The BMJ, e-cigarettes and Scotland

The British Medical Journal clearly expects Scotland to lead on its crusade against e-cigs, as it did with the smoking ban and in the way it has not blinked in its pursuit of plain packaging of tobacco. Fiona Godlee, BMJ editor, declares that the Scottish Government's ambition to end smoking by 2034 will go pear-shaped if it does not take a firm line with tobacco. The Scottish Government along with ex-Mayor Bloomberg of New York earn brownie points with Godlee for taking stern measures against food, drink and tobacco and the paper turns on Bloomberg's action in banning indoor use of e-cigarettes before leaving his post recently. (Godlee uses the word 'smoking', although  you would be no more likely to get smoke out of an e-cigarette than you would out of your kettle.)

There is some unhelpful argument here along the lines of tobacco being normalised by the popularity of e-cigarettes, and it seems based on the assumption that tobacco companies are a significant player in the e-cigarette economy. She says, 'E-cigarettes also legitimise the industry, buying tobacco companies a seat as “partners” at the health policy table'. Not only is this untrue (at least in the view of Rose, quoted here), it is also quite irrelevant to health policy.

Another plank of her paper is asserting that the BMJ will not reverse its decision to decline publication of papers that have been funded by the tobacco industry. This is a related error. The veracity of papers is determined by its content: funding is a consideration, which it is why it is declared, but funding does not determine accuracy or otherwise. Tobacco companies are legal entities and players in the market place and there is no reason to dismiss them from public debate, which exists to allow the weighing of different perspectives against each other. Health policy is another arena in which tobacco companies have a contribution to make (balanced by other interests, obviously); Godlee allows her position that tobacco companies have no place in health policy to influence her view on whether e-cigarettes are a beneficial alternative to smoking. This seems to me to be a conflict of interest, since her desire for tobacco control interests to dominate the health policy arena over-rides the health concern. If this results in the banning of a safe alternative to smoking when medicinal alternatives fail to work, there is at least potential for severe adverse health reactions.

As far as Scotland goes, so far they have backed the UK as shown in this Parliamentary motion published last June:

Motion S4M-06979: Stewart Maxwell, West Scotland, Scottish National Party, Date Lodged: 12/06/2013

New Restrictions on Electronic Cigarettes

That the Parliament welcomes the decision by the Medicines and Healthcare Products Regulatory Agency that electronic cigarettes (e-cigarettes) will be licensed as a medicine in the UK from 2016; understands that the new classification will assist in ensuring that the promotion of these products to children and non-smokers is prohibited; regrets however that this decision will not be implemented for a further three years; believes that any change in the classification of e-cigarettes should ensure that they are sold only by appropriately licensed premises; highlights that e-cigarettes are currently unregulated and the associated potential health risks are unknown, and encourages smokers to take the advice of the British Medical Association, which directs patients to regulated products and licensed nicotine replacement products to help quit smoking.

 *S4M-06910 Stewart Maxwell: The Scottish Directors of Public Health and E-cigarettes—That the Parliament welcomes the position of the Scottish Directors of Public Health (SDPH), which, it believes, has strongly advocated that NHS policies on tobacco should treat electronic cigarettes (e-cigarettes) the same way as normal cigarettes; understands that SDPH has claimed that the use of e-cigarettes in NHS grounds perpetuates the idea that smoking is normal behaviour and acceptable in public areas; believes that the potential of e-cigarettes as a tool in harm reduction and the risk that they pose to health and safety is still to be determined; notes that smokers who wish to quit can use evidence-based nicotine replacement therapy products and contact NHS Smokeline to find out further information, and urges them to use one or both of these approaches instead.

This shows that the party leading Scotland to independence in the referendum this coming September has a steep learning curve on the subject of e-cigarettes. Vapers in Scotland should renew their efforts to brief parties that support the independence project with their concerns about regulating e-cigarettes, especially in the event of a yes vote. (In the event of a no vote I predict that not much will change, because Westminster is top-down rule.)