Editorials

Regulation of electronic cigarettes

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5484 (Published 05 September 2014) Cite this as: BMJ 2014;349:g5484

Re: Regulation of electronic cigarettes

We agree with some of the concerns raised by Professor Ashton particularly in relation to the potential effect of e-cigarettes on population health and tobacco control.(1) It is crucial that we do not lose sight of the fact that tobacco smoking is still the largest single preventable cause of ill health and death in the UK. However, the reduction in smoking rates should be seen as a public health success story.(2) But, safeguards are needed to ensure that rates do not increase.

E-cigarettes are increasingly popular, and in the UK we have already seen the establishment of high-street vendors of such products, thus potentially contributing to the perceived normalisation of this activity. The widespread use of e-cigarettes might also help to normalise smoking in public once more, and could act as a gateway to traditional cigarettes.(3)

For existing smokers, they might be a temporary aid toward cessation efforts, however they are not without their own drawbacks. Nicotine is a highly addictive compound, and is therefore not harmless when tar and other substances are not present. There is also the possibility that e-cigarettes will develop a market of their own, and could appeal to young people and non-smokers, leading to a new drug habit that replaces smoking in the future. Research into such possibilities is not currently well developed.

The widespread use of such devices has not been demonstrated to be conducive to health and as such we are not in favour of e-cigarettes being widely advertised or promoted. We support any move to restrict their use and sale only to circumstances where there is evidence for their effectiveness.

We conclude by making five key recommendations.
1. E-cigarettes should be seen as a part of the armoury of devices intended to wean smokers away from cigarettes, and nothing more.
2. E-cigarettes should not be promoted to non-tobacco users.
3. More research is needed into the efficacy of e-cigarettes.
4. There needs to be further debate about the use of e-cigarettes in public places (including workplaces).
5. Careful monitoring of the promotion and use of e-cigarettes is needed.

References
1) Ashton J. BMJ 2014;349:g5484

2) Royal College of Physicians. Fifty years since Smoking and health. Progress, lessons and priorities for a smoke-free UK. Report of conference proceedings. London: RCP, 2012.

3) Fairchild AL, Bayer R, Colgrove J. "The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame”." N Engl J Med 2014, 370; 293-95

Competing interests: No competing interests

10 September 2014
Michael C. Watson
Associate Professor in Public Health
Dr Mark Forshaw (President Elect, Institute of Health Promotion and Education. Subject Leader in Psychology, Natural Sciences and Psychology, Liverpool John Moores University.)
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA