For non-smokers, the research is becoming increasingly clear that E-cigarettes can cause harm to their health. My own research funded by a grant from the Royal Adelaide Hospital has shown that even the flavouring components can be harmful to lung cells, but so too can nicotine delivered by an E-cigarette. It is for smokers and ex-smokers that the picture is blurry.

The current research certainly suggests that E-cigarettes are less harmful than tobacco cigarettes, but it’s important to remember that almost all these studies have been performed on healthy non-smoker lung cells, not current smoker and ex-smoker cells. These cells are already compromised by current and previous smoking.

We also don’t know if there are new health problems that can arise from using both E-cigarettes and tobacco cigarettes, or if they interact for a possibly worse effect in dual users. Furthermore, researchers have started by looking at the known effects of cigarettes, but evidence is starting to appear that we need to look at other effects beyond cigarette harms, to ensure that E-cigarettes aren’t causing a whole new range of harms via different biological pathways to cigarettes.

These studies are only just now starting to be done, and of course, we don’t know the health consequences of long term use of E-cigarettes. Without all of this information no one should be making definitive statements about how much safer E-cigarettes might be.

It is important that large government funding bodies like NHMRC fund more research into E-cigarette effects on health, not just a review into the research, with only one study currently funded. Currently the funding in Australia for research into the effects of E-cigarettes on health is mostly through smaller philanthropic funds, despite almost everyone agreeing more research is needed.

If, after more research free of conflicts of interest, the data concludes that E-cigarettes are able help smokers quit, then it’s important that research is done and regulations are put in place to ensure that any products available are the safest they can be to users and those around them and that they actually lead to quitting, not just switching.

The recommendations of the majority report are hugely welcome. E-cigarettes have been in widespread use in a handful of nations for only a few years, yet vaping advocates are claiming we know they are almost harmless.

If someone had held up a global megaphone 10 or even 20 years after cheap factory-made cigarettes saw smoking skyrocket at the beginning of last century screaming “smoking is harmless” history would have judged them reckless fools. We need to be wary of reckless fools with regulating e-cigarettes.
 
E-cigarettes could be a benign or an evil genie. Everyone knows that genies are notoriously difficult to put back in the bottle. This is why sane public health policy should treat e-cigarettes with utmost regulatory caution until we know enough about their long term risks and benefits.

All but failed states do this routinely with new pharmaceuticals: strict regulation at first, followed – if warranted – by relaxed regulation down the track. But with proper regulation, there’s always the opportunity to withdraw the products if bad news comes in. Current government policy and the majority report have it exactly right.
 
If someone with a kitchen lab came along saying 'my new potion will cure cancer or AIDS so cut the red tape and get out of my way', we’d tell them to go and show their evidence to the Therapeutic Goods Administration who are vastly experienced in dealing with shonks.

It speaks volumes that e-cigarette companies think they are above  a system that every other player has had to use since the thalidomide scandal.

Overall, in my opinion, the report is a balanced, well-researched and considered document, which considers all sides of the debate and much of the science. The findings and recommendations can be summarised as: simplifying, streamlining and improving the uniformity of existing policy and legislative frameworks.

The recommendation to permit the sale of nicotine e-cigarettes (and e-liquids) would seem to be a sensible step towards removing the current black market trade and use of highly concentrated nicotine liquid to blend with over the counter e-liquids - which carries significant risks from inadvertent overdoses or poisoning.

The report highlights the need for increased fundamental research on the health effects of electronic cigarettes and e-liquid constituents. NHMRC projects such as “The health effects of electronic-cigarettes”, which I am an investigator on, seek to do this.

Not mentioned in the report is the importance of the carrier liquids, glycerol or propylene glycol, which have been found to have differential health effects in our preliminary work ( https://doi.org/10.1152/ajplung.00203.2016). The possibility of chronic allergic or other effects from these carrier liquids also exists.

The committee should be commended for upholding the integrity of the TGA and the NHMRC, two of Australia’s independent statutory health bodies, which will help to ensure that the evidence rather than lobbying and misinformation underpin public health policy in Australia.
 
We also commend the Minister for Health, Greg Hunt, and assistant minister Bridget McKenzie, for their recent public comments also supporting the TGA and the NHMRC over lobbying. The TGA and NHMRC are pillars of our health system. They are there to help protect against arbitrary decisions.

Once we start circumventing them and deferring to lobbyists, whether from industry, ideologues or individual advocates, cracks will appear in the system. Cancer Council is involved in the scientific review of e-cigarettes and we are doing so within the NHRMC research framework, as we should.
 
As Deputy Chair and Opposition committee member Steve Georgana has highlighted in his additional comments, there is an ever-present risk of tobacco industry lobbying around e-cigarettes. Australia has an obligation under the WHO’s Framework Convention On Tobacco Control to mitigate against its influence.

Australia has a long history of working towards complete tobacco reduction and whether e-cigarettes will contribute to or detract from this goal is a matter of controversy. Although there is evidence to suggest that e-cigarettes contain less toxic compounds than traditional tobacco cigarettes, it is clear that e-cigarettes contain considerable levels of toxic compounds.

Unfortunately we cannot make an evidence-based decision as to whether e-cigarettes will lead to a small or large reduction in risk. In light of this uncertainty, it is reassuring to see that the recent Inquiry into the legalisation of e-cigarettes containing nicotine in Australia recommended an independent review of the current evidence by the NHMRC and an ongoing evaluation of the evidence every two years.

In contrast, Mr Zimmerman, Chair of the committee, has authored a dissenting report in which he recommends that 'nicotine used for E-cigarettes be made exempt from Schedule 7 of the Poisons Standard'. In contrast, his recommendation as to the restriction of flavour additives lacks a similar level of conviction.

Evidence from the United States suggests that e-cigarettes containing flavour additives are preferred by the majority of adolescents and minimising their inclusion is likely an important component of reducing youth uptake.

Furthermore, a large body of evidence now demonstrates the high toxicity of many flavour additives while there is little suggestion that they contribute to the potential for e-cigarettes to reduce tobacco smoking.