The House of Commons Science and Technology Committee has just published a report on e-cigarettes. Those involved in tobacco control outside England are amazed at its conclusions although not entirely surprised as the England has long been an international outlier on this issue, far out of step with the rest of the world. For example, two major reports, from the US National Academies ofScience and, only a few days ago, from Australia, highlight how much is not known. The American Heart Association agrees that " the potential health effects unknown, especially in long-term users" and has made a series of recommendations that are almost the opposite of those in the Commons report. And it's not just in the Anglophone world. leaders of the European Respiratory Society recently responded to a paper on e-cigarettes in England saying "(A) There is little evidence that e-cigarettes are an aid to smoking cessation and much evidence that tobacco manufacturers are advertising e-cigarettes as a bridge to starting nicotine and as a vehicle for long term continuation”; and “(B) no-one, expert or otherwise, can credibly assert that e-cigarettes are safer than tobacco in the long term, given that they contain a whole new tranche of unregulated and unstudied compounds being inhaled into the lung." It is especially astonishing that the 95% safer figure is used, given that it has no credibility internationally. There are serious questions about the funding of the meeting it came from and it is simply impossible to know how safe a product is when it has only been used widely for a relatively short time. It took decades to discover the health effects of smoking.
The World Health Organisation has said explicitly that a precise figure cannot be given, referring to "Unsubstantiated or overstated claims of safety and cessation". Also, as reported earlier this week in a study from Birmingham, new evidence is appearing weekly raising concerns about safety.
It is equally astonishing to see the claim that they are a proven smoking aid given the recent publication of a large controlled trial in the New England Journal of Medicine concluding that "Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit. ". Moreover, there is now lots of evidence from observational studies that they reduce quitting.
The suggestion to increase nicotine is especially worrying given that organisations such as ASH have argued that the UK is safe from the rapid increase in use of Juuls by schoolchildren seen in the USA because of the lower levels permitted here. The report simply dismisses concerns such as that by the former chair of the American Academy of Pediatrics Tobacco Consortium, who has said “Juul is already a massive public-health disaster". But then, the report ignores the considerable evidence that these products are a gateway to smoking.
Fortunately, other countries are not following England's direction, despite massive pressure from a very well funded Big Tobacco operation. Instead, they are waiting for the results on our giant experiment on our people.
The House of Lords Home Affairs Committee has a sub-committee on the EU. It is an extremely impressive group, chaired by a former head of the diplomatic service, and with a former chief executive of the NHS among its numbers. I was asked to give evidence on the prospects for retaining the European Health Insurance Card post Brexit. What other arrangements does the EU have with third countries? Are there arrangements from before we joined the EU that we could revive? This involved a lot of homework - for example, dredging through the National Archives to find ancient treaties. That was a fascinating exercise. Several were with countries that no longer exist, such as Czechoslovakia (although in that case it seems that David Davis is unaware that it split in two in 1993), Yugoslavia, and the USSR. The wording revealed how far we have come. Many of the treaties talked of how, if a national of one country was residing in another, he would be entitled to something, as would his wife. Clearly, the possibility of a woman ever working abroad was unimaginable to them. I've written a blog about what I discovered on the BMJ website. But to cut a long story short, it is clear that, once again, UK ministers are living in cloud cuckoo land. Their remarks reveal a profound ignorance of even the most basic aspects of how the EU works. I cannot see any prospect of retaining the EHIC given the UK government's red lines. No wonder our European neighbours are now planning for the worst. Until now, they persisted in the belief that the UK government could not be so stupid. But now they realise that it is. And it is both tragic and embarrassing.