Unintended consequences
Attempts to restrict the consumption of shisha and other niche tobacco products may very well push smokers to cigarettes.
By George Gay
Content warning: I’m going to be a little disrespectful to all but one of the legislators in Toronto, Canada, who voted on Bill 45.
According to a story by Chris Doucette in the Toronto Sun in December, Schedule 3 of Bill 45, a bill that in May passed its third reading by 99-1, puts the same restrictions on the use and sale of e-cigarettes as those imposed on traditional tobacco cigarettes. In part, this means that retailers will no longer be able to show customers how best to choose e-juice, how to fill an e-cigarette with e-juice, how to operate e-cigarettes and how to clean these devices.
Unless I’m missing something here, this is a staggeringly daft piece of legislation. For one thing, it seems to imply that the legislators, through lack of observation or failure to investigate properly what they are legislating about, believe that e-cigarettes are little different from traditional tobacco cigarettes—perhaps that they carry the same level of risk. But then such muddled thinking, or lack of thinking, has occurred elsewhere, infamously within the hallowed halls of the U.S. Food and Drug Administration (FDA)—and others have flagged up this sort of nonsense before.
What seems to be even dafter is the idea that you would prevent people from learning properly how to use these devices. This is an assault on knowledge. This is the sort of restriction you expect from totalitarian regimes and extremist organizations, not from a provincial Canadian government. Surely, given that some people are going to use e-cigarettes, it would be sensible to allow those people to learn how to use them properly.
Doucette started his piece with the war cry of a group of demonstrators, “Vaping is not smoking!” That the demonstrators had to point this out was bad enough. That the legislators missed the point is a calamity.
But perhaps we have to accept that e-cigarettes and vaping constitute a technology and a social advance that is just too difficult for a lot of politicians and bureaucrats to grasp. The EU Commission, the FDA and the World Health Organization (WHO), aided and abetted by the Luddite wing of the tobacco control community, have all been doing their bit to try to smash this particular machinery of change. They’ll probably all be a lot happier when vapor products—viable, lower-risk alternatives to tobacco cigarettes—are dumped in the trash can of history, and tobacco products, especially cigarettes, are once again in the ascendancy. You know where you stand with smokers and other tobacco users. You can demonize them, denormalize them and steal their money through unconscionable levels of taxation, and they just take it. Pesky vapers take to the streets with their noisome placards.
On shaky ground
As I write this, waiting to hear what the FDA deeming regulations have to say on e-cigarettes, it certainly seems as though vapor products are standing on shaky ground, at least in a number of countries, and this raises the question about what will happen should the Luddites win the day. Will there be a resurgence in tobacco products and, if so, in what types of products?
Well, if you’re a resident of Toronto, the demise of e-cigarettes is unlikely to provide a boost for shisha smoking. According to a story in the Toronto Star, the Toronto City Council voted in November to ban shisha use inside licensed establishments such as bars, restaurants, cafes and lounges, effective April 2016, a move that was expected to affect about 70 businesses. Now if you are going to ban tobacco smoking in enclosed public spaces, it is logical that shisha smoking should be included. But there was one aspect of the council’s deliberations that seemed to make no sense. Lawyer Noel Gerry, who represents 14 of the businesses that were expected to be affected, was said to have described as “outrageous” the argument that the impact would be similar to that of banning tobacco use in restaurants. It is difficult not to agree with him. Banning cigarette smoking in a restaurant might be seen by some as an annoying inconvenience. Banning the use of shisha in a shisha lounge is on a different level. The clue is in the name of the establishment.
The fact that shisha smoking might be under attack in Toronto wouldn’t on its own cause an investor to check her share portfolio for the pungent smell of highly flavored tobacco, but the cumulative effect of what is happening in other parts of the world might. Shisha seems to be under attack in any number of places, in any number of ways, for any number of reasons. In November 2014, Singapore banned shisha on the grounds that, in Singapore at least, it was regarded as an “emerging product” that appealed to young people. Clearly concerned about—but seemingly with scant knowledge of—e-cigarettes, Singapore was intent on banning such emerging products to prevent their proliferation and entrenchment. It was the fairly usual reaction to a change that had not been engendered by official action and that was therefore not understood: Stop it in its tracks.
Meanwhile, in December, Mahak Mannan, writing for 7Days, said that a leading oncologist had called for stricter measures to combat smoking, especially shisha and medwakh smoking, in the United Arab Emirates (UAE). The doctor was quoted as saying that while smoking generally was the biggest cause of lung cancer in the UAE, it was shisha that was the big issue.
The question arose, however, as to whether it really was such a big issue. Earlier in the year, the results of a survey had apparently shown that tobacco smoking was “falling out of favor” in the UAE. A story by Anam Rizvi and Jennifer Bell in The National did not mention who carried out the survey and gave few details of the results, but it said that 76 percent of respondents had said they did not smoke cigarettes or shisha. And of those who did admit to smoking, few admitted to smoking every day: 16 percent in the case of cigarette smokers and only 3 percent in the case of shisha smokers. Admittedly, medical doctors were said to have been skeptical about the results. One said that his estimate was that 70-75 percent of his patients were smokers, which, if it is correct, would turn the result of the survey on its head. Perhaps the survey question was badly phrased.
Meanwhile, calls were made last year in Muscat, the capital of Oman, for the banning of shisha cafes, though whether such a ban could be brought in soon was a moot point. A story in the Times of Oman had it that the municipal authorities there were having trouble enforcing restrictions that were supposed to limit the hours during which such cafes could open. A worker in one cafe was quoted by the Times as saying that his establishment opened 24 hours a day on all but two days of the year.
Also last year, in Bermuda shisha was to be swept away as part of legislation banning any tobacco or related product that included flavors, and in Nigeria the sale and use of shisha was to be banned as part of anti-tobacco legislation that otherwise addressed more usual issues such as public-places smoking, health warnings and advertising.
Learning lessons
It is true that, in some other places, the opponents of shisha have their work cut out, however. In many places where shisha is commonly consumed it has a social acceptability that no longer exists in the case of cigarette smoking in the West, an acceptability that in some places means that a trip to a shisha lounge might be regarded as a family outing. They have to overcome also the belief held by some people that bubbling tobacco smoke through water somehow gets rid of the nasty substances, which, of course, it doesn’t.
And they probably have to try to learn some lessons from the West about not over-egging the propaganda put out about the dangers of smoking. In the West, overzealous tobacco control people decided, no doubt after working with focus groups, that cigarette smokers could be turned from their habit simply by getting governments to require that tobacco manufacturers sell their products in packs bearing pictures of the most grisly diseases they could imagine and depict, with the obvious result that some of those pictures bore no relation to anything any smoker had ever seen and were, therefore, dismissed. To make matters even more confusing, in the U.K. it is now fashionable to blame some of those diseases directly or indirectly on sugar, and the time will come when guidance will have to be given on whether, for instance, smoking or sugar is the major cause or causal factor in tooth decay.
In a similar fashion, I notice that shisha opponents are tending to go too far in emphasizing the problems caused by this type of tobacco consumption. By “too far,” I mean making statements that do not seem to the man in the street to add up, or make sense. It is often stated, for instance, that an hour or a “session” of shisha smoking is the equivalent of smoking 100 cigarettes. I have no information about whether or not this might be true, partly because it is never really explained what “equivalent” means. But if I were a young hour-a-day shisha smoker, I would look at this figure and wonder whether it could be true that “equivalent” meant doing the equivalent damage, because if it did, it would mean that I was rushing towards Armageddon at seven times the speed of the average cigarette smoker. Indeed, I would look about me and wonder why there existed any middle-aged and old shisha smokers.
Shisha smoking is said above to be relatively socially acceptable, and it is clear why that is so: It is often a social undertaking. It is not something that is done on the run, while riding your bike or outside the pub in three minutes flat while standing uncomfortably in your shirtsleeves at minus 5 degrees Celsius. So it has a lot to recommend it, and it seems to me that there is a need for some sensible studies to be carried out into how shisha is generally used, how harmful it is, and how harmful it is relative to cigarettes. Bans, restrictions and stating that an hour of smoking shisha is the equivalent of smoking 100 cigarettes are probably well-meant in that they are aimed at stopping people from smoking, but if such actions merely encourage people to switch from smoking shisha to smoking cigarettes, you need to be sure that this is a positive health move.
At the start of this piece I mentioned (and many people better qualified than I am have also mentioned) that policies aimed at banning or discouraging the use of e-cigarettes and, therefore, almost encouraging the continued use of cigarettes are devastatingly counterproductive. Surely, we don’t want to make a similar mistake with shisha and other products.
It seems that any product, such as snus, that might be hugely less damaging than are cigarettes, or any product, such as cigars, that might be moderately less damaging, are coming in for attention from tobacco control people that is out of all proportion to the problems that they cause. The EU, the FDA and the WHO all seem not to like niche products, especially new niche products.
It would seem that the strategy in a number of countries is to pick off the outlying products first, the nontobacco vapor products and OTPs, and then concentrate on what is left: cigarettes. Unless these policies have been properly thought through and are supported by fairly robust evidence, they seem to me to add up to a dangerous, damaging and, in the mid-term at least, counterproductive strategy.