Use e-cigs in the fight against tobacco, says former ASH director

My attitude to the smoking ban is unchanged: I still believe it is step too far, especially when since it was based on a phenomenon (secondary smoke) that I regard as highly speculative.

But I am now interested in the e-cigarette issue. There can be little doubt that e-cigs are the bastard child of the two warring parents: tobacco and tobacco control. The child has now taken on its own identity and has many of its own friends. Had tobacco control not come along, e-cigs would not, so to speak, have been conceived at the time that they were. Not only have they satisfied the demand of an alternative to smokers that is acceptable on health grounds – no tar is inhaled into the lungs, but they have done so by avoiding the much feared smoke that is a product of smoking tobacco.

Tobacco control can huff and puff but a paternity test would probably prove my suggestion that the e-cig is its own doing. Legitimate health concerns followed by a virulent campaign against smoking (that continues even now) have provided the incentive to produce a product that smokers can enjoy without bothering anyone else.

Committed smokers fear that the e-cigarette will be 'forced' on them and I hope that they are mistaken. I would still like to see the smoking ban rescinded. But the reason e-cigs are interesting to me is that they are an effective alternative to smoking, meaning that we don't really need tobacco control any more. Action on Smoking and Health has a mission to fight 'the harm caused by tobacco', and, with e-cigs, much of the problem is resolved.

Among the good things that former director of Action on Smoking and Health Clive Bates says in this piece (a Rapid Response to the piece discussed here) is that he scolds tobacco control for its inveterate hostility to tobacco companies:

Negativity about the tobacco industry is inevitable and appropriate, but there has long been scope for a different business model to emerge [8]. Many in the public health community regard the industry as, a priori, capable only of causing harm as they strive to make money [9]. But this idea is not universally accepted, and there are different ways of looking at the role of tobacco companies when it comes to ‘harm reduction’ [10]. ... Big Tobacco is moving into e-cigarettes because it has to, not least because its customers may want nicotine, but increasingly they don’t want the smoke that goes with it. Meeting that changing demand happens to be a very positive one for public health, and it could ultimately change the tobacco industry itself for the better.[emphasis added]

I am not sure whether Big Tobacco is actually capable of becoming a significant player in the e-cig market, but the point is that Clive Bates (and many others) can see beyond the caricature of Big Tobacco as irrevocably and completely evil. Another dynamic is possible.

Tobacco control has allowed its hatred of tobacco companies to present a conflict of interest with its own health goals. Every time it declares a wish to destroy tobacco companies it takes its eye off the ball of public health improvement, preferring to focus its attention on winning a war, on destroying an industry. Is this a bid to improve public health, or more to gain market share for nicotine-based cessation medications?

I haven't seen smokers' groups forming themselves to discuss the merits of nicotine patches. This phenomenon has occurred with e-cigs: there is a market of people who are actively interested in the product, which has evolved to become affordable.

OK, perhaps I am daydreaming a little with the fantasy that e-cigs will finish off tobacco control. But if all it can now do is to try and frighten users away from e-cigarettes, what will it then achieve? 'The best thing you can do for your health is to stop smoking': this logic has to remain the purpose of tobacco control. It cannot now shift the goalposts and insist on the right to dictate to users how to stop smoking. That horse has left the stable and e-cig shops are everywhere.

It may be that tobacco control can survive by taking on the cause of e-cigs, but I am not sure how that would stack up financially. I am sure that some of their revenue stream must come through pharmaceuticals but I haven't figured out exactly how it works. I expect to see tobacco control continue to insist that patches 'n' Champix R best, digging itself deep into its own grave as it does so.