Letter to Professor Ashton

Dear Professor Ashton,

On Friday eight highly respected, credible, and independent public health and tobacco addiction experts, including Professor Ann McNeill, Professor Peter Hajek, and Professor Robert West, wrote in the journal Addiction expressing their concerns about the recently published WHO commissioned review of evidence on e-cigarettes. These experts did not state that e-cigarettes were 100 per cent safe; they simply stated that the WHO review contains important errors, misinterpretations and misrepresentations and that as a consequence the WHO could be putting policy-makers and the public in danger of foregoing the potential public health benefits of e-cigarettes.

Following the Addiction report you, in your capacity as President of the UK’s Faculty of Public Health, took part in at least two BBC radio debates, one with Professor Robert West and one with the former head of ASH Clive Bates. It is fair to say that these were rather ill mannered debates on your part. Whilst Professor West focussed on actual evidenced based facts, you preferred to highlight your concerns for which in many instances there was little or no evidence. In your debate with Mr Bates you even went as far as to say nicotine made people go blind and despite repeated requests from the interviewer you were unable to provide a single piece of evidence to back up this statement.

Over the weekend you then engaged with a number of e-cigarette users (vapers) on Twitter. We were not engaged in any of these exchanges but we have seen the tweets (see attached). Whilst you may have been subjected to a number of antagonistic tweets, which we would not condone, there can be no excuse for some of the language you used in your own tweets. Nor can there be any excuse for searching through Twitter to find tweets that vapers had posted weeks or months earlier and then to insult them. I include below a selection of your tweets.

“What do you call an unfettered, anonymous abusive apologist for the e-cig tobacco complex? A coward”

“I think I have identified a new species of human being this week. Obsessive compulsive abusive onanist with ecig tendencies”

“Have you always been an anonymous c..t or do you occasionally have a smudge on (sic) of personality and a human identity?”

“These abusive ecig people remind me of the lads who used to play with themselves behind the bike sheds at school”

“They (e-cig users/ supporters) are even more pathetic than that. Need ecigs to get aroused”

“Why are most of these ecig trolls anonymous? Are they just completely pathetic or pawns of Big Tobacco?”

You clearly realise how damaging these tweets are, not just to you, but also to the Faculty of Public Health, as you spent some time deleting the more abusive tweets from your twitter feed. As we have written, we do not condone any abusive tweets that you may have received, but you are the professional, the head of the Faculty of Public Health. You are the one appearing in the news and debating on national television and radio. You are the one who heads up a body that should make pronouncements based on evidence based research. It is clear from these tweets and by your increasingly alarmist pronouncements on the radio that you do not have much time for e-cigarettes and certainly no time for the vapers who rely on them to prevent them going back to smoking tobacco cigarettes.

In the radio debates and in your engagement on Twitter you have made clear that you are biased against e-cigarettes and vapers and that your position is not based on an objective review of all the available facts. How therefore can you speak openly on this issue again? Whilst you remain as its president it will also be impossible for the Faculty of Public Health to speak on this issue without anyone raising the question of bias. This is hugely disappointing. As a campaign representing e-cigarette users, their friends, and their families we have no interest in a purely one-sided debate in which only pro-e-cigarette people are allowed to speak. We want a wide-ranging debate with all arguments expressed and robustly debated. In your actions over the last few days you have made this more difficult. It would therefore be better for all concerned if you did the decent thing and stepped down from your position as President of the Faculty of Public Health as you have clearly brought both the position and the wider organisation into disrepute.

We will be publishing this letter on our website and copying it to the Secretary of State for Health.

Yours Sincerely,
Save E-cigs

Tweets from Prof Ashton

Why we feel we are left with no option but to place our contentions in front of the judiciary.

Guest post from Fraser Cropper, CEO of Totally Wicked.

Judiciary

 

Totally Wicked, as some readers may be aware, has filed a challenge against the Tobacco Products Directive (TPD), and I want to take this opportunity on the Save e cigs blog to explain a little more about what we have done and why we feel we are left with no option but to place our contentions in front of the judiciary.

Firstly we haven’t taken the decision to challenge the TPD lightly, and we would not have undertaken this if we didn’t believe that a) we are doing the right thing, and b) that we have what we believe to be a solid case.

Our legal challenge is essentially questioning why the TPD mandates that e- cigarette laws should be stricter than tobacco laws. Article 20, the article that relates specifically to electronic cigarettes, to our mind represents a disproportionate impediment to the free movement of goods and the free provision of services. It places electronic cigarettes at an unjustified competitive disadvantage to tobacco products; it fails to comply with the general EU principle of equality, and breaches the fundamental rights of electronic cigarette manufacturers.

Therefore as a company are asking that the EU courts consider the TPD and pass its objective judgement on the regulatory framework that the TPD has delivered.

Article 20 will place unnecessary burdens on the industry, while at the same time completely ignoring the core needs of the user, those of diversity of product range, varying nicotine strengths and a vibrant community to encourage and support. All of these will be removed by the TPD.

We want all consumers to have enough information to make a judged decision and make sure that quality is of a standard that is acceptable. We want regulation that protects customers from ingredients and product deficiencies that could cause them harm, and this can easily be achieved through regulation that is proportionate, that gives the sector the justifiable opportunity it needs to have to give people a realistic option other than conventional cigarettes.

There is enough compelling evidence and research that proves e cigarettes are hundreds of time safer than conventional cigarettes, so our basic premise is this:why should our product be placed under greater regulatory constraint than a product that has killed many hundreds of thousands of people, and continues to do so? Where is the regulation that reflects the value these products are bringing? 2.5. million users in the UK have independently chosen to use e cigs, but nowhere in the TPD is the transformational potential recognised and engaged constructively.

It is a fallacy to suggest there is no ability for the government to affect the necessary controls, because there absolutely is enough control within the consumer regulations to suitably regulate electronic cigarettes, however the government have not chosen to utilise them. There are problems; there are imports that are not acceptable, yet the current regulatory environment could do away with them, if there was a will. Instead the TPD instructs disproportionate regulation that will significantly adversely affect a creative and paradigm changing nascent industry that deserves to be supported.

We want to grow as a business, we are an ethical company, we employ over 150 people directly and many hundreds more through our reselling base, but we have an illegitimate threat hanging over us. We are in the process of opening a new fluid production facility here in the UK that will provide jobs, and produce e liquid of the highest quality and standards, yet we have no idea how the TPD will impact this.

We are optimistic about the hearing in the Administrative courts on the 6th October, we expect to be heard in the CJEU next year, and we very much hope that the outcome will be a Tobacco Products Directive that reflects the reality of e cigarettes, the value they are providing, has them in a context that reflects the users needs and ultimately lets us get on with running our business – one of selling excellent quality products that have transformed many thousands of users’ lives.

 

 

 

 

Totally Wicked to challenge Article 20 of the TPD – a vaper’s view

In June 2013, when the UK MHRA announced that e-cigarettes would be regulated as medicines, the idea that anyone was going to destroy the very industry that had provided me, and millions of others, with an attractive and very much safer alternative to smoking, jarred me into action – and so I found myself in the increasingly frustrating world of consumer based vaping advocacy.

I had never been an advocate for or against anything much before and so found myself pretty much out of my depth most of the time. Public Health ‘science’ relies a lot on epidemiology and nebulous concepts such as gateway theory and the precautionary principle, and I quickly learnt that it is a field full of people who, not content with simply presenting the results of their studies, proffer political solutions to their perceived, and often contrived ‘problems’ as well. And more than that – there are those who, because of the letters behind their names, seem to be permanent invitees to comment on both press articles and TV and radio coverage, and who think nothing of using their twisted analyses of those studies to further their own political agenda. They never seem to consider the inherent risks to current vapers and smokers who may have switched in future in the event that their political aspirations were to be successful.

It was against this background that vapers in their thousands signed petitions and wrote to their MEPs in the latter part of last year. The European Commission, presumably at the behest of the governments which make up the Council (who in turn take their advice from the aforementioned Public Health lobbyists), had produced draft legislation which, if passed, would have required the Parties to regulate e-cigarettes as medicines (article 18 applied to e-cigarettes and later emerged as article 20). Article 18 was defeated in the European Parliament in December 2013, when MEPs, having listened to their constituents, voted for amendments which would allow most e-cigarettes to be regulated as consumer products. Unfortunately, during the ridiculously undemocratic (but leaky) process of ‘trialogue’ further amendments were agreed (now in article 20) which were basically a total compromise.

But compromise is rarely the right answer when you are talking about the health and right to chose of millions of people. What of those whose preferences are excluded by the arbitrary and restrictive measures of article 20 of the TPD? What about those businesses which will disappear, not because their products are sub standard or dangerous, but simply because they lack the resources to comply with the utterly disproportionate reporting requirements? What are they, just collateral damage? And if so, who are the beneficiaries of their loss? There is only one answer to the latter question – the tobacco industry, whose core product is not subject to anything like the same barriers to market and who as a result will welcome the return of many vapers to smoking with open arms.

The regulation of e-cigarettes could have been so much better. They are neither a medicine nor a tobacco product and framing them in the context of either was a mistake. Bespoke regulation could have had the effect of improving quality, raising awareness of the safer choice, providing a good level of information and confidence to the consumer and weeding out the cowboys whilst regulating marketing proportionately. Instead we have a mish mash of arbitrary limits and reporting requirements which will do no more than stifle innovation, limit consumer choice for no reason and ultimately inhibit the very appeal that has lead 2 million people in the UK alone to make the switch. The tobacco industry must have breathed a collective sigh of relief.

Consumers have been making these arguments for a very long time. So have the e-cigarette industry, however in the Public Health arena they are persona non grata. In the minds of some in the Public Health world it is simply not possible to be in business and at the same time care about the health and well being of your customers. Based on past performance this may be true of the tobacco industry, and it is true that that industry has recently bought in to the cigalike sector, however the TPD will barely affect their products. It will however decimate the refillable tank sector. Strange then, that that is the very sector that provides the products which most total switchers use and is comprised almost exclusively of companies independent of the tobacco industry.

Last week large independent e-cigarette company Totally Wicked leapt into the arena with the announcement of their legal challenge to article 20 of the TPD. Totally Wicked have long been a company that is not afraid of taking the bull by the horns, and certainly doesn’t shy from controversy, sometimes to their own detriment. Here is their press release: Totally Wicked Formally Challenges Tobacco Products Directive

This move has upped the anti to a very large extent. On the one hand, if they are successful it could be back to the drawing board for e-cigarette regulation in Europe; but on the other, if they fail, things could be made very much more difficult for any future challenges. If Totally Wicked succeed governments could take the opportunity to press for even more products to fall under medicinal regulation, but conversely the delay will allow time for more real science to emerge and many more vapers to join the fight. It’s certainly a gamble. As a vaper, and with only a passing grasp of the vagaries of EU law, I am both elated and terrified by the prospect of the challenge that they have taken on.

Totally Wicked and their advisors will be well aware of the limited basis on which such challenges can be made, and of the fact that thousands of consumers, many of whom will be their own customers, will be watching their every move. Vapers will feel that Totally Wicked’s fight is their fight too, the interests of industry and consumers are well aligned, and both support and criticism are sure to follow in the months ahead. It will be an additional challenge for them to pursue these proceedings whilst at the same time ensuring that their customers remain informed and understand the nuances of the decisions which have to be made along the line. But the status quo is intolerable, so someone had to do it and I’m not in the least bit surprised or disappointed that it was them. I salute them and wholeheartedly support them in this challenge. One thing is for sure, exciting times are ahead.

 

Sarah Jakes, Vaper.

Initial response from Save E-cigs to WHO proposals for the future regulation of e-cigarettes:

As a campaign we are particularly concerned about proposals to regulate e-cigarettes as both a tobacco product and a medicinal product, a ban on the use of flavourings in e-liquid, and a ban on the use of e-cigarettes indoors.

Quote for interested journalist:

“E-cigarettes are neither a medicinal nor a tobacco product, they are simply a viable alternative to conventional tobacco products that millions of current and former smokers globally rely upon to prevent them returning to smoking cigarettes. We are therefore very concerned that many of the WHO’s proposals, some of which go against independent and credible scientific research, will simply result in many existing vapers returning to smoking. This cannot be what the WHO wants. We urge the WHO to think again and to engage with vapers who after all are the ones most impacted by these proposals.”

 

Postponement of our event in the House of Commons,

Sadly our event event- E-cigarettes and Harm Reduction and Why Getting the Regulation Right is Vital, due to take place in the House of Commons at 14:00 on the 2nd of September, has been postponed to a later date.

We had put a huge amount of effort into this event and had secured, what we thought was, a good line-up of speakers.

We have not taken the decision lightly and are acutely aware of the inconvenience this may cause some people, however, it had always been our intention that this event would not be ‘just another e-cigarette event’, but instead one that genuinely moved the debate forward. For that we had hoped to have a significant number of politicians attending.

Due to global events and the possibility of major debates regarding said events taking place when parliament returns in September, it has just not been possible for many politicians to be able to commit to attending this event and therefore we took the decision to hold our event at a later date.

We will let you know when a new event is planned, but until that moment I would like to ask you all to put your efforts into supporting these very important petitions:

Welsh Petition to prevent the ban of vaping in public places (closing date 12/09/2014): https://www.assemblywales.org/epetition-list-of-signatories.htm?pet_id=1023

EFVI: http://www.efvi.eu where if we can get 1 million signatures across Europe, then the EU Parliament have to take another look at the Tobacco products Directive, which at the moment is set to radically alter the e cig landscape for the worse.

And finally, if you can – go along to the e cig summit – http://www.e-cigarette-summit.com or more importantly – GET YOUR MP to attend it – as we need to get the TPD changed, and for that to happen, we have to take action. We went last year, and it really was a very worthwhile event.

 

 

 

 

 

 

 

 

 

Cigalike vs. refillable e-cigarettes: Don’t stub out the cigalikes just yet….

Lynne Dawkins, Drugs & Addictive Behaviours Research Group, School of Psychology, University of East London

 

E-cigarettes are the subject of intense debate: some consider them one of the greatest public health breakthroughs of our time, with the potential to save millions of smoking-related deaths; others fear they could re-normalise smoking, undermining tobacco control efforts which have made smoking socially unacceptable.

E-cigarettes come in all sorts of shapes and sizes. Some, commonly referred to as first generation devices, resemble tobacco cigarettes (cigalikes) with an orange mouthpiece resembling a cigarette filter, a white battery and an LED which glows when the user inhales on the device. These devices comprise low-capacity disposable or re-chargeable batteries and combined cartridges and atomisers (cartomisers). Second generation devices resemble pens or gadgets and use larger batteries and fluid filled reservoirs (clearomisers or tanks), filled from bottles of e-liquid. Third generation devices bear little visual resemblance to cigarettes, use larger-capacity batteries, replacement heating coils and wicks for atomizers, and adjustable and programmable power delivery.

 

E-cigarette use (commonly referred to as ‘vaping’) resembles the act of smoking : the user holds the device and draws on it like a cigarette; the vapour produced is drawn into the lungs and exhaled like smoke; and tobacco (or menthol) flavouring mimics the taste of inhaled tobacco smoke. Moreover, first generation cigalikes look exactly like cigarettes and are often contained in boxes resembling cigarette packets. Although regular e-cigarette users (‘vapers’) tend to use second and third generation devices which deviate from a cigarette-like appearance (Dawkins et al., 2013), most e-cigarettes found in retail outlets across the UK and US (and therefore most likely to be encountered by smokers) are first generation cigalikes. This has led to a growing concern among public health officials that e-cigarette use may re-normalise smoking, especially if they look like cigarettes and their use is misperceived as smoking. Given the gradual cultural shift over the last 50 years which has transformed tobacco smoking from a ubiquitous socially acceptable behaviour into a distasteful or repugnant habit, fears abound that e-cigarettes may allow re-entry of tobacco smoking into public view.

So, just how important is cigarette-like appearance for a smoker transitioning to e-cigarette use?  Or, is visual appearance irrelevant as long as there is effective nicotine delivery? If first generation cigalikes are indeed less effective than their refillable, newer generation counterparts and few smokers opt for them when presented with a refillable alternative, there would be little reason to encourage their promotion.   Drawing on data from the combustible literature, although nicotine is clearly a critical component of tobacco smoking, increasing evidence points to the role of non-nicotine, sensorimotor factors – the look and feel of the cigarette. For example, smokers prefer smoking to other forms of nicotine administration (e.g. patch, gum, nasal spray) and report enjoying the hand-mouth activity, taste, smell and sensation of smoke in the respiratory tract (Parrott & Craig, 1995). Smokers have also been shown to prefer smoking a cigarette containing no nicotine (denicotinised) over receiving nicotine intraveneously (Rose et al., 2010) and denicotinised smoking can also reduce nicotine withdrawal symptoms and smoking urges (Barrett, 2010; Perkins et al., 2010).

 

In order to explore preferences for cigalikes versus later generation refillable devices, we asked 100 smokers who had little or no experience of e-cigarettes to choose between a first generation cigalike and a second generation eGo when both devices were placed in front of them. 50% chose the cigalike device and stated that they did so because it resembled a cigarette. Clearly, cigarette-like appearance is important for many smokers who are thinking about using an e-cigarette. But is cigarette-like appearance important when the e-cigarette is actually used?   To address this question, we randomly assigned 63 abstinent smokers to one of two conditions: a first generation cigalike with a white battery and orange filter (white; cigarette similar condition) or a first generation cigalike with a red battery and orange filter (red; cigarette dissimilar condition). The flavour (tobacco) and nicotine content (18mg/ml) were the same in both conditions. Participants rated their urge to smoke and nicotine related withdrawal symptoms before, and 10 minutes after, using the e-cigarette.   The reduction in urge to smoke and withdrawal symptoms was significantly greater for those in the white (cigarette-similar) condition compared with the red condition, especially for those who had not used an e-cigarette before (Dawkins et al., under review).   We concluded that visual similarity to a cigarette is important for smokers who are new to e-cigarette use, at least after short term use in the lab. This could be an expectancy effect or a secondary reinforcing effect whereby cues (e.g. the visual appearance of the cigarette), by virtue of their continued association with nicotine delivery, become moderately pleasant in their own right, capable of alleviating some of the discomfort associated with not smoking.

Nevertheless, regular vapers tend to move away from cigalikes to second or third generation refillable devices (McQueen, Tower & Sumner, 2011) and there is some evidence that these may be more effective for quitting (Farsalinos et al., 2013), perhaps due to more efficient nicotine delivery (Farsalinos et al., 2014). We therefore explored whether a second generation eGo device was better than a disposable cigalike for reducing urge to smoke and nicotine withdrawal symptoms in 100 abstinent smokers who used the e-cigarette for 10 minutes. There was a significant reduction in craving and withdrawal symptoms in both groups. In other words, the disposable cigalike was as good as the second generation device, and both groups reported receiving a ‘hit’ from the e-cigarette. There were some differences though – those in the second generation condition rated the e-cigarette as more satisfying and were more likely to use it in a quit attempt (Dawkins et al., under review). Although there are hundreds of cigalike products available and these findings cannot be generalised to all first generation devices, they do demonstrate that cigalikes at least have the potential to be as effective as refillable devices for short term alleviation of tobacco craving and withdrawal symptoms. Perhaps as smokers transition from smoking to vaping however, cigarette-like appearance becomes less important alongside an identity shift away from a ‘smoker’.

Taken together, these findings suggest that first generation cigalike products may have their place among the plethora of e-cigarette devices, at least to draw smokers into initial e-cigarette use and away from smoking. Nevertheless, this needs to be balanced carefully against any disadvantage associated with a possible re-normalisation of smoking. Moreover, cigarette related visual cues, may even serve to maintain a tobacco smoking addiction if they remind the smoker of cigarettes, which may explain why second generation devices are preferred for stopping smoking. Nevertheless, until trials comparing cigalikes and refillables for quitting smoking are conducted, there is no compelling evidence as yet to stub out the cigalike.

 

References

Barrett SP. (2010). The effects of nicotine, denicotinized tobacco, and nicotine-containing tobacco on cigarette craving, withdrawal, and self-administration in male and female smokers. Behavioral Pharmacology, 21, 144-152.

Dawkins L, Kimber C, Puwanesarasa Y, Soar S. (under review). First versus Second Generation Electronic Cigarettes: Predictors of Choice and Effects on Urge to Smoke and Withdrawal Symptoms. Addiction.

Dawkins L, Munafò M, Christoforou, G, Olumegbon, N. (under review). The effects of e-cigarette visual appearance on urge to smoke and withdrawal symptoms in abstinent smokers. Nicotine and Tobacco Research.

Dawkins L, Turner J, Roberts A, Soar K. (2013). ‘Vaping’ profiles and preferences: An online survey of electronic cigarette users. Addiction 108, 1115-1125.

Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V. (2013). Evaluating nicotine levels selection and patterns of electronic cigarette use in a group of ‘vapers’ who had achieved complete substitution of smoking. Substance Abuse , 7, 139-146.

Farsalinos KE, Spyrou A, Tsimopoulou K, Stetopoulos C, Romagna G, Voudris V. (2014). Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices. Scientific Reports, 4, 4122.

McQueen A, Tower S, Sumner W. (2011). Interviews with ‘Vapers’: Implications for future research with electronic cigarettes. Nicotine and Tobacco Research, 13, 560-7.

Parrot AC, Craig D. (1995). Psychological functions served by nicotine chewing gum. Addictive Behaviors 20, 271-8.

Perkins KA, Karelitz JL, Conklin CA, Sayette MA, Giedgowd, GE. (2010). Acute negative affect relief from smoking depends on the affect situation and measure but not on nicotine. Biological Psychiatry, 67, 707-714.

Rose JE, Salley A, Behm FM, Bates JE, Westman EC. (2010). Reinforcing effects of nicotine and non-nicotine components of cigarette smoke. Psychopharmacology, 2010, 1-12.

 

 

 

 

 

 

 

 

Major event in the House of Commons…..

Houses of Parliament

 

On the 2nd of September Save E-cigs is organising a major event in the House of Commons hosted by Rt. Hon Jack Straw MP (Labour), Mark Pawsey MP (Conservative), and John Pugh MP (Liberal Democrat). The meeting will be held in the Attlee Suite from 14:00 – 16:00.

At present there is a significant debate taking place as to how exactly e-cigarettes should be regulated. The Tobacco Products Directive, which the UK Government will be transposing over the next two years, sets some guidelines, but does not dictate actual regulation in many areas. Should they be included in the smoking ban as the Welsh Government has proposed? Should they be regulated as a medicinal product, a tobacco product, or something else? Our event will look at all these issues in detail. Speaking at this event will be:

· Professor Gerry Stimson, London School of Hygiene and Tropical Medicine and the National Institute for Health and Clinical Excellence
· Clive Bates, Former Head of Action on Smoking and Health
· Louise Ross, Leicester Stop Smoking Services
· Professor Robert West, Professor of health psychology and director of tobacco studies at University College London’s department of epidemiology and public health
· Oliver Kershaw, Founder of the E-cigarette Forum
· Jill Rutter, Institute of Government

This meeting will not be just another event discussing e-cigarettes, it will genuinely move the debate forward; setting the scene, looking at what happens when policy makers get regulation wrong, and setting out how e-cigarettes could and should be regulated.

It is vital that all those with an interest in e-cigarettes engage on this important topic. If you would like to attend this event please RSVP to campaign@saveecigs.com.

We have invited every MP to attend this event; however, to ensure that they attend it often helps if their constituents encourage them to attend. We would therefore be very grateful if you could please get in touch with your local MP and encourage them to attend this important event.