smokefree said:A petition to the US FDA to "Keep life saving electronic cigarettes
available" is at:
http://www.thepetitionsite.com/1/keep-life-saving-electronic-cigarettes-ava
ilable
2,500 have already signed the petition, with many comments on the
effectiveness of e-cigarettes.
- - -
An Interview With David Sweanor on the E-Cigarette, tobacco harm reduction,
snus and other issues
E-Cigarette Direct
March 31, 2009
E Cigarette Interview with David Sweanor
David Sweanor has worked with numerous companies and organisations,
including the International Union Against Cancer, World Health
Organization, World Bank and the Pan American Health Organization, on the
issue of tobacco harm reduction. He has received both international
recognition and prestigious prizes for his work.
ECD: How did you get interested in the issue of Tobacco Harm Reduction?
DS: I have been actively involved in tobacco and health policy issues since
the beginning of the 1980s. During that time I have tried to apply the
lessons from other successful public health campaigns. Any effort to reduce
death, injury or disease entails some combination of four broad strategies:
1) Measures to prevent people from ever engaging in a risky behaviour
2) measures to get those engaging in the behaviour to cease engaging in it
3) efforts to prevent injury to third parties as a result of the behaviour
4) efforts to reduce the risks to those who will continue the behaviour.
By the early 1990s there was no doubt that the vast majority of the harm
caused by smoking was from the method of nicotine delivery rather than from
the nicotine itself. There would be a parallel problem if people got
caffeine from smoking tea leaves rather than making an infusion of these
leaves in hot water. At the same time the projections of future smoking
rates was for increasing consumption despite global anti-tobacco policies,
and there was increasing scientific understanding of the reasons people use
nicotine. An abstinence-only policy aimed at a nicotine-free world was
simply unrealistic.
So certainly by the 1990s, and much earlier in the case of far-sighted
researchers such as Michael Russell, it was clear that there were huge
gains to be made from dealing with the delivery system. Oddly, though there
had by that time been much focus on issues such as where the product could
be used, how it was taxed, limits on advertising, controls on places of
sale, packaging requirements, etc., there was little to nothing being done
about the product itself.
ECD: What progress has been made since you got involved?
DS: Short answer: Not enough.
Longer answer: There is now a much greater awareness that there is a very
pronounced continuum of risk depending upon how nicotine is delivered. We
are also seeing greater (though still poor) availability of medicinal forms
of nicotine and a proliferation of new nicotine products. There is also no
longer any scientific doubt that combustion-based products are massively
more hazardous than non-combustion products such as Swedish snus. My
experience is that as soon as someone grasps the concept of the continuum
of risk and recognizes that all nicotine use is not going to end anytime
soon, the pieces start coming together. This comes at a time that many
countries are moving toward regulating tobacco products and discussing the
need for some form of comprehensive regulatory oversight of the full range
of nicotine products. Clearly, any rational health-focused regulation will
demand that we deal with issues of differential risks.
ECD: I know that you don't necessarily agree with our theory that there is
a conspiracy against alternative forms of smoking. Yet you have said Snus
is a far safer alternative to smoking than cigarettes. How do you explain
the reasons for illogical bans against alternative forms of tobacco such as
in the European Union, where Snus has been banned but both cigarettes and
more dangerous forms of chewing tobacco remain legal?
DS: I think cigarettes have dominated the marketplace of most countries for
so long that people have trouble even thinking of alternatives. Many of
those who seek restrictions on non-combustion products, and certainly some
of the companies selling them, see them as a way to perpetuate rather than
replace cigarette smoking. When snus was positioned as a potential
additional problem, rather than as a potential partial solution to a much
bigger health problem, efforts to keep it off the market seemed logical.
We also have an issue with the tendency of our species to do something
because we can rather than to look at issues in a more comprehensive way
that will better meet long term goals. It was possible to get laws banning
a tobacco product that was not yet on the market, just as today it is
possible to enforce existing drug laws to ban new recreational nicotine
products. Had there been greater awareness of relative risks and a less
risk-averse mentality snus could have been seen the way auto safety
advocates saw Volvos - an agent of change for the marketplace.
ECD: What damage has been caused by the Snus ban?
DS: I think the key thing is that we have lost a great chance to
effectively show proof of concept for the provision of less toxic
alternatives to cigarettes. As soon as there is recognition that consumers
can access nicotine without repetitious inhalation of tobacco smoke, and
that some portion of current smokers find this to be an acceptable (even
preferable) alternative to smoking, it causes a paradigm shift. If we get
to the point of no longer seeing cigarettes as a nicotine maintenance
monopoly we could change the face of public health. If we recognize that
the needs of smokers can be met in a way that does not necessarily result
in the untimely death of roughly half of long term users maybe we can move
society conceptually to the point that nicotine delivery can go through the
same metamorphosis as weve seen with auto safety, telecommunications,
sanitation, pharmaceuticals, food preparation standards, alcoholic
beverages and a myriad of other goods and services. The market could be
transformed (assuming an appropriate regulatory system) through a virtuous
circle of increasing consumer awareness and ever-less-hazardous
alternatives to cigarettes.
In addition the ban on products such as snus causes significant ethical and
human rights problems. The idea of simply denying access to such a product
to millions of smokers - people who are thus left using a massively more
hazardous product - should be a great cause of concern. Misleading
statements about the risks of products such as snus, especially those from
major health organizations and government health departments, also run the
risk of eroding consumer trust in public health authorities - a problem
that ultimately impacts far more than issues of nicotine.
ECD: Do you see any parallels between Snus and the Electronic Cigarette,
and the opposition against both of them?
DS: Some part of the opposition to nicotine products comes from the same
moral absolutism that we see in other abstinence-only efforts on issues
concerning such things as alcohol and sexual activity. Actually, on a very
wide range of issues there is a tension between those on a
moralist/absolutist quest (usually tied to ideas on the perfectibility of
mankind) and those on a pragmatic public health mission. It would wrong to
characterize those on a moral quest as being public health advocates, and
this is true whether looking at abstinence-only campaigns on sex, on
alcohol, on illicit drugs or on nicotine. Campaigns based on making better
people rather than making people better are driven by moral concerns rather
than public health concerns.
ECD: You've stated that electronic cigarettes are not safe, but that they
are a lot better than cigarettes. Just how unsafe are they?
DS: After many tens of thousands of research papers we know what causes the
illnesses associated with smoking. In short, its the smoke, stupid.
Non-combustion products will vary in their risks, but everything we can see
about the sort of product sold in the West (whether smokeless tobacco,
electronic cigarettes or medicinal nicotine) tells us that cigarettes are
orders of magnitude more hazardous.
As to not safe, we perhaps need elaboration. The point I try to make when
faced with the its not safe canard is that nothing meets the criteria of
being absolutely safe. Everything has risks, so simply pointing out that
something is not safe shows a person to be either ignorant or disingenuous.
The key issue in looking at safety is that it is a relative concept; we
need to look at safety of any activity compared to some alternative. Rather
than the unattainable standard of safe we should be thinking in terms of
safer. Despite the risks associated with soccer, I would, for instance,
prefer my children play soccer rather than play with live hand grenades.
ECD: You are a supporter of the electronic cigarette? Can you tell us why?
DS: I am a supporter of less toxic alternative for smokers. Nicotine use
should not come with a death sentence.
Ideally we need a nicotine regulatory authority that can facilitate efforts
to get alternative products to smokers, accurately inform them of relative
risks and move them as far as possible down the continuum of risk.
The nicotine market needs to experience a shake-up and the entrepreneurs
who appear to be behind the e-cigarettes might be sufficiently
risk-tolerant to cause it to happen. The issue needs to get on the public
and political agenda, and we will not get the needed re-thinking of the
whole nicotine market until this happens.
ECD: Opponents of the electronic cigarette have said that it could stop
smokers from giving up, that is untested and untried and that claims that
the electronic cigarette are healthier than normal cigarettes are unproven.
How would you respond to these allegations?
DS: There is no innovation that I am aware of that did not cause detractors
to list various potential negative consequences were the product to be made
available even safety bicycles in the 1890s! But when the status quo is
one that will, according to the WHO, result in a billion deaths this
century surely we need more than a fear something bad might possibly happen
to reject an alternative to that status quo.
The obvious solution is to have a regulatory agency that facilitates
getting the least hazardous products to consumers, with post-marketing
surveillance to control any unintended negative consequences. It certainly
would make much more sense than the current state of affairs where
government agencies are banning products like snus and e-cigarettes,
greatly constraining the potential market for medicinal nicotine, and thus
protecting the cigarette cartel rather than the health of citizens.
If there is anyone who believes cigarettes are no more hazardous than
e-cigarettes Id recommend a remedial course in basic sciences. For
anti-nicotine campaigners who say we need to wait for more research I would
point out the way they are proving Nietzsche correct - we take on the
attributes of our enemies. Cigarette companies spent decades making
spurious claims that we need more research before we could move on policy
measures, despite the already-existing basis for informed policy measures.
They provide very poor role models.
ECD: One criticism that has been levelled at the electronic cigarette is
that we don't know the effect of heating up a nicotine vapour and inhaling
it into the lungs. Is this a valid criticism?
DS: We certainly know that inhaling a heated nicotine vapour into the lungs
is one heck of a lot less hazardous than inhaling the same vapour along
with the thousands of chemicals and dozens of known carcinogens that are
inhaled when that vapour is delivered by smoking a cigarette. An
investigation to determine if the non-smoke vapour is, say, 1/100 or
1/1,000 the risk of cigarette smoking might be a good thing. But if someone
thinks cigarettes should not be challenged in the marketplace until we have
such results I think they need to try thinking a little more deeply. They
should also question whether they have undergone a Nietzsche-like
transformation that is causing them to be sounding like a 1970s cigarette
company executive.
ECD: How do you feel about the public health campaigners, via their
campaign to ban electronic cigarettes, attempting to limit the choice of
addicted smokers unable or unwilling to quit smoking to cigarettes and
cigarettes alone?
DS: I dont think public health campaigners do this. I think some people on
a moralistic abstinence-only agenda take this position, just as some take
the position that consumers of alcohol should have no alternative to
products like Jamaican Jake or that no one should have access to birth
control, or that ...... addicts should not be given clean needles. But
those people are not public health campaigners.
At the same time, I think there are people who are legitimate public health
campaigners who oppose products like e-cigarettes. This can be because they
want all such products to come within a comprehensive regulatory framework
for all medicinal and recreational nicotine products; one designed to help
move smokers away from cigarettes. They fear that unregulated products
could proliferate and create a huge snake oil business. But I also think it
is incumbent upon such people to be advocating for such a regulatory
framework rather than just inadvertently protecting the cigarette business.
ECD: The issue of electronic cigarettes is up in the air at the moment. How
do you see the future - will it follow Snus into oblivion or will it become
the smoking method of the future?
DS: I think we are in the early stages of a revolution on recreational
nicotine delivery. Just as with the telecommunications revolution it is
likely impossible at an early stage to know how it will change. But it is a
safe bet that consumer interests and entrepreneurship will combine to cause
fundamental change, as we are already seeing with the rapid growth of
non-combustion tobacco products in places such as Norway and the United
States and the much greater use of medicinal nicotine products for purposes
other than near-immediate nicotine cessation. The winning products in this
market transformation will likely be of a wide variety, given differing
consumer preferences and the nature of dynamic markets. I personally think
that some of the most successful products will likely help consumers wean
themselves off nicotine over time. But hundreds of millions of
smoking-caused deaths will be averted by greater consumer choice and a
proliferation of products, untold billions of dollars will be made by the
owners of the successful products, and innumerable jobs will be created as
this market transforms. Seldom is there an offer to become a billionaire
while saving millions of lives. I think there will be takers.
Sorry about the length, I haven't even finished reading it myself.
Cheers,
-Mickey
