The Gateway theory vs. the Firewall theory

... this is one of my
favourites today.

The one on the right looks pretty much like my
vaping gear a year ago...

This Wednesday I read this article published in Dagbladet's opinions section (in Norwegian but I'll give you some highlights below). Tone Bergli Joner, who entitles herself "textbook author", presents her arguments against vaping, which is honestly one of the weirdest, most misleading pieces of crap I've read in a long time. Actually, having a look at the very first words, under the image, reveals that this woman has absolutely no clue what she's talking about: "E-cigarettes look more and more like regular cigarettes". Oh do they? You might argue that these words should have stopped me from reading on... but I guess I couldn't help wondering what on earth came next.

She goes on to talk about cancer and that it's a lot cheaper to prevent it than to treat it (doh!) and praises the tobacco act for saving thousands of lives, making sure to mention the success of plain packaging in Australia while she is at it. Then she moves on to telling us why she thinks the Norwegian government should not repeal the ban on e-cigarettes. A couple of highlights:

Nicotine. Another legally sold product that leads to nicotine addiction.

Are you sure about that? I've tried, God knows I've tried, to find any hint of evidence that nicotine without tobacco is addictive. I've discussed this with Sanner and Grimsrud, our most beloved anti-vaping advocates, claiming to be the leading experts on tobacco and nicotine addiction in this country. I could not, no matter how hard I tried, get them to come up with some evidence.

Not effective to stop smoking. A large study published in The Lancet Respiratory Medicine in January, shows that the chances of successfully stop smoking drops 28 percent when going through e-cigarettes. It is curious that Karl Erik Lund, now research director at the Institute of Public Health, mistrust the very reputable scientists behind the study as "controversial." It's Lund who is controversial because for many years he has been an activist for snuff as a means of smoking cessation, contrary to advice from the WHO, the EU and the five Nordic health directors.

Yeah, Glantz again. I'm not going to go into his reputation... again. Norway and Sweden has a lot less lung cancer than the rest of the world. You may call Lund "controversial", but that doesn't mean he's not right. It means he has the guts to tell the truth when he sees that his government and probably his boss gets it all wrong. There's also accidents with e-liquid, cancer from vapor and of course using e-cigs to do drugs. Well, to get to the point I'd just say this about those: We have other far more dangerous household products, you're doing it wrong if you manage to get cancer from e-liquid vapor and you can use a coke bottle to do drugs. Moving on to the one I want to talk about:

Tempting young people. Elegant design, new flavors, rumors that they are less harmful than regular cigarettes, can make them very tempting for young people, who otherwise would not smoked. We can get the same development as with snus.

Now why is getting the same development as snus a bad thing? This development is responsible for very low cancer rates in Norway and Sweden compared to the rest of the world. In other words, it has prevented cancer, just like Joner wants. I see this argument presented all around as a bad thing. Think about the children!

In another article in Dagbladet's opinions section, one that was very positive to vaping actually, they did some calculations on the effect of vaping from a public health perspective. These are all figures made just to prove a point, but what the author says is that if in some years 40000 smokers have switched to vaping, we also have to estimate 5000 non-smokers starting, and 1000 of them move on to smoking. Now I don't believe that will happen, but lets just say his numbers are about right. He then says 15 % of the 40000 will avoid dying from smoking related diseases, meaning 6000 lives saved. Then among the 5000 previously non-smoking vapers 1% will die from nicotine damage (again, I think the numbers are off, but lets move on), and among the 1000 who moved on to smoking 15% will die from it. A total of 200 lost lives. So, even with these numbers, which I'd say is very pessimistic, that's 5800 lives saved. Or is it?

There is one little thing that "everyone" seems to leave out here: What if vaping did not exist? Would these 5000 people still be non-smokers? I highly doubt it. The way I see it, most of them would start smoking, especially if we're talking about teenagers. I think that teenagers experimenting with vaping are also the ones that would experiment with smoking (and possibly a lot of other things). So the way I see it, those 5000 never smoking vapers do not contribute to more deaths, but rather the opposite. I'd say among the 4000 vapers who did not move on to smoking, there is a substantial number that were stopped from starting to smoke cigarettes. Using the 15%, estimating that say 75% of the 4000 would have started smoking, that's another 450 lives saved.

I know, I know, these numbers are not exactly scientifically proven, but that's not my point either. The point is that everywhere I turn I see people worried about non-smokers starting to vape, and it is always presented as a bad thing. I don't see it that way. If a non-smoker, especially a young one, starts vaping, I believe there is a good chance that vaping has a actually prevented this person from becoming a smoker, and possibly prevented a death by lung cancer. I will never be able to prove this, as there is just no way of knowing what would have happened to this teenager if vaping did not exist. But still, to me it makes much more sense this way. In the same way the gateway theory can never be proven, since there is really no way that one could know if a vaper that moves on to smoking would have gone straight to smoking if vaping did not exist. However, turning the whole thing upside down, we can have a look at some real-life numbers and get some indications on which theory that seems more plausible, the gateway theory... or the firewall theory: We are still waiting for the first never-smoking vaper that moves on to smoking to emerge... and then there is this: Electronic Cigarette Age Restrictions May Drive Teens to Traditional Cigarettes. Being a computer geek, working with network elements on a daily basis, I'd say it looks like vaping acts kind of like the CPE equipment I work a lot with. They're called gateways, but they also act as firewalls, giving the people on the inside (smokers) a gateway to get to the outside, while keeping unwanted people out.

If our goal is to prevent cancer from smoking, like Joner wants, would it be better to remove our brand new firewall leaving the real gateways to smoking wide open? Should we allow the TPD to weaken a wall that is currently strengthened every day by innovation? Or should we let vaping innovation continue the ongoing work to tighten security and close as many holes in the wall as possible? What do you think?