Our Letter to the Welsh Health and Social Care Committee

On the 17th of September the Health and Social Care Committee took evidence from amongst others, Dr Stephen Monaghan of BMA Wales and Dr Jane Fenton-May of the Royal College of General Practitioners.

In their evidence Dr Monaghan and Dr Fenton-May made a number of statements:

  • Nicotine is addictive
  • Nicotine is dangerous
  • Children share e-cigarettes and therefore contact hepatitis
  • Vaping undermines the smoking ban
  • E-cigarettes are targeted at children
  • Passive vaping is dangerous
  • E-cigarettes lead to the renormalisation of smoking and are a gateway to smoking
  • The e-cigarette industry is owned by tobacco
  • People using them do not realise that they contain nicotine

Like you, we believe that policy should be based on evidence and as a campaign representing the interests of vapers, their friends, and their families, this is particularly important to us. It was therefore interesting that when asked by two members of the committee to provide evidence, they were unable to provide a single piece of evidence to support a single one of the above statements.

Does vaping undermine the smoking ban?

There is no evidence what-so-ever to indicate that vaping undermines the smoking ban or makes it harder to enforce. The Chartered Institute of Environmental Health, the body tasked with enforcing the ban, stated that there is a 99.7 per cent compliance rate with the smoking ban, and they have found no evidence to support the idea that vaping in public is undermining this.[1]

Are e-cigarettes targeted at children?

No. Evidence produced by a variety of organisations including ASH and the American Cancer Society (ACS) clearly shows that flavours do not entice non-smokers to use e-cigarettes. Researchers from the ACS[2] found that flavours did not increase the attractiveness of e-cigarettes to teenagers. Rather, ‘Even after controlling for other statistically significant correlates, the odds of a smoker being willing to try an e-cigarette were 10 times those of a non-smoker.’

Flavours are though important for adult smokers switching to vaping. In research[3] carried out by Dr Konstantinos Farsalinos and others, vapers stated that the availability of flavours was “very important” in their effort to reduce or quit smoking. This research also found that the majority of vapers would find e-cigarettes “less enjoyable” or “boring” if flavours were restricted, while 48.5 per cent of vapers stated that it would increase their cravings for tobacco cigarettes and 39.7 per cent of vapers said that without flavours it would have been less likely for them to reduce or quit smoking.

Strict new advertising rules also make it impossible for the industry to target children through advertising and a ban on the sale of e-cigarettes to under 18s will soon be introduced in Wales.

Are e-cigarettes used regularly by children?

 No. Looking specifically at Wales, Cancer Research UK concluded: ‘Looking specifically at two studies dedicated the use of e-cigarettes amongst young people in Wales only a minority of teenagers who try e-cigarettes go on to become regular users. And the majority of those who do use the devices regularly were already smokers.’[4] This is backed up by research undertaken by ASH.[5] We also know of no cases of hepatitis contacted from shared vaping.

Do e-cigarettes lead to a renormalisation of smoking and act as a gateway to smoking?

No. We are very lucky in the UK that a significant amount of work is done on the issues or gateway and renormalisation. This work in updated on a regular basis and is principally carried out by Professor Robert West and ASH. Both state that there is no evidence that e-cigarettes act as a gateway into smoking[6] and that there is no evidence that vaping risks re-normalising smoking.[7]

Is the e-cigarette industry really owned by big tobacco?

No. Figures produced by the Electronic Cigarette Industry Trade Association (ECITA) show that of the 407 brands/companies operating in this sector in the UK only six are owned by tobacco companies. The companies they own are those that manufacture and sell the cig-a-like e-cigarettes. These are the more ineffective products that are used by an increasing minority of vapers as research from the University of East London demonstrates.[8]

Is nicotine addictive and dangerous?

 Most e-liquids will contain pharmaceutical grade nicotine. It will be MHRA approved and the same as that used in NRT products. This clean nicotine in and of itself is not a harmful substance. Professor Robert West said, “E-cigarettes are about as safe as you can get. We know about the health risks of nicotine. Nicotine is not what kills you when you smoke tobacco. E-cigarettes are probably about as safe as drinking coffee.”[9] Over the summer a number of bodies including ASH[10] and the Royal Society of Public Health[11] called for more to be done to ensure the public understand that nicotine is ‘not the deadly component in cigarettes.’

Nicotine is addictive when consumed via cigarette smoke. However, as Professor Linda Bauld and others have made clear, nicotine when consumed in a form other than tobacco is not a particularly addictive substance.[12] You can see this with vapers. Many heavy smokers when they first switch to vaping will start off using a high strength nicotine e-liquid, but over time they will reduce the strength they use and some will even go on to vape nicotine free e-liquid. Vapers often forget to vape; would they do this if they were addicted?

Is passive vaping dangerous?

No. A major scientific study undertaken by Dr Konstantinos Farsalinos and Professor Riccardo Polosa concluded that the “effects of e-cigarette use on by standers are minimal compared with conventional cigarettes.”[13] A review of the available literature conducted last year by researchers at the Drexel University School of Public Health in Philadelphia concluded that “exposures of bystanders pose no apparent concern.” Finally the US Food and Drug Administration conclude that all other substances measured for e-cigarettes were far below allowable levels for human inhalation. They state that levels are so low that it is more hazardous to an individual’s health to breathe the air in any major metropolitan city during rush hour.

Conclusion

Dr Monaghan’s and Dr Fenton-May’s statements were caveated with ifs and maybes. There should be no room for ifs and maybes in policy making. When asked they were unable to provide members of the committee with any evidence to support their statements. In this briefing we have countered their statements with facts and we have drawn those facts from ASH, Cancer Research UK, the MHRA, Professor Linda Bauld, Professor Robert West, Public Health England, ECITA, Dr Konstantinos Farsalinos, the ONS, Royal Society of Public Health, Chartered Institute of Environmental Health, University of East London, Professor Riccardo Polosa, the American Cancer Society and others.

Banning vaping in enclosed public places is not a minor change as supporters of the ban will have you believe. Vapers will go back to smoking and fewer smokers will switch to vaping.

We have pointed out time and time again that there is no evidence to justify this ban. We have provided AMs with numerous briefings and we have written countless times to the Minister and his officials. We feel like we are banging our heads against a brick wall and when we watch evidence sessions like the one on the 17th of September we simply want to cry. What do we have to do to get a fair hearing and for facts to triumph over unfounded, evidence free fears?

 

Yours sincerely

 

Save E-cigs

 

 

 

 

[1] Meeting of the All-Party Groups on Smoking and Health, Pharmacy, and Heart Disease 10 June 2014

[2] http://www.jahonline.org/article/S1054-139X(12)00409-0/fulltext

[3] http://www.mdpi.com/1660-4601/10/12/7272

[4] http://www.cancerresearchuk.org/about-us/cancer-news/news-report/2015-04-16-regular-e-cigarette-use-low-among-teens-analysis-suggests

[5] http://www.ash.org.uk/media-room/press-releases/:latest-data-finds-no-evidence-that-electronic-cigarettes-are-a-gateway-to-smoking-for-young-people

[6] http://metro.co.uk/2014/04/27/e-cigs-cleared-of-being-route-into-smoking-4710734/

[7] http://metro.co.uk/2014/04/27/e-cigs-cleared-of-being-route-into-smoking-4710734/

[8] http://www.uel.ac.uk/psychology/staff/lynnedawkins/

[9] The Guardian newspaper 05 June 2013

[10] http://www.ash.org.uk/:ash-supports-calls-for-more-to-be-done-on-public-understanding-of-nicotine

[11] http://www.theguardian.com/society/2015/aug/13/health-bosses-promote-e-cigarettes-harmful-tobacco-smoking-experts

[12] http://www.scottishparliament.tv/category.aspx?id=19&page=1&sort=date

[13] Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review:

Konstantinos E. Farsalinos and Riccardo Polosa

published online 13 February 2014 Therapeutic Advances in Drug Safety

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European Union regulating e-cigarettes based on ideology and theories, but not science

Guest post by Dr Farsalinos

It is unfortunate for a scientist to see how politics work and how decisions are made. For public health issues, especially for the very sensitive issue of smoking, one would expect that common sense and scientific facts would prevail. Instead, we are seeing decisions made on the basis of theoretical concerns, fear-mongering tactics and intimidation.

The pending regulation for electronic cigarettes seems to be a characteristic example of applying theory on top of real evidence. There has been an astonishing effort to mis-present science, misinform regulators and the society by distorting the results of scientific studies and eventually kill a product which will probably revolutionize tobacco harm reduction. Recently, we are overwhelmed by stories demonizing nicotine. Suddenly, after so many years of research and hard evidence coming from population studies, we are seeing the news media discussing about nicotine causing cancer and heart disease. We are seeing journalists trying to interpret cell studies, while in reality I doubt if they understand a single word of what they read. Obviously, they should not be the only ones blamed; it is scientists who give the information to the news media and they push for publicity. The result is a complete distortion of truth. It is shocking to see someone support that a cell study is good enough to discard all hard evidence from population studies showing that nicotine does not cause heart disease or cancer.

However, there are other questions raised by such tactics. First of all, why is every study on nicotine targeting e-cigarettes? Don’t NRTs also have nicotine? Why don’t we hear anyone discussing about nicotine in NRTs? Well, probably because e-cigarettes are a hot topic. However, few years ago, studies showing nicotine to be harmful were strongly opposed by scientific groups (such as Cancer Research UK), stating that: “The interpretation is highly speculative and contradicted by evidence that many millions of people have been using nicotine replacement therapy with no increased risk of oral or any other cancer. If reports like this stop people using what for many would be a life-saving medication it would be very unfortunate.” They are absolutely correct, but the same statement should be done today for e-cigarettes.

All this intimidating publicity has only one result: it harms the health of smokers by discouraging them from using a less harmful alternative like e-cigarettes and it harms the health of vapers some of whom have relapsed to smoking after hearing all this misinformation.

Coming back to regulatory decisions, it is unprecedented that a product is regulated based on theoretical concerns, especially when such concerns are completely contrary to any available evidence. It is a big “victory” of the antismoking advocates (who in fact have become anti-smokers) that the agenda is not evidence but theories; theories about normalization, theories about use by youngsters, theories about health effects. Every scientific study shows the exact opposite from what they support, but none cares. Theory is more important that evidence. We have come up to a point when a professor is supporting that “We are witnessing the beginning of a new phase of the nicotine epidemic and a new route to nicotine addiction for kids” while at the same time his own study mentions that “Students who had smoked every day in the past 30 days had the highest rate of current e-cigarette use (50.8%), compared with .6% among those who not currently smoking cigarettes (p < .001).” (emphasis added).

How should this be called? Science? It is really sad that scientists are so disrespectful of smokers and their need to find a getaway from smoking. They believe they should be punished for initiating smoking and for medicine’s inability to develop an effective smoking-cessation medication. It is a dangerous path that should be condemned.

Regulators should stay away from propaganda tactics. They should be properly informed and base their decisions on facts, not on theories. Regulating based on anything besides evidence is like opening the floodgates; it will have severe consequences and will definitely harm public health.

 

Legislation in ignorance portends unintended consequences

David Dorn examines all the reasons the EU parliamentary circus needs to completely re-think its approach to the Revisions to the TPD with regard to Electronic Cigarettes.

First, my declarations of interest. I am a vaper, of nearly five years standing. In that time I have not smoked a tobacco cigarette, yet I do not consider myself to be a quitter. I have continued using Nicotine, my recreational drug of choice, but have reduced the risks associated with its use – the very risks Big Public Health has bombarded me with for over thirty years.

You’d think, therefore, that Big Public Health would be not only massively chuffed for me, but would welcome my new habit as a substitute for the old one – the one they keep telling has a 50/50 chance of killing me – and support me spreading the word.

You’d think the likes of Cancer Research UK, ASH UK and the BMA would be pinning pictures of e-cigs to their walls, telling everyone how marvellous they are, and talking to their cronies in both Westminster and the EU Parliamentary circus to get them to make sure they’re more available than tobacco cigarettes, more sexy, advertised more widely and generally surrounded by the kind of buzz that has people saying “I want one of those”.

You’d think that Tonio Borg, the EU Commissioner responsible for the Revisions to the Tobacco Products Directive, would be sitting with a smile on his face typing into the text of the RTPD “we need to get these things on every shop shelf in Europe, in more places than you can buy tobacco cigarettes, and make them so appealing that everyone will want one.

You’d think…

But no. Despite some of the less extreme members of Big Public Health acknowledging that Nicotine and Caffeine are as alike as those two Irish Pop Stars – you know the ones – their colleagues continue to paint Nicotine as “highly addictive” “poisonous” “dangerous” and, in some particularly bizarre cases “carcinogenic”.

They are being ignorant – either wittingly or unwittingly.

And yet further no. Some of the members of Big Public Health preach the mantra of “re-normalisation of smoking behaviours” (that last word has recently been tacked on to their little phrase, because they KNOW e-cigs don’t re-normalise smoking). They just don’t get that, if Nicotine and Caffeine are like two peas in a pod in almost all respects, there is no problem with any amount of people enjoying either or both in whatever form. As “addictions” go, we’re probably talking a “habit” rather than all-out heebie-jeebies brought on by withdrawal and relapse.
One wonders what THEIR drug of choice is? A nice fruity red? A sharp white? A blue WKD?

And even more no. Even in the EU Parliament, there are MEPs who should know better who are, even as I type, being misled by Big Public Health and, in this case, Big Tobacco, who are trying to get them to knuckle under to a particularly insidious plan allegedly hatched by the Lithuanian Presidency and the Commission which would see every e-cig device that actually works and satisfies taken off the market, and only utterly crapulous looky-likey disposables left to be sold in, well, God only knows where, because they won’t be advertised, can’t be talked about, can’t have forums and, well, just won’t exist as far as non-voters are aware.

They need to wake up. They need to realise that they are being blackmailed by the notion that the TPD will not get through in this parliament unless they give in on the completely stupid, crass and unworkable proposals the Presidency and Commission has tabled.

Here’s an idea. Keep the rest of the TPD. It’s a mess, but obviously makes somebody happy. But take Article 18 out, and resolve to build a proper, bespoke regulatory framework for e-cigs and other nicotine containing products.

If they buckle, if they cave, if they wimp out, they will be jointly responsible for the biggest Public Health dividend ever imagined disappearing in a puff of (Big Tobacco) smoke.

They can’t want that, can they?