Why Australia’s ban on nicotine vaping is wrong
Posted on March 24, 2019
The arguments used to ban nicotine vaping in Australia are very weak, paternalistic and unethical, according to a new critical analysis.
The analysis by leading Australian researchers Wayne Hall, Kylie Morphett and Coral Gartner was just published in the international peer-reviewed medical journal Neuroethics.
Here are some of the key points raised in the analysis:
A ban is paternalistic
A vaping ban denies adult smokers the choice of using vaporisers rather than tobacco cigarettes in order to protect the smokers’ own health. Such a ban is hard to justify when there is clear evidence that vaping is far less harmful and exposes users to far fewer chemicals than smoking.
Adults should be able to make free and informed choices about their health and should be provided with accurate information.
The 'gateway' argument
The evidence that vaping is increasing cigarette smoking in young people is weak. While vaping is associated with later smoking, there is no evidence that vaping causes young people who would never have smoked, to start. Another plausible (and more likely) explanation for the association is 'shared liability', ie that young people who experiment with vaping are more likely to go on to smoke and use other drugs anyway.
Furthermore, the gateway hypothesis is inconsistent with the population trends in cigarette smoking among young people in the UK and US. Youth smoking rates have been falling steeply. In the US, the decline has been faster than ever.
A ban is inequitable
An ban denies adult smokers the choice to vape and justifies this in terms of preventing adolescents being recruited to cigarette smoking. This policy clearly disadvantages addicted smokers, and especially socially vulnerable groups, such as people with serious mental illness and Indigenous people who find it particularly difficult to quit smoking.
A ban prohibits the sale of a less harmful way of obtaining nicotine (vaping) while allowing the sale of the most harmful nicotine delivery system, the combustible cigarette.
While the long-term health risks of vaping nicotine may not be clear for many years, the risks of tobacco smoking are well-known, with up to two-thirds of continuing smokers expected to die from tobacco-related diseases.
The 'TGA approval' furphy
Some defenders of Australian policy claim that nicotine vaporisers should seek approval as medicinal products for smoking cessation, to show they are safe and effective. This ignores the major obstacles to obtaining approval by the TGA and the commercial disincentive to do so.
The small independent companies that manufacture most products do not have the funds or experience in pharmaceutical regulation to conduct clinical trials or apply to have their products registered as therapeutic goods. Only tobacco or pharmaceutical companies have had the financial resources to fund clinical trials and navigate the pharmaceutical regulatory process.
Misuse of the precautionary principle
Supporters of the sales ban justify it by invoking the 'precautionary principle' to argue that a total ban is justified in the face of incomplete evidence and that vaping may cause harm.
However, the precautionary principle requires a complete risk assessment of both the risks and benefits. It needs to take into account the benefits to smokers who quit and the development of a totally unregulated black market.
For example the AMA President Dr Tony Bartone requires evidence of zero harm before approving vaping. However, this standard is not applied to any consumer products or to medicines, where decision-making is based on weighing up the risks and benefits.
An alternative to a ban
A sales ban is 'poorly justified, weakly based in evidence and is paternalistic'. It is unlikely to prevent youth uptake of vaping and has many unintended consequences, such as denying adult smokers access to a less harmful way of obtaining nicotine.
There are legitimate public health concerns raised by the advent of vaping that justify a precautionary policy response.
But this does not require a ban on the sale to adult smokers. A less restrictive compromise approach could include achieve the same goals.
Vaping could be regulated to minimise youth access. This would allow the sale of approved vape products to adult smokers under restricted conditions that minimise youth access and uptake. For example, sale could be limited to licensed vape shops, tobacconists and shops that sell adult products.
Initially, there could be restrictions on advertising and vaping in public places. Vapers should be provided accurate information and educated about the risks of dual use.
These policies could be modified as evidence on the public health impact of vaping became clearer. This approach is more ethically acceptable and better respect the interests of smokers than a ban on their sale or use.
Posted by Colin Mendelsohn, firstname.lastname@example.org