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News and Comment

What’s the evidence for banning electronic cigarettes?

12 December 2013

We asked the BMA why they want them banned in public.

Update 18/12/2013: Last night the European Union reached a decision on its policy on electronic cigarettes. While they didn’t fully adopt the European Commission’s proposal to compulsorily regulate e-cigs as medicines, the decision will mean the most commonly-used (and least ‘cigarette-like’) refillable e-cigs are effectively banned, and the availability of e-cigs that are approved will be greatly reduced. This move towards heavy regulation appears to be driven by the fear that e-cigs might be harmful or act as a gateway to conventional tobacco – despite little or no evidence for either claim, as set out below.

As individual EU member states will now decide whether to regulate e-cigs as medicines, it’s even more important that the debate in the UK is informed by reliable evidence. We still haven’t heard back from the BMA about the evidence behind their position – perhaps Viscount Ridley raising our Ask for Evidence in the House of Lords yesterday might prompt a reply.

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Today public health officials in Wales have called for electronic cigarettes to be banned in public. This follows a call from the British Medical Association (BMA) for a ban earlier this year. The European Commission are also considering heavy regulation on the availability of electronic cigarettes.

We sent this letter to the BMA on November 15th asking for the evidence behind their claims about ‘re-normalising smoking’ and ‘passive vaping.’ Despite a number of reminders, we have not yet received a response.

 

"For the attention of Co-Chairs of the BMA Public Health Medicine Committee, c/o Will Frost

Dear Will,

Football clubs have been receiving letters from the BMA asking them to stop people using electronic cigarettes in stadiums, something that train companies have already done, citing the Association's advice. As you may know, Sense About Science helps civic organisations to ask for and negotiate evidence and we also respond to their enquiries about whether claims are evidence based. I have had a look at everything I can find on this issue and I am a bit surprised about the strength of your advocacy in light of the evidence.  

From your briefing note (pdf), I would appreciate an explanation of the following points:

  • The briefing says that there isn't enough evidence about the safety and efficacy of e-cigarettes, but cites studies that conclude that e-cigarettes “are a safer alternative to tobacco cigarettes” and that “e-cigarette use has substituted for use of licensed nicotine products rather than growing the market.” Professor Peter Hajek writes in Lancet Respiratory, “more dangerous chemicals such as bleach rely on packaging and common sense rather than on medicinal licensing.” Your conclusion that they should be banned in public and regulated as medicines appears to be in opposition to this. Why?
  • Since your briefing was published, an RCT by Bullen et al concluded that “E-cigarettes, with or without nicotine, were modestly effective at helping smokers to quit, with similar achievement of abstinence as with nicotine patches, and few adverse events.” There's also a Cochrane review imminent. Are you planning to consider and revise your campaign in light of these?
  • The claim about 'passive vaping' needs clarifying as the potentially dangerous compounds found in e-cigarettes are present in concentrations orders of magnitude lower than in conventional tobacco, so much so that there is "no apparent risk to human health from e-cigarette emissions based on the compounds analyzed” according to McAuley et al.
  • I couldn't find any evidence to back up your claims about “reinforcing the normalcy of smoking behaviour," or e-cigarettes being attractive to children or being a gateway to conventional smoking. Is this a hunch?

Best regards,

Prateek Buch

Director, Public Policy Unit
Sense About Science"

Co-Chairs of the Public Health Medicine Committee


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