Fighting fire with fire – the e-cigarette debate

Since the advent of e-cigarettes the NHS and other medical professionals have been cautious about encouraging the use of this tobacco free alternative to smoking. The lack of medical trials has meant that the long term effects of smoking vapour have been largely unknown. However are we now ready to embrace e-cigarettes as the lesser of two evils? Public Health England seems to think so.

A recent report has announced that the use of e-cigarettes in place of tobacco could cut smoking related deaths by up to 76,000 per year in England alone, and estimates that E-Cigarettes are 95% safer than their tobacco based counterparts.

Growing in popularity, there are now estimated to be 2.6 million e-cigarette users in Britain, and Public Health England says “we encourage smokers who want to use e-cigarettes as an aid to quit smoking to seek the support of local stop-smoking services, given the potential benefits … PHE looks forward to the arrival on the market of a choice of medicinally regulated products that can be made available to smokers by the NHS on prescription”.

E-cigarettes are not completely risk free though, with Public Health’s own figures showing that 4,000 deaths a year would still occur with the use of the vapour alternative. A lack of regulation of the industry has raised concerns over quality control, earlier this year a Briton died after their e-cigarette exploded next to an oxygen tank, and the effectiveness of e-cigarettes as an aid to quit smoking. “We need to see a stronger regulatory framework that realises any public health benefit they may have”, but addresses significant concerns from medical professionals around the inconsistent quality of e-cigarettes, the way they are marketed, and whether they are completely safe and efficient as a away to reduce tobacco harm”, said the British Medical Association.

If Public Health’s statistics turn out to be accurate, e-cigarette use could well become the most effective and successful method ever of reducing the number of smokers throughout Britain and the secondary diseases such as cancer and respiratory problems that plague the NHS. But it cannot be ignored that e-cigarettes are still harmful and the recommendation for use by the NHS effectively sanctions the use of a treatment known to cause at least some harm to the user, albeit the lesser of two evils.

The announcement by Public Health comes close to endorsing the use of e-cigarettes and promotes it as an almost risk free method of smoking. Fear is growing that this attitude to “vapouring” may in fact encourage younger adults to smoke, who previously would have been put off by the ill effects of tobacco. Smoking rates have dropped considerably since the smoking ban in public places was introduced in 2006 and it has long been thought that the younger generation could be the first for many years to live in a relatively smoke free society. But, endorsement of vapouring from the Health Service could divert that attitude towards an acceptance of tobacco free smoking.

A Welsh government spokesperson responded to Public Health’s report by saying “we are concerned the use of e-cigarettes may renormalise smoking, especially for a generation who have grown up largely in a smoke-free society … we are not alone in our concerns – the World Health Organisation and other international bodies have called for greater regulation of e-cigarettes and 40 other countries have already taken similar steps”.

Whatever your viewpoint, this announcement suggests that smoking in one form or another will be present in British society for years to come. And perhaps the interest and investment in vapour technology could eventually lead to a totally harm free way of smoking, which is probably the best compromise that society and the health service could hope for.