Public health should step aside. Vapers are now leading the fight against smoking

Thirty years ago the then Secretary of State for Health Norman Fowler persuaded Margaret Thatcher of the need for radical approaches to prevent the spread of HIV infection among people who inject drugs. These included providing needles and syringes to drug users and making the heroin substitute drug methadone more widely available. Frontline staff were urged to reach out to drug injectors. Drugs harm reduction, as it was called, was a public health success and the UK avoided a major epidemic of injecting-related HIV infection.

E-cigarettes, I believe, are the harm reduction equivalent for smoking. They have the potential to dramatically reduce smoking levels in Britain. Indeed, they have already done so. According to the Office for National Statistics, more than 863,000 current e-cigarette users are no longer smokers and a further 720,000 people are both ex-smokers and previous e-cigarette users.

Public health leaders do not share my view. Their response has ranged from the extremely negative to the ultra-cautious. Some of the same people who initiated drugs harm reduction in the 1980s have opposed tobacco harm reduction. Clearly harm reduction is rather selectively applied.

Thirty years ago the then Chief Medical Officer Donald Acheson supported harm reduction. Sally Davies, our current Chief Medical Officer, worries that vape stores make e-cigarettes look cool and chic, and that cookies and bubblegum flavours are aimed at children. Only one out of 150 local directors of public health has written about the potential of e-cigarettes to bring help bring an end to smoking.

Despite this opposition the vaping movement has, in just a few years, changed the landscape of smoking cessation. E-cigarette sales have overtaken sales of nicotine replacement therapy (NRT) products. They are the most common device used to help people stop smoking. Smoking cessation services are losing business, with the number of customers who set a quit date declining 45 per cent between 2011/12 and 2014/15.

For those trying to stop smoking, e-cigarettes have profoundly changed the experience. For the first time quitting cigarettes is no longer associated with being a ‘patient’ and personal struggle. It is a pleasurable way of using nicotine without the stigma and guilt associated with smoking cigarettes.

For some becoming a vaper is an important transformation in personal identity. For those with a liking for gadgets vaping becomes a hobby. For some it’s a matter of a shared experience and fun — as demonstrated by the growing number of vaping exhibitions and festivals. There are no NRT fests.

Becoming an e-cigarette user involves helping yourself and helping others. It’s a do-it-yourself approach to switching from smoking. There is a lot of help and advice on how to vape. Awareness of e-cigarettes has spread by word of mouth and social media forums. The UK E-Cigarette Forum has a daily average of 10,000 visits — numbers to make public health leaders green with envy.

In the new landscape of smoking cessation there are nearly one million ‘frontline staff’ and ‘outreach workers’ — the new vapers who have stopped smoking and can advise their smoking friends about vaping. There are also 1,500 to 2,000 free ‘smoking cessation advice centres’ — ie vape shops.

This is an intervention which has nil cost to the state. Compare this with the annual investment in NHS smoking cessation services, which in 2014 was about £120m, or £513 per successful quit. We need a radical rethink about the need for and nature of these services.

E-cigarette makers, vaping stores, vaping forums and vapers are the new frontline in helping people switch from smoking. It is an example of public health objectives being delivered without the involvement of public health professionals.

I started off by bemoaning the antipathy shown by many public health opinion leaders. I wanted them to be involved. But now I realise they only have a small part to play. Unlike for HIV/AIDS, the role of experts is minimal — there is no need to invest in costly services.

Their main role is to endorse the use of e-cigarettes, to reassure the public of their safety, and not to create obstacles to their use. Put simply, to enable vapers to bring information to their peers. It’s vapers who are now leading smoking cessation.

Professor Gerry Stimson is director of Knowledge-Action-Change. This article is adapted from a lecture hosted by the London Drug and Alcohol Policy Forum.


  • Paul McNamara

    And therein lies the rub. Does anyone really think Public Health experts are going to willingly give up their jobs and status as experts with all the funding and influence that goes with it?

    E cigarettes are a threat to public health – hence their opposition.

    • Dirtrider129

      Very true and to the point

      • I agree

      • E-cigarettes, I believe, are the harm reduction equivalent for smoking. They have the potential to dramatically reduce smoking levels in Britain. Indeed, they have already done so. According to the Office for National Statistics, more than 863,000 current e-cigarette users are no longer smokers and a further 720,000 people are both ex-smokers and previous e-cigarette users.

  • John_Page

    And what is the EU’s policy on vaping?

    • things used to be better

      You’ll find out after the referendum.

    • JonathanBagley

      The EU Tobacco Products Directive, which comes into force next month, describes the EU’s policy. The best place to read about it is Clive Bates’ blog. http://www.clivebates.com/
      The TPD places a lot of restrictions on vaping and will make it much more expensive for those who don’t resort to the black market it will provoke.

  • Glen Appleton

    Excellent article with great points on vaping and the opposition! I very much enjoyed reading it.

  • DavidL

    The public health lobby is wrong. Other medics have endorsed e-cigs as a powerful aid to quitting the weed, whilst pointing out, reasonably enough, the need for more research. So has the anti-smoking group, ASH.

    • jude

      ASH UK are silent when vaping is banned in public places, they are silent when laws are enacted that punish people for quitting smoking, and in the case of Australia, vapers are made into criminals for simply quitting smoking by switching to vaping, and sales of vapour products are banned in an effort to force people back to smoking. These laws, bans and punishments are supported by the liars and the ignorant in public health in Australia, as well as those in anti-smoker/vaper groups like ASH in Aus.

      It is true that many medical professionals support vaping, but they are out numbered by the huge number of the greedy, and lying ANTZ that are the “useful idiots” of governments determined to keep tobacco sales up, tobacco taxes rolling in, and the profits of their friends in pharma and tobacco companies flowing.

      This issue has always been about money, first and foremost, with the love of power over the lives of the people, a close second. It has never been about health.

  • picolax

    Prof Stimson talks about “identity as a vaper”, Looking through big tobacco literature, key to it all is identity as a smoker, a rebel, being cool, outlaw etc. Seems the vaping identity is following a similar trajectory. With big tobacco buying up many vaping companies this is unlikely to change.
    I agree that it is a good nicotene substitute measure, how much less harm it causes long term is not necessarily evident at this point as long term harms necessarily take a long time to show.
    Using the analogy of methadone or other opiate substitution makes me think I still wouldn’t want, except through choice, to have people banging up around me and would prefer they do it in a safe, controlled environment, same goes here, i don’t want to inhale the vape unless by choice. I also don’t want vaping advertising which looks eerily similar to smoking ads of years past.
    There is NO long term evidence of harm, positive or negative, therefore I dont want to find out twenty years down the line there is and I have been needlessly exposed to vaping in a public enviroment just to satisfy someone else’s idea of “freedom” (that has actually been pushed on us by corporate advertising).
    Vape on by all means but, as with smoking, not next to me or my kids.

    • IMSiegfried

      Where’s Michael J. McFadden when you need him? But, Picolax, have you read about the dangers of third hand smoke (never mind second hand smoke or vaping)? http://www.tobakkonacht.com/PDF/TNSite-StudiesOnTheSlab-TheGiblets.pdf
      I think you’ll be surprised, and maybe even a little more shocked by the devastating health effects caused by third hand smoke. More research too, on second hand smoke here: Chris Snowdon’s “Velvet Glove, Iron Fist” or Rick DiPierri’s “Rampant Antismoking Mentality.” You’ll find there’s a lot of well researched information out there you don’t even see on the evening news!

      • picolax

        Ah, free choice, do you have it, or are all your thoughts just driven by the “man”. There is a lot of research out there, including massive amounts released from tobacco companies vaults, (which actually is one of the world’s largest repositories of psychological wisdom and fantastic reading) which suggests we are not the free choice warriors we think.

        I am not anti smoking per se, as I said it is up to you own perceived choice but don’t do it near me or my kids. I am still a smoker, I am just not smoking at the minute as I recognise the health impact 30 plus years had on me. Research from Bristol suggests less stress on heart cells with vaping, good, but still nowhere near enough evidence of low impact for me to want anyone vaping around me

        What I am anti is tobacco companies, and they have latched on to vaping. Empirical evidence found they were a pack of f£&£ed up greedy arseholes who continued pushing a known lethal product and actively impeding laws against their profit making. (Which strangely enough I didn’t get from the news but while researching a masters, but hey let’s not let that get in the way of a put down).

        You want to be on the side of the perceived free, go ahead, your choice, just be wary of who you share a bed with

        • Feadin deTroul

          You absolutely have the right not to have people smoking or vaping near you and your kids, and I will stand by you on that. But you should do your homework better – try first to read the Royal College of Physicians study and recomendations.

          Also, In a couple of months you will be right regarding tobacco companies controling vaping – if FDA reg will go through. As of now, you are not.

    • Rob Heyes

      Tobacco companies are almost entirely confined to the rather pathetic cigalike market (with the exception of the only vaping product to have gained a medicinal licence in the UK).

      As it turns out, at least in the case of the US, tobacco companies have been wasting their money, since the FDA has now handed the entire market to them on a plate – assuming that none of the forthcoming legal challenges don’t succeed. Europe has tried and largely succeeded in doing the same thing with the Tobacco Products Directive which comes into theoretical force on the 20th May 2016 and full force a year later.

  • Niall Yeldham

    It’s all about tax money. The government don’t get tax from heroin.

    • Thomas Hutchings

      Really, well then there will be a whole lotta law enforcement paychecks bouncing when they figure that one out at the DEA.

  • Thomas Hutchings

    To anyone who has actual first hand knowledge of both vaping and smoking, statements such as “how much less harm it (vaping) causes long term is not necessarily evident at this point” are so patently devoid of any validity that the urge to throttle the ignoramus making it is nearly irresistible. The benefits of switching from smoking to vaping are so obvious to anyone making that change that they are forced to assume that those in the “we just don’t know” camp are, A: making their living off of tobacco tax dollars, IE; FDA CDC, pick a state, pick a smoking cessation professional, or B: just willfully ignorant busy bodies with no familiarity with the facts related to the matter. The fact is any smoker such as myself (32 years of 2 plus packs a day, previously trying and failing to quit with every other imaginable cessation method) understands that when e-cig proponents say 95% less harmful than tobacco cigarettes that 5% is just a concession to all the nay sayers that yes long term data should be gathered but the 95% less harmful is a effing fact. I and my wife have been free of tobacco cigarettes for 27 months. I had my last cigarette the day I bought my first vape pen. Smoke and taxes is all the argument against e-cigs is made of. we don’t even Vape regularly anymore and when I do it’s at zero nicotine.

  • Bill Godshall

    As a public health advocate who strongly supports vaping and who has
    campaigned to keep lifesaving vapor products legal and affordable to make,
    market and use since 2009, I take issue with the title of this article.

    All real public health advocates strongly support smokers switching to vaping.

    Vaping opponents are NOT public health advocates, but rather are public health frauds
    who should be held legally and criminally accountable for their egregious actions that
    have protected cigarette markets and threatened the lives of all vapers and smokers.

    During the past 25 years, Big Pharma companies have given hundreds of millions of
    dollars to researchers, medical groups, health groups, lobbyists, politicians and many
    others to deceitfully hawk Big Pharma drugs as the only effective way to quit smoking
    and to demonize and ban all other smokefree tobacco/nicotine products (that compete
    against Big Pharma drugs and Big Tobacco cigarettes).

    The solution is not to demonize the field of public health, but to save public health by
    exposing and purging these public health frauds from their powerful and well paid positions
    at government health agencies (including the WHO, US DHHS and UK MHRA), healthcare
    organizations, medical groups, universities, etc.

    Public health malpractice is best resolved by denouncing, holding accountable, and
    weeding out the malpractitioners.

    • Vapeix

      Bill, I 2nd that. I had to take a 2nd look at the title before I clicked into. It’s been a while since we’ve chatted, glad to see you are still active. Thanks for all of your hard work! -Kyle Newton

    • Dirtrider129

      I do agree with you, the question is how do we expose these public health “frauds” and get them out to be held accountable for what they are doing.
      The problem is that there are so many of them watching each others backs to keep from being exposed.

    • EKeller

      It would seem that the behavior of the vaping opponents perfectly matches the legal definition of “fraud”:

      The term ‘fraud’ is generally defined in the law as an intentional misrepresentation of material existing fact made by one person to another with knowledge of its falsity and for the purpose of inducing the other person to act, and upon which the other person relies with resulting injury or damage.
      http://www.lectlaw.com/def/f079.htm

  • tiniow

    God I hate vapers. They look like dummies for adults, all these grown men and women latched on at the teat. For some reason they feel the need to clutch onto this lifeline in a way rarely seen with a cigarette, like a toddler knowing they are getting ‘a bit big for this now’ but clinging on desperately.

    Not to mention the awful sickly smell they produce and the fact that their dependents feel they can puff away on trains, and other places despite the ban because they are the ‘healthy alternative’

    • Jenny

      It’s ok, we are used to being reviled as smokers so your hate is just another brick in the wall. You’d think we were bashing old ladies or abducting children or something. But no, just a simple human failing…and certainly not worse than your callous and indiscriminate spreading of venom.

    • Feadin deTroul

      God, I hate people that hates other people.

  • Carl O’Kelley

    E-cigarettes are not harm
    reduction because they harm in a gruesome and glaring new way that combustion
    cigarettes have never done. They detonate and incinerate practically daily,
    maiming, scarring and even blinding desperate and delusional nicotine addicts
    in addition to injuring bystanders. Vaporizer peddlers who
    claim that their machines only go ballistic due to user error, worn out parts,
    mismatched chargers or after market batteries are liars. They are blowing up in
    nicotine addicts faces while in use, not in pockets, even while being demonstrated
    in vape shops by e-cigarette peddlers. E-cigarettes are Incendiary Explosive
    Devices which spontaneously detonate and incinerate when used exactly as
    e-cigarette manufacturers and sellers instruct them to be used. E-cigarette huffing is more harmful than smoking, bringing the hazards of
    both some of the same carcinogens and toxins in cigarette, smoke plus going
    ballistic, and most e-cigarette huffers still smoke cigarettes anyway. E-cigarettes
    are drug paraphernalia for getting high on heroin, crack, THC or meth in
    addition to a nicotine fix, and when they are used at workplaces employers and
    coworkers don’t know what’s in them. The Food and Drug
    Administration must make sale of them illegal, the Consumer Product Safety
    Commission must make importation of them illegal, and the Occupational Safety
    and Health Administration must make it illegal to bring them to workplaces.

    • EKeller

      Since it is not e-cigarettes that explode or catch fire, but rather lithium batteries, perhaps you should petition OSHA to make it illegal to bring laptop computers, tablets, and cell phones to workplaces. I take offense at the accusation that I use e-cigarettes to “get high.” After trying for over 45 years to stop smoking without success, I owe my 7 years of smoke-free status to having switched to vapor products. Before you write another word about the comparison between smoke and vapor, I suggest you read this report from Public Health England: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf

    • James Abbott

      This is the most ill informed response I have ever read. As already stated in another reply, it is the batteries that “Explode”. Which in itself is difficult to achieve. The number of “exploding” vaping devices is negligible compared to the number of lives of has helped. User error plays a huge part as to why they Explode so unexpectedly. And by “user error” I include the purchase of poor quality batteries. Lithium batteries are used in a huge range of products, however, these products have little current draw so are less unlikely to fault.

      There has also been numerous reports of mobile phone batteries exploding, laptop batteries exploding and you don’t think we should ban these products? No… You seem to think that that’s fine.

      You clearly have done zero research on this topic. You probably heard someone say ecigs explode and jumped on some kind of health and safety bandwagon. Your comment is seriously, if not dangerously, ill informed and just down right cretinous.

      Oh… Here’s where you should start your belated research. http://Www.google.com

      • Rob Heyes

        It is definitely very ill informed, perhaps Carl O’Kelley works in tobacco control?

    • PurrrdyGurl

      Since you are so fond of copying/pasting your same rant, I will do the same for you 🙂

      Sir, you may want to admit yourself to your local Psych ward,
      immediately! It sounds to me that you know absolutely NOTHING about
      ecigs! Your claim that ” e-cigarette huffers still smoke cigarettes
      anyway. E-cigarettes
      are drug paraphernalia for getting high on
      heroin, crack, THC or meth” is the most ludicrous statement that I think
      I have ever read! I smoked 2 packs a day for 37 years. I started
      vaping over 2 1/2 years ago and have not smoked ONE SINGLE regular
      cigarette since! I have used many different ecigs as well as many
      different flavors that I mix myself, and I have NEVER, EVER, had
      anything explode or even behave strangely. I really take offense to
      your BS stance that I am using my ecigs for getting high on heroine,
      crack, THC or Meth! Please tell me exactly how these illegal substances are being used in ecigs. You are a misinformed moron, in the worst kind of way! Take your disinformation elsewhere, please!

    • Jenosaurus LadyMulder Dorfmeye

      You are disgustingly ill-informed. This whole spiel is completely off base.

    • Feadin deTroul

      If that’s the way you take our heroine, don’t. Use an old fashion seringes instead. Using an ecig makes you delusional.

      Oh, BTW, earth’s round and we have been to the moon. And we also don’t burn witches anymore.

    • Dragonmum

      Sir…….No, I really can’t be bothered replying to such drivel.

  • David Parr

    I have attempted to quit with every nicotine replacement therapy available & failed within 3 months. I am now 5 months into using a vape device & 3 1/2 months cigarette free. I have even halved my nicotine strength in my liquid. As the article above suggests the NHS & Government should back this new way to quit but I worry the new TPD regulations rather than ensuring that products are safe will greatly reduce the choice & availability. I am aware that David Cameron received a question in PMQ’s yesterday & advised he would look into it but will be unable to do anything as this is an EU directive. As a new vaper I want the products to be safe but not regulated to the extent they become extinct. Maybe they NHS does have a part to play to ensure the TPD does not remove this product as a nicotine replacement therapy???

  • Martyn Butler

    In 1982 I too tried to warn about the dangers of HIV, went on with friends to create the Terrence Higgins Trust that is today the largest sexual health charity in Europe,
    Today I am heavily involved in education, marketing in both retail and wholesale vaping products.
    After a recent brush with cancer, my surgeon, immediately after giving me the diagnosis said “Give Up Smoking Today” I never looked back, but I could never have done it without switching to VAPE.
    Like the author, I continually see parallels with the disinformation, downright lies, scaremongering, people at risk ignoring health advice, and completely barmy regulations, that in the long term do more harm than good.
    HIV had a Diana moment, the tabloids turned, safety became the keyword, education and promotion of safer practices became the norm.
    Vaping has yet to have its “Diana Moment” but in my opinion it cannot come soon enough.

    Leading from the front – In a cloud of Vapour

  • Dirtrider129

    Loved the article, had lots of very good points. I believe they should just step aside because we vapers are working very hard and succeeding at bringing smoking to a halt. The PH officials that actually do care about what vaping can accomplish should just help support it and the other public health frauds should be exposed and held accountable for the death and destruction they are working to continue for personal gain and other special interests.