Intended for healthcare professionals

Rapid response to:

Letters Electronic cigarettes

Electronic cigarettes: the renormalisation of nicotine use

BMJ 2016; 352 doi: (Published 28 January 2016) Cite this as: BMJ 2016;352:i425

Rapid Response:

Re: Electronic cigarettes: the renormalisation of nicotine use

There is no ‘one size fits all’ medicinal regulation approach to the debate on e-cigarettes as Auf and others suggest [1,2]; the regulatory and epidemiological contexts differ greatly between countries and there is simply not enough evidence to justify the claim that one approach is universally more effective.

In the UK, e-cigarettes are used almost exclusively by smokers and ex-smokers, including a million ‘vapers’ who have completely stopped smoking [3]. Currently there are no medicinally licensed products available, and as such the exclusively medicinal regulation suggested by the authors would essentially be a de facto ban; and while the consequences of a ban are not known, the risks cannot be ignored.

In the UK – unlike the US – e-cigarette advertising is already tightly regulated and will be more so by the summer under the new EU Tobacco Products Directive (TPD) [4,5]. Just as an ad ban in the US risks challenge under the First Amendment, so a proposed ‘medicines only’ regulation would contravene the EU TPD [6].

A de facto ban will make it easier for many to carry on smoking than to switch to e-cigarettes, and risks maintaining more smoking role models, especially for children in the most disadvantaged families where smoking prevalence is highest.

Smoking tobacco kills almost 80,000 people in England every year [7] and we must not lose focus on the need for a comprehensive tobacco control strategy.

The challenge for us all is to ensure that e-cigarettes are a route out of smoking, not into it, and to leverage any potential for reducing harm from tobacco.

In the 1980s, many different approaches were taken to tackle HIV. While some jurisdictions closed down gay bath houses and interned people with HIV, others favoured a harm reduction approach promoting condom use and needle exchanges. Both prohibition and harm reduction offer risks and opportunities, and it is simply too early to know which approach will work to tackle smoking rates.

What is clear is that any policy on e-cigarettes must be based on a balanced reading of the evidence and be monitored with rigour and candour.

3 Action on Smoking and Health Use of electronic cigarettes (vapourisers) among adults in Great Britain 2015
4 UK Code of Non-broadcast Advertising, Sales Promotion and Direct Marketing (CAP Code) Section 22; UK Code of Broadcast Advertising (BCAP Code) Section 33
5 Tobacco Products Directive (2014/40/EU) Article 20, Section 5
6 Tobacco Products Directive (2014/40/EU) Article 20
7 Statistics on smoking – England, 2015, HSCIC, 2015

Competing interests: Prior to 2007 MD conducted research on patient experience funded through unrestricted grants from pharmaceutical manufactures to the charity which employed him.

01 February 2016
Prof. Kevin Fenton
National Director Health & Wellbeing, Public Health England
Martin Dockrell
Public Health England
Wellington House, 135-155 Waterloo Road, London SE1 8UG