On e-cigarette safety The Lancet has decided to shoot the messenger

    28 August 2015

    So the pushback begins. An anonymous editorial in The Lancet today wields the hatchet at the recent Public Health England report which said that e-cigarettes are ‘around 95 per cent safer than smoking’. The Lancet has never been keen on e-cigarettes and it doesn’t like the 95 per cent figure, but rather than come up with a better one, it has chosen to shoot the messenger. The editorial traces the 95 per cent estimate back to a study written by David Nutt and colleagues whom it describes as ‘a small group of individuals with no prespecified expertise in tobacco control’.

    This will be news to dyed-in-the-wool anti-smoking campaigners such as Martin Dockrell, who worked at Action on Smoking and Health until recently, and David Sweanor, a longstanding member of the Canadian Non-smokers’ Rights Association. Both were co-authors of the study, as was Dr Karl Fagerström, a world-renowned nicotine scientist who gave his name to the Fagerström test. The other eight authors also have relevant experience, including Nutt himself who, in 2010, convened a similar panel to rate the hazards of various substances for a study that was published in, er, The Lancet. (Nutt’s 2010 drugs panel included three members and met for a one-day workshop. His e-cigarette panel included 11 members and met for two days. Which is the ‘small group’?)

    With wearying predictability, The Lancet launches into an ad hominem attack on two of the 11 authors of Nutt’s study. The editorial notes that one of the authors has consulted for a distributor of e-cigarettes and another has been a consultant to the pharmaceutical industry. Since Big Pharma does not make e-cigarettes and sees them as a rival to their own nicotine products it is debatable whether the second of these is a competing interest at all, but it is nevertheless there in black and white in the original study, as competing interests always are.

    According to The Lancet, the declared interests of two out of 11 authors of one study cited by Public Health England ‘raises serious questions not only about the conclusions of the PHE report, but also the quality of the agency’s peer review process’. This risible attempt to make a mountain out of a mole hill suggests that The Lancet is less interested in assessing the scientific evidence than in groping around for anything that might help blacken the PHE report’s name in the eyes of the public.

    This is a technique the magazine has been perfecting ever since it laid into the now-legendary scientific pioneer John Snow in the 1850s. When Snow concluded that cholera was spread through the water supply and not, as the medical consensus had it, through the air, The Lancet accused him of being in the pay of the polluting industries. And they were right. He was. But that did not stop germ theory being right and miasma theory being wrong. The Lancet finally got round to correcting its notoriously terse obituary of Snow two years ago. One might hope that by now the magazine would have learned how to play the ball rather than the man.

    It is not as if the claim that e-cigarettes are much less hazardous than smoking hinges on a single study by David Nutt. The latest PHE report builds on a previous PHE report by different authors who concluded that the health hazards posed by e-cigarettes are ‘likely to be extremely low’. There is a good deal of toxicological evidence showing that contaminants in e-cigarettes are an order of magnitude lower than those found in tobacco cigarettes, including a study which concluded that ‘none of the more than 10,000 chemicals present in tobacco smoke, including over 40 known carcinogens, has been shown to be present in the cartridges or vapour of electronic cigarettes in anything greater than trace quantities’.

    The National Institute for Health and Clinical Excellence noted in 2012 that there are ‘no firm cases of harm that are directly attributable to e-cigarette use’. To date, the main dangers associated with e-cigarettes have involved people blowing them up by using the wrong charger.

    If there is a problem with the PHE report it is that it is too definitive in claiming that e-cigarettes are ‘around 95 per cent safer than smoking’ when the existing evidence suggests that it would be more accurate to say ‘at least 95 per cent safer than smoking’. At the very least, the authors should have said that vaping is 95 per cent safer than smoking, with a five per cent margin of error either way.

    Better still, they should have put the ball in the naysayers’ court by pointing out that e-cigarettes have been on the market for years, millions of people use them, none of them have died as a result and there is no evidence that they could lead to serious harm. On the contrary, people have avoided serious harm by using them to quit smoking. It is time for the burden of proof to fall on the accusers.