Is the European Commission about to crack down on an effective method to quit smoking?
Christopher Snowdon, Head of Lifestyle Economics at the Institute of Economic Affairs, examines a recent EU report on vaping. While vaping is being embraced by the NHS as an effective method to help smokers give up cigarettes, the EU’s SCHEER committee report takes a prohibitionist approach which could deprive smokers of a proven means to quit.
This article was originally published by Brussels Report, and is reproduced with the kind permission of its editor and the author.
At the end of last month, the EU’s ‘Scientific Committee on Health, Environmental and Emerging Risks’ (SCHEER) published its opinion on electronic cigarettes. Its findings could give the green light to further attempts by the European Commission to stamp out vaping. This contrasts with Britain’s National Health Service at the same time announcing plans to offer free e-cigarettes to smokers in emergency departments.
When SCHEER’s preliminary opinion was published last September, many experts were surprised by the negative tone.
Hypothetical risks were amplified while stronger evidence showing the benefits of e-cigarettes in smoking cessation was downplayed. Similar evidence reviews from agencies such as Public Health England and the U.S. National Academies of Sciences, Engineering, and Medicine have drawn from a wider evidence base and given a more balanced assessment.
In response to criticism, the EU’s SCHEER committee has modified its position somewhat. It has downgraded its interpretation of the evidence that e-cigarettes are a ‘gateway’ to smoking and are a risk factor for cardiovascular problems from ‘strong’ to ‘moderate’, but it maintains that ‘passive vaping’ is a plausible health risk and concludes that ‘electronic cigarettes should only be considered to support smoking cessation for a limited time and under supervision’.
With this recommendation, SCHEER goes beyond its remit of assessing the effects of vaping on the human body and embroils itself in policy.
The EU’s SCHEER Committee downplays how vaping helps people to quite smoking
In science, the strongest evidence comes from randomised controlled trials (RCTs). Several RCTs have shown that smokers are significantly more likely to quit if they switch to vaping, but SCHEER gives them short shrift.
More evidence has been published since September confirming e-cigarettes’ effectiveness in smoking cessation, but while the SCHEER committee acknowledges this research in its final opinion, it continues to insist that the evidence is ‘weak’. This is a baffling conclusion, especially when the committee interprets objectively weaker (non-RCT) evidence for various health risks as ‘moderate’.
No one claims that e-cigarettes are completely risk-free and even the SCHEER report does not deny that they are far less harmful that smoked tobacco. Vaping products contain nicotine, which is known to have a modest effect on the cardiovascular system similar to caffeine and certain foods, but there is no evidence that this poses a significant health threat to vapers, let alone to bystanders. As the SCHEER report notes, the most common respiratory problem associated with vaping is mouth and throat irritation which dissipates over time. These are the kind of small risks that individuals are prepared to tolerate if they enjoy using a product, particularly if the alternative is smoking.
The reality is that for the vast majority of vapers, the alternative is to continue smoking. There is overwhelming evidence from economics and epidemiology that e-cigarettes and cigarettes are substitutes for each other. If you clamp down on vaping, you inadvertently encourage smoking. Countries such as the UK and USA, where vaping has flourished, have seen sharp drops in the smoking rate. In most EU countries, where only one per cent of the population vapes and e-cigarettes are treated with suspicion, smoking rates have barely fallen since 2014.
The EU’s SCHEER Committee treats evidence selectively
The problem with the SCHEER report is that it not only treats the evidence selectively, but it looks at the issue from the wrong end of the telescope. ‘Harm reduction’ is a well-established concept in public health and refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviours.
Harm reductionists take people as they come and offer them a safer way of doing what they enjoy. In tobacco harm reduction, the relevant comparison is between the risks of vaping and the risks of smoking. Instead, SCHEER imagines a world in which nobody uses nicotine and compares e-cigarette vapour with fresh air. This approach has some scientific merit – we do want to know what the risks of vaping are – but by downplaying the benefits and exaggerating the risks, anyone relying on this report alone might think that there are no net benefits from the invention of a vastly safer nicotine delivery device at all.
The European Commission may ban flavours in vaping products, which would remove a means for smokers to quit tobacco
This is a worry for consumers because the SCHEER report is designed to alert the European Commission to the ‘potential need for legislative amendments’ to the Tobacco Products Directive.
It wanted to regulate e-cigarettes as medical devices in the last Tobacco Products Directive, which came into force in 2016. Its plans were derailed by the European Parliament, but it may soon try again. The European Commission seems particularly interested in banning flavours in e-cigarette products, a policy copied from American prohibitionists which would make vaping much less appealing to smokers who are thinking of switching to a product that could save their lives.
In reality, the SCHEER report does not compel the Commission to do anything. The only evidence for health risks which the SCHEER report rates as ‘strong’ in the final opinion relates to poisoning and injuries due to burns and explosions. These hazards have already been dealt with in the existing Tobacco Products Directive and do not require further legislation.
However, while the report does not explicitly call for any new laws, it gives the European Commission ammunition if it wishes to table some. As the evidence that e-cigarettes are relatively harmless and effective smoking cessation devices continues to grow, the SCHEER report will be used as a crutch for those who continue to lobby against them.