The tobacco endgame: a view from the United Kingdom

The United Kingdom, or to be accurate England as the other three countries take a different view, stands with New Zealand as one of two countries worldwide where the public health community see electronic nicotine delivery systems, commonly termed e-cigarettes or vapes, as an important part of the tobacco endgame [1]. In the text that follows I will set out why they are wrong.
I can recall the first time I heard about these devices, sometime about 2010. I was at a meeting in New York as the chair of the Global Health Advisory Committee of George Soros’s Open Society Foundations. We were the largest funder of harm reduction for drug users, an extremely controversial issue, especially in some of the countries in central Europe and the former Soviet Union. We supported Methadone replacement therapy and needle exchange schemes based on good evidence that they reduced many of the harms associated with illicit drug use. Given this, you might expect that I would have welcomed these new products. After all, they were being promoted as a safer alternative to smoking, and I had published extensively on smoking and smoking-related diseases, especially in Central and Eastern Europe. Surely, anything would be better than inhaling large amounts of carcinogenic tar?
But I also had conducted a lot of research on the tobacco industry. With my colleague Anna Gilmore, we had described how the industry had exploited the chaos in the former Soviet Union to promote its products [2, 3]. With Swiss colleagues, we had exposed a secret operation in Germany whereby Philip Morris acquired a testing plant where it could design experiments that would give it the result it wanted and then commission others to do them [4]. They would work extremely hard to find the precise conditions supporting their position, particu­larly regarding second-hand smoke. Of course, we never heard about all the experiments that did not support their position.
In these circumstances, as it became clear that the tobacco industry was supporting these products, I became suspicious. Why would an industry that made so much money out of smokers be trying to reduce the size of its potential market? [5]. It didn’t make any sense. Now, there are those who believe that we should celebrate when sinners repent. In many cases, they are right. But I saw very little in the actions of the tobacco industry to encourage me to believe that they really were repenting.
The more that I looked, the more...


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