Dear Ms Evans,
We are writing in response to your recent opinion piece published on the Social Change UK website.
Save E-cigs is a campaign that represents vapers, their friends, and their families.
In your piece you state that you are not against e-cigarettes, but this is not how your article comes across. In both tone and content it is hostile to e-cigarettes. More than that it is not a balanced article. You state at the beginning of your piece that ‘evidence is king’ yet you make a number of evidence free statements or deny, when it does not suit your line of attack, that evidence exists when it does.
In your piece you argue that there is not enough information available to disprove the argument that e-cigarettes are a gateway into smoking. There is actually a significant amount of very credible evidence that clearly demonstrates that virtually all e-cigarette users are either current or former smokers and that no evidence exists of e-cigarettes being a gateway product.
The latest research produced by Action of Smoking and Health (ASH) concluded that that just 0.1 per cent of e-cigarette users had never smoked tobacco cigarettes previously. Commenting on ASH’s latest research, Deborah Arnott, Chief Executive of ASH, said: “There is no evidence from our research that e-cigarettes are acting as a gateway into smoking.”In addition to this, the largest ever EU-wide study on this issue, carried about by the Harvard School of Public Health also concluded that there was no evidence that e-cigarettes were a gateway to smoking.
Looking specifically at children and the gateway effect, research undertaken by Queen Mary University in London found that a child trying a tobacco cigarette for the first time is 50 per cent likely to become a regular smoker. The same research found no evidence that a child trying an e-cigarette for the first time goes on to become a regular vaper.
You suggest that e-cigarette use may actually encourage people to continue to smoke and may actually harm quit attempts. If ‘evidence is king’ where is your evidence?
Many vapers have tried numerous times to quit smoking using conventional nicotine replacement therapies, which have a 90 per cent failure rate, however with e-cigarettes they have all cut down their smoking or stopped completely. Professor Robert West, Professor of health psychology and director of tobacco studies at University College London’s department of epidemiology and public health said: “We found that those using the e-cigarette were about 60 per cent more likely still not to be smoking than those using the licensed product or nothing at all.” E-cigarettes are however not some form of more effective nicotine replacement therapy, they are totally different and need to be regulated accordingly. Speaking in Parliament recently, Professor Robert West also made clear that in all his research he saw no evidence of dual use undermining quit attempts or prolonging smoking, if anything he saw evidence of a move amongst dual users to quit completely. This was supported by the latest Smoking Toolkit Study, something you should be familiar with, which concludes, ‘evidence does not support the view that electronic cigarettes are undermining quitting or reduction in smoking prevalence.’
As the evidence shows, not only are e-cigarettes not a gateway to smoking, they do not re-normalise smoking either. Professor Robert West, following his latest research concluded:“Despite claims that electronic cigarettes risk re-normalising smoking, we found no evidence to support this.”
When it comes to the advertising of e-cigarettes, you are concerned that some of these adverts make e-cigarettes look ‘desirable’; is that not a good thing? After all, e-cigarettes are recognised as being safer than tobacco cigarettes. Professor Peter Hajek of Queen Mary University London and the NHS have both made clear that e-cigarettes are “orders of magnitudes safer than tobacco cigarettes.” The NHS made clear that they were 1,000 times safer. Is it therefore not better for smokers to switch to e-cigarettes? Again the answer must clearly be yes. Professor John Briton from the Royal College of Physicians said: “If all the smokers in Britain stopped smoking cigarettes and started using e-cigarettes we would save five million deaths in people who are alive today. It’s a massive potential public health prize.” Therefore, if these adverts are encouraging people to switch to a safer alternative then what is the problem?
Perhaps you are concerned about the impact of advertising on children? Well you need not worry. Research undertaken by John Moores University concluded that, ‘Despite widespread advertising of e-cigarette brands in print, visual and social media, the majority of participants (children) reported that they had not seen any advertising for e-cigarettes and showed a lack of awareness of advertising and marketing strategies and approaches’.
Of course there must be regulation of advertising, which is why we welcomed the recent Committee of Advertising Practice consultation and look forward to reading their proposals. However, the issue of advertising will not be around for much longer as the revised Tobacco Products Directive bans the advertising of e-cigarettes from 2016.
In your piece you raise concerns about tobacco companies moving into this market. We are a vapers group and are not spokesmen for the industry; however, it strikes us as a good thing if tobacco companies are moving away from making and selling harmful tobacco products to making and selling e-cigarettes.
The key thrust of your piece is about e-cigarette usage amongst children. The latest research produced by ASH concluded that, ‘e-cigarettes are used by both smokers and ex-smokers, but there is little evidence of use by those who have never smoked or by children.’ ASH found that 98 per cent of 11 – 12 year olds had never tried an e-cigarette, the figure for 13 – 14 year olds was 96 per cent. The crucial thing is how many of these children, having tried an e-cigarette once go on to use them regularly. We know from figures produced by ASH that very few young people are using e-cigarettes on a regular basis.
In your piece you made much of the issue of flavouring, implying that flavours are used to attract children. Evidence produced by a variety of organisations including ASH and the American Cancer Society (ACS) clearly shows that flavours do not entice non-smokers to use e-cigarettes either. Researchers from the ACS found that flavours did not increase the attractiveness of e-cigarettes to teenagers. Rather, ‘Even after controlling for other statistically significant correlates, the odds of a smoker being willing to try an e-cigarette were 10 times those of a non-smoker.’
However for those adult smokers who have switched to e-cigarettes, flavours are important. Why?
The key health benefit of e-cigarettes is determined by how many smokers switch to them or use them as a staging post to quitting completely. This means that e-cigarettes have to be an attractive alternative to tobacco cigarettes for established smokers. Flavouring is an important part of this as the nicotine solutions have no flavour. Removing or banning flavourings would actually reduce the appeal of e-cigarettes to smokers.
In research carried out by Dr Konstantinos Farsalinos and others, vapers stated that the availability of flavours was “very important” in their effort to reduce or quit smoking. This research also found that the majority of vapers would find e-cigarettes “less enjoyable” or “boring” if flavours were restricted, while 48.5 per cent of vapers stated that it would increase their cravings for tobacco cigarettes and 39.7 per cent of vapers said that without flavours it would have been less likely for them to reduce or quit smoking.
This major piece of research concluded:
- That far from marketing flavours to attract children, flavours are marketed to ‘satisfy vapers’ demand’,
- Flavours contribute to both perceived pleasure and the effort to reduce or quit smoking,
- Restrictions on flavours could cause harm to current vapers, and
- Current flavour variability must be maintained.
The proliferation of flavours reinforces that view that these are recreational consumer products, not smoking cessation aids, medicines or tobacco products.
We welcomed the decision by both the UK and Welsh governments to introduce bans on the sale of e-cigarettes to under 18s. As 99.9 per cent of e-cigarette users are current or former smokers, such a move was not just responsible, it was also common sense. It will now be up to the authorities to enforce this ban. As an aside, perhaps you could inform us as to which pizza takeaways in North Wales were selling e-cigarettes. A number of vapers took the time to call round such places and were unable to find a single one selling e-cigarettes.
In your piece you raise the issue of passive vaping and cite countries where public vaping bans have been introduced, including Wales where such a ban has been proposed.
The ban on smoking in enclosed public places was introduced to benefit the health of non-smokers whose health was put at risk as a result of being in close proximity to smokers. Therefore any proposal to include e-cigarettes within this ban must also be to protect the health of non-vapers.
Is passive vaping dangerous? A major scientific study undertaken by Dr Konstantinos Farsalinos and Professor Riccardo Polosaconcluded that the ‘effects of e-cigarette use on by-standers are minimal compared with conventional cigarettes.’
One of the examples you cite, of a country that has introduced a public vaping ban, is Spain. Following the introduction of the ban in Spain there has been a 70 per cent fall in the number of vapers and a 60 per cent decrease in the number of vaping shops. People that had made the switch to e-cigarettes are unfortunately now smoking again. Surely this is not something you would like to see repeated elsewhere?
Such bans are not supported by the public who are actually very supportive of e-cigarettes. A recent poll by the BBC found that 75 per cent of the public would be happy if their friends or family switched from smoking tobacco cigarettes to using e-cigarettes, and 62 per cent of the public said that e-cigarettes should not be banned in public.
Finally, you raise the issue of regulation. E-cigarettes are currently regulated by at least 17 EU Directives and a number of other regulations at the Member State level. The revised Tobacco Products Directive when it comes into force in 2016 will introduce further regulation and see e-cigarettes more strictly regulated than some tobacco products. You mentioned the specific example of the inclusion of health warnings. These warnings are not as you implied akin to those on tobacco products, they are simply to inform people of the addictive nature of nicotine.
Yes nicotine is addictive but that does not mean it is dangerous. Caffeine is addictive, is that dangerous? The nicotine contained in e-cigarettes is the same pharmaceutical grade nicotine used in NRT products (some of which are inhaled). As Professor Robert West said: “E-cigarettes are about as safe as you can get. We know about the health risks of nicotine. Nicotine is not what kills you when you smoke tobacco. E-cigarettes are probably about as safe as drinking coffee.”
Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London, said: “E-cigarettes are orders of magnitudes safer than cigarettes because they do not release smoke which contains toxins which are responsible for heart disease, lung disease, and cancer.” The NHS has also concluded that e-cigarettes are 1,000 times safer than tobacco cigarettes. You should also note that many vapers use an e-cigarette that does not contain any nicotine.
In your approach you are going against the precautionary principle as it was originally intended, you are trying to mitigate for a risk that has yet to be proven and in doing so may do more harm than good. Given that 99.9 per cent of e-cigarette users are current or former smokers, and given that e-cigarettes are significantly safer than tobacco cigarettes, the only sensible thing to do is to encourage e-cigarette use up until the time (if such a time were ever to arise) when a direct negative risk between e-cigarettes and a vapers health can be proven beyond doubt. To do anything else would be to condemn millions of smokers in the UK to an even earlier death. Would you rather someone smoked or vaped?
All those with a genuine interest in public health need to stay focussed on the bigger picture – significantly reducing the number of people who die from tobacco related illnesses. Conventional nicotine replacement therapies are not tackling this in any significant number, but e-cigarettes could. Already 2.1 million smokers have switched to e-cigarettes. The rise of e-cigarette sales is directly contributing to a decline in tobacco cigarettes sales. In the words of Professor Robert West: “What is the problem that requires further regulation?” This should be a cause for celebration, not concern.
 Research undertaken by Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London
 Study carried out on 5,000 smokers, by Professor Robert West looking at the success rate of different methods to stop smoking: nicotine gum, nicotine patches, nothing, or e-cigarettes. Reported on BBC Breakfast 28 April 2014
 Meeting of the All-Party Groups on Smoking and Health, Pharmacy, and Heart Disease 10 June 2014
 The Independent Newspaper, 29 March 2013
John Moores University – ‘Young People’s Perceptions and Experiences of Electronic Cigarettes’
 Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review:
Konstantinos E. Farsalinos and Riccardo Polosa
published online 13 February 2014 Therapeutic Advances in Drug Safety
 The Guardian Newspaper, 05 June 2013
 Professor Robert West speaking at the E-cigarette Summit, The Royal Society, London on the 12th of November 2013.