Smoking (and european regulation) kills — matt ridley

My Times column is on harm reduction, Swedish snus and e cigarettes

Is this the end of smoking? Not if the bureaucrats can help it.

Sweden s reputation for solving policy problems, from education to banking, is all the rage. The Swedes are also ahead of the rest of Europe in tackling smoking. They have by far the fewest smokers per head of population of all EU countries. Lung cancer mortality in Swedish men over 35 is less than half the British rate.

Have they done it by being more zealous in ostracising, educating and shaming smokers in that paternalistic Scandinavian way? No they did it through innovation and competition. In the 1980s Swedes developed a tobacco product called snus, which you put under your upper lip. You get the nicotine but not the tar. Snus is the most popular and effective way of quitting smoking in Sweden (and Norway).

You will not have seen snus on sale in Britain, for the simple reason that the EU banned it. When Sweden joined the EU, it negotiated a special opt out. To this day, despite abundant evidence that snus is saving Swedish lives by the bucket load, despite advice from experts, and despite a devastating critique of its own feeble defence of the policy, the European Commission remains committed to the snusban.

You may think this is rather an obscure topic with which to occupy such a prominent opinion pulpit as this page but it is a vital background to the debate about electronic cigarettes for, if snuscan halve smoking and lung cancer deaths, imagine what electronic cigarettes could do. These are objects that mimic the actions of smoking but are maybe 1,000 times safer, and whose sales are doubling each year,without any government encouragement or medical prescription. E cigarettes may wipe out smoking in a couple of decades. Professor David Nutt of Imperial College describes them as the greatest health advance since vaccines .

Tobacco sales are falling in Europe and America and the industry fears it is facing in electronic cigarettes its Kodak moment as when digital photography destroyed a dominant film camera firm in a flash. Wells Fargo in the USA predicts that
e cigarettes could out sell cigarettes within ten years.

Surveys show that e cigarettes are now the most popular method of quitting smoking, despite a lack of encouragement from the authorities. Pick up a leaflet from your chemist on how to quite smoking and you will find they are not even mentioned. When I made a speech on this topic in the House of Lords, I was stunned by the enormous response I got from vapers , enthusiasts for e cigs. What was especially startling was how many of them told of trying to quit for decades, then finally succeeding.

Yet, instead of welcoming this technology, the powers that be, in Brussels and Whitehall, are determined to throw obstacles in its way. Last week the European Parliament voted in support of the Commission s proposal that bans reusable electronic cigarettes and those with a nicotine concentration over 20mg/ml. Our own government is intent on translating these EU restrictions into British law, egged on by the British Medical Association and the big pharmaceutical industry, which burble on about protecting children from a new threat and not wishing to see the renormalising of smoking.

Why are public health officials so resistant? The European Commission frequently displays a precautionary bias against innovation, weighing any risk of a new product, however small, but not the risk of an old product it might replace hence its attitude to genetically modified crops. In raising the unknown (but small) risks of e cigarettes, the public health establishment is missing the point. What counts is harm reduction, not perfect utopian safety. Don t let the best be the enemy of the good, said Voltaire. The ban on strong e cigarettes, the ones preferred by those trying to quit smoking, could prevent the saving of 105,000 European lives a year, according to modelling by London Economics.

And there s the Dunning Kruger effect, whereby incompetent people are too incompetent to see incompetence. An EU official with a lower second class degree from the University of Malta so badly mangled the results of 15 scientists on harm reduction by e cigarettes that they all wrote to correct him.

The British government s medical regulator, the MHRA, sticks obstinately to its belief that medicinal regulation will improve technological progress in e cigarettes, ignoring reams of evidence that high barriers to entry inevitably stifle innovation. Doctors, represented by the BMA, seem to hate the idea of people buying, rather than being prescribed, products that stop them smoking. Worse, some of the firms advertising e cigarettes and selling them through Boots are now subsidiaries of Satan itself the tobacco industry. Not wishing to emulate Kodak, Big Tobacco is rushing to buy up e cigarette makers.

Big Pharma wants regulation of its rivals because it makes a packet out of nicotine replacement therapies (patches and gums), which have a poor track record of helping people to quit. And politicians? Well, they just seem to enjoy banning things.

In short, says Professor Gerry Stimson of the London School of Hygiene and Tropical Medicine, the public health response to e cigarettes has been dominated by attempts to regain ownership of the issue from a consumer led self help movement. Not invented here the old bureaucrat s cry.

The reason these cynical campaigns have succeeded at all is that most of us confuse nicotine with smoking. As far as anybody can tell, nicotine is harmless at the doses present in cigarette smoke. It s the tar that kills. Nicotine is addictive, but so is caffeine, and a cup of coffee has a lot more potentially dangerous chemicals in it than an e cigarette. Vaping could well be less risky and antisocial than coffee drinking.

Yet so brainwashed are we into thinking that nicotine is harmful that we cannot see an advert for vaping without a Pavlovian revulsion, and spouting a load of tosh about protecting kids from a possible gateway into (rather than out of) smoking. And that ignorance is being exploited by the reactionary opponents of this disruptive and life saving innovation. They would apparently prefer that smoking continues its very slow, but doctor supervised, decline over the next 50 years than all but vanish in 20.

[epha briefing] regulation of nicotine containing products (ncps) including electronic cigarettes — european public health alliance

The future legislation of Nicotine containing products (NCPs) including e cigarettes is part of ongoing discussion on the revision of Tobacco Products Directive (TPD).

EPHA Briefing on Regulatory options for Nicotine Containing Products (NCPs) in the EU

Annexes to the EPHA Briefing on Regulatory options for Nicotine Containing Products (NCPs) in the EU

In light of the available regulatory options for Nicotine Containing Products (NCPs), identified and presented in the EPHA Briefing, EPHA recommends the following principles of future EU wide NCP legislation, public health requirements of NCPs, and policy options for regulating NCPs

Principles of future EU wide NCP legislation

  • Public health needs to be the driving motivation of regulation of NCPs. All NCPs should demonstrate proven safety and quality
  • NCPs must not become a gateway product, especially for young people and must not re normalise smoking
  • NCPs should be regulated at EU level, in order to reduce existing health inequalities, and to provide greater legal certainty, in line with the EPHA European Charter for Health Equity
  • NCPs should be regulated in an appropriate manner in line with the precautionary principle.
  • Future NCP regulation should take into consideration the future and fast development of this market.
  • NCPs should facilitate access to social support networks through the provision of information. Tobacco cessation services (quit lines) are crucial to sustained and successful efforts to quit smoking. NCPs of high quality have significant potential to help smokers who are not otherwise ready or able to quit smoking.

Public Health requirements of NCPs

Regulation of NCPs, including e cigarettes, needs to protect public health by ensuring

  • product safety and quality,
  • control of advertising and sponsorship,
  • market surveillance and monitoring,
  • accesibility of NCPs for existing smokers

Policy options for regulating NCPs

  • Appropriate safety assessment should be a cornerstone of any future EU legislation.
  • The public health benefit of NCPs is that they may help smokers to quit smoking. In order to maintain the same standards for the same products, both the product safety aspects and the claimed effects of the given product should be taken into consideration by future regulation of NCPs.
  • Strict marketing limits similar to tobacco and medicine marketing rules are essential so that NCPs do not promote smoking behaviour either in a direct or indirect way.
  • Given the potential of products such as e cigarettes not containing nicotine to indirectly promote smoking and undermine smoking cessation policy, the European Commission should be empowered to adopt delegated acts to regulate these products appropriately.
  • Having no new regulation on NCPs, or maintaining long transitional periods which is equivalent to maintaining the status quo has the potential danger of market developments which do not provide a high level of public health protection to EU citizens, violating Article 168 of the Treaty on the Functioning of the European Union (TFEU). Therefore, the transition period before the application of the new NCP legislation, as well as the binding deadline for the European Commission to submit a report about the application of the future NCP legislation should be as short as possible, and the European Commission should be empowered to adopt delegated acts in other to be able to reflect public health risks emerging from the rapid market development.
  • Appropriate monitoring including surveys and data collection is necessary so that any future legislation should rely on the latest data and evidence. Particular attention should be given to the attitudes and preferences of children and young people in that regard.
  • Future regulations should include elements which ensure appropriate funding and resources for more research for both social and biomedical aspects of NCPs.
  • Flavourings have two dimensions On the one hand, some flavours are necessary to make NCPs intended for oral use palatable. On the other hand, additional flavours can make NCPs more attractive for both smokers and non smokers. NCPs should be allowed to contain the necessary flavours which are allowed in Nicotine Replacement Therapies (NRT) but should be subject to flavouring restrictions, as regards additional flavourings not necessary for the use.
  • An appropriate simplified authorisation procedure for NCPs merging the necessary elements of other legislations would be useful ensuring that NCPs comply with the principles and guidelines of Good Manufacturing Practice (GMP), Manufacturers present all ingredients of the products, including emissions and a Risk Management Plan for monitoring and recording any adverse reactions, similarly, NCPs should be subject to appropriate labelling and packaging rules
  • The future legal framework should ensure that accessibility to NCPs for existing smokers is not hindered while ensuring that they are unappealing and inaccessible to minors.

EPHA related articles

  • Joint press statement Mixed victory for tobacco control in European Parliament’s vote
  • Final countdown public health community calls on European Parliament to vote for a strong Tobacco Products Directive
  • Joint Open Letter to President of European Parliament Philip Morris lobbying activities on the Tobacco Products Directive
  • EPHA Calls for Strong Tobacco Products Directive (TPD) without further delay
  • Sign the ERS petition for a strong Tobacco Products Directive!
  • Global Initiative Don’t Touch the Spanish Tobacco Law
  • EPHA Open Letter to Spanish Prime Minister Smoking should be banned at «Eurovegas»
  • EPHA and Public Health NGOs call for an updated EU Tobacco Products Directive
  • EPHA position paper Revision of the Tobacco Products Directive
  • EPT Tobacco Directive (Revision) European Commission Proposal Revision of The Tobacco Products Directive (25 June 2013)