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Leading journal questions Public Health England’s stance on e-cigarettes

E-cigarettes: setting out the available evidence for the public Public Health England (PHE) is deeply disappointed with the BMJ’s news story: “Leading journal questions Public Health England’s stance on e-cigarettes”. The Lancet editorial, to which this news story refers, contained a number of assertions that PHE has refuted in a published response. [1]

The authors of PHE’s expert review on e-cigarettes [2] have set out the evidence for the estimate that e-cigarettes are around 95% safer than smoking. [3] This evidence includes the facts that: 1) the constituents of cigarette smoke that harm health – including carcinogens – are either absent in e-cigarette vapour or, if present, they are mostly at levels much below 5% of smoking doses; and 2) the main chemicals present in e-cigarettes only have not been associated with any serious risk.

The Lancet, and the BMJ news story both focus their criticisms on the study by Nutt et al. which is cited in PHE’s review. We disagree strongly with the charge that PHE’s review does not meet our standard for scientific rigour and evidence. We would add that the study by Nutt et al. was one source within an extensive peer-reviewed evidence base, on which he authors drew in reaching their conclusions on the relative safety of e-cigarettes.

PHE’s expert review clearly acknowledges that the overall evidence base on the safety of e-cigarettes is still developing. Furthermore, we have repeatedly stressed that ongoing monitoring and research are needed. But PHE has a public duty to spell out clearly that the current best estimate, based on the peer-reviewed literature, is that e-cigarettes, while not risk-free, carry only a fraction of the harm caused by smoking.

It is even more disappointing that the BMJ has followed the Lancet in ignoring the significant findings of this comprehensive expert review. These include: 1) e-cigarettes are now the most popular stop smoking aid in England and can help smokers to quit smoking or reduce their cigarette consumption; 2) while experimentation with e-cigarettes has increased among young people, regular use remains rare and almost entirely confined to those who have already smoked; and 3) there is so far no evidence that e-cigarettes are undermining the long-term decline in smoking among adults and young people.

PHE has not “fallen short of its mission” in publishing the latest evidence on e-cigarettes. The public increasingly – and mistakenly – believes that e-cigarettes are at least as harmful as smoking tobacco. This may be keeping smokers from using e-cigarettes as a tool to help them to quit smoking and compromising the potential for these products to help reduce the harm from the nation’s number one killer.

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