By Linda Bauld
Source: The Guardian
In his recent ‘Comment is free’ piece Nash Riggins claims that vaping is just as dangerous as smoking, and expresses robust support for NHS Boards in Scotland who intend to ban the use of electronic cigarettes when their grounds go tobacco free in April.
The reader might be left with impression that the use of nicotine is simply not compatible with public health aims, and that e-cigarettes should be subject to the same restrictions as tobacco products. However, to reach such a conclusion Riggins overlooks an extraordinary body of evidence pointing to the contrary. Disregarding this evidence could mean missing out on the potential of e-cigarettes to save lives. Let’s look at his assertions.
E-cigarettes are not safer than smoking
Smoked tobacco is a lethal product that kills one in two of its regular users, who lose on average 10 years of life. Smokers die from the tar particles and toxic gases drawn into the body from smoking rather than from the nicotine. However it is the nicotine that is addictive. Many smokers find it very difficult to give up nicotine and will continue to smoke cigarettes without an alternative. That’s why products like nicotine replacement therapy were invented and are licensed as safe to use, including for groups like pregnant women who smoke and children over the age of 12 who smoke.
E-cigarettes are currently unlicensed, but both the National Institute for Health and Clinical Excellence and the Medicines Healthcare Regulatory Association acknowledge that their use is safer than continued smoking. This is not simply an opinion, it is an evidence-based statement, and one that is supported by tobacco control organisations in the UK. To imply otherwise is incorrect. This does not mean e-cigarettes are risk free, but few things are. What it does mean is that their use is safer than continued smoking.
The nicotine in e-cigarettes is dangerous
The author claims “E-cigs don’t contain the same type of nicotine you might find in an ordinary tobacco leaf. They contain liquid nicotine, which can be lethal.”
Nicotine is a substance naturally found in particular plants, not just tobacco leaves but aubergines, tomatoes, potatoes and some flowers. However, when derived from the tobacco leaf it is addictive and tobacco is possibly the most used drug in the world following caffeine.
In its base form, nicotine is a liquid. Although synthetic nicotine has been manufactured, it is not commercially viable and the nicotine in electronic cigarette liquid comes from exactly the same source as the nicotine in tobacco – it is extracted from plants including the tobacco leaf. This is also the source for nicotine in Nicotine Replacement Therapy.
Public misunderstanding of nicotine prevails and even those involved in delivering support to smokers to stop can hold the view that longer term nicotine use (of licensed or unlicensed products) is harmful. So it is a common misperception. The NICE guidance makes it clear that this concern is misplaced. It is about understanding the difference between high risk and low risk.
Riggins is correct that drinking liquid nicotine could be lethal particularly for a child. However, there are many poisons in households that can kill or harm children if consumed, and ingesting licensed nicotine-containing medicines also confers risk.
To put this in context, in the USA there were 2.6 million calls to poison control centres in 2013 and 0.06% of these related to nicotine products including e-liquids. These liquids need to be safely packaged and clearly labelled, and users need to keep these products away from children.
Electronic cigarette use should be banned in public places
There is an ongoing debate about e-cigarette use in public places and the recent case of NHS grounds in Scotland highlights this. Public consultations in Wales and Scotland have asked whether they should be included in smokefree laws. However, it is important to be clear about the health evidence. E-cigarette vapour is not second hand smoke. In fact, it is not smoke at all and there is no good evidence that exposure is harmful to bystanders (particularly outside, as in NHS grounds). To claim otherwise is simply factually incorrect.
While some of the longer term impacts of continued vaping are unknown, using health arguments to support public places bans is not viable. Other grounds including etiquette or aesthetics are issues for individual businesses or premises to consider.
In the near future at least some electronic cigarettes will become licensed as stop smoking medicines, and when that happens NHS bans will be unworkable. For the moment, however, they simply serve to discourage smokers from trying what appears to currently be the most popular aid to stopping smoking in the UK. These products are a disruptive technology and debates on their merits will continue. However, while it does, those who feel moved to comment should do some reading first.
Linda Bauld is Professor of Health Policy at the University of Stirling and Deputy Director of the UK Centre for Tobacco and Alcohol Studies. She is a former scientific adviser on tobacco control to the UK government, and recently chaired the NICE guidance group on tobacco harm reduction.