E-cigarettes: What are the risks?

15 December 2014

Interview with

Robert West, University College London

Over the past few years the use of electronic or E-cigarettes has expanded massively, sparking a passionate debate among scientists, health organisations and users about their safety and risks as well as their potential benefits for helping people to quit. But what's the scientific evidence about their safety, and who's using them? Kat Arney spoke to Robert West, Professor of tobacco research at UCL...electronic cigarette

Robert -   We know a lot about the concentration of the vapour that's coming from e-cigarettes.  The best estimate is that it's somewhere in the region of a twentieth as harmful as cigarette smoke which of course is extremely harmful.  Not completely safe, but much safer than smoking.  We know that the vast majority of people who are using e-cigarettes, certainly countries like the UK are smokers who are trying to stop or cut down.  Very, very few people who are never smokers or long term ex-smokers are using these products.

 Kat -   People who are concerned about e-cigarettes, they sort of broadly fall into two camps.  There's almost the Father-Ted-style "careful now" and then there's the people who go, "these are much less harmful than cigarettes, we should just let people use them, we should encourage people to use them to get away from traditional cigarettes".  Where do you kind of see these two camps dividing up?

 Robert -   I think one of the problems is that the two camps are coming from different moral positions.  One camp is coming from what you might consider a utilitarian position where you count deaths and you count harm, and you weigh it up and you try and formulate policies on the basis of which policy is going to cause the least harm or the most benefit.  The other camp, although they don't necessarily say this, that's my impression, is that they're coming from much more absolute stance that tobacco industry is bad, nicotine is bad, smoking is bad, and it's all as bad as each other.  What you tend to do, once you start with a certain moral position, you tend to see the evidence in that way and you tend to shape the evidence in that way.  So, the moralistic camp tends to exaggerate the harms of e-cigarettes and the potential dangers and downplay the potential benefit.  The other camp downplay the risks and actually potentially exaggerate the benefits.  It's a difficult job to try and find a path through this in terms of saying, "What are the actual facts here?"

 Kat -   As scientists obviously, we should be basing our decisions on facts and you would hope that health policy makers would base their decisions on facts.  Do you think we have enough scientific evidence about e-cigarettes or what more evidence do we need to gather before we can work out - are they safe?  Who should be using them?  How should they be legislated for?

 Robert -   I think it's like any health policy decision.  You collect data and then you formulate policy and then you collect more data and you adjust policy.  And so, I think the policy approach that's being adopted by the English Department of Health and Public Health England is about right, which is to take a relatively cautious view but also, to recognise potential benefits.  So e-cigarettes, if they don't make a medicinal claim can be manufactured and sold as a consumer product but with restrictions.  So, you can't sell it to people under 18 and there are restrictions on marketing.  And you monitor as we do on a monthly basis what goes on, you see how things are developing.  That policy seems to be working quite well.  We're tracking the smoking problems and the use of e-cigarettes on a monthly basis in England.  What we're finding is that problems continue to decline.  Actually, quitting rates are higher now than they have been since we started tracking it back in 2007, so that's looking quite good.  We're not seeing takeup of e-cigarettes among non-smokers.  You know, so far so good.

 Kat -   One of the things that people do get concerned about is for example, we're now seeing adverts on the sides of buses for e-cigarettes that look for all the world like adverts for cigarettes.  A lot of big tobacco companies have now bought in to e-cigarettes and people are worried that it's maybe renormalizing smoking after a lot of work to make smoking not look cool, to ban tobacco advertising.

 Robert -   There is a theoretical risk that the way that e-cigarettes are marketed that they could be seen to renormalize smoking and to undermine all the work we've done on tobacco control, so we have to look at that.  But one thing to remember about the tobacco industry is that they would like nothing more than for e-cigarettes to go away.  What better way of helping to make e-cigarettes go away than to do terrible things, buy up e-cigarettes and get the public health community to be anti-e-cigarettes.  And then you have this accidental unholy alliance between the public health community and the tobacco industry, both achieving the common goal of making e-cigarettes disappear.  The thing to remember is that the death toll from smoking is absolutely enormous and gigantic.  It's a catastrophe that continues on a daily basis with 6 million people a year worldwide being killed by tobacco, dying prematurely as a result of something that seems to be accepted within society.  So, we just have to remember what the challenge is here.

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