With a controversial ban on electronic cigarette use in public places in Wales now looking likely, DDN hears from anti-smoking charity ASH on why, perhaps surprisingly, it thinks the plan is misguided
Although the treatment sector is slightly less polarised than it was, the harm reduction/abstinence argument has raged for so long that’s it’s become the field’s background music. So it’s interesting to see similar debates played out – sometimes bitterly – around electronic cigarettes, with some seeing them as a powerful harm reduction tool and others as a cynical attempt by the tobacco industry to recruit more consumers while also winning over the health lobby.
As DDN went to press, Oil and Gas UK became the latest organisation to enter the fray, advising its companies to ban the use of e-cigarettes on offshore installations. But the most high-profile intervention is last month’s Public Health (Wales) Bill, which includes plans for a country-wide ban on their use in enclosed public spaces. The legislation is scheduled to come into force in 2017 and has divided the health sector, with organisations including the BMA and Public Health Wales in favour, while ASH and Cancer Research UK – neither friends of the tobacco industry, to put it mildly – are among those lining up against.
The Welsh Government’s stance is that the law would help to stop smoking becoming ‘re-normalised’ after the positive impact of the 2007 ban, and also prevent e-cigarettes acting as a ‘gateway product’ to tobacco. Both Cancer Research UK and ASH refute the ‘gateway’ argument, however. ‘We can’t see any evidence that electronic cigarettes are re-normalising smoking, certainly in the UK,’ ASH’s director of policy, Hazel Cheeseman, tells DDN. ‘We’ve seen this steady drop in the number of young people smoking, which is great, and those who are using electronic cigarettes are largely young people who are already smoking. Our own research found that – as did large school-based surveys in Scotland and Wales.’
Among those young people who’ve never smoked but have tried e-cigarettes, most of the use seems to be short-lived experimentation, she says. ‘They’ll say they tried electronic cigarettes once or twice, but we aren’t at the moment seeing that translate into regular use of electronic cigarettes, let alone regular smoking.’
There’s no guarantee that experimentation won’t translate into regular e-cigarette use, she concedes, but questions whether that would necessarily be an entirely bad thing. ‘If electronic cigarettes turn out to be a replacement for smoking, then over the longer term what you would expect to see be would be young people who might otherwise have smoked taking up electronic cigarettes instead.’
Does this mean that they really are effective harm reduction tools? ‘They certainly would appear to be at the moment. In the adult population you’ve got 2.6m regular users of electronic cigarettes, according to our research, and about two out of five of those have quit smoking altogether, while pretty much all the rest tell us they’re either actively trying to quit or cutting down on the amount they smoke and using electronic cigarettes instead.’
There’s also little evidence that vapour from e-cigarettes is harmful to bystanders, says ASH, and they have mass appeal in a way that nicotine-replacement never did. The risk then, presumably, is that the Welsh ban could discourage smokers from switching? ‘That’s one of the reasons why we wouldn’t support the decision – it gives a false perception,’ she states. ‘People aren’t always out there looking at all the evidence – it’s not their job to do that – so they use shortcuts to understand how harmful something is. If you say something’s banned people will automatically assume that’s because it’s bad for you.’ What about the argument that widespread use of e-cigarettes undermines the positive impact of the smoking ban? ‘If they’re concerned that kids and adults are going to see people using these products and think it’s OK to smoke, I guess that’s a hypothesis, but I don’t know of any evidence that supports it.’
The treatment sector is used to its harm reduction versus abstinence debate being bitter and divisive – is this debate heading in the same direction? ‘It’s obviously been a difficult one, and people have disagreed, but in the UK we’ve actually had much more of a rounded debate than other countries, because we’ve had this tradition of harm reduction and we tend to be more pragmatic.’
So what about the claim that the tobacco industry’s involvement is little more than a cynical ploy to get the health lobby onside – a Trojan Horse? ‘Tobacco companies have actually been quite late to the party in terms of electronic cigarettes,’ she states. ‘They certainly weren’t the people that invented them, and it’s only in the last couple of years that they’ve started investing in them. We should definitely be suspicious of their motives, as – obviously – they’ve never previously demonstrated that they’re interested in public health. But the products on the market that seem to be most effective at helping people quit and have growing appeal – the ones that you refill yourself – aren’t really owned by the tobacco industry yet, though that might change.
‘However, one thing is clear. While tobacco companies continue to make billions from selling a lethal product, there’s no room round the table for them, whatever else they’re selling.’
Bill at gov.wales