Views on e-cig­a­rettes may need re­think­ing

The West Australian - - OPINION - Gareth Parker

In pub­lic health, the or­tho­doxy of harm min­imi­sa­tion is en­trenched — es­pe­cially when it comes to the use and abuse of drugs and al­co­hol.

The prin­ci­ple is that ap­proaches of out­right pro­hi­bi­tion or ab­sti­nence towards drug and al­co­hol use ig­nore the hu­man re­al­ity of some level of use.

It is bet­ter to recog­nise this fact and to de­velop ap­proaches that en­sure neg­a­tive con­se­quences are min­imised and con­tained as much as pos­si­ble.

Thus nee­dle-ex­change pro­grams are funded by tax­pay­ers be­cause it is bet­ter that if peo­ple are go­ing to in­ject drugs in­tra­venously, they do so with­out the risk of spread­ing dis­ease, which would worsen pub­lic health over­all.

Sim­i­larly, su­per­vised in­ject­ing rooms op­er­ate on the idea that it is bet­ter for a drug user to do their thing in a con­tained space rather than out on the street — and if over­dose oc­curs it is bet­ter that this hap­pens where there is a chance of in­ter­ven­tion rather than lonely death.

It’s a sound ap­proach but, cu­ri­ously, it goes out the win­dow when it comes to a prod­uct that — at the very least — holds strong po­ten­tial as an aid to as­sist peo­ple to quit smok­ing and avoid pre­ma­ture death.

That prod­uct would be e-cig­a­rettes — battery-op­er­ated elec­tronic de­vices which heat liq­uid-con­tain­ing car­tridges to a vapour, which is then in­haled, or “vaped”.

In a week where it was re­vealed that the num­ber of Aus­tralians who smoke had ac­tu­ally in­creased for the first time in decades (though rates fell marginally on a per capita ba­sis), it is fair to ask whether anti-smok­ing ef­forts are reach­ing the point of di­min­ish­ing re­turns.

And it is worth ask­ing why smok­ingre­duc­tion ef­forts may be stalling in Aus­tralia, with its puni­tive taxes and plain pack­ag­ing, when in the UK and US smok­ing rates are still fall­ing — and there is less hos­til­ity to va­p­ing.

E-cig­a­rettes are widely avail­able in WA and many peo­ple im­port car­tridges via in­ter­net mail or­der.

But sell­ing vape juice that con­tains nico­tine is ex­pressly pro­hib­ited by our to­bacco-con­trol laws, as is sell­ing any prod­uct which re­sem­bles a real cig­a­rette or cigar.

In prac­tice, va­p­ing de­vices which heat liq­uids that don’t con­tain nico­tine — and make no ther­a­peu­tic claims — are per­fectly legal.

But as ev­ery­one knows, it’s the nico­tine that makes smok­ing ad­dic­tive, and nico­tine is banned by Fed­eral poi­sons laws.

Ab­surdly, there are carve-outs for ther­a­peu­tic prod­ucts ap­proved to aid quit­ting smok­ing and — you guess it — deadly cig­a­rettes.

Ev­ery time the sub­ject is dis­cussed on talk­back ra­dio, lines light up with sto­ries of smok­ers who have butted out as a re­sult of their take-up of va­p­ing (and their sto­ries sug­gest that bans on nico­tine-con­tain­ing liq­uids are eas­ily sidestepped via the in­ter­net).

The prove­nance of those liq­uids is of­ten China, though as man­u­fac­tur­ing stan­dards are un­reg­u­lated, vapers are forced to take a leap into the un­known.

The pre­cau­tion­ary prin­ci­ple — we don’t know the long-term ef­fects of this stuff — is what seems to in­form the great body of ex­pert and peak-body op­po­si­tion to va­p­ing.

Govern­ment health de­part­ments, the Aus­tralian Med­i­cal As­so­ci­a­tion, the Can­cer Coun­cil, Heart Foun­da­tion and oth­ers ar­gue that there is in­suf­fi­cient ev­i­dence to say what long-term dam­age will oc­cur.

But we do know be­yond doubt that smok­ing to­bacco is aw­ful for your health — and it is not the nico­tine that is harm­ful.

In May, a Telethon Kids In­sti­tute study tested four e-cig­a­rette liq­uids on mice and the head­line find­ing was that they could be harm­ful to lung health.

“(T)wo e-juices with glyc­erin as the main in­gre­di­ent and only trace amounts of propy­lene gly­col were al­most as dam­ag­ing to lung health as tra­di­tional cig­a­rettes,” lead au­thor Pro­fes­sor Alexander Lar­combe said.

But liq­uids where the main in­gre­di­ent was propy­lene gly­col had “only a small im­pact on res­pi­ra­tory health”.

There is clearly room for more re­search but in the same way that in­ject­ing drugs with a clean nee­dle in a su­per­vised en­vi­ron­ment is prefer­able to shar­ing in­fected nee­dles in the streets, surely va­p­ing a prod­uct that may carry a risk of lung dam­age is bet­ter than smok­ing to­bacco which is a good chance to kill you.

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