Banning the use of e-cigarettes in hospital grounds in Scotland is a missed public health opportunity, according to the personal view* of a biomedical ethicist writing in The BMJ this morning. Lack of evidence for their safety has been used by health boards to justify the ban, but he has called for hospitals instead to encourage the use of e-cigarettes, and even to provide them free to smokers, because he said “overwhelming evidence” shows they are much safer than conventional cigarettes.
David Shaw, senior research fellow at the Institute for Biomedical Ethics, University of Basel, Switzerland, argued that the ban now in force across Scotland (except for NHS Lothian) means not only that patients who smoke will continue to damage their own health but also that they will be denied the opportunity to access a smoking cessation aid on hospital grounds.
He pointed to the inconsistency of banning e-cigarettes, which – despite their visual resemblance, in some cases, to cigarettes – involve neither tobacco nor combustion, and have much more in common with other nicotine-based smoking cessation products whose used is permitted in hospitals, such as patches and gum.
NHS Dumfries and Galloway’s CEO Julie White was quoted recently by the BBC as saying that e-cigarettes should not be used in the grounds of hospitals until we have more evidence around their use – yet in England, the Medicines and Healthcare products Regulatory Agency will license e-cigarettes as drugs from next year, and Public Health England has published a review showing that they can help people quit smoking.
David Shaw argued: “It is true that the safety profile of e-cigarettes is not yet entirely clear, but substantial evidence shows that they are safe, and overwhelming evidence shows that they are much safer for users than conventional cigarettes.” Furthermore, he said, allowing people to use e-cigarettes during their hospital stay could help them to quit completely.
He added that removing the ban on e-cigarettes and providing them free to patients who are smokers, as well as properly enforcing the smoking ban in hospital grounds, would benefit not just their own health but that of non-smokers too. In practice, he said, many hospitals don’t enforce the ban on smoking in hospital grounds, so that hospital staff and visitors are subjected to passive smoking; wisps of vapour from e-cigarettes, in contrast, are likely to be less “disgusting and harmful to walk through than clouds of carcinogenic smoke”.
He concluded: “E-cigarettes are not completely harmless, and their connections with the deadly tobacco industry make people uncomfortable. But their potentially beneficial effect on individual and public health is undeniable. By refusing to allow the use of e-cigarettes on hospital grounds, the NHS is harming the health of patients and the wider public.”