The public health community isn’t unanimous as far as the ‘harm reduction’ aspect of e-cigarettes is concerned, a new investigation published in BMJ has found, with those in favour of e-cigarettes believing that its time to work with the industry and support such products with those on the other side of the aisle contesting such claims.
An investigation published by The BMJ today reveals how the controversial concept of “harm reduction”, embraced enthusiastically by the tobacco industry, has sharply divided the public health community.
Those against e-cigarettes not only pose questions over the public health benefits of such products, but also believe that harm reduction is a cynical and superficial smokescreen for an industry that has every intention of maintaining global sales of smoked tobacco for as long as possible.
Simon Capewell, professor of public health and policy at Liverpool University’s Institute of Psychology, Health and Society, and others argue that e-cigarettes help to glamorise and renormalise smoking. Worse, he says, they are being used by the industry “as a trojan horse to get inside ministries of health. They are saying ‘This is all about harm minimisation, we’re part of the solution, we’re no longer the problem.'”
However, Deborah Arnott, chief executive of the UK charity Action on Smoking and Health (ASH), dismisses such fears, saying there is no evidence so far that e-cigarettes are a gateway into smoking for young people. “The risk is that smokers who could potentially use these an an alternative to smoking are being discouraged, and that’s not a good thing,” she argues.
Gornall describes how, in 2014, the tension “boiled over into a pitched battle of words” in the run up to the World Health Organization’s Framework Convention on Tobacco Control.
Some 56 specialists in nicotine science and public health policy wrote to Margaret Chan, director general of WHO, urging her to support harm reduction and insisting it was “part of the solution, not part of the problem.” But 129 opposing experts swiftly responded, warning WHO and other public bodies not to “buy into the tobacco industry’s well-documented strategy of presenting itself as a partner.”
One of the organisers of the Chan letter was Gerry Stimson, a former director at Imperial College London and a member of the group producing NICE guidance on tobacco harm reduction.
Stimson has made no secret of his relations with the tobacco industry and told The BMJ that e-cigarettes and other nicotine delivery systems had “huge potential … to help shift people away from smoking.” But “the quandary for many public health experts … is that the solution might well lie with the much reviled tobacco industry.”
Karl Fagerstrom, a Swedish clinical psychologist who has also accepted industry money, said he considered products such as e-cigarettes could have a role in reducing the harm caused by smoking and accused some in public health of losing sight of the true objective.
Another signatory to the Chan letter was John Britton, an epidemiologist who heads the UK Centre for Tobacco and Alcohol Studies, and also sat on the NICE guideline group. “I’m no apologist for or friend of the tobacco industry,” he told The BMJ, but if an alternative means of delivering nicotine comes along “it’s inconceivable that tobacco companies will not get involved and seek to exploit it, and that’s a risk that has to be managed.”
For Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, there is no doubt that tobacco companies are entering the e-cigarette market “solely so they can say they are part of the solution.” But there was, he said, still no evidence that e-cigarettes were effective in helping people to quit smoking.
British American Tobacco (BAT) is now poised to market Voke, the first licensed medicinal nicotine product from a tobacco company.
ASH has welcomed the decision, saying Voke “… will allow smokers to choose a product which meets the high standards of medicines regulation and could be provided on prescription to help them stop smoking.”
But regardless of their true value in the battle against tobacco harm, and the ferocious row they have triggered in the public health community, are all such products anything other than a sideshow, designed to make the tobacco industry look good as cigarettes continue to kill half the people who use them, asks Gornall?
He notes that while BAT says it is “committed to developing and promoting a range of next generation tobacco and nicotine products,” its 2014 annual report clearly states that tobacco remains “at the core of our business and will continue to provide us with opportunities for growth.”
“the controversial concept of ‘harm reduction’, embraced enthusiastically by the tobacco industry”
Lolwut?? The tobacco industry makes about 98% of its money selling cigarettes. Selling cigarettes will always be its #1 preference. They have developed some lower-risk tobacco products (they had nothing to do with vaping technology) for North America and western Europe, but only to extract a few more bucks out of two dying cigarette markets. Most of the world’s smokers live in Asia, the percentage is only going to go up, and they’re perfectly happy buying old-fashioned tobacco cigarettes.
Nicotine itself is not harmful although it is addictive. It is the associated toxins in smoked tobacco that cause harm which e-cigs do not deliver. I went from 20 smokes a day straight to e-cigs without a problem. I’d previously tried NHS recommemded gums and patches, no good at all. If it aint broke, don’t fix it.