First do no harm – smoking and the ethics of vaping…


Michael McBride is crystal clear; our Chief Medical Officer believes too many people are vaping and this is a bad thing.  In a recent TV interview he was unambiguous in his discouragement of e-cigarettes.    The views of CMO are important, people listen and people take note.  He’s not alone; the British Medical Association, WHO, European Commission and the Welsh Assembly are all censorious.   So are they right?

One thing on which Michael McBride and I agree is the need to reduce tobacco harm.   Much effort is applied to this public health problem but we still have too many smokers; about 22% smoke and it’s a key reason for social inequalities in health. In some poorer regions of Belfast 54% of the population smoke whereas in North Down the figure is 10%.   Catholics are three time more  likely to smoke compared to Protestants which suggests a sectarian issue but this I feel is down to culture; priests traditionally were smokers while smoking did not fit well with the Protestant work ethic.  Catholics smokers are well aware of a particular prickly dilemma; if it is improper to smoke while praying, when smoking is it inappropriate so say a quick prayer?

The three Abrahamic faiths seem pretty relaxed with smoking.  I suppose widespread tobacco use has come to us relatively recently compared to the rule books of these monotheist religions and since cigarettes don’t make you beastly with lust or  covetous of money it was largely ignored by the good books that is until we got ISIS who dole out lashes for having a sneaky drag.  Unlikely this latter development will have much of an impact on smoking rates here so it’s health professionals who remain the vanguard in the war on tobacco.

Twenty years ago, those who had tobacco-control as their day job, first realised, then argued, that public health needed to support the innovation of new forms of nicotine.   Karl Fagstrom, a leading scientist in smoking control said in 2003 that;

the battle against tobacco related mortality is over when NRT is not used for cessation anymore but instead of cigarettes”.

This vision should have set the agenda for the next 10 years of smoking control but sadly it didn’t.   The pharmaceutical industry, who produce licensed Nicotine Replacement Therapy (NRT); patches, gum etc, was aggressively resistant to any discussion on developing improved and safer nicotine delivery systems; safer than a cigarette yet satisfying to the smoker.  Why this should be I never fully understood.  I remember at meetings having heated discussions with senior people at GlaxoSmithKline and Pharmacia (now Pfizer) who, it seemed to me at least, were more interested in corporate image than public health or profit for that matter.  Developing better nicotine delivery systems might make Big Pharma more like Big Tobacco and that just wouldn’t do.

And there was the complex issue of regulation.  NRT for stopping smoking was, and is, the most rigorously regulated form of nicotine; the most deadly – cigarettes – is hardly regulated at all.   To successfully market an innovative NRT product seemed impossible in the early years of this century.  Then the medicines regulator – MHRA – had a “Road-To-Damascus” moment and caved into the pleadings and concerns of people who had written widely on the lack of a level playing field in nicotine regulation.

A report from 2005  secured significant relaxation for the use of licensed NRT particularly in pregnancy and heart disease – where it was almost banned – and reduced the public health obsession with “cessation” – stopping for good is great but what about those who cannot stop?   So we got “temporary abstinence” and “stepping down to stop” and finally “harm reduction”.       But licensed NRT products are not very attractive for harm reduction.  E-cigarettes are.

E- cigarettes have become a popular crutch for many who have or are attempting to quit smoking or simply wish to avoid cigarette smoking’s long-term complications. The battery-operated nicotine delivery device simulates the act of tobacco smoking through physical sensation, appearance and even flavour.   Invented by Beijing pharmacist, Hon Lik, it has now secured global commercial success and I predict that Hon Lik will become famous for his contribution to public health.   Of the myriad e-cigarettes brands on the market none is licensed.  This is unhelpful. It might be the lack of licensing that gives the public health specialists, including Michael McBride, such a jaundiced view of the product.

It would be best for all if e-cigarettes were regulated and this might happen in 2016.  Regulation needs to assure that these devices deliver nicotine in a reliable and consistent way and that they contain pharmaceutical grade nicotine (some versions have high levels of nitrosomines a chemical linked to cancer).  But this is nit-picking when it comes to saving the lives that would be otherwise lost to burning tobacco.  And off course the potential reduction in chronic diseases; heart, stroke, lung and many cancers.

The smoking public has voted and huge numbers have switched from a highly dangerous habit – smoking burning tobacco – to a much less dangerous one – vaping.  If government policy continues to vilify e-cigarettes I  would suggest its does so on something more scientific than the “precautionary principle” and a paranoid suspicion that Big Tobacco, who own the e-cigarette companies, have an ulterior motive.  To do this would be to do more harm than good.

Terry Maguire is a pharmacist in West Belfast



  • Chris Jones

    “It would be best for all if e-cigarettes were regulated ”

    ….. the case for regulation is totally absent. There are no discernible negative health impacts

    In those circumstances what business of the state is it what people do?

  • Brian O’Neill

    I assume Terry means regulations for what goes in e-cigarettes to prevent dangerous ingredients. There is a lot of cheap Chinese brands being sold in poundshops and god knows what is in them.

  • Chris Jones

    At that level its fine but watch the Treasury. This is a huge cash cow waiting to be milked.

  • Nate

    1. I wasn’t aware that “Chinese” was a synonym for “probably hazardous.” Are you aware of anyone actually being harmed by those products? I myself am not.

    2. What does the maker of an intrinsically non-hazardous product have to gain by putting “dangerous ingredients” in it? “There might be something bad in there” isn’t good enough. Give us at least one (hypothetical) example of what you’re talking about. Until then, you’re just inventing things to be concerned about.

  • Brian O’Neill

    Fair enough. The iPhone I am typing this on is made in China. I fact the chap who invented ecigs is Chinese.

    I was thinking more of their dubious food safety record

    Like everything in life the branded products should be fine.

  • Turgon

    So a country of 1.3 billion people (the largest in the world) dismissed because of an article about food scandals written in 2011.

    That argument is remarkably close to racism.

  • Nate

    I would say xenophobia rather than racism, but in any event, it’s not an argument to which anyone should want to hitch their rhetorical wagon. Whenever I hear some anti-vaping alarmist use “Chinese” as a euphemism for “hazardous and probably deadly,” it makes me physically cringe.

  • Nate

    Food safety is a good example to bring up, as food safety regulations were only enacted after a clear and present need had been demonstrated that they needed to exist, and that the population as a whole would gain a demonstrable benefit from them. When you enact public health policy based on made-up “concerns” and imagined worst-case scenarios, instead of real things that have actually happened to real people in the real world, the result you get is bad policy 100% of the time.

  • New Yorker

    In the US the big tobacco companies want to outlaw all ecigarettes they do not manufacture. Generally the ecigarettes made by big tobacco are disposable and inferior to those purchased at local shops, kiosks and online. Apparently there is more profit in disposables than higher quality refillable ecigarettes.

  • notimetoshine

    Ecigs are an amazing invention. I loved smoking absolutely loved it and the inevitable diseases and premature death were constantly on my mind. Tried the patches and the gum (rubbish by the way I am sceptical of their usefulness). One day I thought enough, bought an e cig and from the next day haven’t touched a cigarette in 4 months.

  • chrisjones2

    I am happy to see some sort of standards regulation on quality for example your iphone has to meet around 100 international standards before it can be imported. some of those are safety related, some quality but they are based on evidence

  • chrisjones2

    No its not./ The Chinese have a huge lightly regulated market. In many ways its the wild west as the bureaucracy struggles to keep up with entrepreneurial ingenuity

    They recognise the problems themselves and are tackling it

  • chrisjones2

    Like they did Japanese in the 1960s – 70s …and look what happened

  • Darren R

    The industry has been calling for good, but fair regulation for ages and in fact for the most part is very well self regulated. the problem is the EU has put out the TPD which in essence basically bans vaping altogether (this is the regulation alluded to for 2016).

    Licensing is even more unhelpful as your adding more red tape and making it harder for new companies to set up as well as potentially forcing most current ones to close down. Yes there should be standards but there is in making anything. it would be like saying every coffee shop has to have a license to sell coffee, plus each type of coffee has to have a license and each batch of coffee made has to be tested. If your wondering why i bring coffee into this, it’s because caffine and nicotine are from the same family of drugs. Both have the same sort of toxicity and addiction and before someone says nicotine is far more addictive, ask any vaper who has quit smoking for several months and they will correct you on this. While you smoke for the nicotine the other thousands of chemicals in tobacco smoke reinforce that addiction.

    The biggest problem is money. Big tobacco is losing out, the goverment is losing out and big pharma are losing out. You can see the split in pro and anti vaping are split down the line with those you want to help improve health and those with ties to the 3 above.

  • gendjinn

    You should try a little research before inserting both feet in your mouth. You obviously don’t have a clue about the consumer safety challenges with Chinese goods.

    Thanks for the laughter with your racism charge, what was your statement about the middle east:

    “The only times there have been relative peace seem to have been under repressive regiemes (sic).”

    *cough* kettle *cough* pot *cough* black

  • Turgon

    So you too label a country of 1.3 billion people with one sweeping statement. Interesting that despite your ill thought out racism China is the world’s biggest exporter. Looks like the real world has less concern about Chinese goods. Keep up the predjuice though.

  • Sir Rantsalot

    Turgon it’s well known that Chinese goods tend to be made from inferior quality materials. Fabrics, metals etc. Some cheaper chemicals can also be used despite them being poisonous. Maybe you need a break from slugger if you go straight to a ‘racism’ reaction?

  • gendjinn

    LOL. You certainly are great at seeing things that aren’t there! That’s an F for reading comprehension, try harder next time.

    You should stop projecting your racism onto others, it’s not as cunning a rhetorical device as you think it is.

  • Turgon

    Ah so you too apply this “logic” and “well known facts” to the largest exporter in the world.

    The Chinese have a space programme which has put people in space, have built military aircraft including stealth ones; a maglev train. Now which of those have Europeans done? Not just in China but in Africa they have built roads which have revolutionised transport links for many millions. Most consumer electronics including premium ones have Chinese components.

    But you and others dismiss the 1.3 billion people of China and their technical prowess in a sentence: then you object to the suggestion that such stereotypes are racist. Yes keeping digging if you all dig together you may reach China – and discover just how technologically advanced they are.

  • Turgon

    I never dismissed a country of 1.3 billion with one sweeping statement: unlike you. It is quite clearly you and not me who is the racist here.

  • charlie

    Ecig devices need the same oversite as other consumer products, nothing more. The liquids should be approached about the same as processed foods. So far there is no justification for any more than that.

    Vaping has protected me from relapsing back to cigarettes for 8 months. I’m graeatful. I want to give back, help others.

    I’m worried and angry about the prospect of government interfering with access to ecig products. And I’m not paying any more damn excise taxes. Go to hell Mr. Big Government drug dealer.


  • gendjinn

    I don’t think racist means what you think it means.

    But do keep hurling baseless insults, it’s obviously the winning strategy 😉 Keep it up!


  • Turgon

    Yes because you suggested the “challenges with Chinese goods”

    Which ones: the spacecraft, the Maglevs, the electronics, the stealth planes?

    The reality is that since China is the world’s biggest exporter inevitably unless all of its products were perfect some will have problems: as have German products, American, British etc. etc.

    However, you singled out the largest exporter in the world and labelled its products as having “challenges” without any qualification. Since you directed it at one nation / ethnic group: yes it is racist.

  • gendjinn

    Lol. You’re purposefully being funny, right?

    Stating that China has had challenges with consumer good quality/safety is not assigning a stereotype to an entire people. Which is what you did when saying that middle east peoples can only be peaceful under dictatorships. Now I know you are still pissed about being called out on that. But that’s ok, I still love you and forgive you your trespasses.

  • Turgon

    Stop man playing: Though it shows clearly how badly you have lost the argument.

    You unlike me have demonstrated a chauvinistic and racist attitude. No amount of spinning will rescue it now. Keep digging but if you want to see China turn left about half way down: otherwise you will come out at New Zealand.

    Have fun.

  • gendjinn

    You gotta stop projecting your traits and behaviours onto others.

    I recommend you take a moment to reflect on your ill conceived and poorly thought out comments.

  • Steven Jones

    Ecigs is my option approach to stop from smoking, in light of the fact that its taste more pleasant, have an awesome group set up around them, and vaping is an agreeable propensity and leisure activity for some.