Earlier this year, Public Health England (PHE) announced the results of a controversial study which suggested doctors should do far more to encourage the use of electronic cigarettes to help people quit smoking.
The evidence review – only the second conducted by PHE into vaping – was carried out by leading independent tobacco experts, and concluded that at least 20,000 smokers could quit each year if they switched to electronic cigarettes. The number of vapers across the UK has plateaued at a little under 3m, yet the use of electronic cigarettes is believed to be one of several factors leading to a significant drop in smoker numbers.
Yet despite this latest report, not everyone is convinced. Suspicions remain over their impact on health – particularly the long-term effects given that they only hit the market in 2004, although sales did not start to skyrocket until 2013. Even their short and medium-term side-effects have been questioned. Published in the journal Proceedings of the National Academy of Sciences in January, research on mice as well as human cells suggested that electronic cigarettes were carcinogenic and damaged the heart, lungs and bladder.
But PHE insist that “vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits.” They also claim vaping is at least 95 per cent less harmful than traditional cigarettes. That a public health body would promote something which could be harmful at all may seem counter-intuitive, yet it is a clear example of the popularity of the strategy of harm reduction a number of countries are pursuing to reduce smoker numbers.
Initially used for drug addicts, harm reduction involves reducing the side-effects for both users and those near them, rather than trying to make them quit outright. It can range from free needle exchanges to reduce infections among drug users through infected blood, to free condoms to cut sexually transmitted disease numbers.
Harm reduction has seen growing momentum across the globe, with the UK in particular promoting its application to cut the numbers of smokers. Promoting the use of electronic cigarettes and other tobacco replacement therapies and products is a key part of the approach.
A number of heat-not-burn products are also starting to go on sale. These work by heating tobacco to temperatures far lower than those found in conventional cigarettes.
A number of studies – from the likes of Germany’s Federal Institute for Risk Assessment and the independent Committee on Toxicity of Chemicals in the UK – have found that these also pose significantly lower health risks than cigarettes. Some obstacles do remain before they go on sale in certain countries, including the US. But in countries already vigorously pursuing a harm reduction strategy, these products are also being embraced in efforts to reduce smoking, albeit not to the same degree as electronic cigarettes.
Harm reduction can be controversial, with the idea of promoting products which still have the potential to cause harm proving decisive. Just across the Irish Sea from mainland Britain for example, the Republic of Ireland’s Health Service Executive declines to even list information on electronic cigarettes on its Quit.ie website.
Reducing smoking numbers is a huge question which sees different countries follow differing strategies to varying degrees of success. But with harm reduction going hand in hand with declining smoking rates, don’t expect a change in tack any time soon.