European Union politics occasionally produces a humiliating own goal, but few are likely to be as deadly and unethical as a proposed new approach to tobacco policy. On 8 October, the European parliament will consider a new Tobacco Products Directive. If the preferred approach of the lead scrutiny committee (Environment, public health, and food safety committee) is adopted, the EU will be adopting policies on tobacco that will protect the market for cigarettes and deny smokers much lower risk alternatives.
The first thing to recognise is that nicotine itself, though addictive, is almost harmless to health—a little like caffeine. It is the smoke that does the real damage, delivering nicotine through particles of burning organic matter and hot toxic gases drawn deeply into the lungs. Products that deliver satisfying nicotine hits without the smoke have huge potential health benefits by displacing cigarette consumption and helping people to quit smoking.
This concept works in the real world. Politicians should look to the success in Sweden where the adult smoking rate is down to 13%, compared to the EU average of 28%. As a result, Sweden has the lowest rate of tobacco related cancer, cardiovascular disease, and respiratory illness in the EU, by far. The secret of Sweden’s success is “snus,” a form of smokeless tobacco, widely used in Sweden as an alternative to smoking that is 95-99% less risky. So what is the EU policy on snus? It is banned outside Sweden, and it would remain banned under the proposal now facing the European Parliament. It should be simply treated like any other smokeless tobacco, but it is banned because it is sucked rather than chewed—an absurdity that brings the European Union into mocking disrepute.
E-cigarettes have even greater potential, as they can deliver a satisfying hit of nicotine and also emulate some of the rituals and behaviours associated with smoking, making them more appealing. But they too have negligible risk to health. Sales of e-cigarettes are increasing dramatically with million of enthusiastic users. One experienced Wall Street analyst, Bonnie Herzog of Wells Fargo Securities, believes they might overtake cigarettes within ten years. Bearing in mind the World Health Organisation expects one billion people to die from smoking in the 21st century, such a huge switch to e-cigarettes would be one of the biggest public health victories of all time. Here we have a great example of consumers, innovation, and agile small companies mounting an insurgency against smoking, and without any demands for public spending, prohibitions, or coercion. However, the greatest risk to these developments is bad regulation. The worst proposal is to misclassify e-cigarettes as medicines, and so pile on huge costs, red tape, and restrictions that will destroy most companies currently in the market, remove the vast majority of products, and protect cigarettes from competition.
E-cigarettes are self-evidently not medicines, they are consumer products: a relatively safe way of taking a widely used legal recreational drug, nicotine. European consumer law has everything necessary to ensure they are acceptably safe, work as intended, and are properly described. In a market dominated by cigarettes, excessive regulation of much-safer alternatives, supposedly to protect health, will do exactly the opposite. Fortunately, a number of MEPs have now seen through these proposals and are ready to vote for amendments that are proportional, non-discriminatory, and designed to make the European internal market function as intended.
Gerry Stimson is emeritus professor Imperial College London, visiting professor London School of Hygiene and Tropical Medicine, and editor of the International Journal of Drug Policy. He was director of the Centre for Research on Drugs and Health Behaviour, Imperial College London 1990-2004, executive director of the International Harm Reduction Association, 2004-10. Director of Knowledge-Action-Change (K•A•C), a public health events and consultancy company.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Member of the National Institute for Health and Care Excellence guidelines development group on tobacco harm reduction; K•A•C has received a smoking research feasibility grant from a company developing a nicotine product.