British American Tobacco aims to turn electronic cigarettes into medicines in the UK. It's a welcome move, but leaves a bitter taste in the mouth
BACK in the 1950s, when the dangers of smoking were becoming clear and the tobacco industry was panicked, cigarette-makers came up with a wheeze: safer smokes. Filter-tipped, low-tar and "light" cigarettes were the result.
In reality, those cigarettes were not safer at all. Smokers inhaled more deeply or smoked more. And the industry knew it. Internal documents later revealed that they cynically promoted safer cigarettes to discourage people from quitting.
Given this history of smoke and mirrors, you could be forgiven for being suspicious when a tobacco company announces that it is investing in a "reduced risk" cigarette. In December, British American Tobacco (BAT) bought a company called CN Creative, which makes "electronic cigarettes". It is now planning to ask the UK authorities to recognise one of its products as a smoking-cessation medicine.
History repeating? Probably not. You could argue that aiming to profit from curing an addiction that you helped cause in the first place is pretty cynical. But credit where it is due: BAT and other tobacco companies now openly admit that smoking is a serious health risk. There is mounting evidence that e-cigarettes are safer than smoking and really can help addicts cut down or quit. They seem especially useful for hard-core smokers who have failed to quit or who don't even want to try (see "E-cigarettes may soon be sold as life-saving medicine").
There are still unanswered scientific questions, including how e-cigarettes compare with existing medicines such as nicotine patches. That will form a big part of the debate on whether to license them as a medicine.
Long-term safety is also open to question, as is whether they will serve as a "gateway" product attracting new people to smoking, and if their use in public places will renormalise smoking at a time when it is increasingly frowned upon.
But again, the evidence is pointing in the right direction. Tellingly, the anti-tobacco group Action on Smoking and Health has given a qualified backing to e-cigarettes for harm reduction. ASH sensibly points out that e-cigarettes are clearly safer than inhaling tobacco smoke, and says there is little evidence that they will attract non-smokers or make smoking acceptable again. If so, there is little reason to worry about unintended consequences.
Don't hold your breath, though. A similar argument has been made for "snus", a form of oral tobacco mainly used in Sweden. There is evidence that it can help smokers quit and that it is safer than smoking. Sweden has the lowest rates of smoking and lung cancer in Europe, which is often attributed to the use of snus. By some estimates, if Sweden's snus habit was replicated across the European Union it would prevent 92,000 lung cancer deaths a year (Scandinavian Journal of Public Health, vol 37, p 481). And yet it remains illegal everywhere in the EU but Sweden, condemned as a carcinogen and a potential gateway to smoking. The lesson? Harm reduction is a tough sell.
It may be distasteful to watch a tobacco company spearhead a campaign for cigarette harm reduction. But action is sorely needed. If the evidence stacks up, they should be given the benefit of the doubt – for now.
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