Norman Lamb MP, Chair of the Commons Science and Technology Committee, discusses his committee’s inquiry into e-cigarettes.
The decline in smoking rates in the UK has been a triumph of public policy. Following a decade of tough government action on tobacco, smoking prevalence has fallen from 20.1% of the population in 2010 to a record low of just 15.8% in 2016. Despite this progress, however, cigarette smoking remains the leading cause of preventable death in the UK, while smoking-related illnesses cost the NHS £11bn (~€12.5bn) last year. E-cigarettes stand to prevent this.
In its recent tobacco control plan, the Government set an ambition for a ‘smoke-free generation’ with smoking rates below 5%. Electronic cigarettes could offer a force for such change. E-cigarettes reached the UK market in 2007 and the number of people using them has risen steadily ever since. While conventional smoking has fallen, the use of e-cigarettes rose to an estimated 2.9 million adults in 2016.
The risks and benefits of ‘vaping’
But given the millions of current users, there is a startling lack of clarity and consensus about the health impacts of using e-cigarettes. Advocates of the technology argue that they are a valuable tool to help smokers move away from tobacco and ultimately quit smoking conventional cigarettes. Sceptics, however, urge caution on the basis of a perceived lack of evidence of their safety.
Conflicting reports on the benefits and risks of vaping have led to confusion among policymakers and the general public as to whether these are safe devices that hold the key to a healthier, smoke-free society, or a new threat to public health that should be discouraged by governments and regulators. As with many emerging health technologies, commercial interests have crept into the debate and muddied the waters even further.
STC enquiry into e-cigarettes
That is why the Science and Technology Committee has launched an inquiry into e-cigarettes, to examine the evidence and make recommendations to government on how to respond to this recent but potentially game-changing innovation.
We want to understand where the gaps are in the evidence base, the impact of current regulations on the use of e-cigarettes, and the implications of this growing industry for public health and costs to the NHS.
In the UK, regulators and public health agencies have so far adopted a broadly favourable stance. Public Health England’s recent evidence report, published in 2017, advised that e-cigarettes are 95% less harmful than conventional cigarettes, a conclusion supported by the eminent Royal College of Physicians. The National Institute for Health and Care Excellence subsequently reviewed its recommendations for healthcare professionals, and recently told the Committee that e-cigarettes appear to be less harmful compared with smoking and that some smokers found them useful as a tool in their efforts to quit.
For the first time, e-cigarettes were also promoted as a stop-smoking tool in the national ‘Stoptober’ campaign last year. This has been widely viewed as an acknowledgement by health experts that e-cigarettes are an effective and, based on the evidence available, sufficiently safe method of helping people to quit smoking.
However, this attitude towards e-cigarettes is not universal. The USA’s Surgeon General has highlighted what he described as the dangers of e-cigarettes, irrespective of whether they are used as a stop smoking tool. Concerns have also been raised that e-cigarettes could play a role in ‘re-normalising’ smoking for the younger generations, even though no such evidence has been found by health authorities in the UK. A precautionary approach has been taken in Australia, with public health bodies citing an insufficient evidence base. A Committee in the House of Representatives is currently conducting an inquiry similar to ours to reach its own conclusions.
Clarifying the evidence matters. We know that smoking causes around 79,000 deaths in the UK every year. If e-cigarettes can potentially help to save tens of thousands of lives, it should be a priority to communicate these benefits to the public and ensure that our regulatory framework supports their use. Likewise, appropriate steps must be taken if there are legitimate concerns about their long-term safety. It is our duty as policymakers to understand and act – or not act as the case may be – based on the evidence before us.
E-cigs: regulations and innovations
Regulating an emerging and dynamic field is no easy task. New products are regularly being released on to the market – including the much-discussed ‘heat-not-burn’ devices. These are another innovation with gaps in the evidence base; while they are being marketed as a better alternative to cigarettes, evidence submitted to our inquiry suggests that not enough independent studies have been carried out to fully understand their impact.
As the UK moves closer to departing the European Union, the regulation of smoking technologies comes into even sharper focus. Brexit presents several regulatory headaches, but the opportunities should not be overlooked. For the next twelve months, e-cigarettes will continue to be regulated in accordance with the EU Tobacco Products Directive, including the more stringent restrictions on advertising that came into effect two years ago.
As we move into an era where Britain has greater flexibility to shape its own regulatory environment, however, we should grasp this opportunity to consider whether our current approach is in the interests of public health and potentially make the case for fresh legislation based on sound evidence.
The need for clear recommendations
The Science and Technology Committee is committed to promoting evidence-based policymaking. In the case of e-cigarettes, there are plenty of contradicting views. Policy is suffering as a result, meaning that people who stand to benefit from this innovation could be losing out.
Our inquiry seeks to provide some clarity on the evidence. We will look at the relative harmfulness of e-cigarettes and conventional cigarettes, consider their role as a stop smoking tool, and discover where gaps in the scientific knowledge base exist – before making clear recommendations to government on how to plug them.
Norman Lamb MP
Commons Science and Technology Committee
This article will appear in SciTech Europa Quarterly issue 26, which will be published in March, 2018.