Public health

Tobacco industry is gaining e-cig respectability by stealth, respiratory experts warn


The tobacco industry is seemingly being allowed to promote by stealth ‘healthier’ and unregulated e-cigarettes to children and young people without meaningful restriction or penalty, a group of respiratory physicians in the UK has warned.

Professor Stephen Fowler from the University of Manchester and colleagues argue that regulators are essentially turning a blind eye to the marketing tactics of a “resurgent industry”, which risks increasing young people’s exposure to nicotine and several other unregulated inhalants of unknown toxicity.

“The tobacco industry has a record of duplicitous suppression of data; yet, with their promotion of electronic nicotine delivery systems [ENDS] they are regaining ground they previously lost with tobacco cigarettes,” they wrote in a comment published in The Lancet Respiratory Medicine,

As it stands, the response of global governments and learned societies to vaping has been one of “ineluctable opposition”, on the back of several papers highlighting the dangers of e-cigarettes and evidence that “the acute toxicity from ENDS is greater than that of tobacco”.

The authors highlight cases of e-cigarette related acute lung injury in children and younger people and a raft of suspected adverse reactions reported in the UK – 244 as of January 8, 182 of which were respiratory adverse reactions.

“The long-term effects of ENDS are unknown, but given the greater acute toxicity compared with tobacco, it is dangerous to be complacent about the potential risks of prolonged exposure to ENDS,” they warned.

They noted that e-cigarettes had gained “an appearance of respectability” that originally stemmed from a 2014 report by David Nutt and colleagues, which concluded that vaping was 95% safer than smoking, despite a “lack of hard evidence for the harms of most products on most of the criteria”.

Even so, “this figure has been repeatedly endorsed by Public Health England and the Royal College of Physicians, UK, and it has inevitably been used in topline advertising by ENDS companies” building confidence in ENDS “to the extent that they might be prescribed for smoking cessation, despite the absence of any compelling evidence of efficacy”.

Moreover, while the branding and flavours of e-cigarettes suggest that they are being targeted towards children and younger people, “many of whom have never smoked tobacco cigarettes”, marketing approaches – “glamorous, with themes of freedom and rebellion” are more reminiscent of those employed in the past to encourage people to smoke tobacco, the authors suggest.

Many e-cigarette companies, such as Totally Wicked, were already sponsoring professional sports, while others in the industry are also actively looking for similar opportunities.

“The marketing of ENDS to younger people has been normalised and is associated with an increased use by teenagers”, but in the UK “the regulatory authorities, the Royal Colleges, and learned societies (with the exception of the Royal College of Paediatrics and Child Health), are immobilised”, the authors noted.

“At the least, ENDS should be subject to the same legislation as tobacco, and those who supply them to under-age children should be subject to stringent penalties,” they stressed.

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