Viewpoints: should Australia lift its ban on e-cigarettes?

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Two opposing POVs - Creative Commons licence, OK to republish with attribution

https://theconversation.com/viewpoints-should-australia-lift-its-ban-on-e-cigarettes-28410

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The World Health Organisation has just released a report on electronic nicotine delivery systems that calls for their global regulation in the interests of public health. The most well-known such devices are electronic cigarettes or e-cigarettes, which are currently banned in Australia.

In this Viewpoints, Wayne Hall calls for the ban to be lifted, while Ross MacKenzie presents the case for retaining it.

Wayne Hall: Australia has banned the sale of a potentially less harmful way of obtaining nicotine while allowing the most dangerous form – cigarettes – to continue to be sold in convenience stores.

Vapour from electronic delivery systems, or e-cigarettes as they’re popularly known, has been shown to contain fewer carcinogens and less particulate matter than smoked cigarettes.

E-cigarettes have been shown in a randomised controlled trial to have similar efficacy to nicotine replacement products when used as a quitting aid. They may also prove to be a safer longer-term alternative to smoking.

The ban on their sales should be lifted to allow research on the possible public health benefits of these products. But as today’s WHO report says, their sale must be regulated.

They should be sold under tighter restrictions than apply to tobacco until better data are available on their safety and efficacy. And only a limited number of sellers and suppliers should be licensed to sell approved products, allowing for control over quality and safety.

What’s more, all media marketing should be banned to prevent their promotion to children and adolescents.

E-cigarette users should receive product information that clearly explains the uncertainty about their long-term health effects. This would encourage their use for quitting smoking and discourage dual use, that is, using e-cigarettes while continuing to smoke cigarettes.

The sales ban in Australia leaves product quality, marketing, product information and sales to the black market.

Suppliers should be obliged to facilitate research that answers questions essential in developing policy, such as:

• who uses e-cigarettes and for how long;

• how many use them to quit smoking, as a complete substitute for smoking, or only when (and where) smoking is prohibited; and

• how does regular e-cigarette use, alone or in combination with cigarettes, affect the health of users over time.

If e-cigarettes fail to reduce tobacco harm-related harm, as their critics predict, then the sooner we discover this, the better. Meanwhile, we should lift the ban to enable us to properly evaluate their possible value.

Ross MacKenzie: Supporters claim that e-cigarettes represent an important advance in harm reduction and are an effective means of quitting smoking, despite a near-complete absence of research into these claims, or into their safety.

There is a growing body of literature on health risks linked to nicotine, the key component of e-cigarettes. These include head and neck, liver and kidney cancer, among others, as well as impacts on the lung and vascular systems that can have implications for those exposed to tuberculosis.

Given these concerns, and nicotine’s well-established addictive properties, it seems an unlikely substance to position at the centre of harm-reduction or smoking-cessation strategies.

The greatest threat to public health associated with e-cigarettes, however, is the entry of the tobacco industry into the market, as the WHO report notes.

This, coupled with regulatory uncertainty in some countries, has enabled leading cigarette manufacturers such as British American Tobacco, Lorillard, Reynolds American and Altria to aggressively promote electronic products that are designed and packaged to look remarkably like traditional cigarettes.

In the United States, e-cigarette advertisements have been accused of targeting adolescents and children, millions of whom have been exposed to advertisements on television and other media.

Resolution of the current debate has enormous consequences for public health. If not regulated as traditional cigarettes, the promotion of e-cigarettes has the very real potential to re-normalise smoking, undoing decades of progress in tobacco control, which has led to declining smoking prevalence in many countries.

At this point, the risks associated with e-cigarettes far outweigh any ostensible benefit.

Wayne Hall: The dogmatic certainty of those who support e-cigarette sales bans is remarkable given their claim that we lack any evidence on the safety of these products.

They already claim to know that the risks will outweigh the benefits. And they want to insulate their beliefs against being tested by advocating for a ban.

This will make it difficult to discover if anything except tobacco industry-owned e-cigarettes are effective cessation aids. And it will make it even more difficult to discover if they are a safer way of obtaining nicotine in the long term than cigarettes.

While I support the regulation of e-cigarettes as tobacco products, that’s not the policy we have in Australia. Instead, our policy absurdly treats e-cigarettes like illicit drugs: it prohibits their sale and prevents smokers from using them except by black market purchases.

I share the concerns of the WHO and the public health community about tobacco industry involvement in the e-cigarettes business. But I believe these concerns are better addressed by regulation than a prohibition supported by dogmatic claims that undermine the public health community’s assertion to pursue evidence-based policies.

Ross MacKenzie: Another way of saying that Australia has banned a potentially less harmful way of obtaining nicotine is that a product has been prohibited because its potential health impacts are unknown, and its value as means of harm reduction and cessation unproven.

I agree that cigarettes should not be sold in convenience stores and should be much harder to obtain. This is a policy area that the public health community should be advocating for, rather than bringing another, controversial nicotine-delivery system onto the market.

Calls to regulate e-cigarettes offer little comfort given that the marketing, purchase and use of traditional cigarettes is well-regulated, but smoking still causes some 15,000 deaths every year in Australia.

As for smuggling, that’s a criminal issue to be dealt with by appropriate authorities. Arguing that the ban on e-cigarettes will lead to black market sales is uncomfortably reminiscent of tobacco industry arguments that raising cigarette taxes and plain packaging would lead to increased levels of contraband.

Finally, growing evidence that nicotine is tumour-promoting and linked to at least ten types of cancer makes current lobbying to allow another nicotine-delivery system onto the market a decidedly curious initiative.
 
Given these concerns, and nicotine’s well-established addictive properties, it seems an unlikely substance to position at the centre of harm-reduction or smoking-cessation strategies.

What a ridiculous statement, nicotine replacement therapy is probably the most promoted and well known avenue for nicotine addicts to quit smoking, there was nicotine patches, gum and lozenges on the market before I ever heard of or saw an e-cigarette.
 
Exactly - and that's part of the problem, too many people profit from the status quo. If someone can't get an e-cig (although I don't understand how, they're easy to order online and customs don't intercept them as long as you don't order commercial quantities of the juice) then they'll keep bouncing between less effective replacement methods like gum and patches (pumping money into the pharmaceutical industry) and relapsing into smoking (pumping money into the tobacco industry).
 
I don't doubt they are healthier than normal cigarettes but I can see problems with second hand vapour in the future. I tolerate their vapour more than cigarette smoke but find it hard to believe the vapour is completely harmless. Time will tell I guess. Fruity flavours don't really encourage any of my mates to stop using either. It has almost become a habit on its own so selling this as a way to quit smoking is literally a smoke screen.

Nicotine in liquid form is also extremely toxic, a serious health risk if not handled correctly.
 
Damn, you actually can't buy e-cigs in Australia? Are you breaking any laws if you order one online?
 
You can buy the cigarettes but have to import the liquid. It's not illegal to possess only illegal to sell it so importing it from online is how most people get around the legislation

If they were of any true health benefits the government would put them on the PBS and make money from the sales in pharmacies. It would be more effective than a $7 GP gap fee
 
You can buy the cigarettes but have to import the liquid. It's not illegal to possess only illegal to sell it so importing it from online is how most people get around the legislation

The ones I've seen for sale in shops are just the one time use variety, not refillable. But maybe the refillable versions are for sale in other cities.


If they were of any true health benefits the government would put them on the PBS and make money from the sales in pharmacies. It would be more effective than a $7 GP gap fee

You have a lot of faith in our government.

It has almost become a habit on its own so selling this as a way to quit smoking is literally a smoke screen.

I won't argue that it makes it easier to stay addicted to nicotine (at least one of my friends went from a casual smoker to a constant vaper), but you could argue over whether this is a good or a bad thing. On the one hand, you have the cardiotoxic effects of nicotine itself (I'm not yet convinced that PG/VG and the flavoring are toxic when vaporized, I'd need to see an obviously unbiased study first) and the ease of maintaining the addiction, but on the other hand you have the lack of the carcinogenic and toxic effects of cigarettes which are so many they aren't worth listing. Too many smokers have spoken about the immediate health improvement when swapping to vaping for me to doubt their short term benefit. Not to mention the financial benefit.

And yes, you're right, liquid nicotine is toxic if not handled with care - but we've yet to hear of an epidemic of people getting ill or dying because they weren't careful with their e-cig juice.

If I had to put my money down, it would be on the e-cigs being much better for both the individual and society as a whole by a wide margin. And most sane, unbiased sources seem to agree.
 
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It's more likely to be small children falling victim to the liquid I'm afraid. Once again the problem with the legal grey area in Australia is a lack or suitable warnings to consumers. My mate only orders from the US because he worries that the Chinese stuff might not meet FDA standards.

If given an option I'd prefer to second hand inhale someones apple cinnamon tape than a Benson and Hedges but when someone lights up in my car and thinks I will be fine with it they would be wrong. I just can't see how tape of any toxic chemical is not going to have some sort of health side effect. It took 50 years to prove cigarettes were harmful so watch this space I guess.
 
It's more likely to be small children falling victim to the liquid I'm afraid.

Except there's not yet been any flurry of reports of this happening. Once there is, I'll accept it as a legitimate concern, but until then, I don't see it as any more dangerous to children than pharmaceuticals.
 
Just quickly - E-cigarettes aren't banned in Australia. The closer I've got to this issue and other issues around substance control, the more I see that a lot of what is said is speculative or myth.

The Heavenly Vapors case in WA specifically ruled on Section 106 of the Act:
[h=3]106 . Products resembling tobacco products etc. not to be sold [/h] A person must not sell any food, toy or other product that is not a tobacco product but is —

(a) designed to resemble a tobacco product or a package; or

(b) in packaging that is designed to resemble a tobacco product or a package.

South Australia and Queensland have a similar provision in their legislation but this ruling only really applies to the Heavenly Vapor product and products that look very similar. There are so many different designs available to vaporiser manufacturers that this is not really a problem.


I worry when the entire narrative turns to this paternal health care approach... ie. "Here's the evidence... so you better do as it says." Perhaps this is the problem with technocratic thinking more broadly. It ought to be, "Here's the evidence... now that you know, make an informed decision."
People seem obsessed with what other people are doing with their bodies and minds... obsessed with finding links between what someone else does in private and how it affects their public behaviour and engagement. I don't think the links are as solidly tied as some like to think they are... and I worry that pathologising people's choices will remove their ability to discuss their autonomy and why they choose to do something, even when evidence suggests they may be better off not.
 
That's the thing, smoking and releasing vapour doesn't just affect the user but also the other people in the room.

I've never felt any effect from being in a small room with several people vaping - but of course there's the obvious solution of just not spending time in a room with someone who's vaping.
 
This is RIDICULOUS
You cut back ingestion of thousands of chemicals through the use of an e-cig.
I do find e-cig vapour to be irritating to the lungs as well, not as much as cigarette smoke but still quite a bit.
 
The renormalization argument is disgusting. That guy should be publically raped for pretending that encouraging people to smoke real cigarettes will lead to less smokers than if e-cigs are allowed. The gateway to real smoking propaganda theory was debunked with a study featured on the bbc news site. Ross acts as if vaping is equivalent smoking in terms of harm and that it is a rebranding of tobacco. His tobacco industry conspiracy is ridiculous as well. If they caused the problem why is it wrong for them to be part if the solution by helping smokers quit? I know they are just in it for money but that is beside the point.

Another thing that irritates me is when bitches whine about people vaping around them. The only thing you experience from it is the sight of mist and a slight smell that depends on the flavour. People only act irritated when around the vapour because the government has coaxed them into thinking it is harmful in order to safeguard the tax revenue they would lose if people started tolerating it everywhere. Despite the lack of a lingering, noxious stench and irritating effects on the eyes and lungs simpletons start hallucinating that the vapour is hurting them. A nano-dose of second hand nicotine is not going to have any effect on anyone.

One thing that the plebeians don't understand is that you cannot get animals to self-administer nicotine. It is not inherently addictive by itself. There are a number of short-acting MAOI's in tobacco smoke called beta-Carbolines that create the buzz. E-cigs are a step down and do not give you the same buzz.

As for toxicity from the flavourings, apparently those that mimic dairy create some sort of poisonous byproduct. The only worry about these things I have is that the liquid in the tank seems to darken over time until it becomes foul-smelling and I need to wash out the device. Has anyone noticed this? I use the eGo-U vapourizer.
 
I don't have a problem with the general thrust of your argument but there are some points that I would rebut:

One thing that the plebeians don't understand is that you cannot get animals to self-administer nicotine. It is not inherently addictive by itself.

As someone currently addicted to nicotine mints I can unequivocally say this is complete bullshit - I'm an animal and I regularly self-administer because I suffer withdrawals if I don't.

The renormalization argument is disgusting. That guy should be publically raped for pretending that encouraging people to smoke real cigarettes will lead to less smokers than if e-cigs are allowed.

I don't think that is his argument. There have been very significant and successful public health initiatives that have discouraged people to smoke - he is saying that these measure should be continued, strengthened and expanded

His tobacco industry conspiracy is ridiculous as well. If they caused the problem why is it wrong for them to be part if the solution by helping smokers quit?

I don't think these devices are aimed at helping people to quit a nicotine addiction but rather maintain it. Not that it is necessarily a bad thing. A segment of the population actually enjoy inhaling nicotine. I see these devices as a means for people who don't want to quit to continue their habit while minimising the harm it causes. If they were being marketed as a cessation aid then they should be subject to the same controls as any other NRT aid. The problem with tobacco companies marketing them is that they introduce nicotine addiction to a new generation who might otherwise not have become addicts were the sorts of control mechanisms that have been so successful were to play out.

I know they are just in it for money but that is beside the point.

Well, it's not really besides the point - it is a very important point. However, as long as it is legal to sell nicotine in a form that isn't as well regulated as the medicinal forms designed as a cessation aid then there is no reason why we shouldn't allow addicts access to a similar yet less harmful form of ROI. From a HR perspective it is wrong to say you can have very harmful cigarettes but not less harmful vaporisers. But at the same time, the vaporisers should be subject to the same controls, in Australia that would mean zero marketing, taxation, education etc. I do have a a problem with tobacco companies using marketing to sell an addictive product like nicotine. Smokers should have an alternative but it should be tightly regulated and controlled.

Another thing that irritates me is when bitches whine about people vaping around them. The only thing you experience from it is the sight of mist and a slight smell that depends on the flavour. People only act irritated when around the vapour because the government has coaxed them into thinking it is harmful in order to safeguard the tax revenue they would lose if people started tolerating it everywhere. Despite the lack of a lingering, noxious stench and irritating effects on the eyes and lungs simpletons start hallucinating that the vapour is hurting them. A nano-dose of second hand nicotine is not going to have any effect on anyone.

That's hearsay on your part. I would like to see some firm medical research that confirms your assertion before being comfortable with making sweeping assertions. I think you're probably right but without data neither of us really know that to be fact.
 
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FWIW, I have not even hit a cigarette in what will be 3 years in Novemeber with the usage of e-cigs. I am now at around 1.5mg liquid and still decreasing. I will try to quit around new years I believe.
 
I do find e-cig vapour to be irritating to the lungs as well, not as much as cigarette smoke but still quite a bit.

That depends on the ratio of PG/VG. PG produces less of a vapor cloud, but feels harsher on the throat and lungs - some previously-heavy smokers prefer this because it simulates the harshness of a real cigarette. Conversely, VG is much smoother, but produces larger clouds of vapor. Most vendors allow you to choose the ratio, or to go with purely one or the other. My preference was 20% pg/80% vg.
 
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