Is it time to e-ase up on 'vaping'?

By on 22/07/2014 in Blog

Birmingham’s Director of Public Health, Dr Adrian Phillips, looks at the thorny issue of e-cigarettes and whether they have a role to play in helping smokers quit.

There are some things in my professional life I can be absolutely certain about:

  • Smoking kills
  • Obesity is a ticking time bomb that threatens future generations of Brummies
  • We would have a much healthier city if we were all more active

But other issues are not so straightforward of course and a topic where I believe there is no definitive answer as yet is that of e-cigarettes.

It seems there is a new story every week about these devices and experts are lined up to do battle on either side of the debate.

Earlier this year, a total of 53 experts from 15 countries including the UK wrote to the World Health Organisation (WHO) to urge it not to ‘control and suppress’ e-cigarettes, saying they have the potential to save millions of lives.

That was followed up by more than 100 leading public health doctors and specialists from around the world also writing to the WHO, calling for e-cigarettes to come under the same tight controls as tobacco products, with bans on advertising and promotion.

Now I'm not one to sit on the fence but I can see both sides of this argument and, as the city's Director of Public Health, I feel it's important that I should clarify my position. So here goes.

Every year over 4,500 people die in Birmingham from a smoking related disease and smoking is directly attributable to:

  • 1 in 4 of all cancers,
  • 1 in 5 deaths from cardiovascular disease (heart disease and stroke),
  • 1 in 3 of all deaths from respiratory disease

So for obvious reasons I want as many people as possible to quit. I want them to quit inhaling tar and tobacco smoke. We know that this causes lung cancer and heart disease: nearly all the harms due to smoking are due to the products in tobacco leaves. Nicotine may cause some harm but it pales into insignificance when compared to the misery caused by tar and tobacco.

How people choose to quit smoking is a matter of personal choice and the best method is the one that works for you.

Some people can simply 'go cold-turkey', stub out a final cigarette and decide they will have no more. Others need help and our Stop Smoking Service offers a range of support for people who want to quit the deadly habit.

The support might involve nicotine replacement therapy (NRT) including patches, gum, lozenges and microtabs. But at the moment e-cigarettes are not available on the NHS.

That doesn't mean people aren't turning to these devices though and according to research from ASH earlier this year:

  • An estimated 2.1 million adults in Great Britain currently use electronic cigarettes.
  • About one third of users are ex-smokers and two-thirds are current smokers.
  • The main reason given by current smokers for using the products is to reduce the amount they smoke while ex-smokers report using electronic cigarettes to help them stop smoking.

So should e-cigarettes become a new weapon in our fight against smoking?

I'm starting to think maybe they should.

Yes we need more research into the long-term effects, yes we need to ensure e-cigarettes are not marketed to children and young people, yes we need to make sure they are safe and yes we must be careful not to re-normalise smoking.

But ideally I want people not to be addicted to tobacco and its products including nicotine. Most of all I want people who smoke tobacco to stop their intake of tar and tobacco smoke and stop the major harm due to tobacco. If this means that people choose to transfer their nicotine addiction to e cigs or 'vaping' then this must be better than continuing to smoke tobacco.

Am I right? What do you think?

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There Are 11 Brilliant Comments

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  1. Fergus Mason says:

    Well done for taking such a pragmatic approach! The biggest problem we’re facing on this issue is the conflation of the REAL problem – smoking related disease – with a purely moralistic distaste for nicotine “addiction”. There’s nothing wrong with nicotine and e-cigs allow us to enjoy it in a way that’s about two orders of magnitude safer than smoking, so to restrict them (and make them less attractive as an alternative to smoking) is either silly or spiteful. I can’t quite decide which.

  2. Colin Day says:

    Yes, you are right. Its about choice, and given that choice between 100s carcinogens in tobacco, versus a simple cocktail of liquid nicotine and food flavouring, it really IS no choice

  3. Dodderer says:

    You are right – the letter from the 53 experts were the views of scientists involved in smoking cessation.The reply was mainly from those who do not want to see the tobacco industry profit from any product,irrespective of the harm reduction benefit.

    The smoking ban in 2007 was the first in an increasing number of restrictive measures – the result has been that prevalence has remained virtually the same since then.The evidence is that restriction has stopped being effective but restriction is the only solution for many in Tobacco Control and so they pretend their policies are working and we just need more of them.

    It is somewhat of a shock that several DoPHs have looked at the issue of harm reduction with an independent mind and not just blindly followed the Tobacco Control clamour.You will save thousands of lives

  4. EmS says:

    You are correct and very refreshing to read.
    You can’t force smokers to stop. It is and always was a personal choice.
    On re-normalise smoking. It’s not smoking so how can it re-normalise. Better question is does the number of smokers go down or up?
    On the safety. Absolute safe is impossible. Nothing is safe. They must be safer then smoking.
    And on the kids. They will try them. Which do you prefer. Them starting vaping or smoking. And what if the kid was already a smoker?

  5. David Dorn says:

    You have hit on the essence of harm reduction. It is inconceivable that those 2.1million ecig users have not reduced the harm (actually, more accurately, the risk) posed by the inhalation of the by-products of burning tobacco. I would encourage you to contact Louise Ross as Leicester SSS who can help you implement a sound strategy for encouraging risk reduction without renormalisation etc.

  6. Neal says:

    Well done sir. I only wish more people in Public Health had the sense to see vaping for what it is.

  7. John says:

    Absolutely right.
    Nocotine is a mild stimulant, not the bogeyman it has been made out to be.
    Ecigs are, without doubt, the best possible chance we have ever had to finally end the scurge that is tobacco.
    That the Tobacco Control evangelists are standing shoulder to shoulder with Big Tobacco in wanting Ecigs heavilly regulated, is abhorant.
    I, for one, thank you sir.

  8. Mike Barton says:

    It is a genuine pleasure to see a number of public health directors using common sense and thinking for themselves. Harm reduction works in ways prohibition and enforcement of unreasonable rules fails. The letters from the two respective camps were easy to separate. One came from 53 experts in the field of harm reduction, nicotine and tobacco research and was backed by solid science. The other was written by someone without medical qualifications and countersigned by paediatricians and social engineers. Its science was easily exposed as cherry picked data and insupportable qoutes.

  9. Joanne Partin says:

    Thank you sir for your thoughtful, and coherent views on the subject of harm reduction. Is there any chance you could please try to convince all of your political counterparts that something is better than nothing? Refusing to allow people to reduce the harm they are doing to themselves because it appears that they are still smoking is ludicrous.

  10. christopher emmins says:

    You don’t strike me as a silly man ;-) so i think you know you are right but i would like to take this opportunity to say a heartfelt THANK YOU!

  11. Beki says:

    In a word, yes. You are. Far better to allow the choice of harm reduction than limit the opportunity that ecigs represent. Far better to work with those who have chosen a healthier alternative than fight them and risk their relapse to smoking. Thank you for some refreshing open mindedness and balanced thinking.