Ethical imperatives assuming ENDS effectiveness and safety are fragile

Chapman, Simon; Daube, Mike

doi:10.1111/add.12944

Cited by 4 publications

(3 citation statements)

References 16 publications

(23 reference statements)

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“… 75 – 77 Moreover, studies evaluating the effects of smoking reduction do not show consistent results, 78 , 79 while other studies have shown an almost linear association between smoking consumption and disease incidence. 80 , 81 Thus, the conclusion that dual use of tobacco cigarettes and e-cigs is not harm reduction 82 is purely hypothetical and not supported by any evidence. In fact, dual use may have important health benefits if there is substantial reduction in cigarette consumption and if enough nicotine is obtained from e-cigs to prevent compensatory smoking.…”

Section: Evidence Justifying the Precautionary Principlementioning

confidence: 98%

Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)

Farsalinos¹,

Houezec²

2015

RMHP

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Tobacco smoking is the largest single preventable cause of many chronic diseases and death. Effective treatments exist; however, few smokers use them and most try to quit by themselves. Most of the tobacco cigarette’s toxicity is related to the combustion process. Models of harm reduction applied to tobacco suggest that switching from inhalation of combustible products to a noncombustible nicotine delivery product would likely result in a vast reduction in tobacco-related death and illness. Currently available evidence raises no doubt that electronic cigarettes (e-cigs) are by far less harmful than smoking (although probably not absolutely safe) and have the potential to be the most effective tobacco harm reduction products due to their unique property of resembling smoking and providing satisfaction to the user. A lot of controversy is surrounding e-cigs and their regulation, much of which is based on the precautionary principle. Although monitoring and further research is definitely needed, the arguments used to implement severe restrictions or bans are mostly hypothetical, weakly supported by evidence, and, in some cases, derived from mispresentation or misinterpretation of the study findings. Regulators should keep in mind that the target population is smokers who want to reduce or quit their deadly tobacco consumption. To achieve this goal, smokers should be honestly informed on the relative harmfulness of the different products. E-cigs are not tobacco products and are not used as medications. For this reason, a specific regulatory scheme is needed, separate from tobacco or medicinal products regulation. Regulation should implement specific quality criteria for products, rules for the exclusion of chemicals of reasonable concern, and appropriate testing for possible contaminants. Additionally, manufacturing standards derived from the food industry should be implemented and adjusted for specific conditions related to e-cigs. Finding the appropriate balance between safety and acceptability of use by smokers will be important in achieving the maximum public health benefit. Labeling should be specified, with warnings about exposure to skin or through ingestion and discouragement of use by nonsmokers, related to the presence of nicotine. Finally, advertising and marketing should not be banned, but appropriately regulated in order to encourage use by the intended population while avoiding use by never-smokers. E-cigs should be appealing to smokers (but not to nonsmokers), while availability and pricing should be strong competitive advantages of e-cigs relative to tobacco cigarettes.

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Section: Evidence Justifying the Precautionary Principlementioning

confidence: 98%

Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)

Farsalinos¹,

Houezec²

2015

RMHP

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“…Nicotine-containing ENDS can therefore be highly addictive and may result in long-term complications related to cancer or heart disease, potentially for others exposed to ENDS vapour as well as ENDS users themselves 8. Although some argue that a market for ENDS should be permitted on the basis of their lower harm profile relative to cigarettes,9 others maintain that ENDS should be restricted as their widespread use would still have important public health impacts 10…”

Section: Introduction: the Tobacco Harm Reduction Debatementioning

confidence: 99%

Ethics of tobacco harm reduction from a liberal perspective

Eijk

2015

J Med Ethics

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Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or 'e-cigarettes'), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with 'freedom' considered as originating from having options and the necessary information and ability to autonomously choose between these options.

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“…Simon Chapman & Mike Daube claim that the case against a ban has been undermined by observational evidence that smokers who use ENDS are less likely to quit than those who do not. We believe this is a premature conclusion from a small number of prospective studies with conflicting results.…”

mentioning

confidence: 99%

Nuances in the ethical regulation of electronic nicotine delivery systems

2015

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We thank the commentators for their thoughtful reflections on our article.Billie Bonevksi [1] makes a strong case for giving greater weight to equity in regulating ENDS.Equity is an increasingly important ethical value in this debate because cigarette smoking is now concentrated among the most disadvantaged citizens in developed countries where cigarette smoking has been substantially reduced by increasing taxes, banning advertising and implementing smoke free policies. She argues that it is still too early to say if ENDS will realise the health benefits for low SES smokers claimed by their proponents. We agree there needs to be more investigation of their value and some form of regulated access to ENDS is the best way of allowing this to be done.Lyn Kozlowski [2] illustrates the ways in which moral biases have truncated ethical analyses of tobacco harm reduction (THR) policies. He reminds us that moral reasoning often involves a motivated search for reasons to justify pre-existing beliefs, as has occurred on both sides of the polarised debate about THR. Each side is convinced of the justice and cogency of its cause which it supports by the selective citation of equivocal evidence. Each is exasperated by what they see as their opponents' failure to appreciate the strength of their arguments. This creates a readiness to impute the worst motives to those with whom they disagree (e.g. that advocates of ENDS are in the pay of the tobacco industry or that opponents of ENDS hate smokers).

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Ethical imperatives assuming ENDS effectiveness and safety are fragile

Cited by 4 publications

References 16 publications

Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)

Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes)

Ethics of tobacco harm reduction from a liberal perspective

Nuances in the ethical regulation of electronic nicotine delivery systems

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