Cigarette Harm Reduction? What About Harm Abolition?

I have just come across an interesting presentation by one Maciej L Goniewicz, PhD, who works at the Tobacco Dependence Research Unit of Queen Mary University of London and the UK Centre for Tobacco Control Studies. So he should know what he’s talking about. Oh, and he receives research funding from Pfizer, a pharmaceutical company that makes drugs to help smokers quit, varenicline (Chantix) and a form of inhaled nicotine called Nicotrol.

The presentation is a review of e-cigarettes’ ‘efficacy and potential for harm reduction’. Let us get straight to the conclusions:

  • E-cigarettes deliver nicotine
  • After switching from tobacco to electronic cigarettes, exposure to all tobacco smoke toxicants examined so far is substantially reduced
  • E-cigarettes may be useful in reducing the harm of cigarette smoking in those who are unable to quit

I think most people by now are aware that e-cigarettes ‘deliver’ nicotine, that is, they deliver nicotine into the lungs of people who use them. Then the good news: the fumes produced by these devices contain much smaller amounts of the poisons found in ordinary cigarettes. And the conclusion of the conclusions? E-cigarettes may be useful (or maybe not, presumably) in reducing the harm of cigarette smoking – obviously, only if cigarettes smokers switch completely to delivering nicotine into their lungs with e-cigarettes – in those smokers who are unable to quit [cigarettes].

I have emphasized the last few words because they show the great paradox in this kind of approach to the whole smoking problem: all smokers are unable to quit – that’s why they’re smokers. Apart from this oversight, Maciej L Goniewicz, PhD, can’t seem to see the wood for the trees.

Let me explain. He’s been busy estimating the quantities of ‘toxicants’ that smokers and users of e-cigarettes, respectively, take into their lungs and has found that the latter ingest much smaller quantities than the former. But let us suppose, for the sake of argument, that the fumes produced by e-cigarettes – apart from the nicotine which is their whole raison d’être – are entirely free of toxicants of any kind. If smokers could be persuaded by common sense and logic to abandon their pernicious habit of inhaling poisonous fumes from burning tobacco leaf in favour of inhaling pure nicotine by using our hypothetical ideal (but so far imaginary) e-cigarettes, would that be a good thing?

To put the question in a slightly different way, would it be a good thing for millions of people to be wandering around sucking on these new-fangled devices to deliver pure nicotine into their lungs all day, every day (for that is what they do)?

Also for the sake of argument, we’ll put aside the question – and it is a very big question – that long-term use of e-cigarettes to deliver nicotine into your lungs may not be quite so harmless in the long run, let us consider whether it is, or should be, public policy that millions of people will be in the thrall of legalised drug (nicotine) addiction?

It is all very well to talk of harm reduction, as if cigarettes are a permanent feature of everyday life, just as one may talk of harm reduction in car crashes by enforcing the use of seat belts because cars are a permanent feature of everyday life and crashes will inevitably happen. But there is no reason why cigarette smoking should be regarded as being in the same category. If cigarettes were abolished tomorrow, would anyone – apart from the tobacco companies and their shareholders – be any worse off?

If the government are serious about harm reduction, and if they go along with the results of  research such as the above, let them abolish cigarettes at the same time as e-cigarettes and other non-tobacco products are encouraged.

Text © Gabriel Symonds

Gabriel Symonds

Dr Gabriel Symonds is a British doctor living in Japan who is interested in helping smokers quit. He has developed a unique simple method without nicotine, drugs, hypnosis or gimmicks that he has used successfully with hundreds of smokers. Further information can be found at www.nicotinemonkey.com

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