E-cigarette Questions & Answers: The Facts - part four

1. A health organisation has said ‘we just don’t know what’s in e cigarettes’ – do we really know so little?

 The product has been on the market since 2008, and it’s now 2016. So what have the health service been doing all this time? In fact there is quite a lot of evidence about electronic cigarettes, if they bothered to look and to have an open mind. Igor Burstyn claims that exposure to vapers from contaminants in electronic cigarettes currently does not warrant a concern. However, none of this is to say that some regulation isn’t justified to create good basic standards and to improve consumer confidence. The trouble is that many of those saying they don’t know, actually don’t want to know. They want ignorance to be the basis of fear and fear to be the basis of coercive policies.

Burstuyn, I., 2014. Peering through the mist. 


2. Shouldn’t people who want to quit smoking use licensed smoking cessation medicines like NRT?

NRT may help some people, but what if other people don’t want to quit nicotine or choose not to use NRT or other medications? E-cigarette use isn’t about quitting it’s about continuing – in this case continuing to use the legal recreational drug nicotine – in a way that is very much less hazardous to health.  The correct comparator is smoking, not NRT. We should remember that snus has huge benefits in Sweden without ever being approved or highly regulated by anyone – it works so well because it substitutes for smoking. Regulating these products as medicines would kill them off – effectively raising costs, crushing innovation, killing the buzz and dramatically reducing the range of products available.  The main effect of medicine regulation would be to destroy most of the industry, leaving what’s left to the deep pockets of the tobacco industry. There is also evidence to suggest that people using e-cigarettes have more success at quitting than people using NRT – so why would an ethically sound health professional recommend the less effective option?


3. Shouldn’t we just ban vaping indoors as we have done with smoking?

No, unless and until there is evidence of harm, it is not appropriate to use the coercive powers of the law. If someone wants to open a bar that welcomes vapers then the only reason for the law to stop them is if someone else is harmed – or at least there is no prospect of a material risk.  The law shouldn’t be used to regulate consumer choice, good taste, aromas, and aesthetics. The idea that it can hide vaping from view is absurd – people will be outside a building rather than inside.  Owners and operators should make the decisions as they are best placed to weigh different social, economic and wellbeing issues.  Note that allowing vaping can have health benefits: it may encourage smokers to switch and prevent vapers relapsing to smoking. It adds to the value proposition of e-cigarettes, relative to smoking.


4. E-cigarette advertising is targeted at children and should be banned

No it isn’t – and it is a huge evidence-free defamatory accusation to assert that manufacturers are targeting kids. No manufacturer is targeting kids (and if they are they have been a miserable failure, given how few kids vape!) for two main reasons: (1) they’d be suicidally stupid to try it; (2) they have absolutely no need to incur the vast reputational risks involved – the world tobacco market is $700-800 billion, vapour products so far have less than 1% of that.  Their value proposition is strongest for existing smokers who want a change or have growing concerns about their own smoking. Tobacco advertising is banned in the EU because smoking kills over 500,000 people annually in the EU – no such justification can be made for e-cigarettes.  In fact, it is much more likely that e-cigarettes will have a negative death toll – a protective effect on smokers. Advertising is critical in the e-cigarette world and much of it is powerful persuasion against smoking: it is necessary to communicate with smokers; to incentivise, communicate and reward innovation; to build trusted brands; to create buzz… all of this helps to bring smokers over to vaping.

It is possible that some non-smokers may be persuaded to vape or ex-smokers decide to take it up – it would be foolish to claim this is impossible. That creates very little health risk in itself and has to be set against potential huge health benefits to smokers who switch. There are no real absolutes – it’s a matter of being proportionate about risks and benefits.

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