Wednesday, November 23, 2011

Australia Health Authorities are Completely Missing the Point on E-Cigarettes

Health authorities in Australia have banned the use of electronic cigarettes because, as they argue, vaping mimics smoking and encourages people to continue smoking.

According to an article in the Canberra Times: "Canberrans keen to try smokeless ''e-cigarettes'' are running a legal tightrope, with the product banned across Australia despite its increasing availability online. ... The Australian Medical Association said there was no evidence ''e-cigarettes'' helped people quit, and Victorian AMA president Harry Hemley warned the products posed a serious health risk. ... ACT Health said e-cigarettes also encouraged people to continue smoking behaviour. ''Because e-cigarettes mimic smoking in both design and use, the ACT Health Directorate does not support [their use],'' a spokeswoman said. ''The Health Directorate strongly advocates the de-normalisation of smoking and e-cigarettes are counterproductive to this goal.''"

The Rest of the Story

Australian health authorities are completely missing the point. Electronic cigarettes are helping thousands of vapers to stay off of cigarettes precisely because their use mimics smoking. Unlike nicotine replacement therapy or other "approved" drugs for smoking cessation, electronic cigarettes address both the pharmacologic and behavioral aspects of smoking addiction. They are effective specifically because they mimic smoking and thus replace many of the behavioral stimuli associated with cigarette smoking.

Moreover, contrary to the ACT Health Directorate statement, electronic cigarettes do not encourage continued smoking. They are overwhelmingly used by smokers to quit or substantially cut down on smoking. Every electronic cigarette that a smoker uses is one less tobacco cigarette smoked. There is no evidence to support the claim that e-cigarettes in any way inhibit smoking cessation. But there is abundant evidence that e-cigarettes are helping thousands of smokers to quit smoking or cut down on the amount they smoke.

A clinical trial of e-cigarettes among smokers with no interest in quitting found that 55% of subjects either cut down their consumption by 50% or more or quit smoking altogether at six months follow-up. This is remarkable, especially since these smokers had little motivation to quit. Imagine how effective e-cigarettes likely to be in reducing smoking among smokers who actually want to quit.

A further problem with the Australia health authorities assertions is that there is no evidence that e-cigarettes pose health risks (beyond the continued use of nicotine). The Australian Medical Association claims that e-cigarettes poses serious health risks, but does not reveal what those health risks are. That's because none have yet been identified. In fact, e-cigarettes reduce health risks because they usually eliminate or substantially reduce the amount of tobacco smoke that a smoker inhales. The Polosa study demonstrated this. Thus, the best current evidence is that e-cigarettes substantially reduce one's health risks.

The Australian health authorities have it all wrong. And it appears that they have tipped their hand as to why. Their opposition is purely ideological: "e-cigarettes mimic smoking in both design and use."

In other words, they oppose e-cigarettes simply because they look like and are used like regular cigarettes. The fact that they contain no tobacco and do not produce any smoke is irrelevant. The fact that they most likely greatly reduce health risks is irrelevant. The fact is that they look like regular cigarettes and therefore are bad and their use must be discouraged. This is no longer about health - it is about a moral principle: people should not do anything that looks like smoking.

In fact, the e-cigarette is effective (and probably more effective than NRT) specifically because it mimics smoking. My guess is that the smoking cessation product of the future is going to be some sort of device that mimics smoking but is not tobacco-based and produces no smoke (whether an electronic cigarette or some similar smoke-free, tobacco-free, nicotine-delivering device). Such a product could literally save millions of lives. But it doesn't matter, because it looks like smoking.

1 comment:

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