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One of the outstanding weaknesses in some recent research into e-cigarette use is the obvious lack of knowledge that some researchers and commentators have about the workings of vaping devices. indeed, whether by accident or design, some massive 'bloopers' have been made and those have had serious repercussions. How many smokers have disregarded alternative advice and have continued to smoke?
It is difficult for people who are in the front line: people who vape, to express their thoughts and counter the 'wittering's' of some experts. It is difficult for shopkeepers, hairdressers and used car salesmen to have their voices heard above the 'babble' of health professionals, politicians and media presenters all proclaiming loudly, this, that and the other.
Yet... Who are the experts when it comes to vaping? More importantly, are they really experts? Let us take a quick tour and have a look at what some 'experts' have said about vaping.
Let me start with what is to my mind, one of the 'daftest' ones. E-cigarettes may cause tuberculosis. That is correct, e-cigarettes may cause tuberculosis. The following comment appeared in the Cape Bretton Post of 2nd January 2014. It was written by an 'expert.' (But not a medical expert)
“Now most of the e-cigarettes sold here are made in China, where there is very weak government regulation with respect to how they are made. The Canadian government does not know if Chinese workers making cigarettes wear masks. If they aren’t wearing masks, there are increased risks associated with tuberculosis.”
I spotted this at the time and wrote to the professor, pointing out that...
"This is just about one of the most ridiculous statements have ever come across. Pure, unsubstantiated scaremongering and an indication of the lack of care you have taken with your research.
There is a beautiful irony here. Some ‘idiot’ has reasoned that if there is tuberculosis in China, there must be a risk involved. You have decided to parrot this. And here is the irony! You see, the main ingredient in e juice is propylene glycol. Propylene glycol is a disinfectant. And, do you know what? It is used extensively in the war against… yes… come on now… Think! That’s it… Tuberculosis!"
Yes, I know, just because propylene glycol is a constituent in e-liquid does not mean it would prevent infection via vaping - but there again, there are, as far as I am aware, no cases of tuberculosis having been caused through vaping.
Anyway, I am not an expert. Oh! And you may have noticed that my propensity for using emotive terminology has not changed between my writing back then and now - I offer no apology even though scientists avoid doing this... or do they?
An emotive headline but did the researcher claim this? It would appear he did. “[Level of PAHs] in e-cigarettes is at least one million times more than roadside air in Hong Kong,” said Dr Chung Shan-shan, assistant professor in the university’s biology department." The study itself turned out to be 'pure garbage,' sorry, I must stop doing that. The study itself contained one or two weaknesses. No, back to my own style: It was not worth the paper it was written on, or perhaps I should say, the papers it was written in, because I am not sure if the research was ever published except in the world press.
It is not a one off... The New England Journal of Medicine [Published by Marvel Comics? I can say this because I am not an expert and have no ambition to have anything published in publications of disrepute] The New England Journal of Medicine published a report that started a media frenzy.
However, is was soon revealed that, once again there were major flaws.
"This experiment, published in the New England Journal of Medicine, operated the vaping device at a such a high temperature that it produced thermal breakdown products (so-called dry puff conditions), but no user would ever be able to use it this way – the vapour would be too acrid. They went on to calculate human cancer risk from these unrealistic machine measurements and presented the data in way that was bound to mislead, which it duly did and created a world-wide media storm. This was irresponsible science, careless publishing, and credulous journalism adversely changing the perceptions of the relative risks of smoking and vaping in a way that will cause harm. The paper should be retracted in its entirety".
And on and on and on. 'Experts,' media, spouting crap, anything to demonise this perceived threat - and not necessarily a threat to the vaping consumer. Lipoid Pneumonia, Tuberculosis, cancer, gateway,However, thank goodness, there are real experts out there. [Note, no inverted commas].
And now we come to the present day, yesterday in fact. Yesterday I read an article by Sofia Carlsson, Associate Professor, Institute of Environmental Medicine, Karolinska Institute, and Cecilia Magnusson, Professor, Department of Public Health Sciences, Karolinska Institute, here. [You may have to use translate]
They discuss a paper purporting to show a connection between heavy snus use and diabetes type 2. Before saying anything about this, in the above [linked] article they stress, and stress it more than once, that we should not jump to conclusions as there may be confounding factors - how very refreshing...
They also state as a fact: "Smoking is an established risk factor for diabetes, and a new problem in previous studies has been to separate snuff effects from smoking as inter use is common."
This comment started warning bells ringing. So I Googled (five minutes' worth) and the very first thing I came up with was... (page 250)
"Then there are quirky findings. In the Sweden study, researchers also looked at the risks associated with using "snus."... In this study, and in contrast to smoking cigarettes, the use of this nicotine containing product did not significantly increase the risk of diabetes."
Oh aye! But it is the next paragraph I find really interesting.
"The Hopkins' study also had an unexpected finding. Although cigarette smoking was clearly linked to type 2 diabetes, stopping smoking led to higher short term risk. highest in the first three years after cessation with a hazard ratio of 1.9. The last finding is a head scratcher. A report from the University of Oxford, England, involved 1,919 patients followed over 6 years. Of these subjects, 1,216 were initially free of retinopathy
Hang on a second, what on earth is retinopathy? I am not an expert you see. Right, Google: 'Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye'
and 22% developed the pathology over the next 6 years. Of the 703 persons with retinopathy at the onset of the study, 29% progressed with 2 scale steps or more... Not smoking had an unfavourable effect on the development or progression of retinopathy.
A head scratcher right enough.
Sofia Carlsson, and Cecilia Magnusson, rightly emphasise that there may be many confounding factors but also state that, they, "have also, insofar as possible, taken into account other risk factors for type 2 diabetes such as overweight, physical inactivity, heredity, alcohol consumption, and education level." Did they? I do not have access to the research and even if I did, I doubt that I would understand much of it. It just seems to me to be an echo of previous, dubious e-cigarette studies. It just seems to me that not enough attention has been paid to the lifestyles of the participants... For example, is it the case that, like so many heavy smokers, heavy snus users are concentrated within specific society groupings, that they tend to be less active: that their diets are poorer; they belong to a particular ethnic group. (Some racial, ethnic groups continue smoking cigarettes at higher rates) Whatever...
It seems dubious to me that just because diabetes is higher in heavy snus users that it is the snus which is the cause? The researchers welcome any discussion - so do I.
But why do so many researchers publish materials that that are so far from the truth? What can it be that motivates them to go down this road? Michael Siegel, Professor in the Department of Community Health Sciences at Boston University School of Public Health gives us an insight into the world of Tobacco Control. He paints a picture of a world where individuals are indoctrinated and controlled. A world which will broke no contradiction; suffer any criticism.
He says, in an article, containing a great deal more...
"...if I conduct a study and it fails to show a significant relationship between second hand smoke and chronic disease, then all of the sudden, I have automatically become an illegitimate scientist."
"If it fails to show." Is this why so many 'studies' risk ridicule; a combination of induced blindness and fear?
"I was able to overcome my "brainwashing," but it took a lot of courage to do so, and a lot of risk to my career. I paid a heavy price for breaking out of the mould into which I had been cast. It shattered my career in tobacco control. But at least it didn't shatter me, and the person who I really am."
How many experts show this kind of courage, and the answer, surprisingly, is quite a few... these are the experts, the genuine ones, and their number is growing.
The edifice which is Tobacco Control is crumbling. Soon it will be gone.
New Nicotine Alliance would like to offer our thanks to Robert Innes for this guest blog entry. He can be reached on Twitter at @brainyfurball
The EU consultation on excise duties applied to manufactured tobacco ends on 16th February and includes proposals to tax reduced risk nicotine products. It’s vital that nicotine consumers respond to make their feelings known. If the EU permits taxation on reduced risk products the prices will go up and many people will be discouraged from switching. It’s simple and quick to respond to the consultation - it only takes around 15 minutes. Vapers in Power has done a useful guide to it, here. The Clive Bates/NNA briefing is here.
Here's a repost of NNA's "EU Tax policy - harmful to health - our briefing", in case you missed it the first time round:
The EU Commission is currently consulting on a revision to the Tobacco Excise Directive, which could see reduced risk products such as e-cigarettes being included. Our associate Clive Bates has written an in depth briefing together with NNA which details why this is a very bad idea. The full briefing can be read here. The consultation can be found here.
There is no case on principled or practical grounds to apply excise duties to vaping products and other products that offer a much safer alternative to smoking. The value to health and wellbeing associated with switching from smoking to vaping will exceed any benefits arising from revenue collection.
Just as it was with the Tobacco Products Directive, the inclusion of products which do not contain tobacco in the Tobacco Excise Directive is unhelpful and risks creating confusion in the minds of consumers.
If vapour and other reduced risk products are to be included in the directive then our view is as follows:
Excise policies on reduced risk products can have a significant negative impact for human health and is inconsistent with EU requirements to make policy with a high level of health protection.
The EU principle of 'non-discrimination' requires that products with very different characteristics are not treated in the same way - the vast difference in health risks means that reduced risk products must have zero or very low taxation relative to smoked tobacco products.
There is an opportunity to create a regime which will incentivise use of the safer products.
The risk is that poor policy will reduce this incentive, and so protect the market for smoked tobacco products.
Excise duty is a 'sin tax' and switching to low risk products is a virtue to be encouraged, not a sin to be taxed.
Our recommendations for low risk non combustible products are as follows:
If they are included in the directive then a zero rate duty must be allowed.
There should be a maximum rate set which reflects the very substantial difference in risk compared to smoked tobacco.
We urge the European Commission, European Council and member state tax authorities to take great care in striking the balance between public health, revenue raising and administrative costs. The institutions involved should conduct thorough impact assessments, take a hard look at the risks of causing harm to health and then think again about imposing excise duties on products that are already helping millions of Europeans to improve their health and wellbeing and have the potential to help millions more.
On the day that NNA was in the High Court asking for permission to join the effort to overturn the ludicrous ban on snus, and Hertfordshire County Council were holding their very successful 'e-cigarette masterclass', at which delegates learned about vaping, and sensible vaping policy, Public Health Wales issued their new position on e-cigarettes. http://www.wales.nhs.uk/sitesplus/888/news/43873
It is difficult to imagine the machinations that must have gone on within PHW whilst coming to this position. Seemingly realising that a failure to admit that e-cigarettes are very much safer than smoking tobacco cigarettes is now akin to being an anti-vaxxer, they grudgingly advise that anyone who is unwilling or unable to stop smoking should switch to vaping instead. Quite why anyone would want to do so given the rest of the PHW statement is anyone's guess.
Cherry picking from the US Surgeon General report, and of course the World Health Organisation, we are told that:
There are no benefits to children or young people using e-cigarettes.
No one wants to see young people initiate nicotine use via any method, but for those who have or will take up smoking there are definite benefits.
'Confectionary-like' (sic) flavours of e-liquid should not be permitted, in order to reduce the appeal of ENDS to children and young people.
How many times do we have to point out that the majority of adults prefer candy and fruit flavours. Certainly these flavours should be marketed responsibly, but in light of the fact that there is no evidence that 'confectionary-like' flavours, or indeed any other flavours, cause young people to take up regular vaping, all that this policy would achieve is to make e-cigarettes less appealing to those adult smokers who, as PHW admits, would benefit from switching.
Until a more definitive risk assessment can be completed, voluntary restrictions on the use of ENDS in enclosed public spaces should continue.
No doubt PHW would have preferred to push for legislative bans, but given what happened last time they tried, they settle for telling Welsh businesses to do that job for them. Contrary to PHW's carefully selected 'evidence' on this issue, there is no evidence at all of a risk of harm to bystanders, or that vaping renormalises smoking.
Additional 'factoids' in the statement include:
"Use of e-cigs may reduce the likelihood of smokers quitting by displacing scientifically proven methods to help people quit."
"The use of ENDS will act as a gateway to tobacco use."
Needless to say there is no evidence to suggest that either of the above concerns are happening in the real world.
In summary, whilst PHW's assertion that for a smoker, switching to e-cigarettes will significantly reduce the risk of harm to health is welcome, this statement is completely outweighed by the very negative comments which follow. We can all guess what this information will look like:
"Public Health Wales will include information on ENDS alongside other aids to stopping smoking in all information materials and in Stop Smoking Wales support services. Information on all products will be presented to support smokers in making an informed choice about the best way to quit for them."
NNA has succeeded in its request to join the challenge against the ban on snus in the UK and the EU.
The High Court agreed on 26th January that the challenge can be referred to the European Court of Justice. There were two issues before the court.
Swedish Match initiated the challenge to the ban and asked the High Court for a Judicial Review of the legislation. The case was brought against the Secretary of State for Health. The Department of Health opposed the application for Judicial Review on the grounds that it was out of time – they argued that the case should have been brought in 2014 when the Tobacco Products Directive was passed. SM argued that it could not bring a challenge against the law until the EU Directive had been passed into UK law in 2016. The Department of Health did not raise substantial challenges to the details of the Swedish Match case.
NNA’s Gerry Stimson and Jessica Harding were in the court and as the judge spoke it gradually became clear that there would be a positive result. Mrs Justice Lang agreed with SM’s argument that a challenge could only be brought once the law had been passed in the UK. So she agreed that the case could be referred. She then turned to NNA’s case. We asked to be joined to the case as a third party intervenor acting in the public interest and adding important consumer and health rights arguments. Neither Swedish Match nor Department of Health lawyers objected to our application and the judge agreed that we could be joined to the case.
Because the UK law is based on EU Tobacco Products Directive, the case now has to be referred to the European Court of Justice. So we get a chance to put our view at the ECJ. The UK government has signalled its intention to leave the ECJ post-Brexit, but as of now EU legal processes prevail. The advantage of getting this into the EU legal process is that if the ECJ rules in our favour and against the ban, the ECJ decision applies across the whole of the EU, not just the UK.
It will take about a month for the UK to prepare the case to be sent to the ECJ, and the ECJ will likely take up to 18 months to come to a decision – so there is a long way to go yet!
Even getting this far is a triumph for a new, small consumer advocacy group. NNA was only founded in 2015, is a small group of volunteers and has few financial resources. This shows the potential for consumer advocacy groups to make a noise and make a change. Thanks to everyone who is supporting this NNA campaign to get availability of a wide range of lower risk nicotine products.
Testimony to the Norwegian Parliament on the relative risk of snus from Professor Anders Milton, ex President of the World Medical Association.
The High Court has just announced that it will allow the ban on the smoking substitute snus to be referred to the European Court of Justice.
Professor Gerry Stimson, who is leading the legal challenge to the ban by the consumer group, the New Nicotine Alliance, said:
“There’s now a race to see whether European judges or British politicians will lift the ban first. They realise that with British men smoking four times as much as Swedish men we cannot justify continuing the ban on snus. If the European Court doesn’t do it first, I hope that when Brexit happens the bonfire of regulations will begin with this stupid ban on the world’s most successful safer alternative to smoking.”
Snus is pasteurised tobacco product which is placed in a sachet under the lip The European Union maintains a blanket ban outside Sweden which negotiated an exemption when it joined the EU. The US Food & Drug Administration authorised snus in November 2015 http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm472026.htm The New Nicotine Alliance has been intervening in the legal action bought by the manufacturer, Swedish Match How Snus Got Banned
Snus got banned in Europe because of pressure from the then UK public health minister, Edwina Currie. She was fearful about Skoal Bandits. The pharmaceutical industry has argued for the ban on snus to continue as it competes with their nicotine gum and patches. In 2012 the EU Health Commissioner John Dalli was forced to resign following allegations that one of his associates had approached snus maker Swedish Match asking for a bribe: https://en.wikipedia.org/wiki/John_Dalli EU officials have argued that oral tobacco can be a problem - but in doing this they have confused evidence about chewed South Asian tobacco (e.g. http://www.bbc.co.uk/news/health-19718643 ) with snus which is a pasteurised product created to very tight standards (https://www.swedishmatch.com/Snus-and-health/GOTHIATEK/GOTHIATEK-standard/)
Is snus much safer than smoking? The answer from key health organisations is emphatically yes.
US Food and Drug Administration: it chose in 2015 to make snus the first nicotine product it authorised because the science is extremely compelling: FDA authorisation Royal College of Physicians: says that snus “demonstrates proof of the concept” for tobacco harm reduction: “Nicotine Without Smoke” RCP 2016 World Health Organisation: says that snus is “considerably less hazardous than cigarettes”: page 273 WHO Tob. Reg. Report 951 EU Commission: says that “It is undeniable that for an individual substitution of tobacco smoking by the use of moist snuff [snus] would decrease the incidence of tobacco related diseases.”: SCENIHR (2008) This heavyweight analysis is not just from lab tests, but decades of epidemiology which show that on the key smoking diseases including lung and oral cancer, Sweden is doing far better than other countries. In a letter to The Times Professors Farsalinos, Le Houezec, Polosa and Ramström wrote that not only did Sweden have by far the lowest rates of lung cancer and heart disease in Europe but that "younger Swedish men, who have the highest use of snus, have the lowest levels of oral, oesophageal and pancreatic cancer.” (18% of Swedish men use snus, but only 4% of women.) If Sweden’s success was repeated in the UK our male lung cancer mortality would be 54% lower: Scandinavian Journal Of Public Health, 2009 .
UK ONS data shows around a quarter of men still smoke: see figure 1: 16-24 years 25%; 25-34 years 26%; 35-49 years 22%.
Nicotine campaigners take government to High Court over “disastrous ban”
UK is “failing very badly” at reducing smoking compared with Sweden
A consumer group that aims to ensure smokers have safer alternatives to cigarettes is today challenging the government in the High Court in a bid to lift a European Union ban on the oral tobacco product snus. The New Nicotine Alliance led by Professor Gerry Stimson of Imperial College London wants snus - which is used by a fifth of all men in Sweden - to be legalised.
Sweden has by far the lowest rate of smoking in the developed world. Government figures show that just 5% of its men aged 30 to 44 years old are regular smokers compared with 22% in the UK. Scientists conclude that the widespread use of snus as an alternative to smoking is the reason that diseases including lung and mouth cancer are far lower in Sweden.
“The UK is failing very badly compared with Sweden at bringing down smoking rates. It is a tragedy that we have four times as many men in their thirties smoking than in Sweden and disastrous that we are banning the most successful alternative to the biggest cause of preventable death,” said Professor Stimson.
The professor will be telling the High Court of research which shows that male lung cancer rates in the UK could more than halve if it had similar levels of snus use to Sweden. He is particularly angered that some Swedish and Norwegian users have started smoking when they move to the UK because they can’t get their snus here.
“Everyone was taken by surprise by the way millions of smokers flocked to e-cigarettes to help them quit smoking. Yet nine million people in the UK continue to smoke and proven alternatives like snus should be available to help those who want to quit. Smokers should have the widest choice of reduced risk products so that they can find the one that works for them” said Professor Stimson.
In parallel with today’s legal attempts to overturn the ban, a group of 22 Conservative MPs has written to the Health Secretary urging him to include snus in his forthcoming Tobacco Control Plan which will cover Britain’s smoking policy after Brexit.
Snus is a moist, smokeless powdered tobacco. It is sold as a loose powder or pre-packaged in a small sachet (a bit like a mini tea bag). It contains ground tobacco, salt and may contain food-grade smoke aroma flavourings, such as citrus, bergamot, juniper, herb or floral flavours. Most Scandinavian snus is produced in Sweden where it is regulated as a food under the Swedish Food Act. The nicotine content varies among brands.
Is snus an appropriate and acceptable harm reduction product?
Snus fulfils the criteria for a tobacco harm reduction product. It is a low risk nicotine product and delivers acceptable doses to those who use it. In countries in which it is allowed it is popular and has contributed to declines in smoking and smoking related diseases.
How does snus differ from other oral tobaccos?
Snus is a smokeless tobacco. Unlike some other smokeless tobacco types, Swedish snus is not fermented and is pasteurised, which inhibits the growth of bacteria that help the formation of tobacco-specific nitrosamines (an important group of carcinogens in tobacco products). Snus is refrigerated in order to inhibit the growth of toxins.
How is snus used?
Snus is placed between the upper lip and gum. The nicotine is released into the saliva, with the rate of release affected by the amount of saliva. New users experiment (titrate) to find the best rate of nicotine release. http://www.wikihow.com/Use-Snus
Individual studies can produce contradictory findings so evidence must be sought from overviews of key studies and pooled results. A recent systematic review and meta-analysis examined the evidence relating to snus and health across six major Swedish, Norwegian, Danish and Finnish studies, up to 2010. This concludes that the evidence provides scant support for any major adverse health effects of snus: snus is not associated with cancers of the oropharynx, oesophagus, pancreas, or heart disease or strokes. Compared with smoking snus poses about 1% of the risk of cancer or cardiovascular disease. https://www.ncbi.nlm.nih.gov/pubmed/21163315
Snus and lung cancer in Sweden
The rise in the use of snus has resulted in Sweden having the lowest lung cancer mortality and tobacco-related mortality in Europe. It is estimated that if the Swedish smoking prevalence was extrapolated to the rest of the EU, there would be a 54% reduction of male mortality from lung cancer. (Rodu B. and Cole, P. 2009. “Lung Cancer Mortality: Comparing Sweden with Other Countries in the European Union.” Scandinavian journal of public health 37(5):481–86.) http://journals.sagepub.com/doi/abs/10.1177/1403494809105797
Health effects of switching to snus
Given the lower risk profile for snus it has been calculated that the life expectancy of smokers who switch from smoking to snus is little different to the life expectancy of those who stop smoking altogether. The authors of this study conclude that: ’Individual smokers who switched to snus instead of continuing to smoke and new tobacco users who only used snus rather than smoking would achieve large health gains compared with smokers’. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60677-1/abstract
This finding is confirmed by a recent analysis of six major studies which found that switching from smoking to snus is associated with major reductions in morbidity and that switching to snus appears to have much the same reduced health risk as quitting smoking. http://europepmc.org/abstract/MED/23454227
Does snus pose a risk to others?
Snus poses no risk to others, such as work colleagues and family members as there is no combustion and consequently no ‘second hand’ smoke and no risk of fire.
Consumers in both Sweden and Norway are choosing to use snus rather than to smoke. There has been a major increase in the use of snus and a concomitant decline in the smoking of tobacco. In Sweden, snus overtook cigarettes in 1996; In Norway the rise of snus and the decline in smoking resulted in male use of snus overtaking cigarettes by 2006. This happened despite snus use in Sweden and Norway occurring in a context where active promotion of the product was banned and health authorities warned smokers against snus use.
‘Daily smoking’ is even lower in Sweden at 8% compared with 19% in the UK in 2014.
Smoking is fast disappearing in some groups of Swedish men: in 2016 in the 30 to 44 years age group only 5% are daily smokers, less than a quarter of the level in the UK men. https://www. folkhalsomyndigheten.se/ documents/statistik- uppfoljning/enkater- undersokningar/nationella- folkhalsoenkaten/2016/ Tobaksvanor-nationella- resultat-tidsserier-2016.xls
How does the use of snus reduce smoking?
Snus is used to avoid the uptake of smoking, to stop smoking, and to reduce smoking.
Overall in Sweden and Norway the total level of tobacco use has remained stable or slightly declined – what is important is that there has been a major shift away from smoking.
Snus can therefore be considered protective against smoking.
Might other factors in Sweden account for the switch to snus?
No. Sweden has implemented fewer tobacco control measures than the UK. Laws on tobacco use and promotion are less strict that in the UK. They don't have a fully 'comprehensive' smoking ban. Smoking is allowed in designated purpose built smoking rooms in some workplaces and some public places like airport terminals. Smoking is also permitted in designated smoking areas outside in train stations and bus terminals. They don’t have especially high tobacco taxes. There is a ban on tobacco advertising and promotion, but advertising and promotion is allowed at points of sale, as are tobacco product displays. There are total restrictions on tobacco sponsorships.
What does the Royal College of Physicians, Tobacco Advisory Group say about snus?
‘The availability and use of an oral tobacco product known as snus in Sweden, documented in more detail in our 2007 report…demonstrates proof of the concept that a substantial proportion of smokers will, given the availability of a socially acceptable and affordable consumer alternative offering a lower hazard to health, switch from smoked tobacco to the alternative product. Particularly among men, the availability of snus as a substitute for smoking has helped to reduce the prevalence of smoking in Sweden, which is now by far the lowest in Europe…Trends in snus use in Norway are similar to, and perhaps stronger than, those in Sweden, and there the use of snus is strongly associated with quitting smoking.’Royal College of Physicians, Tobacco Advisory Group (2016). Nicotine without smoke: Tobacco harm reduction
Legal status of snus
Snus is banned from sale in the EU (except in Sweden).
The UK Tobacco and Related Products Regulations 2016 and EU Tobacco Products Directive 2014 on which it is based states that ‘no person may produce or supply tobacco for oral use’. Tobacco for oral use is defined as:
A tobacco product which is – (a) intended for oral use, unless it is intended to be inhaled or chewed; and (b) in powder or particulate form or any combination of these forms, whether presented in a sachet portion or a porous sachet, or in any other way’.
How did snus come to be banned?
In 1989 the UK Oral Snuff (Safety) Regulations were passed in response to the introduction of the moist snuff marketed as ‘Skoal Bandits’. This ban was quashed on appeal by the manufacturer.
In the EU, Directive 92/41 banned sales of snus, to harmonise rules in that three member states had already banned tobacco for oral use.
In 1995, on accession to the EU, Sweden obtained an exemption from the ban.
In 2001 the Tobacco Products Directive continued the ban.
The ban was also continued in the 2014 Tobacco Products Directive.
The legal challenge
The Swedish Match legal challenge against the ban on snus
Swedish Match – the main manufacturer of Swedish snus – has brought a challenge in the UK High Court against the ban of the sale of snus. Their legal argument is that the law discriminates against snus compared with cigarettes and with lower risk nicotine products, that the ban is disproportionate, is against the principle of subsidiarity in removing national regulatory discretion, breaches the duty to give reasons for the ban, and is an unjustified restriction on the free movement of goods.
The NNA legal challenge against the ban on snus
NNA asked the High Court to be joined to the case as an ‘intervenor’. NNA is acting as a third party in the public interest, and brings added facts and argument to the case.
NNA argues that the ban is (a) disproportionate, and (b) contravenes the right to a high level of health protection.
Significantly, for the first time in a challenge against UK (and EU) tobacco legislation, NNA argues that the ban infringes human rights. NNA argues that the ban contravenes the EU Charter of the Fundamental Rights vis Art 1 ‘human dignity’, Art 7 ‘respect for private and family life’, and Art 35 ‘health care’.
Art 35 stipulates that a high level of human health protection shall be ensured in the EU policies and activities. NNA argues that the ban is inappropriate as it prevents smokers from having access to a safer product and is an unsuitable means for achieving a high level of health protection.
Progress with the case
The High Court agreed on Jan 26th 2017 that there was a case for a review of the legislation. Because the UK Tobacco and Related Products Regulations 2016 are based on the EU Tobacco Products Directive 2014, the case was referred to the European Court of Justice, on 9 March 2017.
Implications of the case
The ECJ ruling will apply across the EU.
Why did NNA get involved in this case?
NNA sees access to all safer nicotine products as important in helping provide smokers with lower risk alternatives to smoking – so lo-tech snus is important as well as hi-tech e-cigarettes. NNA contends that snus fulfils the criteria for a tobacco harm reduction product and that it should be available in the UK.
NNA is seeking to overturn the UK and EU ban on snus. Snus is a popular and effective harm reduction product which has helped thousands in Sweden and Norway to avoid the risks of smoking. As a result Sweden and Norway have the lowest rates of lung cancer in Europe. But the sale of snus is banned in the EU, except in Sweden. The TPD was bad for e-cigarettes, but worse for snus. We will tell the court that the ban is harmful to health and that UK smokers deserve a better deal – the snus ban kills.
E-cigarettes are having a major impact, but they don’t work for everyone in all circumstances. We want to see wide availability of all safer nicotine products as alternatives to smoking.
Everyone was taken by surprise by the way millions of smokers flocked to e-cigarettes to help them cut down or stop smoking. Yet nine million people in the UK continue to smoke and proven alternatives like snus should be available to help those who want to switch away from cigarettes. When smokers have the widest possible choice of reduced risk products it increases the likelihood of their finding an option that works for them.
Snus is a popular and effective harm reduction product. But the sale of snus is banned in the EU, except in Sweden. The TPD was bad for e-cigarettes, but worse for snus. The EU continued with the ban despite huge evidence for the safety and impact of snus, and despite the overwhelming view of consumers who told the EC that the snus ban should be lifted.
NNA contends that snus fulfils the criteria for a tobacco harm reduction product and that it should be available in the UK.
That is why we are going to the High Court on Thursday 26th to ask for the ban to be lifted. We are piggy-backing on Swedish Match’s request for a Judicial Review of the ban on snus. NNA is asking the Court to be allowed to make its own submission in order to provide a consumer perspective on the ban and of the benefits that will follow if the ban is lifted.
If the High Court agrees that there is a case to answer the case will be forwarded to the European Court of Justice. This is because the UK law is based in EU law - and yes – we are still in the EU as of now and the ECJ process still stands. If, and it’s a big IF, the case is referred to the ECJ, and IF the ECJ rules against the ban then this decision would apply across all of the EU. So, there is a lot at stake.
Snus is much safer than smoking tobacco. Some 46% of deaths due to smoking are respiratory diseases, predominantly lung cancer, chronic obstructive pulmonary disease and pneumonia. Without the inhalation of smoke then for these diseases alone half of premature deaths can be avoided.
Sweden now has the lowest lung cancer and tobacco-related mortality in Europe. There is scant evidence for any major adverse health effects of snus: snus is not associated with cancers of the oropharynx, oesophagus, pancreas, or heart disease or strokes. Switching to snus appears to have much the same reduced health risk as stopping smoking. Snus is not completely free from adverse health effects but these are miniscule compared with the risks of smoking. Snus poses no risk to others as there is no ‘second hand' smoke.
Snus protects against smoking by reducing the uptake of smoking, helping people reduce smoking, and helping people to stop. In Sweden and Norway the increase in the use of snus has been accompanied by a major decrease in smoking. As a consequence the prevalence of male adult smoking in Sweden and Norway is now the lowest in Europe at 11% and 13% respectively.
Smoking is fast disappearing amongst some Swedish men: in the 30-44 year age group only 5% are daily smokers, less than a quarter of the level in the UK.
NNA will tell the court that the ban on the sale of snus is incompatible with evidence for its safety in comparison with smoked tobacco cigarettes and that the ban is against the interests of individual and public health.
The application is supported by Witness Statements from myself, Karl Lund – the leading Norwegian expert on snus, Louise Ross – NNA Associate and an expert on stop smoking services and alternative products, and Judy Gibson - from the International Network of Nicotine Consumer Organisations.
Watch the NNA website and follow @NNAlliance on Twitter and NNAlliance on Facebook for updates on the case and please share our posts on social media.
NNA’s view reflects the weight of consumer opinion in the EU that is overwhelmingly in favour of lifting the ban on snus: according to evidence from the European Commission itself some 83% of the 70,925 who responded to the consultation on the Tobacco Products Directive wanted the ban removed.
We will tell the court that the ban is harmful to health rather than protective of health; that it discriminates against products and consumers, and works against the achievement of a high level of health protection. UK smokers deserve a better deal – the snus ban kills.
Gerry Stimson Chair NNA on behalf of the Trustees
Testimony to the Norwegian Parliament on the relative risk of snus from Professor Anders Milton, ex President of the World Medical Association.
NNA associates attended a debate at London South Bank University on Tuesday evening entitled “A way forward – How e-cigarettes could and should affect public health” which, sadly, only resulted in conveying an entirely misleading message to the approximately 50 people in the auditorium along with many more who logged on to watch a live stream of the event on Facebook.
Unfortunately, most of the panel did public health a significant disservice by repeating almost all the ill-informed canards that their more enlightened colleagues have sought to dispel over the past few years about vaping.
For example, Faculty of Public Health board member Patrick Saunders began the evening stating confidently that there is evidence that e-cigarettes inhibit smoking cessation rather than help smokers switch to vaping – which is quite wrong - and followed up later by dramatically declaring e-cigarettes to be “designed to mimic smoking, are intended to mimic smoking” with no recognition that this might be a positive attraction for smokers wishing to quit. He also said that it was “encouraging to see most places ban smoking and vaping” without a care that Public Health England has rightly identified the public health advantages of vaping being permitted where smoking isn’t.
Professor Andy Parrott of Swansea University – when not advocating for public information films showing tumours and gore to be shown on CBeebies – added that “nicotine is the ideal training drug for addiction” leading to addiction to harder drugs; an idea entirely unsupported by any science, and said that he would recommend nicotine patches over e-cigarettes despite research proving the latter to be more effective.
Dr Helen Walters of the National Institute of Health Research, while mildly supportive of vaping, also appeared to be singing from the vape-sceptic hymn sheet by declaring that she was happy that evidence shows e-cigarettes not to be a gateway into smoking for children in the UK, but that it is a different situation in the US despite youth smoking rates plummeting across the Atlantic too.
It was quite clear that some panellists possessed scant knowledge of the research conducted on e-cigarette health effects and usage, while in amongst all this was Professor Peter Hajek attempting to share the real evidence but being largely ignored in favour of falsehoods spread by other ‘experts’ on the panel. If that was disappointing, it only deteriorated further once discussion was opened to the floor. One by one all the lazy myths about vaping came tumbling out, and there was precious little pushback from the panel to correct them.
The oft-repeated misconception was advanced that a former smoker used his vaping equipment far more often – thereby implying he was self-administering more harm - without anyone pointing out that e-cigarette nicotine delivery is more dilute and tempered compared with smoking so this is a normal occurrence. Public health officers were forthright in condemning e-cigarettes for “substituting one addiction for another” without being educated that nicotine is on a par with caffeine, while another public health professional asserted boldly that “nicotine doesn’t break any kind of habit”, which any e-cigarette user will be able to tell you is not the case.
As for the idea that people might actually enjoy using nicotine and that the safer it is delivered, the better, the wholly clinical approach to the subject matter meant that the very premise was not up for discussion. Although it is encouraging that a London university decided to schedule an event on vaping, it was not so much a debate as a kangaroo court whereby vapers were offered no real defence.
If these misconceptions are to be addressed, and assuming the public health community truly wants to properly understand the attraction of vaping and its potential for public health, it is essential that this kind of event includes people who can do exactly that. Not, as was the case on Tuesday, in the audience with the chance of a minute or two at most to counter the untruths, but on the panel with a microphone given equal prominence and respect. The NNA can boast dozens of citizen experts who are qualified by their experience to talk about the subject and who are far more knowledgeable than many of those on display at South Bank University.
If those entrusted with advising parliamentarians and policy-makers wish to make a positive contribution to public health in the UK, they simply cannot preach ignorantly from their privileged pulpit like this. On Tuesday, they sent a cohort of local authority public health officers and interested students out into the chilly London air with negative, incorrect and evidence-free opinions about vaping to share with their friends and colleagues. They had been informed by ‘experts’, after all.
The way this event was structured may have been well-meaning, but in practice it has caused harm by effectively disparaging a technology which carries huge beneficial potential for population health in the UK and beyond. Health debates like this must include consumer advocates to offer a differing – and informed – view in the future; to not do so is nothing short of ideological public health vandalism.
Andrew Hall may not be the most competent vaper on the planet, but he’s not solely to blame.
You may have seen the media stories today about the Idaho man whose e-cigarette exploded. It seems he was using a hybrid mod. The vast majority of e-cig users use regulated mods containing inbuilt electronic safety features which mechanical and hybrid mods do not have. No reputable vendor will sell a hybrid or mechanical mod to a non advanced user.
NNA trustee David Dorn explains more below:
If you are not aware that Facebook managed to bring the notion of battery and mech mod safety to the fore on January 16th 2017, then you’ve missed a watershed moment in vaping circles.
Let’s precis: Before the Deeming rules came into force in the USA, Andrew, apparently, was using a mechanical mod (that is to say a battery unit with no electronics to protect or regulate the power of the device). It seems to have been a hybrid mod. A hybrid has no 510 connector as we all know it, but simply has a thread to attach a dripper or tank, and relies on the centre post of the dripper (we’ll say) contacting the positive terminal of the battery cell when it’s pushed up by the bottom button. Such a device is inherently unsafe unless a number of criteria are met: 1: The tank or dripper - the atomising device - MUST have a protruding centre contact. 2: The contact cannot be sprung or articulated in any way that would allow the battery’s positive terminal to make contact with the threaded section 3: No matter how far the atomising device is screwed into the hybrid connector, it must never make contact with the positive terminal of the battery unless the button has been pressed 4: Each and every battery used in the device can have no splits, tears or cracks And that’s just the tube itself. If any one of those criteria are not met, there is a very much increased chance of a short circuit scenario occurring, and when a battery cell is short circuited, then thermal runaway is highly likely. As I said, that’s just the battery tube.
Resistance is not futile The next weak link is the coil itself. Generally speaking, in a regulated device, the resistance of the coil(s) is matterless. As long as said resistance falls into the range that the mod can handle, it will deliver regulated power at the user’s chosen level without any issues. If the resistance of the atomiser setup is too low, the electrnics therein will prevent any current from flowing. Not so with a mech or hybrid. There is no intelligence. Reports suggest that Andrew was using a 0.06ohm coil - and although this is far from confirmed, such resistances in coils are not unusual. And that would be fine if, and only if, the battery cell in the device was capable of handling the currents generated when the setup is powered up. In this case, Andrew was expecting an 18650 battery to produce something over 50 Amps (bordering on 200 watts). Without wishing to alarm too many people (just the right ones) there is no 18650 on the market which will produce that much power safely and reliably. Many will do exactly what his did and vent/blow up. In the scenario where a hybrid mod is used and the connector on the atomising device is either flush or recessed, a dead short will occur. In this case, the resistance of the coil is matterless - there is no resistance to the current, and thermal runaway can be almost instant, with little or no notice. It looks awfully likely that that is what happened in this case.
Avoidable? Yes - this kind of thing is totally avoidable. The generality of users, as with all generally available stuff, ought not to need to know Ohm’s law in order to use an ecig safely. That it is not only possible, but also very easy to buy a battery unit which is fully protected, can produce high power and massive clouds, and will not allow you to put yourself in danger by mismatching bits of the setup. Not only that, but such mods will very often be considerably cheaper than boutique hybrids and mechs - it’s not difficult to choose a battery unit that will produce exactly what you need in terms of safely generated power - there are many on the market.
So where next? This is the controversial bit. Look, there are folks out there who are unwittingly lead into purchasing hybrids and mechs. They are, frankly, sexy, “scene”, used by the top echelon of trick vapers and there is a level of kudos applied to users of the most sought-after units. I get that. But they should NOT be the default “next step” in a vaper’s journey. Indeed, were it up to me, I’d be asking vendors not to display them or advertise them. The vast bulk of mainstream vapers are not competent to use them safely. (That’s not to say that those vapers are in any way second class or deficient. For instance, I am not competent to service a motorcycle - it’s not because I’m thick, it’s because I don’t have either the necessary skills or training to do so safely - and when it comes to hybrids, particularly, mistakes are all too easy to make). So, my plea to vape shops” 1: don’t display hybrids and mechs - those vapers who understand them and know them will know you have them. Let them ask. 2: should someone wander into your shop with an ego or an iStick and ask for a mech or hybrid, ask the right questions to determine whether they know what they’re doing. The first one is “WHY?” the answer to that tells you everything you need to know. 3: If a customer constantly comes in for you to re-coil a mech or hybrid device, do your very best to take their setup in part ex for something regulated and safe. Please.
Think about it.
This unfortunate happening has resulted in massive publicity, has certainly resulted in people dumping their ecigs and going back to smoking, and that is, in fact, a net lowering of your customer base.
We have to do everything we can to prevent such things happening again. If we don’t “they” will, and regulations no-one wants will ensue.
Researchers based in North Carolina have discovered that if you lie to smokers about the amount of harmful chemicals in e-cigarettes compared to traditional cigarettes you will put them off using the products. In a study entitled 'How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes', Pepper et al present smokers with four scenarios and then analyse their attitude towards dual use of the products with smoking. The four scenarios were:
That cigarettes and e-cigarettes had the same amount of harmful chemicals
That cigarettes contained 10x more harmful chemicals than e-cigarettes
That cigarettes contained 100x more harmful chemicals than e-cigarettes
That cigarettes contained harmful chemicals and e-cigarettes contained none
Unsurprisingly, in the scenarios where e-cigarettes contained less or no harmful chemicals participants indicated that they would be more likely to initiate or increase dual use of cigarettes and e-cigarettes.
What isn't immediately obvious from the publicly available abstract, but is noted in the limitations section of the full paper hidden behind a paywall, is the fact that the study concentrated on those smokers who said they would start or increase their use of e-cigarettes without stopping smoking. So smokers who indicated that they would completely switch to the safer product were excluded.
Astonishingly, the authors concluded that this apparent encouragement of dual use created by giving smokers accurate information on the relative numbers of harmful chemicals in the products would lead to a harmful continuation of smoking, and that therefore e-cigarettes "may not be able to be approved as a modified risk tobacco product on the basis of reduced chemical exposure alone because the public views information about lower chemical amounts as inherently related to reduced health harms". Paracelsus must be turning in his grave. The underlying suggestion in the conclusion to this study is that the FDA should consider hiding the the fact that e-cigarettes contain vastly reduced numbers and amounts of harmful chemicals when compared to smoking combustible cigarettes.
It is deeply concerning, but unfortunately not surprising to those of us who regularly read the bilge coming out of certain parts of the world, that researchers should feel comfortable suggesting that lying to smokers about the relative risk of products would be a viable public health policy. The obvious consequence of such a policy is that some people who might otherwise have switched to a safer alternative will continue to smoke. It is unfortunate that these researchers appear to have completely ignored them. Whatever happened to ethics?
2016 has been a lively year for tobacco harm reduction and, as you’d expect, the NNA has been extremely busy. This post can’t detail all that we’ve been involved with but we hope here to give you a flavour of our year. There is still much work to do going into 2017 and we are very grateful to all of you who have helped us to get this far: whether by signing up as a supporter, by sharing our posts, giving us advice, donating money or a stand at an expo. We simply cannot do what we do without your help. Thank you. No matter what skill set you have you can be an asset to the NNA, so please drop us a line if you can help.
Last minute victory in Wales
The Public Health (Wales) bill sought to ban the use of e-cigarettes in public spaces so we were delighted when the bill was defeated in March. The NNA, along with other groups and many scientists, had opposed the measure since it was first proposed two years previously. The sinking of the bill was a victory for NNA trustee Simon Thurlow and colleagues’ hard work - and a victory for common sense.
NNA Scotland is, quite possibly, too busy. Fortunately NNA trustee Andy Morrison’s load should be a lot lighter in 2017 because he’s now been joined by new associates Jamie Hollywood, Lorna Strachan and Robert Innes.
Andy was involved in organising the very successful Glasgow School of Vape 3. The day built on the previous Glasgow School of Vape events, bringing smokers,vapers and vendors together so that they could learn from one another. Other invitees this time included people from public health and stop smoking services and researchers from Glasgow and Stirling universities.
The Roy Castle Lung Cancer Foundation study: a study designed to identify the role that e-cigarettes can play in helping people who continue to smoke after a lung cancer diagnosis. Andy and a small group of e-cigarette users are assisting the researchers with home visits to see patients and offer ongoing support through the study. Andy is now assisting with a cardiovascular study too, organised along much the same lines as the Roy Castle one.
Scottish Parliament Event at Holyrood. A discussion about e-cigarettes and individual and public health. This was organised by the NNA and chaired by trustee Gerry Stimson. The panel featured Sheila Duffy (ASH Scotland), Dr Christopher Russell (Centre for Drug Misuse Research, Glasgow), Professor Linda Bauld (Stirling University),NNA patron Steve Christie, Mike MacKenzie (MSP), NNA trustee Paddy Costall and an audience of public health, vapers and vendors. The event was very lively and informative.
Ensuring that vapers have a voice in the ongoing debate: Andy is in regular communication with Sheila Duffy (ASH Scotland) and NHS Glasgow and Clyde and has a positive ongoing dialogue with MSPs and other representatives too. Andy also assists university students and academics on various projects enhancing their understanding of e-cigs and the politics surrounding their use.
A Billion Lives: Andy organised and presented at the UK premier of A Billion Lives in Glasgow, in October. This was well attended by press, public health and vapers.
The Department of Health and the MHRA
NNA trustees have attended various meetings with the Department of Health and the MHRA this year. Meetings centred on the Tobacco and Related Products Regulations and the WHO FCTC COP7. We followed up the Department of Health round table meeting in March with a written submission on the unintended consequences of vaping regulation, written by NNA associate Clive Bates (Counterfactual Consulting). NNA trustees have also been very engaged with local stop smoking services, in various parts of the country.
Consultations and briefings
January saw the publication of the excellent NCSCT briefing on electronic cigarettes for stop smoking services, which had been reviewed by NNA trustees Sarah Jakes and Lorien Jollye. The NCSCT has also asked the NNA to advise on and help disseminate some short videos on vaping, produced by the NCSCT for Public Health England. The first video is due to be released in January 2017 so please look out for it.
March: Sarah Jakes was appointed member of the NICE committee on guidance to stop smoking services.
September: The NNA responded to New Zealand's Ministry of Health on policy options for the regulation of e-cigarettes.
NNA trustees are advising on various studies, topics include: health professionals and their attitudes to e-cigs and NRT with cancer sufferers, the real world experiences of using e-cigs to avoid going back to smoking, the effects of e-cigs on people with stage 4 lung cancer and those suffering from COPD, effects of e-cigarettes on cardiovascular patients and a dentistry study.
All-Party Parliamentary group for E-Cigarettes
The NNA continued to be involved with the APPG this year.
Gerry Stimson and Lorien Jollye both spoke at the January meeting. Lorien focussed on the TRPR’s impact on smokers and new vapers and called for public health bodies to work together to mitigate the effects. In his presentation Gerry emphatically stated that all intervention, the TRPR included, should be judged against its contribution towards stopping smoking. Another of Gerry's key points was that “vapers and vape shops are the new front line in smoking cessation”.
The E-Cigarette Summit, November Andy Morrison and Sarah Jakes attended. Sarah was on the panel which discussed Communicating Research & Evidence.
The NNA was very fortunate to have been represented at the major events this year. It was really good to meet so many of our friends and supporters at them. The Vape Jam UK organisers gave the NNA and Vapers in Power a stand and also very kindly donated the proceeds of their raffle to us. NNA trustee Dave Dorn gave a rousing presentation, you can watch it here
Andy and Jamie attended Vape Collective,. They were delighted to get so many supporter sign ups and enjoyed sharing the marquee with ViP.
Vapefest: Andy and Jamie represented the NNA, sharing a tent with ViP again, and had a good time meeting up with old faces - and lots of new ones too.
The Vaper Expo organisers gave us a very generous donation too, money which we will put to very good use.
Thanks to a friend and supporter of NNA, Chinese e-cigarette manufacturer Innokin heard about the NNA’s work with stop smoking services and wanted to help. We do not take donations from anyone in the nicotine industries, so the best way for Innokin to help would be to help stop smoking services help smokers to stop smoking. This though is not as simple as it should be, because currently there are no medicinally licensed ecigs on the market which stop smoking services could prescribe, and it's likely that any that do gain medicinal authority will be bland cousins compared to those on the consumer market.
We were sorry that Alan Beard felt it was time to step down as Trustee. We were very grateful for the help he had provided to NNA.
We are delighted that Dr Heather Morgan has joined us as our newest trustee and also very pleased to announce that Andrew RT Davies, the leader of the Welsh Conservatives, will be joining the NNA as patron.
We’ve recently appointed a part time administrator, to take the pressure off our overworked trustees. This should lead us into an even busier year in 2017.
It’s wonderful that our list of supporters has doubled this year - but we always need more. It costs nothing to sign up as a NNA supporter and the more supporters we have the more influential we can be. You can sign up here and please consider asking your family and friends to sign up too.
A further shift will unlock greater potential On Tuesday during questions to the Under-Secretary of State for Health in Westminster, Nicola Blackwood replied to a query from Conservative MP Adam Afriyie about the use of e-cigarettes and, specifically, the negative outcomes that will undoubtedly arise from implementation of the EU TPD. The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU. We note and very much welcome Ms Blackwood confirming that there will be a review of the terms of the TPD. They were hastily-drafted and implemented largely from a position of ignorance by MEPs and their advisers in 2014, and we still maintain that many of the requirements are not only unnecessary but also harmful. In the intervening period since the TPD was formulated there has been a shift in perception – backed by a solid evidence base - of the benefits of vaping and tobacco harm reduction in general, so it is of great interest that a government minister is considering the TPD’s efficacy and legitimacy in a post-Brexit United Kingdom. However, there is another small but significant shift in policy required if the full public health potential of tobacco harm reduction methods is to be realised, and it is only the UK government which can affect the change required to facilitate this. It is still officially the government position that e-cigarettes, particularly, should only be used as a smoking cessation aid and not as a recreational product. Indeed, the Department of Health’s representative in the House of Lords, Lord Prior of Brampton, responded on Tuesday to his shadow Lord Hunt of Kings Heath’s support of e-cigarettes by saying that “better than vaping is not to vape or smoke cigarettes or anything else at all”. This is to fundamentally misunderstand the positive public health role that harm reduction can play. Lord Hunt – on the other hand – understands the debate very well in his position as President of the Royal Society of Public Health, one of many UK health organisations to enthusiastically embrace vaping. The Royal College of Physicians has argued that e-cigarettes should be “promoted as widely as possible”, while the government’s pre-eminent public health advisers Public Health England recognise the advantages of vaping and have consulted with consumer groups such as the NNA on the matter. Guidance from the National Centre for Smoking Cessation and Training has also rightly warned against being alarmed about recreational vaping, stating that “we are not a ‘stop nicotine service’ and if we think getting people off their e-cigarette is a good use of our time, we are ignoring a far more important opportunity to help people quit and to stay off cigarettes.”. With all this wise counsel from respected advisers moving in the same direction of travel, it is arguably time for the government to revisit and re-consider its stubborn policy towards recreational use of nicotine. As the NNA has consistently advocated, a vast number of people derive great pleasure from nicotine just as millions enjoy coffee containing caffeine – both judged to be on the same toxicity level by experts – yet we do not hear of government campaigns to wean the public, or even MPs themselves, off coffee. Smokers are not ill and do not require a medical intervention; in fact, for many the very idea is anathema and would deter them from switching to a less harmful alternative. The huge and swift success of vaping in the UK has occurred not because it is viewed exclusively as a smoking cessation device – quite the opposite – instead the success is attributable to vaping being an enjoyable, healthier pastime free from the pressure of real or imagined state coercion. If full nicotine cessation then ensues then so be it, however that should not be the sole consideration. Nicola Blackwood and Lord Prior have been presented with a largely cost-neutral free market solution to their goal of reducing smoker prevalence, they should seize it by embracing recreational vaping, like many of their most respected public health advisers have. In doing so, and eschewing the siren voices of those who value moral judgements over concrete health benefits by calling for regulations, restrictions and bans, they can unlock the full advantageous potential of e-cigarettes and tobacco harm reduction.
The report from the US Surgeon General on e-cigarette use among youth and young adults is just one more example (as if any more were needed) of the lengths to which the prohibitionist faction of tobacco control will go in order to promote its evidence-free ideological agenda. The report cherry picks 'scientific' claims of risk to young people, mainly from studies or analysis which have long since been debunked by experts in the field, and almost completely ignores the large body of science which details the benefits of e-cigarettes to smokers of all ages as either a cessation or harm reduction strategy. The fact that smoking prevalence among young people has declined dramatically concurrent with increased availability of e-cigarettes also seems to have escaped the Surgeon General's attention completely. This report and the policy recommendations contained within leave us in no doubt that regulators in the US care nothing for the lives of current smokers, or of those who will take up the habit in the future. It compounds the misperception that vaping is as dangerous as smoking and it will serve as protection for the incumbent nicotine delivery method, tobacco cigarettes. Well done America. For more detailed analysis of the report please read Clive Bates post here: Bad science, poor insights and likely to do harm - rapid reaction to the Surgeon General's terrible e-cigarette report
Yesterday I spoke at the first meeting of the All Party Parliamentary Group on E-Cigarettes that has been held since trade body UKVIA took over the secretariat. The meeting was in two parts, the first part being an overview of the public health challenges and the second being "industry views" - I found myself rather incongruously in the second part.
Professor Kevin Fenton led off the first part by detailing the work undertaken to date by Public Health England in this area and outlining the challenges we still face. These included public perception of relative risk and the appalling manner in which the media approaches the subject. Professor Peter Hajek then explained the role that researchers have played in this, and detailed some of the methods employed in order to portray what are often trivial or irrelevant risks as important indicators of harm. After a brief foray into the role of UKVIA and how their involvement with the APPG may relate to article 5.3 of the FCTC, George Butterworth then described Cancer Research UK's involvement in research, and in particular their role in analysing and, if appropriate, debunking poor, or poorly reported studies.
After a couple of questions the second part began with Charlie Hamshaw Thomas (UKVIA and Nicopure) praising the UK stance on tobacco harm reduction and also how far industry had come in delivering new and ever better products. Ian Green (IBVTA) then spoke about the challenges which 'Italian style' enforcement would pose to an industry which had spent considerable sums on compliance. A representative from Trading Standards in the audience was asked how they intend to approach the issue, and he replied by saying that their response would be proportionate given the other issues which they are expected to deal with, and would likely be complaint-led in practice.
My turn came to offer the consumer view and I presented the challenges which consumers face under the new regulations and also due to the very poor public perception of vaping. Points raised included nicotine concentration limits, advertising restrictions, usage bans, and the activities of prohibitionist groups such as the BMA and the WHO.
Finally, Andrew Allison of The Freedom Association was invited to speak briefly about the report they compiled which revealed the atrocious state of local authority vaping policies. Kevin Fenton responded by explaining that PHE are working with some authorities on changing this, and will continue to try to improve the situation.
I'm told that 9 parliamentarians attended the meeting, either in person or via their researchers. Some interesting and pertinent questions were asked although time was very limited as we only had an hour. Hopefully future meetings can focus in on the individual challenges identified so that they can be discussed in more detail.
Transparency was on the agenda at COP7, apparently there were concerns after COP6, but (almost) unbelievably, what they achieved was to make it less transparent than ever before.
Prior to COP7 I asked the UK department of health what the problem was with allowing the media and the public, including the tobacco companies, to observe (not participate) and report on the negotiations that go on there. The answer was that the tobacco companies would target and intimidate those delegations with whom they disagree, and go on to interfere in tobacco control policy in those countries. The public and media had to be similarly excluded because the tobacco companies would infiltrate them, or go disguised as them. Paranoid stuff.
I don't think it's a secret that the tobacco industry had numerous representatives in Delhi, as did other independent interested parties such as Asian vaper groups, and even experts on tobacco harm reduction who were there to try to correct the appalling claims made in the WHO report on e-cigarettes. On the first day of COP all of these people were excluded, together with the scant media representation.
The result of this decision was that all independent reporting of the machinations of COP was blocked, but more importantly, so was scrutiny of the actions of the delegates involved. This gave them free rein to attempt to bring in draconian restrictions on harm reduced products with no fear of being challenged by anyone outside of the hallowed halls of WHO.
Well it would have, if it weren't for the numerous leaks that emanated from the process and filtered through to the excluded groups milling around outside.
FCTC is a treaty which the signatories agree to pass into national law. Those present at COP meetings are deciding law in 180 countries. They are deciding the fate of millions of people like me, who smoke or vape and they're doing it on our taxes. And yet the only route of communication we have with the process is via a confusing myriad of snippets occasionally leaked. The idea that the policy positions of the numerous party delegations should be kept secret for fear of intimidation is absurd and undemocratic. These are national government positions for heavens sake. As I write this I still don't know what the official decision on vaping actually is, although rumour has it that the UK position of blocking any new lunacy has prevailed. Who knows. The situation is beyond disgusting and cannot be allowed to carry on.
COP8 will be held in Geneva in 2018, which is a comparatively short journey for the millions of vapers in Europe. I hope to see a large number of them there. If they will not open the doors to us voluntarily we will just have to do whatever we can to force them. Bring it on.
Along with Adjunct Professor of Law at the University of Ottawa, David Sweanor, NNA associate Clive Bates recently submitted a response to the New Zealand Ministry of Health review into legalising e-cigarettes.
As is customary, Clive and David’s work is exemplary and has been featured online at New Zealand news source Stuff in an article entitled “International anti-smoking campaigners' ten messages on e-cigarettes”. It is a concise guide to the many harm reduction benefits of e-cigarette use - and conversely the dangers of over-regulation - which we can highly recommend all interested parties read.
However, one of their observations is particularly well-drawn and will resonate with many vaping consumers. On the subject of bans on e-cigarette use, Clive and David had this to say:
"It is quite possible that banning vaping in public places or severely restricting it would have adverse effects on health."
Today the Chartered Institute of Environmental Health has called for a voluntary ban on smoking everywhere and anywhere that children play or learn. On the face of it that would seem like sensible advice - except it wouldn't be advice, it would be a command, albeit not one that is currently enforceable.
The Framework Convention on Tobacco Control is the World Health Organisation’s masterplan to eliminate tobacco use. Its main activity is the two-yearly Conference of Parties, and the next one – COP 7 – will be taking place in India this November. Preparation for the conference is now in full swing, and various documents have now been released. This includes the WHO’s latest report on vaping.
Yesterday, NNA trustee Lorien Jollye took part in a half day panel debate at the Royal Society of Medicine entitled “Regulation of Pleasure”.
It was an eclectic event which encompassed topics as diverse as illicit drug use and consumption of online pornography, and was attended by around 40 interested medical practitioners and students. Lorien’s contribution was to recount “My relationship with nicotine” and she received much interest from the attendees during the question and answer sessions.
Make no mistake about it, Action on Smoking and Health (ASH) are lobbying very hard to rally opposition against Lord Callanan's fatal motion, which, if it were passed, would kill the Statutory Instrument (SI) which transposes the TPD into UK law.