Let me pitch a hypothetical product to you. It’s a burger, draped in melted cheese, oozing with delicious juices and blanketed in bacon. It smells, feels and – most importantly – tastes like the most cholesterol-laden, artery-clogging and calorific burger you’d find at a fast food outlet. But there’s a difference.
The harmful LDL cholesterol has been replaced with the more beneficial HDL cholesterol, and the masses of saturated fats are actually the healthier, unsaturated versions.
It’s a startling representation of the type of foods which cause obesity (a condition affecting one third of Americans, which can cause heart disease, strokes and some cancers), but it carries only a fraction of the risk.
Obese people with no interest in changing their diets have happily made the switch onto the healthier alternative, thus significantly reducing their chance of premature death. They’d still be healthier if they switched to a traditional healthy diet, but it’s a massive improvement on their current reliance on dangerous fatty foods. In short, there is a huge market, undeniable potential to improve public health and it’s had positive reactions from the target market.
If you had the required bankroll, you’d have to be a moron to pass up on the opportunity. However, if on hearing about this product you didn’t only dislike the idea, you actively tried to prevent it from being sold, it would be entirely reasonable to assume that there was something wrong with you. You’d have to hate burgers in any form, think all fat people should either switch to an un-dressed salad-only diet or die from heart disease, or have a significant financial stake in McDonald’s.
The Facts
Of course, the product above is made up, but a very similar harm reduction device manages to illicit unbridled hatred.
We’re talking about e-cigs. The basics are widely-explained online, but here’s a basic, CliffsNotes-overview of the research surrounding the safety of e-cigs.
- They are significantly safer than smoking cigarettes, and although trace amounts of carcinogens have been detected, they are also found in comparable levels in FDA-approved smoking cessation products (and up to 450 times lower than in tobacco cigarettes).
- There is very little risk to bystanders and they have been shown to help people quit smoking more effectively than existing methods.
- They don’t pose the same risks as smoking for heart function, and inhaling pure nicotine doesn't increase the risk of cancer.
Research is definitely ongoing, but common sense and existing studies on e-cigs present no reason to think that vaping (using e-cigs or vaporizer pens) is as dangerous as smoking, in fact they strongly support the notion that it is significantly safer than smoking, and may enable more smokers than ever to kick their habit.
Just like the hypothetical burger, they might not be perfect, but they have a massive potential for harm reduction and consequently for saving lives. Yet some people outright hate them. The reasons for this could range from self-protection to ideological vilification, but if we aim to protect the future of tobacco harm reduction, it’s vital to understand what drives the backlash.
The Financial Fear
If we were to split the anti-e-cig crowd into groups, the most easily defined would be those who dislike e-cigs because they aim to cripple their profits. In the same way as a McDonald’s shareholder would oppose the new burger which offered all the benefits of their food with significantly reduced side effects, people with a stake in tobacco cessation products inherently distrust e-cigs. They offer the sensation of smoking, the nicotine users are looking for and a fraction of the risks.
Existing smoking cessation methods have success rates of around 7 percent after six months, but even amongst smokers who don’t want to quit, 22.5 percent report abstinence after six months if they use e-cigs. If a reduction of over 50 percent in cigarette smoking is counted as well as abstinence, 55 percent of smokers who didn’t want to quit successfully reduced their consumption after six months with the help of e-cigs.
With more optimistic estimates of existing cessation products being around 12 to 18 percent effective, it’s immediately clear that e-cigs are much better for smokers hoping to quit.
This is excellent if you’re interested in public health, but if you happen to want to sell smoking cessation products rather than actually help smokers reduce the harm they’re doing to themselves, it’s very troubling indeed.
The market for smoking cessation products is estimated at around $3 billion per year, so there is significant profit up for grabs for companies such as GlaxoSmithKline and Pfizer, who offer products such as the Nicorette range and Chantix. As you might expect, the industry is wary of this new competition, and have undeniable incentive to play up the risks of e-cigarettes.
Big Tobacco companies, on the other hand, have started to buy e-cig companies, clearly recognizing their dwindling market and opting to protect themselves in any way they can. These groups have an inherent interest in playing up the dangers of e-cigs, but sadly the methods they use aren’t always above board.
Dirty Tactics
The situation isn't as simple as it could be for those who want to bad-mouth e-cigs to protect their profits, since the underlying motives are so transparent.
The solution to this is to financially encourage other organizations to support your cause. This is why companies like Pfizer fund anti-smoking organizations like the American Legacy Foundation, the American Lung Association and Action on Smoking and Health (ASH), with them paying out around $2.8 million in 2011-2012 alone. Another example comes from GlaxoSmithKline, who gave $1.36 million to the many of the same organizations between 2009 and 2012.
It comes as little surprise that numerous organizations who receive this funding release statements calling for electronic cigarettes to be removed from the market, playing up the potential risks and redundantly supporting the results of poorly-conducted studies.
It’s a dirty web of back-handed funding and conflicts of interest, and it doesn’t look any better if you analyze it in any more detail.
The notion that organization like the American Lung Association, who (and I quote) support “[saving] lives by improving lung health and preventing lung disease,” don’t support such a promising tobacco harm reduction measure is absurd, and seems to make much more sense when viewed as a consequence of their pharmaceutical funding. Even organizations apparently dedicated to improving public health are allowing financial ties to dictate their advice regarding e-cigarettes.
Quit or Die!
So some of the anti-e-cig propaganda out there may well be inspired by generous donations, but there are plenty of examples which can’t be explained through financial interest. These have numerous causes, but could easily be related to the abstinence-based ethic which pervades American addiction treatment.
12 Step programs are widespread, most closely associated with Alcoholics Anonymous. Alongside encouraging the belief in a “higher power,” the 12 Step philosophy is entirely abstinence-based, meaning that they believe the only way you can overcome addiction is to completely stop consuming the substance.
This model has numerous criticisms, but the most relevant one with regards to the e-cigarette debate is from the harm reduction model. It basically states that if an individual can’t stop consuming an addictive substance altogether, it’s much better to make their continued consumption as safe as possible.
This is why e-cigs are tobacco harm reduction – yes, the addiction technically continues, but it causes significantly less damage than smoking tobacco. The abstinence-only approach forces those who can’t stop altogether to keep trying to, even if they consistently fail and endanger themselves as a result.
Harm reduction is a vital compromise – acknowledging that people enjoy consuming substances whilst trying to minimize the impacts on their health. It is a necessary alternative, especially when the poor retention and success rates of abstinence-based treatment are taken into account.
The problem is that the nation’s overall trust in the abstinence-based treatment model leads some to think that those who use harm reduction alternatives (like e-cigs or methadone) are somehow “weak.”
The criticism commonly heard is that the nicotine addiction is just going to continue, or that e-cigs are a gateway to tobacco addiction. This is basically a misunderstanding of the entire purpose of harm reduction, which is arguably driven by the prevalent “quit or die” approach to addiction treatment. This problem spreads much further than the world of e-cigs, but explains a good deal of the backlash.
Of course, if we use the burger example from the introduction, the absurdity of this attitude comes through strongly. The critics of the healthy burger would be arguing that they should either eat raw salads or fatty, dangerous fast food. Relying on reduced harm versions of dangerous products is weak, and only allows the addiction to continue. This is fair, in a way – after all, the individual still relies on the same sensation – but it completely ignores the fact that the abstinence approach doesn’t work for everybody. They would think obese people should either go fully healthy or clog their arteries into oblivion, refusing to accept that a middle-ground approach is more realistic.
Ideological Hatred
The final, undeniable reason for the backlash against e-cigs is an ideological hatred of anything resembling a cigarette.
Hating cigarettes for their health risks is understandable, but hating something just because it looks like a cigarette or contains nicotine is idiotic. Nevertheless, it doesn’t stop organizations like the World Health Organization calling for a ban on e-cigarettes because they threaten to “undermine the denormalization of tobacco use.”
In other words, their superficial similarity to cigarettes is enough reason to ban them. If you follow this through logically, it descends into madness: a commenter on the HuffPost Live debate regarding e-cigs sarcastically asked if we should ban pens because they look like e-cigarettes.
Ideological hatred may seem like a harsh phrase, but how else can you explain things like campaigners comparing smokers to serial killers? People looking down on smokers is unfortunately common, and the same attitude is rubbing off on e-cigs. They see e-cigarettes as a cunning new disguise for the tobacco industry, not something which can help save people from smoking-related diseases. People who hate e-cigs for ideological reasons effectively don’t care about their health benefits compared to ordinary cigarettes. They just want to ban them, at all costs.
This explains why weak arguments – like the idea that e-cigs are desired to lure children – are regularly thrown around. It doesn’t matter if there are numerous flaws with the reasoning; these people are basically executing a smear campaign against e-cigs.
This is potentially the most despicable reason to hate e-cigs of all; condemning people to lives of disease and infirmity because of your own emotionally-charged attitude towards anything resembling smoking.
What Can be Done?
Understanding what drives the anti-e-cig crowd helps to make sense of the torrent of abuse flung at the technology, but it isn’t pleasant reading.
It seems that there will always be opposition to nicotine products and harm reduction, but the future isn’t as bleak as you might think.
It’s clear that people hate e-cigs because of a misunderstanding of the technology or philosophy, financial incentives or an all-consuming, ideological hatred of smokers. In essence, these people have nothing in the way of a reasonable argument against e-cigs.
The only thing proponents of e-cigs can do is offer the rational, evidence-based perspective and hope the right people pay attention.