Harm reducers hit back against WHO e-cigarette denormalisation

Various outlets are reporting research by University College London indicating that for every million smokers who switch to electronic cigarette, 6,000 lives per year can be saved. This follows WHO advice that vaping indoors in public places should be banned in order to maintain the culture war against smoking.

Aside from some of the more breathless “gateway” arguments (illegal drug users do tend to smoke a lot but we shouldn’t conclude that illegal drugs are gateway drugs to tobacco), this debate seems to be about whether to embrace a major harm reduction opportunity, or whether to maintain at all costs a strategy of making smoking and the nicotine habit culturally unacceptable. The UCL study makes a useful contribution by estimating the benefits of harm reduction in terms of numbers of lives saved, and therefore the cost in human life and misery of the culture war.

Harm reduction as a guiding principle for policy on illegal drugs has been around for some time, and while it satisfies neither the libertarians or the prohibitionists, it does address itself to the welfare of users. Opportunities for tobacco harm reduction have existed before. In Sweden a smokeless tobacco product called snus enjoys the rare distinction of being banned throughout the rest of the EU in defiance of the principle of the single market. Snus use is of course much less harmful than smoking.

There is some common ground. Electronic cigarettes should not be available to minors, and advertising should be restricted. There is no need for the highly visible and highly tacky cigarette-themed advertising we see on the high street. The Tobacco Products Directive agreed by the EU earlier this year deals with these points.

The ban on vaping in public places is a thornier question. While there are no plans for doing this in England, there are in Wales. But with vaping being a smokeless and (generally) odourless process, how can you tell if somebody is doing it? Where vapers have given up nicotine by progressively reducing the strength of their eliquid to nil, are they still banned from inhaling nicotine-free vapour? And there is no reason an e-cig can’t be made to look like an inhaler. Do you inspect every asthmatic’s inhaler? What about nicotine inhalers that are approved and regulated as medicines for people giving up smoking?

Yes you see very visible vaping sometimes, but you aren’t seeing half of it. There is a problem here in regulating what is potentially, even in a public space, a very private act that affects nobody else. The sort of act that shouldn’t be regulated at all.

* Joe Otten was the candidate for Sheffield Heeley in June 2017 and Doncaster North in December 2019 and is a councillor in Sheffield.

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  • I suggest you educate yourself on e-Cigarettes: http://circ.ahajournals.org/content/129/19/1972 – it is NOT the case that e-cigarettes don’t have a second hand effect in enclosed spaces. That effect is much more mild than the stench and carcinogen rich exhalations of conventional cigarettes but neither is it completely absent.

  • Jack. Don’t throw stats around without knowing what they mean. Ok so I’ll quote a bigger less biased source than the American heart association. There is NO risk from the second hand vape. http://www.biomedcentral.com/1471-2458/14/18

  • There was a good piece on this in the Radio4 7~8am news slot.

    There are a number of things being conflated here, firstly there is the action of smoking something cigarette like and hence being able to readily determine the difference between a real cigarette and a substitute. This is important if we are to enforce no smoking policies, both from an active enforcement viewpoint and from a passive user viewpoint – can a smoker determine whether the person across the room is smoking or vaping and therefore decide whether it is okay to light-up? (years back I found that simply removing the ash trays was sufficient to stop many people from lighting up although some only noticed the absence when they came to discard the match or ash).

    The second is the emissions, which with e-cigarettes are orders of magnitude lower than with tobacco cigarettes. In fact I suspect the levels of emissions are probably lower than those from a fly spray, air fresher or perfume vaporiser. As for the carcinogen’s, well walking down the typical city street these days and you’ll probably breathe in more carcinogens than are emitted from an e-cigarette.

  • A reasonable article. However, the problem is that there is no significant regulation of e-cigs AT PRESENT. We are debating theoretical restrictions while my local vape shop is handing out free samples of an extremely addictive drug (and all addiction carries costs) and targeting children, all within the law.

    Some political focus on immediate legislation to regulate this sector is needed, rather than interminable theoretical debates taking place with a relative paucity of evidence (although this will increase in time) preventing clear conclusions.

  • There is only one thing to consider here. Do you want to support a product that could obliterate tobacco for good and help save millions of lives, or do you want to throw that product away and just keep people smoking and at the same time help support big tobacco and big pharma who both have massive interests in seeing this happen. I can’t think of any other industry where there would even be this debate. If you had a product that was cheap that you could add to a car that would save 50000 lives a year do you think we’d be discussing this?

  • Oh and g. Of course it should only be sold to over 18’s. No one is arguing otherwise.

  • Miles, it should only be sold to over 18’s. I agree. It’s not though. There are currently no meaningful restrictions on sellers, and people would rather debate obtuse questions of liberty than actually regulate to protect children and non-smokers from addiction.

  • The argument is that the success that we have seen in reducing smoking is by marginalising the behaviour of addiction. Very little else has had much effect. If nicotine inhalers are allowed to be normalised, we can expect to see an increase in addiction.

    My personel view is that addiction is fundamentally illiberal in that it enslaves people to their suppliers, and do not see that it is liberal to provide the space in which addiction can flourish. As a mechanism for weaning addicts out of their addiction e-cigarettes have a role, but I cannot support their use as a means of maintaining addiction.

  • Martin. People are addicted to coffee. People are addicted to sex. People are addicted to sleep to exercise to food to all sorts. It’s a fact of life and is a liberal a choice as you can make. Please remember we are not talking tobacco addiction here. It’s purely nicotine which is actually very similar to caffeine and has almost no impact on your health. As I mentioned previously you either support saving 50000 lives a year or you’re quite happy for tobacco to continue un abated.

  • Miles, Have you considered the possibility that having got addicted to nicotine people may switch to cigarettes to get their nicotine hit? One in every two cigarette addicts die from smoking cigarettes.

  • Miles, comparing caffeine and nicotine is just daft. The latter is far more physiologically addictive, and actually has harmful health effects at typical doses, if less than those of tobacco smoke, whereas caffeine may be beneficial at typical doses, and, at worse, has limited harms.

  • Hi john. This is a tired argument. 1. Do you really think that once someone has tried an e cig that costs 2 pounds, tastes nice, doesn’t smell, and won’t kill them they’d opt for a horrific tasting bunt product that costs £10? 2 ASH the leading health anti tobacco group in the uk have published the actual scientific evidence that busts this myth. There is no evidence that non smokers have converted to tobacco through e cigarettes. http://ash.org.uk/files/documents/ASH_715.pdf

    If you need further evidence please also read this blog. http://antithrlies.com/2014/09/04/kandel-kandel-and-nejm/

    So many people use non scientific evidence and gut reaction to comment. Please read the evidence first rather than trusting the daily mail.

    Finally Martin please tell me you’d rather save 50k lives a year than support the subversive hidden agenda reported in the press that support tobacco companies by spreading false non scientific information about this subject.

  • Miles, I assume you do not know me or what my job was before I retired three years ago. I think I may have read more evidence than you have had hot dinners. But I do not know you either and maybe you just have a preference for cold food.

    I merely asked if you has considered the possibility that people would switch to cigarettes having become addicted to nicotine. You then went into overdrive of dismissive overstatement which would have made Big Tobacco proud.

    But maybe you work for Big Tobacco and hence you do not post under your full name or even your real name?

  • G. Actually caffeine and nicotine are both from the same alkaloid family and are remarkably similar. http://osozo.com/caffeine-and-nicotine-more-similarities-than-differences/

  • John. The point is I’m massively against tobacco which Is why I’m trying to do whatever I can to help the cause Big tobacco are scared out if their minds about ecigs and I want to help us rid the world of it and save lives. I’m iterate because people are being side tracked and not reading the evidence. And miles is my name.

  • *irate not iterate

  • I am always highly suspicious when anyone seems to be trying to belittle the addictive potency of nicotine (or other drugs in the same category such as opiates). Perhaps I should have specified physiological tolerance rather than addiction, a word that is sometimes used in much looser contexts.

    As for saving thousands of lives, I am highly impressed by the success that social marginalisation has had on smoking rates. Anything that compromises this would risk putting the brakes on this welcome trend and thereby put lives at risk. Smoking any half oxidised material is bound to increase the risk of cancers to the respiratory system. Nonetheless, the physiological effects of nicotine on the vascular system and increased risks of heart disease and other circulatory problems are well attested. Use of nicotine inhalers to maintain rather than reduce dependency are likely, for this is how dependency works, to result in increased nicotine intake and concomitant increased cardiovascular dis ease.

  • You’ve got to stop thinking of vaping as smoking. This is the best chance we ever have of getting rid if tobacco for ever and putting smoking in the history books. By continuing arguments based on no science people are inadvertently supporting big tobacco. Please all open your minds and read the science not have knee jerk sentimental or hunch based theories and help save lives.

  • Martin, what a daft thing to say. You are opposed to e cigarettes because they allow people yo voluntarily continue low risk addiction. Presumably then you want to ban caffeine, alcohol, white refined sugar and all the more harmful addictive substances?

  • Nicotine is highly addictive, it rapidly induces tolerance, so nothing like sugar, caffeine and even alcohol and not low risk.

  • Martin. Alcohol is addictive. As is caffeine. http://bit.ly/1tzgz6t

  • >Have you considered the possibility that having got addicted to nicotine people may switch to cigarettes to get their nicotine hit?

    My understanding is as yet there is no evidence to support this highly plausible hypothesis, mainly because e-cigarettes are so new. The informed opinion being that at present people are moving off cigarettes and on to e-cigarettes; there is little evidence (as yet) of non-smokers taking up e-cigarettes (another highly plausible hypothesis). Additionally, my understanding is that researchers will be monitoring both of these effects in the coming years.

    Although we don’t know if e-cigarettes have any unforeseen long term effects, with the massive reduction in adverse effects on both smokers and bystanders (compared to tobacco smoking), I find myself in agreement with Miles and others that we should support the introduction of e-cigarettes but continue to careful control their advertising and sales.

  • Miles, can you remind me what percentage of electronic cigarette companies owned by Big Tobacco?

    Why exactly would they be “scared out of their minds” of their own product?

    I assume you are not a Brazilian footballer and Miles is not your full name?

  • Many people would understand the difference between highly addictive and not so addictive, but obviously not everybody. Admittedly, the concept of physiological tolerance is a bit more specialised, but measurable, which means that the difference is not exactly a matter of opinion.

  • John. They’re behind the curve. Please research this more. Big tobacco own the cig a likes because they’re desperate to try and continue and they fear decline. Their product is a single use cig lookalike. Gen 2 of refillable devices are now more prominent in the market as ex smokers want to distance themselves from tobacco. 70% of the market is small independent manufacturers. Please read this blog by clive bates ex DECC, Wales, the UN, Environment Agency, Cabinet Office, ASH, Greenpeace, & IBM. http://www.clivebates.com and read the report from anti smoking lobby ASH that I pasted earlier. By encouraging vaping we are helping thousands of smokers not to die. Not a bad thing to wish for?

  • Miles,
    Your repeated suggestions that you have done lots of research and others have not might get tiresome.
    There is unfortunately no consensus on e-cigarettes and their potential impact as Clive Bates’ blog makes only too clear.
    I am old enough to remember Clive Bates time at ASH. He did some excellent work. The official ASH line today is pro e-cigarettes. But that doesn’t make them, or Clive or you right!

    Can you tell me where in your extensive research you came across this statement – “70% of the market is small independent manufacturers.”. You seem to believe it to be true.

  • Hi john. Scary! I had that earlier on a reply. My name is Miles Eames, I was a lib dem activist in south London. Currently disillusioned with lib dems. Pro electronic democracy and anti old school politics. I want change in politics as it’s an old boys club that has no relation or meaning to young people. I was a 20 a day smoker for 20 years and I quit through e cigs almost 1 year ago. I hated my addiction and I can’t bear people commenting without any knowledge or experience of what the issues are or what the actual evidence is. That’s why young people hate politics. They get an unreal picture from a sound bite press (I am an ex bbc journalist) and they don’t care about politicking. I have no interest in tobacco other than I hate them as they we’re killing me. E cigs have saved my life and they could save many many more. If people could put away a long prejudice and understand that vape and smoke interests are totally opposite we could save thousands of lives.

  • John. Just saw your last comment. There is one fact here. E cigarettes are safer than cigarettes. To not help smokers move to them is irresponsible and sentencing them to death.

  • John. The USA is leading the market at the moment. 70% is approx USA indies right now. http://blog.thunderheadvapor.com/post/94034090859/independent-electronic-cigarette-companies-on-the-rise. Tobacco companies are buying up companies as they are desperate as I said and are late to the game. That said. Who better to beat the tobacco companies than themselves?

  • John. Btw. Miles would be a good name for a Brazilian footballer! Sadly I’m neither Brazilian and have a bad left foot 🙂

  • I’m an ecig user, I’ve never bought an ecig from a tobacco company BTW but that not why I’ve signed in. I hope I’ve something to add to this important debate:

    Many ecig users (myself included), would welcome decent, evidence-based and proportionate regulation. We want to be reasonably confident that our eliquids don’t contain diacetyl for instance. Why we’re up in arms is that there has been a campaign (off the back of Pharma lobbying – this is in the public record) to disproportionately restrict the availability of the ecigs that work, re Article 20 of the TPD. We’re all people who used to smoke and who know that ecigs are a better nicotine delivery system. Non-smokers have (I think) to separate the nicotine from the tobacco. Is it ok for me to take nicotine?

    If you can accept that, then you shouldn’t (I think) have a problem with ecigs.

  • The emphasis in this debate should focus on harm reduction. Swivelling the spotlight away from harm reduction to the rights and wrongs of nicotine use is entirely counter productive.

    The evidence to date demonstrates that ecigarettes are less risky than smoking regular tobacco. There is no indication from the evidence so far of gateway or re normalisation of smoking via use of ecigarettes. The evidence equally does not show any significant health risks of passive vapour inhalation.

    So, it makes abundant sense in health terms to encourage the switch. The most dangerous course of action would be to continue this denigration of the benefits of switching which results in more desease and more early deaths.

  • Robert Heyes 6th Sep '14 - 1:30am

    John, the e-cigarettes that Big Tobacco are buying up are first generation or what is known as cig-alikes. These devices are around 18% of the market at the last count – in fact I can’t think of the last time I saw one being used in my area. Most vapers are using 2nd or 3rd generation devices (2nd looking a bit like pens, and 3rd looking like all kinds of things, mostly a big metal tube). There are still a lot of independent manufacturers of 1st gen devices in the UK, so big tobacco’s penetration into the market is probably less than 5%.

    Committed vapers such as many of those who comment in places like this do read the research, believe me. Including the research on nicotine and many of us have contributed money to fund research into the flavourings used in e-liquids. Nicotine outwith tobacco smoke is far less addictive than is generally believed. Medical experiments using nicotine patches to treat cognitive disorders found no addiction in the subjects – can’t find the reference at present I’m afraid, but if you have access to online clinical journals then maybe look for “Dr. Paul Newhouse, the director of Vanderbilt University Center for Cognitive Medicine”
    It seems likely that smoking is addictive because of Monoamine Oxidase Inhibitors in tobacco.

    Addictiion to nicotine – or more correctly, dependence, is a bit of a red herring however, that is so often trotted out by ‘public health’ . There are very few downsides to use of nicotine in itself, NICE has recommended the long-term use of NRT to keep people from returning to smoking, since it’s a remarkably safe drug, with fewer deleterious side effects than practically all medicinal drugs.

    One reason that tobacco control don’t like e-cigarettes is that we are seen to be having our cake and eating it too. E-cigarettes, or, more properly, personal vapourisers are used for pleasure, as well as smoking cessation.

    One small statistic for you – there are an estimated 2.2M vapers in the UK, of whom 700k have stopped using lit tobacco completely (Smoking Toolkit Study). Most of those people will have switched in the last 3 years at no cost to the NHS. The Stop Smoking Service (quoted as the Jewel in the Crown of the NHS), helped 147k of smokers to quit.
    The definition of quitting is, I believe, not using lit tobacco after 4 weeks (although it’s a while since I read the figures), it may have been 6 month or even a year, but I don’t think they have the resources to check up on people after a year has elapsed. That’s over a 10 year period. And the cost? £840M. That’s nearly £6000 per smoker, many of whom have almost certainly relapsed.

  • I switched to ecigs nearly 5 years ago and having been following the debate and reading the research ever since.It is the lived experience of users,supporting by the THR supporters versus the established principles of the Tobacco Control movement which refuses to countenance tobacco,nicotine(unless medicinal) or TI.

    There are numerous paradoxes – how can nicotine be both good(NRT) and bad(cigs/ecigs).Permanent NRT use as an alternative is now condoned by NICE.Is nicotine really addictive – I offer this critique http://www.gwern.net/docs/nicotine/2002-frenkdar.pdf which has never been addressed.This analysis was referred to by Imperial tobacco in the McTear case – the judge found that the addictiveness of nicotine was not proven.

    Imagine the difficulty in mapping orbits if you assume Earth at the centre!

    Also consider the case of snus – Swedish smokeless tobacco treated to remove the majority of harmful substances.Over 20% of Swedish males use snus whilst less than 15% of them smoke.Their smoking related disease figures reflect their smoking rate,not their overall nicotine use but still the recent TPD revision maintained the ban throughout the rest of the EU.

    One final thought – prevalence in UK had been falling steadily up to 2007 when the annual ONS survey showed 21% adult smoking.It remained there in 2008 and 2009 before falling to 20% in 2010 where it stayed for 2011 and 2012.These data are of course never highlighted as evidence of a potential failure of policy – we just pretend we are on a continuing downward trajectory and each new policy initiative will accelerate the decline.It’s another lie – or dangerously wishful thinking if you want to be kind

  • Miles 5th Sep ’14 – 11:30pm
    Hi john. Scary! I had that earlier on a reply. My name is Miles Eames, I was a lib dem activist in south London. Currently disillusioned with lib dems.

    Miles (Miles Eames) thank you for being so honest and well done on being free of cigarettes for a year! As you have been so honest I should perhaps return the favour. Most people in LDV who know me will know that I am a former councillor, leader of the council of a London Borough. Most do not know what my daytime job was. I was a civil servant and even though now retired I try to be discrete about my former job. For the last twelve years of my career my job was tobacco policy including e-cigs. Now I am retired my views and opinions are my own but they are of course informed by what I learned from the research that I read, the meetings I was involved in and the expert advice that I listened to over twelve years. Suffice it to say that my personal opinion of e-cigs and snus and the claims made for both are sceptical.

    I will not post anything more in this thread.

  • As a non smoker I have thoroughly enjoyed the atmosphere in pubs and restaurants following the cigarette ban. Until manufacturers make the vapour from e-cigarettes colourless I happy for them to be banned in public places as well.

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