Innovation is a powerful thing. It has dramatically increased our quality of life, and the entrepreneurial spirit behind it continues to amaze us. If someone from 1964 were to see the computers, automobiles or medical diagnostics we have today, they would be astounded. But former U.S. surgeon-general Luther Terry, who released the first ground breaking Report of the Surgeon General on Smoking and Health 50 years ago, would be saddened that cigarettes have not appreciably changed. They are still the same deadly and defective delivery system for nicotine and they remain, by far, the leading cause of preventable death, despite sound policy and improved treatment.
Although there has been little to no innovation in cigarettes (evidence suggests they may actually be more harmful today than they were in the past), there have been great advances in potentially massively less harmful ways to deliver nicotine to the body, such as electronic cigarettes. Unfortunately, Health Canada’s policy to these game-changing devices has been confused, to say the least.
We have known for decades that smokers smoke for the nicotine, but die from the smoke. It is the latter that is the overwhelming cause of the cancers, as well as heart and lung diseases. In other words, it’s the smoke, stupid. Were we to ingest caffeine by smoking rather than brewing tea leaves, the result would likely be the same. Approximately five million Canadians (one in five adults) continue to smoke cigarettes and get exposed to roughly 7,000 chemicals, including 60 that cause cancer. Others face health risks due to second-hand smoke. Many treatments for nicotine addiction, including nicotine gums and patches, are more effective than quitting cold turkey, but still not optimal.
Failure to distinguish between the nicotine and the smoke leads society to miss a huge opportunity to address the seemingly intractable problems associated with cigarette smoking. The quit or die approach is unethical. It is akin to thinking that anyone who drove a car the 1960s, when there were much less stringent safety standards, should totally forgo driving, rather than have easy access to alternate, potentially less risky, products.
Entrepreneurs have found a way to meet the needs those unable, or unwilling, to forgo nicotine by developing, marketing and selling products that can deliver the drug in ways that promise to reduce the associated health risks, simply by getting rid of the smoke. Electronic cigarettes, which deliver nicotine in a combustion-free vapour, are currently the most visible example. But these products are just the beginning of what has the potential to be a tsunami of innovation that could do to smoking what sanitation did to cholera. The products on the market today are just the beginning.