Four years ago, almost to the day, I was sat at the back of this room, vaping discreetly as requested, and trying as hard as I could to be invisible. I’d only been vaping for about 6 months but I was already an active participant in a massive consumer movement against EU regulations, which originally were medicinal in every way except in name.
Just a month before that first summit vapers had succeeded in overturning the impending regulation and they did it simply with their stories. Thousands of people wrote to their representatives in the EU parliament and told them about their switch from smoking to vaping, and the improvements that had made to their health and their lives.
In those days we felt as if we had few if any allies. Huge, multi-national industries with vested interests in either smoking or smoking cessation were lobbying against us. Vocal members of the public health community were denying the truth of our experiences and even our existence, things which we saw with our own eyes day after day.
And yet here I was, sat in a room with hundreds of others watching academics and other experts come up on this stage and say what we already knew, that vaping should be embraced, not feared and had the potential to change the lives of millions.
Passionate vapers are a diverse crowd but we all have some things in common. We want to share our experiences and protect something we love. We also want to ensure that other people will have the opportunity to make the choices that we made, when the time is right for them.
We want lawmakers to understand why that regulation they think is such a wonderful idea really isn’t. We understand this because we created this. It was vapers who took the original e-cigarette, pulled it apart and turned it into something that works. Through thousands of informal channels such as forums and YouTube reviews we pushed industry to improve designs and options and we still do so today.
The independent vaping industry has always been incredibly sensitive to the needs of consumers – and you know why? Because most of them are us. The only difference between us is the fact that their enthusiasm took them the extra step of setting up in business.
So when you see our rowdy revolution remember that what you’re seeing is people trying to stop you fucking it all up. In order to do that some of us have also had to take an extra step – to become almost full time advocates.
The challenges for consumer advocates in this area have been massive and often over-whelming. We are all ex-smokers and let me make this clear, we are resentful of the way that smokers are treated. We naturally rail against coercive methods of forcing smokers to quit, and detest the stigmatisation of smokers that always goes hand in hand with those methods.
And yet we congratulate and support those who make the switch from smoking to vaping, just as public health might anyone who successfully quits smoking. It could be said that our goals are the same – but our ideas about how we get there are often very different.
Because of these differences getting a seat at the table has often been difficult. In the UK NNA has been lucky to have the support of Public Health England, which has opened a great number of doors for us, but has also caused suspicion within the vaping community. In my time in advocacy I have been called a troll, tobacco shill and a brain damaged addict, and that’s just by people in public health, and at the same time been accused of being in cahoots with tobacco control by people on my own side of the fence. None of those things are true but it certainly makes life interesting..
Many consumer campaigns are libertarian and pro-choice in nature and vaping is certainly no exception. The phrase ‘just bugger off and leave us alone’ screams through my head on a regular basis. The freedom to choose what we want to do with our own bodies is vitally important to us, and it’s being eroded.
But vaping is more than just a pro-choice campaign. Whilst many vapers do regard it simply as a more pleasurable alternative to smoking, many others place more importance on the reduction in harm to their health, or the ability to use e-cigarettes to stop smoking. It’s not easy to represent all of these views without attracting criticism from one direction or another.
But these things are not mutually exclusive. If vaping is a pleasant alternative to smoking, people who choose to switch or take up vaping instead of smoking are minimising the harm they do to themselves, whether or not that was their intention.
And this is why engagement between vapers and public health is important for both sides. For public health vaping should be an important harm reduction tool. But like all tools, it won’t work unless you understand how and when to use it. And it won’t work for us if public health try to turn it into something that it isn’t. So what isn’t it?
The word ‘pleasure’ seems to be something of an anathema to some in public health. One of the biggest challenges for consumers is in getting regulators, and those who advise them, to understand that for a great many people vaping is not a medicine, or simply a smoking cessation intervention, it works precisely because it isn’t those things. It works because they enjoy it.
They love the personalisation that’s made possible by the diversity of the market in devices, and the thousands of flavours available. They enjoy the identity of being a vaper and the sense of community that that entails. They love that vaping is similar to smoking, but at the same time a million miles away from it.
But it’s important to remember that for many people vaping is purely functional. They can’t or don’t want spend much money on devices, aren’t interested in personalisation, or being part of a community. They just want something that works. To them all this choice can be a daunting prospect, and they may find the whole vape culture intimidating. Hell I do too sometimes.
For some of those people a good vape shop can make all the difference because they can try out products with the assistance of real world expertise and support. For others the answer may be the confidence an ecig friendly stop smoking service can offer, where they can receive impartial advice together with behavioural support.
If public health truly wants to maximise the benefits of vaping it must recognise all of these experiences as equally valid and equally valuable, as must industry. Both should be asking themselves ‘what can we add’, not ‘what can we restrict’. Start asking the right questions – not ‘does this work’ but ‘why does this work’ and how can we help more people to make it work for them.
Talk to vapers. Listen to and learn from their experiences. Get a better understanding of what motivates people to smoke and to vape (here's a hint: it’s not all, or evenly mostly, about addiction). Talk to smokers and find out what the barriers are to switching, and work out how to help them overcome them, if that’s what they want to do.
There are already researchers working in these areas, but their voices are being lost in the cacophony of politicised junk science press releases that grab the headlines every day.
One area where public health really does need to up its game is public perception, and I don’t just mean on relative risk. Tobacco Control policies have led to the stigmatisation of smokers on a scale that would not be accepted against any other minority.
The public hates smokers, and now it hates vapers – not because they believe the vapour is harmful, but because to them vapers are just those awful smokers getting around the rules. They’re vaping where they shouldn’t be and they’re not even getting horrible diseases to punish them for their bad habits.
This sort of prejudice has led to wide spread restrictions on vaping despite the fact that there is no statutory ban in this country. Many vapers don’t want the public’s sympathy just as people who have, or are trying to give up smoking. We’re used to the fact that the public has no sympathy for smokers, ex or otherwise. What vapers want is a lot more tolerance of something that barely affects anyone else.
Vapers are, on the whole, perfectly capable of working out where vaping is, and isn’t appropriate, and also of being considerate. But why should they have any respect for organisations such as the numerous NHS Trusts who, despite the fact that they apparently supported the recent Stoptober campaign which included e-cigarettes as an option, place a blanket ban on vaping, even in outside areas.
Don’t even get me started on local authorities, you can read about their abysmal efforts in a new report out two days ago from the Freedom Association.
What message do these policies send to smokers? Why should they believe that vaping is any less harmful than smoking if vaping is treated in the same way? Why would any smoker consider switching from one restricted and despised activity to another one? They may as well carry on smoking.
One of the biggest divisions between consumers and public health, and also within public health itself is the play off between reducing harm for current and ex smokers and preventing a new generation of nicotine users.
All too often it is clear that the choices which adults may make, whether that be for reasons of health, wealth or pleasure are considered less important than theoretical and most likely minimal risks to theoretical future children who theoretically may take up vaping.
Many consumers would question why a new generation of nicotine users is even a problem, seeing as there is no credible evidence that a gateway effect exists, and the world doesn’t seem to have a problem with new uptake of similar stimulants such as caffeine.
Of course, in absolute health terms it's likely to better to not inhale anything other than good clean mountain air. Or drink anything other than spring water, or eat anything other than a perfectly balanced diet which probably involves kale smoothies. But out here in the real world many of us don’t want to live like that – we want to enjoy what time we’ve got.
We want to enjoy enjoy a nice chilled glass of Sauvignon Blanc without thinking about breast cancer. We want to be able to take our kids to see the spectacle of the big red lorry at Xmas without being branded irresponsible parents. We want to be able to make our own choices based on accurate information and we want public health messaging to stop sucking the enjoyment out of everything that for us, makes life a little less dull.
But there’s more to this story. In every area I’ve just mentioned there are people whose ultimate goal is not to inform, or educate the public, or even to nudge them into making better choices. There are people in influential positions in tobacco control who are so determined to destroy the tobacco industry rather than allow it to evolve or adapt they’ll do it at any cost – including the health and wellbeing of those who might otherwise turn to safer alternatives.
No doubt the tobacco industry is deserving of its reputation, but fighting their lies with your own lies leaves only consumers as collateral damage. Don’t for one minute think you are doing smokers any favours if you lie about the safer alternatives just because the tobacco industry sells them.
All of the major tobacco companies are now investing in Harm reduced products and yes, I know that they’re still selling cigarettes and fighting tobacco control efforts around the world. But change, especially in an organisation as large and as complex as the tobacco industry, with its share holders to answer to, takes time.
Never forget that it's not just the industry who would have to transition to safer products, its smokers too. And for harm reduction to be successful on the scale that public health would like to see, smokers have to want to – as America will find out if it continues on its current course, you can’t force them. Nor should you.
So if you must fight the tobacco industry, fight them with truth. Make sure that their customers know that a safer alternative is available and where their customers go they will have to follow.
Hold them to account. If they say they want their business to transition to safer products make sure they continue in that direction. But be pragmatic. This won’t happen over night and it won’t happen at all if you continually block them simply because of who they are.
So is it possible to engage at any level with the tobacco industry and remain credible? All too often we see good people with valuable alternative views dismissed not because there is anything wrong with what they say, but with the use of smears and innuendo concerning tobacco industry influence.
Earlier this year Derek Yach announced the formation of the Smokefree Foundation, an organisation which would, basically, take a billion dollars of PMIs money and use it to fund independent research into harm reduced products. Predictably, as we heard earlier from Professor Etter, the idea has been panned by many in tobacco control. Also predictably, the idea of PMI funding a push for a ‘smokefree world’ hasn’t gone down well with pro-smoker groups.
The suspicion and antipathy on both sides is completely understandable and it’s right to be cautious, but if the foundation fails it is, once again, the consumer who loses out. Well funded studies with proper independent oversight are vital in empowering consumers to make an informed decision. They might also go a long way to counter the deluge of junk science that is constantly hitting the headlines.
Whilst giants like the FDA, the World Health organisation and even the EU Commission are sinking huge amounts of resources into funding science to support their restrictive policies on harm reduced products, other Funders, like Cancer Research UK, do seem to be asking the right questions and in the coming years we should see some really good science come through. But for many people this will be too little, too late. The damage in terms of policy and public perception will already have been done.
Consumers are impatient for good quality science and frankly, many of us don’t care who pays for it – for us, tobacco control hasn’t proven itself any more trustworthy in that area than the tobacco industry. Just think on that for a minute.
And what of the media’s schizophrenic treatment of e-cigarettes – where does that come from? Is it any surprise that the public is confused about the risk posed by e-cigarettes when almost on a daily basis they alternate between miracle cure and the work of the devil.
All too often the reason for this seems to stem from two things: policy based evidence making and research impact scores. Combine those two things with the fact that journalists rarely have time to look beyond the press release and bad news sells newspapers better than good news and you have all the ingredients for a public health balls up on a monumental scale.
But where is the accountability? When will someone pay for the harm the scaremongering is causing by denying consumers a balanced and accurate view.
Many countries, some of which are leaders in drug harm reduction, seem to struggle with the concept when it comes to tobacco. Similarly, the World Health Organisation, despite the fact that it supposedly embraces harm reduction, certainly doesn’t embrace e-cigarettes or any other tobacco harm reduction product I can identify.
We watch dumbfounded as this organisation lauds the actions of various notorious world dictators yet refuses to engage with the only stakeholders who matter – consumers.
To us, many policies around the world on e-cigarettes seem insane and to vapers in countries outside of the UK, UK vapers must seem very lucky – and maybe we seem ungrateful. Believe me we are not - but we worked hard for it.
We see what could have been. We see the choices that are taken away from people by the arbitrary and counterproductive restrictions on reduced risk products in the TPD. We see our smoking friends being put off of vaping by the appalling media coverage And where policies are formulated that would punish smokers into switching to vaping we see them becoming resentful and entrenched.
The UK is without doubt a world leader when it comes to e-cigarette policy but it has yet to get to grips with other harm reduced products. Snus is currently banned here and watching the regulators circle around heat not burn is like watching a very wary cat sizing up its prey.
There are other practically harmless nicotine products sold elsewhere in the world that are not sold here because the manufacturers fear that the regulators are hostile. The recreational nicotine landscape is shifting in favour of better public health, but the regulators are still resisting.
Whatever your view on Brexit, it may, depending on the deal we end up with, offer the UK the opportunity to revisit these regulations and replace them with something fit for purpose. Regulations which actually protect consumer safety whilst encouraging the innovation that will bring better and more attractive harm reduced products, whether those products are tobacco or pure nicotine based.
The UK could show the world how a policy of embracing and supporting private sector innovation through appropriate regulation can improve the lives of millions, but has it got the guts? It’s made a good start with the Tobacco Control Plan and the recent Stoptober campaign, but we are still shackled to the coercive policies of the past, and ideological resistance to harm reduction is still endemic in some areas.
This is the fifth e-cigarette summit. By the sixth I hope to see e-cigarettes as just one of a range of safer alternatives readily available to consumers, and I hope to see a lot more consumers finding them an attractive alternative to smoking. In order to achieve this though, there must be a greater acceptance of the (for some) uncomfortable truth that these products are first and foremost used by a great many consumers in the pursuit of enjoyment, and smoking cessation is a welcome by-product.
By all means reap those benefits for the goal of improving public health, but don’t expect a bountiful harvest if you ignore the the single most important factor in the success of vaping in creating ex smokers so far – pleasure.