A new Royal College of Physicians (RCP) report, “Nicotine Without Smoke: Tobacco Harm Reduction” (here), provides “a fresh update on the use of harm reduction in tobacco smoking, in relation to all non-tobacco nicotine products but particularly e-cigarettes. It concludes that, for all the potential risks involved, harm reduction has huge potential to prevent death and disability from tobacco use, and to hasten our progress to a tobacco-free society.” The RCP is among the world’s oldest and most prestigious medical societies.
Note that UK tobacco authorities are not bound by American tobacco legislation that classifies e-cigarettes as tobacco products, so the RCP call for a “tobacco-free society” is less egregious than the U.S. mantra.
Among the RCP’s findings:
· “E-cigarettes are marketed as consumer products and are proving much more popular than [nicotine replacement therapy, NRT] as a substitute and competitor for tobacco cigarettes.
· “E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.
· “E-cigarettes are not currently made to medicines standards and are probably more hazardous than NRT. However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.
· “There are concerns that e-cigarettes will increase tobacco smoking by renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking. To date, there is no evidence that any of these processes is occurring to any significant degree in the UK. Rather, the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.
· “…in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.”
The RCP’s strong endorsement of tobacco harm reduction is significant. In 1962, the college became the first organization to conduct a formal study on the health effects of smoking (available here). That report generated global headlines and likely was responsible for President John F. Kennedy being asked on May 23, 1962, whether smoking causes cancer and heart disease (here and here). The president dodged the question, but two weeks later announced (here) that Surgeon General Luther Terry would study the health effects of tobacco, leading to release in 1964 of the seminal report, “Smoking and Health”.
The sharp contrast between the new RCP report and the FDA’s just-published e-cigarette regulations comes as no surprise to this observer. In 2002, the RCP issued a report titled “Protecting Smokers, Saving Lives” (available here), stating, “As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10-1,000 times less hazardous than smoking, depending on the product.” The RCP noted that some smokeless manufacturers might market their products “as a 'harm reduction' option for nicotine users, and they may find support for that in the public health community.”
From the U.S. public health establishment, no such support was forthcoming.
The RCP issued its second report in 2007: “Harm Reduction in Nicotine Addiction: Helping People Who Can't Quit.” (here) The message was clear and unequivocal: “…that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved… Harm reduction is a fundamental component of many aspects of medicine and, indeed, everyday life, yet for some reason effective harm reduction principles have not been applied to tobacco smoking…This report makes the case for radical reform to the way that nicotine products are regulated and used in society. The ideas presented are controversial, and challenge many current and entrenched views in medicine and public health. The principles behind them have the potential to save millions of lives. They deserve consideration.”
Although the current RCP report received some positive press coverage in the U.S. (here), the Centers for Disease Control maintained its prohibitionist position, noting: “There is currently no conclusive scientific evidence supporting the use of e-cigarettes as a safe and effective cessation tool at the population level.”
University of California, San Francisco professor Stanton Glantz rebuked his British colleagues: “These guys, in my view, are going off a cliff.” Unfortunately, it is U.S. smokers who are being pushed off a cliff by government policymakers who deny them vastly safer alternatives.