Intended for healthcare professionals

Rapid response to:


E-cigarettes: relax rules to help more smokers quit, say MPs

BMJ 2018; 362 doi: (Published 17 August 2018) Cite this as: BMJ 2018;362:k3571

Rapid Response:

Re: E-cigarettes: relax rules to help more smokers quit, say MPs

The House of Commons Science and Technology Committee report on e-cigarettes is well worth reading.(1) The 98 pieces of published written evidence is a good place to start and have been produced by a range of individuals and organisations including: multinational tobacco companies, vaping organisations and public health groups.

We are concerned that the report from the Science and Technology Committee, repeats Public Health England’s claim that e-cigarettes are 95% less harmful than conventional cigarettes.(2) The use of such a statement will lead some people to think that e-cigarettes are quite safe. However, we believe it is far too early to devise a figure such as this when there is a lack of evidence on the long-term health consequences of e-cigarettes.(3,4)

It is basic but important to note that the lungs are delicate organs and have been designed to breathe clean air and any material inhaled long term may be harmful. So it should not surprise us if the long-term impact of the many different unregulated chemicals in e-cigarettes is negative on both individual and population health. We should learn from history - in relation to health, politics and economic interests.(5,6)

Already two very recent studies have had results that demonstrate adverse biological effects.(7,8) The first found that under laboratory conditions lung cells become inflamed when exposed to e-cigarette vapour.(7) Whereas, the second an observational study, concluded that “Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.”(8)

Besides safety issues another important consideration is efficacy of e-cigarettes - helping smokers to reduce consumption or quit altogether. A recent Cochrane Review found that there was little evidence that e-cigarettes are an aid to smoking cessation and recommended that further studies are needed.(9) We are therefore very concerned that the Commons Select committee website has the statement that “E-cigarettes are a proven stop smoking tool ….”(1)

The report also ignores the evidence that e-cigarettes can act as a gateway to conventional smoking, including for young non-smokers.(10) Use of e-cigarettes has increased rapidly over the past decade in the USA, particularly among young people. (10,11) We are alarmed at the rise in use of Juuls in some countries and worried that they may also become a cool lifestyle choice of young people in this country as well as a long-term serious risk to public health.(12-14)

Whilst we agree that smoking still “remains a national health crisis” particularly for certain groups within society, we do not believe that many of the steps in the report should be actively endorsed by the Government. We are surprised that unproven and potentially dangerous e-cigarettes are being promoted at a time when there have been substantial cuts to successful public health services including smoking cessation services.(15-17)

1) House of Commons Science and Technology Committee. E cigarettes. Aug 2018.

2) McNeill A, Brose LS, Calder R, Hitchman SC; Public Health England. E-cigarettes: an evidence update. 2015.

3) Watson M C and Lloyd J. Re: Evidence about electronic cigarettes: a foundation built on rock or sand? Fifteen questions to clear the fog around e-cigarettes. British Medical Journal Rapid Response 22nd September 2015.

4) National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. National Academies Press 2018.

5) Taylor P. Smoke Ring: The Politics of Tobacco. London: Bodley Head Ltd, 1984.

6) Doll R, Crofton J, editors. Tobacco and health. British Medical Bulletin 1996;52(1). London: London Royal Society of Medicine Press.

7) Scott A, Lugg ST, Aldridge K, et al. Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages. Thorax 2018;thoraxjnl-2018-211663. doi:10.1136/thoraxjnl-2018-211663. pmid:30104262

8) Alzahrani T, Pena I, Temesgen N, Glantz S. Association Between Electronic Cigarette Use and Myocardial Infarction. Am J Prev Med 2018; Published online ahead of print 22-AUG-2018 DOI information: 10.1016/j.amepre.2018.05.004.

9) McRobbie H, Bullen C, Hartmann-Boyce J, Hajek P. Electronic cigarettes for smoking cessation and reduction. Cochrane Database Syst Rev. 2014;(12):CD010216.

10) U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.

11) Jamal A, Gentzke A, Hu SS, et al. Tobacco use among middle and high school students - United States, 2011-2016. MMWR Morb Mortal Wkly Rep 2017;66:597–603.

12) Tolentino J. The Promise of Vaping and the Rise of Juul. The New Yorker 2018;May 14 Issue.

13) Huang J, Duan Z, Kwok J, et al. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tob Control. Epub ahead of print: doi:10.1136/ tobaccocontrol-2018-054382

14) Barrington-Trimis, J. L. and A. M. Leventhal "Adolescents’ Use of “Pod Mod” E-Cigarettes — Urgent Concerns." New England Journal of Medicine 2018 (Aug 22nd). DOI: 10.1056/NEJMp1805758

15) Cancer Research UK, Action on Smoking and Health. Feeling the heat: the decline of stop smoking services in England. Jan 2018.

16) Iacobucci G. Stop smoking services: BMJ analysis shows how councils are stubbing them out. BMJ 2018;362:k3649

17) Watson M and Tilford S. Re: Government’s response to inquiry on public health raises fears of more cuts. There should be investment – not cuts. British Medical Journal Rapid Response 10th January 2017.

Competing interests: No competing interests

29 August 2018
Michael Craig Watson
Associate Professor in Public Health.
Dr John Lloyd (Honorary Vice President, Institute of Health Promotion and Education,
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA.