Continuing its long-held support for a harm reduction approach to tobacco control, the RCP calls for “a nicotine regulatory system that applies controls on products in proportion to their potential harm, to promote innovation and diversity, ensure reasonable levels of protection for consumers and, above all, discourage tobacco use”.
The strong endorsement of e-cigarettes by the medical professionals’ body, with some 32,000 members worldwide, adds further weight to the already hefty support that vaping has received in Britain from influential organisations such as Public Health England.
While acknowledging that “some [physical] harm from long-term e-cigarette use cannot be dismissed” and that future products providing better nicotine absorption through the lungs may be more likely to create addiction, the RCP is adamant that it would be insignificant compared with the harms from smoking, suggesting that the risk posed by e-cigs could even be “substantially lower” than the oft-quoted 5% of tobacco’s health hazard.
It notes that “with appropriate product standards to minimise toxin and contaminant exposure in e-cigarette vapour, it should be possible to reduce risks of physical health still further”; adds that “concerns over gateway progression into smoking are unfounded”; and suggests that e-cigarettes enjoy several advantages over nicotine replacement therapy (NRT) as tools for smoking cessation or reduction, including ease of use, the sensory experience for users, and cultural acceptability.
“It is therefore important,” says the RCP, “that the approach to regulating non-tobacco nicotine products recognises the need not only to meet the general requirements of safety and fitness for purpose, but also to encourage the development and uptake of competitive alternatives to the fatally toxic product currently chosen by most habitual nicotine users.
“Therefore, although regulation of all products should be proportionate to their potential hazard, proportionality in nicotine regulation must also incorporate the consideration that regulation that discourages or delays the development and use of non-tobacco nicotine is likely, in effect, to sustain tobacco smoking and hence perpetuate harm to smokers and wider society.”
…except the TPD
The RCP criticises the European Union’s Tobacco Products Directive (TPD), which comes into practical force across the EU next month, saying that “the cap on nicotine concentrations may limit the effectiveness of e-cigarettes as a smoking substitute, particularly for heavier smokers“ and that “the requirement for nicotine products covered by the TPD to carry a health warning emphasising the risks of nicotine, when licensed nicotine products do not, appears illogical, as does the restriction on statements comparing the relative risks of e-cigarettes and tobacco cigarettes”.
More broadly, it warns that “although a facility to recall products from the market is written into the legislation, there are no powers to relax regulations if usage and innovation are unnecessarily or inappropriately constrained by them.
“Despite requiring a review 3.5 years after implementation and at 2-yearly intervals thereafter, the previous EU TPD was not revised for 13 years, which is of great concern because much quicker mechanisms of feedback and revision will be required to maximise the benefits as well as minimise the risks of e-cigarettes.”
On taxation, meanwhile, the RCP suggests that adoption of e-cigs could be encouraged by lower tax rates – as with NRT, for which the VAT rate is 5% rather than the standard 20%.
It also notes that differential taxation of e-cigarettes and tobacco cigarettes would allow much higher rates to be imposed on tobacco as a measure to discourage smoking, “without necessarily exacerbating poverty in those smokers who find themselves unable to quit in response to increases in tobacco prices”.
The report by the RCP’s Tobacco Advisory Group, “Nicotine without smoke: Tobacco harm reduction”, will be available from its Website today.
What This Means: The RCP’s endorsement is not going to end opposition to e-cigs overnight, any more than Public Health England’s did, but it is another adamant expression of support that will be difficult to ignore. It also offers some nuanced, well-thought-out ideas for maximising the public-health benefit of e-cigs – both regulatory and medical – although realising all of those will be hampered by the strictures of the TPD.
– Barnaby Page ECigIntelligence staff