Pursuing Perfection Sometimes Leads to a Less Perfect Outcome

By Mika Horelli, Brussels

There are topics where public discussion feels like walking a tightrope. E-cigarettes are one such topic. Simply writing about it in anything but an absolutely negative tone exposes a journalist to accusations of indirectly marketing a product harmful to health. However, I'm now taking a conscious risk.

From the start, I want to clarify that I have not received any compensation for writing this text, nor is my goal to promote the sale of any product. I have also never been a smoker - neither of traditional cigarettes nor e-cigarettes, and I have no intention of ever starting. It's completely clear to me that smoking in all its forms should be eliminated.

I'm writing about this to reflect on the challenge we face when public discussion of a controversial topic becomes taboo.

My father died of lung cancer 43 years ago. He was then ten years younger than I am now and had smoked for decades. Afterwards, there were sometimes debates within the family about whether his profession as a chemist might have exposed him to dangerous chemicals at work. Perhaps so. One thing is undeniable, though: he was exposed to many carcinogenic substances through decades of smoking. I witnessed firsthand how he struggled to break free from tobacco, but nicotine addiction held him too tightly. He tried but failed to free himself from his addiction. For years, I have wondered if he could have been saved if there had been some real alternative to cigarettes for nicotine addiction available.

Perhaps there are better alternatives to nicotine addiction today than e-cigarettes. In the 1960s and 1970s, nicotine patches or other similar nicotine replacement products were not available. Nicotine replacement therapy was developed only later.

Although replacement products are now widely available, studies show that the most challenging situation is still for many individuals with a robust nicotine addiction. They need more intensive replacement therapy than just nicotine patches.

In recent years, e-cigarettes have become an alternative to traditional tobacco. Different countries have reacted to this product very differently. In my native country, Finland, e-cigarettes are equated with regular tobacco, and both are treated the same under the law. This is also true in many other European countries, such as Sweden, Norway, and Denmark. However, there are also different approaches around the world.

For example, in New Zealand and the United Kingdom, e-cigarettes are viewed differently because they are considered a less harmful alternative to smoking. These countries do not claim that e-cigarettes are harmless - they are not. However, their legislation is based on studies showing that e-cigarettes contain significantly fewer harmful substances than traditional cigarettes. Researchers have identified over 7,000 different chemicals in regular tobacco, many of which are toxic, while e-cigarettes contain considerably fewer harmful substances. Of course, e-cigarettes have been studied for a much shorter time than traditional cigarettes, as e-cigarettes were only developed in the 2000s.

In many countries, even discussion about e-cigarettes is a political taboo because politicians fear that participating in the discussion will lead to them being labelled as supporters of smoking in some way. Following the same logic, talking about armed defence should be interpreted as warmongering because defenders also have to use lethal weapons. This taboo simultaneously kills all sensible discussion about whether e-cigarettes could be used to reduce the harms caused by nicotine addiction. That is, those diseases that result from combustion residues and tar absorbed into the body when smoking traditional tobacco, which is not present in e-cigarettes to the same extent.

Is it sensible to completely exclude even discussion about an unhealthy product that could be one way to help people break free from an even more harmful product, traditional smoking? Isn't overcoming nicotine addiction the goal we should strive for by all available means, even when the means are not perfect but possibly less harmful than the current situation?

I understand very well the concern that young people might start using nicotine through e-cigarettes and become addicted to it. The problem is justified, as studies show that the use of e-cigarettes increases the risk of transitioning to traditional smoking. But we must also assess the motives of any young person starting to smoke - which, before becoming addicted to nicotine, are usually related to social pressures like my late father. How many of them would begin to smoke anyway? Ten years ago, my father's cousin admitted to me at the age of 90 how he had taught my father to smoke when they were in their early twenties in the 1940s. 

Since tobacco is already one of the most strictly regulated legal products, wouldn't it make more sense to focus resources on making it as difficult as possible for new users to start e-cigarettes - but at the same time possibly more accessible to those trying to quit traditional tobacco?

Sometimes, pursuing perfection can be the enemy of good, resulting in a worse outcome than if a justified compromise were accepted. In the case of e-cigarettes, more research and open discussion are needed about their potential benefits and harms from a public health perspective.

Still, I'm not starting any smoking myself, nor do I recommend it to others.