A study released this week by Harvard School of Public Health is just the latest in a series of studies which have found no evidence that e-cigarettes are acting as a gateway to, or renormalizing smoking. In fact, in totality, there is a serious possibility they are having the exact opposite effect.
The latest study was carried out in Europe by Constantine Vardavas , interviewing 26,500 people about their e-cigarette and smoking habits, and found that the number of non-smokers who had tried e-cigarettes was vanishingly small, at about 1.1% of the population. It also found that a fifth of current smokers and one in 20 ex-smokers had tried them at least once.
This pan-European perspective is extremely important, as it replicates several studies which have been carried out in single nations. Of note, England's Smoking Toolkit study run by Professor Robert West of UCL, which showed that e-cigarettes are being used primarily for cessation, and are more effective than over-the-counter NRT, and the ASH UK survey which showed that 700,000 UK smokers have fully transitioned into vaping from smoking. Of course, from those studies alone, it could have been argued that vaping behaviors in the UK and France were culture-bound, but the universality of the Harvard findings suggests that a more pan-cultural phenomenon is at play.
These developments stand in huge contrast to the public statements issued by the CDC when it released its own data last year. Dr. Tom Frieden claimed that their data showed the emergence of a “new phase of the nicotine epidemic” whereas, in fact, it had no way of inferring any long-term usage by non-smokers. This grossly irresponsible statement caused a moral panic, whose reverberations are being seen today with strong moves against e-cigarettes by local legislators nationwide, emboldened by large swathes of the media repeating this scientific dishonesty.
Taken together, all the available evidence shows that vaping products are not creating a gateway effect, are enabling millions of smokers to fully transition away from smoking, and may be creating an interesting and unforeseen phenomenon: Prof Dautzenberg has been quite bold in suggesting that the impact of e-cigarettes amongst Parisian youth is to make smoked cigarettes seem “dirty and nerdy“. That is to say, the massive reduction in youth smoking observed in Paris over the last few years is, in part at least, down to cigarettes being perceived as less desirable because they are being compared with e-cigarettes. This is speculation of course, but is plausible and potentially a very exciting phenomenon: the mere existence of e-cigarettes adjusting perceptions of smoked cigarettes.
Sadly, Tobacco Control has become a campaigning group with one goal: to destroy the Tobacco Industry. This may seem a laudable aim, but it leads a reflexive opposition to Tobacco Harm Reduction; a concept which necessarily involves the probability of the TI turning a profit. The net result is that a valuable “third way” for heavily dependent smokers is thrown out in pursuit of the “Tobacco Endgame”.
What is particularly sad is the degree to which TC ignores the relative weakness of the TI within the e-cigarette category, and unintentionally bolsters their future likelihood of market dominance.
Perhaps the most egregious example of this is the furore over flavors. Flavors are held to be “designed to entice children” (despite no evidence whatsoever that this is actually occurring in non-smoking children). The implication is that this is a tobacco industry ploy, yet a cursory examination of the products the TI has on the market shows a quite different story: the flavors they offer are limited to three or four blandly marketed lines.
There's a simple reason for this. The TI's entire business model depends on low inventory numbers maximising the profitability of the shelf-space they have access to through their distribution network. Their competitors in the CHCs (Clean-Hands Companies) do not have access to this network, but have their own venues: online sales and dedicated vape stores, of which there are an estimated 14,000 in the US alone. Inventory numbers are a huge bonus for these businesses, since vapers have a huge appetite for choice. And the flavors themselves, far from being created to appeal to children, have emerged as a function of adult smoker consumer demand. There is really no reason whatsoever for the CHCs to want to entice children into a market that is already so enormous and so untapped!
There are three principal arguments against e-cigarettes: that they renormalise smoking; that they act as a gateway to smoking; that they are inherently unsafe. So far, there is no evidence for any of this, and powerful and increasing evidence that e-cigarettes are proving to be a miracle product for many smokers. Members of Tobacco Control should be extremely careful what they wish for.
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