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On Wednesday, 9th March 2016 the Economic References Committee Senate Hearing on Personal Choice and Community Impacts was held in Sydney, NSW. The hearing was chaired by Senator David Leyonhjelm and also attended by Senator Chris Ketter.

NNA [AU] Board Members Dr Attila Danko, Donna Darvill and Jenny Stone and two of our Associates, Judith Wolters and Angela Gordon, testified at the Hearing with Dr Alex Wodak also speaking in support of the NNA.

 

 

 

 

The Hansard transcript of the full day's proceedings can be found here under 09 Mar 2016. Economic References Committee Public Hearings

Following is the Hansard transcript of the morning session which includes the NNA [AU] advocates as well as Mr Terry Barnes. Clive Bates and Professor Gerry Stimson also participated via teleconference from the U.K:

 

 

 

ECONOMICS REFERENCES COMMITTEE

Personal choice and community impacts

WEDNESDAY, 9 MARCH 2016

 

SENATE

ECONOMICS REFERENCES COMMITTEE

Wednesday, 9 March 2016

Members in attendance: Senators Ketter, Leyonhjelm.

Terms of Reference for the Inquiry:

To inquire into and report on:

The economic and social impact of legislation, policies or Commonwealth guidelines, with particular reference to:

a. the sale and use of tobacco, tobacco products, nicotine products, and e-cigarettes, including any impact on the health, enjoyment and finances of users and non-users;

b. the sale and service of alcohol, including any impact on crime and the health, enjoyment and finances of drinkers and non-drinkers;

c. the sale and use of marijuana and associated products, including any impact on the health, enjoyment and finances of users and non-users;

d. bicycle helmet laws, including any impact on the health, enjoyment and finances of cyclists and non-cyclists;

e. the classification of publications, films and computer games; and

f. any other measures introduced to restrict personal choice 'for the individual's own good'.

WITNESSES

BARNES, Mr Terry, Principal, Cormorant Policy Advice

BATES, Mr Clive, Director, Counterfactual

CARPENTER, Dr Anthony, Faculty Policy Advisory Committee, Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians

DANKO, Dr Attila Lajos, President, New Nicotine Alliance Australia

DARVILL, Ms Donna, Secretary, New Nicotine Alliance Australia

GORDON, Ms Angela, Private capacity

JENKINS, Dr Stephen, Director, Regulatory and Medical Affairs Asia Pacific, Nicoventures

STIMSON, Professor Gerry, Private capacity

STONE, Ms Jennifer Lynne, Private capacity

WODAK, Dr Alex, AM, President, Australian Drug Law Reform Foundation

WOLTERS, Mrs Judith, Private capacity

 

Evidence from Ms Stone and Ms Gordon was taken via teleconference—

Subcommittee met at 09:35

CHAIR (Senator Leyonhjelm): I declare open this public hearing of the Senate Economics References Committee. The committee is hearing evidence on the committee's inquiring into personal choice and community impacts. The committee has appointed a subcommittee for the purpose of the inquiry hearings. The Senate referred this inquiry to the committee on 25 June 2015, for report by 13 June 2016.

I welcome you all here today. The committee has received 467 submissions to date, which are available on the committee's website. This is a public hearing and a Hansard transcript of the proceedings is being made. Before the committee starts taking evidence, I remind all witnesses that in giving evidence to the committee they are protected by parliamentary privilege. It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to a committee, and such action may be treated by the Senate as a contempt. It is also a contempt to give false or misleading evidence to a committee. If a witness objects to answering a question, the witness should state the grounds upon which the objection is taken, and the committee will determine whether it will insist on an answer, having regard to the ground which is claimed. If the committee determines to insist on an answer, a witness may request that the answer be given in camera. Such a request may of course also be made at any other time.

On behalf of the committee, I would like to thank all those who have made submissions and sent representatives here today for their cooperation in this inquiry. I welcome the witnesses. Do you have any comments to make on the capacity in which you appear?

Ms Gordon: I am a registered nurse and I am also a user of electronic cigarettes.

Mrs Wolters: I am an associate of the New Nicotine Alliance Australia, but I made a submission as a private individual and I am an ex-smoker, thanks to vaping.

Ms Darvill: I am a founding board member, along with Dr Danko, of the New Nicotine Alliance. I am an ex-smoker, current vaper.

Dr Danko: As well as being President of the New Nicotine Alliance, I am also a general practitioner in Ballarat.

Dr Wodak: As well as being President of the Australian Drug Law Reform Foundation, I am appearing this morning as a supporter of the New Nicotine Alliance.

Ms Stone: I am a support worker in homelessness and I am an e-cigarette user, appearing as a private individual.

CHAIR: Thank you for appearing today. I will now ask each of you to make a brief opening statement before we proceed to questions, if you wish to.

Dr Danko: The New Nicotine Alliance Australia is a group of consumers of reduced risk nicotine products such as electronic cigarettes. We receive no funding from any tobacco, e-cigarette or pharmaceutical companies. We stand here today as a group of people representing many thousands of Australians who have only managed to give up smoking by breaking the law. I myself smoked daily from the age of 11 and was unable to give up smoking any other way except by using nicotine electronic cigarettes. I am a criminal, because Australia treats the nicotine I use in my e-cigarettes under schedule 7 poisons laws as a dangerous poison with hefty penalties for possession.

What do you do when you are trapped so tightly in smoking, when you look at your children and wonder if you will be around to see them grow up? I hated smoking, but I loved it so much at the same time. Like many other hardened smokers, I would more easily give up food than smoking. It was only when I found something that gave me the same enjoyment, the same satisfaction I had from smoking—without the smoke—that I could replace one behaviour with another. Now I feel better than I have ever felt in my life. I am able to run and not get puffed out, I have lost my smoker's cough and I know from studying the scientific evidence that I should now enjoy roughly the same life expectancy as if I had quit cold turkey—because any risk from vaping is minimal.

I stand here at considerable personal risk. I risk my professional career and I risk legal consequences to stand against the tobacco controlled establishment that tells me that I am not allowed to give up smoking—because I can only give up smoking 'the wrong way'. But I can no longer be silent. This goes far beyond the nanny state. This is a monstrous state that would keep people smoking who might have given up if they could only access a far safer option.

Judith here, one of our associates, told me about how sick she was before she took up vaping. She described symptoms consistent with end-stage chronic obstructive airways disease, which has a very high mortality rate. She was out of breath after even very short walks and would cough all night, unable to breathe and feeling like she was drowning. She was literally smoking herself to death, and no matter what she tried she could not stop—until she switched to e-cigarettes. Since then her health has improved dramatically. It is likely—I say this as a GP who has looked after patients like this before—that she would not be here today if she had not broken the law and switched to e-cigarettes. It is likely that she would have been dead. Look at Judith now; look how full of life she is. When you consider what attitude we should take towards e-cigarettes and nicotine, think about her and the many Judiths around the country.

Professor Ron Borland of the Australian Cancer Council recently shared with me the latest data on how many people regularly use e-cigarettes in Australia. This was presented at the SNRT world conference on tobacco in Chicago. As of late 2014, it is close to 15 per cent of smokers and recent ex-smokers. It was seven per cent when it was last measured in 2013, so it is exploding despite our draconian laws. This equates to almost half a million people, which is also half a million voters.

Schedule 7 poisons law specifically exempts tobacco, but there is no exemption for nicotine e-cigarettes. Given that not one e-cigarette sold in Australia comes from a tobacco company, this amounts to enshrined protection of big tobacco in law. But how are you going to enforce this law when it is so massively broken, this monstrous law that protects the cigarette market and keeps people smoking? A law that cannot be enforced makes a mockery of the law and leads potentially to embarrassment of the government, especially if it may be faced in the future with a civil disobedience movement with massive media attention. A simple stroke of the pen to legalise low-strength nicotine liquids to even the playing field could change all of this. It costs nothing. In fact, as small vaping shops spring up around the country to take business away from cigarettes—vape shops that act as quit-smoking centres everywhere—you will get more jobs, more taxes and a healthier population with lower healthcare costs.

Our vision is to allow the rapid pace of e-cigarette innovation to continue with only light-touch regulation. All of these small companies are fighting right now to make better and better substitutes for smoking. If we do not stop them with the heavy hand of overregulation, if we allow them to make more and more enjoyable and satisfying substitutes for smoking, eventually there may be no point to smoking anymore. Smoking could simply become obsolete.

Mrs Wolters: Dr Danko has said a lot of what I would have said so I can cut out a lot. It has been an incredible education for me over the last two years reading about vaping and associated research and topics. I have noticed that, over time, the war on smoking has become a war on tobacco companies, smokers, nicotine, and now it is nicotine. If I use nicotine it hurts no-one else, so it can hardly be called a harmful addiction to have. I do not rob banks or anything else, so it is a personal problem of mine and I should be left alone to get on with it. That is one thing that really worries me.

The government could be poised to make a mistake they made in 1991 when they banned Swedish snus for sale in Australia. I only found out about smokeless tobacco products after I had started vaping and researching that. If I had had access to Swedish snus, which is considered to be even safer than vaping, 24 years ago, I may have even stopped smoking that long ago. But the precautionary approach won, so there are a lot of people smoking now. Apparently in the late eighties it was actually banned and a lot of people that were using it went back to smoking, so the government relented and allowed import, but I am not sure about that ban, 100 per cent.

What I find most offensive though is the lack of empathy for people in poverty. Some of the figures from a report in 2013 called Smoking and disadvantage published by the Australian National Preventive Health Agency were 15.1 per cent average across the general population. For people experiencing unemployment it went up to 27.6 per cent; people with a mental illness it doubled; sole parents it went up to 36.9 percent, more than double; Aboriginal and Torres Strait Islanders, 47.7 per cent; people living with psychosis, 66 per cent, prisoners, 74 per cent; people experiencing homelessness, 77 per cent; young people in custody, 79 per cent; and people with substance use disorders, 85 per cent.

So, when tobacco taxation increases, every one of them is driving these vulnerable groups in society further into poverty to a place where they are even less likely to be able to give up smoking. I know what it is like when your bill comes and you think, 'How am I going to pay this. I'd better have a cigarette. Where's my cigarettes?' You do not think, 'I'd better stop smoking now so I can pay this bill.' That is not the way human beings work. I find it morally offensive and viscerally offensive that these groups are being driven further into poverty. I find it very offensive.

Apart from that, the wonderful thing about vaping is that I had three attempts on Champix—I had tried everything else—and I managed to give up three months on the last attempt and then, as soon as I was stressed, I went back to smoking. I stopped smoking 18 months ago last Monday and, if I get stressed, I do not have to have a cigarette, I just vape and it is enough. Those Champix attempts would have cost the taxpayer at least $1,000. It costs the taxpayer nothing for me to permanently stop smoking now.

Ms Stone: I do not have an opening statement. I am just here giving evidence because I smoked for 30 years. I had decided that I was not going to attempt to quit any more. I had weighed up the negatives with the positives and decided that I was going to take the risk and enjoy the quality of life I had been enjoying until I did not. E-cigarettes came along accidentally; I was introduced to them by a friend. I did not believe they would help me give up smoking, but that is what happened. Just naturally, I enjoyed using e-cigarettes more.

I am here because I am breaking the law by not smoking and using e-cigarettes as a safer alternative. I have been vaping for three years and I have learnt a lot about the regulations and I have heard the tone in the media directed by, I think, largely tobacco control bodies putting a negative light on e-cigarettes and scaring people off them. Because I work in homelessness, the figures that Judith gave seem underestimated to me. I would say 95 per cent of the people that I work with are smokers. As I said in my submission, it makes me really frustrated and very sad that I cannot support them in enjoying better health and saving money for actually surviving—instead of spending it on smoking—by switching to a safer alternative. It is illegal for them to do that. That is why I am here.

CHAIR: Thank you.

Ms Gordon: I have prepared a statement. I am a 54-year-old registered nurse. I smoked for 35 years and made over a dozen attempts to quit in that time, all of which failed, and I eventually quit trying to quit. I picked up an electronic cigarette nearly four years ago and have not smoked a cigarette since. It was incredibly easy. My health has improved dramatically and my doctor now considers me an ex-smoker. Unfortunately my government considers me a criminal because the nicotine I use in my devices was reclassified as a schedule 7 poison in 2008 when electronic cigarettes first began to surface in Australia.

I can import it from overseas, but I am breaking the law as soon as I take possession of it. To make matters worse, I recently converted my next-door neighbour to vaping—a woman in her late 60s with early-stage emphysema. She quit smoking completely within two weeks once I set her up with good equipment and liquid. Unfortunately, she does not have the internet and cannot source her own nicotine from international sellers online, so I sell her some of my own at cost price. This makes me a trafficker of a prohibited substance; a black marketeer. My crime is that I gave up smoking the wrong way and am assisting others to commit the same felony.

Prohibition of the sale of liquid nicotine in Australia was based on fears that electronic cigarettes might re-normalise smoking and act as gateway products to tobacco, leading to higher smoking rates. These were purely theoretical concepts which have since been thoroughly debunked. All the evidence shows that electronic cigarettes act only as a gateway out of smoking, not the other way around. Over three million Australian smokers have been denied legal access to an alternative to smoking which is widely accepted now as being at least 95 per cent safer. This catastrophe happened because we have a government which is willing to enact legislation based on nothing more than unfounded fears and suspicion.

I have made a choice to continue using recreational nicotine but not to smoke. I have made that decision based on a well-informed understanding that nicotine without the smoke, the tar and the hundreds of other chemicals in cigarettes is no more dangerous than caffeine. I enjoy vaping just as I enjoy drinking coffee. In Australia, the only form of recreational nicotine that I can legally purchase is the most dangerous form: smoking tobacco. Nasal snuff and Swedish snus have also been banned for sale here despite decades of evidence showing them to be virtually harmless. This is not responsible legislation; this is an outrage.

The only rational response for someone like me is noncompliance and a life of crime, apparently. At least it will be a longer and healthier life than if I obey the law and go back to smoking. If I complied with nanny state regulations, I would take my neighbour a carton of cigarettes instead of an illegal bottle of nicotine juice and assist her to advance her emphysema. Obviously this would be unconscionable. We have no choice but to protect ourselves from those in government who think it is their job to protect us from ourselves. They have no idea of the harm they are doing by eliminating all the competition to big tobacco companies. How can there possibly be a wrong way to give up smoking?

 

CHAIR: Thank you very much. Senator Ketter.

Senator KETTER: Could I get a rough guide on the cost of the delivery systems for e-cigarettes—the hardware and the software, as I think you described it, Dr Danko?

Ms Darvill: A disposable cigalike is probably around the $4 mark. But no-one uses them here because they are illegal because they contain nicotine. For a small e-cigarette—let's say a first-generation one that most people started using—you are probably looking at about $30. For one with a bigger capacity battery, you are probably looking at somewhere around $50 or $60. And they can go all the way up to $300 for something that is fancy or handmade—that is the hardware. Generally speaking, you would probably get about six months life out of one device; but everyone needs at least two because, while one is on charge, you need another one. Then you have got the peripherals such as coils—the disposable parts that keep them going. They probably work out at about $2 each and they would last about two weeks. And then there is the e-liquid. Most vapers would vape somewhere between three millilitres a day and six millilitres a day—some could be one millilitre and some could be 10. If you DIY, as I do, you are probably looking at about 10c a millilitre. That is buying in bulk—I have a big bottle in my freezer—but generally you are looking at between 50c and $1 a millilitre, and that is with or without nicotine.

Senator KETTER: And you say you would use six millilitres a day.

Ms Darvill: On average, it is between three millilitres and six millilitres a day. I vape five millilitres per day.

Dr Danko: It is a significant cost saving compared to smoking. It is often a tenth of the cost, or less, for ongoing e-liquid, which is the main consumable.

Ms Darvill: If I was smoking now, I would be spending more than $30 a day on cigarettes. But I spend probably $1 a day on consumables and might need to reinvest once every six months.

Senator KETTER: E-liquid is currently available on prescription?

Dr Danko: There is a loophole. You can have three months supply of nicotine e-liquid if there is a prescription from a doctor for the purposes of smoking cessation. But, even under that scheme, we are not using it for cessation; we are using it for ongoing recreational use—and the law does not state that that is allowed. Secondly, even when someone tries to get a prescription from a doctor—we have had people who have approached 15 or 20 doctors—

Ms Darvill: One guy did 48 doctors.

Dr Danko: And not one doctor was willing to do that prescription because it is an irregular thing. It is a loophole that a few people know about but it is not very widespread knowledge. As a GP, I know that most doctors feel very uncomfortable about prescribing something irregular.

Senator KETTER: Even if it is for the purpose of getting people away from smoking?

Dr Danko: Yes, because they are taking responsibility for something that someone has sourced overseas which is of uncertain quality and all that sort of thing. They are taking that responsibility when they do a prescription, and doctors are very hesitant to expose themselves to any legal risk or do something that is not what everybody else does.

Dr Wodak: Could I just add two points to what my friends and colleagues have already said and that is that I am sure we all know that smoking is not equally spread throughout the community. It is very much concentrated in economically and socially disadvantaged groups, so the savings that Dr Danko has talked about are critical to people who have very low incomes and wealth. These are people for whom smoking contributes disproportionately to inequalities in health. The fact that they can still get their nicotine but at lower economic cost to them is very significant in health policy terms.

We have only talked about the economic savings to the individual smokers, or vapers, we have not talked about the economic savings to the community. But, of course, if people are using a device to ingest nicotine that is a fraction of the risk that tobacco cigarettes are, then there is also significant economic savings to the Treasury and to the taxpayers. All up, e-cigarettes are a significant economic boon to former smokers as they are to taxpayers and the Treasury.

Senator KETTER: Whilst I certainly take the point that ingesting the e-liquid in a vapour form seems to be safer than smoking cigarettes and tobacco, I could not see anything in here that indicates that vaping and ingesting this liquid into your lungs is necessarily completely without some drawbacks, medically speaking. Are there any studies that go to that issue?

Dr Danko: Yes, I would agree with you that we do not have long-term studies on the potential effects of e-cigarette vapour on the lungs. What we can say though is that, if you examine the toxicology of the substances which are released, many of the substances are completely absent compared to cigarettes and most of the rest are in quantities nine to about 450 times less, roughly one per cent of the emissions. When you are talking about a 100-fold decrease,—when you separate out all the components and look at well studied occupational health and safety laws and occupational health and safety studies—pretty much all of them are below the exposure limits for those. It seems to me a scientifically untenable proposition to say that they could be anywhere near as harmful as smoking, and we always have to compare it to the reference product, which is smoked cigarettes.

Ms Darvill: May I read a short paragraph out of the recently published National Centre for Smoking Cessation and Training report? I will table that. It is a very short paragraph which answers the question there.

CHAIR: Yes.

Ms Darvill: It was only released last week so you have not got it yet. It says:

Is nicotine dangerous?

Nicotine does not cause smoking related disease, such as cancers and heart disease. These are caused by other chemicals found in tobacco smoke. Nicotine is addictive however and it is why people continue to smoke despite knowing about the harmful effects of tobacco. Nicotine in e-cigarettes poses little danger to adult users. In order to prevent accidental poisoning of children, e-cigarettes and liquids should be stored away safely (just as you would with household cleaning products and medicines, including NRT products).

This report goes from the national body to the smoking cessation services within the UK with all of the background information and work as far as the science goes, so I am happy to table that if that is okay.

CHAIR: Is that separate from this?

Ms Darvill: That is the one. You have just received that today.

CHAIR: That is accepted. Thank you.

Ms Darvill: Good, thank you.

Senator KETTER: Can you tell us who the National Centre for Smoking Cessation Training is?

Ms Darvill: They would be the equivalent of the association that Colin Mendelsohn works for.

CHAIR: The UK?

Ms Darvill: It is the UK version of the advisory group that advises stop-smoking services. It would be like our peak body that advises quit services—Quit Smoking NSW, smoking cessation specialists and so on.

CHAIR: I have quite a lot of questions, so this will go for a while. A couple of you mentioned 'quitting smoking the wrong way'. What is the wrong way? What are you referring to?

Ms Stone: The illegal way, using vaping.

CHAIR: Why is that wrong?

Ms Stone: Because it is illegal to possess the liquid nicotine you use in those devices.

 

CHAIR: Is there a right way to quit?

Ms Stone: Using nicotine replacement therapy or prescribed drugs like Champix—any way the government has sanctioned is the right way.

CHAIR: Just quitting cold turkey or nicotine gum is the right way? Champix is the right way? What else is there?

Ms Stone: There are all the over-the-counter nicotine replacement products like nicotine gum and lozenges—there are inhalers and stuff you can buy in the supermarket.

Mrs Wolters: There is a pharmaceutical called Zyban as well. I cannot recall the chemical name.

CHAIR: So they are all the right ways and vaping is the wrong way.

Ms Gordon: The nicotine in chewing gum, inhalers, lozenges and whatever—nicotine patches—is exactly the same nicotine we are using in producing electronic cigarettes. In those forms it is available in supermarkets and kids as young as 12 can buy it. Suddenly, when we use it in electronic cigarettes, it is the work of the devil. You cannot have it both ways. Either it is a harmless chemical in these amounts or it is really dangerous. We need to sort that out.

CHAIR: What is the origin of the ban on the nicotine you use in your e-cigarettes.

 

Ms Gordon: It happened in 2008. It was due to fears that electronic cigarettes were a gateway product to smoking. These were unfounded fears.

Mrs Wolters: States vary too. When I imported my first nicotine at the end of March 2014, there was a page on the internet that said it was legal to import 24-milligrams of nicotine liquid into Australia—and suddenly that disappeared and suddenly I was importing something that was not legal, when originally I had been importing something legal.

Ms Stone: The other reason is that it is not approved by the Therapeutic Goods Administration. It is not in a pharmaceutical product that has been approved. The process of approval through the TGA is extremely expensive. E-cigarettes are part of a consumer driven industry; they are not a big pharmaceutical product. It is prohibitively expensive for small companies to have their product approved by the TGA.

CHAIR: Are all the other nicotine products approved by the TGA?

Ms Stone: Yes.

CHAIR: Even the ones that are sold in the supermarket?

Ms Stone: Yes.

CHAIR: Have any of the Nicotine Alliance members—or indeed anybody that you know of—been prosecuted for importing nicotine?

Dr Denko: As far as I know, there has only been one prosecution for possession.

 

CHAIR: Possession—not for importing?

Dr Danko: Yes, I believe that was the case. There has been one prosecution for possession and that was someone who was running a vape shop and running a petition to try to change the laws in Queensland. The police came around to his shop because he was selling vaping equipment and liquids. I think the assumption was that they were trying to get him for selling and they could not do that, so they decided to charge him for possession.

CHAIR: What is your understanding of how common vaping is in Australia?

Dr Danko: As I said, from the latest figures in 2014, it is roughly or close to 15 per cent of the smoking and recent ex-smoking population. It is amongst those people. It is increasingly common and it is increasing all the time. It is now more than a year after that data was collected, so I am sure the number is bigger than that. It is becoming more and more common. A lot of people know other people who do it. The law to try and stamp it out has clearly been useless in its aims.

Ms Stone: Although it is quite useful for preventing older people who are not internet savvy and also people who are very poor or disadvantaged because of mental illness or being Aboriginal or whatever, having limited access or understanding of buying things over the internet. If we had vape shops like they do in the UK, it would be a lot easier for people who really need to these products for their health to access them.

CHAIR: Your point is that there is substantial civil disobedience going on and the law is largely not being enforced anyway, but those who cannot be civilly disobedient because of technology or finances or whatever are the losers out of this. Is that your proposition?

Ms Stone: Yes, that is what I am saying.

CHAIR: What is the situation in Western Australia? What is different about Western Australia from the rest of the country?

Ms Stone: In Western Australia there is a legal case that is ongoing. A vendor, a man who was selling through the internet the actual devices and non-nicotine liquids, was prosecuted under the law that prevents selling toys and products that look like cigarettes to entice young people. There is a law in most states, I think. He was prosecuted under that law in 2011. That case is still ongoing. The sentence for the latest appeal will be handed down tomorrow, I think. Basically, it is illegal to sell the devices or anything in Western Australia.

CHAIR: Is it illegal to possess them?

Ms Stone: No. It is not illegal to possess the e-cigarette device but, like all states, it is illegal to possess the nicotine e-liquid.

CHAIR: It is not illegal to import it, though. Am I right there?

Ms Gordon: I think you need a prescription from your doctor to import. I think it is legal to import, but you need a prescription to possess it.

Ms Stone: It is not illegal to import it, but it is illegal to possess it.

CHAIR: It is not illegal to import it, so that is what everybody is doing, but once they import it and take possession of it they have broken the law. Is that correct?

Ms Stone: That is correct.

CHAIR: In Western Australia it is also illegal to—

Ms Stone: Sell the hardware.

CHAIR: To sell the hardware, but it is not illegal to own it?

Ms Stone: As far as I know, I do not think it is illegal to possess it.

Mrs Wolters: Or to import over the internet or to order it over the internet.

CHAIR: Or to import the device into Western Australia.

Mrs Wolters: Yes.

Dr Wodak: Although there have been few prosecutions, the fact there is a shroud of illegality hanging over e-cigarettes has undoubtedly dampened down the utilisation of e-cigarettes compared to, say, the United Kingdom where there is a less suppressive legal environment for e-cigarettes and there is much greater utilisation of e-cigarettes to the benefit of people in the United Kingdom.

CHAIR: I have read your submission. That was interesting. We will get onto that. I have had the benefit of reading your submissions, but, by having them in the Hansard, people will know your personal stories and how you became vapers. Ms Gordon, we have not heard much from you. Have you got a story to tell us?

Ms Gordon: I smoked for 35 years. I made many quit attempts in that time. I tried patches, which just gave me rashes; I tried chewing gum and lozenges, which were useless; inhalers tasted nasty; I was prescribed Champix by my doctor and, two weeks into that course, I was driving along the road and had this incredible urge to drive head-on into a semitrailer that was coming. It was just bizarre the way that happened. I had to pull over from the road and sit quietly for an hour. I later found out that there have been a few thousand suicides as a result of people taking Champix. It was an absolutely terrifying drug. My most successful attempt was when I quit cold turkey. I lasted a year, but I gained 10 kilograms in weight and was quite depressed and just as short of breath then as if I had been smoking, and I ended up going back to smoking.

I was 50 years old and I was quite sick. I was smoking well over 40 cigarettes a day. My throat was killing me. I had palpitations and black rings under my eyes. I was so desperate to give up, but the more stressed I got about it the more I smoked. It is the way it often goes with people. I got onto the internet looking for a miracle at that stage, and I found it with electronic cigarettes. I started on a little Cigalike, which I ordered from overseas, and, with the first puff I took of that, I knew that this was the end of smoking. This was the end of it for the world. This was going to take over smoking, and I have not smoked another cigarette since. My doctor considers me an ex-smoker. I no longer get the six-week bouts of bronchitis that I used to get three times every couple of years. My health has improved dramatically. It is as if I have given up nicotine entirely.

CHAIR: Mrs Wolters, we touched on your personal story, but give us—

Mrs Wolters: My father got me to light cigarettes in the car for him when I was about five, but I did not start using regularly until I earned my very first money at 14. I smoked increasing amounts through my life. The first time I tried stopping smoking I was probably only about 17 and I tried cold turkey. In my next attempt I enrolled in a pilot program—I think it was at the University of New South Wales—which was basically research into using aversion therapy for people to stop smoking, which did not work. I tried cold turkey many times. I think nicotine gum was the first thing, but, anyway, I tried many nicotine replacement therapies. I tried Zyban. I tried Champix. I tried hypnosis. I basically tried everything. For at least 45 years I was trying everything, and at the end I was smoking at least 50 rollie cigarettes a day.

CHAIR: 50?

Mrs Wolters: Yes.

CHAIR: Rollies?

Mrs Wolters: Yes. I was very ill. I was dangerously depressed at that time, and I read about e-cigarettes and started looking. I dual used. It took me five months. It was recommended to me that I use 24 milligrams liquid at the start. I used for five months. I mainly smoked and used one like this. Then I realised that I needed very strong nicotine liquid, so I mixed my own at 36 milligrams, which is very strong, but that actually worked. This is the one that got me off smoking. Oh, sorry, I am not allowed to do that, am I?

CHAIR: Yes, you are. It is just that Hansard will not record it.

Mrs Wolters: I was a fairly advanced vaper by then. I had to build my own coils for this. It is mechanical; it is not regulated. You have to know what you are doing for safety. Mostly, these days they are electronically regulated so you cannot blow yourself up. With these ones you have to be a bit careful. So, for five months I dual used. That is the amazing thing about vaping: there are so many variations; people can adapt different strengths, different flavours and different shapes of mods. It is all so variable, so people can create the environment for themselves that they need to give up smoking.

CHAIR: I will come back to the devices and the market for devices. I still want to hear the personal stories.

Ms Darvill: I smoked daily, full-time, from the age of about 15, but, prior to that, probably from the age of 10 I was dabbling in it. My mother was a smoker, and my best friend was my cousin and her parents were smokers. I remember getting her father's rollie papers, stealing a small bag of tea out of the tea pot and taking them down to the school on the weekends and trying to roll them up with the pine leaves at the time. So obviously I was pretty dedicated way back then. When I was 15, we were still able to smoke in our workplaces. Although this may go against the grain of some people who are pro-smoking or pro-choice, to a certain degree I think it did allow people like me to become much more addicted smokers, because they had no restrictions whatsoever. I was a receptionist and I would have my cigarettes on my reception desk and would be puffing away.

The laws started to change when I got to about 23. I had made a couple of attempts at giving up smoking before that, but no really serious attempts. By that stage I was probably smoking 20 to 25 a day. When I went to change jobs at 23, there were no-smoking laws in offices, so I thought, 'This is a good time to change careers.' I decided to become a sales rep and that way I could continue to smoke all day, every day. I had kids when I was about 28 and married a non-smoker when I was 27, but I was with him from about 23.

I tried acupuncture; I tried 'Stop smoking in one hour—money-back guarantee.' The thing was I never went back for the money-back guarantee, so they have got me down as one of their successes. I tried Quitline; I got the quit packs; I had the phone counselling and, in later years, the SMS service. I used Champix. I had a feeling after about eight days on Champix that I was going to die if I continued to take it and die if I stopped it. I hate going to doctors. I am not a doctor's person, but I found myself ringing the after-hours service at nine o'clock one night saying, 'I'm going to die from this. What can I do?' I tried Zyban.

I got pregnant with twins when I was 28. I loved or needed smoking so much that I continued to smoke—not as heavily, but to my guilt I continued to smoke. As soon as they were born I was back up to a pack a day. I started smoking more because I then became a single mum. I was poor and I had no company. You cannot leave the house when you have two small children, so the best thing to do is go out in the backyard to sit and smoke. I found myself getting to the stage where I smoked a minimum of 30 a day and up to 45 a day. I could not afford it. I would make choices that were detrimental to my children. I do mean that I did anything terrible to them. I still fed them and put a roof over their heads, but, if I had a choice of buying watermelon at $2 a kilo or apples at a $1a kilo, if they wanted the watermelon they were not going to get it. I would make buying decisions based on whether I needed a packet of smokes or not.

I tried quitting cold turkey several times. Probably nearly every Sunday night I would say, 'Right, that's it. I'm not going to smoke again tomorrow.' The only quit attempt that I ever made for more than a week that worked was through the Allen Carr method—another money-back guarantee if you do not quit. I never went back again because I felt like a failure, because every time I tried to quit and I could not, or I relapsed, I was a failure. I would become very sick. I was coughing day and night. I would wake up in the morning and I would be coughing so much I would vomit. I started to work out how old my kids would be and, 'if I live to 55, that means they were going to be 24; if I live to 60, that means they were going to be 29, so I might actually end up seeing grandchildren'. This is how I felt.

Anyway, then I watched a program called The Project. I had given up giving up, and I had decided that I was just going to die early—and this is before I was 50. I watched a program on The Project and it was not particularly a fantastic program but there were a couple of ex-smokers on there that said that they got off cigarettes with vaping and it was so good, it was so easy. But then I tried to find them, 'how do I buy them?' No-one would tell me. I would search online, and I had never bought anything online before. So I went to The Project's Facebook page and there were people talking about the show on there and I said: How do I buy this nicotine?' I was private-messaged by a vendor that was in Queensland that said: 'We will sell it to you.' And they were a lovely couple but they were selling black-market, under the counter. I did not have a credit card to buy online but they allowed me to pay it into their bank account, so I paid $110 and I got two devices and two power packs. I got a sample box of 20 e-liquids. It arrived in the post and within my first three puffs I thought, 'I think this is going to work'. Within three days I had given up smoking, and that is more than 2½ years ago now and I have not had one since.

CHAIR: You gave us a bit of an idea, and you were smoking quite a lot before you gave up; tell me your story, Dr Danko.

Dr Danko: Going through medical school and becoming a doctor, I was obviously aware of the health consequences of smoking but, like I said, I just got something from it that I did not get anywhere else. I tried to reduce my risk by not smoking too much. I would give up for periods of time, but then I would be lured back to it. And I honestly felt better when I was a smoker than not a smoker, in myself. I was trying to do everything else I could—exercise, eat well—to reduce my harm. When my sister told me about the electronic cigarettes I thought it was worth a go. I got some from a shop in Melbourne and got my e-liquid online, and started using it, just as an experiment to see what would happen, without too many big expectations of it. Neither did I have a desperate need to quit. I had a bit of a smoker's cough and I was getting a bit puffed out, but it was not like some of the other people.

Interestingly, I immediately reduced most of my smoking to about two or three a day. I still felt I needed those for quite a while and I actually dual-used for about a year. Part of it was a self-experiment. I wanted to see what sort of combination of e-liquids or other things you would need to swap entirely without wanting to. There are certainly a lot of accidental quitters, people who just start trying e-cigarettes and then decide, 'hey, this is better; I don't want to smoke any more'. For me it was not quite there, and so I did some research and found out about other components in tobacco, and I obtained some Swedish snus and also some nasal snuff, and together with those things, once I started that I was able to give up without any effort whatsoever. That to me is the holy grail of smoking cessation. If you can find a combination of device, liquid—anything which is significantly harm reduced; so we are talking about 95 per cent or better harm reduction.

If we can get this out to the whole population, then we could make smoking obsolete. That is what really excites me—it is the idea that 1 billion people could die this century from smoking-related diseases, and if we can find a way to innovate our way out of this tragedy—this disaster—by allowing companies to innovate, allowing consumers to try different things and tell each other about it through social media, then we could save that many lives, potentially.

CHAIR: I am going to come back to Dr Wodak on a different issue. I do not think you are an ex-smoker are you?

Dr Wodak: No. I am not.

CHAIR: Ms Stone, could you tell us your story please?

Ms Stone: I smoked for 30 years. I started when I was 16 or 17, in my last year or two of high school. Prior to starting smoking, I was very against it because I knew it was increasing risks of lung cancer and that it was a bad idea in terms of health. I also knew that they were very addictive. Both my parents smoked and most of the adults I knew smoked, so I used to tell them that they were stupid. Then—I do not know what happened—something changed. I thought, 'Well, everybody says don't do it, and so I am just going to do it.' It was a little rebellion of mine. I was not a particularly rebellious teenager. I also thought that I was immune to the risk, that I had plenty of time before there would be any negative health impacts and that I would just stop.

Gradually over the years I started to smoke a bit more and a bit more until I realised in my mid 20s that I was quite addicted and that it would be hard to stop. I made a couple of not serious quit attempts in my 20s and 30s—just cold turkey attempts which did not last more than a day or two. Then when I was in my 40s I tried hypnosis, which did not work at all but cost me a lot of money. So it was basically a cold turkey quit attempt. That was extremely difficult, and I had a period of about a month where I felt really quite depressed. I put on I think about 12 kilos, which made me feel more depressed, and I did not feel very well. But then I went on a diet and started to lose that weight and I felt better, but after about six months I just got tired of wanting a cigarette. It never went away after six months. It got a little bit better after the first month or two, but it just kept coming, and it was sometimes an incredibly strong need to have a cigarette. I think that those urges just wore me down, and after about six months there was a minor crisis in my life and I went straight out and bought another packet of tobacco and started smoking again.

The second attempt was a few years later. I went to my doctor and got prescribed Champix. That was quite effective. I took it for, I think, about 2½ or three months. I stopped taking the medication early, because I felt strange on that drug. I did not feel like myself and it began to disturb me. So I stopped taking the drug and started smoking about a week later. After that, I thought a lot about smoking. I do not drink a lot. I do not really have any other vices. I try to eat well, although I do not always. So I weighed up the pros and cons, as I said earlier, and decided that I was going to smoke because I enjoyed it, and if I died early from smoking then so be it.

A friend that I had not seen for a while came around and she was using an electronic cigarette. She had not smoked for a year, and I knew that she was a dedicated smoker prior to that. So I was curious. I did not think that it would make me quit smoking, and I had no urge to quit smoking at that stage, but I bought one out of curiosity. Pretty much from when I first started using it I did not need to smoke. I continued to smoke one or two a day for a few weeks and then I thought, 'Why am I bothering to do that?' So now I vape pretty much full-time although I do still have a cigarette every now and then when I am in the company of other smokers and having a drink. That was three years ago, and I have been vaping instead of smoking.

CHAIR: Do you still have an occasional smoke?

Ms Stone: Yes, I do.

CHAIR: Do you think if you stopped vaping that would increase?

Ms Stone: I think, yes, definitely.

CHAIR: Is there any reason why you think you have continued to have a smoke? I think Mrs Wolters or Ms Darvill suggested tweaking the dose. Do you think tweaking the dose would get you off those smokes?

Ms Stone: No, because I think it would be easy not to have those smokes. I just have them because of the environment. I am with friends who smoke and they are lifelong friends so there is a long history of having a glass of wine with my girlfriends—the two friends who smoke. When I am with them it is more for nostalgic reasons. Because I do not feel afraid of being addicted to smoking any more. I know that I prefer vaping, and as long as I can vape there is no fear that I would ever go back to smoking, so I just have one. I am not into that absolutism: 'I am never going to have another cigarette again.' I do not see any reason for that. I think having two cigarettes a month is not going to impact on my health or life anyway.

CHAIR: Dr Wodak, you draw a distinction between tobacco harm reduction and tobacco control. Would you like to discuss that for the committee please?

Dr Wodak: In the middle of last century evidence started accumulating in Britain from Richard Doll and others about the devastating health impacts of smoking, which were at the time not known. This is soon after World War II, in Britain. The evidence accumulated over the next couple of decades and a David and Goliath struggle developed between public health tobacco control people and the tobacco industry, which was extraordinarily powerful and influential. Bit by bit David started to overcome the corporate Goliath and the result has been that hundreds of lives have been saved around the world.

Tobacco smoking prevalence dropped dramatically in this country and other rich countries although unfortunately it continued to rise in poorer countries. I strongly supported the kind of measures that people I regard as heroes were capable of somehow getting through the system. Another dimension was going on in this debate and that was the issue of tobacco harm reduction. Michael Russell, who was a psychiatrist in Britain who did a lot of the research showing how essential nicotine was to the continuation of smoking, coined a phrase which has been often quoted around the world that people smoke for nicotine but die from tobacco. That is really essential to the thought of harm reduction.

I have worked a lot in harm reduction for illicit drugs, but harm reduction is all pervasive in public health and indeed in public policy. It is a form of mitigating risks. Those of us who came here by car today and put on safety belts were practising harm reduction. Harm reduction is everywhere when you go to a children's playground and you see kids playing on swings and underneath them is a foam mattress on the ground rather than concrete. That is harm reduction.

A battle unfortunately began after the development of e-cigarettes early last decade in China by a pharmacist who had lost his father from smoking and had sat around and developed the first generation of e-cigarettes. After that, unfortunately, the public health movement split into those of us who strongly support harm reduction and others who strongly support tobacco control. For those of us from harm reduction, the central objective is decreasing harm—that is, death, disease, crime, corruption, violence and so on. In this case also there is the huge economic cost of smoking. If people can find some way of still ingesting nicotine which is much less harmful than tobacco, so be it. That is what we advocate in terms of methadone instead of street heroin use, and sterile needles and syringes instead of re-using dirty needles and syringes in the street, thereby controlling HIV. There is a consistent thread in all of this. That battle still goes on, and for me the central issue is whether e-cigarettes are less harmful than tobacco and, as well as that, whether e-cigarettes help people to quit smoking, and that debate still goes on. I think that the evidence increasingly favours the idea that e-cigarettes do help people to quit; we have heard that this morning. But, even if they do not help people to quit but all they do is reduce the lung cancer and the heart disease and the strokes and the gangrene, I think that is very positive and I think the regulation of e-cigarettes in Australia is far too oppressive and far too negative. As Attila has just said, the unintended consequence of the heavy-handed regulation of e-cigarettes in Australia is to favour tobacco, which is crazy.

I take this debate as being like many other harm reduction debates that have been raging and still rage today, and we are hearing about pill testing that I am involved in. These debates seem as though they are different, but in reality they are all the same. They are about whether we have a jihad about a particular drug or whether we look for pragmatic, effective ways that respect human rights but nevertheless focus on trying to reduce harm.

CHAIR: Okay, it makes sense. The other side of the argument, the tobacco control people plus the public health lobby, do not like e-cigarettes.

Dr Wodak: No, they do not.

CHAIR: What are their arguments and what do you think of their arguments?

Dr Wodak: They are not really arguments; they are suppositions and concerns. One of the concerns is that e-cigarettes will normalise smoking, and they have been desperately searching around for evidence for this, but I think as time goes by it is becoming clearer and clearer that they have not really got evidence for this.

CHAIR: What do they mean by 'normalise smoking'?

Dr Wodak: That, after decades of demonising and stigmatising smoking of cigarettes, e-cigarettes will somehow change the public image and change the public policy, and that policy will become tolerant and encourage smoking. That is the sort of thing they are talking about, but, again this kind of debate is very common in all of the other harm reduction debates—on illicit drugs, for example. You will see in the current debate about pill testing that one of the concerns of opponents of pill testing at raves is that this would normalise such drug use. The same was said about needle and syringe programs. The same is said in every harm reduction debate.

The same was said, for that matter, about car safety belts. When car safety belts were introduced in Australia in the late 1960s, there were critics of car safety belts, and their argument was, because we try and keep our risk levels at an equilibrium, if a risk behaviour is made safer then that unwanted risk behaviour will become more reckless and more prevalent. That is the argument. It is based on something in psychology called the risk compensation hypothesis. In the case of car safety belts, it became very clear that, even though there might be the occasional motorist who drove a little bit faster or a little bit more recklessly, the net effect of introducing car safety belts was hugely positive. There was a huge reduction in deaths and serious injury. Likewise, in all the other harm reduction debates we find the same kind of battle between fear and evidence. The needle and syringe program debate had a lot of that element to it. There are other fears they have. Dr Danko might take over. He is more familiar with all these debates.

Dr Danko: The first thing I wanted to say about other people in public health is that there are many people in tobacco control and tobacco issues in public health who are for e-cigarettes, and particularly in the UK where they have the greatest experience of a society where they are awash with e-cigarettes. As the use of them has increased, the public health organisations there have all come out pretty much in favour of them. They are pushing the agenda more and more, to the point where even the Prime Minister made a statement about how we should encourage smokers who cannot quit any other way to have e-cigarettes. Their quit-smoking services are moving to be e-cigarette friendly. They are supporting it as a positive health initiative. There would be no-one in the UK, even the opponents of e-cigarettes in the UK, who would ever go as far as to call for their banning to the level we have here.

In Australia we have to realise that tobacco control establishment is quite an insular group that generally has this idea that e-cigarettes are a plot from big tobacco to hook children and then to provide a gateway for smoking. They keep repeating that line in spite of the evidence. They refuse to debate this issue openly with us. They enjoy having media time when they are allowed to speak without any answer, without any question, and there is certainly a bit of support within politics and the ABC for continuing this stance. They tend to roll out the same people again and again and do not allow them to engage in open debate.

CHAIR: This is interesting, because it leads into a comment in one of your submissions in relation to the state of the art of the e-cigarettes, the devices themselves. The comment was that big tobacco is stuck playing catch-up but this is an innovative area. As I am sure you are well aware, innovation is our Prime Minister's favourite topic at the moment. You have got lots of devices sitting there. What does that reflect? What is the industry like?

Dr Danko: The industry is made of many small groups, many small businesses, that are competing with each other to make more and more effective and satisfying substitutes for smoking. They are coming out with new things often every few weeks. Not only are they increasing the effectiveness of them; they are also increasing the safety of them because of consumer demands. There are innovations such as temperature control that avoid overheating the e-liquid.

CHAIR: Why is that important?

Dr Danko: That is important because there was a study, which the people against these desperately hold onto, that e-cigarettes produce formaldehyde. This study has been debunked quite a few times, but it is still often brought out as an argument against e-cigarettes that they can contain formaldehyde five to 15 times greater than a cigarette. The truth is that immediately after that study came out vapers tested their own equipment at the same voltages under the same test conditions that the researchers used and found that those settings were absolutely unvapeable. They involved temperatures much higher with much less fluid on the wick than anyone would ever tolerate, even for an instant. Temperature control means that the temperature is automatically limited so that those conditions never arise. No matter how the device is used or misused, no matter how little liquid is on the wick, it simply will not fire to produce the formaldehyde.

CHAIR: I want to come back to this issue of the market—where the impetus is coming from for this innovation and so forth. Looking forward to the UK, where what you have described is a much more deregulated market than Australia by a long shot, where do you think it is likely to develop over the next decade or two?

Dr Danko: I think it will continue to develop in much the same way, that we will get increased effectiveness and safety. The consumers who have come off smoking demand increased safety; they want more studies—but studies which are done without bias. They want studies that look at e-cigarettes as an opportunity rather than a threat, that look not for ways to support an argument for banning them but for ways to make them safer. I think that this will continue; it is very hard to predict where it will end. When digital photography came out, Kodak still thought they were going to be a player and they rapidly found out that they were not.

CHAIR: What are the possibilities that the market will, as happens with many markets, see the emergence of a relatively small number of major players who dominate—such as we see with mobile phones, televisions and lots of other things? Do you think that is likely to occur with these?

Dr Danko: It is possible, but let us say I wanted to fight a vape shop now. With a thousand dollars I could easily order online and get myself set up. If I were trying to start a tobacco company, I would require probably $100 million or more—it would probably never happen. The barriers to entry are really very small. The essence of the device is simpler than a light bulb. It is just a heated wire and you do not even have to worry about a vacuum, as Edison struggled with. At the same time, there are a huge number of variables that can be changed. One of the interesting things about this phenomenon is that consumers have been the ones at the forefront of developing new methods of using these products. Often smaller companies then follow.

People found that using cotton instead of silicone in the wick gave a better experience and a safer one as well. Then, a couple of years after consumers had developed this on their rebuildable devices, companies came out with premade coils with cotton in them. Again, with different types of coils, tinkerers at home would try different ways of coiling the devices and then talk about it on social media. As some of these ways became popular, small companies followed suit again. This is very much a consumer led revolution—people taking recreational nicotine into their own hands with the smaller companies following that.

CHAIR: Do you foresee a time when any of the tobacco companies—BAT, Imperial Tobacco, Philip Morris—might have a major presence in this area?

Dr Danko: It is not impossible. They have several advantages with distribution networks and resources to undertake new developments that consumers themselves cannot. I do not have any opposition to it. If a tobacco company changes to just selling reduced risk products, they are no longer a tobacco company and they should no longer be pariahs. At the moment, though, they are falling further and further behind because the cost structure and the business model they have makes it very difficult for them to keep up with the rapid pace of innovation of the smaller companies and the consumers.

CHAIR: I imagine that the anti-tobacco lobby that you are referring to, the tobacco control group, would argue that, if the tobacco companies sold e-cigarettes, they would use them as a device for enlisting customers one way or another onto tobacco—or onto whichever of the two was more profitable.

Dr Danko: Yes, that is their argument.

CHAIR: How would you address that argument?

Dr Danko: E-cigarettes were not invented by tobacco companies, but as soon as the tobacco companies entered the market and produced their own little cigalikes they immediately created massive advertisements which harked back to the old days of tobacco companies. The interesting thing is, are they trying to eke out a market within this? Or are they trying to convince tobacco controllers to react against them by creating all these flashy ads to try and get tobacco control to do their dirty work for them in suppressing the e-cigarette market? I do not know the answer to that.

Mrs Wolters: There are some companies, mainly in China, that are emerging that are probably going to be leaders within the industry, possibly fairly exclusively internationally unless regulation is done carefully. If vaping is overregulated, it is almost certain that the tobacco companies and the pharmaceutical companies are going to be the only ones that have the funds to jump through regulatory hurdles. And if tobacco companies and pharmaceutical companies are in that position, they are also in a position to control things like what liquids go in, size, price—and it will make it far less attractive to switch to vaping from smoking. Basically, the status quo is maintained and probably a lot of people would be happy with that.

Ms Darvill: In South Australia, they have just had a regulatory process and they have put out some recommendations that are currently going back to parliament. One of the recommendations is that a vape shop must be licensed. Now that sounds okay, doesn't it? You need a licence to be a vape shop. But the other thing they have done is they have said that anyone that sells e-cigarettes cannot have a tobacco licence. I am undecided as to whether that is good or bad; in one way it is bad because it means that someone that normally smokes and goes into a smoke shop does not get the opportunity to buy a vapour device and maybe never sees or has the opportunity. On the other side of the coin it means that, if you are buying vape equipment, you are not going to go into a tobacco shop to buy some and therefore be tempted back to smoking. Governments do see, in their wisdom, one way or the other. Which one is right—who knows?

CHAIR: It is a very good point. I would like to ask you now about using e-cigarettes in smoking and non-smoking areas. Where can you do it, and where can't you do it? As I understand it, New South Wales recently passed regulations that said that wherever you are not allowed to smoke, you are also not allowed to use an e-cigarette. Is that right?

Ms Darvill: No.

CHAIR: Is that not right?

Ms Darvill: No. That is the case in Queensland. In New South Wales, they have not touched that yet. They have restricted the sale et cetera, but there are no rules at this stage.

CHAIR: Do you mean on where you can use an e-cigarette?

Ms Darvill: On where you can use an e-cigarette.

CHAIR: What do you think about that? I am asking anybody in the group. What do you think about the fact that people have become accustomed to the idea that smoking is not done indoors at all and that if somebody is puffing on an e-cig and there is a bit of vapour coming out, that is also not to be permitted. How do you respond to that?

Ms Gordon: It means that where these regulations have come into place, people who have given up smoking now have to go out with the smokers. And we have been told over and over and over again that passive smoking is really bad for you. Why would you send someone who has given up smoking to go and breathe the smoke of all the smokers? It does not make sense. I will vape anywhere; that is because I will stealth vape. Stealthing is when you hold the vapour for 20 seconds or so inside your lungs and you breathe out invisible air. It is completely unenforceable anyway. Those of us who are experienced, we just get around it—I have vaped in hospital and on aeroplanes—because it is just so ridiculous. It is an insult. We are bullied and bullied and bullied to stop smoking—and when we do it the wrong way we are sent out with the smokers again like troglodytes being sent out into the darkness. It is completely counterproductive.

Ms Stone: The laws on smoking indoors, and restricting smoking in places where there are lots of people or children, are based on evidence that passive smoking is dangerous to bystanders. But there is no evidence for that with vapour; it is not toxic to bystanders. So there is an ideological basis to restricting vaping to areas where people smoke; there is no actual evidential reason to do that.

Dr Wodak: A very good place to look for this battle between tobacco prohibition and tobacco harm reduction is in our prisons in Australia. Unfortunately there are state and territory tobacco prohibitions coming into our prison systems with very little debate or discussion in the community. There are very sensible reasons why you would want to see lower smoking rates among Australian prisoners. It is a serious health hazard. There are very high smoking rates and very high rates of mental illness. It contributes to their poverty in prison. They get very low rates of pay for doing some work while in prison and they end up using a lot of that money to pay for tobacco rather than nutritious food; the prison diet is pretty terrible. Also, it is in everybody's interest to have savings at the end of that period of imprisonment when they go back into the community so they can pay their first bond on somewhere to live rather than having to steal to pay for somewhere to live. Not many people realise this, but their risk of relapse to other forms of drug use such as heroin and amphetamines is much higher if they are smoking than if they have become nonsmokers. So the grounds for trying to reduce smoking in prison are overwhelming.

On the other hand, when this has been tested in courts, very often the courts have found that a prison is somebody's home—while they are imprisoned, that is where they are living. For the state to say to somebody that they are not allowed to smoke while they are in their own home is in my view quite a philosophical leap. The courts, not always but very often, have found that as well.

CHAIR: As far as I have read, the prisoners do not take kindly to it either.

Dr Wodak: We have no evidence that tobacco prohibition is for the long-term benefit of prison inmates—that is, there are no follow-up studies that show that, where there is tobacco prohibition in prison, people who pas through prison benefit in the long term; they relapse as soon as they leave the prison. Are there other problems associated with tobacco prohibition in prison? Yes, there are. There are stories—and we cannot document these—of prisoners rioting and setting fire to prisons. We have had this in Australia as well as overseas. These things are difficult to document because of the secretive nature of prisons. There is a lot of evidence, admittedly of different quality, that when tobacco is banned in prisons other currencies re-emerge or are expanded. There are two other currencies in prison—sex and illicit drugs. There are many case reports of prison systems that have banned tobacco only to find that the heroin problem in the prisons got much worse. So there are many reasons to be concerned about this and there are many reasons to consider other ways of dealing with this problem.

Another dimension to this is that the prison authorities are increasingly aware of the occupational health and safety risks of allowing prison warders to be exposed to smoke from prisoners. How else can we manage this problem? I have done a lot of research about tobacco smoking cessation in prisons, so it is a familiar problem to me. One way of dealing with this problem would be to segregate prisoners who smoke from prisoners who do not smoke and prison employees who smoke from prison employees who do not smoke. According to senior people I know who work in the correctional system, that is not all that hard to do. So we could segregate the two groups—staff and inmates. And, for those prisoners who want to keep on taking in nicotine but do not want to smoke, we could provide e-cigarettes. There are e-cigarettes that have been deliberately designed to be used in prisons. There are risks with e-cigarettes in prisons as well, but they can be revised. Donna has examples of those and can tell you about the technical modifications that make these suitable for the prison environment. I do not see why we have not had this debate in Australia.

CHAIR: One other area that I want to touch on is the importance of the cost of tobacco relative to e-cigarettes and also options for cost reduction in sticking with tobacco as well. How important do you think that is to you? For those of you who smoked and then moved to e-cigarettes, how much of a factor was cost?

Mrs Wolters: For me the cost was not a major factor; staying alive was my motivation. But what has amazed me since I stopped smoking is the fact that I have money to spend on luxuries such as books and decent clothing instead of the cheapest I can buy.

Ms Stone: Cost was not a big factor for me because I was smoking rolling tobacco. That was three years ago. Back then, it was not costing me any more than $40 a week. It is a lot more now. But I think cost is a huge factor for people who are disadvantaged.

Ms Gordon: For me, cost was not a factor in converting from smoking to vaping; that was for health reasons and I just wanted to quit. To save money on smoking I just used black market tobacco. That is the way to save money for people who want to smoke but do not want to pay the tax. And that market—chop chop— is getting bigger and bigger; it is everywhere. So it was just for health reasons that I converted to vaping.

Dr Danko: For me personally it was not a cost issue. But one of the tactics we can use to help other smokers to quit smoking is to initially tell them: 'Give it a try. It's going to cost you a lot less. You're spending a lot of money on smokes at the moment.' What we have with vapers is a whole team of people who can help other people to quit smoking; it is a social, viral phenomenon of people helping each other to quit smoking. It should be seen as a public health bonanza, an opportunity.

Ms Darvill: For me, it was fifty-fifty cost and health—when I say health, I also mean mental health. I could not afford to smoke but I smoked more and more every single day, every single week, because I was so stressed about cost and health. I am absolutely appalled that one of the parties in the next election is proposing to put up the price for smokers by another 12.5 per cent a year. Even though I would love the opportunity to convert every single one of those smokers, I think it is the most aggressive thing I have ever heard. It is appalling. It is only going to hurt the kids, the homeless, the sick and pensioners. People who can afford to smoke already do not; it is the people who cannot afford to smoke who still smoke. That is my view.

CHAIR: That is a good note to end on. Thank you very much for your attendance today. We really appreciate it.

Proceedings suspended from 11:10 to 11:27

BARNES, Mr Terry, Principal, Cormorant Policy Advice

BATES, Mr Clive, Director, Counterfactual

STIMSON, Professor Gerry, Private capacity

Evidence from Mr Bates and Professor Stimson was taken via teleconference

CHAIR: Welcome. Do you wish to add any information about the capacity in which you appear?

Mr Barnes: I am a part-time fellow of the Institute of Economic Affairs in the UK.

Mr Bates: I am a public health blogger and commentator.

Prof. Stimson: I am emeritus professor at Imperial College London.

CHAIR: Thank you for appearing before the committee today. Before inviting you to make an opening statement, I would like to remind Professor Stimson and Mr Bates that the protection of parliamentary privilege in the Australian parliament cannot be guaranteed to jurisdictions outside of Australia. Your evidence should be made knowing the inability of the Australian Senate to protect you outside of the Australian jurisdiction. This is a public hearing, although the committee may agree to a request to have evidence heard in camera, or it may determine that certain evidence should be heard in camera. I now invite each of you to make a brief opening statement, should you wish to do so, and then the committee will ask questions.

Prof. Stimson: I am a public health social scientist and have spent most of my academic career doing research on drug problems. From 1986 onwards, I helped to invent, disseminate, develop and evaluate harm reduction for people who inject drugs, as a way of preventing the spread of HIV infection. Drug harm reduction was an outstanding public health success. I do not smoke and I do not vape—the only drug I use is alcohol—but I have very strong personal views in favour of both drug and tobacco harm reduction. They both share a similar objective—to reduce health risks for people who are unwilling or unable to stop using their drug of choice.

Smoking tobacco is the most harmful way of delivering nicotine. In excess of 4,000 chemicals are released, a number of which are carcinogenic, along with carbon monoxide. The tobacco harm reduction proposition is straightforward. Smokers risk disease and premature death. Most smokers say they want to stop smoking, and many have tried. Many find it hard to stop, and many are unable or unwilling to give up nicotine. Providing safer ways of delivering nicotine via e-cigarettes and other alternative nicotine delivery systems enables people to continue using nicotine but to avoid the health risks of smoking.

In the UK experience, e-cigarettes came onto the market in around 2007. There are a wide range of products and there has been a remarkably rapid uptake of e-cigarettes. The latest data from the Office for National Statistics indicate 2.2 million people currently using them. That is four per cent of the adult population. That compares with the around 18 or 19 per cent of the population who smoke cigarettes. E-cigarettes have now become the most common device used by smokers in the UK to help them quit smoking. It is unlikely that any formal public health initiative could claim so much impact in such a short time. This has, in effect, been a consumer and market solution to a public health problem. I contend that e-cigarette makers, vaping stores, vaping forums and vapers are now really the new leaders in smoking cessation.

Australia led the world in drugs harm reduction to help prevent the spread of HIV, but regarding e-cigarettes it has an illiberal policy that denies smokers better and safer alternative nicotine delivery systems. I believe that the solution is fairly straightforward. Nicotine is a schedule 7 dangerous poison. This effectively prohibits legal access to nicotine. Nicotine needs to be reclassified to make it available for purchase as a consumer product. This change needs to be supplemented by consumer standards for e-cigarettes and e-liquids. Thank you.

CHAIR: Thank you, Professor.

Mr Bates: I became interested in the concept of tobacco harm reduction from 1998 onwards, when I was the Director of Action on Smoking and Health, the main antismoking charity in the UK. I have been committed quite passionately to it ever since. That is my main conflict of interest. I have no other conflicts of interest, financial or otherwise, while I am speaking to you today.

I want to make four propositions for the committee to consider. The first is that it is absurd to have a ban—de jure or de facto—on these products. The arguments around them are often couched in a lot of sophistry. Basically, there are no precedents and no ethical basis for banning a much safer variant of a product that is very dangerous and widely available on the market. There are no precedents for that. Frankly, it is absurd. The second proposition is that the regulatory justifications for doing this—that is, for classifying the products as either medicines or poisons—are without foundation. These products are widely used in Europe and the United States with minimal problems—nothing that is not manageable. They are most definitely not medicines. They are not used for the prevention or treatment of diseases. They are used as much safer alternatives to smoking.

The third proposition is market based. It is ridiculous and completely inappropriate to create a regulatory protection for the cigarette trade by banning a new technology competitor. There is no justification for protecting the incumbent highly harmful product from an insurgent uprising new technology with superior characteristics and much less harm to the user. Finally, my fourth proposition is that these products point the way to the future of ending the enormous burden of death and disease from smoking. A billion people are expected to die in the 21st century, on current trends worldwide. The normal way in which defective or poor technologies fade away is through the process of creative destruction—superior technology coming on the market through innovators coming up with something better that meets the needs of what people want to do but without killing or harming them. There is no reason why those processes should not work to get rid of the cigarettes and all the cancer, cardiovascular and respiratory disease that go along with it.

CHAIR: Mr Barnes, do you have a statement?

Mr Barnes: I have prepared a written statement. With the committee's indulgence, I would like to table it for the record—which also may save some time in exposition. I concur with what Professor Stimson and Mr Bates have just said. Effectively we are dealing with an innovation that is potentially much lower risk than existing combustible tobacco in cigarettes. We are talking about a way of improving people's health and saving lives, yet the way we approach regulation in the public health space in Australia, and in tobacco control in particular, seems to be to prohibit or ban first and to ask questions later. In the UK, on the other hand, they are taking the approach: 'Let's give e-cigarettes the benefit of the doubt. Let the evidence continue to be gathered, but give people access to them.' When you have government agencies and the National Health Service prepared to back them and to recommend them for quit-smoking programs, that is the complete antithesis of what is happening in Australia.

From a policy analysis point of view—I am not a scientist; I am a policy person—it seems to me that, in public health in general and in promoting the cause of harm reduction, we do not get proactive enough in embracing innovation, new technology and new ideas. We should not be afraid of these things; rather we should embrace them If we are talking about the balance of risk, I think letting smokers continue to expose themselves to killing risks through their continued smoking because they do not have easy access to alternatives is morally wrong, as well as wrong in a policy sense.

Another anomaly in Australian regulation in this space is schedule 7 of the Poisons Standard, where the only legally available avenue for nicotine, outside quit-smoking aids, is in 'tobacco prepared and packed for smoking.' If deadly cigarettes are readily available on the open market, why should a much lower risk product alternative to those cigarettes not be available in the open market as well? Again I think that is an example of overzealous regulation having got in the way of common sense.

Senator KETTER: Mr Barnes, are you familiar with the World Health Organization report of July 2014?

Mr Barnes: Yes, I am aware of it.

Senator KETTER: I note that that report observes that transnational tobacco companies have entered the market in this area. In fact each of those companies has an ENDS device, as they call it, on the market. Do you think that is cause for concern? I noticed you touched on that, but you seemed somewhat dismissive.

Mr Barnes: 'Dismissive' is probably not the right word, but I take your point. The way I see it, as I was trying to say in the submission, is that if big tobacco—if you want to call them that—want to enter new markets that ultimately get them out of deadly tobacco, I do not have a problem with that. Basically the free market can encourage change for the good. I do not see them as evil players in that sense—not at all. I think we must all continue to agree that smoking is bad, dangerous and deadly. Combustible tobacco cigarettes are therefore equally deadly and undesirable products in any market. Anything that reduces the rate of smoking is worth trying. Some interventions, like tobacco excise, are worse than others, but nonetheless we are wanting to get people off smoking. We want to give them an alternative. What I am arguing is that basically it should be on the open market and not simply as a quit aid.

Senator KETTER: There are some health risks with nicotine. It is not a completely benign substance.

Mr Barnes: Nothing is risk free.

Senator KETTER: Apart from its addictive component, there are the adverse effects during pregnancy, it might contribute to cardiovascular disease and, according to the WHO, it may function as a tumour promoter. I take the point about the chemicals that are involved in burning nicotine but it is not a particularly nice substance.

Mr Barnes: That is a fair point, but I think you also have to keep this in perspective. Having too much caffeine in your body can be no good for you. Caffeine is an addictive substance. Some have argued that nicotine on its own in moderate quantities, like caffeine, is probably no more harmful than caffeine. I think Shirley Cramer of the Royal Society for Public Health in the UK argued that last year. Anything used badly or excessively carries risk. Any product and any substance carries risk. It is a question of how great the risk in relation to the use is. We are talking about e-cigarettes containing nicotine. My sense—and I am not a scientist in the way that Professor Stimson is, and maybe he can elaborate a bit further—is that, provided that the liquid is secure and conforms to appropriate standards, it should be safe. I am not going to disagree that nicotine in itself is a harmful substance, but everything in moderation.

CHAIR: I also want to pursue this issue of the World Health Organization. Professor Stimson might be able to help with this. In your submission you say:

The World Health Organization estimates that there will still be over 2 million tobacco smokers in Australia a decade from now.

What assumptions did the WHO make in relation to the rate of the decline in smoking? Did they assume the steady decline that has been occurring now for several decades?

Prof. Stimson: The World Health Organization does projections for many countries based on the epidemiological data and extrapolates from that data to predict future rates of smoking. So, yes, the rate of smoking is declining in Australia, but the WHO estimation is that even a decade from now there will still be over two million tobacco smokers in Australia. If we accept that notion—or even if we accept that it will be smaller or greater—there will still be a substantial number of smokers who are at risk of ill health and early death through smoking. So that provides I think an imperative for making available a safer alternative for them

CHAIR: We have heard from other witnesses that the use of e-cigarettes is rising quite fast in the UK.

Prof. Stimson: Correct.

CHAIR: Are there any estimates as to the relative rates of smoking that might occur in the UK versus Australia under the two different regulatory approaches? Australia has a very prohibitive regime for e-cigarettes and the UK has a permissive regime. Is it possible to project what the smoking rates might be in the two countries?

Prof. Stimson: Adult prevalence of cigarette smoking in the UK is declining and has continued to decline in the period where e-cigarettes have become available. There are various estimates but it is probably around 18 to 19 per cent of the adult population now. Going back to about 2007, when e-cigarettes were introduced, it would have been around 20, 21 or 22 per cent. So we are seeing a continuing decline in cigarette smoking in the period in which e-cigarettes have been introduced. It is very hard to make a causal link between the two, but certainly the Office of National Statistics recent survey of e-cigarette use, as I said in my introduction, indicates there are 2.2 million people currently using e-cigarettes, and of those around 850,000 are no longer smoking. That is a huge number of smokers who have shifted from smoking to sole e-cigarette use. I think we have never really seen such switching from smoking so rapidly with any other intervention. Firstly, our trends in smoking are downwards. Secondly, there is good prima facie evidence that e-cigarettes are contributing to that decline.

CHAIR: Also, the suggestion has been made that the major tobacco companies would have a vested interest in the e-cigarette market not growing as fast as it might unless they were leaders in that field. The previous witnesses suggested that they are not. What is your perception on that from a UK perspective?

Prof. Stimson: In the UK we have a mixed market. Many of the original e-cigarettes were imported and distributed by small companies, some made in the UK. The trend in the last two to three years or so has been for major cigarette companies, tobacco companies, to move into the e-cigarette market, either buying up smaller companies or developing their own brands. British American Tobacco, for example, has invested substantial sums of money in scientific developments regarding R&D for e-cigarettes. I think that came about initially as a defensive response to e-cigarettes because tobacco volumes are continuing to decline and tobacco companies see that e-cigarettes are a competitor and want to take a share of that market.

Most tobacco companies now I think are interested in developing their own e-cigarette brands. I have mixed feelings about that. Certainly they can reach more people, they have better marketing clout and so on and so forth. On the downside, there is a question about how rapidly they will innovate and develop new products, because this has been a fast-moving field for innovation. Whether the tobacco companies will be able to keep up with that or even start to lead that I think is a good question. As Terry Barnes said, I do not see any problem in tobacco companies getting interested in selling alternative nicotine delivery systems. I think, 'Keep up the pressure on them to stop them selling tobacco cigarettes and encourage them to transform their businesses more into nicotine companies.' That would be, if you like, my vision for the next 10 to 20 years: seeing a transformation in these companies. They are not going to stop. They will not stop overnight selling cigarettes, but they need to be given every incentive to move into safer nicotine products.

CHAIR: What I want to pursue with each of you is that term you have just used, 'safer nicotine products'. There is a perception that nicotine is nicotine and equally dangerous no matter how it is obtained, and that is actually prompting a regulatory environment here in Australia that tends to treat e-cigarettes as equivalent to ordinary cigarettes. What can you tell us, for the benefit of the committee and to read into Hansard, about the relative hazards of smoking versus use of e-cigarettes with nicotine?

Mr Bates: I think the important thing to understand is that the nicotine is the reason—one of the main reasons—people smoke in the first place. It is a mildly psychoactive drug. You could call it addictive or dependence forming. But it is not the main source, by far, of the harm that is done to people that materialises in the form of cancer, cardiovascular disease, respiratory illness, stroke and all the other things—all the serious health damage and causes of premature death. Those who spoke earlier were right. It is not completely benign; it is not like tofu or something. It does have some health implications, but these are minor. The main role that nicotine plays in smoking and in e-cigarettes is in providing the psychoactive drug that people like to use.

The damage is done by the delivery system. In the case of cigarettes, this is particles of burning, smouldering tobacco that have all the products of combustion that you get if you burn organic material—and the hot toxic gases that are also products of combustion. It is the absorption of those into the lungs, into the body, that ultimately causes all the ill health. If you deliver the nicotine on a relatively benign substance like an aerosol of propylene glycol, there is nothing like the same degree of concern. Although people will say that we do not know what the long-term health implications of e-cigarettes versus smoking are—that is a kind of truism, almost a banality, to say; we cannot go forward 50 years into the future—we do have a lot of important information about what is in e-liquid vapour and what is in cigarette smoke. The difference between those two is that we know that most of the things that cause ill health that are present in cigarette smoke are either not present at all in e-cigarette vapour or are present at very much lower concentrations—two to three orders of magnitude lower.

On the basis of that, the main government public health agency in England has concluded that it is fair to say that, as a way of getting a handle on these relative risks, e-cigarettes are going to be of the order of 95 per cent less risky than smoking. What they are not saying is that they are 5 per cent as risky as smoking. They are saying that, even taking into account the unknowns and allowing for health effects we have not anticipated, that is a fair estimate. At the moment there is no evidence of any serious health concerns arising from e-cigarette use. So we are talking about something that is at least 95 per cent less dangerous than smoking—and probably closer to 100 per cent less dangerous, although we can never be sure.

CHAIR: Is the perception that e-cigarettes are just as dangerous as smoking common in the UK? My feeling is that it is relatively widespread here.

Mr Bates: It is more common than it ought to be and it is one of the reasons Public Health England put that number out. They were very concerned that people had misunderstandings about the relative risk. We had survey data showing that there were substantial numbers of smokers who really did not know, or who thought they were of equivalent risk. Given that reduced risk is one of the biggest selling points of these products—that is the important thing smokers get from this—for them not to understand means that more people would not be taking the decision to switch and therefore more people would be continuing to smoke and therefore more people would ultimately get sick and die from it. That perception—the perception that they are of equivalent risk—is completely false but is quite widespread. It is quite widespread for a number of reasons. There has been quite irresponsible commentary coming from a number of academics and there is a lot of media sensationalism. But the calmer, cooler heads in the expert community—certainly in the UK anyway—have coalesced around this figure of it being 95 per cent less risky than smoking.

CHAIR: Has the NHS helped to correct that perception of the relative harm of e-cigarettes compared with smoking?

Mr Bates: Yes, it has actually. The NHS has taken that on and has included it in its advice. In fact, just last month we had some new guidance, which has gone out to all the stop-smoking services, that embraces this concept, makes the point about there being much lower risk and essentially encourages the people who are professionally engaged in helping people quit—and these are people who are employed in the public sector; they are part of the NHS or local government—to use these figures and arguments and encourage people to try these products if they are struggling to quit smoking.

CHAIR: The people who do not like e-cigarettes argue the precautionary principle: we do not know enough about them; they have the same stuff as in cigarettes. What do you think of that argument?

Mr Bates: I think the precautionary principle here simply does not work. When you apply the precautionary principle you are supposed to look at the consequences of both action and inaction. If you ban something that is much safer than the product that is the market norm and you do that saying, 'Well, we don't know how dangerous it is; we'd better ban it,' the danger is that you just leave people to smoke. It is a kind of reckless precaution: you think you are being responsible and cautious but by denying people an option to move to a product that is much lower risk—because you are not absolutely sure it is lower risk, or you are not paying attention to what we do know but concentrating on what we do not know—you might actually be putting people in greater danger. The precautionary principle does not really fit at all well with that circumstance. It was originally developed for environmental decision making where you had an economic interest that would do some kind of irreversible damage to the environment. You cannot easily port that into a public health situation where there might be unintended consequences of your action that lead to more harm—that is, more smoking because people do not have the option to switch.

CHAIR: Mr Barnes and Mr Bates might like to contribute to this question. What sort of regulatory regime or government policy towards e-cigarettes would you recommend? That includes, say, their use in workplaces and public venues.

Mr Barnes: I think we should be regulating on the benign side. I am not a no-regulation person; I am a sensible regulation person. If we take it as given, on the basis of the weight of evidence to date and using the Public Health England criterion, that it is 95 per cent more safe than smoking, it seems to me that allowing people to vape as much as possible within the bounds of reason—and that includes community and social norms as much as any attempt to regulate—should be encouraged. It should not be discouraged. If we are talking about using public places, common sense should be the guide. In pubs and clubs, for instance, I think it should be at operator discretion and not mandated by law, taking into account the venue, the staff, the patrons and so forth and what their wishes are—as long as people are informed about the product and informed about the practice, know what it is all about and know what they are letting themselves in for.

Treating e-cigarettes as identical to tobacco cigarettes, given the balance of risk is almost certainly much lower, just seems to be counterintuitive in terms of the public policy aspects of this. It is encouraging people to think of them as bad. It is encouraging people to think that it is unwise to use them, yet we still legally condone the use of combustible tobacco cigarettes—with the deadly cocktail of chemicals and gases that that involves. To draw that together: make them available on the open market, do not treat them as a boutique quit-smoking-aid product, allow them to be used as widely as possible—including in public places—and allow community norms to govern some of that rather than hard regulation. I think there should be some reciprocity as well from vapers if they have the opportunity, and are given the opportunity, to vape in public. They should be mindful of others—of passive users and people around them—and show the basic consideration that all of us should show each other in society. That is far better than hard regulation.

Mr Bates: There are some definite things not to do with regulation. Do not do what is planned in the United States and regulate them as if they are tobacco products, using a framework that is designed to prevent innovation and essentially suppress the category completely. That is not helpful for e-cigarettes. They need innovation there. Do not use the approach that has been developed in the European Union, which is a set of arbitrary compromises that were agreed to in haste after failing to agree to regulate the products as medicines. Do not regulate as medicines, which is the Australian and Canadian approach.

The way to do it is to come up with a scheme of regulation that provides consumer confidence and gets rid of rogue products and cowboy operators, but is not so aversive that it creates high regulatory barriers to entry that basically distort the industry and make more of the products and firms unviable, until ultimately you have only the tobacco companies standing, where they have the deep pockets needed to clamber over the regulatory hurdles. I suggest that the way to do that is to have a series of standards that you set for product design and for liquid quality—that you require pharmaceutical-grade substances and food-grade flavourings; that you concern yourself with the electrical and thermal safety of the devices; and that you have labelling that is meaningful to consumers and provides them with useful information, not necessarily to scare them, but perhaps to advise on the relative risk of these products compared to smoking, which is actually useful consumer information. Also, have information on what to do if something goes wrong—where to get help and things like that. Then there are some protective things. You would have child-resistant caps on the e-liquid bottles. You would try to make sure that the integrity of everything that was sold was of a high quality.

If you do that, you are actually strengthening your market. You are building confidence and you are making people who might be risk-averse about trying something that is an alternative to smoking—paradoxically—more confident to use these products and invest in them. At the same time, you are creating a stable framework for the companies to develop new products and to innovate without feeling that the regulatory system has been designed mainly to put them out of business.

Prof. Stimson: I would reiterate much of what has been said. Firstly, do not ban, or do not pursue bans. Some countries are introducing bans, but to do that you then lose all ability to control standards and guarantee consumer safety. Do not regulate them as medicines. It is very cumbersome, lengthy, costly and anti-innovative, and in fact they are not being used as medicines. One of their attractions is that they are not medicines. You talk to vapers, and some of them say to you, 'Well, for the first time, stopping smoking is kind of interesting. It is almost enjoyable.' It is enjoyable. Whereas the medical approach to the treatment of cigarette smoking makes life a little bit of a misery. Do not regulate as tobacco products under tobacco control frameworks. It is completely wrong because tobacco control seeks to limit or prohibit use, whereas in the case of e-cigarettes we need to encourage use by smokers. I think all of the issues that people might be concerned about concerning e-cigarettes can be picked off by good product standards.

There is already some experience of that in the UK. There is the British Standards Institution standard. From France there is a French standard. Then there is the start of a process to develop a European standard for e-cigarettes which will assure consumers of safety and quality. Things like advertising—there should be advertising. One of the problems in the UK is that in the EU, under the Tobacco Products Directive, there is a major ban on most forms of advertising; but if a product is safer than cigarettes, you need to tell people that it is available so do not restrict advertising.

Do not have unnecessary controls over 'vaping' in public places. That is not a matter for the law. That is easily dealt with by managers of premises and by good etiquette and good behaviour on the part of e-cigarette users. There are a number of standards and regulatory options which are light touch. Do not do anything which is going to make it harder to obtain e-cigarettes than it is to obtain their major competitor, which is tobacco cigarettes.

Mr Barnes: It is good to know that I am in furious agreement with my colleagues. The one area where I think there should be hard regulation, without question, is in relation to the sale and marketing of e-cigarettes to minors. I think we do have to treat these products as adult products and make sure that everything— advertising, marketing, point of sale and sale itself—is focused on people over the age of 18.

CHAIR: The reality is that nearly every smoker starts smoking well under 18 years of age. They get access to cigarettes, notwithstanding the fact that it is it legal to sell them to anyone under 18. So do we want under-18-year-olds, 16- or 15-year-olds to start smoking? Do we want them to quit as well?

Mr Barnes: Well, we do not want—

CHAIR: The idea of not having them start in the first place is not all that successful.

Mr Barnes: I take your point. I think we do not want kids to start smoking full stop.

CHAIR: I agree with that.

Mr Barnes: I do take your point about how minors get access and start to experiment and, if you like, are recruited to the market. But what I am saying is I do not think, as a point of policy, that any direct recruiting should take place, that we should not be encouraging or condoning the marketing of these products, as with tobacco, to children. We actually want them to not get involved in the first place. Where these products are of most benefits are to established smokers who are looking for alternatives. I think we need to make the starting assumption we are talking about adult smokers who are legally able to make those choices.

CHAIR: This poses the question that I was getting to. One of the arguments of those who do not like e-cigarettes is that it recruits people into smoking or consumption of nicotine and then ultimately into smoking where they would not otherwise do so. The public Health England submission we have received suggests that does not occur, virtually never. I think what you are suggesting implies that that is a possibility.

Mr Barnes: Yes, I think it is.

CHAIR: Is it such a big risk that it warrants restricting advertising and marketing to under-18s who might already be smoking?

Mr Barnes: That is very good point and maybe my scientific colleague—or Gerry Stimson might be a good one to elaborate on it. What I am arguing is that we cannot control everybody's behaviour but we can direct elements of sales and marketing behaviour in an appropriate direction. What happens beyond that is a matter for individuals. You cannot control the supply chain all the way down, in this case. But I think there is a good public policy case to focus purely on the adult market in terms of that side of things.

CHAIR: Professor Stimson, I might bring you in to this here, if you have any comments on this general issue of under 18s, but there is also a comment that I am going to read out from the submission by the Royal Australasian College of Physicians, who are relatively enthusiastic about restricting e-cigarettes, shall we say. They are 'concerned that e-cigarettes are designed to replicate and reinforce hand-to-mouth smoking behaviour', and they also argue that:

E-cigarettes can … appear especially novel—leading to the recruitment of users who would not otherwise pick up the habit. This has been observed in the US and Poland in relation to nicotine e-cigarettes, where uptake amongst adolescents who have never previously smoked has more than tripled between 2010-11 and 2013-14

Can you offer any comments on all of that?

Prof. Stimson: There are a number of areas there and I can comment on some of them. I think Clive Bates may be able to comment on some of them as well. If I can point first to the UK, the main uptake of e-cigarettes has been by adults and amongst people who are already smokers. The uptake or the trying of e-cigarettes by young people is negligible; it is less than one per cent. So we are not seeing the uptake of e-cigarettes by young people in the UK. I am not so familiar with the Polish data. With the US data, certainly young people try things and you have to look carefully when you are looking at the US data to work out what they are measuring. The problem is that in many of the surveys they have been counting as use any use in the last 30 days or any use in the last year, so you are picking up a lot of tryers. Certainly the level of trying e-cigarettes in the US has been rising, but also, at the same time, there has been a dramatic reduction in the level of cigarette smoking amongst young people. So we have to tease apart exactly what is going on there.

To return to the earlier discussion between the senators, I think there is a bit of a quandary about what should be the policy on the age of sale, because it is quite clear that most people start smoking before the age of 18. Theoretically, if e-cigarettes provided some protection against smoking I think we might be having a debate about their availability to the under 18's, but it is certainly a quandary. It is a quandary in other areas of public health: sexual behaviour does not start at the age of majority, so what do you do about contraception below the age of majority? I think we all know the answer to those sorts of questions. We are moving into new areas here for which we do not have clear answers, but, at the end of the day, harm reduction does not begin at 18. I agree about the complexity of the issues that are being raised, and I do not have a clear answer to that question about age limits. Certainly, e-cigarette companies are not targeting young people. If they have been, they have been remarkably unsuccessful, because of the very low uptake.

CHAIR: Mr Bates, I wonder if you could describe for the committee an account of the Van Heerden case in Western Australia? You have outlined it in your submission, but perhaps you could give us further details.

Mr Bates: I have not seen the legal aspects in detail, but, essentially, he was arrested for selling e-cigarettes using a piece of law that was designed to stop people selling, effectively, toy cigarettes or candy cigarettes. It was felt that that type of product was designed to coach really young people—I am talking about real children—in how to smoke. There are a number of laws on the statute book but they were never intended to prevent a vape shop selling e-cigarettes, which are not cigarettes but look like cigarettes, to adults, which is what they were doing and what he has been basically arrested for. He was charged and found guilty and he has gone through a series of appeals. With the final appeal—I think it is a Supreme Court appeal—we should hear the verdict on Thursday this week, on the 10th.

To me, it is an absolutely ridiculous, abusive use of public health legislation. It was clearly never intended for that. It has been used opportunistically and in a bullying way by the authorities in Western Australia to have a go at him. It is deplorable, in my view. I hope he succeeds and I hope they have to pay his costs and some damages. They would have put him out of business if he had not had a lot of worldwide support for his case.

Mr Barnes: I think it is worth noting too that the van Heerden case reflects the zealousness of the tobacco control bureaucracy in Western Australia. For whatever reason, the officials in that state seem to take their role in this area very seriously. I think that is reflected in government policy in Western Australia regardless of whether it is a Labor or a coalition government. It is interesting, actually, that a week or so ago that same bureaucratic unit attempted to shut down a pub in Perth because it had antique tobacco posters on its walls for Player's Navy Cut, a product that has not been on the market for 60 years or more. It was simply because it related to tobacco. I think the Minister for Health in Western Australia actually put a lid on that. Nonetheless, this is the type of over enthusiasm in compliance and enforcement that is intruding into the way that policy is being made about e-cigarettes in Australia.

CHAIR: Finally, Mr Barnes, the Intergovernmental Committee on Drugs' review of e-cigarettes is being conducted by the University of Sydney. Could you describe that for the committee please?

Mr Barnes: The ministerial standing committee commissioned a policy review in this space, which was contracted to the School of Public Health. I would love to tell you more about it, I really would, but it has been happening in one way or another for the best part of a year now and it still has not seen the light of day. I would think it is in the public interest, as well as in the interest of the governments that commissioned it, to actually have it out there for consultation, debate and discussion. I cannot tell you what is in it. I have not been consulted. Many people in the tobacco control space have not been consulted, let alone consumers.

Just quickly, what has happened while this process, which is supposed to be a national process, has been running is that states such as Queensland and, more recently, New South Wales have gone ahead with their own regulatory decisions and implemented them. If it is supposed to be informing legislation and regulation, it seems to be doing nothing of the sort.

CHAIR: Which minister was responsible for the review in the first place?

Mr Barnes: It would have been Senator Nash, as the minister for public health. I understand she still has it as part of her new portfolio responsibilities.

CHAIR: Okay. I think we might leave it there, unless you think we are missing any compelling points, Mr Bates or Professor Stimson?

Mr Bates: I just have a couple of very quick ones. You mentioned Poland. The concern about Poland came from a very strange, one-off study. The official data shows Polish smoking rates among young people falling at a faster rate than ever between 2013 and 2015. We have a corrective to that. One final thing is that an American economist studied different states that had either banned or not banned e-cigarette sales to under-18s and found that the states where e-cigarette sales to under-18s were not banned had a more rapid decline in smoking. That is Abigail Friedman's paper, which you can look up on the internet or I can send to you. An interesting continuation I think of the point that was being made earlier is that one has to be careful about denying young people access to these when they might otherwise be smoking.

CHAIR: A more rapid decline of smoking amongst young people where e-cigarettes were available to young people—is that what you are saying?

Mr Bates: That is what the findings were, yes. I can send over the summary of that study.

CHAIR: Yes, if you would. Just for the Hansard—so that we can put it into evidence—what is the name of the author?

Mr Bates: The author is Abigail Friedman, or Friedman AS. The paper is 'How does electronic cigarette access affect adolescent smoking?' The paper was published in the Journal of Health Economics in 2015.

 

CHAIR: Thank you very much. If you could just shoot it across to us it would be very helpful.

Mr Barnes: Finally, if I may I would just like to put a quote into the record. It is:

I think we do need to be guided by the experts. We should look at the report from Public Health England but it is promising the see that over all, one million people are estimated to have used e-cigarettes to help them quit or have replaced smoking with e-cigarettes completely. So I think we should be making clear that this is a very legitimate path for many people to improve their health and the health of the nation.

I just want to point out that I did not say that; that was the PrimeMinister of the UK, David Cameron.

CHAIR: A good note to end on! Thank you very much.