Suppose that millions of Britons were driving a dangerous type of car that was killing 80,000 people a year. Suppose somebody invented a new car that was much, much safer, significantly cheaper, and emitted far fewer fumes, while performing just as well. Would you a) ban the new car, or b) encourage people to buy it?
Not that difficult a question, surely. Yet the reaction of many public health professionals and politicians has been to choose a) in an exactly analogous situation relating to nicotine. Why? Because they would rather you did not drive at all.
Take for example this recent pronouncement by the mayor of San Francisco: ‘Tobacco use is the leading cause of preventable disease and death in the United States. Tobacco kills more than 480,000 people a year in this country. That’s more than AIDS, alcohol, car accidents, illegal drugs, murders, and suicides combined’. Therefore, he goes on — in one of the great non-sequiturs of history — he is going to ban e-cigarettes, which have caused none of those deaths and could prevent them, but not ban real cigarettes, which caused nearly all of those deaths.
The vaping revolution took the world by surprise. Invented in China in 2006, the e-cigarette has caused massive declines in smoking in Britain — more than almost any other country — because of an early decision by the Cameron government to resist calls to ban it. It is the reason we have the lowest cigarette consumption per capita in the G7, and the second lowest in Europe, and one of the lowest incidences of lung cancer.
More than three million people in this country now vape; the vast majority of these (97-99 per cent) were smokers when they started vaping, and about half have given up smoking altogether. Vaping spread by word of mouth to eager smokers who wanted to quit but found it hard. E-cigarettes are now the most popular and most successful way of quitting tobacco, and are putting stop-smoking services out of business.
The Department of Health got the point, saying in 2017: ‘We will help people quit smoking by permitting innovative technologies that minimise the risk of harm. We will maximise the availability of safer alternatives to smoking’. But then, in response to the EU Tobacco Products Directive, it banned advertising of e-cigarettes, and mandated excessively small refill bottles and low nicotine limits. Thus, the opportunity for competition and consumer choice to drive innovation in harm reduction is increasingly stifle, even in Britain in favour of paternalistic regulation premised on ‘nanny knows best’, and fossilised straitjackets of regulation.
The relative safety of smoking and vaping is beyond doubt. The dangerous stuff in a cigarette is not the nicotine, but the products of combustion. Levels of all toxicants are far lower in vapour than smoke, and clinical trials show that vapers quickly become indistinguishable from non-smokers on most indicators of risk and ill health. The widely quoted ’95 per cent safer’ figure, from the Royal College of Physicians, is almost certainly an underestimate of the difference.
The nannies who want to ban, discourage, or tax vaping are driven by three main motives. First, precaution: what if this new technology turns out to have unknown risks? But this has the precautionary principle backwards. Much better to take the small risk that there are unknown hazards, than the known risk that there are huge hazards. Precaution should never be an excuse for defending an existing harm, yet all too often that is what it ends up being. The precautionary principle thus interpreted holds the new to a higher standard than the old.
Second motivation: hatred of all things related to nicotine. So ingrained is the detestation of the tobacco industry as a purveyor of addictive death to the world — not unjustified in itself — that the prohibitionists cannot bring themselves to accept the harm-reduction argument that would be routinely easy to see in other cases. That tobacco companies have now started buying vaping companies, and inventing other risk-reduction products such as heat-not-burn cigarettes, only seems to prove the point: anything emanating from the evil empire must be evil. The idea that Big Tobacco might get to be the Prodigal Son really annoys these people.
Third motivation: self interest. The pharmaceutical industry has a nice little earner called nicotine replacement therapy. These patches and gums are bought by the National Health Service, prescribed to patients who want to quit smoking at considerable expense to the taxpayer and — best of all — don’t really work, so the market is limitless. Along comes a private, free-enterprise, non-subsidised alternative that works. No wonder Big Pharma money was behind many of the lobbying campaigns against vaping. Remember, the precautionary principle is the perennial fig-leaf used by the European Union to excuse its protection of large corporate vested interests.
Fourth motivation: the urge to ban. People just love to disapprove. I’ve met all sorts of specious arguments from people about why they hate e-cigarettes. The smell: no, the vast majority of vapours are odourless. The risk to children: no, there is no evidence that young people are taking up vaping at any higher rate than they used to take up smoking. The fire risk: no greater than any other battery product, and far less than cigarettes.
In the end, what I suspect people object to about vaping is the pleasure it gives. What if somebody made nicotine addiction really safe, they worry, so there was no longer any reason to argue against it, eh? What then? A puritan, it was once said, is a person who lives in terror that somebody somewhere might be enjoying themselves. Or as a Glaswegian politician once joked to me: we had better ban sexual intercourse in case it leads to dancing.
Vaping is the perfect example of a voluntary innovation derived from free enterprise that delivers better human health, at no cost to the taxpayer, and no inconvenience to society — and causes pleasure. I neither smoke nor vape and have no financial interest in either, but I wish it every success.
(Photo credit: Guy Ackermans)