A recently published World Health Organization (WHO)-commissioned review of evidence on e-cigarettes contains serious errors, misinterpretations and misrepresentations, which may lead to policy-makers and the public not understanding the potential public health benefits of e-cigarettes. 

The authors, writing today in the journal Addiction, analyze the WHO-commissioned Background Paper on E-cigarettes, which looks to have been influential in the recently published WHO report calling for greater regulation of e-cigarettes. 

They also criticize the authors of the review for intentionally using alarmist language to describe findings and to present opinion as though it were evidence. 

Professor Ann McNeill, lead author from the National Addiction Centre at King's College London, says, "We were surprised by the negativity of the commissioned review, and found it misleading and not an accurate reflection of available evidence. E-cigarettes are new and we certainly don't yet have all the answers as to their long-term health impact, but what we do know is that they are much safer than cigarettes, which kill over 6 million people a year worldwide. Furthermore, the review appears to have informed the policy recommendations published in last week's WHO report on e-cigarettes. Any policies surrounding e-cigarettes must be evidence based and like any product, e-cigarettes should be subjected to some form of regulation. However, the WHO's approach will make it harder to bring these products to market than tobacco products, inhibit innovation and put off smokers from using e-cigarettes, putting us in danger of foregoing the public health benefits these products could have." 

The article by McNeill and colleagues takes nine key statements in the WHO-commissioned review and provides an alternative conclusion and a commentary. Highlights include:

• The review implies that e-cigarette use in youth is a major problem and could be acting as a gateway to smoking when in fact current
• The review fails to acknowledge that e-cigarettes are not just less harmful than tobacco cigarettes but that the concentrations of toxins are mostly a tiny fraction of what is found in cigarette smoke

• The review infers that bystanders can inhale significant levels of toxins from the vapour when the concentrations are too low to present a significant health risk

•  The review gives the impression that evidence suggests that e-cigarettes inhibit smoking cessation when the opposite is true 

Professor Peter Hajek, co-author from the Tobacco Dependence Research Unit at Queen Mary University of London, says, "There are currently two products competing for smokers' custom. One, the conventional cigarette, endangers users and bystanders and recruits new customers from among non-smoking children who try it. The other, e-cigarette, is orders of magnitude safer, poses no risk to bystanders, and generates negligible rates of regular use among non-smoking children who try it. The WHO recommendations blur these differences and if followed, will cripple the competitiveness of e-cigarettes and help to maintain the market monopoly of conventional cigarettes."

Dr Jacques le Houezec, co-author and consultant in Public Health and Tobacco dependence in France and Honorary Lecturer at the University of Nottingham, says, "E-cigarette use has been a consumer led revolution, the speed at which these products have developed and evolved shows just how much smokers are ready to adopt harm-reduction products. The use of e-cigarettes could save millions of lives during this century, and have the most important public health impact in the history of tobacco use." 

The paper follows an editorial published this week in the British Journal of General Practice by public health experts who also argue that public health messages about e-cigarettes should be based on facts and not prejudice. They estimate that for every million smokers who switch from tobacco to e-cigarettes, over 6,000 premature deaths would be prevented each year in the UK. 

Professor Robert West from UCL, lead author of the editorial, says, "I completely understand concerns about potential risks from this phenomenon but it is vital that public health experts separate opinion from evidence and present the latter as objectively as possible."