A report by Royal College of Physicians has endorsed the use of e-cigarettes, or ‘vaping’, in Britain, raising their arguments in favor of e-cigarettes by stating that it has only five percent of the side effects of smoking, a need for a balanced regulatory authority, and encouragement of NRT to wean people off smoking.
The College also published an analysis of the report in the British Medical Journal (BMJ) on April 27, 2016.
The report comes out after a move by National Health Service earlier in 2016 which called for prescription of nicotine sticks to help patients quit smoking, which in turn was based on a 2014 study, branded as weak and biased due to the conflict of interest of the researchers.
Professor Martin from London School of Hygiene and Tropical Medicine and Professor Capewell of University of Liverpool wrote on the policy and pointed out that there were still questions still unanswered based on the available research and the Director of Public Health needs to provide bias free, suspicion free, and evidence based research to establish stronger foundations for their policies.
An e-cigarette product, the “E-voke” device, was also granted the first license by the Medicines and Healthcare Product Regulatory Agency earlier this year.
This new report acknowledged the harm cigarettes can cause to an individual and the society. RCP recognized that cigarette quitting can be a difficult process and vigorous pursuit of tobacco control policies can persuade the smokers to quit.
The researchers also encouraged the smokers to switch to e-cigarettes because they are addicted to nicotine and nicotine without harmful effects in the form of e-cigarettes can be helpful.
Through the use of nicotine (nicotine replacement therapy) to help people quit has been marketed as a ‘medicine’ as of yet, the doctors at RCP suggest that e-cigarettes marketed as consumer products attract people more and have shown to help by being an effective aid to quit smoking.
Nicotine replacement therapy (NRT) entails the use of nicotine without smoking to help people stop smoking.
The report recognized that currently the manufacturing practices for e-cigarettes are not highly standardized but the available product is unlikely to go beyond five percent of the harm smoking can induce in a human. It also called for better product and technological development practices for the manufacturing of e-cigarettes.
Concerns about renormalizing the use of cigarettes by promoting electronic ones and influencing youngsters to smoke cigarettes by acting as a ‘gateway’ were also addressed in the report. The report did not find evidence for any of these claims rather the available evidence suggested the exclusive use of these cigarettes by confirmed smokers to smoking cigarettes.
The report urged for a balanced regulatory strategy to reduce the direct and indirect side effects of the e-cigarettes in an effort to encourage smokers to use these cigarettes instead of tobacco.
John Britton, chair Tobacco Advisory Group for RCP, said, “With sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK. Smokers should be reassured that these products can help them quit all tobacco use forever.”
RCP also highlighted and cautioned against the growing involvement of tobacco industry in the e-cigarette market to exploit these products for marketing cigarettes indirectly. The report encouraged the use of nicotine replacement therapy, e- cigarettes, and use of other non-tobacco products as substitute for smoking in the United Kingdom.
Multiple perspectives on the subject exist today. The ‘For team’ often argues that the e-cigarettes have fewer carcinogens, are effective tools to help cessation of smoking tobacco, are cheaper than traditional smoking expenses, according to one US study, and have less harmful secondhand smoke effects. They argue that e-cigarettes are socially more acceptable due to demure smell, same experience and sensation which can help smokers quit tobacco cigarettes.
The ‘Against team’ debates that the nicotine is still an addictive drug which most of the e-cigarettes contain along with several carcinogens and formaldehyde, the industry is unregulated, youngsters are soft targets, and that the act and routine usage can form subconscious smoking habits.
All these arguments have led to different takes on the published report.
Professor Simon Capewell of the Faculty of Public Health said that there is not enough information available on long term effects of e-cigarettes but there is solid evidence on their use to help people quit smoking.
Professor Jane Dacre, president RCP, also said, “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. With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people. It is an opportunity that, with care, we should take.”
Public Health England has also supported the use of e-cigarettes as an alternative to smoking as well in the past.
Experts from the University of Liverpool and London School of Hygiene and Tropical Medicine have been resistant in backing this effort before more scientific research into the effects of e-cigarettes on individual and on the society as a whole can be conducted.
Dr Tim Ballard, vice-chair of external affairs at the Royal College of GPs, has also refused to support the e-cigarettes right now and has urged NICE to conduct more research to collect information on the subject before the college could get behind it.
World Health Organization, according to a 2014 report, has also called for a ban on the use of e-cigarettes in public and workplaces due to concerns on potential risks for pregnant women and children under 18 and also due to their marketing via candy and fruit flavors.
Several efforts to raise awareness on tobacco smoking and the use of e-cigarettes to help people quit are currently being carried out.
The most important one is perhaps the annual e-cigarette summit, conducted each year to provide a platform to debate the merits and non merits of the usage of e-cigarettes, provides vital information on the subject.
Last year important issues like e-cigarette risks, current clinical trials, evidence on gateway, implementation of TPD, conflict of interests in the scientific studies, and innovation in NRT were discussed.
The event invites more than 300 dignitaries each year from the scientific community to express their views and share information on the subject. Regulators, policy advisors, stop smoking campaigns, health providers, health campaigners, health charities, health campaigners, local and national authorities, public health professionals, scientists, and e-cigarette industry stakeholders are involved in the effort each year.
According to the latest data, nearly 10 million adults in UK smoke cigarettes and two-thirds of them start before the age of 18. 100,000 deaths are reported each year in the UK due to cigarette smoking.
A survey conducted for the current year estimated that out of total eight million smokers, more than a million people who tried to quit used e-cigarettes. Nearly three million people have used them in UK since their introduction in the market till last year.