It is hard to imagine that smokers have it easy in Singapore.
Even before the newest extension to the Smoking (Prohibition in Certain Places) Act in October 2017, the country’s fame in procuring fines was like a warning beacon to locals and foreigners. Smoking, like any other vice activity, leaves a trail of nuisance: thin grey rows of ashes, flatten wet butts, broken plastic lighters, and the occasional makeshift container filled with yellow water — almost all the components that make up a cigarette bodes ill with the nation’s lush sterility.
There are strong, often negative, opinions of smoking and smokers from non-smokers. Mothers worry that smoking acts as a gateway to other illicit pastimes. Health advocacy groups caution the impending threat of second-hand smoke. On social media, we watch viral videos of balloons darkening within minutes, cancer-stricken patients crying with loved ones, and graphic autopsies of ex-smokers. We leave our screens with the certainty that smoking is bad, smokers are bad, and the modern way to combat the bad is to be smoke-free.
Who are we leaving behind?
But even as we progress into a smoke-free vision for the nation, perhaps we should take a step back and consider the group that we are not only leaving behind but forcing apart: smokers. More importantly, we should consider if we have information that communicates to and for both sides. Biased connotations (“smoking is bad”) impress upon us facts as prescribed by some socio-cultural intuition when we should acknowledge them as merely descriptive. “Smoking is an addiction”, “cigarettes are poison”, “smoking is very injurious to life” — these are descriptions fortified over the last few decades in history, sayings that have been debunked by reputable science all around the world, but strangely trivialised here.
The smoke that unfortunately engulfs the nation today is smoke that smokers are forced to produce as a result of this anti-smoke advocacy oversight. Since there are no alternatives to consume nicotine, why are smokers villainised when they turn to their cigarettes? Speaking at the fifth annual E-Cigarette Summit 2017 held in London, Sarah Jakes, representing the New Nicotine Alliance, shares how ordinary people are often caught in a war of science and words when attempting to make these types of informed decisions about their lives: “Fighting lies with lies will leave consumers as collateral damage.” Singapore’s move toward smoke-free will only go up in smoke if we do not consider other measures that can achieve the ideal result inclusive of 13.3% smokers among us. Smokers should be allowed to choose harm reduction, not just life or death.
Smoke-free should not be nicotine free
For us to embrace the next step, we have to confront the big smoke in our small nation. Specifically, consequential smoke from the government’s prohibition of all alternative nicotine delivery systems, such as e-cigarettes, heated tobacco products (HTP), and vaporizers in Singapore. Being smoke-free should not be equivalent to being nicotine free. Research shows that while cancer develops from direct exposure to tobacco smoke carcinogens and toxins, there is no substantial data that indicates whether nicotine by itself can be considered a carcinogen. In fact, one is more susceptible to the pathobiological effects when consuming nicotine as compared to treating it as a harmful, albeit addictive, chemical.
The big smoke in our country concerns more than smokers as the surrounding population becomes naturally implicated. Harm reduction minimises their risk as well.
Recent statements from the Committee of Toxicity (CoT), an independent advisory committee commissioned by the UK Department of Health and Public Health England, show that the novel HTB products demonstrate “a likely reduction in risk for smokers deciding to use heat-not-burn tobacco products compared with continuing to smoke cigarettes as the exposure to HPHCs is reduced”. The same reduction in risk is also found for bystanders, especially since HTB products, such as IQOS, produce aerosol instead of smoke. When discussing the release of carbon monoxide as compared to normal cigarettes, Dr Ed Stephens from the University of St. Andrew termed it insignificant for IQOS users and proposed that users of HTP can be regarded as non-smokers according to this definition.
“It is not for organisations to decide what is safe, but to help people be as safe as they want to be,” shared Martin Dockrell, Tobacco Control Programme Lead from Public Health England. In the UK, harm reduction is their move forward, with the government committed to implementing “evidence based innovation that minimise the risk of harm”, reducing the risk of deaths directly caused by smoking traditional cigarettes.
As of 2017, there are a staggering one billion smokers around the world, and smoking is recognised as the largest cause of death. The World Health Organization (WHO) posits that the tobacco epidemic claims more than 7 million people a year worldwide, 1 million of which are deaths caused by second-hand smoke. Giving one billion people the option of life or death is a dictator’s dream. Giving one billion people the choice to choose is a principle of harm reduction.