This is rather good. Public Health England commissioned a background paper on e-cigarettes from Professor John Britton and Dr Ilze Bogdanovica of Nottingham University and UK Centre for Tobacco and Alcohol Studies. It is a relief to read good, evidence-based, optimistic reasoning from top figures in public health, and to have this commissioned by England’s main government public health agency. I’m sure there are things that I might have said differently in the report, but I can’t disagree at all with the positivity and vision of the summary and conclusions.
9. Summary and conclusions
Smoking kills, and millions of smokers alive today will die prematurely from their smoking unless they quit. This burden falls predominantly on the most disadvantaged in society. Preventing this death and disability requires measures that help as many of today’s smokers to quit as possible. The option of switching to electronic cigarettes as an alternative and much safer source of nicotine, as a personal lifestyle choice rather than medical service, has enormous potential to reach smokers currently refractory to existing approaches. The emergence of electronic cigarettes and the likely arrival of more effective nicotine-containing devices currently in development provides a radical alternative to tobacco, and evidence to date suggests that smokers are willing to use these products in substantial numbers. Electronic cigarettes, and other nicotine devices, therefore offer vast potential health benefits, but maximising those benefits while minimising harms and risks to society requires appropriate regulation, careful monitoring, and risk management. However the opportunity to harness this potential into public health policy, complementing existing comprehensive tobacco control policies, should not be missed.
Hats off also to Professor Kevin Fenton, Public Health England’s National Director for Health and Wellbeing, for writing a fine blog article on this (E-cigarettes and harm reduction: where are we now and what next?) and all within the usually stultifying confines of being a public servant. This must all sound very strange if you are used to the tone elsewhere. When I think of how the authorities are approaching this in other countries I feel a rare stirring of national pride! For example see:
- CDC Director explains what he hates about e-cigarettes – LA Times interview
- Health Canada advises Canadians not to use e-cigarettes and declares them illegal
- Australia’s Therapeutic Goods Administration stresses dangers, harms, poison, law-breaking and fraud
- Public Health Wales can see only downsides and calls for use in public places to be banned by law – which the Welsh Government dutifully offers to do
PHE’s E-cigarette symposium
A shout out to Martin Dockrell, Head of Tobacco Control at PHE, formerly of ASH. I detect his hand in this refreshing approach and what by all accounts was a very useful seminar held by PHE on e-cigarettes on 15 May, with some vapers actually involved – pretty well a first for the government. Good resources from this:
- Professor Kevin Fenton’s slides from the event: Electronic cigarettes and tobacco harm reduction (page 1-17)
- Professor John Britton’s slides: Tobacco use, harm reduction and electronic cigarettes: Implications for health (page 18-56)
- Professor Ann McNeil’s slides: Health inequalities, use of electronic cigarettes & marketing: implications for policy
- National Centre for Smoking Cessation and Training: E-cigarette briefing – surprisingly positive.
Watch the vapers’ views of the PHE symposium: David Dorn hosts Oliver Kershaw and Lorien Sea on Vapour Trails TV – excellent! A great discussion that really brought the meeting to life for me. Dave Dorn’s impression of Martin McKee is sufficient reason alone to watch this.
Snus – a swipe at the European Union and UK Government
Finally, I noticed the authors of the e-cigarette report also have a subtle dig at the government and EU over the ban on snus (oral tobacco) in the EU other than in Sweden, recently reaffirmed in the face of all evidence in the new Tobacco Products Directive Article 17. See pages 11-12 of the PHE report:
Although over recent decades the prevalence of any tobacco use has changed little in Sweden, the prevalence of smoking in Sweden, which has fallen from 30% in the 1980s to 13% today,  is now the lowest in Europe. This in part reflects the effect of existing smokers switching to snus, and partly the effect of new tobacco users initiating snus use but not smoking. [62, 65, 70, 71] One result is that Sweden now has an extremely low and decreasing lung cancer mortality rate  Similar trends and effects on smoking prevalence have been observed in Norway, where use of snus is a much more recent phenomenon, and both snus use has risen and smoking prevalence fallen markedly since the year 2000 […]
Although controversial, the Swedish natural experiment demonstrates that despite dual use and primary uptake of the reduced-harm product by young people, availability of reduced-harm alternatives for tobacco smokers can have a beneficial effect. While snus is not likely to become a legal or indeed politically viable option in the UK, this data proves the concept that harm reduction strategies can contribute to significant reductions in smoking prevalence.
Or put it another way, bad law and lazy politics denies access to products that reduce smoking and cancer in the population as a whole, while giving smokers choices that substantially reduce their own risks. Something I call Death by regulation – and a point that was made to the Secretary of State for Health by several experts, when there was still time to do the right thing with the directive.