My Times column is on harm reduction, Swedish
snus and e-cigarettes:
Is this the end of smoking? Not if the bureaucrats
can help it.
Sweden’s reputation for solving policy problems,
from education to banking, is all the rage. The Swedes are also ahead of
the rest of Europe in tackling smoking. They have by far the fewest
smokers per head of population of all EU countries. Lung cancer
mortality in Swedish men over 35 is less than
half the British rate.
Have they done it by being more zealous in ostracising,
educating and shaming smokers in that paternalistic Scandinavian
way? No — they did it through innovation and competition. In the
1980s Swedes developed a tobacco product
called snus, which you put under your upper lip.
You get the nicotine but not the tar. Snus is the most popular and effective way of
quitting smoking in Sweden (and Norway).
You will not have seen snus on sale in
Britain, for the simple reason that the EU banned it. When Sweden
joined the EU, it negotiated a special opt-out. To this
day, despite abundant evidence that snus is saving Swedish
lives by the bucket-load, despite advice from experts, and despite
a devastating critique of its own feeble defence of the policy, the
European Commission remains committed to
the snusban.
You may think this is rather an obscure topic with which to
occupy such a prominent opinion pulpit as this page but it is a
vital background to the debate about electronic cigarettes — for,
if snuscan halve smoking and lung-cancer deaths,
imagine what electronic cigarettes could do. These are objects that
mimic the actions of smoking but are maybe 1,000 times safer, and
whose sales are doubling each year,without any government
encouragement or medical prescription. E-cigarettes may wipe out
smoking in a couple of decades. Professor David Nutt of Imperial
College describes them as “the greatest health advance since
vaccines”.
Tobacco sales are falling in Europe and America and the industry
fears it is facing in electronic cigarettes its “Kodak” moment – as
when digital photography destroyed a dominant film-camera firm in a
flash. Wells Fargo in the USA predicts that
e-cigarettes could out-sell cigarettes within ten years.
Surveys show that e-cigarettes are now the most popular method
of quitting smoking, despite a lack of encouragement from the
authorities. Pick up a leaflet from your chemist on how to quite
smoking and you will find they are not even mentioned. When I made
a speech on this topic in the House of Lords, I was stunned by the
enormous response I got from “vapers”, enthusiasts for e-cigs. What
was especially startling was how many of them told of trying to
quit for decades, then finally succeeding.
Yet, instead of welcoming this technology, the powers that be,
in Brussels and Whitehall, are determined to throw obstacles in its
way. Last week the European Parliament voted in support of the
Commission’s proposal that bans reusable electronic cigarettes and
those with a nicotine concentration over 20mg/ml. Our own
government is intent on translating these EU restrictions
into British law, egged on by the British Medical Association and
the big pharmaceutical industry, which burble on about protecting
children from a new threat and not wishing to see the renormalising
of smoking.
Why are public health officials so resistant? The European
Commission frequently displays a precautionary bias against
innovation, weighing any risk of a new product, however small, but
not the risk of an old product it might replace — hence its
attitude to genetically modified crops. In raising the unknown (but
small) risks of e-cigarettes, the public health establishment is
missing the point. What counts is harm reduction, not perfect
utopian safety. Don’t let the best be the enemy of the good, said
Voltaire. The ban on strong e-cigarettes, the ones preferred by
those trying to quit smoking, could prevent the saving of 105,000 European
lives a year, according to modelling by London Economics.
And there’s the Dunning-Kruger effect, whereby incompetent
people are too incompetent to see incompetence. An EU official with
a lower second-class degree from the University of Malta so badly
mangled the results of 15 scientists on harm reduction by
e-cigarettes that they all wrote to correct him.
The British government’s medical regulator, the MHRA, sticks
obstinately to its belief that medicinal regulation will improve
technological progress in e-cigarettes, ignoring reams of evidence
that high barriers to entry inevitably stifle innovation. Doctors,
represented by the BMA, seem to hate the idea of people buying,
rather than being prescribed, products that stop them smoking.
Worse, some of the firms advertising e-cigarettes and selling them
through Boots are now subsidiaries of Satan itself — the tobacco
industry. Not wishing to emulate Kodak, Big Tobacco is rushing to
buy up e-cigarette makers.
Big Pharma wants regulation of its rivals because it makes a
packet out of nicotine replacement therapies (patches and gums), which have a poor track record of helping
people to quit. And politicians? Well, they just seem to enjoy
banning things.
In short, says Professor Gerry Stimson of the London School of
Hygiene and Tropical Medicine, the public health response to
e-cigarettes has been dominated by attempts to regain ownership of
the issue from a consumer-led self-help movement. “Not invented
here” — the old bureaucrat’s cry.
The reason these cynical campaigns have succeeded at all is that
most of us confuse nicotine with smoking. As far as anybody can
tell, nicotine is harmless at the doses present in cigarette smoke.
It’s the tar that kills. Nicotine is addictive, but so is caffeine,
and a cup of coffee has a lot more potentially dangerous chemicals
in it than an e-cigarette. Vaping could well be less risky and
antisocial than coffee drinking.
Yet so brainwashed are we into thinking that nicotine is harmful
that we cannot see an advert for vaping without a Pavlovian
revulsion, and spouting a load of tosh about protecting kids from a
possible gateway into (rather than out of) smoking. And that
ignorance is being exploited by the reactionary opponents of this
disruptive and life-saving innovation. They would apparently prefer
that smoking continues its very slow, but doctor-supervised,
decline over the next 50 years than all but vanish in 20.