In a recent Medical Journal of Australia Insight blog on e-cigarette regulation, vaping promoter Colin Mendelsohn responded to a comment, writing “ecigs are consumer products. Medicines regulation is not appropriate. Why should they be regulated more strictly than cigarettes which can be bought at every corner shop?”

Then, without pausing for breath, in his very next sentence he goes on to tell us about how effective in smoking cessation they are, compared to nicotine replacement therapy (NRT), as one recent study reported them to be.  In case you missed it, NRT is a medicine regulated by the  Therapeutic Goods Administration, not a “consumer product” , whatever that might mean.  (see my previous blog and here for comments on the major limitations of the evidence that Mendelsohn cited)

Excitable News Corp journalist Joe Hildebrand puts it this way “How come it’s legal for me to walk into a convenience store and buy something that’s going to kill me but it’s illegal to buy the one thing that could save me?”

The one thing, eh Joe. Tell that to the 30% of Australia’s adult population who are ex-smokers who somehow managed to quit smoking without using an e-cigarette. About 5,440,800 of them, according to 2017-18 ABS data on smoking.

One problem with this trite comparison is that tobacco products are regulated in Australia in many ways that  Mendelsohn strongly opposes for ecigarettes.

• All advertising and promotion for tobacco products has been banned since 1994. Mendelsohn wants advertising for ecigarettes allowed
• the sale of fruit and confectionary flavoured cigarettes is prohibited in South Australia, New South Wales and Tasmania. He is strongly in favour of allowing many flavours, including those that may have high appeal to both adults and teens
• smoking is banned in all enclosed and several crowded outdoor areas like stadiums. He wants vapers to be allowed to smoke in areas where smoking is banned because he says this will add to the appeal of vaping and cause smokers to quit. The rest of us can just put up with clouds of vape like this is bars, restaurants and cinemas, apparently. When many vapers are present (and that would never happen of course), particulate matter levels can reach and exceed those that used to be recorded when smoking was allowed in crowded bars.
• Tobacco products are heavily taxed, depressing demand particularly among low income group and children. Mendelsohn supports reducing tax on ecigs, a policy that would make them more accessible to Australian children, of who only 1.9% smoke daily today.
• Retail display of tobacco products is banned nationally. Ecigarettes are on open display in retailers, something he fully supports
• All products are plain packaged, with large health warnings while packaging for ejuice is a cornucopia of beguiling images

Let’s repeat the same mistakes we made in allowing open slather sales and promotions with cigarettes

But more fundamentally, the galactic dangers of smoking were not fully understood for at least 40-50 years after mass consumption and the commerce that facilitated it had commenced in the first decades of the twentieth century. After mechanisation of cigarette production made them cheap as chips, it then took us 40 -50 years between the 1960s and today to fight for all the policies and campaign funding that have together taken smoking down to its lowest ever levels.

Out of ignorance and under sustained pressure from the tobacco industry, we began by making every regulatory mistake possible when cheap, mass produced cigarettes appeared. Our understanding of the health risks that may be posed by ecigarettes is in its early infancy, given the latency periods that apply with the development of chronic disease.

It is often said that if cigarettes were invented tomorrow, and we knew now what we didn’t know when they entered the market, no government in the world would permit their sale, let alone allow them to be sold in every convenience store.

With pharmaceutical products that save lives, treat illness and reduce severe pain, we allow only those with a 4 year pharmacy degree to sell them. And only to those with a temporary license issued by a doctor (a prescription) to use them. With cigarettes, we foolishly allow them to be sold everywhere.

Very few people (me included) are saying we should ban ecigarettes. But nearly every health and medical agency in Australia and many internationally, including the WHO, are saying that they should be strongly regulated through the TGA so that over time, as knowledge increases we could review whether looser or stronger regulation (perhaps including bans) was appropriate when that knowledge is available.

That’s the way nearly every country regulates pharmaceutical products. Strict, prescription-only regulation at first,  followed by evidence-driven loosening or tightening down the track.

Vaping advocates seem to have understood little from where we went so wrong in unleashing cigarettes and allowing them to be sold everywhere from the get-go. Today they are trying to walk on both sides of the street by insisting ecigs are not therapeutic goods, but in the next breath megaphoning claims about how good they allegedly are in helping smokers quit compared to other therapeutic goods.

Make up your minds?

This 2016  Lancet meta-analysis of smoking cessation and ecigarettes concluded that  ecigs were associated with less quitting among smokers. The 2018 report of the US National Academies of Science, Engineering and Medicine on ecigarettes concluded “Conclusion 17.1 Overall, there is limited evidence that e-cigarettes may be effective aids to promote smoking cessation.” NASEM rated limited evidence four rungs below “conclusive” evidence and just two above “no available evidence”.