A Rose by Any Other Name - Foundation for a Smoke-Free World

A Rose by Any Other Name

What's in a name text overlaid on an image of a rose and a vaping device.

In recent years, various parties have endeavored to name and rename what the majority of consumers call “e-cigarettes.” Most notably, the World Health Organization (WHO) has rechristened these products “Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems” (ENDS/ENNDS). Below, I describe the confusion caused by such renaming efforts—and why it matters.

Name confusion

The term “e-cigarette” was coined 14 years ago when nicotine vaporizers were first invented. The hope was that this name would encourage cigarette smokers to feel more comfortable with these new-fangled devices. Since then, however, many tobacco harm reduction (THR) consumers and advocates have soured on the term. Many now feel that it is too close to “cigarettes,” causing public confusion by invoking inaccurate harm comparisons.

 “ENDS” (electronic nicotine delivery systems) first appeared in a 2010 WHO technical report. At first glance, the name doesn’t stink. It could imply ending smoking, which would be a good thing. But ENDS was coined by an organization that is fiercely opposed to THR.

The compound term “ENDS/ENNDS” surfaced in a 2014 Report of the 6th session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control. Presumably, “ENNDS” (electronic non-nicotine delivery systems) was spliced onto “ENDS” to include nicotine-free e-liquids. The WHO definition states: “ENDS/ENNDS heat a solution (e-liquid) to create an aerosol.” By this definition, “ENNDS” include THC vaping devices, aromatherapy and anti-mosquito vaporizers.

Other names coined over the past few years by researchers include “alternative nicotine delivery systems (ANDS),” “vaporized nicotine products (VNPs),” and “non‐medicinal nicotine delivery systems (NMNDS).” All of these names demonstrate a lack of contact and empathy with the people who use these devices. As THR researcher Carl Phillips noted, such linguistic impositions dehumanize users by “refusing to use the culture’s own vocabulary for itself.” 

This name debate is far more than a matter of superficial preference. A rose by any other name may smell as sweet, but an abundance of awkward nomenclature adds malodorous confusion to an already-confused public health debate over THR.

Confusion not nipped in the bud

In June of 2020, the WHO’s EURO office issued a new brief on “ENDS/ENNDS” stating: “There is conclusive evidence: Completely substituting electronic nicotine and non-nicotine delivery systems for combustible tobacco cigarettes reduces users’ exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes.”

Yet, the WHO recently applauded India and Mexico for banning nicotine vaping entirely; and its recommendations to members states on “ENDS/ENNDS” are decidedly negative. If the WHO cannot arrive at a consistent position on THR, it could, at the very least, use less confusing language.

End the name games

The ideal name for a new thing should describe what it is, what it is not, and what it does. It should be embraced – or at least embraceable – by people who use the new thing. And it should not be imposed on users by groups that are deeply skeptical about it. Finally, the name should not be a mouthful. ENDS/ENNDS fails miserably on all of these measures.

I have argued previously that the clearest and simplest term is “nicotine vaporizer,” or “nicotine vape.” This allows us to distinguish nicotine vapes from “THC vapes,” which are actually different devices (different heating coils, temperatures, and liquids). However, even this term fails to meet some of my criteria for an ideal name. It does not convey what they are (safer) or what they do (help smokers quit).

Recently, a new term, “safer nicotine products” (SNPs) appeared in the Global State of Tobacco Harm Reduction. Based on the criteria suggested above, this is a useful term. However, it is far broader than “ENDS” or “e-cigarette.” SNPs include nicotine patches and gum, prescription inhalers, nicotine vaporizers (“e-cigarettes”), and smokeless tobacco products (e.g., snus).

The stakes in this name game are rather high (7 million preventable deaths per year). A growing number of scientific and public health organizations agree that nicotine vaping is vastly safer than smoking and helps smokers quit.  So, it would be nice if we could at least get the name right.

The need to listen and learn

That will only happen when THR skeptics begin to listen – empathetically and respectfully – to ex-smokers who have quit by switching to safer nicotine products. Ex-smokers deserve a seat at the table in decisions affecting not only names, but research priorities, regulations, taxes, and bans that affect them.  This imperative is consistent with the “ETHRA Manifesto.”  Human rights and lives are not a game.

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