Drug Science submission to the WHO enquiry on vaping

Fifteen years ago, the World Health Organization developed the Framework Convention on Tobacco Control (FCTC), which aims to provide governments with guidelines for reducing tobacco use.

Every two years, representatives meet at the Conference of the Parties (COP) to discuss ways in which the FCTC might be improved. The ninth Conference of the Parties (COP9) is scheduled to take place in November 2021. One topic which will be on the agenda is the regulation of alternative nicotine delivery devices.

Public Health England has said that alternative nicotine delivery devices which are less harmful than smoking could play a crucial role in reducing the huge health burden of smoking. Given this, the All-Party Parliamentary Group for Vaping asks ‘what is the policy rationale for intervention, and how does it compare or differ from current UK Government policy?’

Below is Drug Science’s submission to the All-Party Parliamentary Group for Vaping’s report to COP9.

 

Written by Professor David Nutt:

Vaping of nicotine plus or minus flavours is potentially one of the most important health advances in the history of medicine because cigarette smoking is the largest preventable cause of premature death worldwide. For this reason the UK, led by PHE, truly leads the world in using vaping to help smokers quit and to help minimise young people becoming hooked on cigarettes.

Perversely most of the rest of the world, and the WHO, take the opposite view.  These new products severely criticised and demonised. The reasons for this are a complex mixture of politics, self-interest from anti-tobacco lobby groups and puritanical absolutist hatred of recreational nicotine, even when it is of little harm as when vaped.  There is also some suggestion that the pharmaceutical companies that profit from selling medicines to aid quitting cigarettes see vaping as a commercial threat.  And at the back of all this is the unfounded rather paranoid belief that vaping is a “big tobacco” invention to increase tobacco use, which has been falling in recent decades. In fact most vaping supplies come from small producers and it is the success of these that have attracted some big tobacco companies e.g. Altria into the vaping market.

The ultimate absurdity of the anti-vaping position is the US decision to classify all vaping products as tobacco even when they contain zero tobacco or nicotine. This serves to distort the data on youth smoking in the USA so that the major vaping-induced declines in youth cigarette use are hidden.

What is worse is the way many so-called scientists, medical experts and journal editors, have deliberately distorted the evidence of harms of these new products to the benefit of cigarette sales and to the detriment of smokers health. This subversion of the scientific process has had the effect of scaring many smokers away from potential life-saving alternative products and in some countries has already led to their being banned even though cigarettes are sold openly.

 

What is the evidence?

My charity Drug Science was the first to examine the comparative harms of different forms of nicotine delivery systems using the most sophisticated methodology –  multi criteria decision making [MCDA]. An international expert group found that vaping was overall about 25 times less harmful than cigarettes [ref 1]. This finding was one of the planks on which the PHE recommendations were made  [ref 2] and also helped the New Zealand government’s adopting vaping as a tobacco harms reduction strategy [ref 3 ]. 5 years later in 2019 an Australian expert group comparing twenty drugs which included cigarettes and vaping came to the conclusion that vaping was less than a tenth as harmful [ref 4].  These over-arching analyses are supported by growing data on the health benefits of switching from cigarettes to vaping reported from several expert centres across the globe. Moreover the UK team of Peter Hajek have shown vaping is the best method for helping people to quit smoking.

 

How the vaping evidence is distorted

Here I explore some of the most egregious distortions of evidence that have been used to attack vaping in recent years and proposes a rigorous set of scientific principles that should be fulfilled for any future reports on the harms of vaping.

  1. Comparative harms should always be reported: so publications on the harm of vaping should always report cigarette smoking in comparable amounts as a control condition. For example, one paper claiming harms from vaping in the test-tube failed to report the cigarette control results on the grounds that as all these cells died, they couldn’t detect mutagenic changes!

 

  1. Vaping conditions in lab-based experiments should reflect real-world use of products. For example, a well-publicised paper in the New England journal of Medicine that claimed to have found vaping to produce pro-cancerous changes in cell culture heated the nicotine solution at currents that would never be used when human vape. Despite the best efforts of real experts on vaping the journal refused to retract a paper that was clearly misleading and dishonest.

 

  1. Harms should always be reported in relation to those produced by cigarettes and ideally relative other commonly used drugs. So for example four UK newspapers had headlines claiming vaping produced changes in aortic artery compliance similar to cigarettes. Not only did they fail to reveal that it took 30 mins of continuous vaping to produce the same change as that from one cigarette, but they also omitted to report that the effect of vaping was the same as drinking a cup of coffee or watching a scary movie!

 

  1. Editors and referees should refuse to publish unwarranted extrapolations from lab work to clinical practice. In the example given in 3 a medical “expert” claimed that this change in aortic compliance would mean that vaping therefore had the same cardiovascular risk as cigarettes. A ridiculous assertion given the fact that there are many other toxins in cigarettes – eg carbon monoxide – that are proven to contribute to cardiovascular disease.

 

In addition there are two other approaches that should be considered

  1. Authors who allow exaggerated claims to be made in press releases should be held responsible for them.

 

  1. The scientific community should expose and criticise such non-scientific assertions and the universities or other employers should properly vet and act to remove them from their web sites.

 

References

  1. Nutt DJ, Phillips LD, Balfour D, Curran HV, Dockrell M, Foulds J, Fagerstrom K, Letlape K, Milton A, Polosa R, Ramsey J, Sweanor D (2014) Estimating the harms of nicotine-containing products using the MCDA approach. Europ J Addiction 2014;20:218-225DOI: 10.1159/000360220

http://www.karger.com/Article/FullText/360220

  1. PHE ecigs – https://www.gov.uk/government/news/e-cigarettes-around-95-less-harmful-than-tobacco-estimates-landmark-review
  2. New Zealand nicotine policy. https://www.parliament.nz/resource/en-NZ/SCR_98007/3a8e520de6290062a2ea1b77545bc18f45bb68b7
  3. Bonomo Y, Norman A, Biondo S,Bruno R, Daglish M, Dawe S, Egerton-Warburton D, Karro J, Kim C, Lenton S, Lubman DI, Pastor A, Rundle J, Ryan J, Gordon P, Sharry P, Nutt D, Castle Det al., 2019, The Australian drug harms ranking studyJOURNAL OF PSYCHOPHARMACOLOGY, Vol: 33, Pages: 759-768, ISSN: 0269-8811