E-cigs take center stage as U.K. advises use as a stop-smoking aid

The regulatory territory around e-cigarettes is murky. It's clouded by scientific issues around the potential and relative harm they cause, as well as governmental concerns around its oversight as a tobacco or a smoking cessation product.

But now, Public Health England, which is an operationally autonomous entity of the U.K. Department of Health, has come out with a report deeming e-cigarettes as useful in helping smokers quit the habit. In fact, the agency said that the country's National Health Service is already encouraging smokers to use e-cigarettes as part of their attempts to quit smoking to increase their chances of success.

The report has come out at the same time as an issue of the Journal of the American Medical Association (JAMA) that's focused on e-cigarettes has also been released. But unlike in the U.K., in the U.S. e-cigarettes are primarily being viewed a public health concern rather than a tool for improving public health.

The JAMA issue contains a pair of opinion pieces on the topic--one warning of the threat of an imminent global expansion of the use of e-cigarettes and the other on the use of the devices as a teen gateway to cigarette smoking. The latter is based on a study also detailed in JAMA. The issue also includes a smoking cessation study that doesn't address e-cigarettes, but is instead focused on the use of nicotine patches beyond the 24 weeks advised by the FDA.

As for the Public Health England report, it concludes that e-cigarettes are about 95% less harmful than smoking. It noted that almost half of the country's population doesn't understand that e-cigarettes are "much less harmful than smoking."

The summary of the report also offers an opposite conclusion of the JAMA study--"there's no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers." It found that less than 1% of young and adult e-cig users who have never smoked are becoming regular e-cig users.

In addition, PHE reported that almost all of the 2.6 million U.K. adults using e-cigs, most of them are using the devices to help them quit smoking or prevent a return to the habit. The report is the result of a 2014 request for the PHE to gather evidence around e-cigarettes.

While e-cigs have become core to the smoking cessation strategy in the U.K., in the U.S. the FDA continues to work to sort out how the devices should be regulated. Currently, only e-cigs that are specifically marketed for therapeutic uses are slated to be regulated by FDA Center for Drug Evaluation and Research (CDER). The U.S. agency has issued a proposed rule that it also have the authority to regulate e-cigarettes as tobacco products.

- here is the Public Health England statement
- and the JAMA issue (paid sub. req.)
- and the FDA background on on e-cigarettes

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