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Hospitals are wrong to ban e-cigarette use

BMJ 2015; 351 doi: (Published 30 September 2015) Cite this as: BMJ 2015;351:h5063

Hospitals should stick to their guns in banning e-cigarettes.

Shaw's article on smoke free hospital grounds in Scotland makes a number of valid points, including the additional harms of cigarette smoke in comparison with e-cigarettes. However some of Shaw's lines of attack are simply smoke and mirrors.

Shaw unfairly sweeps up established nicotine replacement therapies (e.g. gum, patches) into the same category as e-cigarettes, using a rushed comment in a press statement to support his claim. Gum and patches do not model smoking behaviour, and Shaw must know that they are widely prescribed and used in hospitals.

Shaw talks about public health gains from e-cigarettes. The US school survey referenced by Shaw found rising use of e-cigarettes and a great majority of children do not consider e-cigarette use as a "great risk" (1). Child vapers surveyed typically use e-cigarettes as a primary source of nicotine rather than a substitute for cigarettes. These are worrying findings. Shaw's claims for a public health dividend from e-cigarettes are not convincingly supported by the references he cites.

It is still early days for smoke free hospital grounds. Shaw is unduly pessimistic to write them off. Parallel work on enforcement, support and education can always be improved, and needs to be given a chance. There are too many potential harms, and existing therapeutic alternatives, to support wider use of e-cigarettes at the current time. Otherwise work towards a tobacco free future risks going up in smoke for another generation.

1) Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the future: national results on adolescent drug use—2014 overview. 2015.

Competing interests: No competing interests

02 October 2015
Douglas G Mackenzie
Consultant in Public Health Medicine
NHS Lothian
Waverley Gate, 2-4 Waterloo Place, Edinburgh, EH1 3EG