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Levels of risk debated again

What degree of risk is acceptable? The question is of vital importance, since everything we do involves risk. Life has been described as a sexually transmitted disease with 100% mortality. Automotive travel is one of the riskiest behaviors that we all take for granted. Everyone feels invulnerable upon getting into a car, but the chances that you will die in an automotive mishap are 1 in 112. Smokers greatly increase their risk of dying from certain diseases, and on average die 10 years earlier than non-smokers.

As the debate swirls around electronic cigarettes, the question is often asked, are they safe? What a silly question. Of course they are not! Nothing is.

How safe? We won't have a precise answer to that question for some time yet, for obvious reasons. Research takes time.

What is absolutely certain now is that vaping is many times safer than smoking. But some participants in the debate about vaping continue to repeat the litany that vaping should not be given a green light until it is proven to be "safe". This is a foolish and impossible goal.

The debate over this foolish demand has surfaced once again, in an article by fretful medics Chris Valentine and Paul Nicholson in the British Medical Journal, and a response by harm reduction champions Konstantinos Farsalinos and Riccardo Polosa.

So how safe does something need to be for acceptance as an alternative to something that is absolutely proven to be horribly deadly? The fretful advocates of more precise knowledge about e-cig safety typically do not say (just as they typically do not distinguish between trace amounts and dangerous amounts when talking about harmful substances in products they oppose). They are often politicians seeking votes among a fearful public. Or activists revolted by the visual image of a smoker. Of course it is easier to sway the public with vague fears than to insist on careful reasoning. Impossible demands for years of research to prove 100% safety are more likely to garner votes and get prohibitionist politicians re-elected, and the fact that they will consign significant numbers of smokers to an unnecessary death can easily be swept under the rug.

The demand that products "should be quarantined until results from long-term studies are available... is not a requirement for any other product approved for human consumption," say the harm-reductionist medics.

The worried duo is quite exorcised by the issue of accidental poisonings. "Children consume products they find in the home," say Valentine and Nicholson. One might add "… when irresponsibly packaged or left lying about." But the fretful challenge bursts like a bubble when compared with policy toward other useful household substances that are harmful if ingested. We do not ban such products – we wouldn't be able to clean our houses or medicate ourselves adequately if we were to ban them. So we take steps to keep them out of the hands of those who might accidentally ingest them. We put them in child-proof containers, and teach responsible householders to keep them behind locked doors or on high shelves. We do not make a public ruckus about their evils, unless of course we are politicians trying to win votes, or public health advocates with an animus against the maligned products.

"The number of cases (of accidental poisonings by e-liquid) is extremely small compared with, for example, household cleaning products," say Polosa anf Farsolinos. "Childproof caps have been now introduced by most producers/distributors and this alone will prevent these rare accidents. Of course, regulation should implement such a requirement. In any case, [it] has never been proposed that medications or household cleaning products should be banned because of poisonings...." They also note that recent research shows fatal levels for nicotine ingestion to be far higher than was thought earlier, when statistics were collected in a scientifically unacceptable way, and furthermore, the inevitable outcome of profuse vomiting renders fatality a practical impossibility in such cases.

Once again, the harm reduction physicians have clearly carried the day in terms of well reasoned presentation of the scientific parameters of the issue. It is time for the medical community to pay serious attention to their arguments.