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Smoke and mirrors

Until safety and efficacy are adequately assessed, Joseph Bush sees the decision to stock e-cigarettes as another example of commercialism trumping health professionalism

On October 6, having just delivered a scintillating lecture to final year MPharm students, I paid a brief visit to the Pharmacy Show taking place a short journey away at the NEC. The principal reason I went along was to witness a debate on e-cigarettes and community pharmacy. But I also had a walk around the exhibition (and ‘stuck it to the man' by grabbing myself a free GPhC mug, GPhC ‘repositionable notes' [generic Post-it® notes], a GPhC pen and a GPhC trolley tag).

I found the exhibition incredibly dispiriting. Alongside the usual pharma representation (GSK, Pfizer), suppliers of pharmacy shelving, accountants specialising in pharmacy etc was a panoply of, er, stuff. And alongside the homeopathy, kinesio-tape, acupressure and a laser-emitting, hair-growth-promoting helmet, there were more than 20 purveyors of e-cigarettes. Their stands were very impressive (one featured a car for some undiscernible reason) and it was clear that these companies had invested not-inconsiderable sums of money on exhibiting – presumably on the basis of seeing some return on their investment in the form of a glut of new orders from contractors eager to stock their wares.

Now, logic suggests that e-cigarettes will be less harmful than standard tobacco cigarettes. I'm relatively certain this will turn out to be the case, although the evidence to demonstrate this is not available and would take years (decades?) to accumulate. I raise this because this "logic suggests that…" kind of thinking has led to unnecessary harm before. And while evidence on e-cigarettes'  effectiveness as a stop-smoking aid is equivocal, they are more attractive to smokers than NRT (which does have good evidence of its effectiveness), with suggestions that 40 per cent of people looking to quit use e-cigarettes in an attempt to do so.

Until safety and efficacy are adequately assessed, I see the decision to stock e-cigarettes as another example of commercialism trumping health professionalism

So we seem to have a situation in which as set of medically licensed products with a proven evidence base is being challenged for supremacy by non-medically licensed nicotine delivery devices with no proven evidence base to support their effectiveness.

Recent data suggests a greater proportion of smokers use e-cigarettes to "help reduce the amount of tobacco I smoke, but not stop completely" and "to save money compared with smoking tobacco" than use e-cigarettes "to help me stop smoking entirely". Using the figures quoted above, and if we assume that a community pharmacy's clientele is representative of the general population (unlikely, I know, but run with me on this one) then more than half of the people purchasing e-cigarettes from a pharmacy have no intention of quitting smoking entirely and a primary reason for many of these purchases will be financial in nature – in large part to avoid paying the punitive taxes applied to tobacco.

Those pharmacy contractors (large and small) who choose to stock e-cigarettes will no doubt assert that they do so because they believe they reduce the harm of smoking tobacco. E-cigarettes may indeed reduce harm – and one day the evidence may support this seemingly logical stance – but during the aforementioned debate, the head honcho of one of the e-cigarette manufacturers revealed that the profit margin for community pharmacies retailing his products was in the region of 55 per cent.

It would be naïve to assume that such a profit margin does not influence a pharmacy contractor's decision as to whether to stock e-cigarettes. I see this – at least until the point when the safety and efficacy of e-cigarettes has been adequately assessed and they are given marketing authorisations by the MHRA – as another example of commercialism trumping health professionalism. It is a seemingly age-old conflict and a war in which the former is victorious over the latter far too often for my liking.

And, yes, thanks. The view is nice from up here in my ivory tower.

Joseph Bush is a senior lecturer in pharmacy practice at Aston Pharmacy School. More from Joseph Bush:

Clarithromycin is linked to certain death - or is it?

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