Neil, thanks for your posting on the WHO position on e-cigarettes. One of the things I find difficult is that WHO's information sheets have very few references. If you make a strong claim like "are harmful to health and are not safe" then it deserves full referencing. There is no reference. Later on there are two references in relation to Conference of the Parties from 2014 and 2016 but these seem to relate to the Framework Convention.
As a number of commenters have said, there is a really important distinction between using e-cigarettes to help people quit tobacco cigarette smoking and initiation by someone who has not previously used nicotine-containing products. I think there is a strong consensus on the latter that we should do all in our power to stop people starting.
However, in relation to the former, health services are keen to know how to help people quit their tobacco dependence. The latest Cochrane from 2022 says "People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010216.pub7/...
It concluded "There is high‐certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate‐certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain. More studies are needed to confirm the effect size. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non‐nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but longest follow‐up was two years and the number of studies was small."
Those most tobacco dependent, eg people with serious mental illness, die up to 20 years prematurely (see Jenna Butler's post). So, if we are to reduce such gross inequality, shouldn't they and their healthcare teams be given fully referenced information about the relative harms of cigarette vs e-cigarettes?
Siân
HIFA profile: Sian Williams is Chief Executive Officer at the International Primary Care Respiratory Group in the UK. Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos. sian.health AT gmail.com
