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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Letter to The Scotsman Newspaper

The Scotsman

 

Dear Sir,

I am writing in response to your recent article, ‘Call for ban on e-cigarettes in public places’ As a campaign that has the interests of e-cigarette users at heart, we are concerned that your journalist reproduced the comments of the British Medical Association (BMA) Scotland and Public Health Minister Michael Matheson MSP, without subjecting them to any scrutiny, if she had, she would have found them wanting.

In the article BMA Scotland made a number of statements that we unchallenged:

  • Increasing numbers of children use e-cigarettes,
  • E-cigarettes are a gateway to smoking tobacco cigarettes, and
  • E-cigarettes help normalise smoking.

Where to begin?

Research, including a recent survey commissioned by Action on Smoking and Health (ASH)[1], has shown time and time again that e-cigarettes are not attractive to young people, and are therefore not used as a gateway to smoking tobacco cigarettes.  Although awareness of e-cigarettes was widespread amongst young people aged 11 to 18, the ASH survey found no evidence that young people either used or perceived e-cigarettes as being a gateway to smoking.

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 either, especially the young, as they have no interest in the product.

Researchers from the ACS[2] looked specifically into the enticement of flavours.  They 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.”

Tobacco cigarettes are the gateway to tobacco smoking, not e-cigarettes.  Also, there is no evidence what so ever that e-cigarettes help ‘normalise smoking’.

The article goes on to report a motion being debated at the BMA Scotland conference welcoming moves by the MHRA to regulate e-cigarettes as a medicine.  Again, had your journalist carried out any independent research, she would have discovered that this is not actually what the MHRA intends to do.

On the 12th of June 2013 the MHRA stated that they wished to regulate ‘nicotine containing products’ (e-cigarettes) in line with the proposed EU Tobacco Products Directive (TPD), which at that time supported the medicinal regulation of all e-cigarettes.

However, on the 8th of October 2013 MEPs voted against the medicinal regulation of e-cigarettes, a move that was later supported by the Member States in Council.  Since then the MHRA is on record as stating that it no longer proposes to introduce the blanket medicinal regulation of e-cigarettes.  The TPD, passed in Strasbourg two weeks ago, proposes medicinal regulation only for those products which seek to make a medicinal claim or those products with a nicotine strength greater than 20 ml.

We welcome the aspect of the BMA Scotland’s motion that calls on the Scottish Government to ban the sale of e-cigarettes to under 18s, and have been calling on the Scottish Government to do this ourselves.  However, it is ludicrous to propose that e-cigarettes should be sold only alongside nicotine replacement therapies (NRT).  E-cigarettes are not some form of more effective NRT; they are a viable alternative to conventional tobacco cigarettes and should be on sale anywhere tobacco cigarettes are sold.

Finally, on the idea that e-cigarette use should be banned in public.  E-cigarettes are not just popular with those who use them; there is widespread support for them amongst the public at large.  A recent poll by the BBC[3] found that 75 per cent of the public would be happy if their friends or family switched from smoking tobacco cigarettes to using e-cigarettes, and 62 per cent of the public said that e-cigarettes should not be banned in public.

With a ban on the advertising and promotion of e-cigarettes soon to be introduced, following the passing of the TPD, where are smokers to find out about e-cigarettes, particularly if they are banned in public places?  Smokers need to see people using e-cigarettes in public, they need to be able to go up and speak to e-cigarette users so that they can find out further information and then hopefully make the switch.

Of course there must be a consideration of those who do not use e-cigarettes, but who would be impacted by second-hand vaping.  However, highly credible research undertaken by Dr Konstantinos Farsalinos, M.D., Researcher, Onassis Cardiac Surgery Center, Athens Greece and Researcher, University Hospital Gathuisberg, Leuven, Belgium; and Professor Riccardo Polosa, Full Professor of Internal Medicine, University of Catania and Scientific advisor for LIAF – Italian League for Anti-Smoking, has proven that there is no problem with passive vaping[4].  The research concluded, “Based on the existing evidence from environmental exposure and chemical analyses of vapor, it is safe to conclude that the effects of EC use on bystanders are minimal compared with conventional cigarettes.”

All those with a genuine interest in public health need to stay focussed on the bigger picture – significantly reducing the number of people who die from tobacco related illnesses.  Conventional nicotine replacement therapies are not tackling this in any significant number, but e-cigarettes could.  Already 1.3 million smokers have switched to e-cigarettes throughout the UK.

It is vitally important that all those reporting on or writing about e-cigarettes do so responsibly.  Irresponsible reporting has the potential to put smokers off making the switch to a safer alternative.  We are a campaign representing e-cigarette users; we have no interest in articles promoting e-cigarettes uncritically either.  All we are asking for is balanced and factual reporting.

Yours sincerely

 

Save E cigs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


[1] ASH surveyed 12,597 adults in 2010 – the questions focused on e-cigarette use and awareness in Great Britain. The preliminary survey was followed up by an additional study of adult smokers and non-smokers in February 2012 and more recently in 2013. ASH also surveyed children and young people aged 11 to 18 in March 2013.

[4] 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

 

Is this the end of smoking? Not if the bureaucrats can help it.

(This article was originally published in The Times, and was written by Viscount Ridley.)

Sweden’s reputation for solving policy problems, from education to banking, is all the rage. The Swedes are also ahead of the rest of Europe in tackling smoking. They have by far the fewest smokers per head of population of all EU countries. Lung cancer mortality in Swedish men over 35 is less than half the British rate.

Have they done it by being more zealous in ostracising, educating and shaming smokers in that paternalistic Scandinavian way? No – they did it through innovation and competition. In the 1980s Swedes developed a tobacco product called snus, which you put under your upper lip. You get the nicotine but not the tar. Snus is the most popular and effective way of quitting smoking in Sweden (and Norway).

You will not have seen snus on sale in Britain, for the simple reason that the EU banned it. When Sweden joined the EU, it negotiated a special opt-out. To this day, despite abundant evidence that snus is saving Swedish lives by the bucketload, despite advice from experts, and despite a devastating critique of its own feeble defence of the policy, the European Commission remains committed to the snus ban.

You may think this is rather an obscure topic with which to occupy such a prominent opinion pulpit as this page but it is a vital background to the debate about electronic cigarettes – for, if snus can halve smoking and lung-cancer deaths, imagine what electronic cigarettes could do. These are objects that mimic the actions of smoking but are maybe 1,000 times safer, and whose sales are doubling each year, without any government encouragement or medical prescription. E-cigarettes may wipe out smoking in a couple of decades. Professor David Nutt of Imperial College describes them as “the greatest health advance since vaccines”.

Tobacco sales are falling in Europe and America and the industry fears it is facing in electronic cigarettes its “Kodak” moment – as when digital photography destroyed a dominant film-camera firm in a flash. Wells Fargo in the USA predicts that e-cigarettes could out-sell cigarettes within ten years.

Surveys show that e-cigarettes are now the most popular method of quitting smoking, despite a lack of encouragement from the authorities. Pick up a leaflet from your chemist on how to quite smoking and you will find they are not even mentioned. When I made a speech on this topic in the House of Lords, I was stunned by the enormous response I got from “vapers”, enthusiasts for e-cigs. What was especially startling was how many of them told of trying to quit for decades, then finally succeeding.

Yet, instead of welcoming this technology, the powers that be, in Brussels and Whitehall, are determined to throw obstacles in its way.

Last week the European Parliament voted in support of the Commission’s proposal that bans reusable electronic cigarettes and those with a nicotine concentration over 20mg/ml. Our own government is intent on translating these EU restrictions into British law, egged on by the British Medical Association and the big pharmaceutical industry, which burble on about protecting children from a new threat and not wishing to see the renormalising of smoking.

Why are public health officials so resistant? The European Commission frequently displays a precautionary bias against innovation, weighing any risk of a new product, however small, but not the risk of an old product it might replace – hence its attitude to genetically modified crops. In raising the unknown (but small) risks of e-cigarettes, the public health establishment is missing the point. What counts is harm reduction, not perfect utopian safety. Don’t let the best be the enemy of the good, said Voltaire. The ban on strong e-cigarettes, the ones preferred by those trying to quit smoking, could prevent the saving of 105,000 European lives a year, according to modelling by London Economics.

And there’s the Dunning-Kruger effect, whereby incompetent people are too incompetent to see incompetence. An EU official with a lower second-class degree from the University of Malta so badly mangled the results of 15 scientists on harm reduction by e-cigarettes that they all wrote to correct him.

The British government’s medical regulator, the MHRA, sticks obstinately to its belief that medicinal regulation will improve technological progress in e cigarettes, ignoring reams of evidence that high barriers to entry inevitably stifle innovation. Doctors, represented by the BMA, seem to hate the idea of people buying, rather than being prescribed, products that stop them smoking. Worse, some of the firms advertising e-cigarettes and selling them through Boots are now subsidiaries of Satan itself – the tobacco industry. Not wishing to emulate Kodak, Big Tobacco is rushing to buy up e-cigarette makers.

Big Pharma wants regulation of its rivals because it makes a packet out of nicotine replacement therapies (patches and gums), which have a poor track record of helping people to quit. And politicians? Well, they just seem to enjoy banning things.

In short, says Professor Gerry Stimson of the London School of Hygiene and Tropical Medicine, the public health response to e-cigarettes has been dominated by attempts to regain ownership of the issue from a consumer-led self-help movement. “Not invented here” – the old bureaucrat’s cry.

The reason these cynical campaigns have succeeded at all is that most of us confuse nicotine with smoking. As far as anybody can tell, nicotine is harmless at the doses present in cigarette smoke. It’s the tar that kills. Nicotine is addictive, but so is caffeine, and a cup of coffee has a lot more potentially dangerous chemicals in it than an e-cigarette. Vaping could well be less risky and antisocial than coffee drinking.

Yet so brainwashed are we into thinking that nicotine is harmful that we cannot see an advert for vaping without a Pavlovian revulsion, and spouting a load of tosh about protecting kids from a possible gateway into (rather than out of) smoking. And that ignorance is being exploited by the reactionary opponents of this disruptive and lifesaving innovation. They would apparently prefer that smoking continues its very slow, but doctor supervised, decline over the next 50 years than all but vanish in 20.

 

Viscount Ridely’s twitter account: @mattwridley

MHRA confirms e-cigarettes are not medicinal products – but they still face a ban!

 If the revised TPD is voted through in its current form on the 8th of October, electronic cigarettes will from 2016 need to be marketed as a medicinal product authorised under the Medical Products Directive regime.  This we and countless others have argued will constitute a ban because electronic cigarettes are not medicines and are not capable of reclassification as medicines.

 Lawyers representing an electronic cigarette manufacturer in the UK sought clarity from the Medicines and Healthcare Products Regulatory Agency (MHRA), whose lead the EU is following, as to whether or not their product range were medicinal.  The MHRA confirmed in writing that, under the Medicinal Products Directive 2001/83/EC, none of the products sold by this company as of the 22nd of August 2013 were considered medicinal, nor were they considered medical devices under the Medical Devices Directive 1993 (Directive 93/42/EEC).  Furthermore they confirmed that the TPD as it currently stands would not alter this fact.

 As a result of this confirmation, the MHRA has confirmed that this company is not required to seek marketing authorisations or any other form of license for its products.  However, in its reply, the MHRA stated that if the draft TPD passes into law in its current form, this company, in order to legally sell its current product range, would be required to seek marketing authorisations from the MHRA under the Medicinal Products Directive.  In other words, this company would have to seek medicines licences for products the MHRA has confirmed are not medicines.

 As a direct result of a freedom of information request by the E-Cigarette Consumer Association (ECCA), the MHRA confirmed in writing that if a product is not medicine the MHRA cannot use medicines regulation to regulate it.

 Having established that none of this company’s product range qualifies as a medicinal product, it would be impossible for them to obtain authorisations and as a result they would be prohibited in law from selling any of their existing products.  This is the clearest statement yet that currently available electronic cigarette products will be banned from 2016 if the TPD passes into law in its current form.

 As this company’s product range is broadly similar to that distributed by other electronic cigarette vendors in the EU, the logical conclusion to draw from the above is that if the draft TPD passes as proposed, there will be a shutdown of the general sale of currently available electronic cigarette products from 2016 throughout the EU.