Whether e-cigarettes could increase consumption of conventional tobacco is “the only thing that matters” about them from a public health perspective, a prominent British academic said today, dismissing many of the other issues that have bedevilled discussion and regulation of the new product category.
Peter Hajek, a professor at Queen Mary University in London and director of the city’s Tobacco Dependence Research Unit, used his keynote address at the First Global Forum on Nicotine in Warsaw to demolish much of the opposition to e-cigarettes and other alternative methods of nicotine delivery.
To start with, he said, the issue is often misconceived: “The comparator is not nothing, but smoking.” In other words, for much of the population, the realistic alternative to obtaining nicotine through products such as e-cigs is not doing without nicotine at all, but getting it from combustible tobacco.
He then suggested that “the goalposts are moving” in terms of anti arguments, with a new one introduced each time an earlier one is answered. Successive cases against e-cigs have included the harms of nicotine, the harms of e-cigarette ingredients, appeal to children, the re-normalisation of smoking, and the rehabilitation of the tobacco industry, he said.
And he observed that “the first gut reaction [to e-cigs] was negative” among many anti campaigners, thanks to factors such as the apparent production of smoke, the “cigarette” terminology, and the “shadows of the tobacco industry”. Confirmation bias – the tendency for us to notice information that backs up what we already believe, rather than that which contradicts it – then entrenched this first reaction.
Other possible contributors to anti sentiment, according to Hajek, include the role of big pharma, which has much to lose if e-cigs supplant its nicotine replacement therapy (NRT) products; zealots on the fringe of tobacco control; activists against smoking who feel that e-cigs threaten their achievements; and activists who perceive the enemy as the tobacco industry, rather than disease.
“Public health issues are often driven by a moral agenda rather than by evidence,” said Hajek, comparing the e-cig debate with polarising issues such as abortion and assisted dying. But, he insisted, “the problems [raised] so far to justify regulating restrictions are just made up”, although evidence supporting them could yet emerge.
The keynote at the Global Forum on Nicotine was given in memory of Michael Russell, a South African-British psychiatrist who pioneered understanding of tobacco use in the 1970s and 1980s and was an early advocate of nicotine products safer than cigarettes.
– Barnaby Page ECigIntelligence staff
Photo: Alberto Carrasco Casado