An e-cigarette is not an NRT, a licensed medical nicotine replacement therapy. It is a consumer Harm Reduction purchase seen as a safer choice, for permanent use, that replaces a dangerous smoke-based delivery system with a clean nicotine delivery system. In a similar way to smokeless tobacco such as Snus, or dissolvable tobacco such as Ariva, electronic cigarettes are a consumer alternative that supplies nicotine without the smoke – so they are likely to be safer than smoking by 99% or more because it is the smoke that kills (certainly not the nicotine).
Tobacco is not particularly harmful, as long as it isn’t smoked, and nicotine certainly isn’t – it has been described as “one of the safest drugs” (see our Quotes page for statements by doctors and professors of medicine on this and similar issues). Note that there is a vast amount of data – more than 150 clinical trials over nearly three decades, with tens of thousands of subjects – that shows long-term nicotine consumption without smoke to be all but harmless.
Nicotine is not associated with cancer or heart disease and there is a great deal of data to support this. This is the advice given by national clinical guidance organisations such as the UK’s NICE .
It is also worth noting that nicotine is the most natural and normal of all consumer stimulants including coffee and alcohol since everyone consumes it as part of the diet, and everyone tests positive for nicotine; no one consumes caffeine and alcohol in vegetables as is the case with nicotine, an entirely natural and normal part of the diet. Don’t believe anyone who tells you otherwise! Smoking is harmful because of the smoke; some (but not all) types of oral tobacco have an elevation of risk for oral cancer; but nicotine alone cannot be shown to have any risk. Indeed, there is a vast amount of data that shows otherwise.
Smokers are supplementing their dietary intake of nicotine in the most harmful way available; e-cigarettes only supply the nicotine, not the smoke, and without tobacco components, so at this point in time the risk is seen as unmeasurably low.
NRT compared to e-cigarettes
An NRT is a licensed medical therapy for treating something classed as a disease (smoking addiction), with a finite length of treatment, after which the therapy ceases and the subject hopes to be free of the original dependence and of the therapy.
In contrast, electronic cigarettes are an alternative consumer replacement for smoking. They can also be referred to as Harm Reduction products, which are consumer-based choices where a safer alternative is chosen by the buyer (such as low-fat foods, low-alcohol beer and so on). Harm Reduction is a consumer-driven process whereby the the purchaser chooses a consumer product as an alternative with perceived lower risks.
The link betweenNRTs and and PVs (personal vaporisers, or ‘e-cigarettes’) is that both, if successful, will save lives. Because e-cigarettes are far more successful than NRTs, they will save many more lives. This is because no NRT has ever been independendently shown to have a success rate better than 10%, measured at the standard 20-month mark for final determination of smoking status (all tests showing anything other than very low success rates are those funded by and run for the manufacturer, and these results are not replicated by independent tests). In general terms it is correct to say that all pharmaceutical interventions for smoking cessation have a 9 out of 10 failure rate; but NRTs are among the worst performers and in some cases can be shown to have a 98% failure rate.
E-cigarettes, in contrast, are shown to be at least three times more successful, and anecdotally up to eight times better. A 31% success rate was seen in one study with the worst possible combination of factors (including no support of any kind), through to around 75% reported anecdotally with the best options including expert mentoring.
Although switching to a PV may be successful in up to 75% of cases in exceptional circumstances, we cannot expect this to be replicated in the real world. A very high success rate of this order is possible where intensive expert mentoring is available, and therefore may be achieved in certain family or work settings. A more likely scenario is that eventually around 60% of smokers will switch to PVs, perhaps over the course of several decades. Because smoking is 50% lower in prevalence in Sweden, and because smoking prevalence is still falling there  , it is possible to say that THR products (Tobacco Harm Reduction alternatives to cigarettes, used as a substitute, by consumer purchase choice) have the capacity to virtually eliminate smoking. This does not seem possible by any other means; indeed, it appears impossible to reduce prevalence below about 20% in many countries (by conventional means).
Since e-cigarettes are more popular with smokers in other countries, and because in places such as the USA and UK we have seen 1% of smokers per year start to use an e-cigarette (a rapid rate of uptake), then it is reasonable to conclude that e-cigarettes will become more popular than Snus in developed countries other than Sweden and vapers will eventually replace (at least) 60% off the smoking population.
How is success measured
The concept of ‘success’ is different for these groups of products: for an NRT, success is the subject being smoke-free and therapy-free at 20 months. Success rates of about 5% are the average. Some drugs have a higher success rate, but have significant risks, some therapies (used by far more people)have extremely low success rates. Hundreds of deaths have been caused by some quit-smoking drugs; not a single instance of mortality attributable to an e-cigarette can be shown.
Success for a Harm Reduction product is when the subject is still using it at 20 months and has switched completely from the original harmful product. Some success ought to be allowed if consumption of the original harmful product has been significantly reduced (as the dose makes the poison).
Since those products that have been tested show virtually zero risk, it is not unreasonable to state that Harm Reduction product users have the same risk as NRT users, i.e. virtually none. We know that:
- Essentially, NRTs don’t work – an failure rate greater than 90% does not indicate a viable solution, since around 9 out of 10 subjects return to a behaviour with significant risk of death
- E-cigarettes appear to have a success rate somewhere between 31% and 75%, depending on the circumstances
- The Snus data from Sweden shows that smoking-related mortality drops in parallel with the reduction in the number of smokers as they change to alternatives – thus it is clear that Snus has very little risk because very few die from using it (an invisible number at population level). A reduction in smoking prevalence by 50% (as has been achieved in Sweden, measured at Q1 2013) becomes exactly paralleled by the same reduction in smoking-related deaths.
- Sweden is the world leader in reducing smoking prevalence
- Sweden is the world leader in reducing smoking-related mortality
- Sweden will have a male smoking prevalence of 5% around 2016 – a phenomenally low figure (it falls at 1% per year)
It then becomes very clear that e-cigarettes and other alternatives will save a far greater number of lives than NRTs. We can see this clearly in Sweden, which has the lowest smoking-related mortality rate of any developed country by a wide margin (it’s known as the Swedish Miracle). The Swedish epidemiological data and the national morbidity and mortality statistics, proves that Harm Reduction saves a phenomenal number of lives, and Sweden actually has a realistic prospect of reducing smoking-related mortality to an insignificant amount – something absolutely unreachable under any circumstances by any other country (unless they follow the Swedish method).
E-Cigarettes will save more lives than NRT
So we can see the principle of consumer Harm Reduction is not just clearly demonstrated but proven by the use of Snus in Sweden. It saves lives in numbers totally unachievable by any other method.
As e-cigarettes have around four main ingredients, all used safely for decades, and at least one professor of medicine has stated they will have the same risk as Snus it is reasonable to assume that e-cigs will save many more lives than NRT. Snus is shown to have no clear elevation of risk for any disease or condition by the national health statistics; is clearly demonstrated by meta-analyses of >150 clinical trials over >25 years to have no reliably-identified elevation of risk for any disease.
Consumer purchase choices are proven to be safer and more effective than medical interventions because Sweden’s smoking mortality rate was reduced in parallel with the reduction of smoking prevalence to 11% at Q1 2013. In other developed countries the smoking prevalence has stopped falling, at about 20%, and now reduces at about 0.4% per year or less. It would take half a century of medical interventions to get the same results as Sweden did with Snus – by which time the Swedish results will be, again, out of reach.
We also know that e-cigarettes are proving more popular than Snus, so their potential is even greater than the 50% reduction in smoking and parallel reduction in deaths seen in ‘the Swedish Miracle’. So, not only are e-cigarettes not an NRT, they are likely to be orders of magnitude more effective in the saving of life.
Unfortunately e-cigarettes are far better
This, in turn, means they are likely to be banned in many places due to the threat to pharmaceutical industry income and tobacco tax revenues. To maintain current income streams and tax revenues, it is necessary for smokers to buy NRTs in an attempt to quit; then fail, return to smoking, try another NRT, fail and go back to smoking, then get sick and need treatment . The expensive and highly profitable chemotherapy, COPD and heart disease drugs are part of the problem because as ecigarettes become more widely used, pharma industry income will reduce in parallel. Since the number of smokers was reduced by 50% in Sweden by the use of Snus, and since ecigarettes are far more popular than Snus, it is quite reasonable to expect that the number of smokers in some countries will be reduced by 60% or more. This prospect is terrifying to the pharmaceutical industry, who fund much of the resistance to ecigarettes especially at government level.
Smokers put lots of money into the tax coffers by the different routes involved – tobacco tax, tax on drugs for treating sick smokers, NRT tax, and all the various taxes generated by hospital treatment. They pay out very large sums in tobacco purchase, then for the profitable drug therapies that it is said many of them will need . This is an incredibly profitable income channel for the pharmaceutical industry, which explains why they allocate so much money to opposition to e-cigarettes.
Smokers also die early, and save the state large sums in pensions and social care costs. An ongoing smoker is said to have about 10 years’ reduction in lifespan compared to someone who has never smoked ; this saves the State huge sums in pensions, social support payments, and healthcare. All in all, smokers are worth their weight in gold.
E-cigarettes stop all that, so are hardly likely to be popular with those in power.
So: ecigs aren’t NRTs
An e-cigarette is demonstrably not NRT. Firstly, ecigs work. They are a consumer choice, they are a successful safe replacement for smoking, they remove the need to purchase quit-smoking drugs, there is no cost to the taxpayer, they reduce or eliminate the need for hospitalization and very expensive therapies, they cut taxes at all levels, and they are highly likely to make very large numbers of people live longer, though with the unfortunate result of more reliance on the state in later years.
None of those apply to NRTs.
The debate in simple terms
The debate is basically this:
- Does the individual have a right to live longer by the choice of less-harmful products?
- Does the State have the right to restrict/regulate/remove access to those products, in order to maintain tax revenues and reduce the number of people living longer?
- Should the pharmaceutical industry be able to pressure government to preserve the status quo and keep smoking prevalence the same, in order to maintain sales of the hugely profitable drugs for the treatment of sick smokers?
- Do we really want to reduce the number of people dying from smoking – or is that just a smokescreen to keep a lot of people in jobs to which they are not entitled; when in fact they are, essentially, parasites living off the sickness and death of others?
Your position on this probably depends on who employs you and pays your mortgage. It’s as simple as that.
If you think it’s OK to restrict, regulate or block access to consumer Harm Reduction products that are guaranteed to save many more lives than current policies, you almost certainly work for the cigarette industry, the pharmaceutical industry, a national health service, or a government or other agency that depends for its funding on one of those.
Nobody else would take such a ridiculous, untenable, immoral, unethical and parasitic position.
 Male smoking prevalence falls at 1% per year in Sweden (2003: 16.7% – 2012: 8%) and will be at 5% around 2016, a phenomenally low figure for a developed Western country.
 ASH UK say that for every smoker who dies from smoking-related disease, another 20 are ill. This appears to imply that 20% of smokers are ill at any given time (as 100,000 per year are said to die in the UK, so that 2 million are ill, and this is around 20% of UK smokers).
 Doll et al showed that continuing smokers average 10 years reduction in lifespan. He also showed that if a smoker quits by age 35 then no lifespan reduction can be demonstrated; although this gets less publicity.