England and the Nicotine Debate

Posted 27th April 2016 by Dave Cross
The New England Journal of Medicine (NEJM) published the co-authored paper on how England is leading the debate on nicotine. Accompanying it, the managing editor of the NEJM also interviewed one of the authors to get her direct perspective on what America can learn from our stance.

Stephen Morrisey, managing editor of the NEJM begins the podcast by laying out the contrast between England and the USA’s approach to vaping: “Last summer, Public Health England, an agency of England’s Department of Health, released a report that strongly supported the use of electronic cigarettes by smokers who can’t or won’t quit smoking cigarettes. That position reflects a long history of commitment to harm reduction in England, which contrasts sharply with the overwhelming focus on nicotine abstinence in the United States.”

Morrisey interviewed Dr. Amy Fairchild is a Professor of Sociomedical Sciences at the Columbia University Mailman School of Public Health. Fairchild has coauthored a paper looking at England’s position relating to nicotine. Morrisey poses: “Why have e-cigarettes become so controversial in the public health community? Even among people who share a common goal of preventing health problems associated with cigarette smoking?”

She explains that the reason for the controversy surrounding vaping, and acknowledging that this hasn’t always been the case, is down to how the issue is framed. “When the issue is framed as a threat to continued use or the impact on non-smokers the idea of harm reduction and e-cigarettes becomes extremely problematic,” she responded. The problem with controversy doesn’t feature to such a large extent when the subject of deaths and illness through tobacco use is addressed, she goes on to explain.

The paper she authors makes the point: “A 2007 report by the Tobacco Advisory Group of the Royal College of Physicians made the case that strategies to protect smokers were key, since nicotine addiction is difficult to overcome and millions of people fail to quit. That report argued ‘that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved’.”

She highlights during the interview that even ASH UK, a body staunchly opposed to tobacco, has put its weight behind the benefits offered by vaping over smoking. This is contrasted in the paper to the response given by America’s equivalent: “The Campaign for Tobacco-Free Kids — ASH’s U.S. equivalent and a powerful voice in anti-tobacco advocacy — has been unequivocal in its denunciations of e-cigarettes.”

“We have taken a prohibitionist approach,” she adds in the interview, “not just to electronic cigarettes but to all kinds of drugs – it’s a national history of our tolerance to risk ... dating from the 1920’s Harrison Act.” And it’s the history of the States to ban rather than reduce the harm that influences its current position on vaping, she argues.

The paper concludes: “Will England change the international conversation about e-cigarettes? The answer will depend, in part, on what the evolving evidence suggests, and it may take years before the answers are definitive. In the end, the sorts of policies that are implemented will depend on whether whoever dominates the debate views harm reduction as opportunity or anathema.”

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker