Leading academic insists #ECigarettes are less harmful than tobacco

| April 18, 2018

A leading academic says that electronic cigarettes are “considerably less harmful” than smoking tobacco. In a Q&A interview with this website, Italian academic Dr. Riccardo Polosa (pictured, below), said that such products are “unlikely to raise significant health concerns”, writes Martin Banks.  

EU Reporter:  Millions of Europeans are now using electronic cigarettes, but are you convinced that they are safe alternatives to traditional cigarettes? What is the science to back this up?

Dr Polosa:  “Even the most stubborn opponents in the tobacco control movement now acknowledge that e-cigarettes, although not risk-free, are considerably less harmful than smoking tobacco. Emissions and exposure data are unequivocally showing that their toxicological profile is of immaterial concern compared to tobacco smoke. Clinical findings on e-cigarette users who have been using these products long-term do not show any early sign of damage to the lung. Also, our work in patients with respiratory conditions shows that e-cigarettes can help reduce cigarette consumption, are very well tolerated and can improve respiratory outcomes in patients with asthma and chronic obstructive pulmonary disorder (COPD) that have switched to regular vaping. This positive evidence is in agreement with many other research studies on the subject. To name just a few, well-respected authorities, such as Public Health England (PHE), Cancer Research UK (CRUK) and Action on Smoking and Health (ASH), recognize the potential of e-cigarettes to reduce the negative health effects of smoking. I am confident that, under normal conditions of use, these products are unlikely to raise significant health concerns.”

EU Reporter:  The manufacturers claim these e-cigarettes could save thousands of lives each year as they help smokers beat their addiction. Is it possible to verify the claim that they are less harmful for those who want to quit smoking?

Dr Polosa:  “There is now growing scientific consensus that e-cigarette use carries much lower levels of risks than smoking; a recent report from Public Health England estimates that vaping an e-cigarette is likely to be at least 95% less harmful than smoking a regular cigarette. Existing tobacco control policies to reduce cigarette use have been only modestly effective and integration with a strategy of switching cigarette smokers to e-cigarette use to accelerate tobacco control progress should be now considered. Recent estimates indicate that replacement of tobacco cigarette by e-cigarette use over a 10-year period may prevent 6.6 million premature deaths, in the US alone. In collaboration with LIAF (Italian Anti-Smoking League), we have started a series of scientific and regulatory initiatives that promote the potential benefits of e-cigarettes with the goal of accelerating the declining trends of smoking prevalence in Italy.”

EU Reporter:  E-cigarettes can be used legally in those public places where real smoking is illegal but some countries and companies have banned them. How would you criticize such moves?

Dr Polosa:  “Unlike second-hand tobacco smoke, there is no direct evidence that passive exposure to vaping may cause significant harm to bystanders. Public Health England and Action on Smoking and Health UK have both produced evidence-based guides to help public places and workplaces make local policy. In consideration of this, I am personally critical of any irrational enforcement of indoor vaping bans. Questions of ‘etiquette’ are relevant as bystanders may find e-cigarette aerosol unpleasant. Some businesses may therefore choose to limit the use of e-cigarettes not for health and safety reasons but because of concerns that customers or employees will be annoyed by their use. Hospitals, schools and airplanes would be environments suited to a vaping ban. But on the other hand, there is no justification for outdoor vaping bans. Banning e-cigarettes sends the misleading message that they are just as harmful as smoking and could deter switching from smoking to vaping. Bans may drive vapers out with smokers and encourage them to restart tobacco smoking. Last but not least, allowing e-cigarette use in some workplaces and public places undermines smoking behaviour by favouring vaping.”

EU Reporter:  The e-cigarette market is regulated under the Tobacco Products Directive. This was done to address fears that unregulated, pirate products could threaten human health. Do you support such regulation?

Dr Polosa:  “Article 20 of the EU Tobacco Products Directive 2014/40/EU (TPD) allows the marketing of e-cigarettes, subject to a number of conditions and restrictions. The regime largely mirrors the medicines regulation without the benefits, namely, without the ability to advertise the product. Furthermore, the TPD was guided by an arbitrary adoption of the precautionary principle, taking no notice of the existing scientific evidence. An example is provided by Article 43, which literally states, “electronic cigarette can develop into a gateway to nicotine addiction and ultimately traditional tobacco consumption, as they mimic and normalize the action of smoking. For this reason it is appropriate to adopt a restrictive approach to advertising electronic cigarettes and refill containers”. Moreover, TPD implementation at member-state level has put additional obstacles for consumers to access products that may be beneficial to public health. In Italy for example the government has enforced an unpopular taxation on e-vapor products and prohibited their sale via internet. It is clear is that including additional marketing restrictions for e-cigarettes will put these products out of reach of many consumers and thus it will be an impediment to European public health. My opinion is that TPD is in need of corrective measures.”

EU Reporter:  In the US, the share of middle and high school students who use e-cigarettes doubled in 2017 from the previous year. One of the biggest concerns among health officials is the potential for e-cigarettes to become a path to smoking among young people who otherwise would not have experimented. How would you react to such fears?

Dr Polosa:  “What fears? There are no such fears! Some anti-vaping advocates are concerned about vaping being a gateway for youth smoking – that is the risk of renormalising smoking and undermining tobacco control. However, the evidence does not support these arguments. Also, the “gateway” theory is a political construct that has been used for decades to fuel drug panics and defend drug prohibition. All the “gateway” nonsense shifts attention away from the social determinants of drug use. Most importantly, in countries where use of vapour products has been particularly common (such as in US and UK), youth smoking rates continue to decline at a faster rate; this clearly negates the very occurrence of a gateway into tobacco smoking.”

EU Reporter:  What do you think the EU should do in relation to e-cigarettes?

Dr Polosa:  “The EU should consider integrating the existing tobacco control policies with a pro-vaping strategy in order to accelerate tobacco control progress and that regulation of these products is better focused on standard for safety and quality to safeguards consumers’ best interest.  Our experience suggests that many former smokers who transitioned to using e-cigarettes believe that the main goal for regulators should be to keep the products available and acceptable as a cigarette replacement. Excessive and ill-conceived regulation will conflict with these basic requirements; it will marginalize e-cigarettes by making them unattractive to smokers and less competitively priced compared with tobacco products.  The silence on the benefits of electronic cigarettes in the EU cannot continue. The European Parliament should work together with the scientific community in order to protect the European citizens, smokers or not, by implementing an effective harm reduction strategy.”

Dr Polosa is director of the Institute for Internal and Emergency Medicine of the University of Catania in Italy, Chief Scientific Advisor to Lega Italiana Anti Fumo (LIAF – Italian Anti-Smoking League).

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Category: A Frontpage, Cigarettes, Electronic cigarettes, EU, Health, Tobacco