US Surgeon General’s misplaced call to arms against e-cigarettes

The U.S. Surgeon General has just released a new report on e-cigarettes which could be influential in further shaping U.S. vaping policy

The report itself is framed almost entirely by the concern about e-cigarette use by young people and, as a result, has virtually nothing to say about the impact of e-cigarettes on adults over the age of 18.

{mosads}In doing so, the report fails to recognize an emerging body of evidence that responsibly produced and marketed vapor products can serve as a less harmful alternative to regular tobacco cigarettes and can even help smokers quit altogether.

The report misses a unique opportunity to recognize — and even champion — the ways in which vaping can play a positive, harm-reduction role that many experts believe has the potential to generate significant public health benefits. 

The U.S. report conspicuously ignores recent recommendations from a variety of respected bodies, including the Royal College of Physicians (RCP) and the United Kingdom’s Department of Health (PHE), which have found in favor of policies that enable tobacco smokers to switch to alternative sources of nicotine such as e-cigarettes and vaping products that contain none of the toxins and carcinogens of traditional combustible products that are so harmful to smokers and bystanders.

The RCP report concludes, among other things, that the “long-term” risk from vapor products is “unlikely to exceed five percent of the harm from smoking tobacco” and that vapor products are not a gateway to smoking.

PHE recently published an independent review of the scientific literature that concluded, according to PHE, that e-cigarettes are “significantly less harmful (around 95 percent safer) to health than tobacco and have the potential to help smokers quit smoking” and that “there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers.”

Judging from these studies, the U.S. Surgeon General would have been far better served to call for a proportionate regulatory response balancing both the harms as well as the benefits. Instead, the U.S. report advocates in favor of e-cigarette bans at the expense of engaging with the available evidence. Indeed, the introduction of vaping products in the United States has coincided with a significant decrease in smoking rates among the adult American population, which have fallen to their lowest rates in generations according to data recently released by the U.S. Centers for Disease Control and Prevention. These encouraging statistics include the reported two million ex-smokers using e-cigarettes and other similar vaping products in the United States today.

We are in agreement that the targeting and advertising of vaping to young people deserves special attention. However, what the report does not appear to recognize is that by recommending that these same young people — who are at the greatest risk of starting to smoke — should have no access to alternative reduced harm products, they are effectively ceding the entire terrain of early experimentation and onset substance use to what is universally seen to be the most harmful product (combustible cigarettes). 

Moreover, the report gives no consideration to the possibility that e-cigarette use by young people may be a viable means of preventing smoking onset altogether.

Rather, the report relies primarily on relatively crude data measures that may not reveal a far more nuanced reality of fluctuating and ephemeral use of e-cigarettes by young people. Qualitative interviews that we have conducted with 16 to 18 year olds have shown that movement in and out of e-cigarette use often occurs within a relatively short period of time (months), suggesting that use may be somewhat fashionable, rather than entrenched.

All told, the consequences of implementing the recommendations contained within the U.S. report will be to reduce the use of e-cigarettes by adults and to restrain the potential for achieving societies’ smoking cessation and prevention goals.

One can only hope that the incoming U.S. administration and Congress develops e-cigarette policy based on a review of the full evidence, maximizing the benefit of these devices in reducing smoking prevalence, while countering the use of these devices by non-smokers.

Neil McKeganey, Ph.D, is director of the Centre for Substance Use Research in Glasgow, Scotland.