NCRI 2015

E-cigarettes should be promoted as a smoking cessation

Prof Linda Bauld - University of Stirling, Stirling, UK

We have a session at NCRI this year which looks at electronic cigarettes. So tobacco use is the leading preventable cause of cancer; we have an objective in the UK to get tobacco smoking rates as low as possible, ideally to 5% by 2034, but if we’re going to do that the current rate of decline isn’t quick enough. So we also need new approaches and one of the new approaches that we’re talking about in today’s session is electronic cigarettes. They have been called a disruptive technology, they’re very controversial, but the session today is going to aim to do three things. We’re going to talk about who is using e-cigarettes, what are they? Secondly, are they safe or safer than tobacco? And, finally, are they useful for smoking cessation and are children trying these devices and what does that mean for the future?

Presumably there’s not been much research into long-term effects?

E-cigarettes were patented in 2004, they’ve really only been available in the UK market since about 2010/2011 so you’re absolutely right, we don’t have long-term evidence of safety. But we do know a lot about e-cigarettes, a lot more than, for example, what we knew about tobacco in the 1950s. So we know what is in them, we know they contain nicotine, most of them, and nicotine is the addictive substance in tobacco but it’s the other chemicals in tobacco, commonly known as the tar, that cause cancer and other preventable disease. So in e-cigarettes what you have is you don’t have the tobacco specific nitrosamines which are carcinogenic but you do have some of the metals, some of the other toxicants that you find in tobacco but they’re at far, far lower levels. So a couple of things we can say about safety: they are safer than tobacco cigarettes, certainly from the data we have. We also know that the vapour that’s released by e-cigarettes isn’t harmful to bystanders in the way that tobacco second-hand smoke is. But you’re absolutely right, we need to continue to do the research and that’s why Cancer Research UK in particular is investing in a whole series of new studies on electronic cigarettes.

What are your thoughts on Wales banning e-cigarettes from public places?

Cancer Research UK gave evidence to the Welsh Assembly, myself and a colleague a few weeks ago, so our view is that if you look at the evidence on second-hand vapour it’s not sufficient to call for a blanket ban on use in public places. The main reason for that, actually, is that if you say to the public that electronic cigarettes are illegal to use in all enclosed public spaces you’re sending a very clear message to the public and that is that e-cigarettes are as harmful as tobacco and we know from the research that that is not the case. What we want is we want people to move away from tobacco use and if they find e-cigarettes helpful then we should be encouraging them to use them, not discouraging them. But of course we have to keep an eye on some of the more controversial issues like our children using e-cigarettes.

Could e-cigarettes have a positive impact on helping people to quit smoking?

The advocates of electronic cigarettes would say they’re potentially revolutionary in that they could transform the behaviour that’s linked to smoking into people using something less harmful. We could almost eliminate tobacco use; that’s the positive picture. Whether that will actually happen is potentially unlikely and one of the reasons for that is regulation. So our session today will also look at some of the new laws that are coming in, particularly the European Tobacco Products Directive that will restrict the marketing and also some forms of the supply of these devices from next year. So they are really promising but I think we have to strike a balance between making sure that people who have never used tobacco don’t start using a product that has nicotine in it with making sure that smokers can access them and use them to stop. At the moment over one-third of every quit attempt that happens in the UK to get away from tobacco is done with an e-cigarette so they’re far more popular than any other quitting device. So I guess it’s watch this space.

Is there the potential for e-cigarettes to be taxed like tobacco?

We know that for harmful products that cause cancer and other diseases we know that fiscal policies, raising taxes, is one of the most effective things you can do to discourage people from using them so you would think, and we know, that tobacco taxes are effective. But to tax e-cigarettes in the same way as tobacco is illogical because actually they have potential as a cessation aid. So the only country in Europe that has introduced an electronic cigarette tax is Italy. The government has looked at that as a revenue raising measure; we certainly are not advocating that in the UK and the UK government is not contemplating that at the moment. Things like nicotine replacement therapy actually are taxed at a lower level than other consumer products, they’re taxed at 5% VAT. So you could argue we certainly shouldn’t be taxing e-cigarettes higher than tobacco and in fact we may even want to create a favourable playing field for these products.

Is there anything else you would like to mention?

In terms of the future of electronic cigarettes a lot of concern has been expressed about whether children and young people are using them. We know that at the moment we’re seeing quite significant levels of experimentation, around 12% of young people in the UK have ever tried an e-cigarette at the moment. But in terms of regular use there are almost no children who have never smoked tobacco who are regularly using e-cigarettes. But that’s another area where we have to continue doing the research and watch what happens in the future.