Kicking up Dust

    Photo: Roman

    Where should smokers turn for sound advice on quitting? That question is surprisingly difficult to answer.

    By George Gay

    Often, some of the most interesting aspects of conferences are thrown up by questions posed from the floor. And this was the case at the September 2021 GTNF in London where, from memory, a participant asked how a smoker could know who to approach for sound advice on using vaping devices to help her quit tobacco smoking. At first hearing, the answer seemed fairly obvious, but the more I thought about it, the more I realized how difficult it was to respond usefully to this important and insightful question. But to come to this realization, it was necessary for me to walk a little way in somebody else’s shoes: to examine the question not from the point of view of a person steeped in the information garnered from many vaping conferences but from the point of view of the smoker in the street struggling through a blizzard of contradictory messages.  

    So how can our smoker know who to approach for sound advice on using vaping devices to help her quit tobacco smoking?

    It would be good to be able to answer this question by pointing to official government agencies in whatever country the smoker lives, but this is problematic. If I look around the world, it seems to me that the number of people who live in countries whose governments I would call reasonably trustworthy is small, and I suspect that many smokers would agree with me. And this is the vitally important point here. Remember, most smokers will have no inside information about the benefits or otherwise of smoking and vaping, so they will be able to base their judgements about these habits only on whether, in general, they trust the source of the information being provided.

    Since I live in the U.K. and know a little about the workings of this country, let me expand on what I mean. Some might say with justification that the U.K. government has consistently put out messages that, in effect, encourage smokers wanting but previously unable to quit smoking to try switching to vaping devices. But our smoker can be expected to accept this advice only if, as a general thing, she trusts the government.

    Is this likely? I would suggest not. There are many stories doing the rounds at the moment that point to the untrustworthiness of the U.K. government in both its national and international dealings, but let me mention just one that I feel is relevant. The high court recently ruled that the government’s operation of a VIP lane for suppliers of personal protective equipment (PPE) during the Covid-19 pandemic was illegal. No prizes for guessing who were some of the big beneficiaries of this scheme, which didn’t always provide satisfactory items of PPE. Given this, it would not be unreasonable, I believe, for our smoker to question whether vaping devices were not being recommended by the government for reasons other than those to do with her welfare and that of other smokers.

    The question under consideration concerns “sound” advice, and so I should declare an interest. What is written above about lack of trust stands, to my way of thinking, whatever is your definition of “sound” advice about smoking and vaping. Some of what appears below, however, is about what I would call “sound” advice: advice that encourages smokers to try switching to vaping if they want to quit smoking and if they are unable to quit using other methods.

    There are, of course, some people who, according to this definition, could provide a smoker with sound advice and who would do so without fear or favor. There were a number of such people who sat on various GTNF21 panels or who participated in the conference in other ways, people of integrity who are experts in their fields. This is all very well, of course, but the genius of the question posed was that it got behind all of this to ask how the smoker in the street can get to know of these people and how our smoker can know for certain that these people are giving out sound messages. After all, everybody who is reading this magazine will be aware of the huge number of counter messages out there, sometimes published in respected journals under the names of people with qualifications that stretch around the block. Some of the people who I would regard as being experts acting with integrity have been maligned and had their work misrepresented in “good” journals. And messages from governments are often counter; those from the U.S. Food and Drug Administration are confusing while those from the World Health Organization appear to be both confusing and counter, which is quite an achievement.

    Learning from the Private Sector

    None of this is reassuring. But, as somebody once said, when you ask questions, you kick up dust, and it’s no good then complaining that you cannot see. So, let our smoker press on to discover what she might learn from the private sector.

    Well, let’s see. At one end of the scale are those companies that really don’t give a damn about the smoker or vaper and that are in the vaping business for a fast buck. Then there are companies intent on making a profit out of tobacco or nicotine, but that would be happier doing good than doing harm while making that profit. Of course, they are always going to be trying to sell the brands they offer, which they probably believe are the best, but about which others may have different opinions, and they are often going to be seen trying to put a spoke into the wheel of their competitors, no matter how potentially beneficial their competitors’ brands might be.

    And then there are companies that probably start out from the position that they want to do good but realize that to do so they have to stay in business, which means turning at least a modest profit. I think it is probably fairly obvious that if you’re looking for sound advice, it would be best to stay away from the first group, assuming that, as in the case of the other groups, you can identify its members. Members of the second group might offer a lot of sound scientific and technical information but, in listening to them, you would need to know how to split that information off from the commercial messages. Those of the third group, meanwhile, especially those among it that comprise vape stores, might give you the best objective advice, though it has to be kept in mind that objective isn’t always right or sound.

    Tobacco Control

    What about turning to tobacco control? As is suggested above, there are those in the tobacco control community who want to do good and who are embracing harm reduction; there are those who want to do good but cannot bring themselves to recommend products whose efficacy relies on their mimicking combustible cigarettes; and there are those who want to do good but haven’t got much of a clue, who believe that nicotine ingested during vaping causes cancer. And, unfortunately, there are those in tobacco control who seem to be interested only in keeping their jobs open until they retire, which means attempting to put a spanner into the works of tobacco harm reduction. To those of us imbued with the definition of “sound” advice given above, it doesn’t take too long to work out who it would be best for the smoker to listen to, but, again, you come back to the question: How can the smoker know?

    Other Considerations

    Everything that is written above looks at this debate from the point of view of the smoker who is thinking of quitting tobacco smoking so as to become healthier. But there might be other reasons. The smoker in question might also want to save money and/or the environment. At this point, things get easier and more difficult. For instance, the smoker wanting to save money doesn’t have to rely on outside advice; she can do the math for herself. The cost of cigarettes and vaping devices and consumables is information available in the public domain, so costing the two habits roughly is fairly easy on the basis of puffs, as advertised in the case of vaping devices. There is a difficulty in the form of a big unknown, however. What will be the future tax strategy of our smoker’s government as it is applied to vaping devices? And probably nobody could provide sound advice in this case, especially as the hue of the government might change if our smoker is lucky enough to live in a functioning democracy.

    Looking at environmental issues is even more difficult up to a point. How you compare the discarding of toxin-containing acetate filters with that of batteries and plastics would test most people, but it seems reasonable to assume that, since vaping devices are relatively new and upcoming while combustible cigarettes are old and on their way out, more development is going to be applied to the former than to the latter. Well, at least that is the case in those jurisdictions that encourage rather than disallow development.

    It is necessary, I think, also to say something about choice, which is seen as the great emancipator of consumers, at least by those who believe in the notion that the free market is the answer to everything. Smokers, such people may argue, are fortunate because they are able to choose between the wide-ranging information available across all media. But of course, this is not choice, it is simply confusion for most nonspecialists.

    So all is lost? Perhaps, though, then again, maybe there is something that can guide the smoker through: questions. Peter Abelard said that the only means we have of judging between apparently conflicting authorities is reason. “Through doubting, we come to questioning, and through questions, we perceive the truth,” he said.

    In other words, the answer to the question lies in asking—lots of—questions. Yeah, I’d go along with that.