Tuesday, June 26, 2012

World Health Organization Needs to Change Stance on Electronic Cigarettes; Current Position is Leading to Public Health Harm

It is clear from an article in last week's Independent Online (Malta) that the World Health Organization's (WHO) current stance on electronic cigarettes is being interpreted worldwide as an assertion that "Electronic cigarettes not considered legitimate therapy to quit smoking," as the article's title suggests.

According to the article: "Contrary to what some marketers of the electronic cigarette imply in their advertisements, the World Health Organisation (Who) does not consider it to be a legitimate therapy for smokers trying to quit. ... Who insists that the electronic cigarette is not a proven nicotine replacement therapy and that it has no scientific evidence to confirm the product’s safety and efficacy. The organisation has repeatedly stressed that marketers should refrain from suggesting that Who considers the electronic cigarette to be a safe and effective smoking cessation aid. ... Who has said it knows of no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking."

The Rest of the Story

The public would be better served by taking direction from Pete Townshend on electronic cigarettes rather than the Geneva-based WHO. To imply, in 2012, that electronic cigarettes are not a legitimate therapy to quit smoking, is as unscientific as an organization can be. And to say that there is no evidentiary basis for the claim that electronic cigarettes can help people quit smoking is to ignore the entire body of scientific evidence and literature on the topic.

At least Pete recognized the importance of quitting smoking (listen to his "After the Fire," which features the famous line "I've gotta stop smoking.") In contrast, the WHO would rather that ex-smokers who have quit using electronic cigarettes return to smoking, instead of staying quit with the use of these "illegitimate" products.

Has the WHO not seen the Polosa study, a clinical trial of electronic cigarettes among smokers with no motivation to quit, in which more than 50% of the subjects either quit or cut down substantially (by more than half) on the amount they smoked? Has the WHO not seen the results of numerous surveys and focus groups as well as the abundant anecdotal evidence of the many thousands of people who have successfully quit or greatly reduced their cigarette consumption with the help of electronic cigarettes? Does the WHO keep up at all with the current literature? Based on his blog writings, I think Pete himself is probably doing a better job of keeping up with current information than the Geneva-based WHO.

Beyond its failure to take an evidence-based position and the health damage that is doing, the WHO's approach to electronic cigarettes is also marred by an error in the criterion they are using to judge the product. The question is not whether electronic cigarettes are "safe" and effective. The question is whether they are much safer than regular cigarettes. Of course they are not safe in an absolute sense. But there is no question, based on the existing evidence, that they are much safer than regular cigarettes. If the criterion is whether they are safe in an absolute sense, then the issue is over. There is no need for any further deliberation.

But that is not the issue. The issue is that millions of smokers worldwide are desperately in need of a better approach to quitting smoking than the WHO-recommended nicotine replacement therapy. Waiting 8 years for definitive clinical trials to be conducted, when the product is already on the market and being used by literally millions of people, is not an appropriate public health policy. Taking the products off the market would essentially force thousands of ex-smokers to return to cigarette smoking. And it would deter many more thousands of smokers from saving their lives by getting off cigarettes and switching to vaping.

The WHO is taking an irresponsible and scientifically unsupportable position on electronic cigarettes. As the real "WHO" would say: "Stop Hurting People."

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