Health Canada’s anti-cigarette stance: Cui bono

Thanks to Health Canada, the e-cigarette climate in this country is an inhospitable one to say the least. There is no problem vaping if you can get them but availability is hit and miss.

Though the view in the community has been that Health Canada does not understand the nature of the product and thus are wielding inapplicable arguments against suppliers and vendors, what remains somewhat confusing is trying to understand what Health Canada has to gain in its actions. (We will assume for the sake of debate that it is purposeful in its ways – we would like to think but cannot presume that it acts in the public interest).

There is no doubt that vaping is massively safer than smoking. It is so much safer that if the whole population vaped rather than just a small portion of the population smoked you would still have a great reduction in smoking related disease. Were there no impediments to obtaining e-cigarettes it is likely that many smokers would switch.

So why the anti-vaping stance of Health Canada? Or to put it this way – who stands to lose if vaping becomes more popular than smoking?

1. The cigarette industry – dropping sales.
2. The pharmaceutical industry – a superior alternative to products that are both less effective and more dangerous. Again dropping sales.
3. The anti-smoking groups – less smoking means less need for activist anti-smoking groups.
4. Government revenues – less collected from smokers and less from tobacco settlements.
5. Health budgets – people living longer lives means increasing the national health burden.

Many of these would not hurt Health Canada. They might face budget cuts along with other departments due to shrinking tobacco revenues but that should be offset by their increased responsibility with more older but ailing folks to take care of.

So again, what do they gain by protecting tobacco and pharmaceutical interests? Do they not chafe from the internal contradictions which arise from encouraging harm reduction in every area except this one?

Note: I am pleased to announce that I have begun consulting for ECTA. While I do not anticipate any conflicts of interest (our goals are the same – improve the availability of e-cigarettes for vapers and smokers in this country) I should stress that my writing here should not be construed as communication from ECTA, These are my opinions.

What I will be doing however is writing more and more about the Canadian situation (perhaps eventually a dedicated blog). It is clear that, even in countries where strong infrastructures supporting vaping exist, attempts at banning continue. One of the great challenges in this country is to build those supports and knowing that every day that goes by more smokers develop a smoking related disease. Hopefully the day will come when Health Canada bestows on smokers the same respect it bestows on every other citizen. The true hope is for collaboration rather than conflict.

The trouble with dedicated nicotine-free e-cigarette producers

First of all there is nothing wrong with nicotine-free options for someone who wants them. The problem is that producers and marketers limited to nicotine-free options, particular in a distorted market (as in Canada where most people think there is a ban) tend to leverage the misperception of nicotine as not only harmful but as one of the main reasons smoking is bad for you.

One of these companies, Smoke NV, based in my home town of Edmonton, was featured on a recent CBC podcast discussing e-cigarettes in Canada.

If you happen onto their site, you will read the following on their Why not nicotine? page.

We simply don’t believe that there is any benefit to having Nicotine in our product, further to this, we believe that research shows that it is not needed for a smoker to enjoy this product.

What has been discussed and is growing momentum is the harm reduction view within research. This is an acknowledgement of the fact that the use of an electronic cigarette is simply safer than the use of a traditional cigarette. Essentially for each puff of an electronic cigarette containing no nicotine you avoid a puff from a traditional cigarette. Obviously traditional cigarettes have been shown to cause cancer, heart disease, pulmonary disease etc. (Harm Reduction, Dr Phillips http://www.tobaccoharmreduction.org/faq/ecigs.htm)

The one reference for the research being used to back their claims that smokers do not require nicotine for an effective substitution is quite a strange one out of the University of East London where smokers found that nicotine-free e-cigarettes did alleviate cravings as successfully as regular e-cigarettes. But here’s the kicker. The subjects were smokers (who typically smoked 10 or more cigarettes a day) who had been deprived of smoking for just one hour and then tested 5 minutes after vaping. Somehow I don’t think that reflects true life experience.

The second paragraph is much more insidious.

Leaving aside the issue that they are linking to writing from a resource I participated in creating – tobaccoharmreduction.org – the subtle move from saying that 1. e-cigarettes are safer than cigarettes to 2. because from our product you don’t get nicotine which 3. must have something to do with all those diseases you get from smoking. (This reminds me of the early days of e-cigarette marketing when the ad copy tended to mislead consumers by harping on about being safer because they tobacco free).

Smoke NV has positioned itself as firmly against nicotine and addiction. Sure, their product is better than smoking but if smokers really enjoy nicotine (and somehow I suspect that is the case) NV products are much more likely to have them scurrying back to cigarettes than a good old nicotine delivering e-cigarette would. So potentially nicotine-free e-cigarettes in competition with regular e-cigarettes could actually be harmful to public health.

On a more cynical note, on a recent vapecast discussing the CBC show, it was suggested that Smoke NV was inserting itself into the market and once Health Canada eased up would release nicotine versions. This might be more than likely. Following a link on a recent Siegel blogpost I found myself at the Tobacco Vapor Electronic Cigarette Association.

This is an American version of ECITA (UK) or ECTA (Canada) – an organizations that promote professionalism and compliance among its members. Oddly enough Smoke NV is one of those members. And though I have not looked through all of them, the ones I have are all your average nicotine delivering e-cigarette companies. Need I say more?

In summary, there is nothing wrong in supplying users who want nicotine-free e-cigarettes. They should be an option. But companies like this are insinuating that by virtue of their product containing no nicotine that it is healthier. And there is no real evidence for that.

E-cigarettes are NOT banned in Canada

You know the old canard – if it walks like a duck, sounds like a duck and looks like a duck its probably a duck? Well, what we have here in Canada is the opposite. Though Health Canada acts as though there is a ban, suggests there is a ban, and though just about everybody in this country refers to the current situation as a ban, there really is no ban.

E-cigarettes are not a health product. They are a recreational consumer good and as such do not fall under the Food and Drugs Act. Nicotine replacement therapies (pharmaceutical nicotine products used for the purpose of quitting smoking) make therapeutic claims and therefore are covered under the act. E-cigarettes make no such claims.

Despite the fact that many smokers have switched to e-cigarettes, vendors do not claim that their products aid cessation. They also do not claim their product, or nicotine, has any health benefits.

Users do make those claims but policy is based on what producers claim and how the product behaves rather than what people say it does for them. For example I could be a smoker who took up scuba diving. The more time I spent underwater the less I smoked. After a while the desire to smoke lessened more and more and I eventually quit. I could tell you that I quit smoking through scuba diving but it does not make scuba diving a quit smoking therapy.

Granted that interpreting where e-cigarettes should be categorized can be a little confusing since they are rather unique in that they are both like and unlike cigarettes, smokeless nicotine products and nicotine inhalers. What makes them really unique is that they deliver enough nicotine to satisfy smokers who are not trying to quit.

There is a strong advisory on the Health Canada website that has been interpreted as a ban.

There is also an additional document aimed at potential vendors in which you see that though they claim e-cigarettes fall under their jurisdiction they refer to them as “health products”.

Market authorization is granted by Health Canada following successful review of scientific evidence demonstrating safety, quality and efficacy with respect to the intended purpose of the health product.
In addition, the delivery system within an electronic smoking kit that contains nicotine must meet the requirements of the Medical Devices Regulations.

Apart from the point that you require a therapeutic claim to be made to be classified as a “health product”, I think many vapers though they certainly believe their e-cig is healthier than smoking still do not consider it a “health product” nor would they think of it as a “medical device”. E-cigarettes are a consumer product and as such are governed by guidelines of consumer protection (safety standards, product labelling, quality control). In many ways consumers are more fully protected there than under Health Canada guidelines. In fact, in the UK, US and in Canada too (see the ECTA site), e-cigarette vendors have banded together to create standards of excellence for the product and marketing guidelines (no selling to minors, no health claims).(See this ECITA post on how nicotine replacement therapies would not pass the standards required of consumer products – it is a British context but roughly similar to the Canadian).

The wording of the advisory is harsh but the strongest evidence for this not being a real ban is the behavior of Health Canada when someone appeals one of their cease and desist letters.

One courageous vendor has stood up to Health Canada (HC) and remains in business. On a recent VapeCast this vendor, who openly sells e-cigarettes via a website, reported on their experience with threats from HC. They received cease and desist letters and said that when they asked HC for the specific law that was being broken HC would not furnish that information. A little time would pass and then HC would send another letter with another argument. These actions ran the gamut from cease and desist to getting customs to seize product.

If there was a legitimate ban in place all they would have had to do was cite the law and take the vendor down. It appears that while they are saying there is a ban there really isn’t.

The problem is that if you think there is a ban then you start acting as though there is. Many vendors have switched to selling non nicotine e-cigarettes (Health Canada does not seem to have a problem with those as “medical devices”) or have simply closed their doors. And though it is easy enough to say that everyone should stand up for the cause, in Canada, almost of these companies are too small to muster the resources that they think might be required.

There is a lot more to say about this. Stay tuned. This will be a recurring topic on the site. Bullying by Health Canada is depriving smokers of a safer alternative to using nicotine – it is saying in no uncertain terms that smoking is the preferable route.

If you have a story about an experience dealing with Health Canada on this issue leave a comment or send me an email describing it and I will report it (I am happy to keep it as anonymous as you wish).