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Evidence about electronic cigarettes: a foundation built on rock or sand?

BMJ 2015; 351 doi: (Published 15 September 2015) Cite this as: BMJ 2015;351:h4863

Rapid Response:

Re: Evidence about electronic cigarettes: a foundation built on rock or sand?

Harm Reduction is Not Well-Served by Bias

McKee and Capewell are measured voices of reason in the current climate of negativity that is promulgated by some in the e-cigarette industry, its lobbyists, users, and by some who sincerely hope that e-cigarettes will greatly reduce global tobacco addiction. The reality is that e-cigarettes will never be risk free, and so it serves no positive purpose to attack studies and discussions on e-cigarette risks and safety. The tactic of constantly shifting the entire debate to “e-cigarettes are safer than tobacco,” is a diversion from the needed discussion of the actual benefits and dangers of e-cigarette use, and it polarizes the conversation, demonizing anyone who questions the safety of e-cigarettes as undermining smokers attempting to quit tobacco.

From our experience, as well as that of others, independent researchers and public health professionals should expect to have their work taken out of context, and be subjected to aggressive trolling. [1,2] Even “harm reductionist” journal editors fuel the conspiracy theories with generalizations, accusing unnamed colleagues of ulterior motives: “bad studies on e-cigarettes are easy to do and easy to get into top journals, which are hungry for publicity. Good studies are hard to do and are difficult to get into top journals if they do not lead to scare stories.” [2]

Researchers funded by the e-cigarette industry also contribute to these issues. For example, as a result of limited trials, it has been suggested that e-cigarettes can be self-regulated by users. [3] However, it is worth remembering that the harm even from traditional cigarettes does not appear until after decades of use, as revealed by studies over large populations.

Why the over-the-top, aggressive attacks on McKee and Capewell’s questioning of e-cigarette safety? Fear of regulation? [4]

McKee and Capewell advocate evidence-based health policy via critical evaluation of all of the relevant scientific data without bias. Such an approach is not only more helpful to health practitioners than industry lobbying, but also best enables long term harm reduction.

1. Gornall, J. BMJ 2015;350:h3317 doi: 10.1136/bmj.h3317.
3. For example, Farsalinos, K. E.; Voudris, V.; Poulas, K. Addiction, 2015, 110, 1352-1356.

Competing interests: No competing interests

25 September 2015
Robert M. Strongin
Professor of Chemistry
David Peyton, Jim Pankow
Portland State University
1719 SW 10 Ave, Portland, OR, USA