Vaping: who decides?

Posted on May 18, 2016

Last week, Nottingham University Hospitals NHS Trust, which runs Queen's Medical Centre and City Hospital, announced that it was ending its ban on vaping in hospital grounds. The trust says it has reversed its policy after new evidence that vaping is much less harmful than smoking. Dr Stephen Fowlie, medical director at the trust, said: 'We have a duty to help our patients and staff make healthy life choices, and can't ignore the potential benefits of electronic cigarettes as a nicotine replacement therapy. We're now allowing e-cigarettes on our grounds to give our patients, staff and visitors more choice in how they quit smoking.'

How very generous of the trust to allow something that is, as far as anyone can tell, completely harmless! But smoking outside is completely harmless, too. This is not really about harm but denormalisation. Not only smoking but anything that looks a bit like smoking must be airbrushed from history. In the case of this particular trust, it has decided that vaping might help people quit smoking and, on balance, allowed people to vape outdoors. But the aim, as ever, is to get people to stop using nicotine altogether. Vaping will still be banned indoors by the Nottingham trust. Freedom of choice isn't remotely on the agenda.

If other trusts follow suit, it will at least get the authorities off vapers' backs to a small extent. But there should never had been a ban on vaping outdoors - or smoking for that matter. The only justification for such a ban would have been a serious risk to others, but that simply never existed. Even the claims of harm from indoor passive smoking have been greatly exaggerated. Outdoor smoke from cigarettes is so dilute, it must be harmless, never mind the output from an e-cig, which is in most cases contain the same stuff used to produce smoke effects in theatres. If the tiny quantity of vapour from e-cigs were really a problem, it would surely be time to ban 'smoke' machines indoors. Clearly, that is idiotic.

The real problem is that the decision to decide what we can and cannot do still lies with the authorities. This was brought home in spades by the recent decision of the US Food and Drug Administration to effectively ban all but the oldest models of e-cigarette until they have been through an enormously expensive regulatory process. Vapers were rightly outraged at the threat to a growing, dynamic and innovative industry in America. But that only illustrates the problems that smokers have faced for years - having their personal choices determined for them by the state on the often flimsy grounds of health. It is particularly galling for many vaping ex-smokers who have switched after being nagged, lectured and regulated endlessly for smoking. Having chosen a less harmful alternative, they are still faced with the same kinds of restrictions.

The lesson is that if we give the state the authority to make these decisions, even in the name of protecting health, we will end up with appalling, illiberal and harmful laws as a result.

Here's an analogy. Imagine a new drug was created which was highly successful at treating dementia. Users of the drug could be completely cured, but there's a catch. Over time, 50 per cent of users would die due to side effects. Most people would argue that the decision on taking that drug should be left up to patients, given proper information, and it's highly probable that most patients would accept the risks for the sake of a better quality of life.

Yet, in many respects, that is the situation with smoking. Everyone understands there are risks to smoking, but for some people, smoking is so important that they would choose pleasure - a better quality of life - even at the risk of a shorter life. Yet the freedom to smoke is constantly under attack because the authorities get to decide on the question of our quality of life. The pleasures of smoking are dismissed as a harmful addiction. When it comes to vaping, the downsides are much lower than they are with smoking, but the same principle applies: if we let bureaucrats and politicians determine our choices, we might well find that we are deprived of those choices.

That's why it is important that vapers always press the argument for freedom and choice. Of course, many vapers quit smoking for health reasons and there is every reason to call out the hypocrisy of health authorities when they take away choices on the grounds of health but actually ignore or manipulate evidence to justify their decision. But fundamentally, the decision about smoking or vaping should be left up to us, not snatched away by puritanical campaigners, civil servants and politicians.