New rules from Brussels effectively banning low-risk alternatives to cigarettes, like e-cigs, will cost lives.
In December 2012, the EU’s executive, the European Commission, announced its proposals to revise the Tobacco Products Directive (TPD), originally passed in 2001, to take account of ‘significant scientific, market and international developments’ that have taken place since. But far from improving Europeans’ health, the proposals as they stand could well lead to many thousands, perhaps millions, of unnecessary early deaths.
In a press release announcing the revision, the EU’s commissioner in charge of health and consumer policy, Tonio Borg, declared: ‘With 70 per cent of smokers starting before the age of 18, the ambition of today’s proposal is to make tobacco products and smoking less attractive and thus discourage tobacco initiation among young people.’ So, for example, the revised directive would provide for some pretty run-of-the-mill tobacco-control measures like bigger health warnings, something likely to be ineffective in persuading smokers to quit – and quite possibly attractive to young people looking for a way to ‘rebel’.
There would also be bans on the use of ‘characterising flavours’ with tobacco products. That would mean an end to menthol cigarettes, on the untested presumption that flavoured products make it easier for young people to get into smoking. In reality, flavoured cigarettes are not wildly popular. Even accounting for menthol, by far the most popular of these flavours, they make up just five per cent of the cigarette market.
However, such flavourings are much more widely used in smokeless tobacco products like snus (moist tobacco placed under the lip, often in small, teabag-like pouches). Snus is widely used in Sweden and, while it is not entirely risk-free, it is a much safer way of getting a nicotine hit than cigarettes. The result is that the rates of lung cancer in Sweden are by far the lowest in Europe, thanks to the low smoking rate – just 12 per cent compared to 21 per cent in the UK. Yet the ban on flavourings – used in around two thirds of snus products – would make snus less appealing, with the consequence that there would be less incentive to choose snus over cigarettes. In the rest of the EU, this is a fairly academic issue; snus is already banned everywhere except Sweden. With its potential to hit the snus market, the flavourings ban is seen in Sweden as a backdoor attempt to get rid of snus there, too.
But things get even worse when it comes to the new kids on the nicotine block: e-cigarettes. These do not contain tobacco at all. Instead, nicotine is dissolved in a liquid, usually an alcohol-like solvent called propylene glycol, which is generally regarded as safe and is widely used in small quantities in food and is also used for ‘smoke’ machines in theatres. When the user draws on the e-cigarette, a small amount of this liquid is heated into a vapour and breathed in. Instead of the smoke from a regular cigarette – which contains small quantities of many different carcinogenic substances – puffing on an e-cigarette provides no more than a dose of nicotine and some harmless vapour. That’s also good news in other ways, since there is no residue of ash and no ‘secondhand’ smoke to worry about, either.
There is every reason to believe that e-cigarettes are much safer than tobacco cigarettes. Even nicotine itself is not carcinogenic. For that reason, e-cigarettes have become very popular in the past couple of years. The Electronic Cigarette Consumer Association of the United Kingdom (ECCA-UK) claims over 700,000 people in the UK own e-cigarettes and the numbers are rising fast. Yet rather than promote this wondrous invention, which could improve the health of millions of people while allowing them to enjoy nicotine, the EU seems determined to ban e-cigs.
A point-by-point demolition of the revised directive is provided by Clive Bates, a former director of the UK anti-smoking group Action on Smoking and Health (ASH). Bates is certainly not pro-smoking, but his approach to the subject is to assume that millions of people like to smoke, despite numerous attempts to dissuade them, and therefore it is better to reduce the harm of their habit as much as possible.
As it stands, the EU is considering regulating e-cigarettes either as medicinal products – treating them like nicotine gum and patches – or as tobacco products. But as Bates points out, neither category makes much sense. E-cigarettes are not promoted as a means to wean oneself off nicotine – though some people clearly use them that way – but rather as an alternative to smoking, to ‘meet the demand for nicotine as a recreational drug that is not especially harmful itself’, in Bates’ words. Therefore, the usual long-winded process of assessing them as medical products should not apply. Nor are they tobacco products, since they contain no tobacco, even if the nicotine comes from tobacco plants. As Bates argues: ‘We would not classify an energy drink as a coffee product if it contained pure caffeine extracted from coffee. E-cigarettes are best considered as “nicotine products” for the purpose of regulation.’
Bates argues that e-cigarettes should be regulated, but only in the sense that any other consumer product is regulated. ‘There may be scope to set specific standards, for example for e-liquids, and member states could develop proper enforcement regimes. But developing regulation within the broad framework of consumer-protection legislation should be the focus of efforts in Europe.’
The real purpose of these regulatory shenanigans is effectively to ban or severely restrict e-cigarettes. While some anti-tobacco campaigners have taken a similar stance to Bates, others have concocted all sorts of justifications and junk science to demand a precautionary approach. In reality, this is an entirely moralistic attitude, a puritanical approach that condemns any kind of mood-altering substance – particularly a habit-forming one like nicotine. For example, one dubious claim is that e-cigarettes will be a ‘gateway’ to using tobacco. There is no evidence to support such a claim. In fact, all the evidence points the other way – existing smokers using e-cigarettes to get away from tobacco cigarettes. To block people from accessing this escape route is rather like padlocking fire doors on the off-chance that someone tries to break in.
Throw in the tobacco-control lobby’s visceral hatred for Big Tobacco – which is already dipping its toes into the e-cigs market – and you have a potent driving force for irrational legislation that does far more harm than good.
E-cigarettes provide almost all the experience of traditional cigarette smoking with, in all probability, one per cent or less of the harm. If e-cigs are banned, a substantial proportion of the population will simply carry on puffing away on the traditional fag, with all the well-established harms that come with regular smoking.
If health really were its overriding concern, the Commission could have put harm reduction at the heart of the revised directive. The snus ban outside Sweden could have been abolished. If the e-cigs market were allowed to develop, it seems quite possible that traditional cigarettes could become increasingly unfashionable. After all, even smokers aren’t too keen on smelly clothes and stray fag butts. Instead of grasping a fantastic opportunity to improve people’s health, the EU’s approach – as illustrated in its prohibitionist approach to snus – is simple, blunt and deadly: quit or die.
Having failed to persuade people to quit their bad habits, the moral crusaders in the tobacco-control lobby have instead decided to appeal for a committee-room stitch-up in Brussels, far from the meddling influence of voters. The fight over the Tobacco Products Directive is a profound illustration both of the authoritarian impulses of many campaigners and medics, and the anti-democratic nature of the EU itself.