I love teasing my friends who use e-cigarettes. There’s something intrinsically uncool about e-cigs – they’re gadgety, a bit silly-looking thanks to their chunkiness and the huge clouds of vapour they produce, and bring to mind the sort of middle aged geezer who hangs around CAMRA beer festivals with a beer checklist. I love to send my friend Dan photos of new vape shops that have silly names like “Vape Lords”, as if he loves vaping so much that he’ll be excited just to see that it exists. The “we get it, you vape” meme came about because vapers often will not shut up about it, which reminds some people of vegans or that guy who tells you he doesn’t even own a TV at every opportunity.
So I understand why people don’t care about vaping and public policy. If you’re not a smoker and haven’t experienced some of the costs of smoking in your own life – a relative dying young from lung cancer, say – it’s easy to just ignore it and laugh about the people who keep hammering on about it.
I was among that group until a few years ago, and thought that the issue was a minor one compared with the weightiest issues in public policy – tax, housing, immigration, Brexit. But nowadays, the more I’ve learned, the more I think that e-cigarettes and related products might be one of the easiest ways to improve people’s lives we have. And if public policy can make them better, and make people more likely to use them instead of smoking cigarettes, then it should be a major priority for people interested in improving human welfare.
Smoking is bad, but…
The first point to note is that smoking tobacco – that is, lighting it on fire and inhaling the smoke – is very harmful. On average, lifelong smokers seem to live for about ten years less than if they had not smoked, and they will be sick more often.
But it is also very enjoyable for many smokers, who judge the trade-offs to be worth it, perhaps because they like the taste or the nicotine. Though it’s important to make smokers aware of the harm that smoking does, most anti-smoking regulation is based on unproven assumptions about smokers’ rationality and ability to compare costs with benefits. I want smokers to be aware of the costs of smoking, and to make sure they bear the costs they impose on others.
But most taxes and anti-smoking regulations are designed to increase the cost of smoking, which unless they are systematically irrational (unproved) is welfare-reducing even if they manage to persuade smokers to stop smoking. In short: only individuals can decide if the pleasure of a lifetime of smoking is worth living for ten years less.
Many anti-smoking policies do not work very well even by their own standards. Taxes do, but indoor smoking bans, display bans, advertising bans and others all seem to do nothing to stop people taking up smoking (though they sometimes do lower smoking rates among current smokers). Plain packaging has been an abject failure in Australia, the only place that has had it long enough for us to measure. And, remember, most of them work by making smokers’ options worse and raising the costs of smoking, not by giving them a better alternative.
E-cigarettes do the job
If some, most or all of the enjoyment of smoking could be delivered with less or none of the harms, humanity would be in luck. Instead of stopping people from smoking by raising the costs of doing so, as most smoking taxes and regulations do, and lowering human welfare, we would be able to lower the number of people smoking (and dying young) while also raising human welfare.
This is the promise of e-cigarettes and other reduced risk tobacco products. E-cigs are much safer than cigarettes. The Public Health England review into them that concluded they were 95% safer was being highly cautious with that figure – the truth may be closer to 99% or 100% safer.
Voluntary uptake of e-cigs since they first came to market has been very rapid and large. Since about 2011, three million people (about 5.6% of the adult population of Britain) have taken them up – one vaper for every three smokers (15.8%, 7.6 million people, smoke cigarettes). Two million of these say that they have used e-cigarettes to quit smoking, and another half a million say they are in the process of doing so, though this number may be somewhat exaggerated as self-response surveys sometimes are.
There are some interesting, though rough and uncontrolled, correlations in smoking and vaping rates that might suggest a relationship that we should be interested in. It was only from 2011 that the smoking rate began to fall quickly again after five years of barely falling at all; and from 2014 there is a sharp drop in under-25s smoking rates right at the same time that there is a sharp rise in e-cig use. That's quite an exciting trend!
The biggest anti-smoking public health groups have come out in favour of e-cigs, with ASH, Public Health England, Cancer Research UK and many others writing to the government to say that “e-cigarettes are the most popular quitting tool in the country with more than 10 times as many people using them than using local stop smoking services”. And fair play to them for that. On their side of the debate, there are people that oppose anything even resembling smoking without good reason for doing so, and giving in to them would have been easy.
Why this stuff matters
What now matters is regulation, where Britain faces some important questions that will determine how much more e-cigs can do. Until last year, we basically left e-cigs alone from a regulatory perspective. There is no legislation (yet) banning their use in public places or buildings, though obviously many places privately choose to ban them indoors (we do at the ASI, during office hours). Advertising as a consumer product is fine, but if you want to make claims about harm you need to get the device regulated as a medical product, which is prohibitively expensive and time-consuming.
There are three questions on the regulatory front that we need to make decisions about. One, after Brexit whether we should continue the Tobacco Products Directive’s rules around things like vape liquid bottle sizes, which make vaping less convenient; two, whether we should change the advertising rules to make it easier for public health campaigners and e-cig companies to advertise the fact that they are much safer than cigarettes (and nearly as enjoyable!); and three, whether we should try to create a regulatory framework for other products that are like e-cigs so that it is easy to bring them to market.
Of these, changing the rules around advertising is probably the most important. The Advertising Standards Agency is currently holding a consultation on this, at the request of public health groups. If they do change the rules the risk is that they only do so in a narrow way, so that e-cigs’ safety can be promoted as part of a stop-smoking campaign but not alongside claims about them being enjoyable, fashionable, or whatever.
The gains are potentially enormous. Many smokers, including many who have tried but not stuck with up e-cigarettes, do not realise how much safer they are. 91% of dual smokers/vapers agreed in a survey that e-cigs were safer, but only 60% of smokers who had not tried an e-cig and 75% of smokers who had tried them but had given them up. 23% of smokers said they hadn't tried an e-cig because they were concerned about safety, and of people who had tried e-cigs but gave them up, 35% said that it was because e-cigs might not be safe enough. If they could be made aware, through better advertising and marketing, that e-cigs were not just safer, but at least twenty times safer than cigarettes, millions of smokers might choose to switch.
To me, one group in particular stands out here. In most age groups, men and women both smoke and vape at similar rates to each other. But in the under-25s group, only 2.6% of women vape compared to 8.9% of men. I do not think it is much of a stretch to assume that the uncool image e-cigs have is part of the reason for this. This age group is particularly important because people who do not become regular smokers while they’re this age are very unlikely to take up smoking in later life. If better and more convincing advertising could be brought to bear to make e-cigs less embarrassing for young women to use, and we merely brought their usage rates up to that of young men, 1.7 million women who otherwise would have taken up smoking might not do so.
1.4 million disability-adjusted life years are lost every year to smoking. Even small shifts from smoking to vaping would have a very large impact in terms of life-years saved. If marketing could make e-cigs less uncool, and make smokers better informed about the safety, the potential gains are huge. The method seems effective, it doesn’t cost us anything, and it’s voluntary, so we’re expanding choice and improving welfare, not just raising costs on a choice we don’t like. For anyone interested in human wellbeing, making public policy more e-cig-friendly seems like it should be a top priority. I even promise to tease my vaping friends less.
If you're going to be at Conservative Party Conference in Manchester next week, you might want to come to our panel discussion on vaping, synthetic alcohol and other ways that innovation is beating the nanny state at its own game. Details here.