It is very heartening, as a GP, to hear the view of the industry that it wants to make sure that e-cigarettes are not available to our children. Certainly, my interest in this issue as a clinician was first sparked when a parent came to me with a primary school child who had been found in the playground with an e-cigarette—that is wrong on so many levels.
I am very keen for e-cigarettes to be removed; I am very keen for them not to be seen in shops and displays at children’s height, so that children can no longer see those primary-coloured products or take them off the shelf to find out what they are. There needs to be a move to get the capsules—with the actual nicotine-containing liquid—into a child-safe form so that there is no risk to our children of them accidentally getting hold of that liquid and ingesting it. Although nicotine can cause vomiting and so on in overdose, it is not guaranteed that a child will bring up the liquid, so they may suffer harm.
It is also heartening to hear that the industry is keen to do a full health study. My concern as a clinician is whether that is happening after the horse has bolted. There is huge use of e-cigarettes, yet we do not have good evidence as to their safety. I absolutely accept that e-cigarettes will do less harm than continued tobacco use. However, I am concerned that the use of e-cigarettes does not always take someone who is using tobacco down the path either to 100 per cent e-cigarette usage or to quit nicotine as an addiction altogether.
There is certainly emerging evidence that e-cigarettes are being used to reduce people’s reliance on tobacco, but those people possibly then maintain their tobacco use for longer. The evidence, certainly in terms of clinical harm, is that the length of period of tobacco use is potentially more harmful than the intensity of tobacco use. That is a significant concern.
There is a need for more evidence. Certainly, the BMA is very keen to see the quick development—or as quick as research ever allows for—of more evidence around the issue to the point at which I, as a GP, can feel confident to recommend the products to my patients as part of nicotine replacement or smoking cessation therapy. As part of the whole gambit, however, there has to be awareness of the evidence that all nicotine replacement therapies are more effective when they are combined with behavioural therapies rather than people just taking products off the supermarket shelf. We need to use e-cigarettes as a product to help reduce the impact of tobacco, but we must not take our eyes off the huge amount of harm that is caused by tobacco use in the UK, as other panel members have mentioned. I want us to be in a place where the evidence is there, but that evidence is going to take a very long time to develop and we need to be brave and move forward faster than that.