Relative harm beats absolute harm when it comes to aids for smoking cessation

Relative harm is a far more important consideration than absolute harm when it comes to deciding whether to use e-cigarettes to quit smoking, according to addiction specialist Garrett McGovern (pictured), who is the medical director of a private addiction treatment programme in Dublin, Ireland.

McGovern expressed concern that policy-makers and health authorities lack the common sense and knowledge to make important decisions on public health issues where harm reduction could play a role – for example, whether to ban flavours in e-liquids, which McGovern believes could have massive consequences on the health of smokers trying to quit.

“As a doctor working in the field of addiction, I’ve seen first-hand the damage that smoking combustible tobacco is doing,” McGovern told TobaccoIntelligence. “E-cigarettes are immeasurably less harmful, and I’ve seen the health of former smokers improving as a result of switching to vaping.”

McGovern describes e-cigarettes as “a disruptive technology designed to battle one of the nastiest habits known to man”. Despite this, their detractors, he says, are creating fear and doubt about the long-term impact of using them, and common sense appears to have “gone out of the window”.

Concern centres around the belief that we don’t know what the long-term impact of vaping is and that using e-cigs could be “a fool’s paradise”.

“Why should we put a barrier up on the basis that we don’t know?” McGovern argued. “If we did that with vaccines, what would happen? Should we wait around for the perfect evidence? You have to allow the evidence to accumulate, but don’t stop giving people access to ways of quitting smoking. Create little channels to go down while we’re working it all out.”


Conversations between government and industry based on evidence


McGovern said that regulation around vaping is heavily scrutinised, and e-cigarettes have been around for long enough to establish potential negative long-term impacts on health. The evidence to date shows that the harms of long-term vaping are a fraction of those caused by a long-term smoking habit.

“The worry is that smokers are switching to something more harmful when they turn to vaping, but it’s so hard to crack the tobacco habit, and I’ve seen such benefits in the general health of patients who have quit via vaping: their lung health improves and their cholesterol levels come down. Wouldn’t it be better to encourage people to switch while we wait for the evidence to catch up?”

As one of the first members of International Doctors for Healthy Drug Policies, McGovern’s mission is to promote sensible drug policies. And he believes there are many policies around that are not sensible, such as that of Ireland’s Health Service Executive (HSE), which does not recommend e-cigarettes as a smoking-cessation tool.

“The HSE position on e-cigarettes is senseless, whereas the NHS [UK National Health Service] has embraced e-cigarettes as part of a suite of options for smokers trying to quit,” he said. “We need to look at the risk of creating barriers to cessation aids such as e-cigarettes – i.e., increased smoking prevalence. The health benefits of being a non-smoker are immeasurable.”

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    He applauded the stance of the NHS, which promotes vaping, in contrast to the Australian prescription-only model. “If there’s no evidence of vaping’s effectiveness, then why is it on prescription? It’s just generated a huge black market.”

    McGovern is calling on industry stakeholders to approach their governments and open up evidence-based conversations to enable a more balanced and informed debate about the consequences of restricting access to e-cigarettes.

    “We seem to have all sorts of lofty aspirations for a tobacco-free world, but the bottom line is we need to get our smoking rates down, and e-cigarettes have a huge role to play in achieving this aim,” he argued. “Governments are picking sides and have kept consumers and industry out of the conversation. They have also painted the vaping industry with the same brush as the tobacco industry. We’ve got to bombard them with evidence to stop this.”


    Unintended consequences of flavour bans


    McGovern – who will be speaking about misinterpreting the precautionary principle for nicotine at the upcoming Global Forum on Nicotine in Warsaw, Poland, from 12th to 15th June – has been talking to policy-makers on Zoom to inform them about the unintended consequences of banning flavours, among other issues.

    “Rising concern about flavours is a big thing at the moment, and I’m concerned about the way that conversation is going. People in the industry are worried that if flavours go, it will annihilate the industry. We have to make sure that doesn’t happen. We have to get the evidence across.”

    Much of the concern around the use of flavours in e-liquid stems from worries about young people vaping. But McGovern believes vaping is delaying the onset of smoking in young people, which is a good thing because smokers who start using combustible tobacco early in life are more likely to be dependent in later life and it will therefore be harder for them to quit.

    “The young people who are vaping in a dependent way – and that means daily or almost daily use – most likely would have smoked anyway,” he said. “And there’s scant evidence that e-cigarettes are a gateway to smoking for young people. Still, seeing young people vaping causes unrest in parents, which generates headlines.

    “The difference between inhaling tobacco and vaping is chalk and cheese. The hatred that’s being generated for e-cigarettes is an attack on common sense, and a lot of irrational conversations are being held. It’s so disappointing because it’s the smoker trying to quit who suffers.”

    In the meantime, e-cigarettes are not going away – at least, not in Ireland – and McGovern remains optimistic about their future in his country. “Although there have been rumblings about restricting flavours over here, we still have relatively easy access to them. And nothing happens quickly in Ireland, we’re very slow to get legislation over the line. So, for now at least, we can hold onto what we have.”

    – TobaccoIntelligence staff

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    This article was written by one of TobaccoIntelligence’s international correspondents. We currently employ more than 40 reporters around the world to cover individual nicotine markets.

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