Australia is a pioneer in tobacco control.
It was the first country in the world to introduce plain packaging for cigarettes.
It is was at the vanguard of strong and graphic health warnings, advertising bans and smoke-free restaurants, bars and workplaces.
Backing for these measures, while at times shaky among some on the right of politics, enjoys broad political and community support.
It is against this backdrop of prohibitionist fervour that Australian regulators and politicians will be asked to deal with a device that many – from cigarette companies to tobacco-control experts – believe could be the biggest revolution in helping people quit smoking.
You may have seen one - an electronic cigarette - a device that delivers nicotine without the harmful side-effects of smoking tobacco.
E-cigarettes are battery-operated devices that create a mist for inhalation that usually contains nicotine. They are often, although not always, designed to look and feel like cigarettes.
Their use (known as ‘vaping’) mimics the behavioural and sensory aspects of smoking and simulates a ‘smoking’ experience.
Fans of the US political drama, House of Cards will have seen the show’s anti-hero Frank Underwood smoking an e-cigarette.
“You’re cheating,” says his wife Clare as a wisp of what appears to be smoke rises from Frank’s mouth, a cigarette-shaped device between his fingers.
“No I’m not,” Franks responds in his deep South Carolina drawl.
“It’s vapour … you should try it – addiction without the consequences.”
Anecdotal evidence suggests many thousands of Australians would concur.
In Europe, over 20 million people are estimated to have tried an e-cigarette and millions of smokers are turning to them as an effective tool to quit tobacco cigarettes.
Many countries, including 28 nations in Europe, are putting in place regulatory frameworks to ensure smokers can purchase and use e-cigarettes, which usually retail for less than traditional cigarettes.
In most States and Territories in Australia (WA is the exemption) it is possible to purchase electronic cigarettes as long as they do not contain nicotine, which is controlled as a poison. If Vapers want nicotine they need to go online.
However, this is a grey area of law, as some states ban the sale of any product that resembles or mimics a cigarette, such as confectionary – you may recall FAGS, a cigarette-shaped lolly complete with a red dyed tip, later rebranded FADS, sans tip.
Wells Haslem client Nicoventures manufactures and sells e-cigarettes in the UK and Europe and hopes to secure regulatory approval to sell them in Australia.
Debate among health experts on the safety and effectiveness of electronic cigarettes is passionate.
Many people who have spent a life time campaigning against tobacco are strident supporters of e-cigarettes, which they argue will save millions of lives by transitioning people off traditional cigarettes, onto e-cigarettes and in many instances off all nicotine products completely.
In late May 53 leading tobacco control experts (including five Australians) wrote an open letter to Dr Margaret Chan, the Director General of the World Health Organisation (WHO), cautioning against the over-regulation of e-cigarettes:
“There are now rapid developments in nicotine‐based products that can effectively substitute for cigarettes but with very low risks. These include for example, e‐cigarettes and other vapour products…
“The urge to control and suppress them as tobacco products should be resisted and instead regulation that is fit for purpose and designed to realise the potential should be championed by WHO.”
In June last year Britain’s Royal College of Physicians published an opinion that “electronic cigarettes and other nicotine-containing devices offer massive potential to improve public health, by providing smokers with a much safer alternative to tobacco. They need to be widely available, and affordable to smokers.”
The UK’s Action on Smoking and Health – ASH UK, one of the world’s most strident anti-tobacco activist groups – has advocated loudly for e-cigarettes to be widely available to adult consumers.
“…The harm from smoking is caused primarily through the toxins produced by the burning of tobacco,” ASH said in a statement in June.
“By contrast, non-burnt pure nicotine products, although addictive, are considerably less harmful. E-cigarettes consequently represent a safer alternative to cigarettes for smokers who are unable or unwilling to stop using nicotine.”
A team led by Professor Robert West, Director of Tobacco Studies at the University College London, undertook a cross-sectional study of 5,863 adults who had smoked within the previous 12 months. The study concluded that “among smokers who have attempted to stop without professional support, those who used e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT (nicotine replacement therapy) product [gums, patches] bought over-the-counter or no aid to cessation”. In fact, West found e-cigarette users were 60 per cent more likely to succeed than if going cold-turkey, or using other nicotine replacement therapies without support.
However, some experts, including the University of Sydney’s Professor Simon Chapman, caution that the long-term health effects of e-cigarette use, particularly on the lungs, are unknown and we need to tread carefully.
Other health experts respond that pharmacy grade nicotine used in e-cigarettes is mixed with water, propylene glycol and glycerol, which have been used widely in food and pharmaceutical products for decades with no adverse health effects.
ASH UK says: “One study concludes that electronic cigarettes have a low toxicity profile, are well tolerated, and are associated with only mild adverse effects”.
“Compared with smoking, using an electronic cigarette is safer. However, in the absence of a thorough clinical evaluation and long term population level surveillance, absolute safety of such products cannot be guaranteed. By comparison, the harm from tobacco smoking – the leading cause of preventable death in the UK – is well established.”
Other critics warn that e-cigarettes could re-glamourise smoking and act as a gateway to non-smokers to take up the habit.
However, both Public Health England and ASH UK have said there is no evidence that e-cigarettes get people into smoking by acting as a gateway.
Studies in the UK and Europe show that about one per cent of people who have never smoked, have reported trying an e-cigarette.
Nicoventures – a stand-alone company in the British American Tobacco Group – argues that e-cigarettes in Australia should be regulated, legal, and widely available for sale.
They must be manufactured to a strict and regulated standard to ensure users know what they are inhaling.
A major risk for e-cigarette users in Australia today is that they do not know what standard their device has been manufactured to and what ingredients are included in the nicotine liquid.
Unlike in the EU and US, to date the Federal Government has not declared a specific regulatory approach to electronic cigarettes.
Chairman address, John Wells
E-cigarettes, Benjamin Haslem & Alexandra Mayhew
365 days of PM Abbott, John Wells
Girls at the Centre, The Smith Family CEO Lisa O'Brien
Nude photos and human rights, Alexandra Mayhew
Sacking the coach, Julie Sibraa
Bringing the black dog to heel, Benjamin Haslem
Senate review, Julie Sibraa
Phil Charley obituary, Keith Jackson AM
Bud Burst, John Wells
Digital Terrorism, Isabelle Walker
Clothing our homeless, Carrie Deane
The value of interns, Madeleine Scott-Murphy