After Singapore’s latest announcement to further restrict e-cigarette devices, news came through alternative media channels of a letter to the health ministry, authored by two prominent British experts in tobacco harm reduction. Professor Gerry Stimson of Imperial College, and Clive Bates, formerly of ASH (anti-smoking charity) have criticised the move as being unscientific, unethical and harmful to health.
The letter asserts that Singapore is seen as a leader within the region in terms of health and social policy, and claims that neighbouring countries, particularly Indonesia and Malaysia, will look at this policy and attempt to replicate it.
So on what basis is such a decision so detrimental to health? To answer that requires a look at the interests at stake. The tobacco market globally, according to BAT, is worth GBP 450 billion per year, with 5.5 trillion cigarettes produced annually. The tax revenue of this is on top of that. Figures for this are hard to come by, but in the UK in 2013, this amounted to GBP 12.3 billion per year.
Tobacco bonds are one of the largest and best performing investments on the Stock Markets. From the profits of these, the Tobacco Settlement Master Agreement pays U.S. government and states a guaranteed income, which is $206 billion over 25 years. Electronic cigarette usage has, in recent years, led to a significant decline in tobacco sales — far more than was foreseen when the agreement was drawn up. Reuters says: “Cigarette consumption has dropped an annual average 3.4 percent since 2000 while many bonds were structured to withstand consumption declines of only 2 to 3 percent”. And here’s the rub: health charity funding is tied to tobacco sales — lung and heart charities have a financial stake in the sales of tobacco — and that means that the rise of e-cigarette popularity correlates negatively with government, state and health charity funding. With e-cigarettes globally rising, and no slow-down in sight, this means continued losses into the future.
Another conspirator in this complicated web of interest are pharmaceutical companies. Their sales of nicotine gum, patches and inhalators are falling. Although these products have permanent cessation success rates among smokers which are negligible (2% of smokers manage to stop by using the patch), they are sold and peddled freely by state-run healthcare systems. Any medication with a 2% treatment success rate would usually be considered an epic failure. But this is a lucrative and apparently worthy endeavour.
Finally, governments themselves stand much to lose. And not just from tax: who will pay pension, healthcare and other costs for all the former tobacco smokers who live much longer than they currently do? Philip Morris’s study on the Czech Republic claimed that tobacco smoking had a net benefit on the economy. Why? Largely because of “reduced health care costs” and “savings on pensions and housing costs for the elderly”. That’s right – smoking kills people sooner, and that saves the economy money in the long run.
So, into this controversial area we have a bunch of stakeholders for whom the elimination of a tobacco market is not in their interests: tobacco companies (obviously), government, pharmaceutical companies, healthcare charities.
Now the great enemy of reason is doubt, and the unknown effects of e-cigarettes are exploited on comment boards and dubious studies as reported in newspapers. Trolls on Singapore news comment boards pass around comments suggesting danger, and scaremongering is a common tactic. The reasoning behind this is, foggy, at best: consider this sensational story from Jakarta, in which mental gymnastics are required to follow the argument. E-cigarettes are dangerous because they contain nicotine? Because the labelling is not consistent? One American study tried to smear e-cigarettes as dangerous because a couple of children and pets had been poisoned by swallowing a bottle of e-cigarette liquid. Clearly, the Straits Times has been laying the way for this in the mind of the public with articles such as this one.
Other articles from around the world. The writer of this Guardian opinion piece seems to make contradictory claims: on one hand he says “E-cigs don’t contain the same type of nicotine you might find in an ordinary tobacco leaf”, and then finishes up by counter-claiming that “no matter how you choose to dress it up, nicotine is nicotine”.
What kind of chop logic is this?
Given the high-level of smoking in Indonesia, and the tobacco companies’s terribly cosy relationship with governments (the Tobacco Control Directive was the “most lobbied directive in EU history”) stories in which the potential harm of these devices is continually highlighted. As we know, ideas in the media become pathways to policy, and bans by regionally-important states such as Singapore provide enhanced justification for bans and prohibition across South East Asia by governments who are, shall we say, easily swayed by private financial incentive.
Now, it may be that an e-cigarette device is not 100% safe, but it is many, many times safer than burning tobacco leaves with tar and other cancer-causing chemicals. Staying the course on e-cigarettes can mean the elimination of the tobacco market by 2040 — in the words of Stimson and Bates — which would mean countless generations of children protected from this scourge to health.
The question is really whether the stakeholders involved in this, each with a finger in the pie, are going to let this scenario come to pass.