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Cate Swannell
Med J Aust 2015; 203 (7): 273. || doi: 10.5694/mja15.n1005
Published online: 5 October 2015

The BMJ questions e-cigarettes endorsement

The BMJ has questioned the decision by Public Health England — (mission statement: “We protect and improve the nation’s health and wellbeing, and reduce health inequalities”) — to endorse the use of e-cigarettes as an aid to quitting smoking. In a report released at the end of August PHE concluded that e-cigs were “95% less harmful” than conventional cigarettes and described them as a potential “game changer” in tobacco control. In The BMJ Professor Martin McKee and Professor Simon Capewell said the available evidence, including a recent Cochrane review, did not show clearly that e-cigs were as effective as established quitting aids. “We might also expect that the prominently featured ‘95% less harmful’ figure was based on a detailed review of evidence, supplemented by modelling”, wrote McKee and Capewell. “In fact, it comes from a single [sponsored] meeting of 12 people.” The sponsors included a CEO with previous funding from British American Tobacco. One of the 12 was a chief scientific advisor with declared funding from an e-cigarette manufacturer, and Philip Morris International. “None of these links or limitations are discussed in the PHE report”, McKee and Capewell wrote.

Dramatic rise in antibiotic use globally

Nature reports that “antibiotic use is growing steadily worldwide, driven mainly by rising demand in low- and middle-income countries”, citing the latest report from the Center for Disease Dynamics, Economics and Policy. The organisation used a review of data from scientific literature, and national and regional surveillance systems to calculate and map the rate of antibiotic resistance for 12 types of bacteria in 39 countries, and trends in antibiotic use in 69 countries over the past 10 years or longer. “Global antibiotic consumption grew by 30% between 2000 and 2010. This growth is driven mostly by countries such as South Africa and India, where antibiotics are widely available over the counter and sanitation in some areas is poor.” The report also found that the use of antibiotics in livestock is growing worldwide, particularly in China, which used about 15 000 tonnes of antibiotics for this purpose in 2010, and is projected to double its consumption by 2030.

Child mortality under six million for first time

A new World Health Organization report says deaths among children aged 5 years and under worldwide have more than halved over the last 25 years, falling from 12.7 million a year in 1990 to 5.9 million in 2015. “While progress has been substantial, a 53% drop in child mortality is far short of the Millennium Development Goal, where countries agreed to reduce child mortality between 1990 and 2015 by two-thirds.” Around 16 000 children under 5 still die every day, most from diseases that are readily preventable or treatable, says the report. Around 50% of global deaths among the under 5s occur in sub-Saharan Africa, while 30% occur in southern Asia. Approximately 45% of deaths among the under 5s occur in the first 28 days of life. One million infants die on the day they are born, and nearly 2 million during the first week following birth. Leading causes of death in this group include complications during labour, premature birth, pneumonia, sepsis, diarrhea and malaria. Most of the remaining deaths among the under 5s are tied to undernutrition.

Static electricity next frontline in malaria control

Dutch researchers have come up with a way of improving the efficacy of mosquito nets using static electricity, according to a report in The Economist. With the WHO reporting a 60% drop in deaths caused by malaria since 2000, In2Care, a Dutch mosquito-control firm, is finding a way to deliver insecticides embedded in mosquito nets more effectively to the target insect. “Current mosquito nets are woven from fibres impregnated throughout with an insecticide”, The Economist reports. “This permits them to be washed and used for years without loss of potency. But it also means this potency is not as great as it could be, because the insecticide is released only slowly by the fibres. Using static electricity, by contrast, means all of the insecticide is held on the surface of a net’s fibres. Much larger doses can thus be transferred to an insect which blunders into the net. In addition, a wide range of insecticides — and even, possibly, the spores of a fungus harmless to people but lethal to mosquitoes — can be applied to the fibres.”

  • Cate Swannell


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access_time 04:03, 11 October 2015
Colin P Mendelsohn

This response by Professors McKee and Capewell (not by the BMJ as stated in the news article) to the report commissioned by Public Health England (PHE) (1) reflects the ideological debate raging around electronic cigarettes (ECs). McKee and Capewell are vocal opponents of harm reduction and ECs and have written a number of negative opinion pieces.

PHE is right to support the use of ECs to improve the nation’s health. There is growing evidence in clinical trials, especially with more effective recent models, and in the real world, that ECs are effective cessation aids. (2) Millions of smokers in the UK have quit smoking or reduced their cigarette intake substantially with ECs. (3)

McKee and Capewell attempt to discredit the multicriteria decision analysis (MCDA) study (4) on which the claim that e-cigarettes are 95% less harmful than smoking is partly based. However this methodology is a validated and robust form of collaborative decision making, especially in situations where perfect data is not available.

The authors of the PHE report state that the ‘95% safer’ figure is also based on the facts that the harmful constituents of cigarette smoke are mostly at levels much below 5% of smoking doses and that the main chemicals present in ECs only have not been associated with any serious risk. (5) It is clear that based on the available toxicological, chemical and clinical evidence that ECs are orders of magnitude safer than smoking.

Public perceptions of the relative risk of smoking and vaping are increasingly misinformed. (3) PHE is right to provide some clarity for potential EC users about the safety and efficacy of ECs based on the best available evidence.

References

1. McNeill A, Brose LS, Calder R, et al. E-cigarettes: an evidence update A report commissioned by Public Health England. PHE publications gateway number: 2015260. 2015 Available at https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update. Accessed 8 September 2015
2. Rahman MA, Hann N, Wilson A, et al. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015; 10(3): e0122544.
3. Use of electronic cigarettes (vapourisers) among adults in Great Britain. Action on Smoking and Health, UK. Fact sheet 33. May 2015 http://ash.org.uk/information/facts-and-stats/fact-sheets (accessed June 2015)
4. Nutt DJ, Phillips LD, Balfour D, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014; 20(5): 218-225.
5. McNeill A. Underpinning evidence for the estimate that e-cigarette use is around 95% safer than smoking: authors’ note. PHE publications gateway: 2015260. 2015 https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update (11 October 2015)



Competing Interests: Dr Mendelsohn has received honoraria for teaching, consulting and conferences expenses from Pfizer Australia, GlaxoSmithKline and Johnson

Dr Colin P Mendelsohn
The Sydney Clinic

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