The smoke and mirrors of vaping

A new report about the tobacco harm reduction potential of safer nicotine products (SNP) such as e-cigarettes tries to clear the air of lies, propaganda and misinformation confusing smokers and politicians alike. By Harry Shapiro

I have spent the last year writing and editing No Fire, No Smoke; the Global State of Tobacco Harm Reduction 2018 inspired by the work of Harm Reduction International who have been monitoring the global state of drug harm reduction biennially since 2006.

This is an entirely new world for me since I started work as the rapporteur for the Global Forum on Nicotine conference back in 2016. But I soon realised that the same challenges that faced and still do face drug harm reduction also present major challenges for tobacco harm reduction. Those who oppose drug harm reduction claim that such interventions encourage continued drug use or even stimulate initiation and at root are simply stalking horses for drug legalisation. Similarly, those who oppose tobacco harm reduction using SNP claim it is all a big con trick by Big Tobacco both to renormalise smoking among those who have quit and encourage young people via the infamous ‘gateway effect’ to take up regular smoking. Leading the charge against SNP is the World Health Organisation who once prohibited their staff from attending an international drug harm reduction conference being held up the road from their offices in Geneva. But if this is all a Big Tobacco conspiracy perhaps somebody would like to explain why, when the Federal Drug Administration recently announced a proposal to ban all e-cigarette flavours, shares in the major US tobacco companies took their biggest hike in years. In fact, there are many tobacco investors who would rather the companies just got back to doing what they do best which is killing half of their customers. And by the way, in value terms, the biggest share of the US e-cig market is dominated by an entirely independent company called JUUL.

But the crux of the whole matter is to tackle the global smoking epidemic. Every six seconds someone dies from a smoking-related disease – six million people a year (more than HIV, malaria and TB combined) – an estimated one billion deaths by the end of the century. Moreover, because of population growth, these figures could worsen, especially in low-and-middle-income countries. Even in western countries where smoking prevalence has been falling, it is the poorest and most marginalised that continue to smoke. In the UK, adult smoking prevalence is down to around 15%. But for those with drug, alcohol and mental health problems, you are looking at figures north of 60%. How many times have users said that giving up smoking is/was harder than giving up heroin? The reason of course is that nicotine is ‘addictive’, although the culture and rituals of smoking play a significant role in smoking ‘addiction’. But compared to the toxins released by lighting a cigarette, the nicotine should be the least of anybody’s worries unless perhaps they have a serious heart condition. What kills people is not the nicotine, but the crap in the smoke.

To my mind anyway addiction is habit plus harm, but if, as all the independent evidence shows, the harm is negligible, then all you are left with is the habit. Of course, many people have given up smoking on their own, while others have used nicotine replacement products like patches and gum. But NRT has a very high failure rate. And so the answer for those who for whatever reason really cannot quit the habit, is to at least switch away from the most harmful way possible of consuming nicotine.

The UK is a world leader in taking a proportionate and pragmatic approach to SNP with health organisations like Public Health England and the Royal College of Physicians (backed by the BMA, NHS and Royal Society of Public Health among others) producing balanced overviews of the products and concluding that e-cigarettes, for example, are anything up to 95% safer than smoking cigarettes and with a role to play in helping people quit altogether. However, we are signed up to the EU Tobacco Products Directive, one of whose more bewildering stipulations actually forbids a tobacco company putting a note in its packets suggesting that the smoker might want to switch away from cigarettes. Anti-tobacco harm reductionists have claimed that the UK is out there on its own in terms of publicly communicating the no-brainer evidence base, but over time some governments, politicians and health organisations around the world have accepted wholly or at least in part the essential premise of SNP as a valid tobacco harm reduction option.

The use of SNP has the potential to spark a global public health revolution, help the UN reach its 30% reduction target for non-communicable disease by 2030 and crucially, unlike all other tobacco control efforts, at no cost to governments. Tragically though there is a determined army of academics, doctors, NGOs and health professionals flying under a banner of ‘public health’ who are in fact engaging in a morally-driven campaign not just against smoking or even tobacco, but against recreational use of nicotine itself echoing the UN’s 2009 political declaration of ‘A drug-free world. We can do it’. Well in case they hadn’t noticed – you can’t. But this doesn’t stop the publication, mainly in the USA, of flawed anti-SNP science funded by huge government grants paying universities to do its dirty work, misinformation which is then used not just in the USA, but globally by news media who obviously thrive on ‘bad news’ stories. The prevailing narrative is to pretend that vaping is just as bad or even worse than smoking or that somehow because we don’t know absolutely everything about these new products, it means we don’t know anything at all. The report spells out in detail the nature of misleading research.

All this propaganda helps to create a wall of prohibition that blocks access to smokers of safer products. And the end game could be that the large companies shrug their corporate shoulders and walk away while thousands of smaller companies worldwide go to the wall. This leaves the moral ideologues slapping each other on the back thinking they have just stuck it to the Evil Empire. Life becomes nice and simple again, all black and white with no inconvenient grey areas. Meanwhile, a chance to put the brakes on the death toll is lost.

The full report and executive summary is available at