I’ve just returned a week with the WHO in Geneva, where I was working on tobacco control. The tobacco control lobby have made huge achievements in the last 20 years, managing to turn the tide of tobacco use in many countries and pushing some countries (like Australia) towards the dream of zero tobacco, without criminalizing anyone or directly engaging in prohibition strategies. However in the past 2-3 years the movement has been inflamed by a new controversy that they seem to be handling rather poorly – electronic cigarettes. Debate on what to do about e-cigarettes has been vocal and bitter, with the tobacco control camp dividing on roughly Atlantic lines between two opposing camps: harm reduction and prohibition. On the one hand, the prohibitionists see e-cigarettes as a product that glamorizes smoking and is no less healthy, and they want to control the proliferation of these products before they can get the market purchase that tobacco obtained in the early 19th century. This part of the tobacco control lobby sees them as a potential gateway to cigarette smoking, and thinks they should be punitively controlled from the start. Another part of the tobacco control lobby sees e-cigarettes as an alternative to smoking, and situates them within a harm reduction framework that suggests they could play an important role in moving smokers away from dangerous tobacco. e-Cigarettes are a nicotine delivery system without any of the carcinogenic products of burnt tobacco, and so offer a way for addicted smokers to satisfy their nicotine needs without inhaling carcinogens; from a harm reduction perspective this makes the e-cigarette a very useful tool in tobacco control. The debate is usefully summarized by the British Medical Journal here, with links, and the journal Addiction has a lot to say on the matter.
For what it’s worth, as someone who worked for years in the field of heroin use, I see harm reduction as the absolute best strategy for dealing with drug use, and I think e-Cigarettes provide an excellent tool for steering smokers away from tobacco. Nicotine itself is not a poisonous or carcinogenic substance, and the only reason to object to its consumption is a moralistic opposition to addiction itself. From a harm reduction perspective, such a position is completely nonsensical: if we object to a drug, we should do so purely for its health or social effects, not for the simple fact that it is addictive, and while the health and social effects of smoking tobacco are huge, there is no evidence of any serious negative consequences of vaping.
I would go further and say that vaping isn’t just a neutral thing – it’s potentially hugely beneficial. In the era of smoking bans, there is a huge market for a product that enables people to smoke in public places, cars, and their family home without offending or harming the people around them. Vaping doesn’t just not harm the individual, it enables them to smoke around those of their friends and family who didn’t take up this stupid habit. As quit campaigns, smoking bans and taxes begin to bite, smokers are surrounded by more and more people who don’t smoke, which gives them increasing incentive to drop tobacco. But tobacco is intensely addictive, so they couldn’t – until this technology offered a way to do it. I’ve gamed indoors with players who vape, and it is absolutely a completely innocuous habit. I’ve gamed with smokers too, and in order to not offend the group they have to pause the game to go outside and smoke. The better option is obvious.
In fact, I don’t think I’ve ever met a smoker who wouldn’t vape in such a situation.
About ten years ago I was involved in an evaluation of a sudden heroin shortage in Australia. One of the main lessons of this shortage was that prohibition and harm reduction are strategies that can complement each other. In an environment of strict prohibition, when sudden market disruptions happen, the availability of harm reduction measures can rapidly take people out of the marketplace for the drug and onto safer alternatives. As we ratchet up the pressure on tobacco companies, increasing taxes and making it more and more difficult to smoke in public, e-cigarettes offer the chance for smokers to switch away from a socially disapproved drug to a more comfortable choice, and our research on the heroin shortage suggests that there is a critical threshold at which people will rush to adopt this new technology. We absolutely need to push the market towards this position, so that as many people as possible adopt a low-harm, low-offensiveness alternative to smoking.
However, there is another huge benefit of e-cigarettes which I think tobacco control advocates need to consider, and which could have a huge impact on the tobacco control movement. To understand it, we need to draw on the lessons of solar power. e-Cigarettes have the potential to drive the tobacco companies out of business in the same way that solar power has begun to put pressure on utility companies through the utility death spiral. This basic model is simple, though disputed: As more and more people install rooftop solar, the utility companies lose money and have to raise prices for their remaining customers, encouraging more to switch to rooftop solar and hastening the loss of customers. This model also applies to e-cigarettes: as more and more people shift to e-cigarettes, tobacco companies will have to recuperate their profits from an increasingly small consumer base, forcing them to raise prices. Fortunately for the tobacco companies their primary production model is incredibly exploitative, so they have a very cheap cost base; but unfortunately most countries now have high tobacco excises, so any cost increase is multiplied to the customer. This will act the way the excise itself acts, encouraging more people to quit or switch to e-cigarettes … and so on.
Solar panels are actually a great market story. Solar power started off as a niche product for satellites, but as companies matured they researched new technologies and became more cost competitive, getting installed in low power applications like calculators and slowly expanding market share. As market share grew the technology became cheaper, and they were able to compete in more and more sectors, until finally now they are able to compete with mainstream utilities. Although the original technology benefited from government projects (especially satellites and space probes) the technology has not itself benefited from subsidies until recently, achieving most of its market share through good old-fashioned market competition and investment. e-cigarettes are similar, having developed through chemical companies in China and slowly expanded into the tobacco market. They’ve been remarkably successful considering the aggressive and anti-market behavior of most tobacco companies, which shows just how unpopular the tobacco product is even amongst many of its regular users. Furthermore, just like solar power, e-cigarettes are now benefiting from the regulatory framework within which they operate. In the past, without any regulatory framework, solar power competed solely on price. But now, with clean air laws and emission standards, solar power competes on these other regulatory aspects, which vastly increases its acceptability. Similarly, where once an e-cigarette would have seemed like a clunky and pretentious toy, it now appears sensible or sophisticated – it enables its user to smoke amongst non-smokers, ensures they don’t disrupt parties or meetings for a break, and doesn’t attractive opprobrium around children. In such a strict regulatory framework it has obvious appeal beyond price; and unlike electricity, smoking is a luxury, a choice, which makes e-cigarettes even more likely to attract rapid uptake.
The implications of this for tobacco companies are terrible, just as solar power is a real threat to utilities. If we allow e-cigarettes unfettered access to the smoking market, leave them largely unrestricted, and reduce taxes on their nicotine, we can quickly force a situation in which tobacco companies are massively undercut by a genuinely disruptive competitor. As tobacco companies lose money they lose the ability to fight court cases against new regulations, and to market aggressively in new markets (such as developing nations). But their only alternative is to raise prices on existing users, encouraging more to switch to e-cigarettes. This is especially problematic for tobacco companies because of their vulnerability to divestment; just this week AXA dumped 2 billion euros of tobacco shares, and encouraged other funds to do likewise. As they lose investors the tobacco companies lose funds to support further expansion, increasing pressure to retain current smokers – who are shifting to e-cigarettes, a product with a diverse corporate background.
Seen in the framework of “disruptive” technologies like solar power, it seems obvious to me what the tobacco control movement’s response should be, similar to that of environmentalists to solar power: encourage changes to the regulatory environment that favour e-cigarettes; reduce barriers to market entry for these products; continue to put regulatory pressure on tobacco companies; advocate laws that prevent tobacco companies from entering the e-cigarette market; and aggressively encourage divestment of tobacco company shares. With this combination of activities, the tobacco control lobby can hasten the end of the tobacco industry, without inconveniencing even a single smoker.