September 9, 2020

expert reaction to Committee on Toxicity report on ecigs

A report, published by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), has looked at potential toxicological risks from electronic nicotine (and
non-nicotine) delivery systems.

Prof Jacob George, Professor of Cardiovascular Medicine and Therapeutics, University of Dundee, said:

“Most e-cig users are former tobacco smokers. When longitudinal data is examined, e-cig users may demonstrate an increased cardiovascular rate above and beyond non-smokers, but how much of this is due to the prior effects of tobacco smoking is unknown.

“The two key points that this report should have highlighted are that the cardiovascular event rate for e-cig users may be higher than non-smokers but it has repeatedly been demonstrated to be lower than tobacco cigarette smokers, and that the impacts seen in e-cigarette users may also be due to prior tobacco use.

“The report correctly highlights that, as a comparative risk, vaping is less harmful than smoking tobacco cigarettes.”

Dr Nicholas Hopkinson, Reader in Respiratory Medicine at Imperial College London, said:

“The UK Committee on Toxicity report on vaping finds that ‘In considering the comparison of E(N)NDS use with cigarette smoking….the relative risk of adverse health effects would be expected to be substantially lower.’  This supports the current UK consensus and the position taken by The Royal College of Physicians in its report ‘Nicotine without the Smoke’. https://www.bmj.com/content/353/bmj.i1745.long

“Most people who vape are either smokers trying to quit or ex-smokers. Smokers who switch completely to vaping will get a substantial health benefit. However no serious authority suggests that vaping is completely harmless, so people should try to quit vaping too if they can in the long-term, though not at the expense of going back to smoking.

“Continued regulation of e-cigarette manufacture, contents and marketing including via the provisions of the EU Tobacco Products Directive is important as well as efforts to identify and reduce or eliminate any toxic components in e-cigarette vapour to minimise the remaining risk as far as possible.

“First line support for smokers who want to quit is a combination of counselling and pharmacotherapy (dual NRT or varenicline) and health systems must ensure that this is universally available.

“The government must also take the necessary steps to hold the tobacco industry to account and reduce smoking levels – these include a levy on tobacco industry profits, funding comprehensive media campaigns to encourage smokers to quit and raising the age of sale to 21 in order to deliver on its Smokefree 2030 target.”

 Dr Jamie Hartmann-Boyce, Senior researcher in Health Behaviours and Managing Editor of the Cochrane Tobacco Addiction Group, University of Oxford, said:

“The new report from Public Health England confirms current scientific consensus: namely that electronic cigarettes appear less harmful than traditional cigarettes, but are not risk-free.

“This evidence is consistent with current public health advice suggesting people who smoke consider switching to electronic cigarettes, but that people who do not smoke cigarettes should not start vaping.

“Cigarettes kill 1 in 2 regular smokers, but much of this risk can be reduced by quitting, even in later life, so it is incredibly important that people who smoke have access to evidence-based stop-smoking support and treatments.

“It is not just people who smoke cigarettes who are at risk from cigarette smoking – the World Health Organisation estimates exposure to second-hand smoke causes 600,000 deaths a year. Evidence from this new report does not suggest considerable harm from vapour to bystanders.”

Prof Peter Hajek, Director of the Tobacco Dependence Research Unit, Queen Mary University of London (QMUL), said:

“This new report confirms that vaping is much less dangerous than smoking. If you are a smoker and find quitting difficult, switching to vaping is the next best option.”

Dr Debbie Robson, Nicotine Research Group, National Addiction Centre, King’s College London, said:

“We welcome the COT’s comprehensive report and recommendations. Around three and a half million people in the UK vape and for those who do so exclusively, they can be reassured that by switching completely from smoking to vaping, they are doing the best thing for their health and wellbeing. In line with PHE commissioned annual evidence reviews that our group produce, those who both vape and smoke should be encouraged to stop smoking as soon as they can, and people who have never smoked should avoid taking up vaping and never start smoking.”

Prof John Britton, former Director of the UK Centre for Tobacco & Alcohol Studies and Consultant in Respiratory Medicine, University of Nottingham, said:

“The findings of this new report confirm that while not harmless, e-cigarettes are substantially less harmful than smoking tobacco. This conclusion firmly endorses the UK policy of recommending vaping as a practical and effective means for smokers to prevent harm from continued nicotine use, and provide welcome, authoritative reassurance that for smokers who find it difficult to quit smoking, vaping is the obvious next best option.”

‘Statement on the potential toxicological risks from electronic nicotine (and non-nicotine) delivery systems (E(N)NDS – e-cigarettes)’ by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) is published at https://cot.food.gov.uk/sites/default/files/2020-09/COT%20E%28N%29NDS%20statement%202020-04.pdf

Declared interests

Prof Hopkinson is the Chair of Action on Smoking and Health (ASH) and Medical Director at the British Lung Foundation

Prof Hopkinson is the Chair of Action on Smoking and Health (ASH) and Medical Director at the British Lung Foundation

Prof Hajek: no conflicts

Dr Hartmann-Boyce: no conflicts

No others received