The World Health Organization attempts, among other things, to eradicate diseases from developing nations. Or so I thought. It turns out the WHO also has a few other hobbies like attempting to eradicate electronic cigarettes from the face of the planet. The organization’s stance has gotten progressively more aggressive to e-cigarettes over the past few year to the point now where the organization wants to see signatory nations completely ban the devices.



What’s all the fuss.

The latest dust-up over the WHO and e-cigarettes comes from a recent report put out to advise the Framework Convention on Tobacco Control. Many in the harm reduction world have come out against the stance put forward by the Convention, and for good reason. One blogger connected the EU’s derailed attempt at a wholesale e-cigarette ban to the WHO’s directive for signatories to ban the devices.

Things are a little more complicated in the US, which is what is called a “non-party” to the convention. It turns out the Bush administration never sent it Congress for ratification. However, the US does participate to a lesser degree and often supports the recommendations put forth by the WHO. It seems that the FDA’s early actions against e-cigarettes back in 2008 were also influenced by the WHO.

Most of what the WHO had to say back in 2008 was a complaint that companies were advertising the devices as cessation devices, and claiming the WHO somehow endorsed the devices. The Organization noted that not enough research existed to make any sort of determination about the safety or efficacy of the devices at the time.

The next major move on e-cigarettes was in 2010 during a regulatory consultation discussing electronic cigarettes. A PDF of the presentation is available on the WHO’s website. The recommendations made in the presentation may sound familiar.

The presentation also hit on the lack of scientific evidence at the time on the safety and efficacy of electronic cigarettes. Again, pretty standard stuff, especially in 2010. Latter parts of the document called for members to examine how to regulate (or ban) ENDS (electronic nicotine delivery systems). There were also helpful guidelines for regulators and consumers. The consumer part was penned by Health Canada, a group that has recently come under fire for trying to ban e-cigarettes while allowing cigarettes to be sold.

Clearly in 2010 the WHO had a leaning toward making electronic cigarettes go away. At the time, the justification was a lack of evidence supporting e-cigarettes. Mostly, because common sense and anecdotal evidence isn’t quite enough to make anyone think that maybe some effort should be made into seeing if there might be something useful here.

Things Get Weird

Fast forward to 2012 (it seems that the WHO does something on e-cigarettes every 2 years). Things just seem to fall apart at the WHO. In a document written in June for a conference coming up (as of this writing) in November of 2012, the recommendations get more stern.

At this point, the call is now for participating nations to flat-out ban electronic cigarettes.

The document continues to note that more research is still necessary to understand the impact of electronic cigarettes. 4. Recent studies and publications point out that more research on ENDS must be conducted, especially with regard to their safety and the marketing claims made by the manufacturers (such as “alternative to smoking” or “helps smokers quit”). It is consistently noted that the popularity of ENDS is growing and that a thorough examination of these products is needed.

This is despite the fact that most reputable vendors shy away from cessation. As for the “alternative to smoking” thing, what else would it be, an alternative to riding the bus or something?

Again, this isn’t really new territory here, but there have been some studies emerging showing exactly that e-cigarettes help even unmotivated smokers to reduce their cigarette usage or abstain entirely. In addition, the report notes that none of the member states have bothered to do their own research into the safety or efficacy of e-cigarettes.

Which might explain why the organization takes a sudden shift in its approach later in the document.

The WHO essentially proposes three different approaches completely devoid of anything as urbane as science to bring about justification for e-cigarette bans and one that sort of kicks the obvious while it’s down.

First, there’s the idea that e-cigarettes look like smoking:

33. It should be noted that ENDS are products resembling cigarettes and could therefore undermine the denormalization of tobacco use upheld by the WHO FCTC. One of the guiding principles of the guidelines for implementation of Article 12 (Education, communication, training and public awareness) is Norm change. It stipulates that it is “essential to change social, environmental and cultural norms and perceptions regarding the acceptability of the consumption of tobacco products, exposure to tobacco smoke …”. Parties are therefore invited to consider that a ban of ENDS as already undertaken by some Parties would contribute to changing the social norms regarding the consumption of tobacco products.

This particular argument is the real driving force behind a lot of prohibitionist movements. It’s not the idea that someone might be harming themselves or others, but rather e-cigarettes look like smoking. That’s it, no need to prove harm, just that if it looks like something else that is bad, it must also be bad.

Next, we have the imitation product approach:

34. Another aspect to consider is that if ENDS are regarded as imitation tobacco products and banned, all ENDS would be covered, regardless of whether or not they contain nicotine, tobacco extracts, or make health claims. Parties may wish to consider that strong measures to prevent further spread of ENDS could be considered under a number of provisions of the WHO FCTC, including Article 5.2(b) which requires Parties to “adopt and implement effective … measures … for preventing and reducing … nicotine addiction …”. Most ENDS contain nicotine, and would therefore contribute to maintaining an addiction to nicotine.

To be honest I’m sort of confused by this one. Are they trying to say ban e-cigarettes as counterfeit cigarettes? If not, how exactly does nicotine free e-cigarettes run afoul against the overreaching mission of abolishing nicotine?

The next item is where I personally think the WHO has jumped the shark. I won’t give it away, I’ll be back after the quote:

35. Furthermore, under Article 13.2, Parties have an obligation to undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship. “Tobacco advertising and promotion” is defined in Article 1(c) as “any form of commercial communication, recommendation or action with the aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly”. Therefore, Parties may also wish to consider whether the sale, advertising, and even the use of electronic cigarettes can be considered as promoting tobacco use, either directly or indirectly. Regardless of whether or not ENDS contain nicotine or tobacco extracts, they are used to mimic smoking, which could be considered as a (direct or indirect) promotion of tobacco use. Article 16.1(c) could also be relevant since it requires Parties to prohibit “the manufacture and sale of … any other objects in the form of tobacco products which appeal to minors”.

I’m having a hard time coming up with a comment for this one. This is such a blatant example of circular logic it hurts to think about it. The use of a product is an advertisement for that product. Why not cut to the chase and point out that smoking is advertising cigarettes, so, cigarettes should be banned. There I just solved the world’s smoking problem, you’re welcome. Oh yes, and just for good measure, did you see that last sentence there where they tossed in the still unproven claim that e-cigarettes are appealing to minors?

Finally, the last suggestion isn’t so much exploiting a loophole as it is completely ignoring the laws of physics:

36. Additionally, the use of ENDS could hamper the implementation of Article 8 (Protection from exposure to tobacco smoke) as ENDS users in public places may claim that their electronic cigarette does not contain tobacco and/or does not produce second-hand tobacco smoke. Parties may also wish to note that Article 14 (Demand reduction measures concerning tobacco dependence and cessation) and its guidelines for implementation refer to evidence-based treatment for tobacco dependence and tobacco cessation, and to making available medications that have been clearly shown by scientific evidence to increase the chances of tobacco cessation.

Another way to classify this one is to call it the “hey, look! It’s Elvis” approach. Essentially, the idea here is trying to create smoke where there is none by pointing out that e-cigarettes haven’t been tested as a cessation device. Those two things have nothing in common. At all. The simple fact is there isn’t smoke, because nothing is burning, even if evidence supported that e-cigarettes were terrible at cessation (they don’t prove any such thing), that still doesn’t magically make what comes out of ecigs smoke. Boiling water is a terrible cessation therapy, but that doesn’t mean the steam is actually smoke.

What’s the big idea

While I never agreed with it, I could at least grasp the idea that the WHO would be chilly about e-cigarettes until there was irrefutable evidence that these things help people quit smoking, or at least won’t make users grow a third arm. Clearly, that’s not what is going on here.

The organization seems to have made up its mind and now wants to mold the conditions within countries to go with what they’ve cooked up. No matter how thin these arguments are.

The document looks a lot like what I’ve seen from many a cut-rate prohibitionist group, only this one uses a lot more words to say the same thing.

Actually, that is a little backwards on my part. The cut-rate groups are saying what the WHO said, not the other way around.

The only thing I can’t really figure out is what’s pushing the agenda. It’s fairly cut and dry with many prohibition groups who are trying to keep their grant money from their pharmaceutical sugar daddies free-flowing. There’s also the true believers who simply buy into the idea that nicotine in all forms must be done away with no matter the cost in real, human lives.

But, I’m not sure I can so easily fit the WHO into such a neat package.

What do you think? What’s driving these seemingly desperate attempts to get e-cigarettes wiped off most of the world’s store shelves?