The toll of tobacco smoking is public health problem number one. The World Health Organization (WHO) predicts that one billion lives will be cut short by “tobacco” (smoking) this century, if current trends continue. Yet, despite the abject failure of currently-approved methods for helping addicted smokers quit, public health authorities, nonprofits, and politicians worldwide are doing their best to impede, rather than promote, a potentially miraculous new technology devoted to that very goal: electronic cigarettes and e-vapor products (e-cigs).
From San Francisco to Washington to New York, self-styled experts as well as heads of federal agencies routinely warn smokers not to even try using them, no matter how often they’ve failed to quit.
Now the same message will be coming from Moscow! The WHO’s own tobacco control treaty (the Framework Convention on Tobacco Control, FCTC) will be discussed, debated and revised over the next week in the former seat of the USSR. While this treaty has some feel-good measures that have not (and will not) have much effect on reducing the toll of cigarette smoking — much like our own tobacco law, enacted in 2009 — the net damage it does to public health far outweighs any conceivable benefits. Again like our own law, it has high hurdles for any new product to enter the market.
That’s a problem, because new often means reduced-risk nicotine delivery, especially for e-cigs. Sections ostensibly aimed at benefiting public health — plain packages, encouraging cessation methods we already know do not work, raising taxes (including on e-cigs), forcing cigarette companies to list their ingredients — have not reduced smoking significantly in any of the 180 or so signatory nations (the USA has never adopted the treaty, and in any event we are boycotting the Moscow meeting as part of our anti-Putin campaign. I doubt he will lose any sleep over this charade, however, nor will it impact public health).
Smoking rates have declined slowly or not at all over recent years in Europe and America, while Asian populations have taken up the habit avidly, egged on by big tobacco’s predatory recruitment tactics largely abandoned in the west. While most smokers want to quit, the currently approved methods work about one time in ten, an unacceptably low “success” rate.
Something must be done to change the trend. Many scientists working in the fields of tobacco, nicotine and addiction agree: a coordinated program of harm reduction — supplying nicotine to smokers without the deadly smoke, mainly with e-cigarettes or snus-type smokeless tobacco — combined with current approved methods, is the most reasonable path towards reducing this toll.
This groundbreaking, disruptive technology appeared less than ten years ago: e-cigs supply nicotine in a mist of water vapor and propylene glycol and/or glycerin, after being heated by a battery sparked by the user’s — vaper’s — inhalation. Ignoring the potential public health miracle before their eyes, in 2009 the U.S. FDA tried to bar their importation, calling them unapproved medical treatments, despite the unavoidable fact that no such claim had been made. Federal courts stopped that gambit, and the market for e-cigs began to skyrocket — and it continues to do so to this day. Indeed, reliable experts have predicted that reduced-harm products such as e-cigs will overtake sales of combustibles over the next 10-15 years!
Evidence supporting the benefits of e-cigs for tobacco harm reduction is readily available for any not reflexively blind to it. And, judging by the accelerating market for these products, concomitant with the impressive decline in cigarette sales, they seem to be much more effective than the older, FDA- and EU-approved products.
So what has the response been from the public health agencies and nonprofits? One might imagine them jumping with joy at the prospect of finally reducing the deadly impact of smoking. On the contrary, in a perverse twist, our CDC, FDA, all the big health nonprofits (ALA, AHA, ACS) and many academic centers (especially UCSF) have monolithically condemned their use. Politicians running local governments, and “concerned” congressional committees have taken up the hyper-precautionary mantra, often slyly changing the topic to attacking “big tobacco” for trying to “re-normalize smoking” and/or trying to attract and addict young people to nicotine — despite all evidence to the contrary (there are thousands of e-cig and vapor product companies, almost none of which have anything to do with big tobacco).
A prime example of such regressive thinking is the FDA’s recently published “deeming regulations,” which would effectively force all the current e-cig/vapor products to traverse a regulatory minefield to retain market access, consuming years and millions of dollars (along with who knows how many smokers’ lives), sending most of these small companies into bankruptcy or into the waiting arms of — that’s right — the big tobacco companies: ostensibly anathema to the beacons of public health.
It’s not just American anti-e-cig propaganda and the destructive FCTC impeding the spread of these devices: the EU’s tobacco directive proposal is under attack for the nonsensical and counterproductive regulations it contains, which would render e-cigs and vapor products ineffective. Fortunately, a British e-cig company (“Totally Wicked”) is making progress amidst the byzantine EU regulatory apparatus in getting the most horrendously perverse aspects of this measure thrown out.
What’s going on here? Is there any valid rationale for the global antipathy among the authorities to what seems to be a public health miracle in the making? It depends on your definition of rational. Many of those now working in “big tobacco control” (formerly known as public health) are veterans of the tobacco wars of the last century and have a deeply-ingrained hatred of anything related to cigarettes, tobacco or nicotine (even e-cigs which merely resemble cigarettes, yet have no tobacco and emit no smoke). Politicians and city councils may buy into they mythology against e-cigs to preserve their lucrative tax receipts from cigarette sales and settlement-generated payments; some just crave electorate-rousing sound bites about “protecting our children’s health.”
The big nonprofits eagerly accept vast sums from the pharmaceutical companies whose nicotine-replacement products are threatened by effective cessation methods, while academics have built their careers on appearing to be so virulently anti-smoking that they pretend not to notice the difference between tobacco smoke and e-cig vapor.
While vaping continues to attract smokers at increasing rates, the propaganda spewing forth from the temples of regulation and academia is having some effect: more smokers are expressing concern or caution about trying e-cigs and e-vapor products to help them quit. But one thing is certain: smokers are not stupid, although they made a bad decision to smoke, as teenagers are wont to do. They know now how harmful smoking is, and three-quarters want to quit; if given truthful information, they will find their way towards effective reduced-harm products to assist them in their difficult task. The shame of “public health” is that many thousands will die needlessly, having swallowed the dire warnings issued by conflicted purveyors of anti-e-cig myths. Many of those false prophets are in clear violation of their ethical and professional commitments, and must one day be held to account.
