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Patients should be encouraged to use free e-cigarettes in hospitals, argues academic

Health boards in Scotland have banned the use of e-cigarettes, but this presents a missed public health opportunity

BMJ

Hospitals should encourage the use of free e-cigarettes on hospital grounds to improve the health of patients and the wider public, argues an expert in The BMJ today.

Earlier this year, all health boards in Scotland except NHS Lothian introduced a ban on the use of e-cigarettes on hospital grounds. The justification for the policy is that more evidence is needed on the safety of e-cigarettes.

However, this rationale is not sufficient and "by refusing the use of e-cigarettes on hospital grounds, the NHS is harming the health of patients and the wider public," argues David Shaw, a senior research fellow at the Institute for Biomedical Ethics, University of Basel, Switzerland.

While the safety e-cigarettes isn't entirely clear, he argues that "substantial evidence shows that they are safe, and overwhelming evidence shows that they are much safer for users than conventional cigarettes."

Public Health England recently published a review which found that e-cigarettes can help people to quit smoking, and the Medicines and Healthcare Products Regulatory Agency will license e-cigarettes as drugs from 2016.

"Hospitals should be using e-cigarettes in creative ways to improve patients' health rather than banning them while continuing to tolerate conventional smoking around their premises," he explains.

Patients should not be denied an opportunity to access a smoking cessation aid on hospital grounds to help them improve their health, he argues, adding that it's inconsistent to ban e-cigarettes while allowing the use of nicotine patches and gum.

Furthermore, the ban will increase the risk of passive smoking among hospital staff and visitors because patients tend to smoke conventional cigarettes just outside or on hospital grounds. Allowing e-cigarette use would alleviate this problem because nicotine vapour is likely to be less harmful than carcinogenic smoke, he explains.

Patients might switch to e-cigarettes during a hospital stay rather than return to tobacco cigarettes, he adds, and this would benefit individuals as well as public health.

Part of the argument behind the ban is that e-cigarettes normalise smoking for young people. But he cites research that suggests fewer children smoke conventional cigarettes in countries where e-cigarettes are available.

However, he acknowledges that "e-cigarettes are not completely harmless, and their connections with the deadly tobacco industry make people uncomfortable." Nonetheless, he concludes "their potentially beneficial effect on individual and public health is undeniable."

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