Ceci n’est pas une cigarette

For the past six years, a merry band of ‘vapers’ has been gradually growing, coalescing and spreading the word about their nicotine product of choice: the e-cigarette.

Although it is not marketed as a stop-smoking aid, the vaping community is predominantly made up of people who were, until they started using the e-cigarette, smokers. The missionary zeal associated with the recovering tobacco addict is never far from the surface. There is even a sort of vaping palare. ‘Vaping’ is itself short for vaporising. ‘Electro-fags’ contain ‘carts’ filled with ‘e-juice’. Conventional cigarettes are ‘analogue’.

Patented in 2003 and primarily manufactured in China, the e-cigarette’s rise has gone largely unnoticed. The actress Katherine Heigl induced a collective gasp from David Letterman’s audience when she whipped out her e-cigarette on the Late Show in September. Last week, a photograph of X-Factor contestant Matt Cardle puffing on an electro-fag probably generated more confusion than recognition amongst those who saw it.

E-cigarettes look – at a squint – like normal cigarettes, right down to the red tip that glows when used (experienced vapers have learnt that the blue and black variety tend to attract less attention in the pubs and clubs of smokefree Britain). When the device is drawn on, a battery heats an atomiser, which vaporises the nicotine, and the user blows out a satisfying cloud of water vapour. It’s not hard to see how such a product could be an effective substitute for cigarettes. It mimics the act of smoking and delivers nicotine while avoiding the dozens of carcinogens found in the smoke of its combustible cousin.

With the anti-smoking movement now engaged in a war of attrition with the UK’s hardcore of over 10million smokers, and with Action on Smoking and Health (ASH) reaping ever-diminishing returns from its increasingly bizarre wish-list of heavy-handed legislation, a technological innovation that could break the deadlock is just what the doctor ordered. For anti-smoking campaigners, however, there is only one way to deal with this exciting new possibility: e-cigarettes must be banned immediately.

John Banzhaf of ASH International has been whipping up panic about the electro-fag since he first heard about it. The veteran anti-smoking activist has made the evidence-free claim that traces of nicotine in e-cigarette vapour can cause heart attacks in non-smokers and appeals to supporters on his website with this heart-rending plea: ‘If you don’t want people sitting next to you – in a waiting room, restaurant, bar, or any other area where smoking is now prohibited – using one of these devices to get around smoking bans, and forcing you and your loved ones to inhale deadly nicotine, please help now!’

Banzhaf, admittedly, is a cartoon anti-smoking zealot made flesh, but he is not alone in wanting e-cigarettes off the market. Citing the precautionary principle, legislators have already banned them in Australia and Canada. This week, an article in the anti-smoking movement’s house journal, Tobacco Control, has called for regulators everywhere to take e-cigarettes off the market while their safety can be evaluated. Earlier this year, the Medicines and Healthcare products Regulatory Agency (MHRA) said it wanted e-cigarettes to be classed as medicinal products and taken off the shelves.

The manufacturers argue that e-cigarettes are not medicines but safe recreational products. Containing just three ingredients – nicotine, water vapour and propylene glycol – the prospect for harm is minimal. Nicotine is not carcinogenic; when peddled by the pharmaceutical industry, it is portrayed as positively ‘therapeutic’. Although it is possible that unscrupulous manufacturers could produce defective devices or make unwarranted health claims, the same is true in most industries and it is something that can be addressed through routine regulation. It does not require prohibition, even on a temporary basis.

The authors of the article in Tobacco Control evidently took the Theo Paphitis approach of testing the product to destruction but were still only able to come up with the feeblest of safety concerns. They claimed that liquid from the cartridges leaked on to their hands, and warned that ‘nicotine can be absorbed through the skin and cause harm, especially if amounts are large’. But the amounts are not large. The liquid in an e-cigarette cartridge is typically just two to three per cent nicotine. That is well below the UK’s legal limit of 7.5 per cent. Beyond this, they could only fret about how the disposal of the plastic cartridges might affect the environment, and pondered the risible possibility that nicotine might interact with nitrous acid to create ‘third-hand smoke’.

The simple truth is that not one death has been attributed to the use or misuse of e-cigarettes since they appeared in 2004. Niche product though it may be, this is a sufficient length of time for any action against it now to be viewed as reactionary rather than precautionary. In the same six years, some stop-smoking drugs have been shown to have killed many people, and of course several million more have had their lives cut short as a result of cigarette smoking. And yet it is the e-cigarette that faces the chop.

For the vaping community, prohibition would mean switching back to analogue, with all the health hazards that would entail. As a public health strategy, this seems wilfully perverse, but it is not without precedent. Vapers who expect any ban on e-cigs to be short and sweet should look at the curious case of snus, the smokeless tobacco product that has been banned in the European Union thanks to anti-smoking campaigners inspiring a brief moral panic in the 1980s.

Skoal Bandits were pouches of moist snuff designed to ensnare millions of children into a life of nicotine addiction, or so thought Action on Smoking and Health in 1985. Believing them to cause oral cancer, ASH spearheaded a campaign against the infernal Bandits, which ultimately led the European Commission to ban the sale of moist snuff in 1992.

This arbitrary prohibition created difficulties when Sweden prepared to join the EU two years later. Having used pouches of moist snuff – known there as snus – for 200 years, the Swedes did not relish mass abstinence. Negotiating an opt-out became something of a deal breaker. The EU complied and for the past 15 years Sweden has been the only EU country allowed to sell snus. This has been a boon for the Swedes and a tragedy for everyone else, since the theory that moist snuff causes oral cancer has been comprehensively debunked, while a large body of evidence shows that snus is an extremely effective substitute for cigarettes. Sweden now enjoys the lowest smoking rate and the lowest lung cancer rate in Europe, especially in its northern regions where snus consumption is at its highest.

And yet the EU’s ban on snus remains in place; a grand bureaucratic folly which, according to one study, may be costing the EU 200,000 lives a year (see European Journal of Epidemiology 19). The European Commission plans to review the situation next year but the pharmaceutical industry is lobbying hard to keep the ban in place. It is the very fact that snus and e-cigarettes are designed for pleasure rather than treatment which, paradoxically, make them such good substitutes for cigarettes amongst people who do not see smoking as a disease nor themselves as patients.

Anti-smoking fundamentalists seem suspicious of anything that mimics the act of smoking (electro-fag) or is produced by the tobacco industry (snus). Some worry that such products act as a gateway to smoking, despite evidence from Sweden showing snus to be a way out of smoking. Others, like Banzhaf, complain that e-cigs and snus contain an addictive drug and could be used by smokers to ‘get around’ smoking bans. It sometimes seems as if the whole aim of tobacco regulation is to punish those who want to use nicotine products and to go after anyone who might be enjoying themselves. In the end, a ban on electro fags will only lead people who have adopted them back to using the most dangerous forms of tobacco.

Christopher J Snowdon is the author of Velvet Glove, Iron Fist: A History of Anti-Smoking, available from his website here.