Guest post by Jocelyn Davies AM Plaid Cymru

 

Jocelyn Davies AM

Jocelyn Davies AM

I believe that the Welsh Labour Government’s plan to make using an e-cigarette in an enclosed public space illegal is wholly wrong.

The e-cigarette ban will mean that vaping is treated exactly like smoking tobacco under the law. The Government risk stigmatising a new product that is helping many people reduce the amount they smoke and even give up altogether.

I have to declare a personal interest in this issue: I vape myself. I had previously been using lozenges to help me stop smoking, and had been for a long time. It was worry about the effect they were having on my teeth that prompted me to look into alternatives.

A huge amount of the growth in popularity of e-cigarettes has been fuelled by word-of-mouth. I was attending a conference and noticed two women sitting on the next sofa in the hotel lobby vaping. We fell into conversation about it and it was on their recommendation that I then went into an e-cigarette shop to get advice from them. If the Public Health (Wales) Bill passes in its current form, I would not have been able to talk to those women and the e-cigarette shop would not have been allowed to demonstrate their products to customers like me to show us how they work. I may never have discovered that e-cigarettes are, for me, a device that is incredibly successful in helping me continue not to smoke in the long-term.

If you’re a smoker, one advantage of a cigarette is that it’s a highly reliable way to deliver the nicotine fix you need. As long as you have a lighter, you can be pretty sure that your cigarette won’t fail. If you plan to use an e-cig to help you give up, you need reassurance that the device is similarly reliable and unless you’ve had a conversation and a demonstration of how they work, you’re unlikely to have faith in their reliability. Making e-cigarettes less visible and more difficult to get hold of will not promote public health. Far from the Government’s concerns that e-cigarettes normalise smoking, in my experience, seeing people vaping normalises the use of an effective tool to help you give up.

I admit that e-cigarettes are so new that little is known yet about the long-term impact they may have on health. I think it is important to remain sceptical about manufacturers’ claims that you can put a numerical value on exactly how much better for your health they are than smoking. We just don’t know yet. But Government policy should be based on evidence and so far there is no evidence to suggest that e-cigarettes are anything like as dangerous as smoking and plenty of evidence to show that they help people quit.

Of course, there are many places where you might want to restrict e-cigarette use. They are not appropriate everywhere. Some restaurants already stop their customers vaping inside and they should be free to do so. But to treat e-cigarettes exactly like tobacco, to make it an illegal offence to vape in a public place, is an entirely wrong-headed policy and totally out of line with people’s lived experiences. It shows a complete lack of understanding of the psychology of addiction and smoking. On this issue, the Health Minister is completely out of touch.

The ban on e-cig use is not something that should be snuck into a Bill on an unrelated topic, this is something that should stand alone. If Welsh Labour are committed to banning e-cigarettes, then they should put it in their manifesto and wait until after the election when they have a mandate from the electorate to act.

Finally, and this is a pretty radical question to ask, I wonder why we tolerate tobacco use at all anymore? We know how damaging tobacco is for public health, why not ban smoking altogether? We could encourage everyone to move to e-cigarettes instead. The Health Minister seems to be using e-cigs as his own tobacco substitute, banning them rather than banning cigarettes as perhaps he’d really like to.

The Welsh Labour Government’s knee-jerk reaction to a new technology that is helping many more people give up smoking is an unpopular mistake. I will be pressing the Health Minister to reconsider.

 

Note from the Editor:

A few people were concerned about Jocelyn’s comment re banning smoking. To clarify,, Jocelyn is not advocating a tobacco ban, she is merely speculating about the health minister’s reasons for a vape ban, and is making the point that vaping seems to his substitute for tobacco.

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

A reply from The Chief Medical Officer for Wales, Dr Ruth Hussey.

Dear Save E-cigs,

Thank you for your email regarding the recently published findings from
researchers at Cardiff University about e-cigarette use among children and
young people in Wales.

I am glad you found the research of use. It is important we increase our
understanding in this area and in doing so, work with our academic
colleagues, submitting the findings to scientific journals to ensure the
research is subject to scrutiny. I recognise that this and other studies
show regular e-cigarette use among young people is largely limited to
current and ex-smokers at present. These studies also show that regular use
of e-cigarettes, as currently defined, is limited to a small number of young
people.

As it will be some time before definitive evidence becomes available
regarding both the efficacy of e-cigarettes as an aid to smoking cessation
and their long-term health impacts, it is important that we continue to
monitor the evidence as it emerges. In the meantime, I believe that we
should be doing everything we can to prevent a new generation becoming
exposed to nicotine, which is an addictive substance and has been shown to
impact on brain development. Whilst I recognise that e-cigarettes, along
with nicotine replacement therapy, may be helpful to smokers in giving up
tobacco, I believe we should remain cautious in our approach to
e-cigarettes, particularly use among children and young people.

Dr Ruth Hussey OBE

Six months ago I had genuine concerns that we were going to throw the baby out with the bath water …

 

Guest Post by Mike MacKenzie, MSP.

Mike MacKenzie MSP

 

Six months ago I had genuine concerns that we were going to throw the baby out with the bath water as regards electronic cigarettes. An informal lobby was developing a head of steam urging us to do just that.

As a lifelong heavy smoker who has found redemption and a painless way to quit using e-cigarettes I had a personal axe to grind. I haven’t had a cigarette now for two and a half years but even so I still need the crutch of the electronic cigarettes. Intuitively I think I would find it relatively easy to give up electronic cigarettes but I am a great believer in picking the time to fight such battles. Fighting battles on too many fronts can mean you lose them all and I have a real fear that a ban on e-cigarettes would see me back smoking tobacco.

In any case as a lifelong keep fit enthusiast I am relatively in tune with my body and it is sending me signals that e-cigarettes are not nearly as harmful as tobacco was. I can measure my much better performance on the treadmill and the rowing machine, but my general energy levels are also higher as is my ability to remain alert and focussed for long periods. Medical evidence seems to support this view; that e-cigarettes are at worst benign and many health professionals argue strongly on their merits.

Of course regulation is required. We need to make sure that there is a consistently high standard and that no nasty products lurk needlessly within nicotine fluids. I believe we can do this effectively without denying smokers the opportunity to take the easy route offered to quit tobacco use.

I am reassured in this by talking to colleagues many of whom seem now to agree with me. Following the recent Scottish Government re-shuffle I am now a member of the Parliament’s Health and Sport Committee. You can be sure I will be taking full opportunity to make these arguments when the Committee undertakes it’s scrutiny of any forthcoming legislation.

 

 

 

 

Good COP bad COP.

 Good cop Bad Cop

 

We’ve all seen the tweets from Drew Johnson from his time in Moscow when he was reporting on the Framework Convention of Tobacco Control (FCTC)– if you’ve not seen them, then follow him on twitter @Drews_Views.

Drew is a journalist and despite being frogmarched out of some FCTC meetings he managed to report what was going on – i.e. the removal of the press, the removal of the public and the holding down of dissenting delegates. He also told us about e cig discussions held behind closed doors – and we can all draw a parallel with the EU TPD there.

But what did COP6 do for vaping?

Did they head any of the warnings and letters that were sent?

Yes, yes they did.

They took note of all the ones that hate e-cigs.

We sent them a briefing – you can read it here:

Now, words have power – just say the word should, and then say the word love – and you will hopefully feel a difference in the way you feel and react. Should will probably make you tense a little, love will hopefully help you to relax. Words have a profound effect on how you feel and respond.

So, bearing this power in mind – why have the WHO FCTC coined the acronym ENDS when discussing electronic cigarettes. Are they subliminally telling us something?

But back to COP6 and was it a good COP or bad COP scenario?

Starting out with the good COP (to soften you up, make you relax a little – have a tea and some donuts…)

Did the WHO FCTC do anything good in relation to e cigs?

Well, they want to prevent e cigs ending up in young non-smokers hands – they don’t want a new generation of nicotine addicts.

They want to prevent unproven health claims for e cigarettes.

But that’s it – (remove said tea and donuts and let the heavy take over…)

Bad COP wants to ‘monitor’ e cigarettes, he wants to ban them, ban the advertising of them, and destroy the tobacco industry, (I’m paraphrasing here but you get the idea). He also wants make e cigs a tobacco product so the FCTC can destroy those too.

Now, there have been a great many articles written about the WHO’s FCTC COP6 meeting, and the usual phrases have been trotted out to defend these awful decisions –i.e., ‘they are protecting the children’, plus a nice new one – they are also protecting women and foetuses.

But what will the effects of these e cig policies be? Bearing in mind that signatories of the FCTC are obliged to implement them – and that includes good old Blighty.

The majority of the suggestions made are already in the TPD, so nothing too new – except the desire to ban e cigarettes if possible and to make them a tobacco product.

And these are bad things because they will warn people away from e cigarettes.

People do still give the WHO the credence it no longer deserves, they do listen to what comes out of the WHO media, and surprisingly, many see them as an authority on health.

I know, I know.

Essentially what the FCTC is doing though is telling people that switching to a product that is in the realms of 95% less harmful than tobacco is not the right thing to do – and they are doing it on the grounds of poor research and listening to people who just don’t like e cigs – its an ideology, much like communism or libertarianism.

It’s a belief.

But a belief that will harm people. People will carry on smoking instead of switching.

We at Save e-cigs think global health is far more important than implementing ideology, and it is a sad day for Public Health and the FCTC that they can come up with regulations like these.

Looks like Bad COP wins the day.

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

The proposal to ban vaping in public in Wales. A comment by Darren Millar AM.

Darren Millar AM

Darren Millar AM

As smoking bans become more widespread around the world smokers are looking for alternatives that will allow them to continue to get their nicotine fix unabated and many have found a solution in electronic cigarettes.

Here in Wales, as is the case elsewhere in the UK, they are currently allowed just about anywhere in public – even where tobacco smoking is banned.

However, the Welsh Government’s public health white paper consultation, published last month, includes plans that would see Wales become the first part of the UK to ban the use of electronic cigarettes in enclosed public places.

Ministers say they are responding to concern that the devices normalise smoking and undermine the smoking ban.

Personally, I am unconvinced by the arguments for a public ban on e-cigarettes and I fear this would be a huge step backwards for quitters.

There is a clear danger that forcing someone who is using e-cigarettes to kick their habit to go outside into a smoker’s hut will put them in temptation’s way and harm their health due to second-hand smoke exposure.

We should be giving people a helping hand to quit – not yanking them backwards. Anything that stigmatises those working hard to improve their health should be very carefully examined.

Dr Pat Riordan, director of the Health and Healthcare Improvement Division, which runs Stop Smoking Wales, agrees. He has said “The last thing we want to do is alienate smokers who are using e-cigs in good faith as a part of their attempt to cut down or quit smoking.”

Public health guidance from the National Institute for Health and Care Excellence ‘Tobacco: harm-reduction approaches to smoking’ supports the use of licenced nicotine containing products to aid people in cutting down or quitting smoking.

And a recent BBC poll of nearly 1,000 people suggested most people supported the use of e-cigarettes in public places.

Professor John Britton, of the Royal College of Physicians has stated that if all the people in Britain who currently smoke traditional cigarettes switched to e-cigarettes, 5 million lives would be saved from smoking related deaths – a huge saving in not just unnecessary deaths but also many millions of pounds which would otherwise be spent on medical care and supporting a bereaved family.

Of course, quitting smoking would have the same effect, but it is clear that not every smoker could or would want to stop smoking.

A recent survey of more than 1,600 e-cigarette users found that 61% would return to tobacco if e-cigs were banned. With one person dying from smoking-related illness every 90 minutes in Wales and with smoking the biggest cause of avoidable ill health and early  death in the UK, surely it is better for people to be using e-cigarettes than the real thing.

E-cigarettes clearly work for 2.1million adults in the UK and the Welsh Government must bring forward the evidence behind their proposals to provide clarity on the justification for these proposals within the Public Health Bill.

People who choose to use e-cigarettes do so because they are trying to kick a very addictive and unhealthy habit. We should be supporting these people in their efforts as much as we can, not hindering them.

 

Please note Darren Millar wrote this piece in May of this year for his own blog, but has kindly allowed us to reproduce it here.