober campaign encourages smokers to try vaping – bravo!

Update 24 September: Cancer Research UK says its hasn’t “been prevented from doing anything by the ASA that we are aware of, so don’t know why this story appeared” and PHE ads were still running on TV last night. So please treat the posting below as an analysis of the legal situation.

So newspaper reports suggest we have the ridiculous situation of the UK Advertising Standards Authority (ASA) banning adverts for vaping that are part of a public health quit smoking campaign, ‘Stoptober’. The Sun reports UP IN SMOKE: Anti-smoking adverts by Cancer Research see charity in row over barmy Brussels rules that would BAN them.

The ASA is quoted in The Sun’s article:

The ASA said yesterday:  “Our rules prohibits ads for unlicensed, nicotine-containing e-cigarettes, in line with European law which took effect in 2016.  Ads for products and brands are prohibited and have not been seen or heard on TV or radio since last year.”

I have not seen the Cancer Research ads, but the TV advert from Public Health England (screen shot above) clearly mentions e-cigarettes so would be caught by the ASA’s reasoning.

The Sun concludes that the problem lies with the ‘barmy’ EU directive?  But does it?  Not so fast… Continue reading “Advertising code at fault over e-cigarette public health ad ban”

English tobacco control plan embraces tobacco harm reduction – world first


The Department of Health (UK/England) today released its tobacco control plan for England: Towards a smoke-free generation: tobacco control plan for England (PDF)

The embrace of vaping and other low-risk alternatives to smoking runs through the text. This is probably the first significant government policy paper anywhere that recognises and pursues the opportunities of tobacco harm reduction, rather than defining these technologies as a threat to be suppressed.  For that, the Department of Health and its allies deserve considerable credit. Continue reading “English tobacco control plan embraces tobacco harm reduction – world first”

Anti-vaping zealots write flat-earth letter to The Times

MckeeTimesA remarkably self-regarding letter is published in The Times (London) today.  The writers are reacting with hostility to the outstanding Royal College of Physicians report, Nicotine without smoke: tobacco harm reduction, and the very positive editorial in The Times (Vaping Vindicated) that followed its launch.

In my view, their letter is truly dreadful, but it is also very revealing. In this post, I take a look at the arguments they make.

Update 2 May: my reply published in The Times.

Continue reading “Anti-vaping zealots write flat-earth letter to The Times”

Blending evidence and empathy – a new guide to e-cigarettes

NCSCT Electronic Cigarette briefing V2
“a new worldwide high point in the blending of evidence with empathy”

I would like to  draw your attention to a really excellent new briefing on e-cigarettes from the UK National Centre for Smoking Cessation and Training … this is version 2, February 2016.

I think this represents a new worldwide high point in the blending of evidence with empathy in official public health advice…

Please do have a read: it is full of wise advice and thoughtful insights which I think are useful to anyone involved in reducing death and disease from smoking.  I’ll just draw a few out.
Continue reading “Blending evidence and empathy – a new guide to e-cigarettes”

TPD implementation – maximising harm by going beyond the minimum

julie andrews
Caption contest: the hills are alive with the sound of…

It’s hard to keep up with the public health madness in Europe.  Not content with creating the worst EU Directive ever made, laden with unintended consequences, many member states are now working hard on compounding their error by gold-plating the directive’s wholly unjustified costs, burdens and limitations on e-cigarettes and smokeless tobacco with additional measures that go beyond the minimum.

Professor Gerry Stimson and I have made a small effort of resistance – here are two submissions to the Austrian consultation on TPD implementation. Austria proposes to ban internet sales of e-cigarettes and to ban all forms of smokeless tobacco, not just snus. We have tried to place these in the wider context of harm reduction and unintended consequences of poor policy-making. Continue reading “TPD implementation – maximising harm by going beyond the minimum”