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NAQC Newsroom: Research

Viewpoint: Evidence, Policy, and E-Cigarettes — Will England Reframe the Debate?

Tuesday, April 19, 2016  
Posted by: Natalia Gromov
Sharon H. Green, Ronald Bayer, and Amy L. Fairchild
Viewpoint: Evidence, Policy, and E-Cigarettes — Will England Reframe the Debate?
N Engl J Med 2016; 374:1301-1303 April 7, 2016.
While I sometimes disagree with commentaries I highlight in this bulletin, I rarely respond here to those differing points of view. I make an exception in this case, not because I disagree with the views expressed in the New England Journal of Medicine (NEJM) by Green, Bayer and Fairchild (I agree with some statements they make and disagree with others), but because they seem to conflate some very real lingering effects of Puritanism and a history of Prohibition in the US with a less open approach to harm reduction. It is true that NRT (nicotine replacement therapy) use is historically more prevalent in the UK than the US, (a 2008 survey by Hammond and colleagues, ‘Smokers’ use of nicotine replacement therapy for reasons other than stopping smoking: Findings from the ITC Four Country Survey’, Addiction, Open Access copy here, found NRT use in the US [13.2%] only modestly below the rates in Canada [16.5%] and Australia [16.3%], with all three countries significantly behind the UK, at 22.3%) but hardly by orders of magnitude. The debate over reframing the debate on e-cigarettes will continue elsewhere, but I don’t think the argument can be made that resistance is due to a “more absolutist approach”, as the NEJM authors claim is the case in the US. As elsewhere, the main discussion is focused on net harm reduction to individuals and societies after the costs of e-cigarettes are factored in.

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