Harm reduction within reach

Members of parliament have warned the UK Government that misconceptions about electronic cigarettes mean that it is missing an opportunity to tackle a major cause of death.
In a press note issued today alongside its report, E-cigarettes, the House of Commons Science and Technology Committee said that these products, estimated to be 95 percent less harmful than conventional cigarettes, were too often being overlooked as a stop-smoking tool by the National Health Service (NHS).
‘Regulations should be relaxed relating to e-cigarettes’ licensing, prescribing and advertising of their health benefits,’ the note said. ‘Their level of taxation and use in public places must be reconsidered.’
In what will be seen by many as one of its most important interventions, the Committee said that it believed the risk for smokers of continuing to use conventional cigarettes was greater than the uncertainty over the long-term use of e-cigarettes. ‘To gather independent health-related evidence on e-cigarettes and heat-not-burn products, the Committee is calling on the Government to support a long-term research programme overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment,’ the note said. ‘The Government should make its research available to the public and to health professionals.’
The chair of the Committee, Norman Lamb MP (pictured in 2017), said smoking remained a national health crisis and the Government should be considering innovative ways of reducing the smoking rate. “E-cigarettes are less harmful than conventional cigarettes, but current policy and regulations do not sufficiently reflect this and businesses, transport providers and public places should stop viewing conventional and e-cigarettes as one and the same,” he said. “There is no public health rationale for doing so.
“Concerns that e-cigarettes could be a gateway to conventional smoking, including for young non-smokers, have not materialised. If used correctly, e-cigarettes could be a key weapon in the NHS’s stop smoking arsenal.”
The Committee is recommending that:

• ‘The Government, the MHRA (Medicines and Healthcare products Regulatory Agency) and the e-cigarette industry should review how approval systems for stop smoking therapies could be streamlined should e-cigarette manufacturers put forward a product for medical licensing.
• ‘There should be a wider debate on how e-cigarettes are to be dealt with in our public places, to help arrive at a solution which at least starts from the evidence rather than misconceptions about their health impacts.
• ‘The Government should continue to annually review the evidence on the health effects of e-cigarettes and extend that review to heat-not-burn products. Further it should support a long-term research programme overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment with an online hub making evidence available to the public and health professionals.
• ‘The limit on the strength of refills should be reviewed as heavy smokers may be put off persisting with them — and the restriction on tank size does not appear to be founded on scientific evidence and should therefore urgently be reviewed.
• ‘The prohibition on making claims for the relative health benefits of stopping smoking and using e-cigarettes instead has prevented manufacturers informing smokers of the potential benefits and should be reviewed to identify scope for change post-Brexit.
• ‘There should be a shift to a more risk-proportionate regulatory environment; where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarettes, heat-not-burn and tobacco products available.
• ‘NHS England should set a policy of mental health facilities allowing e-cigarette use by patients unless trusts can demonstrate evidence-based reasons for not doing so.
• ‘The Government should review the evidence supporting the current ban on snus as part of a wider move towards a more risk aware regulatory framework for tobacco and nicotine products.’

In welcoming the report, the UK’s New Nicotine Alliance (NNA) said that it contained several evidence-based policy proposals that would positively transform the way vaping was viewed by businesses, institutions and the public alike.
It said that it ‘warmly welcomes this report for its clear and unequivocal message that e-cigarettes and other alternative nicotine products are far safer than combustible tobacco and should be treated as such’.
“E-cigarettes are a proven safer alternative to smoking and the UK boasts 1.5 million former smokers who have converted from combustible tobacco to exclusively vaping instead,” said Sarah Jakes, the NNA chair. “The Science and Technology Committee has wisely recognised that misconceptions about e-cigarettes are threatening further progress in encouraging their use by smokers who choose to quit.
“We welcome the Committee’s call for a root and branch review of how risk-reduced products are treated by businesses, institutions and government itself. The report is a beacon of enlightenment in an area of public health which is often burdened by dogma and outdated thinking towards the use of nicotine…”
Jakes said also that there was a lot of confusion about e-cigarettes among the public, health institutions and businesses; so the report was timely and could have hugely positive implications for public health if its recommendations were implemented in full.
“Sir Norman’s Committee has done an excellent job of peering through the mist of misunderstanding surrounding e-cigarettes and its policy proposals can go a long way to dispel the – often deliberately fabricated – misconceptions that are deterring many thousands of smokers from switching,” she said. “We would urge the government to read the Committee’s findings carefully and act on them without delay”
Commenting on the report, the Vaping Industry Association (UKVIA) said that, following an extensive inquiry into e-cigarettes, the Committee had concluded that the government was missing significant opportunities to tackle UK smoking rates.
The UKVIA highlighted that the Committee had urged the government to consider tax breaks for vaping products; to allow wider use of vaping in public places; and to create a streamlined route to medically licenced vaping products.
It pointed out too that the report called on the government to reconsider the regulations around e-cigarette packaging and advertising. ‘Advertising rules currently prevent the industry from making health claims comparing vaping to smoking,’ said the UKVIA. ‘The Committee believes this is stopping UK smokers (almost seven million), from making informed decisions about switching to vaping …’
The report said also that restrictions on nicotine strength, tank size and bottles was not founded on scientific evidence and should be urgently reviewed.
“The Science and Technology Committee report is a ringing endorsement of vaping’s public health potential,” said John Dunne, who appeared before the Committee on behalf of the UKVIA.
“They are absolutely right that advertising restrictions are preventing smokers from hearing the truth. More and more people wrongly believe vaping to be more harmful or as harmful as smoking. This is a direct consequence of advertising restrictions that prevent the industry from telling smokers that vaping is 95 percent less harmful. If health bodies can say it, why can’t we?
“The industry is pleased to see the Committee recognise the nonsensical packaging and nicotine strength regulations, that only hamper vaping’s potential appeal to smokers looking for an alternative.”