It’s been an interesting few days for smokers intent on stopping their habit.


Electronic cigarettes are to be regulated as medicines

Last week saw welcome new guidance from the National Institute for Health and Care Excellence (NICE) – the first to recommend that licensed nicotine-containing products (NCPs) can be used to help people cut down on the amount they smoke (as well as to help them stop entirely).

Today the Medicines and Healthcare Products Regulatory Agency (MHRA) has made its long-awaited announcement of its intention to license NCPs such as e-cigarettes, which have – until now – fallen outside both medical regulation and NICE’s guidance for quitting and cutting down.

This is good news. We’ve wanted to see e-cigarettes come under “light touch” regulation for some time – as it could ensure their safety, quality and effectiveness, restrict marketing that risks cross-promoting tobacco smoking, and stop them being sold to under-18s.

So we think it’s a great idea to bring e-cigarettes within MHRA licensing.

The ideal solution?

One thing everyone interested in reducing the toll of tobacco can agree on is that e-cigarettes are a controversial issue. Our recent blog article on the topic covered some of the unanswered questions about e-cigarettes, and generated a lively discussion in the comments section.

In the article, we raised issues about the contents of e-cigarettes, their safety and their long-term use.

But it’s important to get the balance right: it would be wrong to give the impression that there are no risks at all – hence the call for light-touch regulation and monitoring. Yet it’s important to remember that using these products is almost certainly safer by far than smoking tobacco.

In the debate about e-cigarettes it’s not the product safety that’s most hotly disputed, but their potential impact on a smoker’s motivation to quit, and on the progress made so far in reducing the UK’s smoking rates.

Tobacco is by far the most important preventable cause of cancer in the world. Smoking accounts for one in four UK cancer deaths, and nearly a fifth of all cancer cases – including those caused by exposure to second-hand smoke.

The good news is that quitting smoking significantly reduces the chances of developing one of the fourteen cancers related to tobacco use. The sooner you quit the better, but it’s never too late. But nicotine is highly addictive and many attempts to quit smoking fail.

Some argue that e-cigarettes are a huge opportunity to wean smokers off a deadly product by offering a nicotine “hit” without them having to inhale tobacco smoke.

The argument goes that, in a free market, consumers will always choose a safer product over a more dangerous one – so the better e-cigarettes can replicate cigarettes, the more they will spur a mass move away from tobacco smoking with little need for further public health interventions.

This is after all what we all want – an end to the death and disease caused by smoking.

Fatal attraction

But as well as this promise, e-cigarettes have several potential theoretical downsides:

  • what makes e-cigarettes beautiful could also make them dangerous – their replication of the act of smoking could be too close to the ‘real thing’ to allow smokers to ever effectively escape their tobacco habits and potentially to revert back to smoking tobacco;
  • using e-cigarettes in smoke-free areas could potentially give smokers less motivation to quit smoking the rest of the time;
  • and their use in smoke-free places and in marketing images could have a knock on effect of ‘renormalising’ smoking, by confusing or contradicting the messages about the harms of smoking. This could undermine public health efforts to deter young people from taking up smoking.

At this stage we simply don’t have the necessary evidence to be able to say with any confidence which of these arguments – if any – is correct. But we have plenty of experience to warrant some caution.

A market flaw?

Sitting above these opportunities and risks is something we’re extremely wary of: the fact that the big tobacco companies are investing in NCPs.

For example Nicoventures – the company that owns one of the first of these types of products to be put forward for MHRA licensing – is owned by British American Tobacco, one of the four companies that control over 90 per cent of all global tobacco sales.

In a future post, we’ll be exploring the issues of conflicting interests that arise from this dual corporate ownership of cigarettes and their potential nemesis.

But for now, we’re remaining mindful of the first principles of internationally agreed public health guidelines: “there is a fundamental and irreconcilable conflict of interest between the tobacco industry’s interests and public health policy interest”.

Watch this space.

Alison Cox, Tobacco Control Lead