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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

Blowing smoke, shedding no light: responses reveal bias against e-cigarettes

I thank the various respondents to my article on e-cigarettes for their contributions to the debate. Unfortunately, their arguments all contain errors. Douglas Mackenzie failed to detect my sarcasm in the article: obviously nicotine patches and gum can be used in Scottish hospitals. My point was simply that it was ridiculous to claim that smoking cessation aids have no place in Scottish hospitals. More importantly, he does not make it clear why it would be a problem that schoolchildren in the USA do not regard e-cigarettes as a great risk. All the evidence shows that they are not a great risk, so all this shows is that the children are well-informed.[1]

Prof Schuurmans also underestimates the potential advantages of e-cigarettes. As seen in the recent Public Health England report, there is substantial evidence that e-cigarettes are effective in reducing harm and increasing cessation rates (two separate things, a point that Prof Schuurmans does not acknowledge).[1] It is rather ironic that he states that “If electronic cigarettes were the solution to tobacco addiction they would have reduced smoking prevalence dramatically by now in countries where they are freely available” while also arguing against their use. Perhaps they are actually the solution, but the entrenched attitudes of e-cigarette opponents such as himself prevent them from being used to good effect. Furthermore, “first, do no harm” is not a precept of bioethics, but of medicine, and quoting it in order to attack a new technology that could ultimately reduce harm is misleading.

Alain Braillon suggests (perhaps not entirely seriously) a collaboration between the NHS and the tobacco industry to provide e-cigarettes to patients. For obvious reasons, any e-cigarettes provided by health services should not generate profit for those who created the deadly addiction in the first place. Rainer Kaelin goes further and appears to suggest that my arguments have been paid for by the tobacco industry. This would be offensive if it weren’t so laughable. If he were up-to-date with the literature, he would be aware that I am very skeptical of tobacco industry involvement in general, and e-cigarette research in particular (see my recent article in Addiction [2]). It is also entirely wrong to say that my argument is that there should be no regulation: at no point in the article did I say anything of the kind. It is disappointing that so many doctors and public health experts have such a hatred of the tobacco industry that it blinds them to the extent that they cannot objectively assess the potential benefits of e-cigarettes. Their collective attitude appears to be that there is no smoke without fire, and that e-cigarettes must be opposed at all costs, even if this approach costs smokers their lives.

1. McNeill A et al. Ann McNeill and colleagues reply to Martin McKee and Simon Capewell. BMJ 2015;351:h5010
2. Shaw DM. Etter JF. Elger BE. Should academic journals publish e-cigarette research linked to tobacco companies? Addiction, online early. DOI: 10.1111/add.13067

Competing interests: No competing interests

12 October 2015
David M Shaw
Senior Research Fellow in Biomedical Ethics
Institute for Biomedical Ethics, University of Basel
Bernoullistrasse 28