E cigarettes
Should regulators aim to reduce the harm to the many or just take it entirely away from the few?Getty Images

The battle over the e-cigarette has been raging for some time now, but unless you're a smoker, you could be forgiven for ignoring it. Most recently, it has been dividing regulators and traditional enemies of smoking over the question of whether it is a dangerous new way of getting addicted to nicotine, or a benign alternative to tobacco for smokers.

It matters to non-smokers too, because the outcome of this debate will help to determine how safer alternatives to alcohol and other drugs are treated as well.

New rules imposed by the EU mean that e-cigarettes will be required to display health warnings, sponsorship will be restricted and all advertising will be banned.

Regulations for public health and safety often act as a carrot and stick – punishing polluters, while encouraging cleaner alternatives, for example. The idea is to not just suppress bad things, but to encourage the invention of better alternatives.

The trouble is, it doesn't always work that way. Sometimes the people making the rules become obsessed not with harm reduction but harm elimination.

Consider the sex education debate between advocates of abstinence-only education and people who want to promote condom use. No, condoms aren't 100% safe, but they're a lot more reliable than hoping that teenagers won't have sex in the first place. Unsurprisingly, condoms win out every time.

The same debate is taking place within the world of public health over e-cigarettes. For some of these campaigners and regulators, e-cigarettes simply "regularise" bad behaviours like smoking, and still carry some risk.

The precautionary principle means that these regulators are more on the side of abstinence-only than of true harm reduction.

E-cigarettes are not really cigarettes at all − there is no tobacco involved, and nothing gets burned. A vaporiser turns a solution of nicotine propylene glycol, glycerine, and flavourings into a fine mist that the user inhales and absorbs into their bloodstream. They don't taste the same but the evidence so far suggests that they're substantially healthier than normal cigarettes, causing at least 95% less harm to users, according to the Royal College of Physicians (RCP) (although this has been questioned by other experts).

The big debate is whether harm left over is tolerable. Both the US Food and Drug Administration and the EU's new Tobacco Products Directive classify e-cigarettes as tobacco products, making access and information much harder to come by. The precautionary principle means that these regulators are more on the side of abstinence-only than of true harm reduction.

And the RCP disagrees with them, reminding us that of Britain's nine million tobacco smokers, e-cigarettes have the potential to get "half or more" off cigarettes – and should be promoted heavily as such. As well as those doctors, anti-smoking lobby groups like ASH have tentatively endorsed e-cigarettes and dismissed the idea that they lead to a take-up of smoking.

What's at stake is whether it's viable for firms to come up with alternatives to harmful products that are safer for users, if still harmful to some extent.

Neither doctors nor these public health types are usually noted for their love of personal choice. For liberals, it's more than a happy coincidence that giving people more choice is the best way to help them. When governments try to stamp out things that people really enjoy doing, they usually fail, and often end up making things worse.

The public health split over harm reduction and harm elimination goes beyond e-cigarettes too. What's at stake is whether it's viable for firms to come up with alternatives to harmful products that are safer for users, if still harmful to some extent.

If the harm reducers backing e-cigarettes win their debate, it may pave the way for us to solve a lot of other public health problems in a similar way. Not every smoker likes the way e-cigarettes taste and feel; but some tobacco firms are working on alternative reduced-risk tobacco products that taste closer to the real thing and give the same nicotine hit without causing as much harm to users. They'll make more money that way: it's a win/win.

If we are becoming able to invent safer alternatives to tobacco, alcohol and drugs, we need a regulatory system that fosters these innovations.

Right now, because the abstinence types dominate the way we do regulation, products like this face extremely high barriers to introduction. As tobacco products, they can't advertise – so even if they do come up with a substantially safer cigarette, they can't tell anyone about that – and would likely face the same sort of tax burden as cigarettes too, even though we justify these taxes on the basis of the harms caused by tobacco.

It's not just tobacco either. The Psychoactive Substances Act, which comes into effect on 26 May, means that by default any alternative to existing narcotic drugs is illegal, so good luck with getting a new "safe cocaine" product past the home secretary, who has to approve the legalisation of any drug banned by the act. This will likely be a significant problem for David Nutt, the government's former drugs advisor who is now working on a low-harm "alcohol pill" that aims to give us all the fun of booze without as much of a hangover.

If we are becoming able to invent safer alternatives to tobacco, alcohol and drugs, we need a regulatory system that fosters these innovations. This requires a complete rethink of what we've got, a move from the precautionary policy to so-called "permissionless innovation" where new products are assumed to be acceptable for sale, with appropriate caveats, without overwhelming evidence otherwise.

As with environmental rules, public health regulations should encourage safer new inventions that people will adopt of their own free will. Abstinence-only public health policy obviously doesn't work. If we let it, new technology might.

E-cigarettes and the meteoric rise of vapingIBTimes UK