Britain's leading physician organization has concluded that the nicotine-delivery devices are more likely to benefit, rather than harm, public health, and urged cigarette smokers to switch to the products.
A report released Thursday by the Royal College of Physicians (RCP) made it clear that the group views e-cigarettes as potentially game-changing smoking cessation devices.
The publication comes as the FDA finalizes plans widely expected to regulate e-cigarettes like traditional cigarettes.
The report summarized the quickly evolving research on e-cigarette safety, concluding that the emergence of the devices "has generated a massive opportunity for a consumer -- as well as healthcare -- led revolution in the way that nicotine is used in society."
The RCP writing committee found little evidence of e-cigarette use among nonsmokers, stating that, in the U.K., e-cigarette use is almost entirely limited to current or past conventional cigarette smokers -- in youths as well as in adults. The report didn't address concerns about e-cigarette use by teens as a gateway to smoking.
"Smokers should be reassured that these products can help them quit all tobacco use forever," said John Britton, of the U.K.'s University of Nottingham, who led the committee that wrote the report. A summary by Britton and colleagues appeared in The BMJ.
"This report lays to rest almost all of the concerns over these products, and concludes that, with sensible regulation, electronic cigarettes have the potential to make a major contribution towards preventing the premature death, disease and social inequalities in health that smoking currently causes in the U.K.," Britton noted in a written press statement.
It also highlights the stark contrast in how e-cigarettes are being viewed by health officials in U.K. and the U.S., where most major health organizations, including the American Lung Association, the American Academy of Pediatrics, and the American Heart Association, have long called for strict federal regulations on e-cigarette products.
In an interview with MedPage Today, American Lung Association public policy spokesperson Erika Sward noted that since e-cigarettes are regulated in Great Britain, but are not yet regulated in the U.S., comparing what is happening in the two countries is "comparing apples and oranges."
E-cigarettes are regulated in Britain as general consumer products, with additional restrictions on advertising and selling to minors. Some e-cigarettes are also licensed for use as smoking cessation devices.
The lack of federal oversight in the U.S. means that little is known about what chemicals other than nicotine are used in the nearly 500 e-cigarettes products on the market here, Sward noted.
"England is farther ahead than the United States in the regulation of these products, so what this group is saying is not really relevant at the time to the U.S. market," she said. " Our position is that the FDA needs to regulate e-cigarettes, and then we can see if this applies here."
Calls for the FDA to regulate e-cigarettes like conventional tobacco products are not universally supported, however.
In an opinion piece published this week in the journal Nicotine, seven tobacco control experts, including several from the U.S., called on the FDA to focus on discouraging use of the products by non-smokers, especially children and teens, instead of discouraging their overall use.
The experts argued that while increasing taxes on e-cigarettes and other vaping products to the level of those imposed on tobacco cigarettes will discourage use by youth, it will also discourage the use of these products by smokers who want to quit or reduce their reliance on cigarettes.
"The primary aim of tobacco control policy should therefore be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to vaporized nicotine products rather than quitting all nicotine use," David T. Levy, PhD, of Georgetown University Medical Center in Washington, and colleagues wrote.
Levy told MedPage Today that the focus of public health officials should be on encouraging users of cigarettes and other traditional tobacco products to quit.
"We need stronger policies that discourage smoking cigarettes," he said. "If e-cigarettes are a gateway to smoking then that would be a clear negative, but there is very little evidence that this is the case."
Sward disagreed, citing growing evidence that e-cigarette use may lead to smoking, including a study published last August in the Journal of the American Medical Association, showing e-cigarette use among high-school students in Los Angeles to be associated with a greater uptake of traditional cigarette use.
"There is significant evidence to show that e-cigarettes are turning into a gateway product for smoking," she said.
Michael Cummings, who co-authored the analysis published in Addiction reported providing testimony on behalf of plaintiffs in cases against the tobacco industry. All other authors declared no relevant relationships with industry.
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