September 15, 2015

expert reaction to article questioning the evidence on the safety and efficacy underpinning PHE’s recommendation of e-cigarettes as an aid to quitting smoking

The effects of e-cigarettes on public and individual health is the subject of an article published in The BMJ, with the authors arguing that there is uncertainly around the benefits and harms from the devices.

Prof. Linda Bauld, Professor of Health Policy, University of Stirling, and CRUK/BUPA Chair in Behavioural Research for Cancer Prevention, Cancer Research UK, said:

“This analysis repeats views that have already been made by these public health colleagues regarding the recent Public Health England report on e-cigarettes. Their views have been previously published in the Lancet and several national newspapers. Their arguments against the PHE report and related evidence can be easily critiqued. Whether intentional or not, instead of promoting public health, the very considerable influence and energy of these colleagues is discrediting the work of the leading nicotine and tobacco researchers who authored the PHE report. This approach merely plays into the hands of the tobacco industry, who will be delighted to see this latest example of public health ‘in-fighting’. Meanwhile, smokers whose lives could be saved by switching to e-cigarettes, a less harmful alternative to tobacco, will be deterred from doing so by this latest attempt to create confusion. As leading clinicians, I would like to see McKee and Capewell focussing on how to prevent premature death and disease. In my opinion this analysis will just confuse members of the public, not serve them.

“On content, this analysis raises questions about the effectiveness of e-cigarettes for smoking cessation, querying the findings of the Cochrane review, but then goes onto say that ‘where there is uncertainty about risks… and harmfulness’. Yet the Cochrane review made clear that, in the studies reviewed, none found that smokers who used electronic cigarettes had increased health risks to smokers who did not use electronic cigarettes. Other evidence in the PHE report supports this conclusion. The analysis also asserts that e-cigarettes could be a gateway to tobacco smoking, yet neither the PHE report nor indeed a subsequent American study found evidence of a causal link between young people experimenting with electronic cigarettes and then using tobacco. In my opinion, careful and measured assessment of existing evidence on this topic is needed to inform the public, instead of creating alarm based on assertions not supported by studies to date.”

Prof. Robert West, Professor of Health Psychology, UCL, said:

“The PHE report was produced in an attempt to pull together the available evidence and clarify some misunderstandings that had been created by widespread dissemination of incorrect reading of the available data.

“Unfortunately the BMJ analysis piece, by public health figures who had been involved in the original misunderstandings, will probably confuse the public and policy makers and further undermine the credibility of public health science. This topic requires careful, reflective analysis and research, not propaganda.”

Prof. Paul Aveyard, Professor of Behavioural Medicine, University of Oxford, said:

“In my opinion, McKee and Capewell appear unable to see the forest for the trees. While they pick individual studies, the totality of evidence is clear. We have many years of scientific understanding to draw on that tells us about the safety of nicotine and its effectiveness in helping people quit smoking. Electronic cigarettes are devices to deliver the nicotine that people who smoke need without the harmful constituents of cigarettes. Electronic cigarettes themselves are new, but the science they draw on is well-established.

“The key facts are that electronic cigarettes have become much the most popular aid to help people stop smoking. During this same period, smoking prevalence has fallen, while the success rate of quit attempts has risen. Reassuringly, the prevalence of smoking in young people is at an all-time low.

“McKee and Capewell invoke the precautionary principle to suggest greater restrictions on electronic cigarettes. Instead, the precautionary principle suggests that we should not change policy when all the indications are that electronic cigarettes are supporting people to stop smoking.”

‘Evidence about electronic cigarettes: a foundation built on rock or sand?’ by Martin McKee and Simon Capewell published in the BMJ on Tuesday 15 September 2015. 

All our previous output on this subject can be seen at this weblink:

http://www.sciencemediacentre.org/tag/e-cigarettes/

Declared interests

Prof. Linda Bauld chaired the programme development group on tobacco harm reduction that was responsible for producing guidance on harm reduction for the National Institute for Health and Care Excellence (NICE) in 2013.

Prof. Robert West: “I have not and will not accept any kind of funds, payments or hospitality from companies that make e-cigarettes because of the risk of being perceived as tainted on that count. I undertake research and consultancy for companies that manufacture smoking cessation medications and licensed nicotine replacement products. My salary is funded by Cancer Research UK.”

Prof. Paul Aveyard: “I have done one day of consultancy for Pfizer on smoking cessation in the past 3 years.  My salary is paid by the University of Oxford and the NHS.”