It is no shock that when science and politics don’t coincide, then politics will win the day – and in Australia, it was unlikely that the MPs on the enquiry committee would go against the government, embarrass the Health Minister and spark hellfire from the medical establishment to rain down on their heads.
Even so, the final decision was a 5-3 split with the Chair not only issuing a very rare minority view, but writing a minority foreword to the whole report, “While the evidence base regarding E cigarettes is still emerging, there are clear indications that E-cigarettes are significantly less harmful to human health than smoking tobacco cigarettes. If long term smokers who have been unable to quit smoking tobacco cigarettes switch to E-cigarettes, thousands of lives could be saved”.
And if a minority report is supposed to be brief, how about this one from committee member Andrew Laming; “Life is short and shorter for smokers. Just legalise vaping”. I expect to see that quoted in conference presentations for some time to come.
The report itself was balanced and anodyne which made the outcome all the more disappointing. Anybody reading that report without the political background could have imagined the vote going the other way because of the degree to which the anti-harm reductionists were reduced to clutching at straws in the face of evidence from several esteemed harm reduction big guns. In a desperate piece of shroud-waving, two prominent caped crusaders attacked the oft-quoted PHE 95% e-cig risk reduction conclusion as having no basis in science. One of them possibly came perilously close to a visit from guys with big hats and badges for claiming that the study led by Professor David Nutt which produced the figure, involved those with no experience of tobacco control and who had been in the pockets of Big Tobacco. That said, I wondered just how much tobacco control ‘experience’ is required to ban everything. Just how much straw was being grasped came with the dire warning that children might swallow e-cig batteries. Links to the full report and an analysis from The Spectator below.
To drive home the points, one of those Top Guns, Associate Professor Colin Mendelsohn published a paper in the Internal Medicine Journal of the Royal Australian College of Physicians entitled ‘Electronic cigarettes in physician practice’ where he asserted that doctors have an ethical obligation to steer patients who cannot quit smoking towards harm reduction alternatives.
This is how The Australian reported the story:
“The battle over e-cigarettes has flared again with a scientific paper declaring doctors have an ethical obligation to consider recommending them for patients who cannot stop smoking. Written by University of NSW conjoint associate professor Colin Mendelsohn, and published today [the] paper cites research that found smokers who switched to e-cigarettes had significant health improvements, including improvements in asthma, chronic obstructive pulmonary disease, blood pressure, cardiovascular health, lung function and pneumonia risk.
It also noted that recent studies in the US and Britain, where e-cigarettes are legal, found the new models of e-cigarettes, particularly, were associated with higher success rates in quitting smoking.
However, Professor Mendelsohn’s position is contrary to the stand of the Australian Medical Association, the Thoracic Society and the Australian government, all of which have said smokers should give up smoking, but have shied away from endorsing e-cigarettes as a useful temporary option for hard-core smokers.
An Australian parliamentary committee concluded last week that the ban on e-cigarettes should remain, saying “current regulatory arrangements for nicotine e-cigarettes remain appropriate” and “further research into the health impacts is needed”.
However, a minority report found e-cigarettes could help smokers who had tried and failed to quit. E-cigarettes, the report said, “could save many thousands of lives” and they should be available “as a consumer good to Australians”.
In its submission to the parliamentary inquiry, the AMA said “e-cigarettes should not be seen as a socially acceptable alternative to smoking, and their safety and usefulness as quit smoking aids had not been established”.
Further south, PMI won an important victory for the HEET stick component of the IQOS heat not burn product. On May 10, 2017, the New Zealand Ministry of Health (MoH) charged Philip Morris with two breaches of s 29 of the Smoke-Free Environments Act 1990. The charge alleged that PM1 imported and sold a heated tobacco product in breach of s 29, which makes it an offence to sell, or import for sale, any tobacco product which is labelled or otherwise described as suitable for chewing, or for any other oral use (other than smoking). The MoH was not challenging the legality of IQOS, but rather the legality of the HEETS tobacco sticks.
The judge dismissed the case finding that HEETS was not caught within the law’s meaning and also found that banning HEETS would also be contrary to the purpose of the law In his conclusion, the judge said: “[I]t can be said that the use of ‘HEETS’ while it may have associated risks in itself, is not as harmful or potentially harmful as ordinary cigarette use. This finding would fit squarely with the purposes stated in [the relevant sections of the Smoke-Free Environment Act].”
But overall, the NZ government is taking a positive approach to safer nicotine products, issuing a public statement in March 2017 with a commitment to develop a regulatory framework “to provide a pathway for emerging tobacco and nicotine-delivery products to be regulated as consumer products in the future.” , This was followed in August 2017 with follow up commitments, including statements by the Associate Minister of Health such as, “The Government is taking a sustained, evidence-based approach to reducing smoking. This is yet another way we can help Kiwis kick the habit for good.”
The Ministry of Health convened a Technical Advisory Committee currently working through the whole range of tobacco harm reduction issues while National MP, Nicky Wagner lodged the Smoke-free Environments (Regulation of Electronic Cigarettes) Amendment Bill, designed to allow electronic cigarettes containing nicotine to be sold to persons over 18 years of age," Ms Wagner said, "Currently the sale and supply of nicotine e-cigarettes and e-liquid as consumer products is illegal. However, the Ministry of Health itself has said that e-cigarettes have the potential to contribute to the Smokefree 2025 goal”
Of course, it is fun taking a pop at those who have entrenched views discrediting the value of safer nicotine products in reducing death and disease from smoking. Some may argue that anti-tobacco harm reductionists are not a homogenous group, that there are shades of disagreement and that their views are held just as firmly and sincerely as those who support harm reduction. Maybe, but I’m sorry having a firmly held view in support of creationism for example, doesn’t make it correct; it is based on belief not science. And so it is with opposition to safer nicotine products. There is no credible science now that would support the view that e-cigarettes are as dangerous as cigarettes. None. And even if you dispute the margin of safety, it is significant. In my view, everything else is largely irrelevant. The big fall- back position is that nicotine is addictive whether that’s getting young people ‘hooked’ on nicotine or smokers switching not quitting.
But if the prize is actually to keep people alive, to be with their families, go to work and enjoy a reasonable life-span, then being ‘addicted’ to nicotine, a drug which causes negligible harm to users and none at all to the community or wider society - doesn’t matter. It only matters if you take a moral standpoint on the idea of people being ‘addicted’ to anything, however benign. Or if your end-game is neither a smoke-free world, nor a tobacco-free world, but an end to the recreational use of nicotine
Perhaps the views of anti-harm reductionists, however influential, will wither on the vine. Around the world, aside from those countries which already allow access to safer nicotine products, legislators in Canada. Norway, the Philippines, Russia and elsewhere are at different stages of considering what an appropriate control regime should look like. There are rumours in the wind of the FDA considering some kind of OTC safer nicotine product being made available. Developments in New Zealand are promising while tobacco harm reduction activists in Australia can build on that report.
Ultimately though, it could be simple consumer power that renders any draconian controls relatively powerless. The move to safer products was a bottom-up consumer-led phenomenon and consumers will hopefully win the day because even in some of those countries when products are banned entirely, consumers are buying online. And the ubiquitous nature of global online purchasing of everything from hat pins to hand grenades is pretty much unstoppable.
Nevertheless, it remains important to keep up the pressure, to contribute to political enquiries, challenge existing laws, write the op-eds and letters to journals exposing junk science. It will be a marathon not a sprint, but millions of people around the world may live to be thankful for a race eventually won.
You learn something new every day. Apparently guess what’s big in the UK Premier League apart from gargantuan salaries and egos (and I don’t mean the batteries)? It’s snus, which has caused the Daily Sleaze to get apoplectic. The game’s ruling body is also in a snit, but they haven’t banned smoking among players as pointed out by this sensible article in Spiked.
Meanwhile in Scotland, Glasgow Rangers have a new partner for next season, the e-cig retailer Vapourized with a store opening up inside the ground. This official link between tobacco harm reduction and sport may be a global first.
And finally….cannabis may lead to smoking cigarettes! Who knew?