ASH comment on Lancet editorial on e-cigarettes

Friday 28 August 2015

ASH was saddened to see the Lancet editorial today attacking Public Health England (PHE) for having ‘fallen short of its mission’. [1]

To criticise Public Health England for quoting an estimate, contained in the expert review it commissioned, that e-cigarettes are 95% less harmful than tobacco on the basis that the methodology behind the estimate was weak is to miss the point.

To quote Professor Michael Russell in the BMJ in 1976 “People smoke for nicotine but they die from the tar.” [2] As the expert review concludes, electronic cigarettes do not contain most of the toxic and carcinogenic constituents of smoke. Any they do contain are in very low doses, mostly far below safety limits for occupational exposure. [3]

Furthermore from May 2016 a new regulatory framework is being put in place which will ensure that in future there will be greater transparency about the contents and emissions of electronic cigarettes and stricter controls on product standards. [4]

There is therefore no question that electronic cigarettes are substantially less harmful than smoked tobacco and that smokers can significantly reduce their risk by switching. Whether the reduction in risk is 95% or slightly less (or slightly more) is not the key point. What is of much greater concern to ASH (as shown by the YouGov smokefree Britain polls for ASH) is that a growing number of smokers are failing to understand the relative risks and may as a result be put off switching from smoking. [5]

Public Health England has a statutory responsibility to ‘promote the health and wellbeing of the nation’. It has not fallen short. It has fulfilled its mission by putting the message out clearly – while electronic cigarettes are not risk free, they carry only a fraction of the harm caused by smoking.


Notes and Links:

Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see:
ASH receives core funding from Cancer Research UK and the British Heart Foundation.

[1] Editoral: E-cigarettes: Public Health England’s evidence-based confusion
The Lancet Volume 386, No. 9996, p829, 29 August 2015
[2] Russell MJ. Low-tar medium nicotine cigarettes: a new approach to safer smoking.BMJ 1976;1:1430–3
[3] PHE E-cigarettes: an evidence update. A report commissioned by Public Health England. PHE, August 2015.
[4]  EU Tobacco Products Directive. Article 20
[5]  Total sample size was 12,055. Fieldwork was undertaken between 26th February and 12th March 2015. All surveys were carried out online. The figures have been weighted and are representative of all GB Adults (aged 18+).

% who agree electronic cigarettes are a lot less harmful than regular cigarettes % who think  none or a very small portion of the health risks of smoking comes from nicotine
Current electronic cigarette user and ex-smoker  67% (n=239) 36% (n=239)
Current electronic cigarette user and current smoker 53% (n=366) 21% (n=366)
Ex-electronic cigarette user and current smoker 33% (n=811) 21% (n=811)
Never electronic cigarette user and current smoker 17% (n=768) 11% (n=826)