ECD: The reaction in the UK seems to be that these devices might help, but that more research is needed. Should more research be done into electronic cigarettes before we allow them to be used by smokers?
Adrian Payne: Well, it’s certainly good that some commentators think that e-cigarettes might help; current smoking prevalence rates are proving surprisingly stubborn to conventional public health interventions. Apart from the reduced harm aspect, e-cigarettes do offer that touchy-feely behavioural aspect of cigarettes that for the most part other alternative products don’t. When it comes to the need for more research, I agree with this, but it should not be at the expense of taking the products of the market in the meantime. If this were to be the case, it really would be a cruel irony if smokers who had switched to e-cigarettes were, as a result, forced to revert to smoking regular cigarettes.
ECD: Should health groups help to fund this expense, as they should also be un-biased. Also, should the e cigarette be taxed by the government to compensate for potential loss in revenue?
“I’d hope that governments would use tax policy to steer smokers towards safer products rather than drive them away from them.”
ECD: The current advice for smokers from bodies like ASH UK is that nicotine replacement aids should be used by smokers instead of electronic cigarettes. How effective are these aids in helping smokers give up over the long term?
Adrian: Nicotine replacement aids clearly work for some people, but overall these aids are much less effective than one might anticipate, especially over the long–term. For example, in a recent study they were found to be effective in only 1.6% of users, although this admittedly this was better than the 0.4% achieved with placebo treatment.
It’s of course feasible that the development of newer nicotine replacement aids that more closely reproduce the pharmacokinetic profile of the intake of nicotine from cigarettes might improve on this, and currently there is a lot of interest in testing this concept. But at the end of the day it seems the most important thing that helps smokers to give up is having the willpower to do so. If e-cigarettes prove over time to be an effective transition tool in enabling smokers thinking about quitting to develop and build on the willpower to help them do so, then it would be an obvious benefit. I’d hope that if this is the case, bodies like ASH UK would recognise it as such and respond positively by revising their advice accordingly.
Adrian: Times have changed since the EU ban on snus was originally imposed and even hard-line tobacco control advocates now acknowledge that snus is much safer than cigarettes. So the reasoning for maintaining the ban seems more political than scientific, especially given that some smokeless products that are potentially much more harmful than snus are legally on sale. Quite bizarre really!
“…the reasoning for maintaining the ban [on snus] seems more political than scientific…Quite bizarre really!”
Perhaps the best answer would be to replace the specific EU ban on snus with a comprehensive overhaul of EU tobacco and nicotine regulation. I’d hope that this would put all nicotine-containing products under the same regulatory umbrella, classify them according to risk, and ensure that consumers are informed accordingly so that they can self-regulate their risk.
To get back to your question, according to one study over 200,000 premature deaths might be avoided annually in just fifteen EU countries if smoking rates were as low as in Sweden, which is attributed in large part by many observers to the Swedish preference for snus instead of cigarettes. So intuitively, it’s very tempting to say ‘yes’. However, without snus having been on sale legally in the UK it’s not really possible to give a definite answer. This is because we don’t know what the UK consumer reaction might have been to snus being made available as an alternative to cigarettes.
It’s not sufficient to just put a less harmful product like snus on the shelves in the hope that consumers will buy it; it has to have consumer relevance and sufficient utility to stimulate trial and repeat purchase. The same is of course true for e-cigarettes and any other less harmful cigarette-alternative. This is where public health backing, rather than criticism, of the launch of such products can play a vital role in getting the message across to the consumer, even if these products originate from the tobacco industry.
ECD: Do you see parallels between snus and e-cigarettes?
Adrian: Absolutely, there are definite parallels here. Both products offer smokers nicotine-providing alternatives to cigarettes at a vastly reduced relative risk, primarily because of users not having to inhale tobacco smoke. Both products also offer the consumer some elements of the ritualistic aspects of smoking that medicines don’t. And Sweden offers a good example of how preferences have changed when consumers are given the choice. That doesn’t mean to say that either type of product would necessarily have a universal attraction for smokers. But even if only a small minority of smokers switched, the public health benefits could still be considerable.
“Prohibition didn’t work for alcohol in the US and I see no reason why it should work for tobacco either.”
Finally, I’d say that the current controversy about both snus and e-cigarettes is indicative of the fact that current models of tobacco and nicotine regulation have outlived their usefulness. Urgent revision is required to help, rather than hinder, consumers being able to make healthier choices if they either don’t want to, or can’t, quit their nicotine dependence entirely. E-Cigarettes and the voices of the many vapers world-wide could prove to be a powerful catalyst for change in this regard; as someone who has long had a passionate interest in tobacco harm reduction, I certainly hope so!
Please note that comments of the interviewee do not necessarily represent the views of ECigaretteDirect.
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