- By Richard Craver Winston-Salem Journal
Making it government policy that smokers be encouraged to switch to electronic cigarettes as “a considerably less harmful alternative” if they can’t quit is the recommendation of a bipartisan legislative panel.
However, instead of the proposal coming from Congress, it has surfaced out of a bipartisan U.K. House of Commons committee.
Nevertheless, the Parliament Science and Technology committee’s report is likely to add new fuel to the fire on both sides of the Atlantic Ocean as to whether e-cigs and heat-not-burn traditional cigarettes should be promoted as a public-health benefit.
U.K. government officials said they will consider the recommendations, which follow up on a series of U.K. scientific reports suggesting e-cigs carry up to a 95 percent lower risk compared with traditional combustible cigarettes.
The growth in U.S. e-cigs sales, particularly top-selling Juul, comes despite increased FDA scrutiny and criticism from anti-tobacco advocates about anecdotal reports on youths using the product, including while they’re in school.
“The House of Commons committee report on e-cigarettes is science-based, rational and reasonable, and it will have absolutely no effect on health authorities and regulators in the U.S.,” said Brad Rodu, a professor of medicine at the University of Louisville and an anti-smoking advocate.
The FDA announced plans on July 28, 2017, for a sweeping regulatory “road map” on tobacco and nicotine products that included limiting or eliminating flavorings, such as menthol in traditional cigarettes and candy and fruits in e-cigs and vaporizers.
However, the FDA also supports extending the application deadline for regulatory review for new products, such as e-cigs and vaporizers, from late 2018 to as far out as August 2022.
The next regulatory update from the FDA could come any day following months of taking public comments.
“British health authorities have been telling smokers the truth about vaping since 2011,” Rodu said.
“Meanwhile, American authorities, in pursuit of a ‘tobacco-free society’ and a ‘tobacco endgame,’ demonize all smoke-free products with untruths and give continuing life to urban anti-vaping myths.”
Opportunity? The committee said e-cigs present “an opportunity to significantly accelerate already declining smoking rates, and thereby tackle one of the largest causes of death in the U.K. today.”
About 2.9 million smokers in the U.K. are using e-cigs to stop smoking; about 79,000 are dying annually from tobacco-related diseases.
The committee addressed several public health U.S. e-cig and heat-not-burn issues — that the products and their non-tobacco flavorings could serve as a gateway to traditional cigarettes, particularly by teens, and there could be second-hand vapor concerns with consumption in public areas.
“It has also proven challenging to measure the risks from ‘second-hand’ e-cigarette vapor because it is negligible and substantially less than that of conventional cigarettes,” the committee said.
The committee said concerns “have not materialized” in e-cigs attracting young non-smokers in significant numbers.
The committee recommended the U.K. government work with manufacturers to further develop e-cigs as smoking-cessation options and making e-cigs available to mental-health patients in an attempt to improve their physical health.
“Many businesses, public transport providers and other public places do not allow e-cigarettes in the same way that they prohibit conventional smoking,” the committee said. “But, there is no public health (or indeed fire safety) rationale for treating use of the two products the same.
“There is now a need for a wider debate on how e-cigarettes are to be dealt with in our public places, to help arrive at a solution which at least starts from the evidence rather than misconceptions about their health impacts.”
The committee acknowledged, as anti-tobacco advocates have cited, that “there are uncertainties, nevertheless, especially about any long-term health effects, because the products have not yet had a history of long use.”
“Ultimately, however, any judgment of risks has to take account of the risk of not adopting e-cigarettes — that is, continuing to smoke conventional cigarettes, which are substantially more harmful.”
“The government should review with the e-cigarette industry how its systems for approving stop smoking therapies could be streamlined to be able to respond appropriately should e-cigarette manufacturers put forward a product for licensing.”
ReactionBritish American Tobacco Plc, which owns Reynolds American Inc., said in a statement the report “offers an accurate and pragmatic snapshot of the current state of play of the e-cigarette market.”
“While recognizing the significant risk-reduction potential of e-cigarettes, the committee also addresses a number of challenges to realizing their potential.
“Adopting an evidence-based approach to amending the e-cigarette product format restrictions, taxation and where they can be used will also help remove the hurdles currently facing smokers who may be looking to switch to e-cigarettes.”
BAT addressed another heated public-health issue — whether the U.K. government should allow manufacturers to promote e-cigs and heat-not-burn products.
“Amending the marketing restrictions currently imposed on the e-cigarette category would allow us to correct misinformation regarding the potential reduced risk of e-cigarettes vs. smoking, and to communicate the availability of these products to smokers,”
“We hope local councils and health bodies will feel confident to include e-cigarettes in their local cessation programs, and that they will feel comfortable consulting with responsible industry players for the roll out of these products.”
The top-selling U.S. e-cig Juul entered the mainstream retail marketplace in 2015, and is sold in the form of a pen or a USB device. That design makes it easy to hide its usage.
On July 10, the company declared in a regulatory filing it has sold $650 million in securities from a $1.25 billion offering launch June 26.
Juul continues to expand its market share gap with R.J. Reynolds Vapor Co.’s Vuse at 70.5 percent to 10.8 percent, respectively. The market share is based on Nielsen data reported by Wells Fargo Securities analyst Bonnie Herzog.
On April 22, the FDA expanded and tightened its oversight over Juul products, including taking steps to halt online sales to youths on eBay.
Two days later, Juul Labs agreed to take significant steps to address federal and state regulatory concerns, including “actively supporting” initiatives to raise the minimum age to at least 21 to purchase tobacco products. It has since halted plans to roll out up to 55 new flavors.
Complicated issueAnti-tobacco advocates stress that the Parliament committee’s reports represents just one view of a complicated and increasingly politicized U.S. public health issue.
For example, the Campaign for Tobacco-Free Kids cited a January report from the U.S. National Academies of Sciences, Engineering and Medicine that it said “reached different conclusions about the relative health risks and risks to kids of e-cigs.
However, the U.K. report was focused on adult tobacco consumption and cessation.
“Key findings of the National Academies report include there is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults,” Campaign spokesman Vince Williams said.
“Overall, there is limited evidence that e-cigarettes may be effective aids to promote smoking cessation.
“While e-cigarettes are likely to be less harmful than conventional cigarettes, ‘the implications for long-term effects on morbidity and mortality are not yet clear’ and ‘the absolute risks of the products cannot be unambiguously determined at this time,’” Williams said of the academies’ report.
DebateAnti-smoking analysts said current U.S. regulatory policies are not as based on scientific evidence as they should be such as restrictions on the sizes of vapor liquid tanks.
“My fear is that activists and elected officials in the U.S. will take nothing away from this report, but the thought of making vaping products pharmaceutical quit aides, while ignoring the importance the report places on a well-functioning consumer market,” said Gregory Conley, president of the American Vaping Association.
Scott Ballin, past president of anti-smoking alliance Coalition of Science or Health, said the FDA should review not only the positive public-health aspects to e-cigs, but also “recognize that it will be important to monitor progress and look at the evolving science.”
Stephen Pope, managing principal of London-based financial-services firm Spotlight Ideas, expressed concern the recommendations could be derailed because of an attached proposal to lower excise taxes on e-cigs and heat-not-burn products compared with traditional cigarettes.
“I fear that whilst the Conservatives would like to cut taxes, the finances of the nation cannot afford it,” Pope said. “Labour, under (the leadership of) Jeremy Corbyn, would tax anything that they see as raking funds to pay for their many, many plans.
“I could see the Liberal Democrats wanting to cut the tax, but is there the courage to make such a cut and recoup the money by raising tobacco taxes even higher?
“The Exchequer gains a great deal of money from taxing all forms of tobacco,” Pope said. “They must see flashing (pound) signs on e-cigarettes for as they become more popular, so the chance to rake money in is irresistible.”