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Taking a stance sharply at odds with most American public health officials, a major British medical organization urged smokers to switch to electronic cigarettes, saying they are the best hope in generations for people addicted to tobacco cigarettes to quit.
The recommendation, laid out in a report published Thursday by the Royal College of Physicians, summarizes the growing body of science on e-cigarettes and finds that their benefits far outweigh the potential harms. It concludes resoundingly that, at least so far, the devices are helping people more than harming them, and that the worries about them including that using them will lead young people to eventually start smoking traditional cigarettes have not come to pass.
This
is the first genuinely new way of helping people stop smoking
that has come along in decades, said John Britton, director
of the U.K. Center for Tobacco and Alcohol Studies at the University
of Nottingham, who led the committee that produced the report.
E-cigarettes, he said, have the potential to help half or
more of all smokers get off cigarettes. Thats a huge health
benefit, bigger than just about any medical intervention.
That conclusion is likely to be controversial in the United States,
where arguments about e-cigarettes have jolted the traditionally
low-key public health community.
E-cigarettes deliver nicotine without the harmful tar and chemicals
that cause cancer. Some public health experts see e-cigarettes
as the first real chance in years for 40 million addicted Americans
to quit. But others, including the federal Centers for Disease
Control and Prevention, have focused on the potential dangers
of e-cigarettes, for example that they could extend smoking habits,
that they could be a gateway to traditional cigarettes for children,
or that their vapor could to turn out to have long-term health
effects.
These guys, in my view, are going off a cliff, said
Stanton A. Glantz, a professor of medicine at the University of
California who has been outspoken in his criticism of e-cigarettes.
They are taking England into a series of policies that five
years from now they all will really regret. They are turning England
into this giant experiment on behalf of the tobacco industry.
But some American public health experts applauded the report,
saying the emphasis on policies that reduce harm, such as recommending
that smokers try e-cigarettes or giving clean needles to drug
users, would probably save more lives.
This is two countries taking pretty much diametrically opposed
positions, said Kenneth E. Warner, a professor of public
health at the University of Michigan School of Public Health.
One is focused exclusively on the hypothetical risks, none
of which have been established. The other is focusing on potential
benefits.
He added, The British are saying, Lets see how
we can help the main smokers today, who by the way are largely
poor and less educated, and lets not focus so much on kids,
who may or may not be sickened by this 40 years down the line.
Smoking is still the largest cause of preventable death in the
United States, with more than 480,000 people a year dying of smoking-related
illnesses. In past decades, smoking was spread throughout society,
but today in Britain and the United States, smokers tend to be
poor, less educated, or mentally ill.
E-cigarettes, now a multibillion-dollar market, have gained popularity
faster than the federal government has managed to regulate them.
The Food and Drug Administration has not yet published final rules
that would subject them to federal oversight.
A spokesman for the C.D.C. said the agency would not comment on
any report other than its own. He reiterated the C.D.C. position
on e-cigarettes: There is currently no conclusive scientific
evidence supporting the use of e-cigarettes as a safe and effective
cessation tool at the population level. The science thus far indicates
most e-cigarette users continue to smoke conventional cigarettes.
But the report cites evidence from Britain that e-cigarettes have
helped with quitting. Robert West, director of Tobacco Studies
at University College London, analyzed monthly household survey
data going back to 2009 in England, and concluded that use of
an e-cigarette during an attempt to quit was associated with a
50 percent increase in the chances of success, compared with using
no aid or using a product such as nicotine patches without any
professional counseling. He estimated that around 20,000 smokers
in England quit smoking in 2014 because of e-cigarettes.
Professor Glantz cited his recent analysis as evidence that e-cigarettes
in fact reduce the chances someone will quit smoking.
The Royal College of Physicians is a respected doctors group
that helps set medical standards in Britain. It issued a groundbreaking
report on the dangers of smoking in 1962 that was seen as the
precursor of the American surgeon generals report of 1964
that linked smoking with cancer. The organizations last
major report on reducing harm from tobacco use came out in 2007,
before e-cigarettes became mainstream, and its authors said the
new one was an attempt to evaluate their benefits and harms.
The report walks through a decade of science, listing studies
that find in favor of e-cigarettes as well as studies that do
not. It asserts that e-cigarettes are only 5 percent as harmful
as traditional cigarettes, a conclusion that some American experts
say has been lost in the United States in the rush to condemn
e-cigarettes. It states bluntly that long-term effects of nicotine
are likely to be minimal.
The emergence of e-cigarettes has generated a massive opportunity
for a consumer as well as a health care-led revolution in the
way that nicotine is used in society, the report said. As
the technology of e-cigarettes improves, so the vision of
a society that is free from tobacco smoking, and the harm that
smoking causes, becomes more realistic.