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Risk and responsibility

A long-awaited report about the health risks of heat-not-burn tobacco products was published this week.

According to BBC News:

The Committee on Toxicity (COT) looked at the available evidence about the risks of two heat-not-burn products that have recently gone on sale in the UK - IQOS and iFuse.

The devices heat tobacco to a high enough temperature to create a vapour but not smoke.

They are different to e-cigarettes, which vaporise a liquid containing nicotine - the highly addictive compound in tobacco smoke.

The committee found that people using heat-not-burn products are exposed to between 50% to 90% fewer "harmful and potentially harmful" compounds compared with conventional cigarettes.

Despite this all the reports I’ve seen were keen to focus on the negative. The BBC report, for example, was headlined ’Heat-not-burn tobacco 'is a health risk.

Other reports followed suit. ’Heat not burn' cigarettes still harmful to health, say government advisers (Guardian), ‘Heat-not-burn' tobacco is still a health risk even if 'smokeless' devices are safer than cigarettes (Daily Mail), while Reuters headlined its report, ‘Heat-not-burn' tobacco may be safer but still a risk: UK panel.

The BBC quoted COT chairman Professor Alan Boobis who said:

“The evidence suggests that heat-not-burn products still pose a risk to users. There is likely to be a reduction in risk for cigarette smokers who switch to heat-not-burn products but quitting entirely would be more beneficial."

The Guardian quoted Deborah Arnott, CEO of ASH, who said much the same thing:

“The COT concluded that while ‘heat not burn’ products are lower risk than smoking they are not risk-free, so quitting tobacco use completely is still the healthiest option.”

Boobis warned, “We have to be very much on our guard that these are not seen as recreational devices.” Goodness, no.

(Small point. Why is the chairman of the Committee on Toxicology making such partisan, even tendentious, comments? Surely he should be impartial and comment only on the facts?)

The BBC also noted that:

The panel was concerned that young non-smokers might start using the products.

There were also worries that the products could lead people to take up smoking cigarettes.

Now where have we heard that before? Clue: exactly the same thing was and is being said about e-cigarettes despite the lack of evidence that e-cigs are a gateway to smoking or tobacco in any form.

More important though is the insistence that because heat-not-burn products carry some risk then complete abstinence is the best course of action.

The risk posed by e-cigarettes may be even less (95 per cent according to Public Health England and the Royal College of Physicians) but as long as there is any risk public health campaigners will continue to insist that quitting all forms of nicotine (patches and gum excepted, no doubt) is the preferred outcome.

Significantly the Guardian reported that:

If you are having trouble stopping smoking, [Boobis] said, first try the licensed nicotine replacement therapies, such as patches and gum. “Then think about e-cigarettes. If that really doesn’t work, there are the ‘heat not burn’ devices,” he said.

You can read Forest’s full response to the COT report on the Asian Trader website (Smokers’ group welcomes heat-not-burn tobacco report). BBC News used this short quote:

“Electronic cigarettes are a step too far for many smokers so if the government wants smokers to quit there has to be a range of products that fills the gap between combustible tobacco and e-cigarettes."

In the light of the COT report it’s worth reminding ourselves that Carl Phillips has commented many times on the wisdom of vaping advocates pinning their hopes to the claim that e-cigarettes are ‘95 per cent less harmful than combustible tobacco’ and here’s why.

Every headline that greeted the COT report on heat-not-burn products could be applied just as easily to e-cigarettes.

Replace the words ‘heat-not-burn’ with ‘e-cigarettes’ and the following headlines are no less valid:

‘E-cigarettes still harmful to health, say government advisers’, ‘E-cigarettes still a health risk even if 'smokeless' devices are safer than cigarettes’, ‘E-cigarettes may be safer but still a risk’.

The point is, most things carry some element of risk. Today however we live in a risk averse society so anything that is not proven to be 100 per cent ‘safe’ is going to be a target – sooner or later – for the public health industry.

Whether the risk of using e-cigarettes or heated tobacco is 50, 90 or 95 per cent less than the risk of smoking cigarettes is largely irrelevant.

As far as the anti-niconistas are concerned it’s still a risk and if you believe all the scaremongering about smoking even a small risk relative to smoking is significant. It's certainly not harmless.

That 'fact' alone is enough to keep public health activists busy for decades because I don’t expect them to rest until every recreational nicotine user on the planet has been saved from this “highly addictive” drug.

That’s why the battle we face goes way beyond health and harm reduction. It’s also about choice and personal responsibility.

Truth is, if the public health industry gets its way e-cigarettes and other harm reduction products are merely stepping stones to the prohibition of all nicotine devices.

The battle we have to win therefore is the right for adults to make informed choices about a range of products that offer different degrees of risk, and the right to take responsibility for those choices as well as our own personal health.

Adults must also have the right to consume a range of nicotine products, from combustible tobacco to heated tobacco to snus to vaporisers and electronic cigarettes, without excessive regulations (or taxation) dictating their choices.

Harm reduction is great but ultimately this is a war on choice and personal responsibility. If we lose no product is safe.

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Reader Comments (4)

Here were go again. The prohibitionists are plying their anti-choice propaganda and the media is parroting it without question.

Thursday, December 14, 2017 at 19:58 | Unregistered CommenterVinny Gracchus

You can not make a product that is already safe to use any safer.

We have billions of subject years of data that shows that making hundreds of million people stop using cigarettes over decades makes no difference whatsoever to how many people die of lung cancer.

Compare the lung cancer rates of the USA where people were told to give up smoking in their millions and lung cancer rates in the former soviet union where the authorities did nothing until recently and you get the same lung cancer signatures.

Billions of subject years says that cigarettes do not drive lung cancer rates. Therefore, the reality is that replacing cigarettes with anything else is just a marketing stunt.

If decades of data on billions of people shows us that not using a product does not reduce harm then how can altering the nature of a product reduce harm? If anything it introduces the risk of harm because we have not got billions of subject years of data like we have with cigarettes.

Friday, December 15, 2017 at 12:29 | Unregistered CommenterFredrik Eich

I second what Frederik says in the comment above. HnB is the latest trick of Big Cigarette to keep the money coming while their customers get an inferior, potentially dangerous product. It started with filters in 1950s, then putting less and less tobacco in a cigarette, of a worse and worse quality (recon, expanded) in order to reduce 'tars'.

Saturday, December 16, 2017 at 19:46 | Unregistered CommenterVlad

The reconstituted and expanded tobacco was the Smoking and Health Program of the National Cancer Institute's idea, they thought that using less tobacco would make for a safer cigarette.

National Cancer Advisory Board Release Statement on Nicotine and Tar Reduction 1975

“The research conducted by the Smoking and Health Program of the National Cancer Institute and other national and international organizations has identified promising techniques for reducing toxic elements of smoke.

Page 5
"Dilution can be achieved by the use of extenders and diluents in reconstituted tobacco sheets. Such diluting materials as cellulose synthetic tobacco extenders, inorganic salts, clays and kaolin appear promising. Additionally,tobacco can be expanded, puffed or freeze dried so that less of it is required to fill each cigarette”

Monday, December 18, 2017 at 9:16 | Unregistered CommenterRose2

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