Interview with Karl Erik Lund, Research Director for the SIRUS tobacco unit, Part 2

I hope you all found yesterdays reading interesting. It was at least an all time high pageview count on the blog. I for one am waiting eagerly to see the results of the upcoming study of the culture of vaping that Karl Erik talks about. Here is part 2 of the interview. 

Vaping Giraffe: Let's think of a scenario where all smokers switch to e-cigarettes. This would of course lead to a massive change in public health and economy. One would think a lot of money could be saved since treatment of smoking related diseases would be massively reduced. On the other hand it might lead to people living longer (which would be a cost) and reduced tax income from cigarettes. Do you know of any calculations done on such or similar scenarios?

Karl Erik Lund: I do not approve of such an approach. In the Check Republic, spokesmen for the tobacco industry stated that tobacco gained the economy because smokers tend to die before they became a burden on the social security budgets. This is absurd! Any such calculation that somehow makes an early death profitable for the state economy has an unethical sentiment.  The ultimate goal for a reasonable health policy should be to help people live healthier and longer lives, unaffected of any economic cost-benefit analysis. In Norway where the tobacco-specific tax are very high, smokers probably ‘pay their way’. They have higher sickness rates and charge the public health system more heavily, but the accumulated amount already paid to the state through taxation will probably cover for this. In other economies where tobacco taxation is low and health care costs is covered by the individual and not the public, the situation might not be the same. Non-smokers tend utilize the health care system somewhat less, but live longer and receive pensions for a longer time. Again, I think such kind of calculation is a ‘red herring’, and that promoters of e-cigarettes should abstain from this approach.            

Vaping Giraffe: What do you think is the health authorities main reason for keeping the ban on e-cigarettes with nicotine?

Karl Erik Lund: Spokesmen for the Directorate of Health have repeatedly used the precautionary principle to justify the ban on e-cigarettes. Some also fear that e-cigarettes will renormalize smoking, and other keep using the gateway-argument – even though there is no empirical evidence for either. The precautionary principle opens up for a really interesting discussion. The human costs of a continued ban are very high, smokers are buying lousy and potential risky e-cigarettes over the internet and the ban is an obstacle for smokers to move down the risk continuum of nicotine products. You have to weight these costs against the gains from a precautionary principle. Applying a rational decision model approach, one will find limited support for the precautionary principle.    

Vaping Giraffe: I've read that around 70% of the worlds tobacco consumption is done in developing countries. Still I can find very little about e-cigarettes in these countries on the web. What is your thoughts on that? Are you familiar with any projects in developing countries?

Karl Erik Lund: Even if e-cigarettes have originated from China and much of the production takes place in China, the popularity of e-cigarettes have occurred  in typical developed nations. Following a diffusion-of-innovation model, e-cigarettes will eventually become popular in developing countries as well. Most tobacco-related deaths take place in countries like China, India and Indonesia, which means that e-cigarettes potentially can have an enormous impact on public health. I am not familiar with any projects going on in that part of the world at the moment.  
 
Vaping Giraffe: The tobacco industry and the pharmaceutical industry are two of the largest industries in the world, both now looking at a new competitor that will take a lot of customers from them. What do you think their strategy for keeping the customers are?

Karl Erik Lund: Until now, the pharma industry has been somewhat hesitant to enter into the e-cig business. Their strategy has been to fight the e-cig diffusion through political lobbying. The tobacco industry, however, has been more ambivalent towards e-cigarettes. Right now Big Tobacco are test-marketing their own products, so they have every intention to enter into the e-cig business. For the consumers, this is probably a good thing because they can afford to invest a lot of money which eventually will result in better products on the market. At the same time, Big Tobaccos engagement is bad news for the e-cig proponents advocating for market access. Politicians and policy makers connote bad representations to all products from Big Tobacco.     

Vaping Giraffe: The EU is from what I understand in the finishing stages of a new tobacco directive. Does Norway have to follow this directive, or can we choose not to?

Karl Erik Lund: There is a formal choice, but every practice indicates that Norway will follow the EU-regulations. However, as the tobacco-product-directive looks right now, before the final negotiations between the Parliament, the Commission and the Council, the member states can decide by themselves whether e-cigarettes should be regulated as a medical device or a consumer product. 
 
Vaping Giraffe: Have you heared of "Norsk Dampselskap" (the Norwegian Union of vapers) and if so what do you think of their work?
 
Karl Erik Lund: Yea, I take great pleasure in reading posts on their wall. Many competent people acting as counsellors and giving great advices to novices in vaporing. I am really touched by all the personal histories from smokers who have replaced tobacco by e-cigarettes.  
 
Vaping Giraffe: Do you have any recommendations for vapers that want to fight for their case? How could ordinary people get engaged?

Karl Erik Lund: Consumers groups are very powerful and have great impact on politicians and policy makers. We must not underestimate their potential influence. I was lucky enough to participate in a meeting with members of the European Parliament in October last year along with Clive Bates, Gerry Stimpson, Jaque LeHouzac and Konstantinos Farsalinos – all world-leading specialists on e-cigarettes. We were amazed how the politicians appeared to be attentive and responsive towards consumer groups. Letters to politicians is still a powerful channel of influence.  

I'd like to send a big thanks to Karl Erik Lund for taking the time to answer this. I'm really looking forward to following the research done by him and SIRUS. I did also notice that one of his colleagues posted on the "Norsk Dampselskap" Facebook group asking for participants for the upcoming study mentioned in part 1. I'm in!