Switch to Vaping to Avoid ‘Almost all of the Harm from Smoking,’ says Royal College of Physicians

by Steve Barrett

Switch to Vaping to Avoid ‘Almost all of the Harm from Smoking,’  says Royal College of Physicians

The first organisation to publish a report on cigarettes and lung cancer in 1963 has recommended that e-cigarettes should be promoted by physicians and Public Health bodies.

LONDON, U.K. — A new report released today from the Royal College of Physicians (RCP), Nicotine without smoke: tobacco harm reduction, should provide reassurance and encouragement to smokers that vaping is a viable option for quitting. The 200-page report concludes that in the interest of public health it is important to widely promote vapour products and other non-combustion tobacco / nicotine products as substitutes for cigarettes. The extensive analysis also estimates that vapour products are likely pose no more than 5% of the risks associated with cigarettes, with the authors further noting that the actual figure may be substantially lower.

Among the key messages in the exhaustive report is that any potential risks of vapour products must be compared against those posed by smoking.

“Some harm from sustained exposure to low levels of toxins over many years may yet emerge, but the magnitude of these risks relative to those of sustained tobacco smoking is likely to be small,” writes the RCP. “However, the absolute magnitude of any risk attributable to e-cigarette use is likely to be very small in absolute terms, and hence substantially smaller than that arising from tobacco smoking.”

The report, which was produced by the RCP’s thirteen-member Tobacco Advisory Group, is a review of the latest evidence on the subjects of smoking, nicotine, and alternative products.

The RCP also finds:

  • E-cigarettes are not a gateway to smoking- in the UK, use of e-cigarettes is limited almost entirely to those who are already using, or have used, tobacco
  • E-cigarettes do not result in normalisation of smoking – there is no evidence that either nicotine replacement therapy (NRT) or e-cigarette use has resulted in renormalisation of smoking. None of these products has to date attracted significant use among adult never-smokers, or demonstrated evidence o
    f significant gateway progression into smoking among young people
  • E-cigarettes and quitting smoking – among smokers, e-cigarette use is likely to lead to quit attempts that would not otherwise have happened, and in a proportion of these to successful cessation. In this way, e-cigarettes can act as a gateway from smoking.
Gregory ConleyGregory Conley, President of the American Vaping Association, said the following in reaction to the report:








“This pronouncement by the RCP is historic. In 1962, while the U.S. government was being bullied by tobacco companies into virtual silence on the dangers of smoking, it was the RCP that released the first comprehensive analysis linking smoking to lung cancer. It was only after the RCP published its report that the U.S. Surgeon General began work on what would eventually become the landmark 1964 Report on Smoking and Health.

“There are striking parallels to the debate that is occurring now on vapor products. Decades ago, it was the tobacco industry that was seeking to suppress the truth from the public. Today, the biggest barrier to accurate information about nicotine is not tobacco companies, but perceived protectors of public health like the CDC and the American Lung Association.

“When the RCP told the truth about cigarettes in 1962, it took two years for the U.S. government to play catch up and release its own report. It should not take two months, let alone two years, for American public health authorities to correct their past misstatements about vaping.  The FDA and CDC must seriously consider the RCP’s guidance before moving forward on any new regulations or public campaigns about smoke-free nicotine products.

“For those in mainstream tobacco control, the question for them is, how can you dismiss this report out of hand? The authors are credible experts without financial conflicts of interest in tobacco or vapor products. At some point, these groups will have to realize that the science has long outpaced their rhetoric.”


Report summary

  • Smoking is the biggest avoidable cause of death and disability, and social inequality in health, in the UK.
  • Most of the harm to society and to individuals caused by smoking in the near-term future will occur in people who are smoking today.
  • Vigorous pursuit of conventional tobacco control policies encourages more smokers to quit smoking.
  • Quitting smoking is very difficult and most adults who smoke today will continue to smoke for many years.
  • People smoke because they are addicted to nicotine, but are harmed by other constituents of tobacco smoke.
  • Provision of the nicotine that smokers are addicted to without the harmful components of tobacco smoke can prevent most of the harm from smoking.
  • Until recently, nicotine products have been marketed as medicines to help people to quit.
  • NRT is most effective in helping people to stop smoking when used together with health professional input and support, but much less so when used on its own.
  • E-cigarettes are marketed as consumer products and are proving much more popular than NRT as a substitute and competitor for tobacco cigarettes.
  • E-cigarettes appear to be effective when used by smokers as an aid to quitting smoking.
  • E-cigarettes are not currently made to medicines standards and are probably more hazardous than NRT.
  • However, the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.
  • Technological developments and improved production standards could reduce the long-term hazard of e-cigarettes.
  • There are concerns that e-cigarettes will increase tobacco smoking by renormalising the act of smoking, acting as a gateway to smoking in young people, and being used for temporary, not permanent, abstinence from smoking. To date, there is no evidence that any of these processes is occurring to any significant degree in the UK.
  • Rather, the available evidence to date indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.
  • There is a need for regulation to reduce direct and indirect adverse effects of e-cigarette use, but this regulation should not be allowed significantly to inhibit the development and use of harm-reduction products by smokers.
  • A regulatory strategy should, therefore, take a balanced approach in seeking to ensure product safety, enable and encourage smokers to use the product instead of tobacco, and detect and prevent effects that counter the overall goals of tobacco control policy.
  • The tobacco industry has become involved in the e-cigarette market and can be expected to try to exploit these products to market tobacco cigarettes, and to undermine wider tobacco control work.
  • However, in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK.



Steve Barrett
Steve Barrett


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