For richer or poorer, for better or worse, Dr No is a smoker. And like most smokers, he knows he should quit. And – since you ask – no, it isn’t that easy. If it was, Dr No would now be an ex-smoker. Instead, even in the face of all the evidence, the cost, and a family history that includes a father and a grandmother who died from smoking related diseases, will-power time and again fails. He has managed smoking holidays, but sooner or later the nicotine magnet draws Dr No in again. In his orbits of despair, Dr No is as likely to escape the nicotine magnet as the moon is to escape the earth’s gravitational field.
It is with considerable interest then that Dr No has watched the development of electronic cigarettes, and the reaction of his profession to their development. Conventional nicotine replacement therapy – NRT – is at best barely effective, if at all, in helping smokers to quit. The whole NRT enterprise carries a somewhat sordid air, with its products more often than not to be found on the shelves alongside ointments for piles and once-you-pop-you-gotta-stop condoms. Even now, traditional barbers are most likely murmuring the ears of discerning gents, ‘A little patch for the weekend, sir?’ By and large, conventional NRTs do for nicotine addicts what incontinence pads do for sex-addicts: they take the fun out of it.
E-cigs, on the other hand, tick many of the boxes needed to be an effective alternative to smoked tobacco nicotine delivery systems. They provide something tangible to hold, and satisfy the oral need to put one’s lips round something and suck. They deliver something to inhale, and with that the all-important throat hit, not to mention flavour – it is difficult to find a flavour that has not been incorporated into e-liquid, the fluid used to generate the nicotine laden vapour – and a ‘smoke’ – it is actually a vapour, meaning e-cig users are vaping, not smoking – to exhale. Even the non-cigarette-imitative devices – once one has accepted the notion of sticking a Mag-lite pen torch with a nipple on it in one’s mouth – can even, dare one admit it, be made stylish, so long as one does not dangle the device, bookish style, from a lanyard round one’s neck.
As there is no smoke without a fire – e-cigs are no-burners, more kettle than bonfire – there are none (apart from nicotine and even that is optional) of the hundreds of toxic constituents found in tobacco smoke, meaning that, at least in theory, the choice between tobacco cigarette and e-cig should be a no-brainer. If the tobacco cigarette is Russian Roulette with most chambers loaded, then, on the available and admittedly still somewhat limited evidence, e-cigs are Russian Roulette with most, if not all, chambers empty. Dr No knows which game he’d rather play – as do the millions who are switching from most chambers loaded nicotine delivery to most chambers empty delivery.
Such choices are to be welcomed and indeed encouraged. So what do the authorities in general and health experts in particular do? The BMA has as usual tut-tutted, its Kirk chapter calling recently for a wee ban on e-cigs in public, warning they risk glamourising nicotine. NICE currently favours conventional NRT, tagging e-cigs as ‘unlicensed products that are currently being marketed’, which hits all the wrong notes – ‘unlicensed’ (read danger), ‘marketed’ (read profit) – in all the right order to discourage e-cig use for smoking cessation. The MRHA has stuck its oar in, insisting that e-cigs are medicines, and so must be regulated as medicines, guaranteeing e-cigs will get gummed up in a morass of bureaucratic tar. WHO has waded in, describing e-cigs as a ‘threat’, and the European Parliament – no surprises here – wants bigger, better regulation. HMG on the other hand remains coy – possibly because tobacco is treasury-friendly.
The only notable counter-covnterblaste to the manifold abufes of this vile cuftome of vaping (sic) – indeed one might say welcome breath of fresh air – came last week in news of an open letter to WHO written by over 53 ‘leading specialists in nicotine science and public health’ urging it to consider e-cigs to be part of the solution, not part of the problem. Dr No couldn’t agree more. He even wonders whether e-cigs shouldn’t be glamourised, sexed up, and sold in supermarkets alongside the booze. Who knows – but not as yet it seems WHO – we might even save a few lives.