New PHE review, divisive media reports

New PHE review, divisive media reports

Late last night various tweets were being posted by the media with previews of today’s papers front pages from i, Daily Telegraph, Daily Mirror and The Times. All four were based on an impending publication from Public Health England (PHE), but as is the norm for the media, the headlines didn’t actually reflect the contents of the publication.

I’ll admit to being a little wary of today’s news based on those previews alone, despite assurances from Lorien Jollye that the report from PHE was actually a very very good thing. As with anything related to vaping and smoking I’m very cynical and the preview headlines all had a common theme which sadly led me to believe the wrong thing.

Each one of these previews raised huge red flags with me simply because NHS prescription would normally infer medical licensing, which none of the current vapour products have, except one which I found out yesterday is utterly rubbish (not entirely surprising).

As expected, the morning bought a whole different side to the story. The PHE review became available so I had a scan through the summarised sections this morning.

PHE Review: Key Messages

In a nutshell, PHE wish to encourage the use of electronic cigarettes as an option for smoking cessation via the stop smoking services with behavioral support, continue research into their safety, monitor uptake to ensure those that shouldn’t be using them continue to not do so, and above all they clearly state that electronic cigarettes are 95% safer than cigarettes, which we already knew but it is always nice to hear it from an independent body.

Cue a flurry of media “reports” in response to this positive news from PHE, each of them taking the line that “e-cigs will be free on the NHS”, which the PHE report doesn’t state. At all.

There were, however plenty of soundbites from the authors of the review:

“My reading of the evidence is that smokers who switch to vaping remove almost all the risks smoking poses to their health. Smokers differ in their needs and I would advise them not to give up on e-cigarettes if they do not like the first one they try. It may take some experimentation with different products and e-liquids to find the right one.”

~ Peter Hajek


“There is no evidence that e-cigarettes are undermining England’s falling smoking rates,”

~ Ann McNeil

The big non-surprise for me was the comments from Dame Sally ‘Backbone’ Davis:

“there continues to be a lack of evidence on the long-term use of e-cigarettes”

But the report itself received an endorsement from the UK CMO despite her own misgivings about the lack of long-term research.

Whilst various prominent figures gave their support to the PHE review, some were a little less welcoming and others remained silent. Of course, we all remember the twitter meltdown of the Faculty of Public Health’s president Prof. John Ashton and the subsequent unfeeling “apology” later issued by the FPH, so it comes as no surprise that their message was rather lacking.

FPH Statement

FPH “welcomes” the report and will “review it carefully”, no doubt it’ll get filed in ‘file 13’ but it is telling that they insist that “the best thing any smoker can do for their health is to stop smoking now and forever”. Then go on to mention that anyone who wants to quit smoking to go to NHS services which use “evidence-based treatments that are proven to best help them to quit”.

That to me says, plain as day, “we’ll read this review, but continue to recommend Champix, Zyban and NRT, failing that smokers can quit or die”. This latest statement is completely at odds with a previous statement on the preposterous proposals from Wales:

FPH Statement

The RSPH were fairly encouraging with their recommendation that e-cigarettes be embraced and nicotine be de-stigmatized, but that came with the caveat that smokers can no longer smoke in pub beer gardens. Uh uh, no. Not having any of that sunshine. All that will do is further isolate smokers from viable alternatives making it harder for them to be exposed to actual users.

Public distrust is increasing

Very few of the media articles mention the fact that faith in vapour products in the eyes of the general public has substantially decreased, yet the PHE review clearly mentions that public perceptions of vaping have been damaged, mostly due to terribly written articles (yes Jasper I’m looking at you for one!), which is a sad thing especially when I’ve seen tweets from former vapers that have gone back to smoking for fear of misconceived harms.

Harm perception

It really is saddening to see that many in the UK view e-cigs as “just as harmful” or even “more harmful”, but it is telling that most of those who think that are “never users / ex-smokers”, “never users / current smokers”, “ex-users (both)” and “ex e-cig user, current smokers”. All the groups that could benefit from this technology have the highest rate of harm perception, and most of that can be laid squarely at the feet of the media.

But the finding runs counter to public perception: nearly half of people questioned (45.6 per cent) didn’t realise that e-cigarettes are much less harmful than smoking.

~ Cancer Research UK

In contrast, 22% believe that vaping is as harmful as smoking. Depressing figures.

For all my doubts about Deborah Arnott, she hasn’t been pulling any punches recently, and her response to the PHE review is no exception:

Arnott comment

Today’s PHE publication has merely reinforced what we already knew to be true, and for once despite the headlines, the media have actually done us a favour by implying that vapour products may be prescribed on the NHS. Go big or go home would apply there. But.

It’s a big but. Having discussed this very topic with Nicky from Harrow yesterday, having e-cigs “prescribed” sends the subtle message that vaping is a “cure” for a disease. Smoking isn’t a disease, it’s an individual choice. By allowing the NHS to prescribe them gives the perception that they are a medicine along the lines of NRT, something that vapourisers clearly are not. Becky covers this far better than I can over on her blog, but I’m definitely not in favour of a medicalised e-cig at all. I suspect that a medicalised device will be pretty boring and tasteless without the joys of the varied experience we get from the current products.

This to me is the key factor to vapourisers that have made them the successful device they are today. Consumer-driven products that have evolved at a rapid pace since their inception in 2003, the wide availability of the products, the choices available to find a setup that suits the users needs plus the dazzling array of flavours, all have seen NRT fail at some point, some have even tried to give up smoking using NRT, I myself half-heartedly “tried” a few times, but a common theme among many is that “we never intended to quit smoking”.

That is harm reduction at its finest, using existing motions that mimic an enjoyable past-time to reduce the harm done to the user. This, I feel is something that many either don’t want to or can’t understand, and sadly the damage done by the decades of anti-smoking campaigns, and recent anti-vaping scare stories has embedded a significant negative perception in the eyes of the general public, it also seems that there are still some within public health and government that hold the same opinion.

BMA Comment on PHE Review

Unsurprisingly, it’s the BMA and the Welsh Government that are insisting that strong regulations, in line with tobacco are needed and insisting that vapourisers need to be completely safe. It comes as no surprise then that the Welsh Government flat refuses to amend the current proposed Bill in light of the PHE review citing none other than the World Health Organisation; another “health body” that has remained ominously silent in response to the latest news.

The proposed ban from Wales flies in the face of the evidence reviewed and can only be seen as a US-style attempt at controlling the Welsh public.

“Fears that e-cigarettes have made smoking seem normal again, or even led to people taking up tobacco smoking, are not so far being realised based on the evidence assessed by this important independent review,”

~ Linda Bauld

So far, three separate surveys run by Cancer Research UK, ASH UK and Linda the “renormalisation” and “gateway” arguments put forward by those against vaping do not show any youth cigarette uptake, nor do they show that vaping undermines the efforts of current legislation or re-normalises smoking in any form.

I do find it amusing that Stanton Glantz referred to the UK as “an experiment” in terms of regulations for e-cigarettes, if the UK is an experiment than frankly, it’s working. The lenient, hands-off approach taken by the UK regulatory bodies thus far have enabled vaping to reach an estimated 2.6 million users and have potentially changed 76,000 lives.

One thing is for sure, the unregulated market of them the past 5-6 years has only resulted in less smoking and more science proving that they work to help smokers quit. One might wonder given what we learned from the report, why the TPD was drafted that would restrict the industry, limit the choices of the consumer and drive people back to smoking?

~ Dimitris Agrafiotis

The debate surround vaping will no doubt continue for some time with plenty of moves and counter moves between both sides, and as a reminder of what can happen Lorien posted an old, but still relevant blog post, which if medicalisation ever comes to pass is most likely the future we can all expect. At the very least this review should prompt all public health bodies to review their stances on vaping as a whole. But for right now, my response to today’s news?

Full of win meme

Bravo to all the people involved, this is a massive win despite the irrelevant headlines!