E-Cigarettes Are Safer And The NHS Should Welcome Their Use
In its clearest message yet that e-cigarettes are CONSIDERABLY safer than smoking Public Health England has released a new review clarifying their position on vaping.
PHE has gleaned information from a variety of reputable sources and among the key conclusions is e-cigarettes should be on sale within NHS hospitals alongside other nicotine replacement products.
They key points of the review are: :
- vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits
- e-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more
- e-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates acro
ss the country
- many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette
- there is much public misunderstanding about nicotine (less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine)
- the use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million
- the evidence does not support the concern that e-cigarettes are a route into smoking among young people (youth smoking rates in the UK continue to decline, regular use is rare and is almost entirely confined to those who have smoked)
This is the fourth review PHE has done on the state of the vape and the first since 2015 and covers a great deal of research into e-cigarettes with very many experts – studies and scientific papers used as evidence.
In a nutshell PHE strongly believes as many as 57,000+ lives a year in England alone could be saved if more smokers quit using e-cigs.
As always the mainstream media has pounced on one single angle of the review and that is e-cigarettes should be made available on NHS prescriptions and patients should be allowed to vape in their beds on hospital wards.
Cue the anti-vape brigade pouncing on that one morsel – I’ll look at that further down.
OK this is a resounding green light for vaping and indeed smokers thinking of quitting and I shall break it down into the key areas.
So who exactly are Public Health England?
The UK Gov website says:
…PHE exists to protect and improve the nation’s health and well-being, and reduce health inequalities.
We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and providing specialist public health services.
We are an executive agency of the Department of Health and Social Care, and a distinct organization with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific expertise and support.
So this is not some tiny little office tucked away in a backwater of Westminster – when this renowned organization speaks on health matters the world listens.
OK let’s break this huge in words and consequence review down into manageable chunks.
The Purpose of the Evidence Review Of E-Cigarettes
Smoking rates in England have fallen to the lowest point in history and in the PHE review last year it showed whilst 15.5% of the population still smokes – it’s a huge fall with says PHE e-cigarettes obviously playing a major role.
Given tobacco related diseases are still the leading preventable cause of death and e-cigarettes are most likely to be contributing considerably to the drop in smoking prevalence – this review is required to advise Governments and the NHS on policies surrounding the use of e-cigs.
Heat Not Burn products have been included in the review – something that grates with me but more on that at the end.
The Myths Around Nicotine
PHE makes it VERY clear that nicotine is a relatively harmless substance and suggest that nicotine in lit tobacco products may mix with other chemicals adding to the addictive properties.
The review says:
While nicotine has effects on physiological systems that could theoretically lead to health harms, at systemic concentrations experienced by smokers and e-cigarette users, long-term use of nicotine by ‘snus’ (a low nitrosamine form of smokeless tobacco) users has not been found to increase the risk of serious health problems in adults, and use of nicotine replacement therapy by pregnant smokers has not been found to increase risk to the foetus
The review also makes it very clear that vaping during pregnancy is considerably safer to both the mother and baby than smoking.
PHE comes across as quite cross about the public’s understanding of the harm from nicotine [you can blame the media for that!] saying:
Misconceptions of nicotine and different nicotine-containing products need to be addressed.
These have deteriorated further since the PHE report in 2015 which called for clear and accurate information on relative harms.
So let’s be clear here – nicotine is a pretty safe chemical when used correctly particularly in e-cigarettes and PHE go as far to say that as e-cigarettes have evolved the delivery of nicotine has improved making them more than ever ‘attractive alternatives‘ to smokers looking to quit.
E-Cigarettes And Young People
I’ve lost track of the amount of times I’ve personally rebutted this argument that e-cigs lead to kids smoking.
PHE are VERY clear on this hot anti vaping topic:
Despite some experimentation with these devices among never smokers, e-cigarettes are attracting very few young people who have never smoked into regular use. Click To Tweet
E-cigarettes do not appear to be undermining the long-term decline in cigarette smoking in the UK among young people.
Is that clear enough for the anti-vape lobby?
Somehow I doubt it.
E-Cigarettes and Adults
Despite a surge in the use of e-cigarettes the number of vapers in England has largely remained at the current level of 3million – roughly 6% of the population.
PHE says the vast [and I mean vast] majority of vapers are former smokers with the tiniest fraction of 1% so called never smokers.
Given these kind of reviews and studies like to look at so called socio-ecomonic factors the interesting thing here is that there’s no rich and poor divide when it comes to vaping.
Indeed the review says:
The most common reason for e-cigarette use continues to be in order to stop smoking, and smokers who use e-cigarettes on average have higher motivation to stop smoking than other smokers.
Might I suggest the current level of smokers switching to vapers is largely down to the scare stories that pepper the media on an almost weekly basis…
E-Cigarettes and The Reduction Of Smoking In England
Whilst the number of vapers in England appears to have leveled out in the latter part of 2017 PHE makes it quite clear the enormous health benefits e-cigarettes bring:
…the evidence suggests that e-cigarettes have contributed tens of thousands of additional quitters in England.
You really can’t be any clearer than than when it comes to the worth of e-cigs and vaping as a smoking cessation tool alone.
As far as policy is concerned PHE tells local stop smoking services and councils that:
- Stop smoking practitioners and health professionals should provide behavioural support to smokers who want to use an e-cigarette to help them quit smoking.
- Stop smoking service practitioners and health professionals supporting smokers to quit should receive education and training in use of e-cigarettes in quit attempts.
Poisonings – Fires and Explosions
Nothing gets the media more whipped up in an anti-vape frenzy than reports of a badly wrapped battery exploding in a vapers pocket or bag OR come to that the risks of poisoning from e-liquids.
However – the PHE review covers this and makes it very clear poisoning – fires and explosions are EXTREMELY rare.
On poisoning they say:
There are recorded cases of poisoning from e-liquid in the UK. These have predominantly involved accidental ingestion with fewer incidences of other routes (eg ocular or dermal) of exposure.
E-cigarette poisonings reported to medical centres most commonly occur in children under five years old. Toxic effects for this age group are usually short in duration and non-severe.
…Incidents of poisoning in children are often preventable and have involved liquids stored non-securely, in unmarked containers or in containers without safety caps.
I know I don’t have to say this but please keep your e-liquids away from children and in childproof bottles!
As to fires caused by faulty vape equipment PHE says:
Information provided to us through a Freedom of Information request suggest that, where recorded, they occur in low numbers and are vastly outweighed by fires caused by smokers’ materials.
There were no fatalities from fires caused by e-cigarettes in the reporting period.
As to ‘exploding’ e-cigarettes the review states:
Incidents are very rare. The cause is uncertain but appears to be related to malfunctioning lithium-ion batteries.
That’s true to some extent and as many more experienced vapers know battery safety is of the utmost importance.
Please check those battery wraps before use and if there’s the slightest damage replace or re-wrap!
E-Cigarettes And the Risk To Health
Once again recent media scare stories have suggested that e-cigarettes can cause cancer.
This is another hot topic I’ve rebutted numerous times however PHE makes its position crystal clear on this emotive subject:
As to the old argument of so called passive vaping PHE once again rebuts this:
To date, there have been no identified health risks of passive vaping to bystanders.
Public Health England whilst recognizing e-cigarettes are not 100% safe – after all what is – they do give a clear indication of the positive health benefits of smokers making the switch:
Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits over continued smoking.
Based on current knowledge, stating that vaping is at least 95% less harmful than smoking remains a good way to communicate the large difference in relative risk unambiguously so that more smokers are encouraged to make the switch from smoking to vaping.
It should be noted that this does not mean e-cigarettes are safe.
I believe they mean are not 100% safe and like I said what is?
Heat Not Burn Products
The PHE review says the arrival of HNB products such as iQOS is relatively new and in England the use is extremely low.
They also point out that much of the ‘research’ on the effect on health are limited on the whole to ‘in house’ studies – in other words research carried out by Big Tobacco’s own in house scientists.
Calling for more independent research PHE says:
Heated tobacco product use reduced urges to smoke, but smokers consistently reported heated tobacco productuse to be less rewarding compared with smoking a cigarette.
…The limited evidence on environmental emissions from use of heated tobacco products suggests that harmful exposure from heated tobacco products is higher than from e-cigarette, but further evidence is needed to be able to compare products.
Given the available evidence PHE is unclear as to whether HNB is a viable smoking cessation tool but they believe they could be more dangerous to health than e-cigarettes.
Expert Reactions to the PHE Review
The New Nicotine Alliance said:
We are very pleased to see that PHE are reinforcing and building on the message that vaping is substantially safer than smoking.
For many years now England has led the world with its pragmatic approach to reducing the harms of smoking by encouraging the use of safer alternatives, but public misperceptions about the relative safety of vaping have increased.
We hope that this report will go some way to setting the record straight.
Professor John Newton, Director for Health Improvement at PHE said:
Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.
Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.
It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.
That last line should be sent to every single media outlet in the world in huge bold letters.
As I’ve said many times every single time the media runs a scare story around vaping they are in effect sentencing millions of smokers to slow agonizing lit tobacco related deaths.
Fraser Cropper – chairman of IBVTA – the Independent British Vape Trade Association said:
The ability of vaping to transform the public health landscape is routinely undermined by the repetition of irresponsible reporting which ignores the relative risk of vaping and smoking.
We welcome this updated evidence review from Public Health England which re-enforces the harm reduction potential and public health gains which can only be realised if smokers are given accurate information about vaping.
We especially welcome the report’s recommendation that further research should specifically assess the impact of the EU Tobacco Products Directive on consumers and the independent vape sector, free from any links to the tobacco industry, who introduced vaping to the UK and who continue to run the overwhelming majority of vape businesses in this country, as well as their customers.
Professor Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London agreed:
It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.
People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm.
The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death.
There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes.
Speaking of the myth that vaping leads youngsters to smoking – Professor Linda Bauld, author and Professor of Health Policy, University of Stirling and Chair in Behavioural Research for Cancer Prevention, Cancer Research UK said:
Concern has been expressed that e-cigarette use will lead young people into smoking.
But in the UK, research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1%, and youth smoking continues to decline at an encouraging rate.
We need to keep closely monitoring these trends, but so far the data suggest that e-cigarettes are not acting as a route into regular smoking amongst young people.
The evidence is clear and mounting – e-cigarettes are not only considerably safer than smoking – they also are the very best way to quit that deadly habit.
Final Thoughts On The PHE E-Cigarette Review
I called this article a ‘resounding support of vaping’ and without doubt it is.
Public Health England has long championed vaping and e-cigarettes as both life saving and life changing products and continues to do so in even more glowing terms.
They make it very clear that for every single negative false scare story the media churns out about the ‘dangers of vaping‘ – usually from obscure sources – more smokers wrongly believe vaping is as dangerous if not more so than smoking.
This is plainly false and it’s not me saying it – it’s world renowned experts who know what the hell they’re on about.
If I’m a little annoyed about one thing – it’s the inclusion of Heath Not Burn products in this review.
Whilst I of course welcome more research – it’s the fact that HNB is being lumped in with e-cigarettes and this could cloud the positive arguments.
My point is quite simple – e-cigarettes do not contain tobacco – yet HNB products do.
No matter how you dress that up with suspect in house research or slick PR and marketing – the fact remains HNB contains tobacco and e-cigarettes do not.
I would like to see a clear distinction made between the two and definitely vaping removed from the Tobacco Products Directive [TPD] because quite simply there’s NO tobacco in there!
Otherwise this is yet another fantastic shot in the arm for vaping – vapers and of course smokers and let’s hope the whole world is watching.
The Truth About ‘Vaping In Hospital Beds’
As to this call for vapers to be allowed to smoke in hospital beds?
That’s a little ‘sexed up’ as they say.
That little snippet has of course been pounced on and nowhere in the review does it make the case for that.
The quote comes from Martin Dockrell – PHE tobacco control lead who told the Guardian:
We would certainly encourage them [hospitals] to make at least some single occupancy rooms where people can vape.
That’s the direct quote – the rest is attributed to what he said without the quotation marks.
But hey that’s just enough for the press to pounce.
It’s a tiny point but the tabloids in particular are going to town on this particularly as the NHS is currently under severe financial pressure.
That’s how newspapers and now the online media work and have worked for years – it’s click-bait aimed at the ‘tut tut’ Mr Angry from Tonbridge Wells.
However many NHS properties operate a no vaping policy on their land and inside buildings and this is something that urgently needs addressing.
One thing is very clear and that is the media has decided almost collectively to give little if any positive coverage of vaping or indeed the potential e-cigarettes have to save lives.
It’s sad but true bad news sells.
OK I’ll step off my soapbox – again lol.
Key Vaping Policies For the NHS
To be very clear these are the key points made regarding e-cigarettes and the NHS:
- e-cigarettes, alongside nicotine replacement therapies are available for sale in hospital shops
- vaping policies support smokers to quit and stay smokefree
- smoking shelters be removed
- frontline staff take every opportunity to encourage and support patients to quit
As to offering e-cigarettes on NHS prescriptions there’s no plans only a suggestion for this to happen especially given the only ‘licensed product’ of its kind given the green light for such a scheme – the eVoke produced by British American Tobacco 2 years ago – is no longer in production.
That – as they say – is a whole different article to tackle!
So to sum it all up – this is an extremely positive review and moving forward it means the battle to get acceptance that vaping is far safer than smoking is being won at least by health experts in the know.
The main battle is public perception and that I’m afraid is down to the mainstream media and how they portray vaping.
I won’t hold my breath for a sea-change from them but can only hope many of these Public Health England recommendations and policies are followed – leading to more smokers quitting and more lives will be saved.
You can read the full review here: Evidence review of e-cigarettes and heated tobacco products 2018