I've been trying for years to get the tobacco harm reduction industry to address the question, 'Why don't more smokers switch to e-cigarettes?'
In 2016 Forest funded a study by the Centre for Substance Use Research that led to the report, 'The Pleasure of Smoking: The views of confirmed smokers'.
It included a section on e-cigarettes that resulted in a peer-reviewed paper, Why Don’t More Smokers Switch to Using E-Cigarettes: The Views of Confirmed Smokers, being published by the International Journal of Environmental Research and Public Health.
Attempts to persuade the organisers of various vaping conferences to discuss the issue fell on stony ground and I sensed that it's because most vaping advocates are unwilling to accept the heretical idea that many smokers, even those who have tried vaping, still prefer combustible tobacco.
Credit then to the New Nicotine Alliance for inviting two confirmed smokers – Liz Barber and Hazel Chinnery – to discuss the issue on a webinar last week.
The third speaker was smoking cessation campaigner Louise Ross, vice-chair of the NNA and one of two people who manage the Quit for Covid Twitter account.
Three moments stood out for me. The first (at 32:40) was when Liz responded to an earlier comment by Ross that stop smoking services wouldn't "twist the arm" of anybody who wasn't ready to quit.
According to Liz:
I'm well past the point where I feel as though I've had my arm twisted. I feel as though I've been wrung round with all of the anti-smoking rhetoric and everything else, all of the measures. It's all I have heard for years and I'm not one of these people who takes kindly to that ...
ASH went all out and wanted to denormalise me and much else beside so in terms of anybody offering any anti-smoking 'services' to me, forget it, I wouldn't go anywhere near any of you with a bargepole because of ASH.
Later (46:45), responding to Ross' defence of ASH, Liz renewed her attack:
I think, Louise, [and] this is something that I cannot emphasise enough ... but what really, really, hardened me against any of this, first and foremost, was ASH and their entire methodology and the misinformation and the slurs, and everything, that went on for so long ...
There is just no way that I am ever going to stop smoking on the back of anybody thinking that ASH could have possibly had any persuasion on me on that particular decision.
I can't tell you how much I despise them as an organisation and it didn't really endear me to them any further when after havering about it for what seemed quite some time to me, as to whether they were for [e-cigarettes] or against them, they eventually landed on what I think is the right side of it.
Why would you not want to encourage the use of something that is demonstrably, as far as anybody knows, far far safer for you than cigarettes, but there was one point in time that that didn't matter as much as it mattered than nobody was using anything at all ..
ASH more than anybody has done more to get my back up and entrench me.
It's also worth hearing Hazel Chinnery's experience of being in hospital after she broke her ankle (33:45):
About a year and a half ago I fractured my ankle and as you can imagine that was a horrible time for me. I do live on my own. I had a surgical boot and I had crutches. So a day or so after I fractured it I had to go to the fractures clinic at the hospital ... and I went there and, do you know, they were great, don't get me wrong ... but at one point in time they put me in this room with this person and I was asked about eating habits and drinking habits and smoking, obviously.
Given at that point in time I was pretty upset with all of this, I basically didn't even know how I was going to feed myself, because with two crutches and a surgical boot how do you cook, how do you eat, I couldn't carry things from one place to the next ... getting a shower, getting upstairs to bed, you know, things like that, that was all that was on my mind, and of course I was given a lecture on smoking and I was told, "You really need to give up smoking."
And I thought, "Are you kidding me, at this point in time? This is all that you've got to say to me?" And I was really, really angry. I thought, I've got a lot more pressing problems at this precise moment. Now, if they'd said to me, right if you give up smoking today then tomorrow your ankle will be absolutely perfect, then I might have thought about it.
But it wasn't because I knew that I was in for the long term. It took quite a while before that ankle actually was better ... And that wasn't the first time. There's been other times where, you know, you go to the dentist, or whatever, the first thing they ask you is about, like stop smoking. Every time I hear the words 'smoking cessation' I run a mile. Don't wanna know. Sorry.
One more thing struck me about the webinar and that was Louise Ross's litany of reasons why many smokers haven't switched to vaping.
Some, she said, had "discarded the idea of vaping" because they had only tried "one of the early ones". Others were put off by "indoor vaping" bans. Another reason was that the "safer message" was "being undermined all the time".
Excuses, excuses. Yes, there is some truth in all of them but the most basic reason, which vaping advocates like Louise Ross choose to ignore, is this. Despite the far greater health risks, many smokers prefer smoking combustible cigarettes and won't be coerced to quit by the likes of ASH and other smoking cessation activists.
Incredibly, and despite Liz Barber's obvious commitment to smoking, Louise also seemed to suggest that if an e-cigarette Liz recently took on holiday (to use when she couldn't smoke) hadn't leaked in her handbag then she too might have quit smoking:
I'm sorry your [e-cigarette] leaked, that's a real shame, because you could have been convinced at that point, couldn't you?
No, Louise, she really couldn't. As she explained patiently and at length, Liz is a confirmed smoker. Like millions of people she enjoys smoking. Why can't you and every other smoking cessation activist get your head around that simple fact and accept it?
By all means offer support to the relatively small number of smokers who want help to quit (although I personally think it's a waste of taxpayers' money), but smoking cessation doesn't end there, does it?
Quit smoking campaigners support smoking bans and punitive taxation – anything, in fact, that 'denormalises' smokers and their habit and makes it physically more difficult and more expensive to smoke.
Liz Barber and Hazel Chinnery aren't alone. They represent a significant number of smokers who not only want to be left alone but are actively 'reaching for their fags in defiance' (copyright Claire Fox).
Anyway, to watch the 60-minute webinar in full click here. It starts a bit slowly but warms up!