More than 100 specialists sign letter calling for tighter controls, after 53 scientists warned that regulation would cost lives
More than 100 leading public health doctors and specialists from around the world have signed a letter to the director general of the World Health Organisation, Margaret Chan, calling for new controls on e-cigarettes and warning that they may be a stalking horse for the tobacco industry.
The experts want the WHO to bring e-cigarettes under the same tight controls as tobacco products, with bans on advertising and promotion. They say there is insufficient evidence so far that e-cigarettes are harmless and can help people to quit smoking.
Their biggest concern is that, if advertising and marketing are allowed, smoking will be "re-normalised", undermining public smoking bans and undoing decades of effort to marginalise cigarettes and persuade people of the harm they do.
"By moving into the e-cigarette market, the tobacco industry is only maintaining its predatory practices and increasing profits," says the letter. It says the WHO must not be misled by the industry's efforts to present itself as a partner, as it did with filters and "low-tar" cigarettes in the past before scientists showed that those things did not reduce harm.
"If the tobacco industry were committed to reducing the harm caused by tobacco use, it would announce target dates to stop manufacturing, marketing and selling its more harmful products rather than simply adding e-cigarettes to its product mix and rapidly taking over the e-cigarette market.
"It would also immediately desist from its aggressive opposition to tobacco control policies such as tax increases, graphic health warnings and plain packaging," says the letter, whose signatories include Professor John Ashton, president of the UK Faculty of Public Health; Professor Rifat Atun, of the Harvard School of Public Health; and Professor Robert Beaglehole, of the University of Auckland.
Supporting the public health doctors are experts in paediatrics and cardiovascular disease, including Dr Hilary Cass, from Guy's and St Thomas's NHS Trust in London, and Professor Helmut Gohlke, of the German Cardiac Society. Other signatories include Dr Jay Berkelhamer, of Emory University School of Medicine in the US, and Professor Frank Chaloupka, director of the Health Policy Centre at the University of Illinois.
The issue is controversial even within the public health community. This month, 53 scientists who take a very different view wrote to Chan (pdf), saying that regulating e-cigarettes in the same way as tobacco products would cost lives by reducing the numbers using e-cigarettes to quit smoking.
"These products could be among the most significant health innovations of the 21st century – perhaps saving hundreds of millions of lives. The urge to control and suppress them as tobacco products should be resisted," they wrote.
But Simon Capewell, professor of clinical epidemiology at Liverpool University, speaking on behalf of the UK Faculty of Public Health, said its members were very anxious about the boom in e-cigarette use and the possible commercial interests behind it.
"The Faculty of Public Health is deeply concerned about the superficial analysis of e-cigarettes and that the potential harms of e-cigarettes have been systematically underestimated," he said. "The faculty is also concerned that the tobacco industry is cynically using discussions around e-cigarettes to undermine successful tobacco controls."
He said the industry was claiming e-cigarettes were solely a device to help people stop smoking, but the addition of flavours such as strawberry and bubblegum to the nicotine vapour suggested that children were being targeted. It was possible that they may help some people to quit, but more evidence was needed, he said. "From the faculty's point of view, that is the single possible value they might have."
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