10.2. SR 09-08-2015 - Laserfiche WebLink

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13 3.3 Seeing through controversy Many points are made against e-cigarettes but they almost all suffer from flaws and can mislead users about risks. Professor Robert West detailed six typical flaws (or ‘tactics’ if you believe this is deliberate) in an editorial in the journal Addiction 50. It is worth highlighting the ways in which science is being misused so that readers can be better placed to evaluate the messages. Failure to quantify: e.g., statement that e-cigarette vapour contains toxins so creating the impression that they are dangerous as cigarettes, without indicating that the concentrations are typically orders of magnitude less than tobacco smoke. Failure to account for confounding and reverse causality: e.g., arguing that use of e-cigarettes reduces chances of stopping because in cross-sectional surveys the prevalence of e-cigarette use is higher in smokers than in recent ex-smokers. Selective reporting: e.g., focusing on studies that appear to show harmful effects while ignoring those that do not. Misrepresentation of outcome measures: e.g., claiming that e-cigarette use is prevalent among youth by using data on the proportion who have ever tried and creating the misleading impression that they are all current e- cigarette users. Double standards in what is accepted as evidence: e.g., uncritically accepting conclusions from observational studies with major limitations when these claim that electronic cigarettes are causing harm, but discounting similar or better controlled studies when these appear to show the opposite. Discrediting the source: e.g., arguing that researchers who have received financial support from e-cigarette manufacturers (and even companies that do not manufacture e-cigarettes) are necessarily biased and their results untrustworthy, and presenting themselves as having no conflicts of interest when their professional and moral stance represents a substantial vested interest. 3.4 The case of snus – a cautionary tale Many of the same ‘population’ arguments were made on a precautionary basis in the case to ban ‘oral tobacco’ in 1992 throughout the EU, even though it is 95-100% less hazardous than smoking. On accession, Sweden was granted an exemption from the ban. In fact, this product is the reason why Sweden has by far the lowest rate of smoking in the EU: 13% Swedish adults vs 28% EU average 51. Snus has three main effects in Sweden and Norway: it is used to quit smoking; it is used to substitute for smoking; it diverts young people from onset of smoking. It provides a compelling ‘proof of concept’ for tobacco harm reduction, and a warning about perverse impacts of regulation. It also showed that tobacco control activists were prepared to mount a campaign against a product that was achieved real reductions in disease and premature death. 3.5 Concern about the tobacco industry A further source of critics’ concern is the possible negative role of the tobacco industry, which is unsurprising given the history. In practice, and in the present, it is hard to see what this could be if the e-cigarette industry remains competitive. The tobacco industry’s long-standing cigarette-based business model is threatened by e-cigarettes. To survive the disruption they will need to enter the market (as they are doing) and produce high quality attractive alternatives to smoking or risk losing share in the recreational nicotine market to other tobacco or non-tobacco e-cigarette companies. It is more likely that they will become important drivers of a wholesale switch from smoking to vaping 50 West R, Electronic cigarettes: getting the science right and communicating it accurately, Addiction, virtual edition on e- cigarettes, December 2014. [link] 51 European Commission, Special Eurobarometer 385, Attitudes of European Citizens to Tobacco, March 2012