E-cigarettes as medical or recreational devices – is there room for both?

In the latest New Scientist is a report on British American Tobacco’s acquisition of an e-cigarette company and apparently “is now planning to ask the UK authorities to recognise one of its products as a smoking-cessation medicine”.

Most of us pro-harm reductionists and vapers in general much prefer the recreational designation of e-cigarettes for more than one reason.

If medicalized they will 1. have the same sort of gestation times that new drugs to market do (years and years of testing) 2. limited availability 3. greater restrictions on the forms they might take (less choice for the consumer) and 4. power will be concentrated into fewer hands (only large companies like BAT will be able to afford the testing requirements).

If not medicalized, if recreational consumer products, they will 1. remain available subject to conforming to consumer protection guidelines 2. they will be as available as cigarettes (and isn’t that pretty important?) and 3. you are more likely to have one that suits your needs.

Ironically if categorized as medicine the immediate effect will be a harm to public health in making smokers wait years til they are cleared. (Of course, if BAT is pushing for medicalization it is most likely because they now that would give them quite the edge since few other groups could pony up the funds to join the party).

There is also the distinct possibility that as medicines they will be allowed a greater latitude in harm than is allowed in consumer products. Champix would have never been considered safe enough as a consumer product but somehow as medicine having a shot at quitting smoking is worth the risk of suicide.

But perhaps there is a third way – a compromise. Two distinct products not unlike the relationship of the pharmaceutical inhalers and e-cigarettes.

Why not leave the recreational e-cigarette available while allowing a product that is similar but tested as a cessation device. Big Tobacco and Big Pharma could market their cessation e-cigarettes in competition with regular e-cigarettes.

Imagine all of us vapers as runners (I know at least a few of us must be). We have a choice between running the streets, out in the country, in the woods, changing our pace as it suits us, and then we have the option of a treadmill. Roughly the same but oh so different.

That’s the post.

On a separate note I would like to announce the publication of a collaboration between James Dunworth and myself on an ebook Electronic Cigarettes: What the Experts Say

This collection of interviews with scientists, activists and users, compiled over 4 years of writing for the Ashtray Blog, explores whether the electronic cigarette is really safe – and what is behind the campaign against them. (For more details on the contents)

All profits will be donated to The Consumer Advocates for Smoke-Free Alternatives Association (CASAA) and to the E-Cigarette Consumer Association of the UK (ECCA UK). You can download the book at either Amazon UK or Amazon USA.

Cheaper than a cup of coffee and all for the cause.

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  • castello2  On February 22, 2013 at 12:45 am

    Awesome! I will donate a pot of coffee!

  • Clive Bates (@Clive_Bates)  On February 25, 2013 at 6:01 am

    I agree with this two track or ‘opt in’ approach to medicines or consumer regulation for e-cigarettes. My response to the New Scientist article:

    Why Should E-cigarettes Be Regulated As Medicines?
    Thu Feb 21 12:16:27 GMT 2013 by Clive Bates

    There is a liberal argument that goes like this: if people want to sell them, people want to buy them, they are much less risky than cigarettes and they comply with norms of consumer protection – like being safe, working as intended (ie not faulty), and as-described – then why is the medicines regulator involved, and why is it necessary to set a bar before they can be placed on the market? Nicotine is a widely-used legal recreational drug that in itself is almost harmless, so why obstruct a much less dangerous way to take it with huge regulatory burdens that do not apply to cigarettes?

    E-cigarettes are not a medicine, and they are not used to quit smoking in the same way as NRT (ie complete withdrawal from nicotine, with NRT providing subliminal relief from craving). E-cigarettes are used to smoke (‘vape’) in a different way, to obtain a satisfying nicotine ‘hit’ without many of the extreme disadvantages of tobacco smoke, but with some of the same ritual. The people using them do not define themselves as in treatment, and those selling them do not define themselves as health care providers. The appropriate comparator is a cigarette, not NRT smoking cessation products.

    The health experts and campaigners should beware what they wish for. They could end up piling on compliance burdens, costs and disproportionate restrictions on e-cigarettes that do not apply to cigarettes – killing off the innovative suppliers. They may end up throttling an incredibly important ‘insurgent’ industry with the potential over time to transform the cigarette market. According to the WHO, one billion deaths are likely from tobacco in the 21st Century. Public health experts need to get used to the idea that changing markets for nicotine to much less dangerous products could dramatically reduce this awful toll.

    Medicines regulation does have a place when therapeutic claims are made and perhaps to support health care professionals in recommending novel nicotine products to smokers. The right approach is to make medicines regulation an ‘opt in’ for those vendors who want to make health claims or who think the advantages in terms of consumer confidence, access to health care markets and assurance for retailers is worth it. Otherwise, standard consumer protection legislation has all the necessary tools to ensure e-cigarettes are safe, fit for purpose and as-described, without asphyxiating them with red tape.

    • Paul L. Bergen  On February 25, 2013 at 10:32 pm

      Thanks for the input Clive…couldn’t have put it better.


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