How has this lack of knowledge arisen?
There probably isn't a person in the country who doesn't understand that smoking is harmful to health. Most appreciate that smoking repesents the largest preventable cause of death in the United Kingdom.
Unfortunately perceptions regarding the dangers of smoking are often confused. Nicotine has became synonymous with the harmful effects of smoking but nicotine is not the culprit.
An example from 2015 (2) typifies the beliefs that many qualified doctors held. Dr Frank Bures warned that the nicotine in e-liquids could cause, "a big drop in blood pressure, slowing heart rate, central nervous system depression, muscle weakness and/or paralysis, difficult breathing, coma, respiratory failure/arrest and death. It is really impossible to say anything good about e-cigarettes".
The issue of individual misunderstanding is then compounded when large organisations repeat inaccuracies. The UK Centre for Tobacco and Alcohol Studies attacked the World Health Organization (3) in 2016 for arguing that, "policy measures recommended to reduce tobacco use should be applied to e-cigarettes ". The Centre said, "The WHO report fails to accurately present what is already known about e-cigarettes. In particular, it: positions e-cigarettes as a threat rather than an opportunity to reduce smoking".
Doctors and nurses, as we've seen during the Covid pandemic, are incredibly busy. Without directed training, they will form opinions about vaping from announcements by the likes of the World Health Organization and from national media, just like the rest of the population.
Carefully Chosen Experts
When newspapers carry stories about vaping, journalists frequently call on a select group of individuals to offer opinions. For instance, Stanton Glantz, is on record (4) as saying that misunderstanding the relative risk of vaping is "a good thing". Professor Michael Siegel warned (5), "Professor Glantz does not believe that accurate communication is the way to go. Apparently, inaccurate communication is better. This would almost be funny, were it not for the fact that many adults are going to die because of it ".
By 2018, others from the select group took to the British Medical Journal , aimed at and read by clinicians, to write: "There is no reliable evidence to show that e-cigarettes are safe or that they did not provide a 'gateway' to smoking for youngsters ". This fed into attitudes revealed in a research report (6) by the National Cancer Research Institute and the New Nicotine Alliance charity (7). They discovered a stunning level of ignorance and fear among cancer surgeons and cancer nurse specialists and concluded, "Training of health professionals and local adoption of e-cigarette advice are needed".
Public Health England (PHE)
PHE picked up on this problem in 2019, in its document (8) concerning what works for smoking cessation. It wrote, "Perhaps the greatest obstacle we face is the widespread misconception amongst smokers and health professionals that most of the harm of smoking comes from the nicotine. While nicotine is the addictive substance in cigarettes, it is relatively harmless". It prompted many medical organisations to try to address the problem and speak directly to NHS staff. The British Medical Association provided answers to typical questions doctors should use ( 9 ), telling them, " that using an e-cigarette is substantially safer than smoking tobacco ". The Royal College of GPs in conjunction with Cancer Research UK released a training video, podcast and written instructions (10), and the National Centre for Smoking Cessation and Training produced a training module for professionals (11 ).
Royal College of Physicians
In addition, the Royal College of Physicians issued advice (12) on tobacco harm reduction, addresing the matter of budget cuts to smoking cessation services (impacting staff training), and calling for vaping to be allowed by all NHS Trusts on hospital grounds. Even PHE joined in, addressing misunderstanding on its blog (13) by raising and debunking the most common myths about e-cigarettes. Ultimately, all of these messages haven't had the desired impact according to PHE's recent evidence update (14), and more needs to be done as misunderstandings regarding the dangers and risks of vaping persists.
Clearly, more investment in training is needed as busy professionals don't seem to have the time to read all of the advice - but there is something we can do to change this. Advocacy organisations have been calling on vapers to talk about their success at quitting cigarettes or other tobacco products by switching to vaping when they visit their GP. John Newton, PHE's Director of Health Improvement, commented on the launch of the recent Vaping in England report that vaping helps fifty thousand smokers each year to stop smoking, but warned, "Thousands more could have quit except for unfounded safety fears about e-cigarettes". "For anyone who smokes, particularly those who have already tried other methods, we strongly recommend they try vaping and stop smoking - ideally with additional support from their local stop smoking service for the very best chance of quitting for good."