In July 2013, a group of 12 experts in decision science, medicine, pharmacology, psychology, public health policy, and toxicology rated the relative harm of 12 nicotine-containing products by using 14 criteria addressing harms to self and others.1
The group concluded that combustible cigarettes were the most harmful and that electronic nicotine delivery systems (electronic cigarettes or e-cigarettes) were substantially less harmful than combustible cigarettes. These results have been characterized and repeated in the popular media as e-cigarettes are “95% less risky” or “95% less harmful” than combustible cigarettes. However, as the authors noted in a sweeping statement regarding the shortcomings of their own work, “A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria.”1(p224)
Despite this lack of hard evidence, Public Health England and the Royal College of Physicians endorsed and publicized the “95% less harmful” assertion.2,3 Senior Public Health England staff emphasized the “evidence” underlying the 95% figure, despite the evidence being lacking. Much has been written about the dubious validity of the “95% less harmful” estimate in 2014 to 2016, especially about the paucity of research on the health effects of e-cigarettes available in 2013. After six years of e-cigarette–focused research, which has yielded a growing body of hard evidence regarding harm (see Appendix A, available as a supplement to the online version of this article at http://www.ajph.org, for a nonexhaustive list), the time has come to re-examine that estimate.
Thomas Eissenberg PhD, Aruni Bhatnagar PhD, Simon Chapman PhD, Sven-Eric Jordt PhD, Alan Shihadeh ScD, and Eric K. Soule PhD, MPH – AJPA – January 8, 2020.
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