Royal College of Physicians Announcement

Published by Matt Brown on 18th May 2016

Following on from last summer's report by Public Health England, the Royal College of Physicians has today released its own report, in which they recommend promoting e-cigarettes as a substitute for smoking.

Main conclusions of the report

  • E-cigarettes are not a gateway to smoking – in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco
  • E-cigarettes do not result in normalisation of smoking
  • E-cigarettes and quitting smoking - among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened
  • The data suggests that they are unlikely to exceed 5% of the risk associated with smoked tobacco products
  • Regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers
  • E-cigarettes are likely to be beneficial to UK public health
  • Smokers can therefore be reassured and encouraged to use them, and the public can be reassured that e-cigarettes are much safer than smoking.

In more detail

The report from RCP, 'Nicotine without smoke: Tobacco harm reduction', focuses on the importance of harm reduction when dealing with the public health burden from smoking.

It's an extensive study, weighing in at almost 200 pages, and looks at the wider tobacco control effort, including government legislation and traditional NRT. Of most importance to us, of course, is the report's conclusions about e-cigarettes.

Focusing as it does on harm reduction, the statement that the promotion of e-cigarettes as a substitute for tobacco is likely to see a public health benefit is particularly welcome.

The report also refutes claims that e-cigarettes represent a gateway to smoking, or that they 're-normalise' smoking in some fashion. It states that 'e-cigarette use in Britain is, to date, almost entirely restricted to current, past or experimental smokers. As with NRT, there is no evidence thus far that e-cigarette use has resulted, to any appreciable extent, in the initiation of smoking in either adults or children.'

Looking at any potential risk presented by the use of e-cigarettes, the RCP concludes that 'e-cigarettes are probably close to NRT in the harm that their use confers on the user and others' but also that they are 'likely to generate significant health gains in the UK.'

Of particular importance in terms of safety, the report states that while carbonyls such as formaldehyde have been detected in vapour, it is only under conditions beyond that of normal use, i.e. past the point of wicking material beginning to burn, something which several scientific studies have deliberately ignored. It goes on to conclude that while such toxins may be present at negligible levels, in future it can be expected that these levels will fall still further through production and quality improvements.

The RCP also makes the point that the addiction potential of current e-cigs is likely to be low, stating that other chemicals in tobacco smoke most probably help to enhance the addictive effect of the nicotine present in cigarettes.

Professor John Britton, chair of the RCP’s Tobacco Advisory Group, said:

"The growing use of electronic cigarettes as a substitute for tobacco smoking has been a topic of great controversy, with much speculation over their potential risks and benefits. This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the UK.

Smokers should be reassured that these products can help them quit all tobacco use forever."

The findings of the RCP should be welcomed across the industry, demonstrating as they do a position we've known ourselves for years. The report also echoes a similar report issued by Public Health England in August 2015. Hopefully, today marks the start of a movement towards supporting e-cigs among other public health bodies.