Smokers Urged to Switchto E-Cigarettes by British Medical Group
Taking a stance sharplyat odds with most American public health officials, a major British medicalorganization urged smokers to switch to electronic cigarettes, saying they arethe best hope in generations for people addicted to tobacco cigarettes to quit.
The recommendation, laidout in a report published Thursday by the Royal College of Physicians,summarizes the growing body of science on e-cigarettes and finds that their benefits far outweigh the potential harms. It concludes resoundingly that, at least so far, the devices are helping people more than harming them, and that the worries about them — including that using them will lead young people to eventually start smoking traditional cigarettes — have not come to pass.
“This is the first genuinely new way of helping people stop smoking that has come along in decades,” said John Britton, director of the U.K. Center for Tobacco andAlcohol Studies at the University of Nottingham, who led the committee that produced the report. E-cigarettes, he said, “have the potential to help half or more of all smokers get off cigarettes. That’s a huge health benefit, biggerthan just about any medical intervention.”
That conclusion is likely to be controversial in the United States, where arguments about e-cigarettes have jolted the traditionally low-key public health community.
E-cigarettes deliver nicotine
without the harmful tar and chemicals that cause cancer
. Some public health experts see e-cigarettes as the first real chance in years for 40 million addicted Americans to quit. But others, including the federal Centers for Disease Control and Prevention
,have focused on the potential dangers of e-cigarettes, for example that they could extend smoking habits, that they could be a gateway to traditional cigarettes for children, or that their vapor could to turn out to have long-term health effects.
“These guys, in my view,are going off a cliff,” said Stanton A. Glantz,aprofessor of medicine at the University of California who has been outspoken inhis criticism of e-cigarettes. “They are taking England into a series of policies that five years from now they all will really regret. They are turning England into this giant experiment on behalf of the tobacco industry.”
But some American public health experts applauded the report, saying the emphasis on policies that reduce harm, such as recommending that smokers try e-cigarettes or giving clean needles to drug users, would probably save more lives.
“This is two countries taking pretty much diametrically opposed positions,” said Kenneth E. Warner, aprofessor of public health at the University of Michigan School of PublicHealth. “One is focused exclusively on the hypothetical risks, none of which have been established. The other is focusing on potential benefits.”
He added, “The British are saying, ‘Let’s see how we can help the main smokers today, who by the way are largely poor and less educated, and let’s not focus so much on kids, who may or may not be sickened by this 40 years down the line.’ ”
Smoking is still the largest cause of preventable death in the United States, with more than 480,000 people a year dying of smoking-related illnesses. In past decades, smoking was spread throughout society, but today in Britain and the United States, smokers tend to be poor, less educated, or mentally ill
E-cigarettes, now a multibillion-dollar market, have gained popularity faster than the federal government has managed to regulate them. The Food and Drug Administration has not yet published final rules that would subject them to federal oversight.
A spokesman for the C.D.C. said the agency would not comment on any report other than its own. He reiterated the C.D.C. position on e-cigarettes: “There is currently noconclusive scientific evidence supporting the use of e-cigarettes as a safe and effective cessation tool at the population level. The science thus far indicates most e-cigarette users continue to smoke conventional cigarettes.”
But the report cites evidence from Britain that e-cigarettes have helped with quitting. Robert West,director of Tobacco Studies at University College London, analyzed monthly household survey data going back to 2009 in England,
and concluded that use of an e-cigarette during an attempt to quit was associated with a 50 percent increasein the chances of success, compared with using no aid or using a product such as nicotine patches without any professional counseling. He estimated that around 20,000 smokers in England quit smoking
in 2014 because of e-cigarettes.
Professor Glantz cited his recent analysis
as evidence that e-cigarettes in fact reduce the chances someone will quitsmoking.
The Royal College of Physicians
is a respected doctors’ group that helps set medical standards in Britain. It issued a groundbreaking report on the dangers of smoking in 1962 that was seen as the precursor of the American surgeon general’s report of 1964 that linked smoking with cancer. The organization’s last major report on reducing harm from tobacco use
came out in 2007, before e-cigarettes became mainstream, and its authors said the new one was an attempt to evaluate their benefits and harms.
The report walks through a decade of science, listing studies that find in favor of e-cigarettes as well as studies that do not. It asserts that e-cigarettes are only 5 percent as harmful as traditional cigarettes, a conclusion that some American experts say has been lost in the United States in the rush to condemn e-cigarettes. It states bluntly that long-term effects of nicotine are likely to be minimal.
“The emergence of e-cigarettes has generated a massive opportunity for a consumer as well as a health care-led revolution in the way that nicotine is used in society,” the report said. As the technology of e-cigarettes improves, “so the vision of a society that is free from tobacco smoking, and the harm that smoking causes,becomes more realistic.”