Are worried doctors set to block e-cigarette prescriptions? Two in five nurses and doctors would feel uncomfortable recommending e-cigs to smokers, a survey shows

30 October 2021

Victoria Allan. Source: The Daily Mail

Prescriptions for e-cigarettes may face a roadblock due to the reluctance of many doctors to recommend them.

England is set to become the first country in the world to prescribe e-cigarettes to help smokers quit, it was announced this week.

But two in five nurses and doctors would feel uncomfortable recommending e-cigarettes to smokers, and one in six would never do so, according to a survey of more than 2,000 staff commissioned by Cancer Research UK just two years ago.

Another as-yet unpublished study, involving the University of Oxford, which interviewed 11 medical staff, found most struggled to advise long-term use of e-cigarettes because of concerns about unknown long-term effects. 

Paul Aveyard, professor of behavioural medicine at the University of Oxford, who was involved in both pieces of research, said: ‘GPs find it difficult handing patients something which may cause them harm, even where e-cigarettes are far safer than cigarettes… They struggle to give people devices which may not be entirely safe or may perpetuate addiction to nicotine.

‘The only clinicians we found are comfortable with it in recent research were those who give methadone or opioid replacements to heroin users, on the same principle that this is much safer. 

‘Nonetheless, e-cigarettes on prescription are a good idea, and if they are approved by the regulator and available on the NHS, it may help to change GPs’ perception.’

Evidence has linked vaping with an increased risk of cardiovascular diseases and lung disorders, although experts agree it is much safer than smoking.

Professor Martin Marshall, of the Royal College of GPs, called for more investment in community smoking cessation centres, adding: ‘Vaping should only be seen as a way to give up smoking, with the intention to then give up vaping.’

John Dunne, of the UK Vaping Industry Association, said vaping had been proven to be far more successful than all other forms of nicotine replacement therapy.

The vaping lobby are ignoring the health risks of prescribing e-cigarettes, warns SIMON CAPEWELL

By Simon Capewell

Sajid Javid’s announcement that the Department of Health is paving the way for e-cigarettes to be prescribed on the NHS in England is deeply worrying.

Yes, there are still 6.1million smokers in England, and while smoking remains the leading cause of preventable death we must redouble our efforts to tackle this problem.

But as a scientist who has spent 30 years in public health research, particularly in regard to heart disease, smoking and diet, I can assure the Health Secretary that e-cigarettes are not the answer.

Worse, they will generate a raft of other health problems.

When vaping first took off seven years ago, I was open to the idea that it might help reduce smoking. 

But with mounting evidence of the harms vaping can cause, I have become increasingly worried by the unquestioning enthusiasm on the part of some public health bodies whose first duty is to protect us.

I previously raised the issue with the (now-dissolved) Public Health England and with the Department of Health, who repeatedly dismissed my concerns. This laissez-faire approach contrasts with that of many global health authorities. 

Following a 2016 report by the World Health Organisation about the health risks e-cigarettes pose, countries including China and India banned or severely restricted their sale.

England is out on a dangerous limb. Officials here have fallen for the exaggerated claims of the pro-vaping lobby, and are ignoring the health risks. The main claim, that e-cigarettes are a major aid to quitting, is wrong. 

If that were true, why would the multi-national tobacco corporations be pushing vaping so hard? ‘E-cigs’ are a means of attracting new cigarette smokers, as I will explain. 

E-cigarettes are in fact one of the least effective quitting tools, accounting for only about 10 per cent of long-term quitters in the UK.

Many of those who try to quit smoking via vaping continue to use both e-cigarettes and lit cigarettes. This is a big win-win for tobacco firms. Most of the UK’s 3million vapers who still smoke have no plans to quit.

Next let’s address the industry claim that e-cigarettes are 95 per cent less harmful than lit cigarettes, a figure based on no solid evidence whatsoever as far as I am aware. Yet this spurious figure was picked up by PHE.

More robust evidence estimates that, at best, e-cigarettes are 50 per cent less harmful.

Champions of e-cigarettes say there is ‘no evidence’ of long-term harm. In fact, there is plenty of evidence. 

Nicotine is highly addictive while the superheating of the 100-plus flavourings used in e-cigs to disguise the taste of nicotine and produce vapour can generate harmful chemicals, many of which are found in lit-cigarette smoke.

Research shows that e-cigarettes can be even more addictive than lit cigarettes which is why the use of youth-focused flavourings such as bubblegum is so appalling.

Nicotine poses a particular risk for the young because it disrupts the development of crucial brain connections.

Personally I doubt very much that e-cig manufacturers will be submitting their products any time soon for UK medical approval.

With half a dozen other, safer quit-smoking approaches available, it is clear that e-cigarettes should not be promoted by the NHS.

Simon Capewell is a public health expert and professor of clinical epidemiology at Liverpool University