On the 19th of March CRUK (Cancer Research UK), together with the BHF (British Heart Foundation), ESRC (Economic and Social Research Council) and MRC (Medical Research Council) held the first of two workshops on the subject of gaps in e-cigarette research. NNA trustees Sarah Jakes and Gerry Stimson attended. Read on for Sarah's account of the day.
I have to say, whenever I see proposals for further research into e-cigarettes my heart sinks. There are already hundreds of studies on the subject and it's hard to see what else anyone could want. The emerging consensus among experts is that, based on what we already know, vaping is at least 95% safer than smoking and only long term studies will narrow that down with any accuracy. Anything else is little more than speculation.
There is nothing at all to suggest that the residual 5% is a real risk of harm. It just represents the 'we can't know yet' factor and may very well translate into nothing. But that doesn't seem to stop some research groups, notably those based in the US, from devising unrealistic studies which are invariably peppered with scary words such as 'toxic' and 'carcinogenic' which, once translated into media stories, have the effect of discouraging smokers from switching to the safer alternative.
So given my views above, why did I attend? Because whether we like it or not further research will be done and this workshop was an opportunity to have the consumer voice heard. To their credit, CRUK bent over backwards to ensure that we were there, that people knew we were there, and to ensure that we had the opportunity to make our views known.
The morning session started well with presentations from Ricardo Polosa, Jaques Le Houzec and Peter Hajek and which covered the potential public health gains from e-cigarettes including tobacco harm reduction, and the emerging concept of tobacco harm reversal. These were followed by discussions around the 6 tables during which we were asked to come up with 3 questions for research to answer regarding the effects of nicotine and the mechanism of its delivery. Our table quickly descended into chaos and accusations of going 'off topic' but did eventually manage to raise questions on long term effects and effects on vulnerable groups such as pregnant women and young people, as did most of the others. Our third question was on the possible effects of nicotine in other patient groups such as in tackling obesity.
The afternoon started with a presentation from Maciej Goniewicz which touched on third hand vapour and increased formaldehyde emissions from higher powered devices. On the former subject Maciej went to great lengths to point out the fact that you would have to lick some 30 square meters of floor to ingest (I can't remember how much but a tiny amount) of nicotine, and so that much of his presentation showed e-cigarettes in a positive light. However, in the latter part, his assertion that vapers turn up the power in order to increase the nicotine delivered and in so doing may be inhaling harmful amounts of formaldehyde was not so welcome. Needless to say I disagreed with both Maciej's premise and his conclusion based on the study methodology. Unfortunately for Maciej he was on my table so we later had quite a lively discussion on that subject.
Maciej's presentation was followed by one from Tim Gant of PHE which focussed on the content of emissions, and then one from NNA's associate Louise Ross, who is the stop smoking services manager for Leicester. Louise had been tasked with explaining vaping and the feedback she had been receiving from service users. She ensured that all in the room knew who the actual vapers present were (myself and Jaques Le Houzec) so that people could ask questions.
The day finished with a summary of the areas of interest identified during the day and closing comments. Mine was a plea to both researchers and funders to not simply study vapers but also to utilise their experience, i.e. consult them on study design and include them on research panels in order to ensure that their results are actually relevant to real world use and therefore helpful. I very much hope that didn't fall on deaf ears.
As a result of our participation we have already been contacted by a team enquiring into assistance with a pilot study of the use of e-cigarettes by patients awaiting thoracic surgery.The next workshop is in May and we hope that NNA will be invited to particpate once again.