United Kingdom Doubles Down on Support for Tobacco Harm Reduction

The United Kingdom Department of Health’s new position statement (here), “Towards a Smokefree Generation,” is, as Clive Bates wrote (here), “probably the first significant government policy paper anywhere that recognises and pursues the opportunities of tobacco harm reduction, rather than defining these technologies as a threat to be suppressed.  For that, the Department of Health and its allies deserve considerable credit.”

Indeed.

British health authorities have been telling smokers the truth about vaping since 2011 (as I have noted here, here, here and here), and British smokers have listened – the UK’s vaping population has ballooned to 2.9 million (here), while smoking has significantly declined.  In fact, a Public Health England official recently reported (here) that the UK smoking rate is now the second lowest in the European Union, after SWEDEN!

Meanwhile, the U.S. persists in advocating for a “tobacco-free society” and a “tobacco endgame,” demonizing smoke-free products with untruths and giving continuing life to urban anti-vaping myths.  The UK paper underscores this stark contrast.

“Towards a Smokefree Generation” sets forth the facts about e-cigarettes’ relative safety:

“… the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco.”

The UK Department of Health promises to help smokers make the switch:

“The government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products. Public Health England has produced guidance for employers and organisations looking to introduce policies around e-cigarettes and vaping in public and recommend such policies to be evidence-based.”

The paper dismisses the unfounded claim that second-hand vapor is a health threat:

“Public Health England recommends that e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy.”

Additionally, the document invites the introduction of new tobacco harm reduction products, an apparent reference to products like Philip Morris International’s heat-not-burn iQOS:

“… there has been the development and very recent introduction of novel tobacco products that claim to reduce the harm of smoking. We welcome innovation that will reduce the harms caused by smoking and will evaluate whether products such as novel tobacco products have a role to play in reducing the risk of harm to smokers.”

Concluding, the UK pledges:

“Public Health England will continue to provide smokers and the public with clear, evidence based and accurate information on the relative harm of nicotine, e-cigarettes, other nicotine delivery systems and smoked tobacco, to enable informed decision-making.”

American health authorities, are you listening?

U.K. E-Cigarette Perceptions More Accurate than U.S.

Words, and honesty, matter in communicating public health advice. Today, survey data in the U.K. and the U.S. demonstrate the effects of truth-telling versus obfuscation regarding e-cigarettes.

I have previously noted stark differences in the characterization of e-cigarette use by health authorities in the two countries (here).  Evidence-based assessments by Public Health England (here) and the British Royal College of Physicians (here) encourage smokers to switch to e-cigarettes, while government agencies and trusted medical organizations in the U.S. obscure the relative safety of e-cigarettes.

Reflecting the above, new surveys demonstrate that 55% of adults in the U.K. correctly believed in 2015 that e-cigarettes were less harmful than cigarettes, while only 26% of Americans held that view (see the chart). 

The British survey was conducted by Action on Smoking and Health U.K. (here).  I generated the U.S. numbers from National Cancer Institute Health Information National Trends Survey (HINTS) data (available here).  There were minor differences in the wording of the survey questions, but I think the results are comparable and informative.

While the U.K. results aren’t ideal, the U.S. results are deplorable and must be attributed to the misinformation campaign waged by public health authorities. 

Tobacco prohibitionists continue their pursuit of a “tobacco-free society” or “tobacco endgame”, supported by a regulatory scheme that transfers hundreds of millions of dollars annually from tobacco manufacturers through the FDA and NIH to anti-tobacco researchers and institutions (here). 

Unlike the U.K., where prestigious medical societies and experts routinely share the scientific facts about e-cigarettes, there is no balance in the U.S. to the tsunami of misinformation.  Given this, it is remarkable that even one-quarter of Americans know the truth about e-cigarettes, and that 2.5 million former smokers currently use them (here).

Smokeless tobacco products, chewers and dippers have been targets of a similar misinformation campaign for 35 years; the HINTS survey demonstrates the effect of that effort.  Asked if smokeless tobacco products were less hazardous than cigarettes, only 11% of participants correctly answered “yes,” 67% responded “no” and 22% didn’t know.  In other words, 89% of Americans have no clue that dipping and chewing are 98% safer than smoking.  Anti-tobacco propagandists are directly responsible for this dismal statistic. 

Misinformation keeps people smoking and keeps smokers dying.

British Government Backs E-Cigarettes for Smokers

Public Health England last week became the first national government agency to endorse e-cigarettes as safer options for current smokers.  Its report also dispelled several bogus anti-tobacco claims.

PHE encourages smokers to switch to e-cigarettes in order to stop smoking and to reduce smoking-related diseases and deaths.  The agency strongly rejects the claim that vaping is a pathway to smoking: “There is no evidence that e-cigarettes are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it.”

Additionally, PHE refutes scaremongering about nicotine poisoning (a subject I previously discussed here): “When used as intended, e-cigarettes pose no risk of nicotine poisoning to users, but e-liquids should be in ‘childproof’ packaging. The accuracy of nicotine content labelling currently raises no major concerns.”

I have noted that some researchers have fabricated claims that vapor contains dangerous levels of formaldehyde (here and here).  PHE rejects the assertion: “Two recent worldwide media headlines asserted that e-cigarette use is dangerous. These were based on misinterpreted research findings. A high level of formaldehyde was found when e-liquid was over-heated to levels unpalatable to e-cigarette users, but there is no indication that…users are exposed to dangerous levels of aldehydes.”

Unfortunately, the PHE report overreaches in one respect.  It says that “best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes,” and this became the dominant media headline upon the report’s release.  To be accurate, PHE should have reported that e-cigarettes are far less harmful than combustible cigarettes, without specifying a percentage; there is no hard data to support a number.

The 95% is derived from the reported opinions of a group of international experts in a publication last year.  The opinions were merely “guestimates”.  In truth, the health risks of long-term vaping are not known, and they are at this time unknowable.  While there is universal agreement among tobacco research and policy experts that inhaling a vapor of propylene glycol, nicotine and flavoring agents is vastly safer than inhaling smoke containing thousands of toxins, the precise risk differential is unknown.

I routinely criticize e-cigarette opponents for violating scientific principles when they make outrageous claims against the products.  Recognizing that the PHE report is a welcome endorsement of tobacco harm reduction and e-cigarettes, I am disappointed that its value is at all compromised by a comparison that cannot be scientifically validated.