Promote E-cigarettes to Cut Smoking Rates, Say MPs

Peter Russell

August 17, 2018

Restrictions on e-cigarette manufacturers promoting their products as a healthier alternative to smoking tobacco should be eased, MPs have said.

An inquiry by the House of Commons Science and Technology Committee said restraints on licencing and prescribing them should also be relaxed.

"Smoking remains a national health crisis and the Government should be considering innovative ways of reducing the smoking rate," commented committee Chair Norman Lamb MP.

'Substantially Less Harmful Than Smoking'

MPs heard an estimate that e-cigarettes were substantially less harmful – by around 95% – than conventional cigarettes because they do not contain the most dangerous ingredients, tar and carbon monoxide.

The committee acknowledged that some doubts linger over the long-term health effects of e-cigarettes because they are a relatively new invention and do not yet have a history of long-term use. However, they concluded that existing smokers should be encouraged to quit smoking tobacco in favour of e-cigarettes because they represented a less harmful alternative.

Concerns that e-cigarettes would act as a significant 'gateway' to conventional smoking, including for young non-smokers, had not materialised, MPs said. Also, the devices did not pose a significant health risk through second-hand inhalation.

Around 2.9 million people in the UK currently use e-cigarettes. It has been estimated that about 470,000 people are using them as an aid to stop smoking, and tens of thousands are using them to successfully quit smoking each year.
 

Ease Regulations and Review Vaping Ban in Public Places

MPs said the Government should allow more freedom to advertise e-cigarettes as the relatively less harmful option, and provide financial incentives, in the form of lower levels of taxation, for smokers to swap from cigarettes. 

They also called for ministers to reconsider restrictions on 'vaping' in public places. MPs said although many businesses, including public transport providers, do not allow e-cigarettes in much the same way that they prohibit smoking tobacco, there was no public health or fire safety rationale around the e-cigarette ban.

Limits on e-cigarette refill strengths and tank sizes, and the approval systems for stop smoking therapies such as e-cigarettes, should be reviewed, they said.
 

NHS Trusts 'Should Review Their Policies'

The committee also heard evidence that individuals with mental health problems smoke significantly more than the rest of the population and could benefit considerably from using e-cigarettes, but that it was "unacceptable" that a third of the 50 NHS trusts in England which responded to a survey ban them. NHS England should set a policy of mental health facilities allowing e-cigarette use by patients unless trusts could demonstrate evidence-based reasons for not doing so, the report said.

It called on the Government to support a long-term research programme into e-cigarette use, overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, with the detailed evidence being made available to health professionals and the public. 

"If used correctly, e-cigarettes could be a key weapon in the NHS's stop smoking arsenal," said Mr Lamb. "E-cigarettes are a proven stop smoking tool and, while uncertainties undoubtedly remain about their long-term health impact, failing to explore the use of e-cigarettes could lead to the continued use of conventional cigarettes, which currently kill around 79,000 people in England every year. 

"Medically licensed e-cigarettes would make it easier for doctors to discuss and recommend them as a stop smoking tool to aid those quitting smoking.  The approval systems for prescribing these products must be urgently reviewed."

Public Health England (PHE) commissioned research on the safety of e-cigarettes and concluded earlier this year that they were substantially less harmful to health than smoking tobacco. However, it acknowledged that vaping was not proven risk-free, and the long-term impact of e-cigarettes was not yet known.

However, if a patient was interested in using e-cigarettes and using them to help quit smoking, guidance from the National Institute for Health and Care Excellence (NICE) advises informing them that many people have found e-cigarettes helpful in stopping smoking. Patients considering this approach should be told to stop smoking completely.

Could Vaping Damage Lungs and Promote Infection?

Doubts about the safety of vaping were raised earlier this week by new research that suggested the vapour from e-cigarettes could boost the production of inflammatory chemicals in the lungs, which might make them more vulnerable to infection.

The small study in the BMJ journal Thorax , led by the University of Birmingham, found that e-cigarette vapour condensate was significantly more toxic to alveolar macrophage function than non-vaped e-cigarette liquid.

"While further research is needed to fully understand the effects of e-cigarette exposure in humans in vivo, we suggest continued caution against the widely held opinion that e-cigarettes are safe," the authors concluded.

Committee's Report 'Is Evidence-Based'

Commenting on the Science and Technology Committee findings, Linda Bauld, professor of health policy at the University of Stirling, said: "This report is a welcome and evidence-based respite from all the scare stories we see about vaping.  

"The Science and Technology Committee's recommendations urge the Government and others to do more to support smokers to switch to vaping. These recommendations are based on a fair and accurate assessment of existing evidence from the UK that suggests vaping is significantly less harmful than smoking, few young people who have never smoked regularly vape, smoking in young people continues to decline, and e-cigarettes are helping smokers to quit.

“The report shines a light on the mismatch between this evidence and current practice."

Robert West, professor of health psychology and director of tobacco studies at University College London (UCL), said: "While the report may be seen by some as radical in recommending action to facilitate the use of e-cigarettes, from the point of view of a scientist working in the field it is a welcome and common sense translation of the evidence base into a programme of action. I hope it will have a major impact on the evolution of policy."

The Mental Health and Smoking Partnership, which gave evidence to the inquiry, said it welcomed the recommendations. Professor Ann McNeill, co-chair of the partnership and professor of tobacco addiction in the National Addictions Centre at King's College London said: "For too long services have been complacent about smoking among mental health patients and not provided enough support to help smokers become smoke free. A more evidence-based and consistent approach to e-cigarettes would be an important step forward, helping smokers to see that there are much less harmful alternatives for them.

"Trusts should ensure that all smoking cessation treatments are available and accessible to smokers. Trusts that allow the use of e-cigarettes have had a positive experience, with smokers welcoming the chance to make a positive choice to improve their health."

A Department of Health and Social Care spokesperson said: "The best thing a smoker can do for their health is to quit. However, we recognise that the evidence surrounding the use of e-cigarettes is evolving, and there are over 3 million vapers in the UK already. 

"We will carefully consider the evidence and recommendations made in this report and will respond in due course."
 

Prof Robert West undertakes research and consultancy for companies that develop and manufacture smoking cessation medicines but not e-cigarettes or tobacco products. His research is funded by Cancer Research UK.  His group at UCL submitted evidence to the committee

E-cigarettes, House of Commons Science & Technology Committee, 17th August 2018. Report.

Pro-inflammatory effects of e-cigarette vapour condensate on human alveolar macrophages, Thorax, August 2018. Paper.

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