Don't treat e-cigarettes as medicines; glamorise them

My Times column tackles an egregious example of regulation doing more harm than good:

Should shampoo be classified as a medicine and prescribed by doctors? It can, after all, cause harm: it can sting your eyes and a recent study found traces of carcinogens in 98 shampoo products. Sure, shampoo can clean hair if used responsibly. But what’s to stop cowboy shampoo makers selling dangerous shampoo to the young? Far too many shampoo manufacturers try to glamorize their product. Time for the state to step in.

Far fetched? If only. This week the European Parliament sensibly declined to accept the European Commission’s directive to regulate as medicines those glowing-tipped electronic nicotine vapour dispensers called e-cigarettes. The British government, astonishingly, expressed its disappointment at the vote, and still intends to treat e-cigarettes as medicines from 2016. “We believe these products need to be regulated as medicines and will continue to make this point during further negotiations,” a spokesperson for the Department of Health said. Who’s “we”, by the way?

All the signs are that “vaping” is rapidly gaining market share from smoking. Having begun as an ingenious innovation in China in the early 2000s, the e-cigarette is now big business, with sales of more than £2 billion this year, and with the number of users doubling in some parts of the world just in the last year or so. The big tobacco firms are rushing to acquire the Chinese start-ups or their knowhow, a sure sign that they expect to lose customers to vaping. And they will: vaping helps people stop smoking.

Examine the evidence and you will find that e-cigarettes are saving far more lives than shampoo, and probably doing no more harm. A recent study in New Zealand, published by the Lancet, divided 657 smokers into three categories; one-third were asked to use nicotine patches, one-third e-cigarettes and one-third fake (placebo) e-cigarettes. The e-cigarette smokers were more likely to abstain from smoking entirely during the experiment, more likely to halve their use of cigarettes if they did not quit entirely, and three times more likely to continue with the product afterwards.

Meanwhile a thorough search for medical threats caused by inhaling nicotine vapour – as opposed to smoke – continues to find very little. Nitrosamine and formaldehyde are found at levels 1,000 times lower than in cigarette smoke. Dose matters in toxicity. Even a former director of Action on Smoking and Health (ASH) has described vaping as ''a very low risk alternative to cigarettes, used by smokers as a pleasurable way of taking the relatively harmless recreational drug nicotine''. Don’t forget there’s moderately good preliminary evidence that nicotine helps slow progression of Alzheimer’s, so it might even do good.

None the less, all round the world the health nannies are itching to get their regulatory hands on e-cigarettes. In a dozen countries, mainly in Latin America, the things are banned altogether (presumably after subtle lobbying by tobacco farmers and the cigarette industry). Here the “NHS Choices” website contains a magnanimous concession that until they are regulated in 2016, the Medicines and Healthcare products Regulatory Agency “will not ban the products entirely during this interim period, but will encourage e-cigarette manufacturers to apply for a medicine licence.” Meanwhile, it warns darkly, e-cigarettes “are only covered by product safety legislation”.

On the same website the NHS recommends instead a white, bulbous thing called a “nicotine inhalator”, which is a “licensed quit smoking aid, available on the NHS, [that] consists of just a mouthpiece and a plastic cartridge”. Somehow, I don’t think they have got the hang of glamorized marketing. But if they concede the principle that nicotine inhalers are safe and should be made available to people at taxpayers’ expense, what are they doing trying to regulate the sale and purchase of devices, at no cost to the taxpayer, that do almost the same thing but might actually look cool, rather than embarrassing, in the street? I cannot help feeling that the Department of Health is more interested in retaining control of the nicotine market than promoting health. This is known in economics as regulatory capture. Maybe “we” means the makers of patches and inhalators.

Be in no doubt that regulating e-cigarettes as a medicine would kill people. It would discourage their use, by putting up the cost of launching, selling and monitoring them and it would make it harder to buy them. It would therefore, given that we know they help people stop smoking, kill. That’s the likely effect of what the Department of Health proposes. As so often, the precautionary principle, by weighing the costs but not the benefits of a new technology, does net harm.

Vaping costs much less than smoking, not least because it is untaxed, so it is bound to spread fairly fast. It’s likely to overtake smoking within a decade, some think. Frankly, we should be changing regulations to encourage it: it should be allowed indoors, as a further incentive to help smokers quit. E-cigarette makers should be allowed to advertise (which this week’s European Parliament vote prevented) so as to help it grab market share faster and save lives faster. So what if this leads to a “re-glamorising” of people putting cylinders between their lips? Remember, “we” objected to smoking because it hurt people, not because it was glamorous.

Passive vaping is also far more pleasant than passive smoking, as I can attest, for the simple reason that it obeys John Stuart Mill’s harm principle: that you can do what you like unless it harms others. This is a concept that used to elude smokers in the old days, when some were for my taste too addictively oblivious to how much discomfort their smoke, ash and stale smell caused to others. There is simply no sensible reason to object to somebody else vaping – even on an aeroplane.

The addiction that we should be worrying about is the addiction of regulators to harmful regulation. America’s Centers for Disease Control and Prevention (CDC) last month said it was ''deeply troubling'' that e-cigarette use among American teenagers has doubled, even though less than 10% of the users had never smoked a real cigarette – ie, most of them were probably cutting their risk of death. Yet justice officials from 40 American states have now demanded that the Food and Drug Administration regulate vaping. It would have done by the end of this month if the government had not shut down.

By the way, if you are now worried about shampoo, don’t be. Coffee and organic broccoli have more carcinogens in them than most chemical products. But that does not make them dangerous. It’s all about dose.

PS. A source in the European Parliament, after reading my article, added a fascinating detail:

A further interesting point is the subtle role played by big pharma, who fund hundreds of various anti smoking organisations that curiously all lobbied against e-cigarettes. They, of course, want control of the market, have all the pharmaceutical grade production facilities and large corporate compliance departments whereas most existing e-cig companies are small scale start ups.