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A new report is released today (April 28, 2016) by the Royal College of Physicians (RCP) in the UK, titled: “Nicotine without smoke: tobacco harm reduction”. The 200-page report addresses the important but controversial issue of tobacco harm reduction, a concept that was first described by Prof. Mike Russel in 1976. Of note, the RCP first published a report promoting the principle of tobacco harm reduction in 2007. That report clearly stated that harm reduction, as a complement to conventional tobacco control policies, could offer a means to prevent millions of deaths among tobacco smokers in the UK alone. What is new in today’s report is the addition of electronic cigarettes into the arsenal of tobacco harm reduction.
The report starts by acknowledging two facts about e-cigarettes: 1. They are quite popular among smokers; 2. They have been highly controversial, resulting in different responses from regulatory bodies in different countries.
Further into the report, e-cigarettes are characterized as “an ideal tobacco harm reduction product”. This is because of effective nicotine delivery and self-titration of nicotine intake in the absence (or presence at negligible levels) of the vast majority of harmful constituents of tobacco smoke. The report also acknowledges the importance of the psycho-behavioral resemblance of e-cigarette use with smoking (sensory irritation, motor simulation).
The authors of the report make an extensive review of the literature about the safety of e-cigarettes. While acknowledging that e-cigarettes are not risk-free, they present evidence that the levels of harmful emissions are very low. Importantly, they repeat the estimation reported in the report by Public Health England, and expand on that by saying: “Although it is not possible to quantify the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure.” (my emphasis). They also accept the better efficacy of new-generation devices in delivering nicotine, making them more satisfying for smokers. Finally, they acknowledge that there is no evidence that e-cigarettes have renormalized smoking and that there is any gateway-to-smoking effect. Of course, the report recognizes the value of regulation to ensure the good quality of the products and to avoid promotion of e-cigarette use to youth and non-smokers.
The report is extremely important and is expected to be highly influential. It provides a valid and unbiased approach to currently-available evidence, presents any uncertainties about long-term risk without hysteria and intimidation, and accepts the huge potential of e-cigarettes in reducing smoking-related disease risk among smokers and the lack of evidence that e-cigarettes are acting as gateway to smoking. For the latter, I am aware of a study, which will soon be published, evaluating the patterns of e-cigarette use and how they affected smoking status in the European Union. This is based on data from the Eurobarometer 2014, which was performed through personal interviews in a sample of more than 27,000 Europeans. Stay tuned for this important study…