Truthful “Action” on E-Cigarettes in the United Kingdom

Action on Smoking and Health (ASH), a British “campaigning public health charity that works to eliminate the harm caused by tobacco,” has published a landmark report on e-cigarettes acknowledging that they “provide effective nicotine delivery” and present “little real-world evidence of harm.”  In addition, “ASH supports regulation to ensure the safety and reliability of e-cigarettes but, in the absence of harm to bystanders, does not consider it appropriate to include e-cigarettes under smokefree regulations.” 

I encourage you to read the 9-page report, which is available here.  I’ll highlight some important points, many of which I have made previously (PubMed Links to the original ASH references are provided where possible).

Nicotine Substitution

“In 1976 Professor Michael Russell wrote: ‘People smoke for nicotine but they die from the tar.’ (reference 6).  Indeed, the harm from smoking is caused almost exclusively by toxins present in tobacco released through combustion.  By contrast, pure nicotine products, although addictive, are considerably less harmful.  Electronic cigarettes consequently represent a safer alternative to cigarettes for smokers who are unable or unwilling to stop using nicotine.”

Propylene Glycol

“There is little evidence of harmful effects from repeated exposure to propylene glycol, the chemical in which nicotine is suspended (references 12 , and 13) One study concludes that e-cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects. (reference 14).” 

I should add that the investigators in ASH reference 12 also found that propylene glycol vapor killed bacteria and viruses that were suspended in the air of enclosed spaces (here and here), another potentially positive aspect of this agent.

Second-hand Vapor Risks

“Although e-cigarettes do not produce smoke, users exhale a smoke-like vapour which consists largely of water.  Any health risks of secondhand exposure to propylene glycol vapour are likely to be limited to irritation of the throat.  One study exposed animals to propylene glycol for 12 to 18 months at doses 50 to 700 times the level the animal could absorb through inhalation. Compared to animals living in normal room atmosphere, no localised or generalised irritation was found and kidney, liver, spleen and bone marrow were all found to be normal (reference 12).

“The fact that e-cigarettes look similar to conventional cigarettes has been said to risk confusion as to their use in public places, such as on public transport.  However, given that the most distinctive feature of cigarette smoking is the smell of the smoke, which travels rapidly, and that this is absent from e-cigarette use, it is not clear how any such confusion would be sustained.”

In other words, ASH does not buy into indoor e-cigarette bans because these products don’t expose bystanders to toxic agents, and e-cigarette vapor is instantly distinguished from the smoke of combusted cigarettes.    

While ASH has over many years aggressively opposed the tobacco industry, it notes on its website that it “works to eliminate the harm caused by tobacco.  We do not attack smokers or condemn smoking.”  In this case, ASH has honored this sentiment, objectively evaluating e-cigarettes and establishing a credible position.