Evidence use in E-cigarettes debates: scientific showdowns in a \u2018wild west\u2019 of research

Katherine E Smith,Heide Weishaar,Shona Hilton,Theresa Ikegwuonu

doi:10.1186/s12889-021-10396-6

Abstract

BackgroundAgainst a backdrop of declining tobacco use, e-cigarette markets are growing. The UK now has a higher percentage of e-cigarette users than any other European country. These developments have prompted fierce discussions in scientific, advocacy and policy communities about how best to respond. This article is one of the first to examine the role of evidence in these debates.MethodsWe analysed 121 submissions to two Scottish policy consultations on e-cigarettes (in 2014 and 2015) and undertook interviews with 26 key informants in 2015–2016, following up with a sub-set in 2019–2020. All data were thematically coded, and our analysis was informed by insights from policy studies and the sociology of science.ResultsFirst, we affirm previous research in suggesting that e-cigarettes appeared to have triggered a breakdown of old public health alliances. Second, we demonstrate that, amid concerns about research quality and quantity, actors are guided by normative outlooks (and/or economic interests) in their assessments of evidence. Third, we show that, despite describing e-cigarette debates as contentious and polarised, actors engaging in Scottish policy debates exhibit a spectrum of views, with most interviewees occupying an uncertain ‘middle ground’ that is responsive to new evidence. Fourth, we suggest that the perceived divisiveness of e-cigarette debates is attributed to recurrent media simplifications and tensions arising from the behaviours of some actors with settled positions working to promote particular policy responses (including by strategically enrolling supportive evidence). Fifth, we argue that the actions of these actors are potentially explained by the prospect that e-cigarettes could usher in a new tobacco ‘policy paradigm’. Finally, we show how scientific authority is employed as a tool within these debates.ConclusionsE-cigarette debates are likely to reconcile only if a clear majority of participants in the uncertain ‘middle ground’ settle on a more fixed position. Our results suggest that many participants in Scottish e-cigarette debates occupy this ‘middle ground’ and express concerns that can be empirically assessed, implying evidence has the potential to play a more important role in settling e-cigarette debates than previous research suggests.

Highlights

Against a backdrop of declining tobacco use, e-cigarette markets are growing
Caught in the crossfire and forced to choose sides Since our analysis suggests that many of the actors engaging in Scottish policy debates about e-cigarettes occupy a fluid and uncertain ‘middle ground’ (Fig. 2), this raises questions as to why our interviewees ([and others: [15]) describe e-cigarette debates in the UK as so divisive and antagonistic
Our data suggest that the emergence of e-cigarettes in the UK has contributed to a fracturing of a long-standing public health alliance [18, 19, 27] in ways that imply the actors involved held distinct values and beliefs, which are being illuminated via the new questions, opportunities and challenges that e-cigarettes throw up

Summary

Introduction

Against a backdrop of declining tobacco use, e-cigarette markets are growing. The UK has a higher percentage of e-cigarette users than any other European country. While Public Health England has promoted the relative safety of e-cigarettes (compared to conventional smoking), supporting calls for relaxed regulation [5, 6]), the US has taken a more restrictive approach [7], banning most flavours from 1st February 2020 [8], while Australia and some US cities and states have opted to ban their sale entirely [9, 10] It is policymakers who are divided: key charities involved in battling the tobacco epidemic have come down on different sides of e-cigarette regulatory debates [11]; media coverage suggests key actors promote opposing messages [12]; and public health advocates, once allies in the fight to reduce smoking, find themselves on opposing ‘sides’ [13]. Since a more divided tobacco control movement has long been an aim of transnational tobacco companies [16], it is crucial to understand how and why this fragmentation has occurred

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Discussion

Conclusion