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Observations Observations

E-cigarettes and the marketing push that surprised everyone

BMJ 2013; 347 doi: (Published 26 September 2013) Cite this as: BMJ 2013;347:f5780

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Re: E-cigarettes and the marketing push that surprised everyone

Martin McKee is often provocative but not always right. On e-cigarettes, he needs to rethink. (E-cigarettes and the marketing push that surprised everyone, Observations, 26 September 2013).

E-cigarettes are not, as he argues, a tobacco industry response to the public health controls on smoking. It is worth recalling that 28% of adults in the European Union still smoke despite years of the policies McKee describes. Nor is the tobacco industry suffering as much as we might like. British American Tobacco's share price has risen five-fold since the WHO Framework Convention on Tobacco Control was signed in May 2003.

These products have emerged from outside the tobacco industry, which still has only a small market share. Demand comes from smokers who value the recreational drug nicotine and enjoy the behavioural rituals of smoking but don't like the idea of dying from horrible diseases or the other consequences of smoking. Its a highly rational, market-based phenomenon, not a tobacco industry conspiracy. Growth has been so rapid and the user response so positive that investment analysts at Wells Fargo Securities suggest that e-cigarette consumption could overtake cigarettes within a decade. If that happened it would be a stunning victory for public health. The investment bank Goldman Sachs lists e-cigarettes as one of eight globally disruptive technologies. But the disruption in question is to the cigarette-based business model of the tobacco companies. The tobacco industry's belated move into e-cigarettes is not so much a response to public health policy but arises from fear that they will be left standing as their market is eroded and then destroyed by e-cigarettes. This move should be welcomed, not spurned - anything that draws multinationals away from dependence on lethal products and redirects their formidable energies to products that cause negligible harm is a good thing.

Advertising of e-cigarettes is not something to worry about or ban, rather it should be embraced. It is how smokers will find their way to these new products and it is how new brands will push the cigarette brands aside. The normal controls on truth and fairness in advertising, supplemented by restrictions of the type applied to alcohol, should be sufficient to balance public health opportunities and fears that something might go wrong.

Teenagers will inevitably use these products, but that is not a cause for a moral panic: they experiment with everything done by adults. But at present, usage amongst young people and non-smokers is extremely low. Even if they are used by teenagers, it may be as a beneficial alternative to smoking, a diversion away from harmful smoking behaviour. There is no evidence at all of e-cigarettes causing anyone to take up cigarette smoking. It seems unlikely that people who would otherwise be non-smokers would use an e-cigarette as a route to smoking. Who would switch from clean near-harmless vaping to filthy harm-inducing smoking?

McKee has an indirectly correct point: public health policies such smoking bans help drive smokers to stop smoking, and, for some, to choose e-cigarettes. It is likely that e-cigarettes provide an especially valuable health option for the confirmed and determined nicotine users who have no interest in quitting nicotine completely, attending smoking cessation clinics or wearing patches. It would be absurd therefore in the name of public health to pile on layers of costs, red tape and restrictions that make e-cigarettes less appealing as an alternative to smoking. All that would achieve is to protect the cigarette industry, slow down the transition to e-cigarettes and add to the eventual death toll from smoking. The idea of regulating a recreational consumer product as a medicine fails in both common sense and in law. If it was attempted, it would raise severe barriers to entry, drive out most of the existing companies and leave the market to the big tobacco companies. It is hard to see why Martin McKee and WHO favour an approach that protects cigarettes and gifts the disruptive e-cigarette market to Big Tobacco.

Note: author is former Director Action in Smoking and Health (1997-2003) and a former civil servant (2003-2012). These views do not necessarily represent current views of former employers.

Competing interests: No competing interests

29 September 2013
Clive Bates
Counterfactual Consulting and Advocacy
London, UK