September 21, 2015 1:00 pm JST
John Boley

Smoke and mirrors in the debate over e-cigarettes

When Hon Lik, a Chinese pharmacist, invented the electronic cigarette in 2003, his aim was to find a way to stop smoking, first for himself and then, after commercializing the concept, for others to stop the habit too.

     He had no idea of the chaos that would ensue.

     Using an e-cigarette is not smoking. It does not burn anything and it does not emit smoke, particulates -- the nasty little bits that can cause such damage to health -- or tar. E-cigarettes heat a liquid containing a mix of flavors, usually including nicotine, and emit nothing more noxious than water vapor. An e-cigarette is not a cigarette at all.

     This basic paradox has dogged the device ever since. Increasingly, governments and public health authorities across the globe have wrestled with the question of how to deal with them. This debate is now raging across Asia.

     A fog of confusion surrounds the device in many countries. In Hong Kong, Malaysia and Macau, decisions are imminent on whether to ban e-cigarettes altogether in the ostensible name of blocking a "gateway" to smoking and protecting youth health in the face of rapidly rising sales.

     This is despite evidence from the EU and the U.S., where millions of smokers have successfully switched from smoking to "vaping," as the use of e-cigarettes is called, and that the devices can be a highly successfully aid to people trying to quit smoking.

Dog's breakfast

Singapore, Indonesia and Thailand have bans of varying effectiveness. In Japan, Australia and New Zealand they are "sort of" banned. Some Asia-Pacific countries ban the liquids but not the device; some do the reverse. Others distinguish between e-cigs containing nicotine and those that do not.

     The entire issue is a dog's breakfast, with consumers as confused as authorities.

     In a recent opinion poll of adult smokers in six regional markets, conducted by Ipsos on behalf of factasia.org, 75% of respondents said it would be wrong for governments "to prevent or delay legalizing less harmful alternatives to cigarettes for adult smokers."

     Some 82% of smokers across the region said that "through tax and regulatory policies, the government should encourage adult smokers to switch to less harmful alternatives to cigarettes and ensure they are not used by youth."

     Yet governments appear determined to do the opposite of what their citizens want.

     This is a shame, given the welter of independent reports in recent months that indicate the legitimization and regulation of e-cigarettes could be nothing less than a life-saver.

Same risk as coffee

In August, Public Health England, a U.K. government department, said e-cigarettes are "significantly less harmful to health than tobacco and have the potential to help smokers quit smoking."

     The U.K.'s Royal Society for Public Health called for public confusion over nicotine to be addressed as a way of encouraging smokers to use safer forms of the substance, calling nicotine "no more harmful to health than caffeine."

     In August, Dr. Derek Yach, former cabinet director at the World Health Organization and the man largely responsible for drafting its Framework Convention on Tobacco Control, which restricts cigarette packaging and marketing globally, called for e-cigarettes to be brought "into the mainstream" and for governments to "end the war on e-cigarettes and view them as the smoking cessation aid that they are."

     Policymakers should "adopt regulations that encourage smokers to shift to reduced-harm products such as e-cigarettes and tighten up on regulatory actions aimed at regular cigarettes," said Yach.

     Here in Asia, many authorities appear untroubled by facts or the weight of independent opinion from acknowledged experts in harm reduction, even though reducing death and disease associated with smoking is a stated public health aim everywhere.

     The anti-smoking lobby has polarized between the quit-or-die hard-line approach of adherents of the WHO against the less punitive approach of a growing chorus of independent experts. In numerous countries, as Yach observed, there are vested interests that support cigarette production and impede rational consideration of expert testimony.

Time consuming

The main argument from governments seems to be that drafting regulations to ensure safety standards for products and ingredients, as is done with other consumer items, and implementing age-of-sale restrictions to keep e-cigs away from the young would be too difficult and time-consuming.

     In the factasia.org survey, 70% of adult smokers said they would consider switching to e-cigarettes if they were legal and met quality and safety standards. Clearly there is demand for a less harmful alternative to smoking for those who cannot, or do not, want to stop using nicotine.

     In July, Dr. Marewa Glover, a New Zealand-based leader of smoking cessation programs, blasted governments such as Singapore and "even our closest neighbor Australia" for "imposing draconian, nonevidence-based bans and restrictive laws and taxes to stop smokers switching to vaping, to stop further evolution of vaping products and to even outright ban the sale of the hardware and the e-liquids in addition to the often already banned nicotine."

     Outright bans are a simplistic, even counter-productive, response to a complex issue. If unrestricted youth access to e-cigarettes is a concern, sales can be restricted to adults. If harmful additives are a concern, governments can regulate the content of the e-cigarette liquids and they can also regulate the devices. Why give up a promising means of getting smokers to switch to something now seen to be "at least 95% safer than cigarettes," as one medical expert recently put it?

     If only Hon Lik had called his invention something else.

John Boley is co-founder of factasia.org, a Hong Kong-based consumer advocacy group promoting debate on the regulation of tobacco and other nicotine-related products in Asia.

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