Balancing the risks and benefits of e-cigarettes through regulations

How best to regulate e-cigarettes is a hot topic and growing science. In line with successful harm reduction approaches in HIV/AIDS and illicit drugs in the UK [1], and Professor Michael Russell’s legacy of nicotine harm reduction [2], the UK government adopted an approach to e-cigarette regulations which managed the risks (e.g. of youth never smoker uptake) whilst maximizing the benefits (smokers using e-cigarettes to stop smoking). This approach has now been implemented within the framework of the European Union Tobacco Products Directive (EU TPD) [3], the pros and cons of which were described very ably and comprehensively by Gruszczynski [4]. I disagree with Gruszczynski however that UK is a notable exception in the case of marketing. In line with other EU Member States, the UK prohibits print and broadcast advertising, and in common with at least a few other Member States, it allows domestic e-cigarette advertising (e.g. billboards, point of sale). In addition, in the UK, an advertising code restricts, inter alia, the ability of any advertisements to attract adolescents and be confused with smoking [5]. The UK government has also prohibited e-cigarette sales to under 18 year olds [6], on a par with tobacco. So, whereas critics suggest that the UK position is unique, a more objective assessment puts UK regulations in line with the majority of OECD countries towards the centre of the regulatory spectrum, eschewing both prohibition and unconstrained market forces. Indeed, among OECD states, de facto prohibition is the exception. Both New Zealand [7] and Canada [8] have abandoned their previous ‘medicines only’ approach in favour of a policy more closely aligned with the UK.
Importantly, the UK is a leader in tobacco control, as evidenced by topping the European Tobacco Control Scale [9] and having one of the lowest smoking prevalence in the European Union [10]. We have implemented most tobacco control interventions, and whilst we should enhance these and add more, there is a broad consensus [11] recognizing the additional contribution that harm reduction approaches make within the tobacco control armoury. Most of the allure of tobacco smoking is due to the cigarette’s ability to deliver shots of nicotine to the brain faster than by intravenous injection, along with a cocktail of other substances that enhance the effect and/or do a vast amount of damage. Hence, finding alternative, less harmful, sources of nicotine which can satisfy smokers, is an...


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