And Now We See Through a Glass, Darkly pt 1

My very first guest blog! Quite excited actually. This is linked to my blog so to get a full picture of the situation that arose to prompt this I'd read both. Consider this 1 of 2 or 2 of 2 depending which way round you read them.

This is from Sarah Jakes (@twigolet) who is a fellow vaper and member of the board of NNA. Both my blog and this one are NOT opinions of NNA they are ours as individuals.

I want to say this before I move on to write my own post about the NHS and e-cigs. Sarah and I have come at this from different angles and what really struck me when I read this in the email she sent me was how uncomfortable it is to acknowledge the point she is making, but she is so right and I hope a lot of people (especially those involved in tobacco control in any form) read this and see one of the realities laid bare.

I have to say Thank You to Sarah, I was really upset today at the accusations and this email and her support meant a lot. Thank you also for the messages I got from other vapers - I really appreciate it!

So read on folks. Read on.

Ecigs, NNA and the NHS

Last night one particular aspect of a blog written by James Dunsworth on the Ashtray blog http://www.ecigarettedirect.co.uk/ashtray-blog/2015/09/public-health-u-turn-on-e-cigs.html sparked what was, to me, a rather odd response on Twitter. The blog was a summary of events at an APPG meeting in Westminster on Wednesday which NNA attended, and the comment was this:

Lorien [trustee] of the New Nicotine Alliance believes that if the NHS supply e-cigs it would reassure smokers that e-cigs are safer than tobacco cigarettes.

She also pointed out that a decent e-cig kit would set some smokers back a week’s worth of tobacco. Coupled with a worry about whether e-cigs are safe or not that would stop a lot of smokers from trying them. If e-cigs were supplied on the NHS, smokers could take the risk of using them without losing a week’s worth of tobacco.

The discussion at the meeting surrounding the provision of ecigs on prescription was provoked by the media coverage surrounding the recent Public Health England report most of which focussed on that issue. It was widely accepted at the meeting that this was an irritating distraction from the main thrust of the report, which was to correct public misconceptions about the relative harms of ecigs when compared to smoking. However, NNA does not control the agenda at APPG meetings, parliamentarians do, and so the matter was raised and discussed.

The comments on Twitter were strongly suggestive that NNA is actively supporting and promoting the notion that ecigs should be regulated as medicines. In fact what was actually said was “Lorien’s NNA statement sells our consumer choice to statist f*cknuts. Which is why I don’t trust NNA”. How anyone could come to that conclusion without having consumed a large amount of some sort of paranoia inducing substance baffles me. In fact, I find it utterly insulting given the large amount of our own time and energy which Lorien and the other trustees, including myself, have given up in order to fight this battle. The fact that the UK has one of the most progressive policies in the world with regards to e-cigarettes is very far from solely down to us, but we’ve certainly played our part alongside a great number of other organisations and individuals.

NNA has no official position on whether or not ecigs should be provided on the NHS. A common argument for provision by prescription is that smoking prevalence is highest in poorer groups of people who may not wish to take the financial risk of purchasing an ecig and prescription will assist with this barrier. My own view is that that is an over simplification and I explained my thoughts in a recent email:

Whenever I hear the socioeconomic arguments about smoking behaviour / cessation and ecigs I wonder why no one ever seems to ask themselves why people in the lower groups show higher dependence and failure to quit. If their quit attempt rate is the same then I guess you can say that as many of them want to quit as do in other groups, so what is it about being poorer that makes that more difficult? 

I don't think it's as simple as offering them free stuff although that might help. But a decent starter kit can now be bought for the price of 3 packs of hooky fags, so what is making the difference? I think it's something that runs much deeper. When people quit I think that's because they're looking to the future in terms of health and wellbeing, and maybe that's something people do less of if they have little in the way of prospects. They see the health warnings, think they probably should quit but don't really have as much incentive to stick at it as more affluent people do? 

For many people smoking could be one of their only luxuries, and it's a social thing which people share - it could be that it means a lot more to people in those groups than it does to those with more alternatives. If so then the lost enjoyment cost of giving up smoking could outweigh the perceived benefits, or at least be much more finely balanced than in other groups. The 'health inequality' arguments are then futile because the balance people seek is about much more than just health and finances. Medical and scientific thinking seem to very often forget about the 'people factor'.

Lorien however, quite rightly points out that for some groups of smokers free or low cost ecigs could be beneficial. Let’s be clear here, we’re not talking about a lifetime supply and we’re not suggesting offering them to people who already vape. What we are talking about is enabling the NHS to offer people a device which could start them on the road to switching to vaping – people who would not otherwise try, perhaps because they don’t want to risk spending their cigarette money on a product which will not replace them, or perhaps because they are not confident about the relative safety of ecigs. In either case the NHS can offer confidence and support for those who lack it and perhaps for some a cost effective financial (for the state) solution for those who won’t take the initial risk. 

Whilst I have my doubts about the efficacy of any medicinally regulated ecig (if one were ever to exist) I believe the lives and health of all smokers are important, and so I think we have to try.

The above has absolutely no bearing on NNAs support and advocacy for ecigs as a consumer product. We are firm believers that an important benefit of the current market is the fact that consumers choose to use ecigs as a safer alternative to smoking. They work precisely because they are not medicinal and because they empower people to take control of their own health and lifestyle. This is a point which NNA makes frequently to legislators, regulators and practitioners alike. However, ecigs don’t work for everyone who wants to stop smoking, and so if Lorien is right and NHS prescription could help a further group of people then that is what a caring state should try to do. Consumer regulation and medicinal regulation are not mutually exclusive ideas and I’ve seen absolutely no indication of any intent to use the latter to the detriment of the former – in fact quite the opposite – what I see is a political will to make both markets succeed. Tin foil hatters may have differing views but I’m afraid we’ll just have to agree to disagree. Sorry about that.