Despite concerns expressed by many in the public health community, e-cigarette makers have for the first time been allowed to show them being used in television adverts in the UK. The first was broadcast last night.
This is only temporary. In two years, the European Union's Tobacco Products Directive will make such adverts illegal. However, in the meantime, the rule change by the UK's Advertising Standards Authority allowed an opportunity for e-cigarette manufacturers – which now include all the major tobacco companies – to show that they could be socially responsible. They have blown this opportunity.
The advertisement, shown on ITV, starts with an attractive young woman running her hand over her tight black dress as she tells viewers: "You know that feeling you get when something's great. You can touch it, hold it, even see it. Well, now you can taste it." Then, just like in the 1950s movies when a sultry temptress blew smoke into the air, she exhales a white cloud of nicotine-laden vapour.
Usual tactics
To anyone who has been studying the marketing of e-cigarettes in the US, this similarity with older cigarette promotions is hardly surprising. The US organisation Tobacco Free Kids has identified seven ways that manufacturers are replicating the tactics that were so successful in recruiting generations of young smokers, such as the use of sex, rugged men and glamorous women. A US Senate report condemned these manufacturers for their aggressive promotions directed at young people.
But what does it matter? Surely if, as the advocates of e-cigarettes argue, these products are a game changer in the war against tobacco, then we should be promoting them, using any tools at our disposal? Unfortunately, it is not quite so simple.
First, although there are many anecdotes from smokers who claim that e-cigarettes – properly known as electronic nicotine delivery systems – have helped them quit, so far no one has been able to show that they are more effective than nicotine replacement therapy, itself not very effective as a quitting aid. Second, there are many questions about their safety.
Here it is essential to recall one simple fact. The companies promoting these products so aggressively are not doing so on the grounds that smokers will use them for 10 to 12 weeks as a means of withdrawing altogether from nicotine. Why would they? It would be very difficult to justify the sums being invested in marketing on that basis.
Instead, they see them as products that people might use for 30 to 40 years. For such long-term use, the concerns about toxicity are quite different. They include growing evidence that nicotine promotes tumour growth.
Appealing to kids
Second, manufacturers use a wide range of flavourings, such as peach, candy floss, and even Gummy Bear, that seem designed to appeal to children. However, while humans have evolved defence mechanisms in their guts and livers to eliminate toxins from foods over many millennia, these products have never been inhaled over decades.
Third, there is increasing evidence that the ultrafine particles released in e-cigarettes may have adverse consequences for the cardiovascular system. For these reasons, a wide range of medical and public health bodies, including the World Health Organization, have expressed serious concern about their promotion.
But what are the advertisements really promoting? Is it e-cigarettes, traditional cigarettes, or both? VIP, the company that made the first advertisement under the new code was itself unsure, describing it in a now deleted tweet as the first "smoking (sic) advert to be shown for half a century".
As the US group Smoke Free Movies has shown, imagery of smoking, or something that looks like it, is incredibly powerful in promoting youth smoking. Given the growing presence of the tobacco companies in the e-cigarette market, do we really believe they want to close down their main business?
Profile: Martin McKee is a professor of European public health at the London School of Hygiene and Tropical Medicine
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