Editorial in Lancet medical journal criticises PHE for basing its advice on research funded by organisations with links to the tobacco industry

Public Health England has come under fire for basing its advice on the safety of e-cigarettes on research funded by organisations with links to the tobacco industry.

Last week, PHE announced that e-cigarettes were 95% less harmful than conventional cigarettes and suggested they could one day be offered alongside nicotine patches as a smoking cessation aid.

But the statement has caused concern among those, including some local authority directors of public health, who say there is not enough evidence to justify it and who fear an official endorsement of the safety of e-cigarettes will benefit the tobacco companies.

Multinational tobacco manufacturers are now among the lead players in the e-cigarettes market. Their critics fear that if vaping becomes acceptable, smoking will be rehabilitated too.

An editorial in the Lancet medical journal criticises PHE for relying for its 95% assertion on a paper led by Prof David Nutt of the Independent Scientific Committee on Drugs, which calculated the level of harm caused by different nicotine delivery systems, from cigarettes to cigars, pipes, nicotine patches and e-cigarettes. They took into account a wide range of risks, from the effect of addiction on people’s incomes to fatal lung damage to accidental poisoning.

The Lancet points out that the Nutt paper states that there was a “lack of hard evidence for the harms of most products on most of the criteria”. It was also concerned about the funding of the paper and conflicts of interest on the part of some of the authors.

The paper was funded by EuroSwiss Health and Lega Italiana Anti Fumo (LIAF). EuroSwiss Health is run by Delon Human, a South African doctor who has two other companies, Health Diplomats and NicoLife, based at the same address, which have accepted funding from British American Tobacco. Human was also funded by BAT in 2010 to write a book called Wise Nicotine, which was described as “a plea to health professionals to become nicotine-wise, and for smokers to demand information and access to safer forms of nicotine”.

Human is secretary general of the Africa Medical Association. Kgosi Letlape, one of the authors of the Nutt paper, is its president. There is no suggestion that Nutt or Letlape has accepted tobacco industry funding.

LIAF is an Italian anti-smoking organisation. Its chief scientific adviser is Riccardo Polosa, another author of the Nutt paper. Polosa states there that he is a consultant to Arbi Group Srl, an e-cigarette distributor. Polosa is pictured in an endorsement on the website of the e-cigarette, called Catagoria, that he researched with the support of LIAF.

E-cigarettes may have a part to play in helping some people quit smoking, says the Lancet editorial. “But the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency’s peer review process,” it says.



“PHE claims that it protects and improves the nation’s health and wellbeing. To do so, it needs to rely on the highest-quality evidence. On this occasion, it has fallen short of its mission.”

PHE has hit back, saying its review that led to the 95% statement was based not only on the Nutt paper but also on one by Robert West of University College London and colleagues, which also found that although e-cigarettes were not 100% safe, there was little evidence of any harm.

Ann McNeill of the Institute of Psychiatry, who conducted the review for PHE, said new studies that had raised the alarming prospect of harm from chemicals in e-cigarettes did not, in fact, demonstrate new risks. “Some flavourings and constituents in e-cigarettes may pose risks over the long term. We consider the 5% residual risk to be a cautious estimate allowing for this uncertainty,” she said. Ongoing monitoring was necessary in case new risks emerged, but “on current evidence, there is no doubt that smokers who switch to vaping reduce the risks to their health dramatically”.

Nutt said in a blogpost that: “The funding of the nicotine study was provided by a Swiss-based consulting firm interested in this question as an unrestricted grant to the charity DrugScience. They had no involvement in the subsequent meetings and publications. An Italian anti-smoking charity made a small financial contribution at the publication stage to help pay for open access.”

The group involved in the study was chosen because of their expertise in a variety of fields, he said. “As is inevitable in such a field, several had or have had ‘interests’ in aspects of nicotine and tobacco supply or harm reduction, and these were declared at the time,” he said. The study was carried out in such a way that individuals with a bias would not be able to influence the outcome.

“With one in five people believing e-cigarettes are at least as harmful as smoking, it is important that the public know that based on current evidence vaping carries a fraction of the risk of smoking,” said Kevin Fenton, director of health and wellbeing at PHE.

“While the long-term impact of using e-cigarettes remains unknown, our comprehensive evidence review estimates that e-cigarettes are around 95% less harmful than smoking. Nearly 80,000 people a year die of a smoking-related illness and smoking costs the NHS £2bn a year. Given all the evidence about the potential benefits e-cigarettes offer to reduce harm and to help smokers quit, if a smoker wants to quit with an e-cigarette they should be supported to do so.”

But those who feel the safety of e-cigarettes has not been proved and worry about the involvement of the tobacco industry feel PHE has not properly weighed the evidence or considered where it is coming from.

Prof Simon Capewell, from the University of Liverpool, said he was “surprised and disappointed to hear about the substantial conflict of interest” because it undermines the credibility of the whole group.

“The truth is that the 95% safer figure is now in serious doubt. The second problem is that this is a major distraction because the real question is how much safer is fresh air for non-smokers and children compared with being exposed to vapes from others in enclosed spaces? I think that is a major health question which must be addressed.”

• This article was amended on 30 August 2015. An earlier version incorrectly stated that Prof Capewell was an author of the Lancet editorial.