February 9, 2018

Stanton A. Glantz, PhD

Public Health England goes even more overboard on e-cigs; when I first heard this I this I thought it was a joke

When I got emails from people asking me what I thought about Public Health England’s latest report on e-cigarettes that recommended allowing e-cigarette use in hospitals and by pregnant women, I thought it was a joke, real fake news.


But it is real, so here are some reactions to their press release (reproduced below):




PHE publishes independent expert e-cigarettes evidence review



A new PHE e-cigarette evidence review, undertaken by leading independent tobacco experts, provides an update on PHE’s 2015 review. The report covers e-cigarette use among young people and adults, public attitudes, the impact on quitting smoking, an update on risks to health and the role of nicotine. It also reviews heated tobacco products.

The key findings of PHE’s Evidence Review are that:

·         Vaping poses only a small fraction of the risks of smoking and switching completely from smoking to vaping conveys substantial health benefits;

SAG>> Everyone, including me, currently thinks that completely switching from cigarettes to e-cigarettes is less dangerous than smoking.  The problem is that very few smokers completely switch; they become dual users who simply add e-cigarettes to cigarettes.  This statement also ignores the evidence that, for most smokers, using an e-cigarette depresses the likelihood that they will quit smoking, which increases long-term health risks.  It is also becoming clear that e-cigarettes have a different risk profile than conventional cigarettes, so the effects of dual use – the most common use pattern – is worse than smoking.

·         E-cigarettes could be contributing to at least 20,000 successful new quits per year and possibly many more;

SAG>> Because, on average as used in the real world, e-cigarettes depress quitting, this number can’t be correct.  (And, yes, I know that the NAS report was slightly more enthusiastic about quitting; it said they “might” help quit smoking.  That is a long way from what PHE is saying.)

·         E-cigarette use is associated with improved quit success rates over the last year and an accelerated drop in smoking rates across the country;

SAG>> See previous comment.  We will have more specific data published on this soon.

·         Many thousands of smokers incorrectly believe that vaping is as harmful as smoking; around 40% of smokers have not even tried an e-cigarette;

SAG>>  It’s a good thing that 40% of smokers have not tried e-cigarettes, because they will be more likely to successfully quit than the smokers who have tried them.

·         There is much public misunderstanding about nicotine. Less than 10% of adults understand that most of the harms to health from smoking are not caused by nicotine;

SAG>> But this does not mean that nicotine is harmless.  In addition to being the addictive drug in cigarettes, it can directly cause and heart lung disease and aggravates cancer.  (You can watch an excellent discussion of the lung effects of nicotine and e-cigarette use by pulmonologist Jeff Gotts at our recent Billion Lives symposium here.)

·         The use of e-cigarettes in the UK has plateaued over the last few years at just under 3 million;

SAG>> That’s a good thing.

·         The evidence does not support the concern that e-cigarettes are a route into smoking among young people. Youth smoking rates in the UK continue to decline. Regular use is rare and is almost entirely confined to those who have smoked

SAG>> This is the most shocking assertion of them all.  Every single study done examining the gateway effect of e-cigarettes leading to cigarette smoking shows a strong link.  Indeed, the National Academy of Sciences report that PHE (selectively) quotes below concludes: There is substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults. And the NAS committee wrote this report before the recent publication of more studies confirming and expanding understanding of this link.

PHE’s evidence review comes just a few weeks after a US National Academies of Sciences, Engineering and Medicine report on e-cigarettes. Their conclusion on e-cigarette safety also finds that based on the available evidence “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes.”

SAG>> It would have been nice for PHE to quote all the conclusions, including many demonstrating adverse biological effects as well as the gateway effect (discussed above).  This is another example of PHE’s intellectual dishonesty.

Prof. John Newton, Director for Health Improvement at PHE said:

“Every minute someone is admitted to hospital from smoking, with around 79,000 deaths a year in England alone.

“Our new review reinforces the finding that vaping is a fraction of the risk of smoking, at least 95% less harmful, and of negligible risk to bystanders. Yet over half of smokers either falsely believe that vaping is as harmful as smoking or just don’t know.

SAG>> I continue to be flummoxed that people in England keep quoting this 95% number, which is based on no actual data, as we watch the evidence for adverse health effects of e-cigarettes keep piling up.

“It would be tragic if thousands of smokers who could quit with the help of an e-cigarette are being put off due to false fears about their safety.”

Prof. Ann McNeill, lead author and Professor of Tobacco Addiction at King’s College London said:

“It’s of great concern that smokers still have such a poor understanding about what causes the harm from smoking. When people smoke tobacco cigarettes, they inhale a lethal mix of 7,000 smoke constituents, 70 of which are known to cause cancer.

“People smoke for the nicotine, but contrary to what the vast majority believe, nicotine causes little if any of the harm. The toxic smoke is the culprit and is the overwhelming cause of all the tobacco-related disease and death. There are now a greater variety of alternative ways of getting nicotine than ever before, including nicotine gum, nasal spray, lozenges and e-cigarettes.”

Prof. Linda Bauld, author and Professor of Health Policy, University of Stirling and Chair in Behavioural Research for Cancer Prevention, Cancer Research UK said:

“Concern has been expressed that e-cigarette use will lead young people into smoking. But in the UK, research clearly shows that regular use of e-cigarettes among young people who have never smoked remains negligible, less than 1%, and youth smoking continues to decline at an encouraging rate. We need to keep closely monitoring these trends, but so far the data suggest that e-cigarettes are not acting as a route into regular  smoking amongst young people.”

PHE is calling on smokers and a number of bodies to act on the evidence:

·         Smokers – anyone who has struggled to quit should try switching to an e-cigarette and get professional help. The greatest quit success is among those who combine using an e-cigarette with support from a local stop smoking service.

·         Local stop smoking services and healthcare professionals – should provide behavioural support to those smokers wanting to quit with the help of an e-cigarette. A new training course on e-cigarettes for healthcare professionals by the National Centre for Smoking Cessation and Training is now live.

·         MHRA – continue their work in regulating and licensing e-cigarette products and support manufacturers to expedite the licensing of e-cigarettes as medicinal quit aids. PHE believes there is compelling evidence that e-cigarettes be made available to NHS patients.

·         NHS Trusts – to become truly smokefree Trusts should ensure: e-cigarettes, alongside nicotine replacement therapies are available for sale in hospital shops; vaping policies support smokers to quit and stay smokefree; smoking shelters be removed; and frontline staff take every opportunity to encourage and support patients to quit.

The Government’s new Tobacco Control Plan for England, includes a commitment to “maximise the availability of safer alternatives to smoking”. It makes clear that e-cigarettes have an important part to play in achieving the ambition for a smokefree generation.

Contact information

Philippa Simons
[email protected]

Notes to editors

  1. McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of e-cigarettes and heated tobacco products. A report commissioned by Public Health England. London: Public Health England. Report available here.


Ann McNeill 1,2, Leonie S Brose 1,2, Robert Calder 1, Linda Bauld2,3,4, Debbie Robson 1,2

Additional contributors to individual chapters:

Ilze Bogdanovica (Ch 11) 2,5, John Britton (Ch 11) 2,5, Jamie Brown (Ch 7)2,6, Peter Hajek (Ch 4,9) 2,7, Hyun Seok Lee (Ch 12) 1, Magdalena Opazo Breton (Ch 11) 2,5, Lion Shahab (Ch 7,9)  2,6, Erikas Simonavicius (Ch 12) 1, Robert West (Ch 7)2,6

King’s College London

UK Centre for Tobacco & Alcohol Studies

3 University of Stirling

4 Cancer Research UK

University of Nottingham

6 University College London

7 Queen Mary, University of London

  1. Over the past few years e-cigarette use has hovered at just under 6% of the adult population in Britain. The most common reason for e-cigarette use continues to be to help with quitting and they are the most popular quitting tool in England. At the same time, quit success rates have been improving and we are also seeing an accelerated drop in smoking rates (currently 15.5% in England): smokinginengland.info/latest-statistics
  2. 79,000 people in England die every year as a result of smoking (http://digital.nhs.uk/catalogue/PUB24228), and over half of long-term smokers will die from a smoking-related illness if they do not quit.


  1. PHE 2015 e-cigarettes evidence review: McNeill A., P. Hajek et al, E-cigarettes – an evidence update: A report commissioned by Public Health England, Public Health England, August 2015
  2.  on evidence for ‘around 95% safer’ estimate.
  1. Nicotine without smoke: tobacco harm reduction, Royal College of Physicians, April 2016
  2. Smoking Toolkit Study
  3. ASH (May 2017) Use of e-cigarettes (vapourisers) among adults in Great Britain
  1. Bauld, Linda, Anne Marie MacKintosh, Brian Eastwood, Allison Ford, Graham Moore, Martin Dockrell, Deborah Arnott, Hazel Cheeseman, and Ann McNeill. "Young people’s use of e-cigarettes across the United Kingdom: Findings from five surveys 2015–2017." International journal of environmental research and public health 14, no. 9 (2017): 973.
  1. Towards a Smokefree Generation: A Tobacco Control Plan for England, Department of Health, July 2017
  1. NHS Digital, Statistics on Smoking: England, 2017
  2. US National Academies of Sciences, Engineering, and Medicine (January 2018) Public Health Consequences of E-Cigarettes


About Public Health England

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. We are an executive agency of the Department of Health and Social Care, and a distinct delivery organisation with operational autonomy. We provide government, local government, the NHS, Parliament, industry and the public with evidence-based professional, scientific and delivery expertise and support.


Here is some of the press coverage:






And an editorial in The Lancet touting the PHR report:



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