I don't smoke, I never have, and even just a few years ago I was in the "quit or die" camp regarding smokers.
I got more compassionate after learning about the issue, when "vaping", the action verb for poorly named "e-cigarettes", got war declared on it by the Obama administration. It wasn't my knowledge of the science that changed - I already knew nicotine is not as harmful as tar and arsenic and hundreds of other toxic compounds found in cigarette smoke - it was more my empathy. Someone who's never been addicted to anything can't really be organically empathetic about smoking cessation and harm reduction, so I had to try.
One thing I learned surprised me and it was reaffirmed again recently; 90% of the public think nicotine is harmful like cigarettes. It's not true but since that remains the perception, it is a crippling defect in public acceptance. If non-smokers think nicotine is the same problem as cigarettes, we can't be surprised if they are for more bans on nicotine.
There is an obvious reason nicotine and smoking are conflated; for the most part, cigarettes have been the prime way to get nicotine. Yes, chewing tobacco also works but I never saw Audrey Hepburn or Marlon Brando spitting a wad of chew in a movie. People associated smoking with the nicotine because that's how it was commonly obtained. That is why I told the vaping community to jettison the 'vaping is not a tobacco product', that it shouldn't be regulated like tobacco, argument they had been using. We get optically pure nicotine from tobacco. Synthetic versions are far too expensive. Trying to say it was not related to the thing it is almost exclusively derived from was silly.
Instead, focus on the fact that nicotine is not harmful. No one has gotten cancer from nicotine gum, lozenges, and patches. It can be addictive, sure, just like caffeine, and like caffeine its LD50 is in the highly toxic range, but just like with coffee you can't ingest enough to be harmed without really trying. With nicotine, one person did try and commit suicide in 1931, but at 500 times the toxic dose it still didn't work.
Once you have established that nicotine is not harmful, unless we want to ban Red Bull (caffeine) and Budweiser(ethanol) and soybeans(estrogen) too, then you can show people need more options. Gums, lozenges, and patches do mollify the physical craving, but don't have better success with smokers because there is a psychosocial aspect to cigarette addiction. Ask a former smoker when they miss it and they won't say they miss smoking first thing when they wake up, that is probably why they quit, they will invariably say they miss it during after dinner conversation or in a bar or something else social.
The closer you come to replacing a harmful form of nicotine with something far less risky, the better. E-cigarettes do that better than a patch because the behavioral mechanism is similar. (1)
Why the drama in the US?
When it comes to vaccines and agriculture, we are far more pro-science than England, but when it comes to smoking cessation and harm reduction, they may lead the world.
Their
(1) Last year at FDA, I testified in support of a product called iQOS, which mimics smoking behavior so well without any smoke, and has had such incredible success getting people off cigarettes in Japan, I will buy one for my mother if it is ever approved.
RSPH is calling for public confusion over nicotine to be addressed as a way of encouraging smokers to use safer forms of the substance. Tobacco contains nicotine along with many other chemicals, but nicotine by itself is fairly harmless.
Nicotine is harmful in cigarettes largely because it is combined with other damaging chemicals such as tar and arsenic, and as a highly addictive substance getting hooked on nicotine is one of the prime reasons why people become dependent on cigarettes. Electronic cigarettes and Nicotine Replacement Therapy () contain nicotine but don’t contain the harmful substances found in cigarettes.
Alarmingly RSPH research reveals that and the organisation is now calling for measures to promote safer forms of nicotine products to smokers and make it harder to use tobacco. Among the measures which are being called for in its report: Stopping smoking by using other sources of nicotine:
Introduction of a smoking exclusion zone around pubs, bars and schools – allowing use of e-cigarettes but not allowing cigarette smoking. If smoking was banned from outside pubs and bars 50% of adults would be more likely to use these areas, and roughly one third of smokers would be more likely to use alternatives to cigarettes such as e-cigarettes or NRT;
Greater utilisation of e-cigarettes by smoking cessation services; only 3 out of 134 stores selling tobacco also sold NRT products;
Mandatory sale of Nicotine Replacement Therapy in shops selling cigarettes. In one study fewer than 0.5% of retailers sold Nicotine Replacement Therapy; almost three quarters of the public (70%) support mandatory sales of such products;
Licensing of all purveyors of cigarettes so that Local Authorities can remove the license of any retailers found not to be acting in accordance with tobacco legislation, such as age restrictions and the display ban;
Renaming e-cigarettes nicotine sticks or vapourisers to distance them from cigarettes
Shirley Cramer CBE, Chief Executive of RSPH, said: “Over 100,000 people die from smoking-related disease every year in the UK. While we have made good progress to reduce smoking rates, 1 in 5 of us still does. Most people smoke through habit and to get their nicotine hit. Clearly we would rather people didn’t smoke, but in line with NICE guidance on reducing the harm from tobacco, using safer forms of nicotine such as NRT and e-cigarettes are effective in helping people quit.
"Getting people onto nicotine rather than using tobacco would make a big difference to the public’s health – clearly there are issues in terms of having smokers addicted to nicotine, but this would move us on from having a serious and costly public health issue from smoking related disease to instead address the issue of addiction to a substance which in and of itself is not too dissimilar to caffeine addiction.”
I've never vaped either. But telling people they should not do things simply because I won't do them is just the kind of social authoritarianism we should oppose. But it is just the social authoritarianism that many who wrap themselves in the veil of freedom adopt; they need to ban things because you are too stupid to make an informed choice.
Let's not be that second group.
