“Dangerous experiment” or tool to reduce inequalities in health, the prospect of medically prescribing electronic cigarettes in England for smokers who want to quit smoking is far from unanimous.
At the end of October, the British government changed the approval process by the British health products regulator, MHRA, which could make England the first country to prescribe the characteristic crackling device as a medical device.
Manufacturers could already “in theory” request such a classification, emphasizes Linda Bauld, professor of public health at the University of Edinburgh, “but that did not happen”.
In question, the complexity and the cost of the procedure, which led the Ministry of Health to make modifications to “actively encourage” the industrialists, explains to AFP the university.
While admitting that electronic cigarettes “contain nicotine and are not without risk”, the Department of Health, based on British and American studies, stresses that they are less harmful than tobacco.
This is the leading cause of preventable premature death, with nearly 64,000 deaths in England in 2019. And if the number of smokers is at its lowest in the United Kingdom, England still has 6.1 million.
Deterrent price
According to Linda Bauld, 30% of smokers have not tried to switch to electronic cigarettes, “and when you ask them why, their main concern is around safety.”
Thus, a medically approved device would be reassuring. Or even a little too much? “It’s a possible argument, it could be a concern,” she admits.
Another deterrent is the price of the vaping device, usually 50 to 60 pounds sterling (58 to 70 euros). Prescribed by the public health service, the NHS, the device would become much more accessible. And the number of smokers being more important in the most disadvantaged categories of the population, the medically prescribed electronic cigarette could thus help to reduce health inequalities, she underlines.
Professor Peter Hajek, from Queen Mary University in London, generally sees the government announcement as “good news” and points out that “a good proportion of smokers who start using electronic cigarettes quit smoking altogether”.
There is “no doubt”, he maintains, that switching from tobacco to vaping avoids “almost all the risks”.
The situation is far from being so clear, said his colleague Jonathan Grigg, professor of pediatric respiratory and environmental medicine at the same university.
“The long-term effects are unknown,” said Professor Grigg, president of the European respiratory society, opposed to the recommendation of electronic cigarettes to quit smoking.
“Misleading methods”
British health authorities welcome electronic cigarettes, he continues, stressing the isolated nature of London’s policy.
The closest example is Australia, where sales of devices and refills are prohibited unless you have a prescription.
The prescribed vaping should only intervene as a “last resort”, he underlines, deeming “incredible that the NHS”, the public health service, “pays anything to the tobacco industry” behind these devices , given their “deceptive methods” in the past. For him, “it is a dangerous experiment”.
Very critical of the government’s health policy, Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, would be “surprised” if the relaxation of the approval criteria is a game-changer.
And any prescription for an electronic cigarette should, according to him, be part of a behavioral follow-up over several weeks, “this is the only way in which it has been shown to work in tests”.
At the end of July, the World Health Organization (WHO) warned against electronic cigarettes and called for better regulation.
According to the UN agency, 32 countries ban the sale of these electronic nicotine inhalers and 79 have adopted at least one measure to limit their use, such as banning advertising. On the other hand, 84 countries have no safeguards against their proliferation.