To Vape, or Not to Vape: That is the Question!

I recently signed up for the Vaping Post, an online publication that ‘brings information on vaping’. They add, ‘We consider that the electronic cigarette (vaporizer) is a method of risk reduction for adult smokers who can’t or don’t want to quit smoking.’ Having set out their raison d’être they rightly caution that:

Vaping exposes the user to the toxic and addicting effects of Nicotine…[and that] the use of e-cigarettes is not medically recognised as a mean for facilitating smoking cessation.

As I have pointed out before, it’s obvious that smokers ‘can’t or don’t want to quit smoking’ – that’s why they’re smokers. And as for feel-good notion of ‘harm reduction’, what about reducing the harm to zero by ceasing to poison yourself with nicotine in any shape or form?

Having read the Post’s manifesto and disclaimer, one might think that this should be the end of the matter; they’ve said all they need to say and could just go home. But no. In support of their perceived need to keep on taking nicotine into their bodies they invoke the Royal College of General Practitioners. This august body has issued a paper on e-cigarettes that contains a list of recommendations for general practitioners (GPs). These are worth looking at, and I’ve added my comments.

1 . GPs provide advice on the relative risks of smoking and e-cigarette use, and provide effective referral routes into stop smoking services.

Why should GPs provide advice on the relative risks of different ways of poisoning yourself with nicotine? The only sensible advice is to stop doing it – by any means.

The problem with referring smokers to stop smoking services, let alone providing effective referral routes (!) to these services, implies that smokers need some kind of ‘service’ to be able to stop smoking. This just reinforces the fears that many smokers have about the apparent difficulty of quitting and implies they can’t do it on their own. Worse, there’s a built-in excuse for failure to stop smoking: the ‘service’ didn’t work!

In any case, the College’s own figures are somewhat underwhelming: ‘Research shows that professional support alongside medication results in 8 per cent success rates at one year, compared with 3 per cent in those who attempt to quit unaided.’

2. GPs engage actively with smokers who want to quit with the help of e-cigarettes.

Is there some kind of passive ‘engagement’ as opposed the active sort? Perhaps they mean talk or discuss with smokers about quitting. It’s difficult to imagine a smoker coming to see me saying he or she ‘wants to quit with the help of e-cigarettes’. He or she could just buy some e-cigarettes and get on with it. But if this were to happen I would point out that what is needed is simply to quit and I would show the smoker how to do it. It’s illogical to recommend a nicotine product to help a smoker stop being addicted to nicotine.

3. Where a patient wants to quit smoking, and has not succeeded with other options, GPs should recommend and support the use of ENDS (electronic nicotine delivery systems or e-cigarettes).

How patronising. Why ‘should’ I recommend e-cigarettes to a smoker who has failed to quit with other options? In any case, you don’t need ‘options’ to quit – you just need to quit!

4. GPs recognise ENDS offer a wide reaching, low-cost intervention to reduce smoking (especially deprived groups in society and those with poor mental health, both having elevated rates of smoking).

Now they’re talking only about reducing smoking. This is defeatist. It won’t do smokers much good merely to reduce smoking – they need to stop! And again, why should you need an ‘intervention’ to do this? It’s the same problem as in 1. – too difficult to do on your own. By the way, what do they mean by ‘wide reaching’? And it’s not nice to be patronising to smokers in deprived groups or those with ‘poor’ mental health, as if such people are less intelligent than others.

5. All GPs encourage smokers who want to use e-cigarettes as an aid to quit smoking to seek the support of local stop smoking services.

They’ve already covered this in points 1. and 2.

What’s so unfortunate in all the noise of the debate about e-cigarettes, is that no one, apart from me, seems to be able to see what the real issue is: nicotine use – in any form – is drug addiction. And what does it do for you? Provide some real pleasure or help, for example, in reducing stress? No. What vaping does for you is – nothing.

Text © Gabriel Symonds

Picture credit: Shurov on Unsplash