UK Public Health Official dismisses FHB’s e-cig report snub

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Martin Dockrell, a top public health official in the UK, has shrugged off the FHB’s dismissal of a UK government commissioned review on e-cigarettes, which claimed they were 95% less harmful than cigarettes.


Public Health England (PHE)’s Head of Tobacco Control Programme, Martin Dockrell, brushed away the Hong Kong Food and Health Bureau’s claims that the UK official public health body’s controversial report on e-cigarettes (EC) as merely one “among the many reviews”.

Earlier in August, an FHB representative replied to HT’s requests for comments on the PHE’s report which stated ECs are 95% less harmful compared to conventional cigarettes, “PHE’s report is among the many reviews conducted by various organizations to look into the effects of ECs. There are other studies showing the harm of ECs.”

Speaking to HT, Mr Dockrell dismissed the FHB’s deprecation of their report. “We are not aware of any other review of this scale commissioned by a national government,” he says. “PHE’s remit letter from government for 2014 to 2015 requested an update of the evidence around ECs. PHE commissioned Professors Ann McNeill and Peter Hajek to review the available evidence. The review builds on previous evidence summaries published by PHE in 2014.”


However, despite PHE’s insistence on the authority of the “landmark” report, the research commissioned by the Government body has been met with plenty of criticism. The Lancet, a medical journal and the BMJ (British Medical Journal), have both attacked the PHE report on grounds of weak methodology and involvement of researchers with conflicting interests.

Shortly after the PHE report was published on August 15, The Lancet published an editorial criticising one of the reports cited in the PHE report. The editorial claimed the 95% figure derived from a paper by David Nutt and colleagues published in European Addiction Research was heavily flawed.

The results of the paper were based on the scores for harm given to nicotine products, including Electronic Nicotine Delivery Systems (ENDS), by an international expert panel led by Nutt.

PHE Report: “first, cigarette smoke constituents that harm health are either absent in EC vapour or, if present, are mostly at levels much below 5% of smoking doses; and second, the main chemicals present in ECs only have not been associated with any serious risk.”

The Lancet editorial wrote, “the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report.”

The PHE soon replied refuting the claims that the findings were not legitimate, saying, “PHE believes the review meets our high standards for scientific rigour and evidence.”

The authors of the report, led by Ann McNeill of King’s College London Institute of Psychiatry, replied saying the editorial unfairly singled out the one paper, “The Lancet Editorial criticises our Public Health England commissioned evidence update report on the basis of perceived flaws in one of the 185 references we used, ignoring the rest of our 111 page document, which addresses population effects of EC use, regulations, attitudes as well as concerns over its safety.”

The reply further explains that the estimate that EC use is around 95% less harmful than smoking is based on the facts that, “first, cigarette smoke constituents that harm health are either absent in EC vapour or, if present, are mostly at levels much below 5% of smoking doses; and second, the main chemicals present in ECs only have not been associated with any serious risk.”

Professor McNeill also responded to similar accusations published in the BMJ from Martin McKee, professor of European public health, and Simon Capewell, professor of clinical epidemiology. She said their statement “directors of public health and the wider community desperately need advice on EC that is evidence based and free from any suspicion of influence by vested interests” was offensive.

She also criticised McKee and Capewell for their lack of expertise, compared to those involved in the PHE review. “We have an extensive track record of research dedicated to understanding smoking behaviour and population and individual approaches to help smokers stop and prevent uptake of smoking; we have published hundreds of primary research articles on smoking, nicotine, and ECs; and we have years of clinical experience in smoking cessation. We have never taken any tobacco or EC industry funds,” said Professor McNeill. “By contrast, McKee and Capewell are not experts in this field—they have carried out no nicotine dependence, smoking cessation, or EC research—but they have a history of warning smokers and health professionals about EC dangers.This may explain their efforts to undermine the message that vaping is much safer than smoking.”

Key caveat

The criticism in the BMJ article also states that EC supporters “focus narrowly on existing smokers, comparing the device effects with those of smoking conventional cigarettes”; EC opponents, on the contrary, compare vaping with non-smoking and believe that it should be discouraged because of “concern about the uptake of ECs among people, especially children and adolescents, who would not otherwise smoke and about their long term health effects.”

Divides in opinion arise from whether vaping is compared to not smoking anything or measuring harm reduction compared to smoking.

Perhaps this is the key caveat between supporters and detractors in the debate. In Hong Kong, the FHB has repeatedly cited research emphasising the harm in e-cigarette use, such as the alleged existence of dangerous amounts of formaldehyde in EC vapour, as opposed to its relative reduced harmful effects.

In her response, Professor McNeill believes comparing vaping with smoking is not a narrow focus. “The task of tobacco control is to reduce death and disease caused by smoking. Switching from smoking to vaping avoids most of the risks of smoking,” she said.

Mr Dockrell of the PHE, believes many of the concerns people have about ECs arise from confusing them with tobacco cigarettes, “The report shows how people are increasingly but mistakenly seeing ECs as at least as dangerous as tobacco. But of course they are not cigarettes, they don’t produce harmful smoke nor do they contain hazardous ingredients on the same scale as cigarettes. The public health duty is to reduce confusion about these products and to make clear that they are entirely different, with entirely different implications for health.”