Electronic cigarettes and harm reduction: How the UK held off regulation that could have killed a life-saving technology

By Matt Ridley. Excerpts:

"Britain is the world leader in vaping. More people use ecigarettes in the UK than in any other European country. It’s more officially encouraged than in the United States and more socially acceptable than in Australia, where it’s still banned. There is a thriving sector here of vape manufacturers, retailers, exporters, even researchers; there are 1,700 independent vape shops on Britain’s streets. It’s an entrepreneurial phenomenon and a billion-pound industry.

The British vaping revolution dismays some people, who see it as a return to social acceptability for something that looks like smoking with unknown risks. Yet here, more than anywhere in the world, the government disagrees. Public Health England says that vaping is 95% safer than smoking and the vast majority of people who vape are smokers who are partly or wholly quitting cigarettes. The Royal College of Physicians agrees: “The public can be reassured that ecigarettes are much safer than smoking.”

Lots of doctors are now recommending vaping as a way of quitting smoking. It is because of vaping that Britain now has the second lowest percentage of people who smoke in the European Union. The youth smoking rate in the UK has fallen from 26% to 19% in only six years."

The UK decided not to ban vaping

"The market did the rest. Entrepreneurs ranging from nightclub owners to former RAF pilots were already sniffing the opportunity to make and sell the devices. Experimental designs proliferated in Britain as nowhere else. As so often with innovators, all they needed was nobody getting in their way. They knew from the start that their target market was smokers desperate to quit, but who found gums, patches, acupuncture and hectoring did not work very well.

Professor Gerry Stimson of Imperial College, an expert on harm reduction, points out that it’s much easier to persuade people to do something if it is enjoyable rather than a painful chore: “For those trying to stop smoking, ecigarettes have profoundly changed the experience. For the first time, quitting cigarettes is no longer associated with being a ‘patient’ and with personal struggle.”"

"That vaping was far cheaper than smoking was a key incentive. Today, Britain has more than twice as high a vaping rate as the rest of the European Union: 5% versus 2%."

• 2.9 million The number of ecigarette users in the UK (of these, 1.5m have completely quit smoking cigarettes)
• £400 Amount the average smoker in Britain spends every three months on cigarettes
• £190 Amount the average ecig user in Britain spends every three months (if buying from supermarkets)
• 95% How much safer vaping is than smoking, according to Public Health England

"True, nicotine is addictive, but so is caffeine, another anti-pest chemical produced by plants that has psychoactive effects, but is ingested by people in a less risky form than smoke. Smoking’s health risk comes not from nicotine, but from the chemicals created in the flame.

So giving smokers nicotine without giving them any smoke just has to be safer. In 2016, a series of key scientific papers from the lab of Dr Grant O’Connell, a scientist working for the ecigarette manufacturer Fontem Ventures, reported that smokers confined in a clinic for five days who switched to ecigarettes got the same amount of nicotine but much less exposure to the harmful toxicants known to cause smoking-associated disease risks, such as nitrosamine and carbon monoxide. After five days, the levels of harmful toxicants measured in their blood and urine was like that of smokers who went cold turkey over the same time. The subjects also had improvements to lung and heart function.

This year the team published one of the first long-term clinical studies, which monitored 209 smokers who used ecigarettes for two years. It found no evidence of any safety concerns or serious health complications in smokers after two years of continual ecigarette use."

"For vaping to be beneficial, it does not have to be harmless. Surveys suggest 98% of vapers are smokers, so even if vaping carries a moderate risk, so long as it is less than the risk of smoking, there will be harm reduction."

"Opponents of vaping still worry it is a gateway into smoking, fearing the young are being lured into nicotine addiction by vaping before moving on to smoking. Clive Bates, a former civil servant and campaigner for progressive causes, lambasts the gateway argument as patronising: “Kids have been weaponised in an activist battle to bend the adult world out of shape where it serves an abstinence-only agenda.”

Bates points out that smoking rates among young people are falling faster since 2010 than they were before, that surveys show the majority of underage vapers are former smokers or would-be smokers, and that young people give harm reduction as their main reason for vaping when asked. As with adults, ecigarettes look as though they are protecting children against smoking much more than luring them into it. In short, the gateway argument just does not hold up.

The argument that vaping cannot yet be proven safe, so must be assumed to be unsafe, is an example of what can go wrong with the “precautionary principle”. If an existing technology is killing people, and a safer alternative comes along to save their lives, then waiting for watertight evidence about the risks of the new technology is effectively culpable homicide. The precautionary principle thus applied holds new technologies to a higher standard than existing ones, stifling beneficial innovation."

"Most premises insist on sending vapers out in the cold to stand shivering among smokers in winter, treating the two groups the same. This, say vaping’s proponents, is madness. It reinforces the false message that vaping is just as harmful as smoking. Further, it actually makes it harder to quit by exposing them to temptation.

One of the advantages of ecigarettes is that you don’t have to finish them. Take one quick puff and put it back in your pocket. With a cigarette, you feel obliged to smoke the whole thing. If a worker has to trek out into the street to vape, he will take more puffs than if he can do it at his desk. And he will waste more of his employer’s time.

It’s actually easy to vape discreetly, with no visible vapour and no smell, so lots of vapers are probably already doing it surreptitiously at work."