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E-cigarettes far less harmful than cigarettes, says Lancet researcher at INFORMS Conference

A London School of Economics researcher examining the public and private dangers of drugs argues against demonizing e-cigarettes in a presentation being given at a conference of the Institute for Operations Research and the Management Sciences (INFORMS). He also calls on public officials to recognize that alcohol causes greater harm than other recreational drugs and more public attention should be paid to controlling its harmful effects.

Lawrence D. Phillips, an emeritus professor at the London School of Economics, will present his research group's findings about the relative risks of different drugs at Advances in Decision Analysis, a conference sponsored by the INFORMS Decision Analysis Society (DAS). The conference takes place June 16-18 at Georgetown University in Washington, DC.

A recent workshop facilitated by Prof. Phillips led a group of researchers to write a letter to the World Health Organization advocating against the classification of e-cigarettes as tobacco. They argued that e-cigarettes should be classified as a device for fighting nicotine addiction. . " It is well known that 'people smoke for the nicotine, but die from the smoke'," he says.

In his upcoming presentation, Prof. Philips draws on a study about drugs in the United Kingdom he co-authored in 2010 that was published in The Lancet. "Drug Harms in the UK: A Multi-Criteria Analysis" has lessons that can be applied in the U.S. and across the world, he says.

The 2010 results are based on an expert panel that was called upon to use participants' judgment to assess the relative harm of 20 different drugs. Because the drugs are illegal and data is extremely difficult to obtain, the participants relied on their collective knowledge and experience to score the drugs and a decision analysis model to aggregate the judgments.

Similar results were obtained in 2013 among a group assessing drug risk in Europe. A .993 correlation between the two panels, which contained different sets of experts, is considered extremely high.

A 2013 expert panel about the relative harm of 12 nicotine products named cigarettes the most harmful but ranked e-cigarettes near the bottom, in ninth place. Prof. Phillips explores its results in his presentation at Georgetown University.

The various panels used decision analysis to determine psychological, physical and social harm to users and to those around them. Members of the United Kingdom's Independent Scientific Committee on Drugs scored 20 drugs on 16 criteria.

Decision analysis of the UK panel ratings showed that heroin, crack cocaine, and methamphetamine were the most harmful drugs to individuals (scoring 34, 37, and 32, respectively). Alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17).

Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Similar results were found when analyzing the continental Europe panel.

Several experts from the drug harm workshop, including The Lancet study's co-author David Nutt, the Edmund J Safra Professor of Neuropsychopharmacology and Head of the Department of Neuropsychopharmacology and Molecular Imaging at Imperial College London, have called on British and international health organizations like WHO to adjust their guidelines about dangerous drugs based on the findings.

In the 2010 paper, they write, "the present drug classification systems have little relation to the evidence of harm. They also accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy."

Prof. Phillips notes the important role of judgment in quantitative models, particularly when there is limited data available, as was the case for these panels. The 20 drugs rated in the studies were alcohol, amphetamines, anabolic steroids, benzodiazepines, buprenorphine, butane, cannabis, cocaine, crack, Ecstasy, GHB, heroin, ketamine, khat, LST, mephedrone, methadone, methamphetamine, mushrooms, and tobacco.

The combined research shows the important role for judgment in quantitative models, particularly when there is very little data available, as in research about illegal drugs. The decision science techniques provided new tools to reevaluate common perceptions and laws governing hazardous drugs.

Contact: Barry List
Institute for Operations Research and the Management Sciences

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