by István Zentai
Magyar Nemzet, March 11, 2013, p. 6-7
original hungarian: https://magyarnemzet.digitalstand.hu/olvaso/20862#4
In Hungary, regulations for smoke-producing, lethal tobacco products are much more lenient than those for nicotine products with minimal health risks, or for products supporting smoking cessation. Nicotine products burning tobacco enjoy legally guaranteed market privileges over methods of nicotine consumption that are less harmful, and over smoking cessation products. We pay for the economic interests of the tobacco industry with bad health and death. According to the data of the National Institute for Health Development, in Hungary one third of men and one fourth of women are smokers. Among those who have finished primary education only and are living in bad financial conditions, one half of the population and 18% of children between 13-15 years (!) smoke regularly. Smoking causes il nesses in 15 different disease groups. In 2010, our hospitals attended to half a mil ion patients with smoke-related illnesses, which indirectly means that the tobacco industry is one of the biggest health „employers”. In the same year, 20.470 citizens died because of smoking-related causes: one third due of lung cancer, one fourth due to heart diseases. Social expenses related to smoking exceeded 440 billion Forints, while taxes paid by the tobacco industry amounted to 360 billion Forints.
Low efficiency of smoke cessation therapies
According to the Annals of Oncology and OECD data, Hungary has never led tobacco
statistics. We are at the top, but there are countries with higher rates of tobacco
consumers and cigarette consumption, both in the past and the present. Why does
smoking cause proportionally twice as much cases of lung cancer than in the Czech
Republic or in Greece? And why four times as much as in Sweden?
Before answering this question, let's make a detour: There are substantial efforts al over
the world to reduce smoking. A huge amount of public funds is al ocated to this Sisyphean
task, whose results become visible in tobacco consumption only slowly, and even later in
the reduction of health related harms. The assumption of policies aiming at reducing
smoking is that there should be less smokers which equals to reducing nicotine addiction.
The futility of these policies results exactly from this assumption. The efficiency of
therapies terminating nicotine addiction is exceptionally low, while provisions to protect
non-smokers do not result in smoking cessation. So when politics consider nicotine to be
the source of the problem and try to restrict nicotine consumption in general, lethal
regulations are the consequence.
Nicotine can have medicinal properties like alcohol and caffeine and thousands of other
substances. It is a poison, but one can get used to ever higher doses. At the same time, it
cajoles the brain to feel happier, and here the circle closes. A rewarding dependency
develops. But nicotine dos not kill. Its lethal dose is so high, its irritating effect so strong,
and its taste so bad that it is not even used to commit suicide. Let's pinpoint it: death and
diseases are not caused by nicotine, and especially not by nicotine alone, but by the
smoke of burned tobacco, an extremely complex stuff that has 4000 different chemical
components, among them 400 poisonous and 40 carcinogen substances. It fol ows that
the negative effects of smoking can be reduced by reducing the number of substances
consumed alongside nicotine. And even more so if we develop a device for smokers that contains besides nicotine only substances that are not harmful.
E-cigarettes are an efficient device
There is conclusive evidence for both statements on a societal scale. For the first, chewing
tobacco, for the second, the electronic cigarette. The home country of the first is Sweden:
“snus”, a kind of tobacco very popular in Sweden, especially among men. While Hungarian
men inhale the smoke of burning tobacco, two-thirds of Swedish tobacco users consume
snus exclusively. This is the main reason why in Hungary four times as many men die from
lung cancer as compared to Sweden. In spite of this, the European Union wants to ban the
sel ing of snus in the whole EU.
The electronic cigarette is a device that electrical y heats up a wire. It delivers a liquid
material that evaporates in the form of dense steam, which is then inhaled by the
consumer. The basis of the liquid is a mixture of propylene glycol, which is widely used in
both the food and the health industry, and vegetable glycerin. If we add flavours to this
liquid, this results in a highly pleasurable vapour. And if also nicotine is added, this results
in a product that delivers nicotine and provides for a high quality sensation. Using an e-
cigarette does not equate smoking, there are no combustion products, nor ash and butts.
The exhaled, harmless vapour does not furnish neither passive smoke, nor is it the source
of harmful third party risks. The nicotine intake can be regulated by the consumer through
the number of puffs and through the choice of nicotine level in the liquid. The strongest
liquids cater for the nicotine hunger of even the most inveterate smokers. Experience
shows us that the usual nicotine concentration for new vapers is 18-24 mg/ml, lower
concentrations are not suitable to get rid of smoking.
E-cigarettes were not designed to eliminate smoking but to replace it. While they provide
for most elements of smoking, including its particular “ritual” and its social components
(think of cigarette breaks at work), they are a safer method of nicotine consumption. They
were designed for those people who can not or do not want to fight down their nicotine
addiction. This is what makes them different from cessation devices that contain nicotine,
such as patches, chewing gums and inhalers, whose success rate is very low, as 85-90%
of smokers smoke again within one year. In the case of e-cigarettes, 75% of users put their
cigarettes down. There are around 20 million users world wide, and 6-7 mil ion among
them live in Europe.
New culture of nicotine consumption
The number of e-cigarette users in Hungary is hard to calculate, due to the persecution of
the product. Authorities estimate their number to 50-100 thousand, users themselves to
15-20 thousand. In spite of the scaremongering of the boulevard media, not one accident
has happened worldwide, and not one disease was caused by e-cigarette liquids that
contain nicotine. E-cigarettes do not coax anyone into smoking, but heavy smokers switch
to them in great numbers. The e-cigarette movement has become the fastest growing
user-driven health movement. Without spending one single cent of public monies, the e-
cigarette market has grown to a 500 mil ion Euro market, i.e. the size of smoke cessation
devices containing nicotine and is approaching the size of the snus market (830 million
Euro)! And nonetheless: the European Commission basical y wants to ban commerce in e-
cigarette liquids containing nicotine, while Hungarian authorities try to persecute it with a
questionable interpretation of current health legislation. Even though for health policies, e-
cigarettes could mean a new, unheard-of and less harmful culture of nicotine
E-cigarettes are permitted by national authorities for 90% of the European population. In Hungary, several offenses are under inquiry or before court, with dubious end. In April last year, a dealer in Germany (which is besides the USA and Russia a leader in e-cigarette consumption and has two million e-cig users) has won his case in court against the state. The court's opinion was that “although nicotine can be considered a medicine, e-cigarettes have no therapeutic or medical effect, and their only aim is to satisfy the nicotine hunger of smokers. Therefore they can only be considered a stimulant, a product consumed for pleasure. Even if there were small health risks, they could not be classified as medicine.”It is clear that in order to classify a substance as medicine it is not enough that the substance “is capable of repairing, improving, modifying biological functions of the body or of furnishing medical diagnoses through pharmacological, immunological or metabolic effects.” All these are for example present in the cure of thirst, dihydrogen monoxide (more commonly knows as water) or in the traditional Hungarian plum spirit (szilvapálinka), which cures symptoms of alcohol withdrawal especially well.
A case to rethink and re-evaluate
It may surprise that the tobacco industry shows a constructive attitude towards e-
cigarettes. The industry has made heavy investments in this field, and it is estimated that
that within 10-20 years up to 40% of its income will come from health-risk-free e-cigarettes.
It is no question that this will really happen, and thereby the tobacco industry will
substantially decrease its role in the medical and pharmaceutical industry. The question is
only if Europe is capable of reacting fast enough, or if the USA will further increase its
head start of several decades in the reduction of harms caused by smoking.
The European Parliament has started a legislation process aiming at the reduction of
smoking on February 25th, 2013, by a public hearing. Its basis is the directive of the
European Council published in December, and its result will be legislation binding for all
member states. This legislation is expected to lead to a reduction of 2% in smoking levels.
As to tobacco smoking: the 136-billion-Euro-market will hardly break down because of
stricter prescriptions regarding packaging, safety warnings and labeling; cigarettes will
remain legal and available. But the legislation affects smokeless tobacco (snus), which is
to be banned in al countries except Sweden, and liquids for e-cigarettes that contain more
than 4 mg/ml will be subject to legislation on pharmaceutical products.
Smokeless products are less harmful
The European Council has decided to subject life-saving and potentially life-saving
nicotine products to much stricter legislation than lethal tobacco products on a continent
where each year one third of all smokers tries to quit smoking, but only 3-5% of them are
successful. And where each year seven hundred thousand persons die from smoking.
The electric cigarette, including components that contain nicotine, don't pose any risks that
could not be dealt with outside pharmaceutical legislation. Among others, the regulation of
tobacco products, which was easily exempted from pharmaceutic regulation, has been
solved, and in addition, other substances and products that are much more dangerous
than e-cigarettes are freely traded and available. The regulation proposed now pushes
back smokeless nicotine products on no grounds, and forces unnecessary restrictions on
the actors of a free market. And in addition, it radical y increases the competitiveness of
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