E-Cigarette Interview with David Sweanor Cont.

What damage has been caused by the Snus ban?

I think the key thing is that we have lost a great chance to effectively show ‘proof of concept’ for the provision of less toxic alternatives to cigarettes. As soon as there is recognition that consumers can access nicotine without repetitious inhalation of tobacco smoke, and that some portion of current smokers find this to be an acceptable (even preferable) alternative to smoking, it causes a paradigm shift. If we get to the point of no longer seeing cigarettes as a ‘nicotine maintenance monopoly’ we could change the face of public health. If we recognize that the needs of smokers can be met in a way that does not necessarily result in the untimely death of roughly half of long term users maybe we can move society conceptually to the point that nicotine delivery can go through the same metamorphosis as we’ve seen with auto safety, telecommunications, sanitation, pharmaceuticals, food preparation standards, alcoholic beverages and a myriad of other goods and services. The market could be transformed (assuming an appropriate regulatory system) through a virtuous circle of increasing consumer awareness and ever-less-hazardous alternatives to cigarettes.

"...the ban on products such as snus causes significant ethical and human rights problems."

In addition the ban on products such as snus causes significant ethical and human rights problems. The idea of simply denying access to such a product to millions of smokers – people who are thus left using a massively more hazardous product – should be a great cause of concern. Misleading statements about the risks of products such as snus, especially those from major health organizations and government health departments, also run the risk of eroding consumer trust in public health authorities – a problem that ultimately impacts far more than issues of nicotine.

Do you see any parallels between Snus and the Electronic Cigarette, and the opposition against both of them?

Some part of the opposition to nicotine products comes from the same moral absolutism that we see in other abstinence-only efforts on issues concerning such things as alcohol and sexual activity. Actually, on a very wide range of issues there is a tension between those on a moralist/absolutist quest (usually tied to ideas on the perfectibility of mankind) and those on a pragmatic public health mission. It would wrong to characterize those on a moral quest as being public health advocates, and this is true whether looking at abstinence-only campaigns on sex, on alcohol, on illicit drugs or on nicotine. Campaigns based on making better people rather than making people better are driven by moral concerns rather than public health concerns.

You've stated that electronic cigarettes are not safe, but that they are a lot better than cigarettes. Just how unsafe are they? 

After many tens of thousands of research papers we know what causes the illnesses associated with smoking. In short, ‘it’s the smoke, stupid’. Non-combustion products will vary in their risks, but everything we can see about the sort of product sold in the West (whether smokeless tobacco, electronic cigarettes or medicinal nicotine) tells us that cigarettes are orders of magnitude more hazardous.

"Everything has risks, so simply pointing out that something is ‘not safe’ shows a person to be either ignorant or disingenuous..."

As to ‘not safe’, we perhaps need elaboration. The point I try to make when faced with the ‘it’s not safe’ canard is that nothing meets the criteria of being absolutely ‘safe’. Everything has risks, so simply pointing out that something is ‘not safe’ shows a person to be either ignorant or disingenuous. The key issue in looking at safety is that it is a relative concept; we need to look at safety of any activity compared to some alternative. Rather than the unattainable standard of ‘safe’ we should be thinking in terms of ‘safer’. Despite the risks associated with soccer, I would, for instance, prefer my children play soccer rather than play with live hand grenades.

You are a supporter of the electronic cigarette? Can you tell us why?

"Nicotine use should not come with a death sentence."

I am a supporter of less toxic alternative for smokers. Nicotine use should not come with a death sentence.

Ideally we need a nicotine regulatory authority that can facilitate efforts to get alternative products to smokers, accurately inform them of relative risks and move them as far as possible down the continuum of risk.

The nicotine market needs to experience a shake-up and the entrepreneurs who appear to be behind the e-cigarettes might be sufficiently risk-tolerant to cause it to happen. The issue needs to get on the public and political agenda, and we will not get the needed re-thinking of the whole nicotine market until this happens.

Opponents of the electronic cigarette have said that it could stop smokers from giving up, that is untested and untried and that claims that the electronic cigarette are healthier than normal cigarettes are unproven. How would you respond to these allegations?

There is no innovation that I am aware of that did not cause detractors to list various potential negative consequences were the product to be made available – even safety bicycles in the 1890s! But when the status quo is one that will, according to the WHO, result in a billion deaths this century surely we need more than a fear ‘something bad might possibly happen’ to reject an alternative to that status quo.

The obvious solution is to have a regulatory agency that facilitates getting the least hazardous products to consumers, with post-marketing surveillance to control any unintended negative consequences. It certainly would make much more sense than the current state of affairs where government agencies are banning products like snus and e-cigarettes, greatly constraining the potential market for medicinal nicotine, and thus protecting the cigarette cartel rather than the health of citizens.

"If there is anyone who believes cigarettes are no more hazardous than e-cigarettes I’d recommend a remedial course in basic sciences."

If there is anyone who believes cigarettes are no more hazardous than e-cigarettes I’d recommend a remedial course in basic sciences. For anti-nicotine campaigners who say we need to wait for more research I would point out the way they are proving Nietzsche correct – we take on the attributes of our enemies. Cigarette companies spent decades making spurious claims that we need ‘more research’ before we could move on policy measures, despite the already-existing basis for informed policy measures. They provide very poor role models.

One criticism that has been levelled at the electronic cigarette is that we don't know the effect of heating up a nicotine vapour and inhaling it into the lungs. Is this a valid criticism?

We certainly know that inhaling a heated nicotine vapour into the lungs is one heck of a lot less hazardous than inhaling the same vapour along with the thousands of chemicals and dozens of known carcinogens that are inhaled when that vapour is delivered by smoking a cigarette. An investigation to determine if the non-smoke vapour is, say, 1/100 or 1/1,000 the risk of cigarette smoking might be a good thing. But if someone thinks cigarettes should not be challenged in the marketplace until we have such results I think they need to try thinking a little more deeply. They should also question whether they have undergone a Nietzsche-like transformation that is causing them to be sounding like a 1970s cigarette company executive.

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