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 Bates: The 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.
“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.
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).
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?
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?
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.