Anyone who knows me well understands that I hate tobacco and the tobacco industry, Thirty years in the operating room, seeing the damage tobacco does to the human body should do that to anyone. People talk about the 45,000 Canadians that die every year from tobacco, but they often fail to mention how much they suffer before they die. It is tough to watch someone try to breathe after a lung has been removed or to see an elderly lady come back for a more aggressive amputation after a previous one failed to heal.

So I will support anything that I think will reduce smoking, from arresting tobacco CEOs for manslaughter to reducing the number of retail stores until every smoker has to walk a mile to buy a pack of smokes. At present, I am advocating for vaping. I think that this new disruptive technology could do for tobacco what Netflix did for Blockbuster – completely replace it with a better, cheaper and more convenient alternative.

I have two groups of friends who share my enthusiasm for getting smokers to quit.

There are the members of the “medical establishment”, for want of a better word, represented by the good, dedicated and hard-working physicians, researchers and policy analysts who I met recently at the 12th Annual Ottawa conference for the Ottawa Model for Smoking Cessation.

And there is the “Vaping Advocacy” groups, represented on this occasion by Rights4Vapers but also by organizations such as Vaping Advocacy and Education Project.

These two groups share many of the same beliefs:

• The tobacco industry is an evil organization which willfuly and knowingly continues to promote the use of a product known to be deadly.
• Smoking is the #1 cause of preventable deaths in Canada.
• The best thing smokers can do for their health is to quit smoking completely.
• Smokers who have quit should be discouraged from lapsing back into smoking.
• Vaping is significantly less dangerous than smoking.
• Vaping with support has been proven to be more effective at achieving smoking cessation than standard nicotine replacement therapy.
• Non-smokers should not vape.
• Vaping product should be regulated.
• Selling vaping products to people under the legal age limit is a crime. Age limits should be enforced.
• Vaping equipment should not be sold in convenience stores and at gas stations.
• Vaping should not be publicly advertised. Advertising should be restricted to in-store advertising in age-restricted stores, information provided in medical environments such as physicians’ office, stop smoking clinics, pharmacies, and inserts in cigarette packages.
• E-cigarettes and vape juice should be made to the highest standards of safety based on best available knowledge.
• There should be ongoing research and monitoring about the safety of e-cigarettes and the most effective ways to use them for smoking cessation.

I think most people in both my groups of “tobacco friends” would agree with all these fourteen points. They could then have a healthy discussion about flavours, about nicotine concentration and about how to avoid “dual use” of vaping and tobacco.

But that is not happpening. Instead, we had a group of vapers invading the lunch break at the conference and a “flame war” on Twitter. The vapers were upset that the conference, which was partly funded by “Big Pharma”, had a controversial academic for their keynote speaker.  Prescriptions for anti-smoking medications dropped by 70% when e-cigarettes became available in the England, so companies like Johnson and Johnson and Pfizer probably do not want to see e-cigarettes become a popular way to quit in other countries. They would have been pleased that this conference gave such prominence to a speaker who is strongly oppossed to vaping.However, invading a private meeting and taking over the OMSC2020 hash tag are not the right way to promote fruitful dialogue.

Twitter “Flame War” at OMSC

I think that vape shop owners and tobacco cessation professionals have enough common goals that they should work together. Given that an estimated 4.6 million Canadians have tried vaping, and that vaping is used by 32% of people trying to quit, smoking cesstion professionals can hardly ignore vapers.

What could co-operation look like?

At the 2020 Ottawa Conference many people enjoyed hearing from three real people who had quit smoking using traditional and established techniques. Maybe next year they could hear from a group of people who were unable to quit using traditional methods, but have succeeded by vaping? We also heard about the efforts to get one patient, “Jonathon” to quit, maybe we could hear about someone else whose quit journey ended in vaping?

In a break-out session we heard from a pharmacist about how pharmacists are trying to establish uniform smoking cessation policies for pharmacies across Canada. Maybe next year we could hear from a vape shop owner about how they assess and manage a smoker who comes to them for advice about quitting? 

If you are a stop smoking professional, and you will have many smokers who still smoke after all your best efforts with NRT and drugs. What can you tell them about vaping?  Can you give any useful advice about products, nicotine concentrations, mods v pods, refillable  v  non-refillable, nic salts v traditional nicotine, artificial flavours v naural flavours? MTL v DTL?  PG/VG ratios? Maybe a break-out session with a vape shop owner and some hands-on time with a JUUL, a Smok, a Vype  a Vapresso and a Puff Bar would help. Mabe some adventurous souls would step outside and try the famous “Unicorn Puke” (A perfect blend of warm summer days with a scoop of rainbow sherbet, Unicorn Puke is for those who love something fun and fruity with a kick. ) while debating what flavours adult smokers really like. 

Vape store owners and researchers need to work together. For example, I hope to be working with some vape shops and Dr. Polosa to recruit vapers for a long-term study of lung function in vapers. People doing vaping experiments need advice from an experienced vaper to ensure that they are using vaping products in a way which reflects the actual useage of real vapers. 

But we could go way further than that. I amagine a future in which smoking cesation clinics have a vape store owner on site to help smokers get the best results from vaping. I also want to see things go the other way, and have trained smoking cessation counsellor see clients in vape shops. Properly trained vape shop owners could become powerful allies in the war against smoking. In France there is a course for vape shop staff who want to learn about smoking cessation. They get an accreditation sticker thay can put in their window as advertising.

Vape shop owners and quit smoking professionals can agree that, for some smokers, vaping with support is their best chance of quitting. Each group has its own sort of expertise and experience. The product knowledge of vape store owners is incredible. Their lived experience with smoking and vaping gives them “street credibility”. Their attire, tattoos and body piercings make many smokers feel they are “at home” with someone like themselves.  Professionals have a knowledge of anatomy, physiology and pharmacology. They have read (or maybe even written) the scientific literature. They have portable CO monitors and pulse oximeters, and access to lab testing. Just imagine what the two groups could achieve together!!!

It will not be easy. There is, for want of a better word, a huge class division. Professionals have more academic education, and time spent in professional training makes them fit in with a middle class elite, even if they were not born into it. They can come across as superior, arrogant or dogmatic. Vape shop owners have very variable backgrounds. The only common denominator is that they almost all were smokers who are passionate about vaping because they believe that vaping saved their lives (and they are probably right). They have enough smarts to run a business and they have great customer service skills. Some of them lack “polish”. They feel they are outside the establishment. Many feel aggrieved, marginalised and unheard, so they can come across as strident.

Their is an inspiring podcast called “Conversations with People Who Hate Me“. It is amazing how often people who fight each other online, can agree on some issues when they talk together. I would love to arrange for some smoking cessation professionals and some vapers to sit down for coffee together, to go to each others workplaces, maybe even to sit in as they each see their own clients. I think both sides have nothing to lose and they, and the smokers we all want to help, have a great deal they could gain. Any takers?