Britain and the U.S.: separated by attitudes to nicotine?

Differing views of nicotine in Britain and the U.S. may underlie a sharp contrast in official attitudes toward e-cigarettes, according to a group of public-health scholars.

“In England, where leading medical organizations regard nicotine alone as relatively benign, the pressing need to reduce the risks for current smokers frames the debate” and e-cigarettes are therefore seen as an acceptable alternative to combustible tobacco, say Sharon Green, Ronald Bayer and Amy Fairchild of the Mailman School of Public Health at Columbia University in New York.

They point to a “long-standing commitment to harm reduction” in Britain going as far back as 1926, when the government’s Rolleston Committee decided that drug addiction was an illness requiring medical treatment which could involve small doses of the drug being abused.

More recently, they say, “application of harm-reduction principles to tobacco products debuted in England in the 1970s, at the Institute of Psychiatry of the Maudsley Hospital” and has continued into the e-cigarette era, for example in the support given to vaping by the anti-smoking advocacy group Action on Smoking and Health (ASH).

But “the overwhelming focus in the United States is abstinence” from nicotine, they write in The New England Journal of Medicine.

“The dominant policy perspective in the United States serves as a foil to the one embraced in England. The Campaign for Tobacco-Free Kids – ASH’s U.S. equivalent and a powerful voice in anti-tobacco advocacy – has been unequivocal in its denunciations of e-cigarettes” and the Centers for Disease Control and Prevention (CDC), a federal agency, has focused on possible health risks of vaping rather than harm reduction, they say.

The trio’s article, “Evidence, policy, and e-cigarettes — will England reframe the debate?”, also highlights differences in the two countries’ approach to HIV, the human immunodeficiency virus which causes AIDS.

“When AIDS came to the United Kingdom in the 1980s, the first government report on…infection among injection-drug users encouraged safer drug practices. Meanwhile, the United States took a prohibitionist position. Tight narcotic regulation and refusal to provide narcotics to addicts as treatment or maintenance defined the U.S. posture for decades.”

What This Means: While these academics’ conclusions will be little consolation to U.S. e-cigarette business facing advertising bans, or for that matter to Scottish ones in the same position, they do illuminate an important point about regulation which can be lost in the minutiae.

The vaping debate is often not really about e-cigs, as such, at all: it is about smoking, and nicotine, and addiction: and those who advocate for light-touch regulation need to understand that it is attitudes to these issues they are up against, not minor misunderstandings of scientific studies.

– Barnaby Page ECigIntelligence staff

Photo: Georgie Pauwels

Barnaby Page

Editorial director

Before joining ECigIntelligence in early 2014 as one of its first employees, Barnaby had a 30-year career as a reporter and editor for newspapers, magazines and online services, working in Canada, the US and the Middle East as well as his current British location. He has edited publications covering fields including technology and the advertising industry, and was launch editor of the first large daily online news service in the British regional media. Barnaby also writes on classical music and film for a number of publications. Barnaby manages the editorial and reporting teams and works closely with the analyst teams, to ensure that all content meets high standards of quality and relevance. He also writes for the site occasionally, mostly on science-related issues, and is a member of the Association of British Science Writers.