Taken from the Guardian 14th October 2016
The largest burdens on public health in the western world are caused by excessive consumption – particularly of unhealthy foods, tobacco and alcohol. These are marketed commodities that exist because people enjoy them, they make shareholders money, and governments like the tax revenues they provide.
There are also powerful industry blocs that strongly defend their rights to sell these products. The sugar industry has just been campaigning against advice from public health experts that we should have a sugar tax, while for decades the alcohol industry has issued misleading claims on the effects of alcohol and opposed the ''nanny state''.
One might, therefore expect public health experts to be delighted to discover that some companies have decided to produce safer products, such as e-cigarette or vaping devices. However, instead of inducing cheers of approval, this change has been vilified by a series of scare stories. Much of this disapproval has come from a vocal few who, unable to find flaws in emerging evidence of the health benefits of switching to vaping from cigarette smoking, have begun to attack those who work in this field.
There are regular claims that conflicts of interest have corrupted the evidence, and it has been suggested that scientists should not work with, or even talk to, the tobacco industry about developing vaping devices. Yet it was these scientists who pioneered the very technology that the industry is now adopting. If we believe vaping saves lives, then we should be encouraging the tobacco industry to pay attention.
There are complex reasons why some public health experts are so mistrustful. In part it reflects the concern we all share that industry puts profits over truth. The tobacco industry is particularly problematic as we know it lied over the harmfulness and addictiveness of tobacco, so why wouldn’t they continue to lie about these new products? The way to deal with this concern is not to ignore tobacco companies completely, but to make them better by using the approach we take for the pharmaceutical industry: hold them to account and make sure they are fully transparent with their product claims and research data.
Another commonly heard concern is that tobacco companies are encouraging vaping so that they can get young people addicted to nicotine and then take up cigarette smoking. This tactic seems unlikely to succeed, particularly as most young vapers don’t even vape nicotine-containing fluids, preferring nicotine-free flavours such as strawberry cake and pear drops. In fact, data suggests that vaping is almost certainly the reason why cigarette smoking in young people has reached an all-time low.
Some people are concerned that the tobacco industry’s interest in vaping is a front to get the products so tightly regulated that only they will have the financial power to comply with all the testing required. This may actually sadly be the outcome in the USA, where the new US food and drug administration rules will make it almost impossible for small vaping companies to continue to trade. In the UK, there is a chance to avoid this monopoly by using Brexit to reject the planned European regulations.
The more suspicious members of the public health community think that once the tobacco industry achieves a monopoly it will stop selling vaping products in a bid to re-energise the cigarette market. This has already happened in some countries such as Malaysia and India, but is an unlikely scenario in the UK, as vaping has already developed into a vast business. Furthermore, if we decide we want to we could prevent tobacco companies from doing this by law, in the same way that regulations in the UK insist that low-alcohol products must be available wherever alcohol is sold.
Added to this entire debate are the more subtle psychological issues that surround decision-making in health. There are some public health leaders who feel vaping only brings harm, so they seek to remove it in any form. They deny there are any benefits but most people, particularly pleasure vapers, would disagree.
Finally, anti-tobacco health campaigners know that banning cigarettes is impossible. Indeed, in the US federal law has guaranteed the perpetual right of tobacco companies to sell cigarettes – they cannot be directly attacked. Thus the anti-tobacco groups have focused their efforts to ban a less-established and less well-funded alternative: vaping. Imagine if we end up allowing smoking to continue, while banning a much less harmful alternative that could help some people to quit.
It is reassuring that the oversight body for public health in England has concluded from its own assessment that switching from cigarettes to vaping will be a major benefit to public health. Some authorities, such as in Wales, are already using vaping as a tool to get smokers off cigarettes. This technology could mean huge wins in cutting down cancer and heart disease, and in time the evidence will surely convince even vaping’s most ardent opponents. Until then, we must not let hypothetical concerns about vaping limit its use, or we shall never gain adequate evidence of its true value in our fight against the clear and present danger of cigarettes.