A prominent British physician has sparked controversy by blaming the country’s message that vapes are “95 percent safer” than cigarettes for youth vaping.
Interviewed by the BBC, Dr. Mike McKean, vice president for policy at the Royal College of Paediatrics and Child Health, said that communicating this was “a very unwise thing to have done and it’s opened the door to significant chaos.”
“There are many young people who have taken up vaping who never intended to smoke and are now likely addicted to vaping,” said McKean. “And I think it’s absolutely shocking that we’ve allowed this to happen.”
The doctor, who treats children with lung conditions, claimed that vaping “could be very bad for you,” though the BBC noted that “he stresses that it is not making lots of children very sick, and serious complications are rare.”
The estimate that vaping is 95 percent safer than smoking originally came from a major, independent evidence review published by Public Health England in 2015.
As the most high-profile serious attempt to quantify relative risks, the review became widely cited by tobacco harm reduction proponents far beyond the United Kingdom—and has been attacked by media and other skeptics in the years since.
“It’s not because they think it’s safe that teenagers are experimenting with vaping.”
Tobacco harm reduction advocates have quickly objected to Dr. McKean’s intervention.
Hazel Cheeseman, deputy chief executive of the charity Action on Smoking and Health (ASH, UK) tweeted evidence that since the 2015 review, British youth aged 11-17 have increasingly perceived vapes to be more harmful.
According to ASH’s annual survey, 54 percent now hold the incorrect belief that vapes are “about the same or more harmful” than cigarettes—up from 25 percent in 2015. Only 33 percent are aware that vaping is safer than smoking—down from 65 percent in 2015. Much UK media coverage of vaping has been negative in recent years.
“It’s not because they think it’s safe that teenagers are experimenting with vaping,” Cheeseman said in a statement released by ASH. “Harm perceptions are even more inaccurate among teens than the adult population.”
“Further regulation will be more effective than scare mongering,” she continued, noting a risk that teens “may be more likely to smoke” if they think vapes are no safer.
“We seem to have reached peak dishonesty in parts of the health community.”
Clive Bates, a tobacco harm reduction advocate and former ASH director, was scathing about McKean’s suggestion.
“We seem to have reached peak dishonesty in parts of the health community,” he told Filter. “Instead of celebrating and sharing the good news that we have nicotine products that substitute for smoking and are likely to be at least 95 percent less risky, we have doctors declaring that it would be better to lie to the public, and pretend all these products are equally dangerous in the hope they won’t use them.”
Bates’ response was echoed by Stuart Ritchie, science writer for the i national newspaper, who wrote:
“The fact that a prominent doctor, head of policy at a major medical organization, seems to be arguing that people should become even less informed—that medical organizations should dilute the truth of their message that vaping is relatively safe—seems quite perverse.”
John Dunne, director-general of the UK Vaping Industry Association, said McKean’s idea is “based on the view of one man and supported by absolutely zero evidence.”
“Hiding the fact that vaping is 95 percent less harmful than cigarettes is not the answer,” he told Filter, “and for every adult smoker who knows this fact, there is a chance we can reduce the 250 people dying every day from smoking in the UK.”
According to the National Health Service, “Every year around 76,000 people in the UK die from smoking, with many more living with debilitating smoking-related illnesses.”
It does seem extraordinary that as such immense harms continue, outcry and frightening headlines should focus instead on a well-evidenced tool for smoking cessation. But it’s a familiar pattern, when United States public health groups also call for the suppression of information about the relative risks of vaping and smoking.
McKean told the BBC that “Vaping is not for children and young people,” and that it “is only a tool for adults who are addicted to cigarettes.”
Many would agree, including the UK government, which plans to offer free vape kits to a million people who smoke, while retaining a minimum age of 18 to buy vapes. Tobacco harm reduction experts have made the case, however, that at a population level, vaping has a net benefit to youth, due to the numbers being diverted from starting or continuing to smoke.
Cheeseman cited the “popularity of disposable vapes” as the issue behind youth vaping. Her organization has said it is “sympathetic” to growing calls for a UK disposables ban, but opposes it on the grounds that this would “turbo-charge” an illicit market without consumer protections or age restrictions.
Can withholding health information from one group of people ever be justified in the name of protecting another group?
The disposables debate rumbles on, amid recent bans in Europe.
But perhaps the fundamental question to arise from the McKean controversy is this: Can withholding health information from one group of people (adults who smoke), ever be justified in the name of protecting another group (youth who might vape)?
I put this ethical query to Brian Earp, senior research fellow at the Uehiro Centre for Practical Ethics, University of Oxford, and associate director of the Yale-Hastings Program in Ethics and Health Policy.
“Children are entitled to age-appropriate factual information about the physical and social world they live in,” he told Filter. “If the thought is that children should be lied to or have true information suppressed because they might not behave as adults wish them to, this is a failure on the part of adults to communicate truthfully and pragmatically with young people or to devise relevant enforceable rules in their best interests.”
“In any case,” Earp continued, “there is no argument for hiding from adults factual information about the benefits and risks of activities which they, as adults, are legally entitled to engage in; it is wrong, disrespectful and—in consequentialist terms—also often ultimately damaging to public health.”