Reducing Harm with Electronic Cigarettes

MARK TYNDALL
Contributed to Ottawa Citizen.
Published Jun 04, 2014
Source: click here

Instead of pursuing a national campaign with defined goals and strategies, we have relied mainly on stigmatizing smokers and promoting an abstinence-only model of control.

Cigarette smoking remains the leading cause of preventable disease in Canada and is a huge drain on our health care system. The estimated direct health care costs of $4.4 billion annually does not begin to capture the progressive health decline of those who smoke prior to receiving a defining diagnosis like cancer, heart disease or chronic lung disease.

Despite champions for tobacco control in Canada, it is remarkable how ineffective the public health response has been. Instead of pursuing a national campaign with defined goals and strategies, we have relied mainly on stigmatizing smokers and promoting an abstinence-only model of control. Those at the front lines of diagnostics, care and treatment of tobacco-related illnesses have pursued more aggressive, expensive and dubious approaches to disease management with too little focus on prevention. For the most part, smokers are left to battle their own addiction.

Higher taxes, graphic pictures on packaging, and tighter restrictions on where people smoke have all contributed to a gradual decrease in smoking, but have not been enough to persuade 4.7 million Canadians to quit. Another contribution to the persistence of smoking is the increasing concentration of smokers among the socially disadvantaged. They are more likely to start smoking, less likely to quit, and unlikely to make demands on health policy. If the richest 20 per cent of Canadian adults were hopelessly addicted to cigarettes and dying of miserable diseases, there would be a more urgency.

There are several indisputable facts about smoking. Firstly, the vast majority of smokers would like to quit based on health concerns, cost, and stigma. Secondly, nicotine is extremely addictive with both physiological and psychological barriers to quitting. Thirdly, the myriad of serious health consequences associated with smoking has little to do with nicotine and everything to do with the toxins inhaled through burning tobacco.

Enter electronic cigarettes. They allow people to quit “smoking” while continuing to receive nicotine through inhaling vaporized liquid nicotine. E-cigarettes are the ultimate harm reduction intervention as they allow people who are unable or unwilling to quit smoking to greatly reduce the health impacts. Led mainly by small entrepreneurs, the uptake of e-cigarettes has been brisk in an environment with little promotion and no regulation.

While the promise of e-cigarettes would seem to be tremendous, there are skeptics. Leading the list of concerns is that e-cigarettes are unproven and may have adverse unknown health impacts. While more research is certainly needed, the elimination of the toxins in tobacco smoke is the primary goal and e-cigarettes do just that. Another concern is that e-cigarettes could be a gateway to cigarette smoking. Although some young people will undoubtedly try e-cigarettes, they would be the same youth who try smoking, and it seems unlikely that they would switch to a more harmful product. A third concern is that we can never trust companies that deal in smoking. While tobacco companies have an appalling track record, we must not let our disdain for the industry undermine the benefits of e-cigarettes. Clearly, there should be regulations to ensure that the dose of nicotine is accurate, that other substances are not added, that sales to youth are restricted, and that there are health-based limits to advertising. This is well within our regulatory capacities.

E-cigarettes have great potential to improve health, save lives and reduce health care costs. By clinging to moralistic arguments of abstinence-only models of substance use, unsubstantiated concerns about the risk to our youth, and a deep-rooted mistrust of tobacco companies, we could truly miss an historic opportunity to radically alter smoking-related disease in Canada and around the world.