Yet another vacuous comment on e-cigarettes has just appeared from the Faculty of Public Health. This time in response to the publication of the credible and cautiously optimistic Cochrane Review [press release / review] on e-cigarettes and quitting smoking. In The Times article on it, E-cigarettes double chance of quitting (£), there was a quote from this increasingly weird organisation, apparently desperate to find some bad news to offset the good…
John Middleton of the Faculty of Public Health, said: “It has taken decades to create a society where smoking is not seen as the norm. Our concern is that e-cigarettes could reverse this.”
Before I give my view, let’s just dispose of this argument by citing the experts who actually monitor smoking and e-cigarette use in England (no-one at the FPH does any serious work in this field). Professor Robert West and Dr Jamie Brown, provide a concise, accessible and highly recommended summary of the evidence in British Journal of General Practice commentary, Electronic cigarettes: fact and faction, which considers this point:
The second concern is that widespread use of e-cigarettes may ‘re-normalise’ smoking, leading to an increase in smoking prevalence, or at least a slowing down of the rate of decline. Yet, in England, where the ‘Smoking Toolkit Study’ surveys the adult population every month, the rise in prevalence of e-cigarette use has been accompanied by an increase in smoking cessation rates and a continued fall in smoking prevalence. (emphasis added)
The West and Brown commentary finishes with a warning that might as well have been signed, stamped and delivered to the Faculty of Public Health.
THE NEED FOR OBJECTIVITY
This brings us back to the question as to why some individuals and bodies involved in public health are so opposed to e-cigarettes. It may be a concern over how things might turn out in the future given commercial incentives, puritanical ethics, distaste for any industry profiting from a psychoactive drug, inappropriate application of a medical rather than a public health model, or even just a gut feeling that e-cigarettes are bad. Whatever the reasons, it is important that interpretation of the evidence and communication with policy makers and the public is not distorted by a priori judgements.
Quite so. And with that out of the way, here is my reaction to the Faculty of Public Health statement:
So, a careful survey of studies shows that e-cigarettes are effective at helping people quit smoking, but a spokesman from the public health establishment decides it might make smoking the norm. An argument for which there is no evidence anywhere, and the opposite – that e-cigarette use makes e-cigarette use more common, and so boosts a rival to cigarettes – is far more likely to the point of being obvious. You really couldn’t make it up.
The Faculty of Public Health has put itself in opposition to these products for reasons that are hard to fathom, but seem to involve baseless moral panics about adolescent use, about appearances, about the drug nicotine and so on. None of these arguments make any sense when you examine the actual data, or here in the real world where 100,000 British citizens die prematurely each year from smoking-related disease, and almost one in five adults are still smokers, with the highest rates amongst the most deprived communities.
Never mind that 700,000 e-cigarette users in Britain are now ex-smokers. Never mind that thousands of people provide eloquent testimony that they work and have improved health, wellbeing, self-confidence and finances. Never mind that they may address the health inequalities challenges of poor smokers, people with mental illnesses, and those who are heavily addicted or really like smoking. No, these pampered academics just don’t like the way it works – i.e. without their blessing.
The final, Orwellian, irony is that these elitist pseudo-socialists are not only trying to deny or obstruct smokers’ access to alternatives at least 95% safer than smoking, they are also protecting the lucrative cigarette trade from disruptive competition, and doing everything possible to make the e-cigarette market ripe for dominance by the tobacco industry. How odd to see the Faculty of Public Health so well aligned with the interests of Big Tobacco.
It’s hard to find anything nice to say about this organisation and I don’t really know why anyone takes it seriously – including the Royal College of Physicians, which must surely be running out of patience with its ugly anti-scientific offspring. I’ve written elsewhere about how the regulatory zealots of the public health establishment would create severe unintended consequences that will work against health and protect the cigarette trade: Turning the tables on public health – let’s talk about the risks *they* create, and this fake PR memo showed they are not (yet) beyond satire. As for the quote I started with, it is a harsh judgement to compare the Faculty of Public Health to the tobacco industry. I’m just not sure any more who it is a harsh judgement on.