This week has been a big week for e-cigarettes in the NZ news. And by that I mean there has been more than one story. Overseas, e-cigs are receiving a lot more attention and commentary.
No doubt the coverage was influenced by the world premiere of ‘A Billion Lives’, a documentary about vaping. The film exposes how the risks associated with vaping have been exaggerated by those with conflicting interests, and how the science/evidence is actually much more promising and optimistic.
There is a lot of misinformation about e-cigs and vaping floating around. In fact, that’s an issue covered in the Initiative’s Health of the State report, which looks at the evidence around e-cigarettes, as well as common ways the science can be misinterpreted. Do read it (I don’t like telling people what to do, but it’s got some stuff on e-cigs that gets missed in public debate).
Whether it is by coincidence or by design, this week new research in the area was announced. Funded by the Health Research Council, University of Otago researchers will gather evidence on e-cigarette behaviour and usage via smart e-cigarettes. (“Microprocessor-controlled vaporisers in the smart e-cigarettes would capture and record users’ behaviour on either an Android or iOS device using Bluetooth technology.”)
In principle, gathering evidence on real e-cig behaviour and usage can only be a good thing. Gathering evidence on how often people use the devices, and how intensely they drag on it, will (in part) determine health effects. This method is also much more accurate and trustworthy than self-reported evidence, or assuming that all e-cig users will use the device the same way.
But – and there is a but – a few alarm bells are ringing that such data could just be collected as evidence to support a ban.
It is this part that makes me question how the evidence will be used:
Researchers lacked the data needed to assess whether such dual use was a “transitional behaviour that supports smoking cessation, or a sustained behaviour pattern that promotes continued tobacco use”.
It assumes those who don’t quit completely would have done so if it hadn’t been for their e-cig use. The worst case scenario is that if e-cig users do not quit smoking completely, they will be labelled ineffective and even dangerous as they stop people reaching full cessation.
- There is an assumption that those who cut down on their smoking receive no benefits, and that the only way to improve your health is by quitting completely. Now, there is no doubt that full cessation will improve your health the most. But surely there are also benefits to cutting down. This is an issue covered in better depth in The Health of the State. What I found interesting is that there is evidence dual users (people who use e-cigs and smoke) don’t draw as intensely on normal cigarettes, and thus draw in less toxins.
- Surely limiting the availability of e-cigarettes (or in NZ’s case, nicotine e-liquids) should be tested on the grounds of safety, not effectiveness. As long as the products aren’t making health claims (like they will be successful in helping people quit), then safety is the top priority.
- Too many claim that the ‘jury’s still out’ on safety, thus limited availability makes sense. But when it comes to physical safety, there has been no convincing evidence to date that e-cigs cause disproportionate harm. There is an open question of long-term safety, but the evidence here isn’t ‘mixed’, by the very nature of ‘long term’, that evidence just doesn’t exist yet. Social or behaviorual ‘safety’ is another question, but again, conclusions on behaviour are likely to be premature as behaviours are likely to develop over time.
- There needs to be a better counterfactual: would dual users have quit completely if it hadn’t been for e-cigarettes? There’s difficulty in comparing vapers with other forms of cessation methods, when different people may be responsive to different therapies. Those who take up vaping may have never considered quitting or cutting down on smoking unless e-cigarettes were an option.
- In and of itself, this is really valuable research. I’d be curious to know how New Zealanders use the product, keeping in mind behaviours will be (in some ways) dependent on social norms and the quality of the technology. The downside of such research, by its very nature, is that by the time anything is published, it’s bound to be out of date.
Conclusion? This research will be useful and interesting, but is not a sufficient reason to hold up regulatory change.