Brian Monteith: The battle over e-cigarettes

Celtic and Rangers football clubs have been urged to repudiate their relationship from e-cigarette manufacturer E-lites. Picture: PA

Two years ago I wrote about how the British Medical Association – the doctors’ trade union – is so gripped by a self-serving politically correct agenda that it damages the important relationship between patient and doctor.

The BMA’s over-the-top and outspoken histrionics continue to throw the profession into disrepute. I warned that its behaviour challenged the notion of “trust me, I’m a doctor” – to the point it would become as absurd as “trust me, I’m a politician”. The profession of doctor risks losing respect – not because of individual cases of malpractice or chicanery, but more akin to the behaviour of teachers’ unions and their willingness to strike, undermining the once universal respect that dominies were held in.

My comments back then upset some people, but the evidence remains unchanged; indeed the BMA is at it again, this time demanding that Celtic and Rangers football clubs repudiate their relationship from e-cigarette manufacturer E-lites and ban their use at designated areas of their stadia.

If we consider what an e-cigarette does in the practical sense, we can see that it delivers a dose of nicotine that meets a consumer’s desire for the experience and, if they believe they have a craving, can, like nicotine patches, help them satisfy that need without resorting to smoking. Nicotine patches and other forms of nicotine replacement therapy have the backing of millions from pharmaceutical companies and can of course be prescribed by doctors – unlike e-cigarettes that have become popular simply by the choice of consumers, the vast majority of whom have been, or remain, smokers.

E-cigarettes go further than patches, though, for in employing inhalation to provide the nicotine hit they allow the consumer to go through a very similar physical process of putting a cigarette-like device to the lips, drawing in a vapour and then holding it between the fingers before repeating the process. It is to all intents and purposes the same sensation as smoking but without the smoke. Thus you will not find the smell in the air and there will be no film of tar to coat the lungs.

There is only a vapour and there is absolutely no danger, real or imagined, of second-hand smoke. But it is the similarity to the physical routine of smoking that is making it far more popular with people wishing to give up smoking or find a less risky approach to consuming nicotine, just as they might prefer to enjoy their morning fix of caffeine through an espresso or cafe latte than being offered caffeine pills.

But there’s the rub: it feels like smoking and looks like smoking – and although smoking is an entirely legal and legitimate act within the decreasing boundaries set by politicians – allowing the very act challenges the central strategy of tobacco control. It reinforces the notion that smoking is normal.

Forgive me if I find some double standards here in this debate. I remember in a more liberal age when I was at university we were challenged to think what was normal and what was abnormal and encouraged to be generally less pejorative and judgmental in our use of the word. Reactionaries who might accuse some behaviour or belief as not being normal were derided and told to change their ways; it was normal to be homosexual for instance, normal to be left-handed and normal to doubt the existence of God (or another life force).

Now those who doubt a God (not necessarily your God), are left-handed, or homosexual, are indeed minority groups, but they are, we generally agree, normal; few would say otherwise. So why is it acceptable to demonise and de-normalise smokers when they constitute not 3.5 per cent (homosexuals); not 11 per cent (left-handers); nor 25 per cent (God-doubters) but last year accounted for 25 per cent of adults, according to the Scottish Health Survey just published.

Indeed last year’s survey put the number of smokers at only 23 per cent so smokers are not only by any measurement normal, they are becoming more numerous – more normal! The failure of regulations, bans and harassment is not so much a repudiation of public policy but, like so many interventions by politicians, has resulted in the opposite of its intentions – a reversal of the long-established decline in smoking.

The extent to which smokers must be abused reached its zenith recently when football commentator Archie Macpherson, recovering from liver cancer, felt it was acceptable behaviour to demand that society must find new ways of “terrorising smokers”. Really? As if it would be perfectly reasonable for members of the public to accost someone smoking in the street, to prosecute people smoking in their own homes, to make them stitch a red circle on to their lapel – or for an old soldier who sacrificed a limb for our freedoms two generations ago to be abused for puffing the aromatic sliced black twist in his pipe?

Had Macpherson said we should terrorise lefties or homosexuals then the commentariat’s dogs of war would have been unleashed on him. But not for abusing smokers – for they are not normal in the eyes of the BMA and those who would terrorise them.

If the distribution of clean needles and replacement drugs such as methadone can form “harm reduction” public policy because it is recognised that drug use and addiction cannot be suppressed, then why is it not acceptable for the public to purchase e-cigarettes with their own money, without call upon scarce NHS resources, and use them wherever they want? E-cigs do not harm a person serving at a bar, or those sitting in an aircraft, in a bus shelter – or at an Old Firm match.

It is time those in public health – including the BMA – recognised that smoking will not go away, that the policies of prohibition are counterproductive and are only creating a new breed of rebels. Better then that they resort to harm reduction and with e-cigs save more lives than they ever will with their laws, their bans and their outrageous terrorising of smokers.