Letters Hold the line against tobacco

BMJ too negative on e-cigarettes

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g332 (Published 21 January 2014) Cite this as: BMJ 2014;348:g332
  1. Clive Bates, director1
  1. 1Counterfactual Consulting and Advocacy, London SW12 0NX, UK
  1. clive.bates{at}yahoo.co.uk

Godlee’s editorial comment took an inappropriately negative view of e-cigarettes.1 The risks are mostly minor, speculative, or implausible, but the opportunities are huge. Thousands of people already use e-cigarettes instead of smoking, and we should understand and empathise more with their experience.2

Before taking a position on e-cigarettes it is worth reflecting on the recent history of “snus.” This smokeless tobacco product is 95-99% less risky than smoking, but it was banned in most of the European Union in 1992 because campaigners argued that it creates a “gateway” and facilitates continued smoking. In reality, where it is still permitted the opposite happened, and smoking prevalence and tobacco related disease are the lowest in Europe by far.3 Hostility towards nicotine use and the tobacco industry blinded many activists and policy makers to the public health opportunity. We should not repeat that mistake with e-cigarettes.

The e-cigarette should be seen as a disruptive intrusion into the cigarette industry, with great potential to reduce harm. More effective and edgy e-cigarette marketing may be beneficial to health if it means that more smokers switch and quit smoking. It should not trigger a dogmatic oppositional reflex.

Negativity about involvement of the tobacco industry is inevitable, but there has long been scope for a different business model to emerge.4 These companies are primarily in a market for legal recreational nicotine, and are now undergoing radical innovation. The rise of e-cigarettes is deeply threatening to them, and is widely characterised as their “Kodak moment.”5 Will we ever see the end of smoking? A plausible endgame would include a transformation of the recreational nicotine market from a harmful to a harmless delivery system. With vigilance, encouragement, and competition, it is possible, and desirable, for the tobacco industry to play an important role.


Cite this as: BMJ 2014;348:g332



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