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The Vaping Post: End of April, the Royal College of Physicians (RCP) published a report on e-cigarette that received a large coverage by the media. What do you think of this report?

Clive BatesThe RCP drew together a panel of experts to provide a synthesis of the science and policy issues. It is a very good piece of work and designed to help policy-makers, campaigners, commentators and consumers understand the science.

I would say there are three really important findings.

First, the RCP gives a carefully worded statement on the relative risk of smoking and vaping, reflecting the reality that we don’t know everything about long term effects and can’t know until several decades have passed. However, because we don’t know everything it does not mean we know nothing.

“Most of the hazardous chemicals in cigarette smoke are either not present in e-cigarette vapour or present at much lower levels, mostly far less than 1%.”
There is extensive understanding of the toxicology of e-cigarette vapour and cigarette smoke. Most of the hazardous chemicals in cigarette smoke are either not present in e-cigarette vapour or present at much lower levels, mostly far less than 1%.  At the same time, we haven’t identified other exposures that would breach occupational health limits, so the RCP has framed this understanding with the following words:

“Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure”. (Section 5.5 page 87)

Given that in 2016, only 15% of the British public accurately believe that electronic cigarettes are a lot less harmful than smoking and 47% of Americans think vaping is no less harmful than smoking, this statement is designed both to reset perceptions of risk to a level much closer to reality, but also to acknowledge uncertainty in both directions, with the stress on the risk being likely to be even less that 5% of smoking.

“Many anti-vaping activists argue that e-cigarette might do harm.”
Second, many anti-vaping activists argue that e-cigarette might do harm because they change smoking behaviour – for example, the ‘renormalise’ smoking, reduce the rate of quitting or create ‘gateway effects’ that recruit adolescents to smoking. The RCP examines the available data and concludes the opposite explanations are more likely:

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 (Key Recommendations).

“The RCP warns regulators that their actions may cause unintended consequences and increase smoking.”
The third important finding is the advice on regulation. The RCP recognises that excessive regulation can be harmful – effectively protecting the cigarette trade and denying smokers better alternatives. Considering RCP is a top-level medical organisation, it is also highly significant that they have understood this as a consumer phenomenon, not a medical smoking cessation treatment. The RCP warns regulators that their actions may cause unintended consequences and increase smoking:

A risk-averse, precautionary approach to e-cigarette regulation can be proposed as a means of minimising the risk of avoidable harm, e.g. exposure to toxins in e-cigarette vapour, renormalisation, gateway progression to smoking, or other real or potential risks. However, if this approach also makes e-cigarettes less easily accessible, less palatable or acceptable, more expensive, less consumer friendly or pharmacologically less effective, or inhibits innovation and development of new and improved products, then it causes harm by perpetuating smoking.  Getting this balance right is difficult. (Section 12.10 page 187)

This is the most critical paragraph in the whole report in my view, and it is where every regulator has gone wrong – the European Union, the FDA in the United States, and the WHO internationally. Without exception, regulators are failing this test and introducing regulation that does more harm than good, apparently oblivious to the squandered opportunity and casual harm they are causing.

The Vaping Post: What are the current fears about it?

“Many in the tobacco control and public health community are doing what the tobacco industry used to do 30 years ago”
Clive BatesMy greatest concern right now is that many in the tobacco control and public health community are doing what the tobacco industry used to do 30 years ago. I think that misleading people and policy makers by pretending that e-cigarettes are more harmful than they actually are is no different logically and ethically to claiming that smoking doesn’t cause cancer or the data is too uncertain to be sure.

 

The tobacco companies used to lie about smoking 30 years ago, but we are seeing some really deceitful statements about e-cigarettes from public health experts today. The noise about e-cigarette coming from some establishment figures is so misguided scientifically and ethically that it should be dismissed without comment. But sadly, it remains influential in politics and regulation.

The Vaping Post: Do you think regulators are only ignorants or maybe corrupted by lobbies like tobacco industry and/or pharmaceutical industry?

“I think some of their distortions and hype are now worse than the tobacco industry ever was”
Clive Bates: Not really, I think more subtle forces are at work. Regulators like to regulate. It’s what they do, and they rarely say “nothing for us to do here, it looks like the free market is taking care of it”. If they can cast themselves as fearless protectors of the people, especially the children, they feel as if they are doing something good for society. The trouble is to do that they have to believe in a problem to which they are the solution.  So the ‘problem’ they need is provided by public health activists endlessly creating moral panics, exaggerating risks, stirring up fear and confusion while ignoring huge benefits to consumers.

It is the hyperbole and distortions of the public health lobby that are the underlying cause of over-zealous regulation, and it will do the exact opposite of what they want – protect Big Tobacco. These health and medical organisations carry a lot more weight and respectability than either the tobacco or pharma industry, but they hardly know anything about business, markets and innovation. I blame them for their arrogance and ignorance, and I think some of their distortions and hype are now worse than the tobacco industry ever was. 

The Vaping Post: What is your opinion on flavors in e-liquids?

“If flavours attracted young people to vaping rather than smoking, that would be a public health win.”
Clive Bates: On flavours, I am really concerned by the incredible ignorance of regulators who think that it would be a good idea to ban them because they think they appeal to children. They clearly form a vital part of the adult experience and part of the transition away from smoking. At the same time, they seem to be of little interest to non-smokers, especially non-smoking teens. But just suppose they were. It’s not actually obvious that would be a bad thing. If flavours attracted young people to vaping rather than smoking, that would be a public health win. But you never hear any regulator really thinking about the interaction between smoking and vaping – which is why they ought to listen carefully to the RCP and stop making such an amateurish mess of their responsibilities to the public.

 

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