Faculty of Public Health and their ‘apology’.

A while back we wrote to the Faculty of Public Health regarding the behaviour of their President John Ashton and his abuse towards vapers on twitter.

This is the letter we sent: https://saveecigs.wordpress.com/2014/09/08/letter-to-professor-ashton/

Below is the reply we had back. Once you have read it, you will understand why we felt it necessary to respond.

Dear Save e-cigs,

Thank you for writing to FPH regarding your concerns about our President, Professor John Ashton. I have investigated the issues raised in your complaint and am writing to advise of the outcome.

FPH agrees that Professor John Ashton’s use of language on Twitter on Saturday September 6 was inappropriate and offensive. Both Professor Ashton and FPH apologise unreservedly for the comments he made.

In investigating your complaint, I have worked closely with FPH’s Board to ensure a thorough process has been followed. FPH’s Board has discussed the matter at great length, given the nature and seriousness of the situation.

The Board has registered its strong disapproval of Professor Ashton’s comments, whilst noting the mitigating circumstances. The Board also agrees that Professor Ashton should continue in his role as President and has given clear direction on the necessary steps to support his return.

You refer to Professor Ashton’s interview on the Jeremy Vine show on Friday 5 September. FPH’s position on e-cigarettes was not as clearly articulated as it might have been, nor was the possible link between nicotine and blindness fully explained. However, I believe that it would be wrong to try and stifle scientific debate or exclude passion from argument. If you would like to read our position, it is available at: http://bit.ly/1p2zEq7 We keep our position under review, considering latest developments and emerging evidence.

When it comes to engaging with the public, we usually do this through our members, as well as partnership work with stakeholders such as other charities and representative bodies.
I would like to personally reassure you that Professor Ashton’s tweets do not in any way represent what FPH thinks about people who use e-cigarettes. Regardless of whether someone represents themselves or an organisation, there can be no place in public health debate for the kind of language that occurred.

FPH keeps our position on e-cigarettes under review, considering the latest developments and emerging evidence. If you would like to read our policy position on e-cigarettes, it is available at: http://bit.ly/1p2zEq7

We are absolutely committed to working to achieve the very best standard of health and wellbeing for everyone.

Thank you again for writing to FPH and raising your concerns.

Yours sincerely

 

This to us is a very poor attempt at an apology, does not address the issues raised, and is basically a ‘whitewash.

This is our follow on letter.

Dear,

Thank you very much for taking the time to respond to our recent complaint. As you are aware, our complaint related to the behaviour of Professor Ashton, not just in his activities on Twitter, but also his conduct in two discussions on BBC radio.

We wish to put on record our profound disappointment with how this whole matter has been dealt with by the Faculty of Public Health and in particular the content of your letter to which we are now responding.

For the record, it is worth pointing out the exact nature of our complaint again.

On Friday the 5th of September, Professor Ashton took part in at least two BBC radio debates, one with Professor Robert West and one with the former head of ASH Clive Bates. He participated in these debates not simply as Professor Ashton, but in his official capacity as President of the Faculty of Public Health – a vitally important fact.

It is fair to say that these were rather ill mannered debates on his part. Whilst Professor West focussed on actual evidenced based facts, Professor Ashton preferred to highlight his concerns for which in many instances there was little or no evidence. In Professor Ashton’s debate with Mr Bates he even went as far as to say nicotine made people go blind and despite repeated requests from the interviewer he was unable to provide a single piece of evidence to back up this statement. Such ill-founded statements not only serve to raise concerns amongst established vapers, they also serve to put smokers off making the switch to a less harmful alternative.

Over the following weekend Professor Ashton then engaged with a number of vapers on Twitter. We were not engaged in these exchanges but we have seen the tweets in question.

In our complaint we acknowledged the fact that Professor Ashton may have been subjected to a number of antagonistic tweets, which we did not condone. As we wrote at the time, there can be no excuse for bad behaviour on Twitter. However, Professor Ashton did not just respond to tweets directed at him, he went out of his way to search through Twitter to find historic tweets that vapers had posted weeks or months earlier, he then used these tweets to insult them. Professor Ashton set out that evening to deliberately seek out and abuse some very vulnerable people.

Whilst we do not condone any abusive e-mails directed at Professor Ashton, he is the professional head of the Faculty of Public Health. He was the one appearing in the news and debating on national television and radio. He is the one who heads up a body that should make pronouncements based on evidence based research.

It is here that we reach the crux of our complaint, a point that you failed to address neither in your complaints procedure nor in the letter to which we are responding.

It is clear from Professor Ashton’s tweets and by his increasingly alarmist pronouncements on radio that he (and remember he never disassociated the Faculty of Public Health from his comments) is not a supporter of e-cigarettes and holds vapers in complete contempt. Please remember that virtually all vapers rely on e-cigarettes to prevent them going back to smoking tobacco cigarettes.

Professor Ashton has therefore laid bare for all to see a total bias against e-cigarettes and vapers; he has also by association inferred that the Faculty of Public Health shares that bias. Furthermore, Professor Ashton has made it abundantly clear that his position (and remember he was speaking not as a concerned individual, but as the President of the Faculty of Public Health) is not in any way based on an objective review of the available facts. How therefore can he continue in his role as president of such an august body?

It is likely that the issue of e-cigarettes will continue to be of significant interest to both the media and policy makers, it is therefore also likely that the Faculty of Public Health and/or Professor Ashton will continue to be invited to opine on the subject. Whilst Professor Ashton remains president of the Faculty of Public Health it will be impossible for the organisation to speak on the issue of e-cigarettes with any credibility. 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. Professor Ashton’s actions have made this more difficult. It would therefore be better for all concerned if the Faculty of Public Health had told Professor Ashton to step aside. We are left wondering what Professor Ashton, or any other of your employees, would have to do to be sacked. Professor Ashton by his behaviour and the Faculty of Public Health in its feeble response to the said behaviour have brought the Faculty of Public Health as a whole into disrepute.

We strongly urge you to look again at this matter.

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

 

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The Save E-cigs Petition handover, what happened and what’s next?

 

 

Save e-cigs Petition Handover

Guest post by Rhydian Mann, Welsh Vaper. (centre of the photo).

Welsh vapers have had a rough time of late, which is mainly down to Mark Drakeford, the current Minister for Health and Social Care. He wants Wales to be seen at the forefront of smoking rate reduction in the UK. In essence this is not such a bad thing. However, the way in which Mr Drakeford has gone about this is not just questionable but also completely ridiculous.

He announced his proposals to tackle smoking in the Public Health White Paper in April (or thereabouts), which included a complete ban on vaping in enclosed public spaces. In this case “public space” comes under any public space that the current smoking ban covers.

Pretty much anywhere which has 4 walls and a roof that you encounter when you leave your own home.

Mark Drakeford said the basis of this was due to fears of ‘re-normalisation’, i.e. the gateway effect where vaping supposedly leads to smoking and all that guff, and makes the of enforcement of the current smoking ban more difficult (as all e-cigs look like cigarettes surely!).

So a public consultation took place and many vapers like myself submitted a reply. However, once this consultation period was over, there has been no mention of it! So the team at Save E-cigs put forward the idea of raising a petition against the vaping ban proposals. With the aid of Simon Thurlow, the petition was launched after approval from the petitions committee, with the end date of Tues 30th September.

How did it do? FANTASTIC! The final amount of signatures on this petition was 1,196. So with this high number, in the general scheme of e-petitions in Wales, what happened next?

Well, on the 1st October 2014, I presented/handed over the Save E-cigs petition to the petitions committee in the Welsh Assembly building known as The Senedd. All the vapers that attended, myself included were under the impression that this handover was rather formal, however, via some communication breakdowns, it ended up more of a photo opportunity and a 15min or so informal chat.

During this chat, I started out by explaining our reasons for raising the petition and what we would like the result of the committee discussions to be. I persistently mentioned the favourite buzzword “evidence” to the committee members and my local Assembly Members (AM’s). The AMs and myself were even shown the results of a poll regarding the proposed ban on public e-cig use. The results stacked up very well in our favour.

E-cigarettes : Should the use of e-cigarettes in public places be banned?

  • Yes – ( 90 votes )
  • No – ( 2478 votes )

Total Answers 2568

Total Votes 2568

Along with other questions and answers there was a very good hint of what the next stage could be, and it could turn out to be very positive.

Unfortunately, an immediate drop of the proposals will not happen, as there are procedures to be followed. The petitions committee will discuss our petition on Tuesday 7th October, which can be watched on Senedd TV from 9am. Our petition will be the 2nd petition to be discussed.

What are the outcomes of this discussion? From what was discussed on Wednesday there are two possibilities.

1 – They ask Mark Drakeford for his views on the matter. Personally, I don’t believe his view will change at all, despite the consultation replies and our petition.

2- There will be an evidence session from vapers to the petitions committee. This is the next step which will be the most beneficial to Welsh vapers because it will be our chance to put the correct evidence over.

The Save e-cigs petition is hopefully one of the first steps in changing the view of the Welsh Assembly. The petition handover was a chance for communication between us and the Welsh Assembly, further communication will happen regardless, as communication can facilitate change.

Our foot is in the door; Welsh vapers will walk in and have their say.

 

Watch Rhydian in action here: http://youtu.be/04oHEZsHbFI?list=UUfFbE37IX0a-XAKE9yw-CPQ

 

 

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.

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.

 

 

 

 

 

 

 

 

The Global Forum on Nicotine… was it worth it?

Global Forum on Nicotine

 

This was my first e cigarette ‘event’ so I had no pre-conceived ideas as to how it would go, who would be there and what the outcome would be. The line up looked interesting and the programme pretty compelling and I was delighted to be there.

It turned out to be two days packed to the rafters with talks and discussions, many conversations were held during the breaks, (where we had fabulous snacks and food, thank you Marriot Hotel) and much was learnt. There wasn’t an awful lot about nicotine if I am honest, but then this was always going to be about e cigarettes; where we are globally, and where we hope to go.

Deborah Arnott from ASH attended, she was on a fact-finding mission for the FCT. She gave a presentation at the end of the conference.  Sadly she still supports med regs, yet accepts the twin track approach agreed by the TPD, but then that presentation was made before she attended. I guess we can cling to a vain hope that she may still change her mind and have a road to Damascus conversion, and realise that e cigs should be pretty much left alone to innovate and get folks away from the dreaded weed.

All the eminent scientists were there, and it was lovely to finally meet them, see them in person and hear what they had to say without reading long and rather dull scientific papers. Prof Hajek is just lovely!

The well- know vapers were there in force, Dave Dorn, Lorien Jollye, Sarah Jakes, Dick Puddlecoat and more, with plenty of wine and beer flowing in the evenings amongst clouds of vapour. (Did anyone know that DD is a trained Opera singer?)

 

But what did Save e-cigs come away with from the Forum?

That Public Health can absolutely see the benefits of e cigs, but can they ethically allow the prescription of them on the NHS, if the Tobacco Industry makes them?

That Vapers, without a shadow of a doubt made the difference at the TPD. Rebecca Taylor MEP made this abundantly clear. Because of vapers getting involved and telling their story, MEPs had to respond. And somehow we need to keep this involvement up.

The reason why snus is still banned? They didn’t lobby, and they didn’t/don’t have the people power behind them. The travesty that is the snus ban was continually referred to, and it is incredulous that it is still banned. It makes absolutely no logical sense.

Working together. This was the common theme and common thread, and was heartening to hear. We all have to put egos’, differences etc. behind us. The TPD could have been better if we had been united. A divided house falls, and we need to ensure that that doesn’t happen again.

 

So what’s next for e cigs? In the words of the world famous fish Dory – we have to ‘just keep swimming’, there’s nothing else for it – keep writing, keep campaigning, and keep on keeping on!

Just keep swimming

Just keep swimming

There are moves afoot for there to be a Global Forum on Nicotine the same time, same venue next year. Let’s hope that the e cigarette industry and community will be able to come together again then, but this time with plenty of progress to report in the regulatory area. Good progress too, in our favour.

So was the GFN worth it? absolutely.

But one final note: Warsaw is lovely, very cheap, but quality cheap, full of culture and if you ever get the chance – go!

 

 

Our Letter to Kelly Evans, writer and marketer at Social Change UK.

Social Change UK

Social Change UK

 

Dear Ms Evans,

 

We are writing in response to your recent opinion piece published on the Social Change UK website.[1]

Save E-cigs is a campaign that represents vapers, their friends, and their families.

In your piece you state that you are not against e-cigarettes, but this is not how your article comes across. In both tone and content it is hostile to e-cigarettes. More than that it is not a balanced article. You state at the beginning of your piece that ‘evidence is king’ yet you make a number of evidence free statements or deny, when it does not suit your line of attack, that evidence exists when it does.

In your piece you argue that there is not enough information available to disprove the argument that e-cigarettes are a gateway into smoking. There is actually a significant amount of very credible evidence that clearly demonstrates that virtually all e-cigarette users are either current or former smokers and that no evidence exists of e-cigarettes being a gateway product.

The latest research produced by Action of Smoking and Health (ASH) concluded that that just 0.1 per cent of e-cigarette users had never smoked tobacco cigarettes previously[2]. Commenting on ASH’s latest research, Deborah Arnott, Chief Executive of ASH, said: “There is no evidence from our research that e-cigarettes are acting as a gateway into smoking.”[3]In addition to this, the largest ever EU-wide study on this issue, carried about by the Harvard School of Public Health also concluded that there was no evidence that e-cigarettes were a gateway to smoking[4].

Looking specifically at children and the gateway effect, research undertaken by Queen Mary University in London[5] found that a child trying a tobacco cigarette for the first time is 50 per cent likely to become a regular smoker. The same research found no evidence that a child trying an e-cigarette for the first time goes on to become a regular vaper.

You suggest that e-cigarette use may actually encourage people to continue to smoke and may actually harm quit attempts. If ‘evidence is king’ where is your evidence?

Many vapers have tried numerous times to quit smoking using conventional nicotine replacement therapies, which have a 90 per cent failure rate, however with e-cigarettes they have all cut down their smoking or stopped completely. Professor Robert West, Professor of health psychology and director of tobacco studies at University College London’s department of epidemiology and public health said: “We found that those using the e-cigarette were about 60 per cent more likely still not to be smoking than those using the licensed product or nothing at all.”[6] E-cigarettes are however not some form of more effective nicotine replacement therapy, they are totally different and need to be regulated accordingly. Speaking in Parliament recently, Professor Robert West also made clear that in all his research he saw no evidence of dual use undermining quit attempts or prolonging smoking, if anything he saw evidence of a move amongst dual users to quit completely.[7] This was supported by the latest Smoking Toolkit Study, something you should be familiar with, which concludes, ‘evidence does not support the view that electronic cigarettes are undermining quitting or reduction in smoking prevalence.’

As the evidence shows, not only are e-cigarettes not a gateway to smoking, they do not re-normalise smoking either. Professor Robert West, following his latest research concluded:“Despite claims that electronic cigarettes risk re-normalising smoking, we found no evidence to support this.”[8]

When it comes to the advertising of e-cigarettes, you are concerned that some of these adverts make e-cigarettes look ‘desirable’; is that not a good thing? After all, e-cigarettes are recognised as being safer than tobacco cigarettes. Professor Peter Hajek of Queen Mary University London and the NHS have both made clear that e-cigarettes are “orders of magnitudes safer than tobacco cigarettes.”[9] The NHS made clear that they were 1,000 times safer[10]. Is it therefore not better for smokers to switch to e-cigarettes? Again the answer must clearly be yes. Professor John Briton from the Royal College of Physicians said: “If all the smokers in Britain stopped smoking cigarettes and started using e-cigarettes we would save five million deaths in people who are alive today. It’s a massive potential public health prize.”[11] Therefore, if these adverts are encouraging people to switch to a safer alternative then what is the problem?

Perhaps you are concerned about the impact of advertising on children? Well you need not worry. Research undertaken by John Moores University[12] concluded that, ‘Despite widespread advertising of e-cigarette brands in print, visual and social media, the majority of participants (children) reported that they had not seen any advertising for e-cigarettes and showed a lack of awareness of advertising and marketing strategies and approaches’.

Of course there must be regulation of advertising, which is why we welcomed the recent Committee of Advertising Practice consultation and look forward to reading their proposals. However, the issue of advertising will not be around for much longer as the revised Tobacco Products Directive bans the advertising of e-cigarettes from 2016.

In your piece you raise concerns about tobacco companies moving into this market. We are a vapers group and are not spokesmen for the industry; however, it strikes us as a good thing if tobacco companies are moving away from making and selling harmful tobacco products to making and selling e-cigarettes.

The key thrust of your piece is about e-cigarette usage amongst children. The latest research produced by ASH concluded that, ‘e-cigarettes are used by both smokers and ex-smokers, but there is little evidence of use by those who have never smoked or by children.’[13] ASH found that 98 per cent of 11 – 12 year olds had never tried an e-cigarette, the figure for 13 – 14 year olds was 96 per cent. The crucial thing is how many of these children, having tried an e-cigarette once go on to use them regularly. We know from figures produced by ASH that very few young people are using e-cigarettes on a regular basis.[14]

In your piece you made much of the issue of flavouring, implying that flavours are used to attract children. 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. Researchers from the ACS[15] 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.’

However for those adult smokers who have switched to e-cigarettes, flavours are important. Why?

The key health benefit of e-cigarettes is determined by how many smokers switch to them or use them as a staging post to quitting completely. This means that e-cigarettes have to be an attractive alternative to tobacco cigarettes for established smokers. Flavouring is an important part of this as the nicotine solutions have no flavour. Removing or banning flavourings would actually reduce the appeal of e-cigarettes to smokers.

In research[16] 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.

This major piece of research concluded:

 

  • That far from marketing flavours to attract children, flavours are marketed to ‘satisfy vapers’ demand’,
  • Flavours contribute to both perceived pleasure and the effort to reduce or quit smoking,
  • Restrictions on flavours could cause harm to current vapers, and
  • Current flavour variability must be maintained.

 

The proliferation of flavours reinforces that view that these are recreational consumer products, not smoking cessation aids, medicines or tobacco products.

We welcomed the decision by both the UK and Welsh governments to introduce bans on the sale of e-cigarettes to under 18s. As 99.9 per cent of e-cigarette users are current or former smokers, such a move was not just responsible, it was also common sense. It will now be up to the authorities to enforce this ban. As an aside, perhaps you could inform us as to which pizza takeaways in North Wales were selling e-cigarettes. A number of vapers took the time to call round such places and were unable to find a single one selling e-cigarettes.

In your piece you raise the issue of passive vaping and cite countries where public vaping bans have been introduced, including Wales where such a ban has been proposed.

The ban on smoking in enclosed public places was introduced to benefit the health of non-smokers whose health was put at risk as a result of being in close proximity to smokers. Therefore any proposal to include e-cigarettes within this ban must also be to protect the health of non-vapers.

Is passive vaping dangerous? A major scientific study undertaken by Dr Konstantinos Farsalinos and Professor Riccardo Polosaconcluded that the ‘effects of e-cigarette use on by-standers are minimal compared with conventional cigarettes.’[17]

One of the examples you cite, of a country that has introduced a public vaping ban, is Spain. Following the introduction of the ban in Spain there has been a 70 per cent fall in the number of vapers and a 60 per cent decrease in the number of vaping shops[18]. People that had made the switch to e-cigarettes are unfortunately now smoking again. Surely this is not something you would like to see repeated elsewhere?

Such bans are not supported by the public who are actually very supportive of e-cigarettes. A recent poll by the BBC[19] 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.

Finally, you raise the issue of regulation. E-cigarettes are currently regulated by at least 17 EU Directives and a number of other regulations at the Member State level.[20] The revised Tobacco Products Directive when it comes into force in 2016 will introduce further regulation and see e-cigarettes more strictly regulated than some tobacco products. You mentioned the specific example of the inclusion of health warnings. These warnings are not as you implied akin to those on tobacco products, they are simply to inform people of the addictive nature of nicotine.

Yes nicotine is addictive but that does not mean it is dangerous. Caffeine is addictive, is that dangerous? The nicotine contained in e-cigarettes is the same pharmaceutical grade nicotine used in NRT products (some of which are inhaled). As 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.”[21]

Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London, said: “E-cigarettes are orders of magnitudes safer than cigarettes because they do not release smoke which contains toxins which are responsible for heart disease, lung disease, and cancer.”[22] The NHS has also concluded that e-cigarettes are 1,000 times safer than tobacco cigarettes[23]. You should also note that many vapers use an e-cigarette that does not contain any nicotine.

In your approach you are going against the precautionary principle as it was originally intended, you are trying to mitigate for a risk that has yet to be proven and in doing so may do more harm than good. Given that 99.9 per cent of e-cigarette users are current or former smokers, and given that e-cigarettes are significantly safer than tobacco cigarettes, the only sensible thing to do is to encourage e-cigarette use up until the time (if such a time were ever to arise) when a direct negative risk between e-cigarettes and a vapers health can be proven beyond doubt. To do anything else would be to condemn millions of smokers in the UK to an even earlier death. Would you rather someone smoked or vaped?

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 2.1 million smokers have switched to e-cigarettes. The rise of e-cigarette sales is directly contributing to a decline in tobacco cigarettes sales. In the words of Professor Robert West: “What is the problem that requires further regulation?”[24] This should be a cause for celebration, not concern.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[1] http://www.social-change.co.uk/news/post.php?s=2014-06-19-e-cigarettes-children-and-adults-who-like-gummy-bears-are-e-cigarettes-a-good-thing

[2] http://www.theguardian.com/society/2014/apr/28/e-cigarette-users-triple-ash-survey

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

[4] http://tobaccocontrol.bmj.com/content/early/2014/04/30/tobaccocontrol-2013-051394.abstract?sid=e065daee-e796-4cd1-8bf5-30ae2696f39f

[5] Research undertaken by Professor Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London

[6] Study carried out on 5,000 smokers, by Professor Robert West looking at the success rate of different methods to stop smoking: nicotine gum, nicotine patches, nothing, or e-cigarettes. Reported on BBC Breakfast 28 April 2014

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

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

[9]http://www.bbc.co.uk/news/health-27161965

[10] http://www.spectator.co.uk/features/9197731/vape-alarm/

[11] The Independent Newspaper, 29 March 2013

[12]John Moores University – ‘Young People’s Perceptions and Experiences of Electronic Cigarettes’

[13] http://ash.org.uk/files/documents/ASH_715.pdf

[14] http://www.ash.org.uk/files/documents/ASH_891.pdf

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

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

[17] 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

[18] http://www.thinkspain.com/news-spain/24345/e-cigarette-sales-in-spain-drop-by-70-per-cent

[19] http://www.bbc.co.uk/news/health-24909648

[20] http://www.clivebates.com/?p=1092

[21] The Guardian Newspaper, 05 June 2013

[22] http://www.bbc.co.uk/news/health-27161965

[23] http://www.spectator.co.uk/features/9197731/vape-alarm/

[24] Professor Robert West speaking at the E-cigarette Summit, The Royal Society, London on the 12th of November 2013.

Post TPD vote response.

Today MEPs had the opportunity to vote to take Article 18 out of the TPD without jeopardising the passage of the wider Directive.  This would have been the right thing to do.  It would have been in keeping with the publicly expressed views of scientists and public health experts.  It was what the overwhelming majority of responsible e-cigarette manufacturers were calling for, and most importantly of all it is what the EU’s 12 million vapers have been calling for for nearly a year.

However, when it came to the vote, MEPs voted by a whopping 478 votes to 130 votes in favour of Article 18 remaining in the TPD!  To the 130 MEPs, which included regular Save E-cigs blog contributors, Martin Callanan MEP, Nikki Sinclair MEP, and Rebecca Taylor MEP, who did the right thing, we simply say a huge thank you, not just for today, but for all your support over the last year or more.  To those 478 MEPs who vote for the retention of Article 18 as part of the TPD, we simply ask why?

Why would any right-minded politician vote for Article 18 when it is so flawed?

 

  • It is based on a misrepresentation of scientific evidence,
  • It subjects e-cigarettes to a stricter regulatory regime than tobacco cigarettes,
  • It bans e-liquid bottles exceeding 10ml in volume,
  • It bans tanks exceeding 2ml in volume,
  • It forces manufacturers to wait six months before putting new products on the market,
  • It poses restrictions on cross-border sales,
  • It bans all promotion of e-cigarettes, and
  • It bans e-cigarettes and e-liquids with nicotine concentrations above 20mg/ml.

The last point is perhaps the most important as independent research published this week by the respected economic consultancy, London Economics, demonstrated that the TPD’s ban on higher strength e-cigarettes, used by 2.5 million Europeans, will increase tobacco smoking by 9.6 million cigarettes a day and result in the deaths of an extra 105,000 people every year.

Where do we go from here?

As a campaign representing vapers, their friends, and their families, we will not give up.  We have a number of very exciting plans which we will be updating you about very soon.

For now, we will publish the full list of the 130 MEPs who voted to have Article 18 removed from the TPD and the full list of the 478 MEPs who voted to keep it in; vapers can then use it as a resource when deciding how to vote in the European Elections later this year.