Intended for healthcare professionals


Nicotine without smoke—putting electronic cigarettes in context

BMJ 2016; 353 doi: (Published 27 April 2016) Cite this as: BMJ 2016;353:i1745
  1. John Britton, professor of epidemiology1,
  2. Deborah Arnott, chief executive2,
  3. Ann McNeill, professor of tobacco addiction1 3,
  4. Nicholas Hopkinson, reader in respiratory medicine4,
  5. Tobacco Advisory Group of the Royal College of Physicians
  1. 1Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
  2. 2Action on Smoking and Health, London, UK
  3. 3King’s College London, London, UK
  4. 4National Heart and Lung Institute, Imperial College London, UK
  1. Correspondence to: J Britton j.britton{at}

John Britton and colleagues set out why a new Royal College of Physicians report supports the role of electronic cigarettes as part of a comprehensive tobacco control strategy

Electronic cigarettes have exploded on to global markets over the past decade and in the process have generated some strongly polarised views.1 2 3 Some believe that e-cigarettes are a disruptive technology that could consign tobacco smoking to history; others think that they are a distraction from core public health aims of eradicating all nicotine use and a tobacco industry ploy to perpetuate smoking and undermine international tobacco control treaties. This article summarises the findings of a new report by the Royal College of Physicians (RCP) on the role of e-cigarettes in tobacco harm reduction.4

Smoking: the biggest avoidable cause of harm to health

There are few practices more harmful to individuals or society than smoking. Life expectancy is reduced by around three months for every year of smoking after the age of 35.5 6 Smoking impairs quality of life through disease and poverty,7 causes substantial harm to others, particularly young people and unborn babies,8 and imposes a heavy financial and opportunity cost on wider society.7 Despite declining prevalence over recent decades there are still nearly nine million smokers in the UK, a high proportion of whom are from among the most disadvantaged in our society.4 Smoking is still the largest avoidable cause of premature death, disability, and social inequalities in health in the UK.

Harm reduction: part of a comprehensive approach to smoking prevention

From its groundbreaking first report on smoking and health in 1962,9 which established the pillars of global tobacco control policy,10 11 12 the RCP has advocated comprehensive strategies to prevent harm caused to individuals and society by tobacco smoking. However, current policy levers have proved more effective in preventing uptake of smoking than in helping established smokers …

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