On e-cigarette safety The Lancet has decided to shoot the messenger

So the pushback begins. An anonymous editorial in The Lancet today wields the hatchet at the recent Public Health England report which said that e-cigarettes are ‘around 95 per cent safer than smoking’. The Lancet has never been keen on e-cigarettes and it doesn’t like the 95 per cent figure, but rather than come up with a better one, it has chosen to shoot the messenger. The editorial traces the 95 per cent estimate back to a study written by David Nutt and colleagues whom it describes as ‘a small group of individuals with no prespecified expertise in tobacco control’.

This will be news to dyed-in-the-wool anti-smoking campaigners such as Martin Dockrell, who worked at Action on Smoking and Health until recently, and David Sweanor, a longstanding member of the Canadian Non-smokers’ Rights Association. Both were co-authors of the study, as was Dr Karl Fagerström, a world-renowned nicotine scientist who gave his name to the Fagerström test. The other eight authors also have relevant experience, including Nutt himself who, in 2010, convened a similar panel to rate the hazards of various substances for a study that was published in, er, The Lancet. (Nutt’s 2010 drugs panel included three members and met for a one-day workshop. His e-cigarette panel included 11 members and met for two days. Which is the ‘small group’?)

With wearying predictability, The Lancet launches into an ad hominem attack on two of the 11 authors of Nutt’s study. The editorial notes that one of the authors has consulted for a distributor of e-cigarettes and another has been a consultant to the pharmaceutical industry. Since Big Pharma does not make e-cigarettes and sees them as a rival to their own nicotine products it is debatable whether the second of these is a competing interest at all, but it is nevertheless there in black and white in the original study, as competing interests always are.

According to The Lancet, the declared interests of two out of 11 authors of one study cited by Public Health England ‘raises serious questions not only about the conclusions of the PHE report, but also the quality of the agency’s peer review process’. This risible attempt to make a mountain out of a mole hill suggests that The Lancet is less interested in assessing the scientific evidence than in groping around for anything that might help blacken the PHE report’s name in the eyes of the public.

This is a technique the magazine has been perfecting ever since it laid into the now-legendary scientific pioneer John Snow in the 1850s. When Snow concluded that cholera was spread through the water supply and not, as the medical consensus had it, through the air, The Lancet accused him of being in the pay of the polluting industries. And they were right. He was. But that did not stop germ theory being right and miasma theory being wrong. The Lancet finally got round to correcting its notoriously terse obituary of Snow two years ago. One might hope that by now the magazine would have learned how to play the ball rather than the man.

It is not as if the claim that e-cigarettes are much less hazardous than smoking hinges on a single study by David Nutt. The latest PHE report builds on a previous PHE report by different authors who concluded that the health hazards posed by e-cigarettes are ‘likely to be extremely low’. There is a good deal of toxicological evidence showing that contaminants in e-cigarettes are an order of magnitude lower than those found in tobacco cigarettes, including a study which concluded that ‘none of the more than 10,000 chemicals present in tobacco smoke, including over 40 known carcinogens, has been shown to be present in the cartridges or vapour of electronic cigarettes in anything greater than trace quantities’.

The National Institute for Health and Clinical Excellence noted in 2012 that there are ‘no firm cases of harm that are directly attributable to e-cigarette use’. To date, the main dangers associated with e-cigarettes have involved people blowing them up by using the wrong charger.

If there is a problem with the PHE report it is that it is too definitive in claiming that e-cigarettes are ‘around 95 per cent safer than smoking’ when the existing evidence suggests that it would be more accurate to say ‘at least 95 per cent safer than smoking’. At the very least, the authors should have said that vaping is 95 per cent safer than smoking, with a five per cent margin of error either way.

Better still, they should have put the ball in the naysayers’ court by pointing out that e-cigarettes have been on the market for years, millions of people use them, none of them have died as a result and there is no evidence that they could lead to serious harm. On the contrary, people have avoided serious harm by using them to quit smoking. It is time for the burden of proof to fall on the accusers.

  • Neil McKeganey

    The interesting thing about the disputed claim that electronic cigarettes are, or are not, 95% less harmful than combustibles is the fact that electronic cigarettes would be making a valuable contribution to tobacco related harm reduction if they were 50% less harmful, 40% less harmful, or any less harmful than combustible tobacco. Nobody on either side of this dispute is suggesting that electronic cigarettes are more harmful than combustibles and as a result it is deeply disturbing that those claiming to represent the health of the public should find themselves advocating against the use of these products.

    • Marion McLean

      Hear hear! Surely, anything that helps people to stop smoking is a good thing? Some doctors actually used to encourage people to smoke at one time so they don’t have much room to talk!

    • Jon Krueger

      That would apply for e-cigarette users who actually quit smoking. Most don’t.

      Odd that you don’t mention that.

      • vereybowring

        Talked to many vapers have you ?
        I have (many hundreds) and most of the ones I’ve met have given up tobacco.

        • Yvonne Leigh

          I gave up a year ago, I was a heavy smoker, I’ve not had one cig since. I love my vaper.

      • Dragonmum

        Actually, most do – some immediately as I did, others may take longer. Almost 6 years since my last cigarette and no desire to light up again – ever!

      • Vape John

        I encourage dual use the first few months. Going from one habit you have been doing for year/decades to another is a transition. It’s stressful for the beginner who wants to quit smoking with vaping products to remember to keep their tank filled, battery charged and to have extra coils on hand. I smoked for 3 months when I started vaping until one day i just didn’t have the desire to smoke anymore. Tasted and smelled awful to the point I was completely turned off from them. Everyone is different though

      • Angel Tibbs

        Prove most don’t or don’t say it. I have not used tobacco for 19 months and counting.
        If the vapers you know use Big Tobacco’s cigalikes….that’s not actually vaping. Consider the source.

      • rideronthistrain

        I quit in only 5 days by vaping and I was a long time smoker. I tried a variety of Big Pharm’s nicotine replacement therapies which were wholly inadequate, caused side effects that were nasty and so I failed every single time. Vaping is a lifesaver imho. Smoke free for 8 months with no desire to pick up a cigarette again. Go to an e-cig forum and you’ll see how many people who have failed with other methods have quit via e-cigs and for those who haven’t quit you’ll see that they have drastically reduced the amount they smoke. Harm reduction!

      • Zarniwoop

        Even if a smoker doesn’t quit completely but uses an e-cigarette 20% 50% 80% of the time surely that is better than 100% tobacco.

      • Well, Jon, according to this survey of vapers. The survey was of 7,238 vapers worldwide from 72 countries. How many people have you asked?
        According to 7,238 people:

        42% quit smoking in one day.
        75% total quit smoking within a month.

        Your 2% IS both acknowledged and represented here in this graph below.

        Odd I DID mention it.
        You must be asking the wrong people.


  • Bill Godshall

    The Lancet editors failed to mention that they have a far greater conflict of interest than any e-cig researcher: continuing to make money from sick and dying cigarette smokers (who could have prevented their cigarette diseases by switching to vaping).

    Besides, according to the growing mountain of scientific and empirical evidence, nicotine vapor products (aka e-cigarettes):
    – are 99% (+/-1%) less hazardous than cigarettes,
    – have never been associated with any disease or disorder,
    – are virtually all (i.e. >99%) consumed by smokers and by ex-smokers who switched to vaping,
    – have replaced more than 4 Billion packs of cigarettes worldwide in the past eight years,
    – have helped several million smokers quit smoking, and have helped several million more smokers sharply reduce their cigarette consumption,
    – are more effective for smoking cessation than FDA/MHRA approved nicotine gums, lozenges and patches (which have a 95% failure rate),
    – pose fewer safety risks than FDA/MHRA approved Verenicline (Chantix/Champix),
    – have never been found to create nicotine dependence in any
    nonsmoker (youth or adult),
    – have never been found to be a gateway to cigarette smoking for anyone,
    – emit trace levels of nontoxic aerosol that poses no harm to nonusers, and
    – have further denormalized cigarette smoking (as youth and adult smoking rates and cigarette consumption have declined every year since
    2007 when vapor sales began to skyrocket).

    More than a year ago, I submitted a comprehensive analysis of all e-cigarette research to the US FDA at
    that also cited hundreds of false and misleading fear mongering claims made about e-cigs by Obama’s DHHS and Big Pharma financed tobacco controllers, and delineated why/how the FDA proposed e-cigarette regulation is actually e-cigarette prohibition (as it would ban the sale of all e-cigs 24 months after issuance of the Final Rule).

    All real public health advocates support smokers switching to lifesaving vapor products. The Lancet editors (like Obama’s DHHS) have committed scientific and public health malpractice of historic proportions by threatening the lives of a billion humans.

    Bill Godshall
    Executive Director
    Smokefree Pennsylvania
    1926 Monongahela Avenue
    Pittsburgh, PA 15218

    • robertblair3174

      You CAN play rough when you have to.

    • Amy

      Also, let me point out that their alleged “smoking cessation” products aren’t really for that purpose. They’re intended to treat nicotine dependence and nothing more. Thus the reason they have a less than 10% success rate.

  • jude

    Where does the “Lancet” get its funding from? Who has the conflict of interest here? Applying the principle of “who benefits”, will explain exactly why we are seeing these attacks on anyone who gives truthful information about vaping. This “publication” or “trade magazine” (which is a more accurate description of this magazine), relies on advertising from guess who? Conflict of interest, yep this trade mag is drowning in it.

  • Christine May

    I love the last paragraph 🙂

  • Neil McKeganey

    Actually at both an individual level and a population level the harm reduction benefit of electronic cigarettes does not require that the user entirely cease his or her use of combustibles since dual use can be associated with both a reduced duration of smoking and a reduction in the quantity of cigarettes smoked. However, that notwithstanding, a very large proportion of e-cigarette users (33% in the UK) are indeed individuals who have ceased smoking.

    • Rob Heyes

      Actually, according the latest figures it’s around 42% in the UK now (1.1M out of 2.6M) – the previous figures were 33%. And that doesn’t count those who have both stopped smoking and vaping as far as I know.

  • Angel Tibbs

    Bravo, and far past time the burden of proof should fall on the accusers. If they are so bleeding knowledgeable – and they have displayed nothing but ignorance and misplaced panic to this point – why are we still hearing naught but Maybe Might Be Could Be and We Just Don’t Know. How many years of not knowing what 4 separate FDA approved ingredients do?
    They seem to have forgotten completely about the proven killers, cigarettes, on whom the jury is NOT out and which are still available to teens and others EVERYWHERE.
    I want them held accountable for all the lives they risk so blithely.