Electronic cigarette harm reduction

Both Sides Of The E-Cigarette: Precautionary Thinking Versus Harm Reduction Theory.

As more reports surface claiming the dangers, or the health benefits, of e-cigarettes it is becoming more and more difficult to wade through the mudslinging to get to the real truth of the issue. That is the concern of many harm reduction advocates all over the world, and that issue is being brought to light in the latest volume of Science Magazine. Amy Fairchild and Ronald Bayer are professors at Columbia University and the authors of this policy report, entitled, “Smoke and Fire Over E-cigarettes” in the June 23rd, 2015 edition of the magazine. Their report outlines the two very outspoken sides to the e-cigarette issue and questions how the interpretation of each side could negatively affect product development and in the end inhibit the potential for harm reduction and the other health benefits that could be obtained with the use of e-cigarettes.

When word broke in early 2014 that the World Health Organization (WHO) was poised to take a harsh stance against e-cigarettes, a group of 53 researchers coming from 18 nations around the world sent an urgent appeal to Dr. Margaret Chan, Director-General of the WHO. The researchers argued that it was critical to remain open to evidence regarding “low-risk non-combustible nicotine or tobacco products that may become viable alternatives to smoking in the near future.” The researchers went on to praise e-cigarettes as a harm reduction devices, one that showed there was “no evidence at present of material risk to health from vapor emitted from e-cigarettes.” Nor was there any evidence of e-cigarettes being a gateway to tobacco smoking. The letter concluded by asking that the WHO becoming the “vanguard of science-based, effective and ethical tobacco policy, embracing harm reduction.”

WHO and Dr. Chan also received a letter from Dr. Stanton Glantz and a group of other researchers claiming e-cigarettes are nothing more than a wolf in sheep’s clothing. Dr. Glantz is a well-known and outspoken opponents of e-cigarettes, and he and his constituents believe that e-cigarettes are simply another product driven by an industry that has no care for the true public health of their customers but instead is only bent on “increasing profits through predatory practices.”

In summer 2014, the WHO released their report on e-cigarettes, and probably not surprisingly, they came out urging for strong regulation for the e-cigarette industry, a move that squarely puts a cog in the e-cigarette’s progress wheel. In a statement, sounding much like the letter from Dr. Glantz and company, the WHO recommended strong regulation and went on to express “grave concern” about the growing role of the powerful tobacco industry in the e-cigarette market, warning that these companies could come to dominate the business and use the current tolerance of the new products as a gateway to ensnaring a new generation of smokers.

The World Health Organization made a clear choice on which side of the debate they fall on, the side of precaution. The precautionary principle is adopted by those who want to ban or severely restrict e-cigarettes. They believe that those who accept the idea of lesser harm are simply being duped and are ultimately naïve pawns in the grand scheme of Big Tobacco’s plans for profits. Ironically, heavy regulation will likely benefit Big Tobacco, as the little guy in the e-cigarette industry will be unable to pay for the costly expenses of regulation, thus opening the door for larger tobacco companies break into the market.

The other side is of course harm reduction, which recognizes not only the e-cigarette as a safer alternative to cigarettes, but also a tool for smoking cessation. Those who agree with this side believe that thousands if not millions of lives could be saved by switching to e-cigarettes from regular tobacco cigarettes.

Fairchild and Bayer discuss the side of precaution, as well as the side of harm reduction in their recent policy report. In doing so they remind us of a shared desired from both sides of the argument. “How can two groups, both of which seek to reduce the terrible burden of morbidity and mortality attributable to smoking, both of whom embrace the centrality of evidence-based policy, come to such different conclusions?” Citing the letters to the WHO as examples, Fairchild and Bayer examine both angles, stating, “The opposing letters reflect very different understandings of what the protection of public health requires.” Though both sides disagree, everyone has the same shared interest of improved public health at heart.

The key difference between both sides, as Fairchild and Bayer point out, is the precaution side aims to cut down e-cigarettes even before enough proof can be gathered either for, or against, the benefits of vaping. And true as this may be, the authors still believe both sides are needed to truly make a fair and balanced decision. The authors state: “Decision-making may draw on elements of both precautionary thinking and harm reduction, but weighing the risks and benefits is unavoidable. It is imperative to recognize that deep precaution precludes that possibility.” The authors believe that precautionary thinking is dangerous to the future of e-cigarettes and our general public health, citing that: “Such a posture doesn’t not serve either science or policy well.”

Precautionary thinking is dangerous, as it truly does stand to stunt the progress and acceptance of e-cigarettes as the important public health devices that they are. Experts believe millions of lives can be saved, even if people just replaced their traditional smokes for e-cigarettes. The truth is, however, many people are using them to help them quit altogether. The availability, variety and ease of access of these important vaping devices is key to their ability to perform as harm reducers and fulfill their role in the overall improvement of public health.

Those who think that e-cigarettes should just be outlawed like all things that resemble smoking, are echoing the “Wingspread Statement of 1998” a foundational document in precautionary thinking. The statement reads: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.” These actions can be seen clearly in the anti-e-cigarette propaganda and movements that clearly work in opposition to the mounting evidence that support the safety and benefit of e-cigarettes.

Reports, like those from Fairchild and Bayer, remind us that there are two sides to the e-cigarette debate, and in a perfect world that should be okay. Cutting off either side is not the way to create fair and effective regulation for all sides involved. However, cutting off even the potential for e-cigarettes to be viewed as beneficial puts at risk the massive life-saving potential that is right at our doorsteps with an overall shift toward using e-cigarettes.

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