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Electronic cigarettes: fact and faction - R West

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Electronic cigarettes: fact and faction
R West
http://bjgp.org/content/64/626/442.long

Prof Robert West introduces an interesting new concept: his personal measure of the scale of the potential reduction in smoking mortality due to ecig take-up. This figure does not appear to align with Britton's figure (5 million deaths preventable just among UK smokers alive today); though all such numbers are simply guesses about hypothetical situations in any case. West thinks that there will be a reduction of 6,000 deaths per year per million smokers who switch (presumably after a circa 25 year timelag, although this isn't stated).

This indicates that with a smoker population of about 11 million in the UK at present (2014) and 100,000 deaths a year (reportedly), then if all smokers switched, the reduction would be of the order of 66,000 deaths; leaving 34,000 deaths a year from vaping. I feel this number is rather difficult to support, since 1,000 deaths a year in a vaping population of 10 or 12 million would be a significant number given that there are few if any disease factors apparent; and uncommon genetic predispositions, rare intolerances, pre-existing morbidities and occasional serious product contamination issues would be required to produce even that number. The huge number of deaths West potentially attributes to vaping (which apparently equals only about a 66% reduction compared to smoking-related mortality if the currently-accepted smoking-related mortality figure of 100k per year is used as the base figure) is apparently predicated on the time it took to associate lung cancer with smoking, and the variability in vaping technologies and practice. Perhaps playing safe to this extent is unwarranted.

However: another completely different interpretation of this is as follows - if West does not believe that UK smoking causes 100,000 deaths a year, and perhaps only (say) 70,000 deaths a year: then his projected vaping mortality rate looks a great deal more practical: fairly close to other projections that assume that, if there are no toxins in the inhaled aerosol observable in morbidity-creating doses, then the mortality rate that can be expected is extremely low.

Even so, there would need to be new diseases created by very low concentrations of toxins, since the smoking-related diseases caused by much higher doses of these toxins are considered to be all but impossible with the tiny amounts present in ecig aerosol. The balance of current opinion is that ecigs are about 1,000 times less toxic than cigarettes (see UK NHS for example). There is no reason why new fatal diseases cannot appear; indeed, we might consider this quite likely in future gen pop projections, considering the growth in new toxins in the environment and the food chain - just that attributing large numbers of deaths to currently unknown diseases newly created by vaping is not seen as a reliable position at this time.

In the end, West's position on the possible mortality rate directly attributable to vaping, as against his stated opinion on the potential reduction compared to smoking, is dependent on his exact, and unstated, figure for current annual smoking-attributable mortality per million smokers - perhaps a rather clever position to take. It has been suggested that this is a bit of a cop-out, since he doesn't say either how many people he thinks smoking kills, or how many people vaping will kill; but many of us will forgive him for this. Going up against the public health industry and its funders is professional suicide.

There are few enough honest public health professionals, since truth and honesty in public health is a route to vilification - it always has been, ever since John Snow - and we need the few honest ones to keep their jobs where possible. You have to make a personal decision about West's approach: is it acceptable to say what the potential gains might be, without rocking the boat? On balance I'm OK with it because it means he'll keep his job and his funding. The implication is that vaping will kill a lot of people, of course - if you believe the tobacco control industry's figure for current smoking mortality. On the other hand, if you believe anything originating from mainstream tobacco control, you need your head examined.

 

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