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E-cigarettes help save lives, says Royal College of Physicians

Sometimes Nanny doesn’t know best

The Royal College of Physicians has issued a report strongly critical of “public health” scolds, such as GPs and EU officials, who want the use of e-cigarettes of restricted.

These anti-vaping crusaders are costing lives, the venerable institution warns, as encouraging e-cigarettes is the most effective tobacco control strategy yet seen.

The report by the college’s Tobacco Advisory Group, titled Nicotine without smoke: Tobacco harm reduction (PDF, 4MB), concludes that public health policy should change to encourage smokers to one of nicotine substitution.

It also warns that the UK’s e-cig regulator, the MHRA, which is part-funded by the pharmaceutical industry, may not be up to the job. The MHRA has only approved one product so far, ahead of the implementation of new EU rules next month.

Why vape?

It isn’t the college’s first intervention. In a March 2014 statement, the surgeons wrote:

Switching completely from tobacco to e-cigarettes achieves much the same in health terms as does quitting smoking and all nicotine use completely.

Nicotine is largely harmless – albeit in strictly tiny doses – but the most popular delivery vehicle, cigarettes, are extremely harmful. But the new report is the college’s first substantial look at tobacco control since 2007, before the popularity of Chinese-designed nicotine vapourisers.

“Harm reduction works by providing smokers with the nicotine to which they are addicted without the tobacco smoke that is responsible for almost all of the harm caused by smoking,” the report advises. It notes how the popularity of second generation e-cigs, which typically use refillable liquid tanks in which flavoured glycerine or propylene glycol is turned into vapour, has caused panic in the tobacco and pharmaceutical industries. The latter had benefited from billions in public health spending on NRT (Nicotine Replacement Therapy) products which are far less effective.

The disruptive effect of e-cigarettes is not confined to the tobacco industry. The chairman of the pharmaceutical giant GlaxoSmithKline, for example, has acknowledged that, in response to the declining performance of their nicotine replacement therapies (NRTs), the company considered manufacturing e-cigarettes before concluding that such a step would be ‘just too controversial’.

Dumping NRTs and using modern vaping products could save the US taxpayer $48bn a year from its Medicaid budget. The UK spent more than half a billion pounds between 2000 and 2012 on pharmaceutical NRTs, which, when combined with the cost of the NHS services, means the NHS spent about £7,416 for each one year ex-smoker; that is, a smoker who had quit for 12 months.

85 per cent of quit attempts in which the NHS was involved failed. By contrast, vaping is a voluntary, low cost alternative – with the costs borne by the consumer.

And yet e-cigarettes have become the focus of “public health” campaigners who want the new technology restricted or banned. Wales came within one vote of banning e-cigarettes in any public place. Some desperate tabloids have attempted to raise a health scare around vaping.

EU bureaucracy

The European Parliament voted to regulate e-cigarettes via a revised Tobacco Products Directive (TPD2). The move has the potential to crush the open market for vaping products, as liquids and hardware could face a six month approval process – but much depends on how EU member states choose to comply. The European Commissioner for Health, Vytenis Andriukaitisa, warned member states that they’d better fall into line or else.

“If some member states do not follow their legal obligations, we will start immediately with infringement procedures, no doubt”, he said this week. The EU rules come into effect on 20 May. So far the implementation has been left to the pharma products regulator, the MHRA.

TPD2 is being challenged in court by a UK company, which argues that its hampers the free movement of goods.

"That even the streamlined Medicines and Healthcare products Regulatory Agency (MHRA) ‘right touch’ medicines regulation has to date awarded a licence to only one e-cigarette, and none that has come to market, indicates that mandatory medicines regulation of e-cigarettes, although valuable as a complement to other regulatory approaches, is not ideal as a single regulatory approach," warns the Royal College of Physicians'(RCP) report.

Public ‘Elf campaigners argue that vaping “normalises” smoking, and acts as a gateway to hard tobacco use. The RCP rejects both arguments. It even supports the advantage of “dual use” – with smokers cutting down by using e-cigarettes alongside tobacco, as dual users are ultimately more likely to quit completely.

Last year Public Health England called for a sweeping reform of government tobacco policy, given the effectiveness of vaping.

Today a leader article in The Times makes plain what the RCS invites us to infer, pointing out that the report "is a rebuke to tobacco lobbyists and politicians who have obscured the debate on e-cigarettes in defence of vested interests and out of sheer ignorance. Health officials who should have known better are also to blame."

Quite. ®

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