BMJ investigation examines bitter dispute over e-cigarettes in the public health community

June 24, 2015

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.

On one side of the increasingly bitter dispute are those who believe it is time to work with the industry in support of products such as e-cigarettes.

Those in the other camp, however, not only contest the claimed public health benefits of the new products but also fear 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.

As cigarettes continue to kill six million people each year, journalist Jonathan Gornall asks who is right?

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."
-end-


BMJ

Related Smoking Articles from Brightsurf:

Smoking rates falling in adults, but stroke survivors' smoking rates remain steady
While the rate of Americans who smoke tobacco has fallen steadily over the last two decades, the rate of stroke survivors who smoke has not changed significantly.

What is your risk from smoking? Your network knows!
A new study from researchers at Penn's Annenberg School for Communication found that most people, smokers and non-smokers alike, were nowhere near accurate in their answers to questions about smoking's health effects.

Want to quit smoking? Partner up
Kicking the habit works best in pairs. That's the main message of a study presented today at EuroPrevent 2019, a scientific congress of the European Society of Cardiology (ESC).

Smoking and mortality in Asia
In this analysis of data from 20 studies conducted in China, Japan, South Korea, Singapore, Taiwan and India with more than 1 million participants, deaths associated with smoking continued to increase among men in Asia grouped by the years in which they were born.

Predictors of successfully quitting smoking among smokers registered at the quit smoking clinic at a public hospital in northeastern Malaysia
In the current issue of Family Medicine and Community Health, Nur Izzati Mohammad et al. consider how cigarette smoking is one of the risk factors leading to noncommunicable diseases such as cardiovascular and respiratory system diseases and cancer.

Restaurant and bar smoking bans do reduce smoking, especially among the highly educated
Smoking risk drops significantly in college graduates when they live near areas that have completely banned smoking in bars and restaurants, according to a new study in the American Journal of Epidemiology.

How the UK smoking ban increased wellbeing
Married women with children reported the largest increase in well-being following the smoking bans in the UK in 2006 and 2007 but there was no comparable increase for married men with children.

Smoking study personalizes treatment
A simple blood test is allowing Vanderbilt University Medical Center (VUMC) researchers to determine which patients should be prescribed varenicline (Chantix) to stop smoking and which patients could do just as well, and avoid side effects, by using a nicotine patch.

A biophysical smoking gun
While much about Alzheimer's disease remains a mystery, scientists do know that part of the disease's progression involves a normal protein called tau, aggregating to form ropelike inclusions within brain cells that eventually strangle the neurons.

A case where smoking helped
A mutation in the hemoglobin of a young woman in Germany was found to cause her mild anemia.

Read More: Smoking News and Smoking Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.