WHO report criticises e-cigarettes – experts respond

The World Health Organization (WHO) has released a report looking at electronic cigarettes and how they should be globally regulated.

Electronic cigarette smoking
Credit: Michael Dorausch (Flickr)

The report recommended restrictions should be placed on the marketing of the devices, their sale to minors and indoor use.

In addition, it points out that there is evidence showing that e-cigarette aerosol is not merely “water vapour” and – although less toxic than tobacco smoke – the vapour may harm adolescents and the foetuses of pregnant women who use them. The report also says that e-cigarettes increase the exposure of non-smokers and bystanders to nicotine and a number of toxicants.

Currently, e-cigarettes have not been approved for sale in New Zealand by the Ministry of Health because it says there is not enough evidence to be able to recommend e-cigarettes as an aid to quit smoking.

Our colleagues at the Australian and UK SMC have collected the following expert commentary. Feel free to use these quotes in your reporting. If you would like to contact a New Zealand expert, please contact the SMC (04 499 5476; smc@sciencemediacentre.co.nz).

Professor Mike Daube, President of the Australian Council on Smoking and Health and Professor of Health Policy at Curtin University, comments:

“The WHO position paper is thorough, comprehensive and important.

“The clear conclusion is that we should be very cautious about any developments around e-cigarettes. The reality is that these products are still new; the potential benefits are still in doubt; and there are significant concerns about possible short and long-term harms.

“There is enormous cause for concern about the way that global tobacco companies have taken over the e-cigarette market, and are using them in efforts to re-normalise smoking behaviour. A major recent report from the US shows that youth e-cigarette use increased threefold there between 2011 and 2013, and that young e-cigarette users were more likely to take up smoking.

“Smoking in Australia is already declining quite dramatically. Only 12.8% of adults are regular smokers, and almost all school students are now non-smokers. We should be extremely careful about allowing anything onto the market here that might reduce the impact of our world-leading programs.

“If any manufacturer wants to market e-cigarettes as a cessation aid in Australia, there is a very straightforward process – they need to go to the Therapeutic Goods Administration (TGA) with evidence of safety and efficacy, so that the TGA can evaluate this and make decisions as to whether they should be sold, and if so under what conditions. There might be a role for them, but my understanding is that no manufacturers have even approached the TGA yet, so we are very unlikely to see e-cigarettes on the market in Australia in the near future, if at all.”

Professor Simon Chapman, from the School of Public Health at the University of Sydney, comments:

“There has been monumental hype circulating about the promises of e-cigarettes as a massive breakthrough in helping smokers quit. The best and largest study so far shows that 80 per cent of smokers who tried to quit using e-cigarettes in the past 12 months did not succeed. This was only marginally better than the success rate of smokers quitting cold turkey.

“Everyone assumes that if you cut down the number of cigarettes you smoke each day by also vaping, that this will reduce your risk of harm. Unfortunately, four very large cohort studies have all found that just reducing, as opposed to quitting, confers very little health benefit.

“Very recent data from the US shows there has been a tripling in the last few years of the number of kids who have never smoked a cigarette – and probably who never would have – starting to use e-cigarettes.

“One of the great myths being circulated is that nicotine is as harmless as coffee. If that was true, why is that even hardened vaping advocates do not recommend that pregnant women use e-cigarettes?”

Prof Ann McNeill, Professor of Tobacco Addiction, National Addiction Centre, King’s College London’s Institute of Psychiatry, comments:

“The e-cigarette market is rapidly evolving and research on the huge variety of products on the market, what they emit and what their health impacts are, lags behind.

“What we do know is that e-cigarettes do not emit the thousands of constituents delivered in tobacco smoke, 70 of which are known carcinogens. Instead e-cigarettes emit a vapourised solution principally of propylene glycol or glycerine, water and flavours, usually with nicotine. Whilst the WHO report concludes that e-cigarettes use ‘produces lower exposures to toxicants than combustible products’ I believe that this is an understatement. We can be confident that e-cigarette use results in much lower exposure to toxins for users.

“Although e-cigarette vapour may be an irritant to people in close proximity to the e-cigarette user, there is no evidence of harm from other people inhaling e-cigarette vapour unlike the known risks of second hand cigarette smoke. There is also as yet no evidence that e-cigarettes are renormalizing smoking.

“Based on their analysis, the WHO proposes a range of regulations for e-cigarettes and my concern is that these will deter smokers from trying to use them. Cigarette smoking is so uniquely dangerous that anything we can do to encourage smokers to stop should be welcomed. In the UK whilst we have achieved remarkable reductions in smoking over recent decades, smoking is now concentrated among our most disadvantaged groups in society, for whom I think e-cigarettes could be a game changer.”