In this interview, Sheila Duffy, CEO of ASH Scotland and Michael Ryan, director of E-lites, the brand of electronic cigarette that is being advertised, go head to head. I don't envy Duffy, who is caught between a rock and hard place, and her position is hard to rationalise. Her loyalty is to tobacco control, which has a mission to reduce the smoking rate. Although e-cigarettes allow smokers to use nicotine without smoking, avoiding some of the alleged health effects of smoking, she is cautious about celebrating the advertising of e-cigarettes because using them mimics the act of smoking.
She also comments on the fact that e-cigarettes contain nicotine: however the ASH Scotland position on smoking cessation is: ASH Scotland believes all proven treatments which help smokers to quit should be freely available on the NHS in Scotland. One major treatment is nicotine replacement therapy, which the NHS supplies in Scotland as elsewhere, yet Duffy does not appear to object to the use of nicotine in NRT. Does she believe e-cigarettes should be free on the NHS?
Duffy is caught between the need to appear to respect people's choices and her dislike of what they choose. Countless people worldwide have stopped smoking – good – but done it using e-cigarettes. Perhaps not so good. She cannot come out and condemn e-cigarettes because they do provide an alternative for smokers and are supported by enthusiasts everywhere who have helped them to give up smoking. Her suspicion of e-cigarettes remains.
Michael Ryan, defending the advertisement of e-cigarettes, argues cogently against Sheila Duffy, rejecting out of hand that people will smoke because they see someone using an e-cigarette. He uses public health concerns about smoking to promote e-cigarettes, an entirely logical choice of marketing strategy in modern Scotland – it is a shame he has to repeat the '4000 carcinogens' story used by tobacco control to describe the content of tobacco smoke. No carcinogen found in tobacco smoke is unique to tobacco smoke and I believe the number of toxins in tobacco smoke that can be harmful to humans (if ingested in sufficient quantity) is fewer than ten.
I am not sold on the idea that mass smoking cessation would have a miraculous effect on public health, even if it could be enforced. What is true however is that millions of people have taken up e-cigarette use, either permanently as a means of quitting or for relief in environments that are hostile to smoking. E-cigarettes seem to be a growing market.
Unfortunately for Sheila Duffy, her methods of promoting smoking cessation have failed: twelve years of escalating smoking cessation and tobacco control expenditure have done nothing to hasten smoking cessation, which has actually slowed down.
Figures on tobacco control and smoking cessation expenditure obtained from FOI request from the Scottish Government, December 2012Number of smokers taken from Scottish Household Survey reports
Helping smokers to quit is a highly cost effective public health measure. ASH Scotland believes all proven treatments which help smokers to quit should be freely available on the NHS in Scotland.