Some truth about e-cigarette regulation and the ‘appalling’ F-grade presentation of the WHO

A public health academic is forceful and direct with the misguided opponents and over-zealous regulators of e-cigarettes. He describes the presentation of World Health Organisation’s Roberto Bertollini to a  European Parliament workshop as ‘appalling’.  This is a measured,  compassionate, but quietly angry and exasperated interview by one of Europe’s leading experts on e-cigarettes, Professor Jean-François Etter.I hope everyone involved with the e-cigarette policy debate will take 5 minutes to view this – it says pretty well all that needs to be said.  Some quotes I’ve drawn out:

Mr Roberto Bertollini made a presentation at the EU workshop which was appalling. His presentation consisted in cherry-picking negative studies,   studies that show that e-cigarettes are bad, and deliberately omitting studies that suggest that e-cigarettes could be useful in helping people quit smoking.  So I confronted him on that and he didn’t like it… 

This is true – Bertollini’s presentation was truly appalling pseudo-science.  But I would go further – there was great exaggeration of the negatives and over-emphasis on minuscule risks in comparison with continued smoking, and deep confusion between hazard and risk.  This sort of presentation spreads fear and misinformation and supports the cigarette market by smearing a credible competitor.  Tom Pruen of ECITA has done an excellent critique of Bertollini’s presentation: why the WHO is not qualified to attempt to educate people about electronic cigarettes. Etter expresses his despair at such poor homework: 

If a student had presented such a work to me I would have given him a very bad grade.  WHO after all is here to protect the health of the public, so by taking such an approach they are not doing their job. 

If only it mattered as little as a student assignment…! This was the privileged position of being able to make a presentation to Europe’s legislators, who are deciding how to regulate these products.  The way we give WHO a bad grade is to suggest that governments give them less money and more direction.  Having established who not to listen to, Etter moves on to what not to do:

It would be a mistake I think to regulate these products as medications, and if they were regulated as medications this would limit access to the product too much and cause many deaths.

This is absolutely right.  Current e-cigarette products are probably about 99% less dangerous than cigarettes (you can say that simply by virtue of the chemistry of their ingredients and physics of how they work).  The public health case is best served by having the greatest number switch from smoking, not from regulating them from 99% to 99.5% safer but much less appealing as a result.  Medicines regulation raises costs, imposes compliance burdens, slows access to market, inhibits innovation, applies dullness-inducing design and marketing restrictions and will largely advantage the cigarette industry by shielding it from competition from better products.

There is a debate between policy-makers who are very conservative and very risk averse, and are ready to regulate these as medications, and the public who appreciates the product and uses it. 

Again, he is spot on.  Regulators instinctively care more about small things that might go wrong than big things that are going well.  The public are much more interested in the huge personal benefits that arise from switching than being ‘saved’ by regulators.  What is surprising is that supposedly ‘progressive’ socialist and green politicians lead this heavy regulation mindset in the European Parliament. Given that long-term smoking is closely linked to poverty and drives health inequalities, you might expect leading politicians like Glenis Willmott (Socialists) and Carl Schlyter (Greens) to listen a bit harder to the public rather than health lobbyists and not be so indifferent to the health of people they represent.  Liberals and Conservatives have understood that a it s better to encourage these products than to smother them.   Etter then turns his fire on the public health community.

Astonishingly, the most vocal opponents of e-cigarettes are people from the public health community, who perhaps don’t understand what is at stake, and just don’t like the product because it looks too much like a cigarette. 

Etter is so right on this… many (but definitely not all) in the public health community don’t like these developments at all.  That’s because they have lost sight of their real goal – which is to reduce cancer and other diseases, not just to campaign for tobacco control policies.  But e-cigarettes have arrived like an insurgency, coming from nowhere creating opportunities for smokers rather than restrictions.   Public health workers have played no part in this uprising, they haven’t ‘approved’ the products, they don’t know much about them or why they are popular, and most importantly they aren’t in control.  I think they are professionally affronted and are responding with a regulatory and rhetorical broadside to fight back.   So Etter states the problem this causes:

If regulators could let the market evolve without regulating it too much and without regulating it unjustly… because currently people who are addicted to cigarettes are condemned to use tobacco, these laws arguably kill millions of people. They are absurd because they block every competitor to cigarette makers. So there’s a need to let competitors to enter the nicotine market so more people will switch from smoking to e-cigarettes and this will save many lives. 

Where regulators are trying to ban or over-zealously regulate e-cigarettes, they really are doing harm.  Which gets back to points I’ve made a number of times [eg here and here]: WHO and many of the public health campaigners  might as well be working as lobbyists for the dinosaurs in cigarette industry*, busily causing more death and disease.  The effect they would have if they got their way is the exact opposite of the one they are supposed to want.

* By the way this comparison with the health lobby is not intended to be unfair to: a) dinosaurs; b) those people in the tobacco industry who understand what this means for consumers and have been buying or developing e-cigarette or smokeless tobacco businesses. There aren’t many ethical things that a tobacco company can do at scale, but that is one of them.

WHO we have a problem… Bertollini isn’t the only one from WHO giving bad advice to the European Parliament. I am still hoping for a response to my critique of the recent presentation of Kristina Mauer-Stender: Are you being manipulated: the wisdom of the WHO examined.  At global level, the WHO is especially misguided – see this open letter to delegates to the tobacco control convention.

And… thanks to SWOF for the video.

14 thoughts on “Some truth about e-cigarette regulation and the ‘appalling’ F-grade presentation of the WHO”

  1. The false scepticism of the tobacco control people toward e-cig and snus is a bit like the fake scepticism of the tobacco manufaturers toward cancer studies in the 60’s when they explain that more evidence is needed.
    The difference is that the tobacco industry never had the power to force people to smoke, or even to create fiscal incentives to this effect.
    The tobacco control people ask for legal coercive measures to prevent people from replacing a dangerous product with non dangerous products like e-cigs and snus.
    When you look at it, it’s quite unbelievable.

  2. Did you notice this?

    French Government [2] and the EU-Commission [3] are currently trying to influencing the public and EU-Representatives with intentional misinformation and incomplete information.

    They are saying, that this paper proves that E-Cigarettes are designed to appeal young people.

    Dr. Dominik Schnichels was argueing at meeting of the IMCO ( Internal Market and Consumer Protection) on 05.30.2013:

    This is alarming, because the study says:

    The percentage of teenagers reporting experimentation of e-cigarettes is 6.4% for 12 – 14-year-old schoolchildren

    64% out of this 6.4% are non smokers – According to my calculations:
    – a total of 277 out of 2834 have tried ecigs,
    – 6.4 % out of these 277 where 12-14 yrs old.
    – 64 % out of these 6.4 % where not regular cigarette smokers (but occasional tobacco smoker’s or ex-smoker or non-smoker)
    = that would be 12 kids out of 2834 interviewed kids….”

    The authors compare these 12 kids only to the small group of “those 12-14 years old who tried an ecig” and not to whole group of the “12-14” of the 2843 kids…

    Science or cherry-picking? These lies are more than annoying – they are dangerous for public health!

    Prof. B. Dautzenberg, author of “E-Cigarette: A New Tobacco Product for Schoolchildren in Paris” [1] and therefore the originator of the scientific statement:

    64% of children aged 12 to 14 years in Paris who tried e-cigarettes had never smoked a real cigarette. In schools, it becomes an initiation of tobacco product.

    and:

    We did not use data beyond three to six months on the product. For the moment, there are not many people who have tried e-cigarettes more than three to six months. And it is a matter of mass. Because, for example, tobacco will kill one billion people in the twenty-first century. If it is 1000 times less dangerous, it’s still 1 million people

    (transcript from tv debate “Hondelatte Dimanche” in french tv” at 17. March 2013 [4])

    Nice, isn’t it? 1000x less dangerous = 1000x fewer deaths! That is an paradigm shift! ;)

    The Professor manipulates with the confusion between “contains 1,000 times less harmful substances” that have been compared to traditional cigarette and “a thousand times less dangerous.”

    This is science? This is a doctor?

    This is ridiculous!!

    [1] http://www.scirp.org/journal/PaperInformation.aspx?PaperID=28003
    [2] http://www.ofta-asso.fr/docatel/Rapport_e-cigarette_VF_1.pdf
    [3] http://www.youtube.com/watch?feature=player_detailpage&v=0VKCefOLD6c#t=397s
    whole meeting: http://www.europarl.europa.eu/ep-live/de/committees/video?event=20130530-0900-COMMITTEE-IMCO
    [4] http://www.youtube.com/watch?feature=player_detailpage&v=wksGd9vz9jY#t=841s

    1. Dr. Schnichels actually said: “Sixtyfour percent of the 12-14 year old kids had never smoked but they had tried electronic cigarettes” – not 6.4%!

      (In the EU-video) at 12:34:55)

      So either someone was very sloppy and gullible when reading this study or promoted a deliberate lie, hoping that anyone actually checking it would be confused by the misleading semantics.

  3. Aside from the insanity within the EU, the Anti Tobacco Industry must surely know it is fighting a losing battle. It is in the same position with its gum and patches, bans and tax increases as were the print unions when hot metal type-setting was superseded by desk top publishing. Any attempts at regulating, taxing or banning ecigs will be ineffective – at worst an inconvenience. Leonardo Di Caprio was puffing on an ecig yesterday while watching the French Open. Even with the French ban, I’m fairly confident he’ll be doing the same next year. Throw in the towel chaps. Save yourselves further embarrassment.

    1. Absolutely right. That’s what’s gonna happen, they fight an unwinnable war!!!!!

  4. An electronic cigarette is a personal vaporizer or an electronic nicotine delivery system.
    You may wonder why you need one but it is rather handy
    because you can carry spare cartridges and a spare battery with you so that
    you’ll always be able to get your nicotine hit wherever you are and no matter if your
    battery runs out or if your cartridge becomes empty. The lithium
    ion battery looks like the part of the cigarette that contains the tobacco.

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