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E-cigarettes – more than a health issue

| October 26, 2015

In Australia one can’t legally buy e-cigarette liquids containing nicotine. Ian A. Maxwell explores the arguments for and against e-cigarettes.

E-cigarettes are often considered as battery-powered substitutes for cigarettes. They are designed to deliver nicotine and/or other substances as an aerosol that is then inhaled. The e-cigarette is argued by some to be an important weapon in the arsenal of people attempting to quit smoking.

However, in Australia there is currently a hidden mini-battle being waged between health and epidemiology experts: those for and those against e-cigarettes. While this battle is raging, one cannot legally buy e-cigarette liquids containing nicotine.

Laws covering e-cigarettes vary quite confusingly between the states. While possession or use of nicotine in e-cigarette liquids without approval is illegal across the whole country, the sale of non-nicotine e-cigarettes is only illegal in some states. Despite this confusion, the use of e-cigarettes by Australians has increased remarkably over recent years. There are virtually no controls for the purchase of nicotine containing e-cigarette liquids via the internet.

Those arguing for e-cigarettes make the following case: if an individual wants to stop smoking and the e-cigarette helps them to do so, then that is a good thing from a health point of view. The medical risks associated with e-cigarettes, they argue, are almost certainly substantially lower than those associated with smoking cigarettes because of the absence of any number of the carcinogens that are prevalent in cigarette smoke. This conclusion is based on all sorts of technical work, which of course cannot be conclusively correlated with any epidemiological data related to health risks – this would take decades. Indeed, if there are no, or even low, risks, then the absence of a correlation between e-cigarettes and health risks could at some point be falsely attributed to a failure of the testing regime and not a lack of health risks.

The arguments against e-cigarettes are varied. One cohort argue that e-cigarettes may act to introduce nicotine to users (usually children according to press releases) that may later convert to the real thing. This reminds me of the old joke where an individual takes up smoking to wean him- or her-self off nicotine patches. Another argument uses the unknown risks of passive inhalation of toxins resulting from ‘vaping’ (the verb associated with the use of an e-cigarette). And yet another position is the untested toxicological impact of e-cigarettes to users. Some work has been done in this area, and e-cigarettes look far less harmful than cigarettes. And yet, opponents of e-cigarettes have suggested that we wait for more definitive data.

There is also an underlying ethical debate in this battle for the hearts and minds of our lawmakers. Those in favour of a ban do not want to see any new forms of potentially harmful drugs or drug delivery platforms being made lawful – their ultimate goal is to have all such drugs and delivery methods banned by law. The more practical specialists in the area note the relative harmfulness of e-cigarettes and cigarettes and punt for the lesser of the two evils. They also note the failure of any current laws that ban drugs to do anything other than to drive up costs and increase the risks of low quality control by manufacturers and distributors.

At a deeper ethical level, we as a community have seceded many of our personal freedoms to our various governments, their administrations and key advisors. This triumvirate weighs up the public health cost-benefits of a new drug delivery platform such as e-cigarettes, and then adds in a risk assessment for personal health risks, and then further spices the calculation with their own self-interests associated with avoiding negative publicity from those opposed to e-cigarettes. Currently, they refer to an absence of definitive data in order to defer making any decisions on the matter. Wise or weak, I cannot say.

The percentage of people smoking cigarettes in Australia has dropped from a peak of over 40% of the population in the 1950s to around 15%. Key influences in this dramatic drop have been consistently negative health messages, increased personal insurance rates, increased cigarette prices, a ban on marketing, plain packaging, the creation of certain social stigmas, and a ban on smoking in various physical environments.

The rate of people taking up smoking for the first time has continued to decrease over the years. But just as importantly, the relative rate of existing smokers who have quit has also been maintained over time. Physical aids such as nicotine gum and nicotine patches have been quite instrumental for those giving up the habit.

Some proponents for e-cigarettes fear that the proportion of smokers in the population will plateau due to a lack of further restrictions that can be made without an outright ban on cigarettes. Indeed, the e-cigarette is now considered by some to be a next key tool for weaning people off cigarettes. Others are promoting further price increases, a license to smoke or a prescription to smoke.

One risk that we all have is that there are campaigners who make a good living off this cause. No matter how successful they are in reducing the degree of cigarette usage in our country, they will fervently chase the remaining few smokers with determination, ignoring the Pareto rule, which implicitly underpins all matters of public health cost-benefits. Once nicotine has been vanquished, these campaigners won’t just go away; they are incredibly organised and they need to eat. They will then target other habits of our daily lives that they find offensive. They scare me a little and there may come a day when we have to ban them as well.

 

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This post was first published in Chemistry in Australia.

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