On 2016 May 23, Clive Bates commented:

The following conclusion drawn by the authors has no foundation in the study:

In conclusion, our study strongly suggests that electronic cigarettes are not as safe as their marketing makes them appear to the public.

There are three main concerns about how this conclusion is drawn:

Firstly, the paper makes no assessment of electronic cigarette marketing claims. I am not aware of any marketing claims for complete safety and the authors do not provide any evidence that this is a common or even exceptional claim made by those marketing e-cigarettes.

Secondly, a cell study of this nature can provide no useful information on the magnitude of the human health risks or whether such risks are even material at all. It is impossible, therefore, to say if any marketing claims are reasonable or misleading on the basis of this study.

Thirdly, the study does provide evidence - though this is buried and barely referred to - that e-cigarette vapour has a much lower impact than tobacco smoke, at least when measured using this methodology. Cells were still alive in the e-cigarette vapour medium after 8 weeks, but all were dead in the tobacco smoke extract within 24 hours. It tends to support, therefore, the more common argument that e-cigarettes are much less hazardous than smoking, but may not be 100% safe.

This has most recently been expressed by the Royal College of Physicians (London) in its major assessment of e-cigarette science, Nicotine with smoke: tobacco harm reduction

Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure. (5.5)

A more detailed and critical discussion of this paper and the related irresponsible media handling was published in May 2016 and should be read by anyone reading or citing Yu V, 2016

Holliday R, Kist R, Bauld L. Commentary, Evidence-Based Dentistry (2016) 17, 2–3. doi:10.1038/sj.ebd.6401143

Media handling

In a quote in the media release one of the authors, Dr Wang-Rodriguez, asserted that evidence so far available shows no difference in risk between cigarette smoking and e-cigarette use.

The overarching question is whether the battery-operated products are really any safer than the conventional tobacco cigarettes they are designed to replace. Wang-Rodriquez doesn't think they are. "Based on the evidence to date," she says, "I believe they are no better than smoking regular cigarettes."

This extraordinary and unqualified assertion created worldwide news headlines (for example, E-cigarettes are no safer than smoking tobacco, scientists warn - The Telegraph).

However, this assertion has no foundation whatsoever in the study. To the extent that the study shows anything about health risks, it shows this assertion to be false. Looking beyond this study, there is no science that supports such a claim anywhere and plenty that bluntly refutes it.

As a result, the interpretation of the findings in this study and the subsequent media handling have attracted severe criticism, for example:

• Clive Bates (this author) - Counterfactual

• Dr Michael Siegel - Boston University School of Public Health

• Adam Jacobs - medical statistician

On 2016 May 19, Clive Bates commented:

None

On 2016 May 19, Clive Bates commented:

None

On 2016 May 23, Clive Bates commented:

The following conclusion drawn by the authors has no foundation in the study:

In conclusion, our study strongly suggests that electronic cigarettes are not as safe as their marketing makes them appear to the public.

There are three main concerns about how this conclusion is drawn:

Firstly, the paper makes no assessment of electronic cigarette marketing claims. I am not aware of any marketing claims for complete safety and the authors do not provide any evidence that this is a common or even exceptional claim made by those marketing e-cigarettes.

Secondly, a cell study of this nature can provide no useful information on the magnitude of the human health risks or whether such risks are even material at all. It is impossible, therefore, to say if any marketing claims are reasonable or misleading on the basis of this study.

Thirdly, the study does provide evidence - though this is buried and barely referred to - that e-cigarette vapour has a much lower impact than tobacco smoke, at least when measured using this methodology. Cells were still alive in the e-cigarette vapour medium after 8 weeks, but all were dead in the tobacco smoke extract within 24 hours. It tends to support, therefore, the more common argument that e-cigarettes are much less hazardous than smoking, but may not be 100% safe.

This has most recently been expressed by the Royal College of Physicians (London) in its major assessment of e-cigarette science, Nicotine with smoke: tobacco harm reduction

Although it is not possible to precisely quantify the long-term health risks associated with e-cigarettes, the available data suggest that they are unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure. (5.5)

A more detailed and critical discussion of this paper and the related irresponsible media handling was published in May 2016 and should be read by anyone reading or citing Yu V, 2016

Holliday R, Kist R, Bauld L. Commentary, Evidence-Based Dentistry (2016) 17, 2–3. doi:10.1038/sj.ebd.6401143

Media handling

In a quote in the media release one of the authors, Dr Wang-Rodriguez, asserted that evidence so far available shows no difference in risk between cigarette smoking and e-cigarette use.

The overarching question is whether the battery-operated products are really any safer than the conventional tobacco cigarettes they are designed to replace. Wang-Rodriquez doesn't think they are. "Based on the evidence to date," she says, "I believe they are no better than smoking regular cigarettes."

This extraordinary and unqualified assertion created worldwide news headlines (for example, E-cigarettes are no safer than smoking tobacco, scientists warn - The Telegraph).

However, this assertion has no foundation whatsoever in the study. To the extent that the study shows anything about health risks, it shows this assertion to be false. Looking beyond this study, there is no science that supports such a claim anywhere and plenty that bluntly refutes it.

As a result, the interpretation of the findings in this study and the subsequent media handling have attracted severe criticism, for example:

• Clive Bates (this author) - Counterfactual

• Dr Michael Siegel - Boston University School of Public Health

• Adam Jacobs - medical statistician