Four Professors and a Counterfactual

All the fun of the fumes

The long-windedly titled The National Centre for Smoking Cessation and Training (NCSCT) recently produced a video called E-cigarettes safety: The facts explained.

The trouble is that there are precious few facts available at the moment; but there are plenty of opinions.

The film features four Professors who are well known e-cigarette enthusiasts, and a layman, Clive Bates, Director of Counterfactual Consulting, whatever that is.

The Shorter Oxford English Dictionary, interestingly, defines counterfactual as ‘Pertaining to or expressing what has not happened or is not the case’ which perhaps explains Mr Bates’s view as stated in the film.

First, let’s hear from Professor Linda Bauld, a behavioural scientist, no less:

We know from studies that nicotine is relatively safe.

What studies? What does she mean by relatively safe?

Next we have Professor Robert West, a psychiatrist:

They (e-cigarettes) don’t use tobacco at all.

This is almost true, except that the nicotine in e-cigarette liquid is derived from tobacco.

Then Ann McNeill, Professor of Tobacco Addiction, explains:

Most things we do in life carry a risk. So, for example driving cars. Cars cause lots of road accidents, lots of people killed on the roads. But we don’t stop people driving. We try to make them (cars) less harmful.

This is a false analogy. Driving is a normal and essential human activity whereas smoking and vaping are not normal activities: they are undertaken only by drug (nicotine) addicts.

Finally, we have Professor John Britton, an epidemiologist:

If we try to put a figure on the relative risk of e-cigarettes compared to smoking, my view is that it’s going to be well under 5 per cent of the risk…so we can be confident that electronic cigarettes are much less hazardous than tobacco cigarettes.

His view? How can we be confident? Just because he says so?

Then he says:

Where their safety lies relative to not using anything is much harder to place.

This is an acknowledgement that e-cigarettes are unsafe, but he can’t tell us to what degree.

He does at least say something sensible—up to a point:

Inhaling a vapour many times a day for decades is unlikely to come without some sort of adverse effect…It would be better avoided, but from the smoker’s perspective it is a far better bet than carrying on smoking tobacco.

A bet? So it’s all a matter of chance? He doesn’t seem to know what his point of view is.

Back to Professor West:

E-cigarettes are substantially less harmful than cigarettes and the reason that we can reasonably infer this is because of the concentration of chemicals that are in e-cigarette vapour compared with the chemicals that are in cigarette smoke.

So he goes from asserting that e-cigarettes are substantially less harmful than ordinary cigarettes to saying that it’s something we can only reasonably infer.

Professor McNeill again:

Flavourings are necessary for electronic cigarettes because people wouldn’t use them if they didn’t have some sort of flavours added. We need to entice smokers to use electronic cigarettes.

Does she realise what she is saying? How about enticing smokers to stop smoking and stop using nicotine in any form?

Professor West:

Some concerns have been raised about…the risks [of] flavourings in e-cigarette vapour…these are flavourings that have been tested and the concentrations are sufficiently low that we wouldn’t expect them to pose a significant health risk.

More opinion, supposition and guesswork. What if his expectations are wrong?

Professor Britton:

The propylene glycol…in electronic cigarette fluid…is used to make theatre fog, it is mildly irritant to the airways but is doesn’t seem to have any lasting long-term effects.

More guesswork. For how long and how often are people exposed to theatre fog? When did you last attend a theatrical performance where there was fog?

He adds:

Glycerol [also present in e-cigarette vapour], likewise, is widely used in food. And again there’s no evidence or reason to expect it will have a significant long term effect on the airway.

Yes, it’s eaten in foods, but this is a different matter entirely from it being inhaled.

And continues:

There is evidence that if you [are in a] room with somebody using one of these products (e-cigarettes) that there is nicotine and perhaps other chemicals in the atmosphere around you but at tiny levels. Levels not to be concerned by at all.

How does he know? I would be concerned about unnecessary eposure to any levels of poisons.

Then he says:

I think if you’re in an enclosed space and somebody’s breathing out clouds of vapour that’s just unpleasant and it’s intrusive and it’s discourteous.

Quite.

Professor McNeill has an extensive list of publications to her name but has she actually treated any smokers? One wonders, when she makes statements like this:

The most effective way of quitting is to use a medication such as nicotine replacement therapy or it could be electronic cigarettes combined with behavioural support.

What does she mean ‘the most effective way of quitting’. Smokers who quit without medication or e-cigarettes combined with behavioural support haven’t done it effectively?

Professor West again:

E-cigarettes [are] there for people who…just want to go out to a shop and buy a product which they can use to stop smoking without seeing a health professional.

Why do you need a ‘product’ to stop smoking? Why not just stop?

And what does our counterfactual consultant have to say?

E-cigarettes [are] an alternative to smoking.

You don’t need an alternative to smoking!

Professor Britton:

E-cigarettes…normalise electronic cigarette use.

That’s the trouble!

And if we could normalise electronic cigarette use for the nearly nine million people in the United Kingdom who are still addicted to tobacco that could only be good thing.

A good thing for whom?

This is a product that can transform health…health-wise [smokers] achieve pretty much what they’d achieve if they quit smoking completely.

A huge assumption.

Do we really want to have millions of people sucking on e-cigarette drug delivery devices many times every day for years on end to gratify their nicotine addiction?

Text © Gabriel Symonds