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Don’t treat e-cigarettes as medicines; glamorise them

My Times column tackles an egregious example of
regulation doing more harm than good:


Should shampoo be classified as a medicine and prescribed by
doctors? It can, after all, cause harm: it can sting your eyes and
a recent study found traces of carcinogens in 98 shampoo
products. Sure, shampoo can clean hair if used responsibly. But
what’s to stop cowboy shampoo makers selling dangerous shampoo to
the young? Far too many shampoo manufacturers try to glamorize
their product. Time for the state to step in.

Far fetched? If only. This week the European Parliament sensibly
declined to accept the European Commission’s directive to regulate
as medicines those glowing-tipped electronic nicotine vapour
dispensers called e-cigarettes. The British government,
astonishingly, expressed its disappointment at the vote, and
still intends to treat e-cigarettes as medicines from 2016. “We
believe these products need to be regulated as medicines and will
continue to make this point during further negotiations,” a
spokesperson for the Department of Health said. Who’s “we”, by the

All the signs are that “vaping” is rapidly gaining market share
from smoking. Having begun as an ingenious innovation in China in
the early 2000s, the e-cigarette is now big business, with sales of
more than £2 billion this year, and with the number of users
doubling in some parts of the world just in the last year or so.
The big tobacco firms are rushing to acquire the Chinese start-ups
or their knowhow, a sure sign that they expect to lose customers to
vaping. And they will: vaping helps people stop smoking.

Examine the evidence and you will find that e-cigarettes are
saving far more lives than shampoo, and probably doing no more
harm. A recent study in New Zealand, published by the Lancet, divided 657 smokers
into three categories; one-third were asked to use nicotine
patches, one-third e-cigarettes and one-third fake (placebo)
e-cigarettes. The e-cigarette smokers were more likely to abstain
from smoking entirely during the experiment, more likely to halve
their use of cigarettes if they did not quit entirely, and three
times more likely to continue with the product afterwards.

Meanwhile a thorough search for medical threats caused by
inhaling nicotine vapour – as opposed to smoke – continues to find
very little. Nitrosamine and formaldehyde are found at levels 1,000
times lower than in cigarette smoke. Dose matters in toxicity. Even
a former director of Action on Smoking and Health (ASH) has
described vaping as ”a very low risk alternative to cigarettes,
used by smokers as a pleasurable way of taking the relatively
harmless recreational drug nicotine”. Don’t forget there’s
moderately good preliminary evidence that nicotine helps slow progression
of Alzheimer’s, so it might even do good.

None the less, all round the world the health nannies are
itching to get their regulatory hands on e-cigarettes. In a dozen
countries, mainly in Latin America, the things are banned
altogether (presumably after subtle lobbying by tobacco farmers and
the cigarette industry). Here the “NHS Choices” website contains a magnanimous concession that
until they are regulated in 2016, the Medicines and Healthcare
products Regulatory Agency “will not ban the products entirely
during this interim period, but will encourage e-cigarette
manufacturers to apply for a medicine licence.” Meanwhile, it warns
darkly, e-cigarettes “are only covered by product safety

On the same website the NHS recommends instead a white, bulbous
thing called a “nicotine inhalator”, which is a “licensed quit
smoking aid, available on the NHS, [that] consists of just a
mouthpiece and a plastic cartridge”. Somehow, I don’t think they
have got the hang of glamorized marketing. But if they concede the
principle that nicotine inhalers are safe and should be made
available to people at taxpayers’ expense, what are they doing
trying to regulate the sale and purchase of devices, at no cost to
the taxpayer, that do almost the same thing but might actually look
cool, rather than embarrassing, in the street? I cannot help
feeling that the Department of Health is more interested in
retaining control of the nicotine market than promoting health.
This is known in economics as regulatory capture. Maybe “we” means
the makers of patches and inhalators.

Be in no doubt that regulating e-cigarettes as a medicine would
kill people. It would discourage their use, by putting up the cost
of launching, selling and monitoring them and it would make it
harder to buy them. It would therefore, given that we know they
help people stop smoking, kill. That’s the likely effect of what
the Department of Health proposes. As so often, the precautionary
principle, by weighing the costs but not the benefits of a new
technology, does net harm.

Vaping costs much less than smoking, not least because it is
untaxed, so it is bound to spread fairly fast. It’s likely to
overtake smoking within a decade, some think. Frankly, we should be
changing regulations to encourage it: it should be allowed indoors,
as a further incentive to help smokers quit. E-cigarette makers
should be allowed to advertise (which this week’s European
Parliament vote prevented) so as to help it grab market share
faster and save lives faster. So what if this leads to a
“re-glamorising” of people putting cylinders between their lips?
Remember, “we” objected to smoking because it hurt people, not
because it was glamorous.

Passive vaping is also far more pleasant than passive smoking,
as I can attest, for the simple reason that it obeys John Stuart
Mill’s harm principle: that you can do what you like unless it
harms others. This is a concept that used to elude smokers in the
old days, when some were for my taste too addictively oblivious to
how much discomfort their smoke, ash and stale smell caused to
others. There is simply no sensible reason to object to somebody
else vaping – even on an aeroplane.

The addiction that we should be worrying about is the addiction
of regulators to harmful regulation. America’s Centers for Disease
Control and Prevention (CDC) last month said it was ”deeply troubling” that
e-cigarette use among American teenagers has doubled, even though
less than 10% of the users had never smoked a real cigarette – ie,
most of them were probably cutting their risk of death. Yet justice
officials from 40 American states have now demanded that the Food
and Drug Administration regulate vaping. It would have done by the
end of this month if the government had not shut down.

By the way, if you are now worried about shampoo, don’t be.
Coffee and organic broccoli have more carcinogens in them than most
chemical products. But that does not make them dangerous. It’s all
about dose.


PS. A source in the European Parliament, after reading my
article, added a fascinating detail:
A further interesting point is the subtle role played by big
pharma, who fund hundreds of various anti smoking
organisations that curiously all lobbied against e-cigarettes.
They, of course, want control of the market, have all the
pharmaceutical grade production facilities and large corporate
compliance departments whereas most existing  e-cig
companies are small scale start ups.



By Matt Ridley | Tagged:  rational-optimist  the-times