The prestigious Royal College of Physicians in Britain has just delivered what can best be described as a ringing endorsement of e-cigarettes, saying they are "beneficial to public health" and the "public can be reassured that e-cigarettes are much safer than smoking."
In the process, the RCP also delivers a stinging rebuke to public-health officials who, for the most part, have taken the absolutist and moralist stand that vaping is as bad as smoking rather than an effective harm-reduction measure.
In its new, 200-page report, titled "Nicotine without smoke: tobacco harm reduction," the RCP's tobacco advisory group makes some sweeping conclusions, including:
- E-cigarettes are not a “gateway” to smoking: Vaping is embraced almost exclusively by those who are using or have used tobacco;
- Vaping does not “normalize” smoking: There is no evidence that never-smokers, and teens in particular, are drawn to e-cigarettes and will end up smoking as a result
- E-cigarettes are, for many, an effective smoking-cessation tool and people are more likely to try quitting if vaping is available as an alternative;
- The potential long-term harm of e-cigarettes is unknown but there is no question the harm is less than tobacco.
In fact, the blue-ribbon panel concluded that, all told, e-cigarettes are about 95-per-cent safer than cigarettes.
The controversy over e-cigarettes isn't going to go away. Not smoking/vaping is better than smoking/vaping – that's indisputable.
But public health officials, who generally embrace a harm-reduction approach over a "just say No" approach to tackling drug use have been strangely inconsistent when it comes to smoking.
With smoking, the attitude has always been: Even one puff is too many and that approach has carried over to vaping.
That black-and-white approach is not appropriate. We know that what is addictive in cigarettes is nicotine but what is harmful is the smoke, the by-products of combustion.
The major benefit of e-cigarettes is that they produce vapour, not smoke, markedly reducing the risks. There are, however, some ingredients other than nicotine in the vapour (largely due to the lack of manufacturing standards), but again, they are substantially less than the known risks of tobacco.
Of course, you still have your addiction to nicotine but nicotine is largely innocuous, much like caffeine. The biggest harm of e-cigarettes then is to your pocketbook because a vaping habit can be costly.
The RCP, in its report, is careful to say that there should be regulation, especially to protect children. But it says the regulatory strategy should focus on ensuring products are safe and standardized rather than discouraging their use by smokers.
Tobacco is lethal.
In Canada, smoking kills an estimated 37,000 people a year. It is a major cause of disability, health costs and premature death. You lose about three months of life expectancy for ever year of smoking.
Despite four decades of anti-smoking efforts, about 15 per cent of adults still smoke, some five million people.
Quitting smoking is really, really hard.
If we continue to embrace an abstinence-only approach, we will fail to help many people reduce how much they smoke and, ultimately, their ability to quit.
Until now, we have treated most smoking-cessation tools – other than laws like workplace bans – as medicine. You can, for example, get a nicotine patch, or nicotine gum to tamp down cravings.
What distinguishes e-cigarettes is that they are not viewed as medicine but a socially acceptable alternative to smoking, something that provides pleasure (or, at least, satiation of a craving) while reducing harm.
In a statement released with the report, Professor Jan Dacre, president of the Royal College of Physicians, said that the RCP has, since 1962, been advocating for better policies and services to help people quit smoking.
This report concludes that e-cigarettes do so, and bring us one step closer to the ultimate goal, a tobacco-free society.
"With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people," Prof. Dacre said.
Embracing the use of e-cigarettes by smokers "is an opportunity that, with care, we should take."
André Picard