I'm with Clive (up to a point)
Monday, April 11, 2016 at 11:30 I may not be Clive Bates' loudest cheerleader but the former director of ASH and I do agree on some things.
On Thursday The Times published a report by health editor Chris Smyth. It's behind a paywall but the gist was that "experts" fear heat-not-burn products "risk confusing smokers blurring the distinction between tobacco free e-cigarettes and traditional smoking".
How patronising. Once the distinction between combustible, heat-not-burn and electronic cigarettes has been explained (it's very simple) why should anyone be confused?
Anyway on Saturday the paper published a letter from Clive Bates. Naturally he focussed on the harm reduction potential of smokeless cigarettes but he also made several points that echo views I have expressed several times on this blog.
See, for example, Nicotine wars – choice is king and Convenience and competition are key for emerging products.
Wearing my Forest hat, heat-not-burn products interest me more than e-cigarettes (a device I nevertheless endorse and frequently defend) because they possess one crucial ingredient – tobacco.
There are two reasons, I believe, why the majority of smokers have not yet been tempted to switch to e-cigarettes.
One - habit. Most people are creatures of habit and smoking cigarettes falls into that category. For some it's a difficult habit to break even if they wanted to (and many don't).
Two - pleasure. Millions enjoy smoking tobacco or they wouldn't do it. You can list the reasons but one factor is the taste compared to, say, herbal cigarettes which many find disgusting.
The taste of tobacco varies. Smokers experiment and find a brand they like. Generally they stick to it, although price is increasingly a factor in their choice.
The reason tobacco-flavoured e-liquids aren't very popular and vapers move on to other flavours is because it rarely matches the taste smokers enjoy or are used to.
Heated tobacco products offer the prospect of a solution to this problem. Instead of quitting tobacco completely, smokers can switch to a potentially safer product that tastes of tobacco because it is tobacco, albeit heated not burned.
Sadly I've seen tweets and comments by some people, including vapers, who seem to regard heat-not-burn products as a threat to e-cigarettes.
Clive Bates isn't one of them. Like me he sees the potential benefit of this technology, and I welcome that. (Credit where credit's due!)
We're not entirely on the same page, however. When it comes to tobacco I believe in unrestricted choice. Let adults decide, without excessive regulation, what they want to inhale and where.
Tobacco controllers don't embrace choice at all. Choice must be restricted. (I've yet to hear a single public health campaigner argue against the forthcoming bans on ten packs and menthol cigarettes, for example.)
In their utopian smoke free world e-cigarettes, heated tobacco and even snus are a means to an end – smoking cessation.
The fact that, given a choice of alternative nicotine products, millions of smokers still choose combustible cigarettes is anathema to them.
It's the elephant in the room they can't bear to acknowledge. Hence even the most 'liberal' tobacco control activists support legislation that seeks to restrict or even prohibit choice.
I'm pleased nevertheless that Clive is inching in our direction. Unlike Professor Robert West (another e-cig advocate), Clive is prepared to let the market decide - up to a point. (He still doesn't believe in letting the market decide on smoking in pubs, for example.)
This development interests me because what we are seeing, following the very public argument between public health activists who support e-cigs and those who don't, is another division - this time within the ranks of campaigners who advocate e-cigarettes as a smoking cessation tool.
On one hand there are those who consider any product that contains tobacco to be a bad thing that must be fought with taxes, restrictions or even prohibition.
On the other there are those who apparently see a future for tobacco products, albeit the smokeless variety.
What advocates of e-cigarettes and heated tobacco products have to understand however is that if you embrace choice it has to include combustible cigarettes.
You can't claim to support choice without accepting the principle that, sometimes, people will make choices you don't approve of.
Coercion and prohibition - policies that are frequently adopted to force people to switch from combustible cigarettes to alternative nicotine devices - must be rejected, publicly and privately.
Unfortunately I suspect that public health campaigners - even the saintly ones - are doing what they always do.
Far from embracing choice, their real goal is to control choice by restricting it to products they approve of.
The Tobacco Products Directive, which comes into force next month, is a case in point. Consider some of the restrictions that are being introduced:
- Ban on ten packs (cigarettes)
- Ban on smaller pouches of tobacco
- Limit on strength of e-liquids
- Limit on size of e-juice containers
Although tobacco control campaigners like Clive are rightly against the new restrictions on e-cigarettes, I have never heard a single one say a word against the new regulations on tobacco.
OK, it would be naive of me to expect them to, but it's their fault that we now have a culture of regulation and suppression. The framework for regulatory intervention was supported by the very people who are now complaining when it's used against e-cigarettes.
The regulation genie is well and truly out of the bottle. At every turn our choices are being restricted. That's why, as I have always said, the war on tobacco is a war on choice.
Anything else is smoke and mirrors.
If Clive Bates really believed in letting the market decide he wouldn't support a ban on smoking in every pub and club in the country.
Like all tobacco control activists he wants to restrict choice, nudging or coercing consumers towards the holy grail of a smoke free society.
If you're comfortable with that, good luck to you.
What I will say, in Clive's defence, is that he is totally consistent in his commitment to harm reduction. And I respect that.
I support harm reduction too. But I also value choice and personal responsibility and in a free society I rate those issues even more highly.
Without the freedom to choose what we eat, drink and smoke we're on the road to a drab, bland society that I personally wouldn't want to live in.
Follow Clive's path in other product areas and the next thing you know alcohol will be banned from pubs and replaced with alcohol free lager and sugar free soft drinks.
Harm reduction, see?
But don't worry, I'm sure you'll have a wide range of alternative refreshments to choose from.
Reader Comments (7)
One thing you leave out of your analysis of political cleavages is support for smokeless tobacco -- or to put it in immediate context, the EU TPD's continuing ban of the popular forms of it in your country and all others but Sweden. This is even more telling about someone's true attitude toward choice (the TPD restrictions on e-cigarettes are silly hassles, but they are far short of a ban). It is also telling about whether they really care about health (ST is almost certainly lower risk than e-cigarettes) or just have some weird mystical aversion to visible bits of tobacco leaf, or are merely defending their personally preferred product.
Clive has long been a consistent advocate against the ST ban. This contrasts with most of the pro-ecig tobacco controllers who either say nothing about it or merely occasionally mention it is bad if someone else brings it up. It also contrasts with many vaping enthusiasts who have fancy themselves as pro-THR, but really only care about their preferred product.
I agree (and have recently explained) that anyone who would deny smokers their preferred choice is not really supportive of harm reduction. But anyone who is not *more* opposed to the ST ban, as compared to mere restrictions on ecigs, cannot even be said to be in favor of risk reduction. Their agenda is something else altogether.
Hear hear. As usual from the happy smoker's point of view you are spot on. Credit where it's due but I still don't trust Clive Bates. He supports these other things because he can see a day when we will be forced to quit and use one of these alternatives. In the language of antis looking to justify their control freakery, I can hear Bates say : what's wrong with that?
Fair point, Carl. Snus does tend to get left out of the conversation. Clearly there's no good reason to ban it and it should be legalised in the UK and other European countries. I suspect however it would attract only a very small niche market in the UK. This is partly out of ignorance of its harm reduction qualities but also for other, possibly cultural, reasons. I know it's not chewing tobacco but we don't have the same history of oral tobacco in the UK. Nevertheless you're right that support for snus is a good indicator of genuine support for harm reduction and most tobacco control activists fail that litmus test.
Oh, there’s lots more reasons, Simon, why many smokers don’t switch to e-cigs after trying them, including (for me):
(a) I can’t “do” vaping. No kidding. It makes me cough and splutter and feel like I’m drowning. I guess I’m just not designed to inhale water!
(b) the few e-cigs that I’ve managed to get the odd successful puff from have been absolutely vile – any flavour, any strength, any model – totally revolting, all of them.
(c) there’s a “clunkiness” about e-cig gadgetry that feels distinctly awkward to use.
(d) there’s no “beginning, middle and end” to an e-cig. None of the vapers I know ever actually “sit down to enjoy a vape” like smokers do, because there’s no starting-point and no end-point – they carry them around in their pockets and sneak them out for a furtive puff or two before stuffing them back in their pockets again, which, to be honest, has a bit of a “teenager-behind-the-bike-shed” look to it. Despite vapers’ protests, vapers always look like they are using their e-cigs as a quitting aid. Maybe if vapers actually looked like they were enjoying their e-cigs more and were more relaxed about using them, I’d find the whole vaping thing less cringeworthy.
I look forward to the advent of heat-not-burn technology with curiosity but, if HNB gadgets are anything like as awkward and “gadgety” as e-cigs, I won’t be bothering to try them!
Visiting Halifax West Yorkshire today i noticed many many tobacco smokers and very few vapers - hooray !
Bravo Simon!
I have to disagree with your comment on why vapers switch to non tobacco flavors. Searching for a liquid similar to a marlboro flavor gets old quick. Most tobacco flavors in e-liquid don't come close to the real thing. As soon as you find a fruity or desert flavor you like, you leave the tobacco flavors alone for the most part. Probably close to 10,000 flavors to choose from.