WHO: are you? The Electronic Cigarette Position Statement.

What is the World Health Organisation?

The WHO is a part of the United Nations. Its sole focus is international public health.

Where does the funding for them come from?

Cash to pay for their operations comes from member nations (that’s us) and private donations from the likes of pharmaceutical companies.

In 2012 the income from the top member states ran at:

• United States $110 million
• Japan $58 million
• Germany $37 million
• United Kingdom $31 million
• France $31 million

Doesn’t the fact that they receive money from Big P mean they are biased?

Yes.

“Several … WHO experts also have financial ties to the pharmaceutical industry–a double role that notably is not published by WHO.”

So, what did they do this week?

WHO released their position on electronic cigarettes in the lead up to an international convention on tobacco controls.

What is this position?

Pretty similar to the uncomfortable ones in the Karma Sutra that you struggle to see how any normal person would manage to achieve without losing three vertebrae.

That doesn’t help, what exactly is their position?

In short, they say that:

• Electronic cigarettes should be banned indoors
• Sales to children should also be banned
• E Juice Flavours should be banned as they attract children
• No one should make any claims that they help smokers to quit until there is hard evidence that they do
• Electronic cigarettes MIGHT pose a threat to teenagers
• Electronic cigarettes MIGHT pose a threat to foetuses

Isn’t that a contradiction? Didn’t they say that claims could only be made with hard evidence?

Yes.

On one hand they are saying that no claims can be made about the quitting potential despite the annual rolling studies carried out by ASH UK while on the other saying that e-cigs might pose a threat even though the research for this is weak and inconclusive.

Why are they saying this?

Rory Sutherland, in the Spectator, postulates that this is

“a desperate attempt to reverse-engineer a logical argument to suit an emotional predisposition.”

Based on what?

He continues:

“As the psychologist Jonathan Haidt has shown, most moralising works this way. We react instinctively, and then hastily cast about for rationalisations. For instance, most Britons feel it is repulsive to eat dogs or even horses. If you ask why, they will contrive a whole series of fatuous arguments to defend what is really an emotional belief.”

Could there be any other factors influencing them?

I refer you back to the section on funding.

But this seems morally reprehensible!

I wouldn’t disagree with you there.

Rather than focus on the actual public health benefit offered by the development of vaping they are hiding behind the weak moral arguments of:

1. “It promotes smoking”
2. “It normalises the act of smoking”
3. “It is a gateway into smoking for non-smokers”
4. “Won’t someone think of the children for goodness sake?!”

That Doctor Farsalinos is always on the ball – what does he say?

He says the statement presents

“an overcautious approach and … one-sided evidence … with selective citation and mis-presentation of science”.

This appears pretty damning, what about Clive Bates?

I’ll quote him directly because he sums up the problems with the position statement in bullet points:

• Exaggeration of minor or implausible risks;
• Selective citation and misrepresentation of science;
• A confusion of objectives and failure to recognise trade offs between them (is it nicotine addiction or disease?);
• Poor understanding of and apparent indifference to the benefits to smokers and the experience of users;
• No conceptual framework for harm reduction, relative risk or the role of vaping as a competitor to smoking;
• No consideration of the ethics of obstructing access or otherwise inhibiting routes to safer nicotine use
• Failure to acknowledge that the purpose of the Framework Convention on Tobacco Control is to regulate tobacco products

Gosh, and Professor Gerry Stimson?

“WHO’s mission is to save lives and prevent disease but once again it is exaggerating the risks of e-cigarettes, while downplaying the huge potential of these non-combustible low risk nicotine products to end the epidemic of tobacco related disease.  WHO claims e-cigarettes are a threat to public health, but this statement has no evidence to support it, and ignores the large number of people who are using them to cut down or quit smoking completely.”

And, as a leading figure in the development and promotion of evidence-based Public Health policy making, he ought to know.

Any other notable commentary from experts?

Prof Ann McNeill, Professor of Tobacco Addiction, National Addiction Centre, King’s College repeats what has been demonstrated by many other experts when she says:

“Whilst the WHO report concludes that e-cigarettes use ’produces lower exposures to toxicants than combustible products’ I believe that this is an understatement. We can be confident that e-cigarette use results in much lower exposure to toxins for users.”

Then she continues to reaffirm that:

“although e-cigarette vapour may be an irritant to people in close proximity to the e-cigarette user, there is no evidence of harm from other people inhaling e-cigarette vapour unlike the known risks of second hand cigarette smoke. There is also as yet no evidence that e-cigarettes are renormalizing smoking.”

You mentioned the annual ASH research, what is their response?

This is from their Twitter feed:

And the actual video…

I don’t do Twitter, anybody else making comments there?

How about TV’s Dr. Christian?

So, will the Department of Health ban vaping indoors then?

It is impossible to say whether they will change their position as a result of external pressure but (according to The Guardian) the answer stands at “No” for now.

Wales still faces the potential for this to happen and the British Medical Association still holds that vaping should be banned in enclosed spaces.

I still don’t understand why people are so against electronic cigarettes

You aren’t alone.

Last week a study by the US Centers for Disease Control and Prevention claimed to establish a link between vaping and the adoption of smoking by teens.

As Spiked explained:

“blogger Carl V Phillips shows, the research this claim is based on is a shocking … piece of advocacy research. Kids are defined as ‘users’ even if they’ve just had a single puff on an e-cig, the figures for those ‘intending’ to try tobacco cigarettes included those who said they probably wouldn’t, and the proportion of children who had tried an e-cig was only about one per cent of this age group.”

Won’t the actions of organisations like the WHO simply drive vapers back to smoking or prevent smokers bothering to quit?

This is certainly the position of market experts like the Berenberg bank.

Is there anything I can do?

Read Clive Bates’ brilliant summary of the arguments (and how to debunk them), continue writing to your MP and MEP and share the facts with your friends – especially your smoking friends.

Can’t I just ignore it all and hope it goes away?

And let rank stupidity like this win the day?

Further reading

• The WHO’s position paper on Electronic Nicotine Delivery Systems (ENDS)
• The Spectator
• The BBC
• Clive Bates
• Dr Konstantinos Farsalinos
• The Telegraph
• The Guardian
• Spiked
• The National Post