There's no evidence e-cigarettes are as harmful as smoking
In his recent ‘Comment is free’ piece Nash
Riggins claims that vaping is just as
dangerous as smoking, and expresses
robust support for NHS Boards in Scotland
who intend to ban the use of electronic
cigarettes when their grounds go tobacco
free in April.
The reader might be left with impression
that the use of nicotine is simply not
compatible with public health aims, and
that e-cigarettes should be subject to the
same restrictions as tobacco products.
However, to reach such a conclusion
Riggins overlooks an extraordinary body of
evidence pointing to the contrary.
Disregarding this evidence could mean
missing out on the potential of e-cigarettes
to save lives. Let’s look at his assertions.
E-cigarettes are not safer
than smoking
Smoked tobacco is a lethal product that
kills one in two of its regular users, who
lose on average 10 years of life. Smokers
die from the tar particles and toxic gases
drawn into the body from smoking rather
than from the nicotine. However it is the
nicotine that is addictive. Many smokers
find it very difficult to give up nicotine
and will continue to smoke cigarettes
without an alternative. That’s why
products like nicotine replacement therapy
were invented and are licensed as safe to
use, including for groups like pregnant
women who smoke and children over the
age of 12 who smoke.
E-cigarettes are currently unlicensed, but
both the National Institute for Health and
Clinical Excellence and the Medicines
Healthcare Regulatory Association
acknowledge that their use is safer than
continued smoking. This is not simply an
opinion, it is an evidence-based statement,
and one that is supported by tobacco
control organisations in the UK. To imply
otherwise is incorrect. This does not mean
e-cigarettes are risk free, but few things
are. What it does mean is that their use is
safer than continued smoking.
The nicotine in e-cigarettes
is dangerous
The author claims “E-cigs don’t contain the
same type of nicotine you might find in an
ordinary tobacco leaf. They contain liquid
nicotine, which can be lethal.”
Nicotine is a substance naturally found in
particular plants, not just tobacco leaves
but aubergines, tomatoes, potatoes and
some flowers. However, when derived from
the tobacco leaf it is addictive and tobacco
is possibly the most used drug in the world
following caffeine.
In its base form, nicotine is a liquid.
Although synthetic nicotine has been
manufactured, it is not commercially
viable and the nicotine in electronic
cigarette liquid comes from exactly the
same source as the nicotine in tobacco – it
is extracted from plants including the
tobacco leaf. This is also the source for
nicotine in Nicotine Replacement Therapy.
Public misunderstanding of nicotine
prevails and even those involved in
delivering support to smokers to stop can
hold the view that longer term nicotine use
(of licensed or unlicensed products) is
harmful. So it is a common misperception.
The NICE guidance makes it clear that this
concern is misplaced. It is about
understanding the difference between
high risk and low risk.
Riggins is correct that drinking liquid
nicotine could be lethal particularly for a
child. However, there are many poisons in
households that can kill or harm children
if consumed, and ingesting licensed
nicotine-containing medicines also confers
risk.
To put this in context, in the USA there
were 2.6 million calls to poison control
centres in 2013 and 0.06% of these related
to nicotine products including e-liquids.
These liquids need to be safely packaged
and clearly labelled, and users need to
keep these products away from children.
Electronic cigarette use
should be banned in public
places
There is an ongoing debate about e-
cigarette use in public places and the
recent case of NHS grounds in Scotland
highlights this. Public consultations in
Wales and Scotland have asked whether
they should be included in smokefree
laws. However, it is important to be clear
about the health evidence. E-cigarette
vapour is not second hand smoke. In fact, it
is not smoke at all and there is no good
evidence that exposure is harmful to
bystanders (particularly outside, as in NHS
grounds). To claim otherwise is simply
factually incorrect.
While some of the longer term impacts of
continued vaping are unknown, using
health arguments to support public places
bans is not viable. Other grounds
including etiquette or aesthetics are issues
for individual businesses or premises to
consider.
In the near future at least some electronic
cigarettes will become licensed as stop
smoking medicines, and when that
happens NHS bans will be unworkable. For
the moment, however, they simply serve to
discourage smokers from trying what
appears to currently be the most popular
aid to stopping smoking in the UK. These
products are a disruptive technology and
debates on their merits will continue.
However, while it does, those who feel
moved to comment should do some reading
first.
