To the health professional, vaping ought to be an important extension to the array of options to assist people who present as smokers. It offers a different strategy for quitting smoking (what matters for health), without the additional hurdle of quitting the addictive drug nicotine - and thereby offering a greater chance of success for some users and may avoid relapse in others. It would be unethical to deny them access or mislead them in some way about these products in the hope that they will quit smoking and nicotine completely. Smokers should be encouraged to try vaping if they like the idea of this option to quit smoking, not just when all else has failed. There is little justification for reimbursing the costs, except perhaps to help highly disadvantaged people over the barrier of the initial outlay, but there is good reason to acquire expertise and give sound, evidence-based advice to any smoker about these products.
This is a different frame of reference to that of, say, an anthropologist, who would ask: “what role does vaping play in society?”
To the anthropologist, vaping should be recognised as a disruptive market-based phenomenon in which users are seeking out satisfactory alternative and better ways to take the recreational drug nicotine. Vaping has emerged through the free-play of consumer preferences and producer innovation, recently enabled by advances in battery technology, in lightly-regulated consumer markets. Vaping has emerged despite opposition of many public health activists and governments who have tried to define and regulate them variously as smoking cessation medicines or tobacco products, though they are neither. They have triggered or revealed a major dysfunctional and malevolent system of science, policy-making and fake news. Vaping has also disrupted the public health community, which has confused and unexamined motives, and pressed for these products to be prohibited, excessively regulated or taxed, even though this will have the effect, if not the intention, of making them less appealing as an alternative to smoking, protecting the cigarette trade and causing more disease and death.
Finally, a consumer might reasonably ask, “what does this mean for me?”.
To the consumer, the emergence of vaping has set up a rival and product category to the ones that have dominated the nicotine market for decades. This is characterised numerous benefits: a fun, clean way to enjoy the pleasures of nicotine, much lower health risks in the short and long term, lots of personalisation, geekiness and new products to try, a sense of achievement and empowerment, a parallel supportive social phenomenon, lower costs, reduced stigma and less mess. On the downside, there is some complexity and difficulty in getting started, and, at least initially, not always the same satisfaction as smoking. However, the trade-offs between benefits and downsides is getting better over time as the products improve and new options emerge. Also, vaping comes with the increasing annoyance of having to endure what can seem like a highly personalised assault on private choices and personal success, as if it is they are working through the anti-smoking play-book all over again. If only everyone else could just back off with their judgemental attitude! A consumer might conclude that what works for them (and those who might follow them) is under an irrational and uncaring threat and, perhaps reluctantly, become an activist.
Each perspective is legitimate and each is open for debate in its own terms. My resolution 2017, is to discuss the harm reduction phenomenon from different perspectives – we need to make sense to policy-makers, health professionals, activists, parents, vendors and consumers.