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Leading journal questions Public Health England’s stance on e-cigarettes

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4684 (Published 02 September 2015) Cite this as: BMJ 2015;351:h4684

Rapid Response:

Re: Leading journal questions Public Health England’s stance on e-cigarettes

The anonymous Lancet editorial (1) now re-reported here (2) criticises our Public Health England commissioned evidence update (3). We published a letter (4) in response to the Lancet editorial which was ignored by the BMJ and so we reiterate and expand on the key messages here.

The criticism was based on perceived flaws in one of the 185 references we used, ignoring the rest of our 111 page document which addresses population effects of e-cigarette use, regulations, attitudes as well as concerns over safety. Both commentaries focused on the estimate of risk reduction and protested strongly against the media reassuring smokers that switching to e-cigarettes provides substantial health benefits, but have provided no data to counter the estimate, nor any reason as to why the message smokers can benefit from switching to vaping is an undesirable one.

Further details on the relative risks are given elsewhere (5,6) . In brief, the estimate that e-cigarette use is around 95% less harmful than smoking is based on the facts that 1) cigarette smoke constituents that harm health are either absent in e-cigarette vapour or, if present, are mostly at levels much below 5% of smoking doses, and 2) the main chemicals present in e-cigarettes only have not been associated with any serious risk. Some constituents and flavourings in e-cigarettes may yet turn out to pose risks over long term; the 5% residual risk is a cautious estimate allowing for this uncertainty. Our review highlighted how smokers are currently misinformed about these relative risks.

One of the aims of our review was to assess whether studies that have recently been widely reported as raising new alarming concerns on the risks of e-cigarettes changed the conclusions of the previous independent review (7). We concluded that these new studies do not in fact demonstrate significant new risks. Our review also documented that e-cigarettes are not undermining the long-term decline in cigarette smoking among adults and youth and are attracting very few people who have never smoked into regular vaping. As we stated in our report, ongoing monitoring is needed to ensure that if any new risks emerge, recommendations to smokers and regulatory requirements are revised accordingly.

Current evidence indicates that smokers who switch from smoking to vaping reduce the risks to their health dramatically. We believe this needs to be communicated and that undermining this message will keep smokers smoking and dying as a result.

McNeill A, Brose LS, Calder R, Hitchman SC
Institute of Psychiatry, Psychology & Neuroscience, King’s College London

Hajek P, McRobbie H
Queen Mary, University of London

References
(1) E-cigarettes: Public Health England’s evidence-based confusion. Lancet, 385, August 29 2015
(2) News: Leading journal questions Public Health England’s stance on e-cigarettes. BMJ 2015;351:h4684
(3) McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: an evidence update – A report commissioned by Public Health England, Public Health England, August 2015
(4) McNeill A, Brose LS, Calder R, Hitchman SC, Hajek P, McRobbie H. E-cigarettes: the need for clear communication on relative risks. DOI: http://dx.doi.org/10.1016/S0140-6736(15)00079-3
(5) See https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...
(6) See http://drugscience.org.uk/blog/2015/08/27/blinded-smoke-why-do-e-cigaret...
(7) Britton J, Bogdanovica I. 2014. Electronic cigarettes A report commissioned by Public Health England, 2014.

Competing interests: HM was an investigator on a 2008 study of e-cigarettes sponsored by manufacturer Ruyan Group and conducted independently at University of Auckland. He has no links with any tobacco or e-cigarette manufacturers. The other authors declare no competing interests.

02 September 2015
Ann McNeill
Professor of Tobacco Addiction
L.S. Brose, R. Calder, S.C. Hitchman, P. Hajek, H. McRobbie
Institute of Psychiatry, Psychology & Neuroscience, King's College London