The e-cigarettes debate ranges from abstinence to pragmatism: ban it or deal with a device that’s just not going away

When parliament conducted an inquiry into vaping that concluded e-cigarettes should remain effectively banned in Australia, the paediatrician turned MP Mike Freelander said the lobbyists came knocking.

“We were lobbied quite heavily prior to and during the inquiry by a number of agencies including those promoting the tobacco industry and some medical professionals who argued for legalisation on the basis of harm minimisation,” the Labor MP says.

“In the last few months there has been more activity … but I think our inquiry came out with the right result and I don’t want to reopen it.”

The increase in lobbying – including Philip Morris engaging Capetal Advisory, revealed by Guardian Australia this week – comes as tobacco companies take a stake in vaping, the great disruptor of the traditional cigarette market.

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Philip Morris International has its iQOS – which stands for “I quit original smoking” – “heat not burn” smokeless cigarette device and in December 2018 Marlboro cigarette maker Altria Group announced it would pay $12.8bn to take a 35% stake in Juul Labs, the maker of one of the most popular brands of e-cigarettes.

“One only needs to see the lobbying to know it has a commercial aspect,” Freelander says. “It’s a bit sad to see in what is a public health issue.”

But despite most parliamentarians on the inquiry finding that e-cigarettes should continue to be controlled as a therapeutic good, several Liberal MPs including Trent Zimmerman, Tim Wilson and Andrew Laming were persuaded, forcing the health minister, Greg Hunt, to order an independent study.

Alex Wodak, a physician and director of the Australian Tobacco Harm Reduction Association, said the MPs were “shocked to find how strong the case is for making the easy switch from high-risk cigarettes to low-risk vaping”.

Wodak cites that in the UK – where vaping is 6% of the market compared with 1% in Australia – the decline in traditional smoking has accelerated, while rates remain flat in Australia. In Japan, sale of traditional cigarettes is down 31% in three years after the introduction of e-cigarettes such as iQOS, he says.

The association is a charity set up by four independent Australian medical practitioners which received funding from two vaping businesses for “initial legal and website costs” but now says it does not accept donations from tobacco companies, their subsidiaries or the vape industry.

E-cigarette use also appears to have negative impacts on lung health, and potentially contributes to respiratory and cardiovascular conditions Parliamentary inquiry

Wodak, who led the St Vincent’s hospital alcohol and drug service for 30 years, compares the public debate on vaping with other harm reduction efforts greeted with “ferocious resistance”, including using methadone to treat heroin addiction, condoms to prevent the spread of HIV, supervised injecting rooms, and pill-testing at music festivals.

“It’s always an argument between abstinence – from people who wish something would disappear from the face of the earth – and pragmatists who mightn’t like it but know since it exists we’ve got to deal with it,” he says.

The Liberal-National Coalition government has commissioned a public health assessment of electronic cigarettes from the national centre for epidemiology and population health at the Australian National University, with the first task to test the theory it helps “hardened smokers” quit.

A spokesman for Hunt said the government’s position on e-cigarettes “remains unchanged and the minister is firmly opposed to changing the current laws particularly in light of recent statements by the US FDA about an epidemic of addiction among teen users”.

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In Australia there is unanimous opposition to vaping among the peak health groups, but Public Health England has declared vaping to be 95% safer than traditional smoking. Nevertheless two recent deaths – in Illinois in August and Oregon in September – have put safety back under the microscope.

The US Food and Drug Administration and the Centre for Disease Control is investigating a link between e-cigarette use and severe respiratory disease.

The parliamentary inquiry found that e-cigarette vapour “has been found to contain dangerous substances such as heavy metals and formaldehyde”.

“E-cigarette use also appears to have negative impacts on lung health, and potentially contributes to respiratory and cardiovascular conditions,” it said, citing submissions from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia.

Chris Zappala, vice president of the Australian Medical Association and a respiratory physician, says there is “no question liquid nicotine has a harmful effect on the airways”, particularly of patients with asthma or other chronic diseases, and that e-cigarettes “could to lead to normalisation” of smoking.

The only way to safely regulate these products is to legalise them Kirsten Daggar-Nickson

Imperial Brands has said it is “deeply troubled by reports linking illnesses to the use of vaping products” but noted the cases were linked to vaping liquids containing THC (tetrahydrocannabinol), the principal psychoactive constituent of cannabis”, not found in its products.

“The only way to safely regulate these products is to legalise them,” its head of corporate and legal affairs, Kirsten Daggar-Nickson, says.

In Australia the commercial sale of liquid nicotine used in vaping is banned, and can be legally obtained only with a doctor’s prescription.

Guardian Australia spoke to four vapers – none of whom had a prescription and all of whom found liquid nicotine could easily be purchased on the internet, particularly from the more liberal neighbouring jurisdiction of New Zealand.

Melbourne vaper and IT professional Martin Kingsley says: “The idea you can’t get liquid nicotine in Australia is ridiculous. It’s for sale at tobacconists under-the-counter. You can buy it here if you just don’t look like a narc.”

Tom Reed had been smoking for half his life when he quit around the time of his 40th birthday. After a few “half-arsed attempts” he was forced to “get real” after an injury when advised that quitting smoking would improve the effectiveness of surgery on his thumb.

Reed’s doctor rejected the idea, but he decided after doing his own reading that vaping would be better for his health than smoking and made the switch.

“I’d used e-cigarettes a few times before but I didn’t like it or really give it a chance,” he says. “After I made a commitment it was ridiculously easy.

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“At first it’s a pretty poor substitute and you feel that you can’t beat the real thing, but it doesn’t take long for your taste to change. I had a cigarette on New Year’s Eve and thought it was pretty shit. It tastes bad; you feel it in your throat and lungs.”

Catriona Thoolen, a farmer and former United Australia party candidate, found quitting smoking difficult because her husband was reluctant to give it up but she says “this latest price rise is the end of our smoking”.

Thoolen says vaping “does the job” by fulfilling her nicotine craving, but her husband “doesn’t believe in it [because he says] it doesn’t feel the same”.

Facebook Twitter Pinterest A vaper refills his electronic cigarette with vaping liquid. Photograph: Samantha Maldonado/AP

She suggests anti-smoking campaigners don’t like vaping because it delivers nicotine with the same hand-to-mouth action and is concerned that liquid nicotine will be subject to the same “sin taxes” as regular cigarettes.

Freelander is concerned that legalisation will increase its use among non-smokers. “[Vaping] probably is a little bit better for you but what about the increasing number of people addicted to nicotine? It’s a pathway to cigarettes.”

Wodak responds that the proportion of regular vapers who have never smoked is “very small” – less than 1% – and it “wouldn’t be possible for e-cigarettes to accelerate the declining smoking rate” if it acted as a gateway to real cigarettes.

Zappala says while “never-smokers” might be small as a proportion of the whole vaping population, large studies in the US and UK show “the gateway effect is real”, particularly in teenagers who are more likely to smoke after vaping.

He also rejects e-cigarettes as a cessation aid citing the fact that between a half and two-thirds of people who quit go cold turkey. The existence of other cessation aids means “it’s not like there are no other options”.

Wodak suggests contrary figures are inflated by counting the total number of people who have ever vaped, an “unrealistic” estimate that counts “transient” users who vape, even without nicotine, and later give it up.

Thoolen’s youngest son, aged 18, is one such vaper who has “never had nicotine” and now appears to be “losing interest” in e-cigarettes.

And Kingsley, who took up vaping to replace infrequent binges of one pack of traditional cigarettes a month, is also looking to quit.

E-cigarette use “creeps in insidiously”, he says. Where previously he smoked only on social occasions to accompany alcohol or drugs, Kingsley now finds himself vaping in his lunch break or going outside to “break up the monotony” of work.

He plans to quit over the summer break, citing the ability to dilute the amount of nicotine to suggest stepping down will be smooth.

Freelander suggests the evidence e-cigarettes help smokers quit is largely “anecdotal” and is disappointed Hunt has revisited the question after the “comprehensive” parliamentary inquiry report.

“There is no new evidence that e-cigarettes are healthy, the only new evidence is to the contrary. There are the cases in the US where it was found inhaled nicotine caused significant lung damage and death, and increasing concern here and in Europe.”

But Wodak welcomes the new study, labeling the government’s opposition to effective legalisation “very disappointing” and suggesting that “arguments based on misinformation” will dissipate, preventing deaths and all the other miseries of smoking.