When it comes to e-cigs, harm reduction must be the order of the day
But surprisingly, when we look around the world – we see countless examples of health authorities doing their best to obstruct the manufacture and sale of e-cigarettes.
In May, the European Commission approved a new directive to reclassify e-cigarettes as tobacco products for tax purposes. This move, when implemented, will drastically increase the cost of the device and further hinder its take up.
And this November, there is a considerable risk that the WHO’s forthcoming Conference of the Parties in New Delhi will endorse similar taxation of e-cigarettes. A previous report from the WHO has recommended this approach.
The economic justification for this is dubious. Sure: if, for some reason, we had a ‘Carrot Tax’, and if a new product containing carrots were launched today, then you could argue that for the sake of consistency, that product should be subject to the Carrot Tax as well. But then, the whole justification for singling out tobacco (and not carrots) for a special excise tax rests on the fact that smoking is associated with health risks, and on the idea that the tax system should have a role to play in deterring unhealthy lifestyle choices. Within that logic – whether we agree with it or not – how can you then justify applying the same tax to what is effectively a smoking cessation tool (and a successful one, it would seem)?
Such proposals show a complete disregard for harm reduction principles – and simple common sense. Many smokers are unable – or at least unwilling – to abstain from tobacco and nicotine altogether, and will continue to smoke in the face of impending adverse health consequences. In effect, the status quo has, until recently, presented smokers with two difficult alternatives: quit, or suffer the harmful effects of continued smoking.
But, thanks to devices like electronic cigarettes, there is a third way for smokers: tobacco harm reduction.
As the popularity of tobacco-free nicotine alternatives has grown, even Big Tobacco has followed the money and moved into the harm reduction space. British American Tobacco (BAT) has launched a vaping product. And PMI has invested over $2 billion into a new form of heat-not-burn smoking device which they claim removes “90% of a normal cigarette’s toxicity.” Sure, they would say that – but the claim is not irreconcilable with more general estimates from Public Health England.
Over the last couple of decades, a widespread exodus of smokers has taken place across the developed world – hastened in recent years by the growing popularity of vaping. In response, big tobacco brands like PMI have been forced to re-evaluate their market position, and have found harm reduction to be surprisingly compatible with business growth.
Previous studies suggest that using an e-cigarette can increase the chances of quitting by up to 50 per cent compared with using no support or one of the traditional nicotine products such as skin patches or chewing gum.
Part of the reason for this is that neither patches nor gum account for one of the key reasons why people enjoy cigarettes – for the ritualistic, social aspect of smoking. E-cigarettes replicate the act of smoking, and can be enjoyed in social environments; this is what gives vaping its edge as a long-term cessation aid.
As a result of this social aspect, a new type of smoker has emerged – the eternal vaper. These are long-term tobacco users who’ve made the switch to e-cigarettes, and might never return to smoking tobacco again.
This still causes many health bodies concern, as the eternal vaper may never plan to give up vaping altogether. But it is the smoke and harmful chemicals in cigarettes – not nicotine – that harms and kills smokers. Although it’s extremely addictive, nicotine is widely considered to be no more harmful than caffeine. This is an obvious point, but one that’s worth repeating.
In an ideal world, the best choice from a health perspective would be abstinence from vaping AND smoking. The next best thing, however, is reducing the damage via tobacco-substitutes which are massively less harmful than the real thing.
Smokers who are reluctant to quit, or find it too difficult to do so, should have access to treatments that keep them away from smoke and cigarettes. If that means they remain on nicotine replacements long-term, then health authorities should be comfortable with that.
By clamping down too harshly on radically safer alternatives like e-cigarettes, bodies like the WHO and EU Commission risk ushering in a new public health crisis – of their own making.