E-cigarettes and English exceptionalism

In the accompanying paper, Professor Gruszczyński reflects on the differing views about the European Union Tobacco Products Directive for e-cigarettes [1]. As he notes, there are some who see them as a means to end the smoking epidemic, while others view them as an instrument that is being used by the traditional tobacco industry to thwart this objective. He concludes that, given the continuing uncertainty about these products, the Directive is an appropriate response. We agree.
We would, however, add one important observation to his thoughtful review of the arguments being made by health organisations. Those whom he quotes as in favour of relaxing restrictions on e-cigarettes and, in some cases, even argue that they be promoted actively, are from one country, England. Yet even there, support for e-cigarettes is far from universal. Thus, the National Institute for Health and Clinical Excellence (NICE), which evaluates evidence on effectiveness of treatments, does not recommend them as cessation aids [2].
Elsewhere in Europe, and indeed also in other parts of the United Kingdom, concerns are widespread and are growing, for several reasons. First, there is growing evidence that these products promote nicotine addiction among young people, with some suggestion that this may be slowing or even reversing the long-term decline in smoking initiation [3]. Second, it has so far been impossible to find high-quality evidence that they increase cessation rates, with much of the available evidence suggesting they reduce them [4]. Third, evidence of their health risks is accumulating, especially in relation to lung and cardiovascular disease [5]. And finally, there are concerns about the enormous resources being used by the tobacco industry to promote them, and in particular the role of the Philip Morris-funded Foundation for a Smoke-Free World [6-8], coupled with the promotion of new products in the British markets designed to maximise nicotine delivery [9], as well as reports that e-cigarette manufacturers are emulating tactics traditionally associated with the tobacco industry [10].
There is particular concern about the now widely cited claim by Public Health England that e-cigarettes are “95% safer” than traditional cigarettes. As has been reported previously, this figure is based not on empirical data but on a meeting of individuals, some with links to e-cigarette manufacturers [11], whose report conceded that the evidence was insufficient to...


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