Tuesday saw the publication of the latest research by Action on Smoking and Health (ASH) into the subject of underage vaping in the UK.
Sadly, the media mostly avoided reporting on the good news that the proportion of under 18s who try vaping has dropped to the lowest level since 2016. There was also little coverage that those who had tried an e-cigarette once or twice in 2019 was lower than in 2015 and that regular use of e-cigarettes amongst 11-18 year olds has declined in 2019 compared to 2018.
We suppose - in this click-chasing world - that bad news sells, but it is disappointing, nonetheless.
Disappointing because the media is very quick to seize on any cherry-picked negative news about vaping from a dwindling band of UK public health professionals who still harbour irrational doubts about the benefits of safer products in this country, many of whom centre their arguments around not only a fear of youths using nicotine, but also that this will lead to a gateway into combustible tobacco use. We can only presume the gateway must be remarkably rusty at the hinges for it not to translate into any prevalence statistics that anyone can actually see in real life.
Both would seem to be fears that are refusing to become a potential problem, let alone a crisis which should make the UK government and a plethora of public health institutions change course and object to e-cigarette use rather than encourage it amongst adult smokers as they currently do.
The research by ASH began in 2013 and has consistently shown that there is no real problem to be solved in the UK regarding youth uptake, although it is always worth being vigilant. This is despite increasing, and now almost universal, knowledge of vaping amongst children, as the ASH report describes.
“Awareness of e-cigarettes amongst young people has risen significantly from 2013, when 67% of 11-18 year olds were aware of e-cigarettes, and 2015 when it reached 93%, and it has remained at this level since then”.
The simple fact is that despite the global panic about e-cigarettes, in a properly regulated market we are seeing safer nicotine products such as e-cigarettes consistently delivering hugely positive benefits for public health. The UK now boasts over 3.2 million vapers and the country’s smoking prevalence is at a record low after dramatic declines which coincide with the period in which vaping has ballooned here. Vaping by children and teens, by comparison, is negligible and mostly made up of those who either already smoked or would have done absent of an alternative. Other countries should take note.
The NNA has made this point recently too. Earlier this month, our Chair addressed industry at the ENDS Conference in London to warn that talking up non-existent problems is playing into the hands of those whose only purpose is to create mischief and obstruct the success of safer products like e-cigarettes in attracting smokers. We also held a press briefing at the Global Forum on Nicotine in Warsaw to emphasise that flavours are an integral part of the harm reduction offering, rather than an inducement to children. We were happy that the views of academia, independent industry and consumers were brought to the table for that event and issued a press release which you can read here.
Tuesday’s ASH research was also accompanied by their own release which declared that “In Britain young people vape just to give it a try, not because they think it’s “cool””, with Deborah Arnott remarking that:
“Smoking prevalence among children and young adults in Britain has fallen substantially since 2010, which doesn’t indicate that vaping has been a gateway into smoking. And to date there is little sign that vaping is the “super-cool” phenomenon among young people here that it is said to be in the USA.”
We agree, and the evidence agrees with us. We would go further and say the same could be said in the future about other reduced risk nicotine options if only public health institutions would have the imagination to be brave and embrace tobacco harm reduction, starting with abandoning the disastrous EU ban on snus, a product which has led to dramatic success in Nordic countries.
It really is time that the stubborn outliers who still cling to evidence-free assertions of imminent youth nicotine Armageddon stopped flogging their ideological long-dead horse at the expense of real progress for adult smokers who choose to quit via alternatives. It is an ex-equine, it has ceased to be.
Thursday saw the staging of the second UK Vaping Industry Association Annual Forum and the NNA was invited to participate. The keynote speaker was TV’s Dr Christian Jessen, an outspoken supporter of e-cigarettes as an innovative solution for smokers who wish to switch away from tobacco.
He delivered a highly amusing and thought-provoking speech on the “mistrust of science” in many policy areas, and how vaping suffers from the same interferences from people whose intentions are far from altruistic. Particularly disturbing was his passionate account of how vaccines have revolutionised the world and led to many diseases – which used to account for vast amounts of deaths globally – now being all but extinct, but how just a few miscreants can cause immense damage to public perception.
Dr Jessen referenced Andrew Wakefield, who produced a now very much discredited study on how the MMR vaccine causes autism and described the drop in public acceptance of vaccines which resulted. The upshot was that measles particularly is enjoying a resurgence and doubt in proven health interventions has proliferated.
Those of us who are involved in the debate around safer nicotine products all know a few prominent individuals who are the equivalent of Andrew Wakefield towards tobacco harm reduction, but Dr Jessen was optimistic that over time their message will be diluted and become increasingly irrelevant. We hope he is correct.
Following his speech, Dr Jessen then joined a session on smoking cessation services chaired by MP Sir Kevin Barron of the APPG on Smoking and Health. Sir Kevin introduced the panel by explaining why he is in favour of industry getting involved in making reduced risk products after a lifetime of his opposing the companies’ very existence. As far as he was concerned, if the products switched smokers away from lit tobacco, he didn’t care much who makes them, and he described how this is one of the few areas where he disagrees with Action on Smoking and Health (ASH).
Sir Kevin was not the only MP on display at the event, with APPG on Vaping founder Mark Pawsey MP chairing a panel entitled “Has the UK become vape unfriendly?”. This is where the NNA came in with our Chair Martin Cullip being invited to speak on the subject.
Martin Cullip speaking at the VApril Forum last week
As you can imagine, considering we have a Challenging Prohibition campaign, Martin expressed our concern that vaping consumers are not being afforded places where they can vape while at work or at leisure, and that this illustrates a general lack of understanding of how e-cigarettes are designed to function. One of the other panellists was Andrew Green of the British Beer and Pub Association who described the concerns of his organisation’s member pub owners and managers towards vaping. It was a robust discussion but Martin spoke to Andrew after the panel finished and there was a definite willingness from the BBPA to better inform their members about the benefits of welcoming vapers – even if only for the boost to their profits which could result – and we hope to continue a dialogue with them so that more pubs might welcome vapers in the future.
Of course, the debate around over-cautious vaping bans is not restricted to pubs. As our last blog article describes in relation to the NHS and other places, there is a lot of undue panicking about vaping which needs to be addressed if the public are to fully understand safer products and to not fall victim to the increasingly isolated siren voices of Andrew Wakefield-esque fearmongers in public health.
For example, one of the highlights of Dr Jessen’s speech – and one which attracted many a laugh from the room – was his account of an appearance on lunchtime ITV show, Loose Women. Following Colleen Nolan describing how she had struggled to quit smoking for years without success, Dr Jessen had produced an e-cigarette starter kit and simply said try this. “You would think I had crapped on the studio floor on live TV”, said Jessen, “such was the Twitter storm I had to suffer after that!”.
It is clear that - even in the UK where vaping is relatively well-regarded and where the success of harm reduction is highly visible and understood by legislators and regulators alike - there is still much to do. It is encouraging to see MPs like Mark Pawsey and Sir Kevin Barron actively taking time to advocate in favour of vaping and we were thrilled to hear that an NNA ‘considerate vaping allowed’ sign is now installed in Mr Pawsey’s office.
Sarah Jakes presents Mark Pawsey with a NNA Considerate Vaping sign, November 2018
It is also great to see such a prominent TV doctor nail his colours to the mast of vaping despite the objectors, and to once again endorse e-cigarettes as he did when we last met him at the launch of the VApril campaign.
Long may his doctor’s orders be that his colleagues – and the public - should embrace products which we, as consumers, know are a radical and successful solution which will benefit many more smokers if allowed to reach full potential.
In March, I was looking forward to a local dance event I had planned for the evening but became ill and ended the day in an Acute Medical Unit for the night rather than “tripping the light fantastic”. The cause was an infection which required a long period on antibiotics.
The hospital concerned had a strict no vaping rule which I challenged each day to provoke a meeting with senior staff until I was interviewed by Matron and Ward Manager. Far from treating my concerns seriously, I was told that what I had done was classified as Aggression to Staff”! I did not think that attempting to convey guidance from Public Health England could be classed as shocking behaviour, so I explained my research into vaping since 2012 and told them that I wished to offer my services to their Hospital Trust, and work with their team to update their policy on vaping, which was sadly out of step with current advice.
To their credit, they listened to my concerns and promised me a meeting with the Stop Smoking Sister. Sadly, the meeting never materialised but, in the meantime, I requested a copy of their vaping policy.
As is disappointingly common, there wasn’t one. Instead, they had simply added e-cigarettes to their smoking policy to say that vaping was only allowed in a smoking shelter and not within any car or building. This had been amended in mid-2018 and was not due for another review until 2023!
I suppose I should not have been surprised even though it was as far back as July 2016 when Public Health England said that workplace policies “should make clear the distinction between vaping and smoking” and that “it is never acceptable to require vapers to share the same outdoor space with smokers”. One can only assume this hospital had not noted this advice or, worse, ignored it.
So, I wrote to the Chief Executive of the NHS Trust to offer my services in assisting them in reviewing their policy to bring it more in line with latest guidance and to align with the government’s Tobacco Control Plan. Encouragingly, he replied to thank me for my message and to say he would “welcome some discussion on this for a future update of the policy” and forwarded my message to those who have the relevant responsibility.
Was my hospital stay fortuitous? Only time will tell. However, it does go to show that citizen advocacy can have an impact if conducted in the right manner.
I am an 87-year-old retired R & D scientist who smoked strong, unfiltered cigarettes for 69 years before making the switch to vaping in 2012. At that time, I was diagnosed with Chronic Obstructive Pulmonary Disease (COPD), the same disease which caused the death of my only son at the age of 47. Since then my lung function has improved immeasurably.
There can be no doubt that for those of us who cannot, or choose not, to live without nicotine, and wish to enjoy the tactile, oral and psychological elements associated with smoking, electronic cigarettes are a much safer alternative, being orders of magnitude less dangerous to our health than inhaling the products of combustion arising from smoking tobacco.
Some who enjoy nicotine may choose to continue smoking, but there are many who – like me – would find great benefit in switching to something far safer. A hospital, therefore, should be the very last place where such a decision is frowned upon.
I am hopeful that the NHS Trust will see sense and change their policy to be more welcoming to vaping, just as the UK government and its public health institutions have done. If nothing else, it has started a conversation amongst a group who had been blindly unaware of the advice currently available from those higher up the public health chain.
On my last cruise I again challenged the no vaping rule on an area of deck not designated for vaping. When a deckhand came over and “chastised” me, saying that is not allowed here I said “ I know, and I am here to stop that”. He then just walked away. I would urge my fellow vapers to challenge this ruling wherever they can as this will not only help awareness, but get the rule changed in the future.
So, if you see a vaping policy that is wrong-headed, it could well be worth politely enquiring as to why. If I can do it, so can you.
Terry Walker (right) with Hon Lik, inventor of the e-cig, at the GFN 2017
A recent TV showing of the Hong Kong Rugby 7s tournament was introduced by a commentator as being broadcast from a place “where the world comes to party”, but a recent development from the country’s government would suggest that this is poor marketing of Hong Kong for the unwary traveller.
The Legislative Council of Hong Kong – after initially toying with the idea of regulating e-cigarettes sensibly – instead made an about-turn and has now produced a draft law which will criminalise possession of e-cigarettes and heated tobacco. In short, anyone caught vaping could be facing huge fines and possibly a jail term of up to 6 months.
The NNA submitted a response to the consultation for this draft bill which you can read here, but considering the severity of the punishment Hong Kong is proposing for anyone who chooses to quit smoking using e-cigarettes, we felt it was worth writing about the clear danger that UK vaping citizens may face if planning to visit.
The proposed Hong Kong law is based on the Thailand model where an internet star was brutally arrested for possession of e-liquid in 2017 and a French tourist was arrested, fined, jailed and deported for merely holding an e-cigarette in February.
Why Hong Kong has decided to go down this route when, in enlightened democracies, the direction of travel has been to relax regulations on harm reduction products rather than criminalise them is anyone’s guess. It does, though, impact on how UK citizens should view Hong Kong as a tourist destination.
Our government advises that anyone visiting Thailand should be aware that they could be imprisoned if they bring their device to the country, and we expect that similar guidance will be forthcoming from the Foreign and Commonwealth Office if Hong Kong decides to proceed with its draconian proposals.
According to the Hong Kong Tourist Board, last year there were approximately 570,000 leisure visitors from the UK and current statistics say that around 6 per cent of those will be vapers. That is around 35,000 who would be at risk of being jailed simply for following advice to switch to e-cigarettes on the advice of public health authorities in this country. In fact, probably more than that considering uptake of e-cigarettes is more amongst middle class smokers who are more able to afford a trip to an exotic location such as Hong Kong.
As anyone who understands how vaping works will know, reduced risk products rely on a regular low level of nicotine being delivered to the user to replace a large blast of nicotine from regular cigarettes. The simple fact is that under these plans, vapers would visit Hong Kong at their peril with their e-cigarette and risk imprisonment or leave their vaping device at home and get their nicotine from conventional cigarettes, which will still be available everywhere, and perfectly legal to smoke.
Our advice, if you are one of the 35,000 or more vapers, would be simply to choose an alternative destination than Hong Kong. There are many others you could visit which will not treat you like a criminal for making a healthier choice in accordance with the UK government’s Tobacco Control Plan and the annual Stoptober campaign.
It is curious to note that the tourist figures also show that Hong Kong annually receives more than 50 million visitors from China where e-cigarettes were invented; more than 2.5 million from Japan and Korea where reduced risk products are incredibly popular, and more than 1.2 million from the USA where vaping is hugely prevalent. If Hong Kong’s ill-judged proposals result in concrete legislation, we could be seeing a lot of stories about tourists being jailed for no valid reason. If they start arresting swaths of visitors from mainland China, one can only imagine the consequences that might entail.
The Legislative Council may well believe that they are doing the right thing with their proposals, but criminalising possession of products designed to help smokers quit tobacco is in direct contrast to their stated aim to 'discourage smoking, contain the proliferation of tobacco use and minimise the impact of passive smoking on the public'.
If they had said they wanted to decimate their tourist industry, it would have made much more sense. If this law passes, vapers would be best served by just not going there.
Just last month, we published a blog describing how government messages on reduced risk products are not getting through to the NHS. You can read the whole thing here but this was the summation.
We are in the second decade of the 21st century but NHS trusts seem to be stuck in the past and not yet caught up on where the government is going. If NHS England truly seeks to reduce smoking by any means, it should be more imaginative in its approach and, if nothing else, at least listen to the messages coming from government and its institutions.
This week, we were also contacted by the Daily Express about new research that revealed only a pitiful 7% of GPs felt confident enough to recommend e-cigarettes to smokers who present themselves to surgery. The NNA was quoted in the article.
Martin Cullip, a trustee of the New Nicotine Alliance, a charity which raises awareness of safer nicotine products, said more education was needed for doctors.
“This is a common theme I’ve come across before where many GPs believe vaping to be harmful,” he said.
“Vaping takes most of the harmful chemicals out – any that are left in there are at very low levels - so you’re delivering the nicotine in a much cleaner form.
“There’s no reason why doctors cannot recommend these devices but if they are not aware of the reduction in harm then they’re not going to do that.”
It is very disappointing that we should still have to make these arguments on the deficiencies of the health system considering the resounding support for vaping as an option for smokers wishing to switch to safer nicotine delivery by groups such as, and not restricted to, The Royal College of Physicians, Public Health England, Cancer Research UK, The Royal Society of Public Health and Action on Smoking and Health.
As our trustee pointed out, the lack of understanding amongst GPs is a recurring theme and does not appear to be receding. In 2013, Nursing In Practice reported on the clear disconnect between government advice and what is being relayed by GPs to their smoking patients:
The survey findings show that a substantial proportion of GPs (40%) believe nicotine to be the first or second riskiest component of cigarettes, incorrectly identifying it as more harmful than smoke.
Many (44% UK, 56% Sweden) also wrongly believe that nicotine in tobacco products is associated with cancer, while 15% in the UK and 22% in Sweden believe the same for pharmaceutical nicotine.
“Although GPs clearly understand that smoking is more dangerous than NRT use, it is worrying that so many associate nicotine with cancer.
This may have been an understandable mistake six years ago, but it certainly isn’t now. Late last year, another study from the University of Oxford came to the same conclusion.
Current dissemination strategies for guidelines are not effective in reaching practitioners, who are offering more cautious advice about e-cigarettes than guidelines suggest is reasonable.
We are now into 2019, with a government so committed to harm reduction as an option for smokers who choose to quit that they see reduced risk products as a core part of the Tobacco Control Plan; that e-cigarettes have been included in stop smoking adverts during Stoptober for two years; and a government which has also fully endorsed vaping following a report by the Science and Technology Committee which called for more acceptance of safer nicotine delivery to tempt smokers to choose safer options.
Yet here we still are with GPs disappointingly badly informed. This statistic from the Express article is starkly damning.
“A worrying 93 percent of healthcare professionals were unaware of Public Health England’s position that vaping is at least 95 percent less harmful than smoking.”
You have to wonder about what messages are being promoted by government institutions if this is the current state of play with GPs. NNA Trustee Louise Ross was particularly surprised on Twitter.
We obviously share her concern. It is disturbing that there is so much misunderstanding still prevalent amongst GPs who are the first responders in the NHS to people who smoke. Something is going desperately wrong here if official guidance from high level public health organisations is not filtering down to GPs who are tasked with meeting smokers face to face.
There is an urgent need for a framework whereby the national guidance on safer nicotine products feeds down to where the knowledge is most needed, which is quite clearly not happening now.
There is no point whatsoever in proposing policies on a macro level if those who meet the public daily do not know of its existence. It certainly does exist, and the Royal Society of General Practitioners has also presented a fact sheet on the subject fairly recently. It is disappointing that GPs are either unaware of, or are wilfully ignoring, the advice of their own professional association along with guidance from national government-backed institutions.
GPs need to be better informed; their misunderstanding has not only continued for six or seven years but it doesn’t seem to be abating. It is well past time that there was a mechanism to ensure that they are more educated about the difference between nicotine and smoking.
Today sees the launch of the second Vapril campaign organised by the UK Vaping Industry Association (UKVIA). The NNA was pleased to be consulted on the initiative in the months leading up to today and we wrote the campaign’s “switch on to vaping plan” which the website accurately describes as “written by vapers for smokers”.
Our contribution was to offer hints and tips from our personal experiences in switching and it is important to highlight why we believe that our input is, indeed, intended to be beneficial to smokers and not yet another hammer to beat them with.
Traditional campaigns aimed at smokers have always focussed on nicotine abstinence and nicotine replacement therapy as the only options; public health organisations have only seen quitting smoking through the lens of clinical treatment without recognising that smokers do not see themselves as being ‘sick’. It is all very well setting up clinics and waiting for smokers to come and ask medics to wean them off lit tobacco, but most find that option unpalatable.
The rapid drop in smoking prevalence in the UK since e-cigarettes have gone mainstream illustrates this very well. Prior to that the decline in smoking rates had flatlined, and tobacco control organisations were scratching around trying to find new angles to get smokers to quit, most of which involved hopeful and unproven policies centred around stigmatisation rather than encouragement.
In fact, the only decline which has mirrored the dramatic reduction in smoking prevalence since vaping became recognised by the public is the uptake of stop smoking services by smokers, with smoking cessation clinics seeing a huge drop in demand since around 2012. As a result, stop smoking services have encouragingly been forced to embrace vaping as an option or become irrelevant.
UK anti-tobacco organisations have increasingly recognised the benefits of vaping with only a few ideological outliers still holding out hope that there might be some disastrous Armageddon to come along and confirm their baseless opposition to tobacco harm reduction.
If you ask smokers why they smoke, they will consistently tell you that it is because they enjoy it. Public health groups can push the argument that they are not actually experiencing pleasure but instead satisfying an addiction, but this approach only speaks to those who are most committed to quitting anyway. If a smoker is absolutely determined to quit, they will do so, but most are not like that and require their enjoyment of tobacco to be replaced by something else. If public health groups wish to speak significantly to smokers they should be doing so by engaging where smokers are rather than from an ivory tower..
As former smokers ourselves, we recognise this and know that reduced risk products can help smokers switch because they can replicate many of the cues of smoking and provide much of the pleasure too, over time. The pleasure aspect is something very much overlooked by most public health bodies – irrespective of whether they support vaping or not - but something that we at the NNA have been emphasising for some considerable time.
The Vapril campaign, although industry-led, should not be dismissed by public health, because it not only speaks to smokers who are looking to choose to quit smoking but is also consistent with recent government advice..
A report by the Science and Technology Committee in August recommending that more should be done to encourage smokers to take up alternative nicotine products was endorsed in full by the government, and last year’s Tobacco Control Plan pledged “to support consumers in stopping smoking and adopting the use of less harmful nicotine products”. Additionally, vaping has been included as an option for smokers seeking to quit by the annual Stoptober campaign for two years now.
Lastly, the VApril campaign can hopefully have an impact in redressing the disappointing decline in perception amongst smokers about the merits of switching to safer products. An avalanche of unscientific scare stories and click-bait media articles promoted by health professionals who should know better has turned many smokers away from the idea of trying vaping to see if it could work for them. Considering the Royal College of Physicians assesses vaping to be at least 95% less risky than smoking, it is to the VApril campaign’s credit that it includes messages like that in its literature along with more populist and accessible advice for smokers who have dabbled with trying vaping but may have been put off before.
TV’s Dr Christian Jessen, a long-time advocate in favour of vaping, has fronted this campaign as he did last year and the NNA is happy to lend our support to him and VApril this time round.
For full information on the VApril campaign, visit their website here.
Chesterfield Royal Hospital unveiled a vaping ban in 2017 which has since been rescinded
In August, the government’s Science and Technology Committee produced a report detailing, amongst other recommendations, suggested policies on e-cigarette use on NHS property. Specifically dealing with mental health facilities, it stated:
NHS England should set a clear central NHS policy on e-cigarettes in mental health facilities which establishes a default of allowing e-cigarette use by patients unless an NHS trust can show reasons for not doing so which are demonstrably evidence-based.
The Committee went further, expressing disappointment that NHS England’s approach to e-cigarettes is not only confused, but also lacks leadership.
We also find it very concerning that there is not a dedicated person within NHS England responsible for implementing the Government’s Tobacco Control Plan.
Responding to the Science and Technology Committee’s report, the government accepted the recommendations in full.
The reference to the Tobacco Control Plan was to highlight that the government pledged “to support consumers in stopping smoking and adopting the use of less harmful nicotine products”. Public Health England has also stated that “e-cigarette use is not covered by smokefree legislation and should not routinely be included in the requirements of an organisation’s smokefree policy”, yet these government messages are still clearly not getting through to NHS trusts.
A new report from Forest – drawing on Freedom of Information requests sent to 200 NHS trusts in England and widely covered by media on Monday – revealed very disappointing results. The use of e-cigarettes was prohibited by 55 per cent of NHS trusts in all their grounds including private cars in the car park, and only 14 per cent planned to amend their policy this year to lift restrictions.
That a majority of NHS trusts are so out of touch with government policy on e-cigarettes betrays a distinct lack of awareness from NHS managers or, worse, a perhaps ideological and unprofessional reluctance to follow official guidance. In 2017 Chesterfield Royal Hospital (see image above) banned vaping sitewide to mark the start of their Stoptober campaign - despite the national 2017 Stoptober campaign's support for e-cigarettes. Their policy has since been rescinded but it’s clear that many other trusts are not taking any heed of government messages on reduced risk products.
It is clear there is a haphazard and uncoordinated approach to the way vapers are treated while on hospital grounds and it seems to us that opportunities are being missed. Banning vaping throughout NHS sites is a blinkered and outdated approach to helping smokers to quit and relies once again on using a big stick where a carrot would produce far more positive results.
In their zeal to banish smoking entirely from hospital sites, NHS trusts appear to be hyper-precautionary to the point of being counterproductive towards e-cigarettes too. If the spectacular success of vaping in the past six or seven years tells us anything, it is that smokers – like everyone else – react more favourably to incentives than restrictions, but there is no incentive being offered by a trust which bans vaping everywhere. The only message it sends is that e-cigarettes are as hazardous as lit tobacco so should therefore be avoided.
Where is the benefit to banning vaping in a car park? Especially if it goes against every pronouncement from government for the past four years on e-cigarettes? If trusts insist on banning all smoking in their grounds, the Forest report’s recommendation that vaping should be permitted in all outdoor areas is a clear incentive for smokers to try e-cigarettes instead. But NHS trusts could be more imaginative than that.
The report also urges that “use of e-cigarettes should be allowed inside hospital buildings (including wards) at the discretion of hospital management”. This may be difficult in a multi bed ward, but many facilities have single rooms or a day room where discreet vaping could be allowed. Instead of adhering to an unthinking policy of banning nicotine use of all stripes, create incentives across the board.
The sum of objections to smoking from hospital visitors is that smoking goes on in hospital entrances, but where else will smokers congregate when shelters have been taken away except where it is least inclement, this is a problem entirely made by managers who have removed any other option. Businesses pay to sponsor roundabouts, why not sell sponsorship to vape businesses of smoking shelters which will only ever be frequented by potential customers? It removes smokers from areas where visitors don’t want them to be and directs them to where they will see a plethora of messages about switching consistent with government advice.
We are in the second decade of the 21st century but NHS trusts seem to be stuck in the past and not yet caught up on where the government is going.
If NHS England truly seeks to reduce smoking by any means, it should be more imaginative in its approach and, if nothing else, at least listen to the messages coming from government and its institutions.
The survey will take just five minutes of your time and by doing it you will be helping to decide the research priorities for e-cigarettes. This research is being conducted by Dr Abby Hunter from the UK Centre for Tobacco and Alcohol Studies and will be followed up later with a second survey, to prioritise the responses from this one.
You can read more about the E-cigarettes Priority Setting Partnership here:
NNA’s Louise Ross and Andy Morrison are both involved with the Partnership and you can read Louise’s blog post on it here:
Electronic cigarettes: First time on a Priority Setting Partnership Group
We do hope that you can help with this as it is vital for consumers to have input into setting the research priorities for vaping.
NB This survey is only accessible from the UK
At the turn of the new year, Public Health England took the opportunity of a lack of political news to launch a short film showing the difference between what is inhaled from a cigarette and from an e-cigarette. It was featured prominently by the BBC, which reproduced the film with subtitles on December 28th, and also gained much national media coverage elsewhere.
As the film mentions, nearly 50 percent of smokers still believe that vaping is as bad, or worse, than smoking. This is a misperception that the NNA would like to see change and so we are pleased that such an important message has received so much publicity. There have, however, been some doubts expressed about the method used by PHE here, which we feel are misapplied.
It is true to say that the film is intended to shock by illustrating the difference between what comes out of a cigarette with what is emitted from an e-cigarette. Lurid headlines from irresponsible media outlets who promote irrational fear about vaping are having a real-world effect of scaring smokers away from alternatives and, consequentially, corrupting free choice. They need to be countered robustly. If a consumer is denied true facts about a product, they are not able to make an educated decision.
Nothing in the film is inaccurate, it has long been known that the dangerous component of lit tobacco is not nicotine, it is the tar. It is the principle that underpins the acceptance of NRT which has not yet been similarly accepted for new safer nicotine delivery systems like e-cigarettes. All PHE has done is present this information in a simple, visible and straightforward way.
It is also important to note that there is nothing coercive about this film. It does not order smokers to quit, it merely presents information in a stark and accessible way in order that smokers might see that their misperceptions about e-cigarettes have come from dubious sources.
The film also only seeks to guide viewers, not to direct them. It is correct that the lung is a marvel of evolution and can filter out much of the tar that is sent its way, but PHE has left the smoker to make the decision as to whether to take that risk or not.
Many smokers will watch the film and dismiss it; they will have made their own risk assessment and decided that their love of smoking is worth continuing with, and we would support that decision. Others who have thought of quitting will have tried e-cigarettes and not been able to get on with them so other options may be available to them, again something that the NNA supports. However, there is a large body of the smoking public who would like to choose to stop smoking with e-cigarettes – and could well be successful - but will have been put off by dishonest scaremongering. It is this demographic that the PHE film seeks to speak to. Like any marketing or advertising, it will only find a receptive audience in those who were already contemplating the idea.
The NNA exists to promote wide availability of alternative products, rather than coercion. We believe – many of us through personal experience - that forcing smokers to quit with a stick is nowhere near as effective as tempting them with a carrot. Harm reduction is grounded in such a philosophy. Availability of accurate information goes hand in hand with availability of the products; it is no use having a wide range of devices on the market if smokers have been conned into avoiding them.
It has long been frustrating for both the public and industry that the truth has not been told about the reduced risk of vaping products in relation to combustible tobacco, and the NNA has often called for this confusion to be addressed. Just like the ASA are doing with the recent decision to allow health claims for e-cigarettes, PHE has tackled the confusion head-on with their film and the more smokers who see it, the more who might be better informed to make a free choice to choose an alternative. To not show the film, or to not produce it, would take away that choice from many thousands of smokers who are dishonestly told that there is little difference between the two options.
On Friday, the Advertising Standards Authority (ASA) published the results of their consultation into e-cigarette adverts and announced that “the Committees of Advertising Practice (CAP and BCAP) have amended the ad rules so that health claims are no longer banned from ads for e-cigarettes.”.
The NNA, naturally, fully welcomes the announcement and we are pleased that common sense has prevailed in this policy area. It has long been frustrating for both consumers and the vaping industry that regulations have prevented the truth being told about the reduced risk products in relation to combustible tobacco.
The ASA exists to ensure that adverts are truthful and do not mislead the public and – while advertising prior to this decision was not telling untruths – accurate and fully truthful information was denied to smokers who have contemplated switching to vaping instead. This development could have a positive impact on decisions smokers make going forward so we congratulate the committees involved for their wisdom in approving messages which have the potential to benefit the public’s health.
As the graphic above shows, before Friday’s decision Public Health England and other public health bodies could declare that e-cigarettes, while not risk-free, are vastly safer than cigarettes, but e-cigarette vendors were prohibited from saying the same thing to their customers in advertising, no matter that it is 100% true.
The ASA has now quite rightly corrected this anomaly.
The consultation responses showed that there were a few health groups opposed to allowing health claims in advertising, but their reasoning was not only weak, but tended to lend weight to the proposal. For example, many prefixed their objections with “The evidence so far shows e-cigarettes are far safer than smoking and can help smokers to stop. However …” or “Current evidence suggests e-cigarettes are less harmful than tobacco cigarettes but …” – but what are these statements if not health claims?
A situation whereby public health organisations can make these claims but those marketing the products are not was clearly absurd, especially since even the most virulent detractors of e-cigarettes cannot challenge the fact that vaping is far safer than smoking.
In recent years, public perception of the benefits of vaping has stalled due to the misguided actions of a small minority of activists who are ideologically opposed to safer alternatives and who have shamefully fomented doubt as to the relative safety of e-cigarettes and other alternative nicotine products. Friday’s decision by the ASA committees, therefore, is timely and can only facilitate a better understanding of e-cigarettes and a greater clarity amongst smokers as to the benefits they could derive from switching.
The government’s Science and Technology Committee recommended liberalising advertising rules to allow health claims in August so we are pleased to see the ASA act to remove the censorship of truth in e-cigarette advertising.
The NNA, once again, is also proud that the UK is leading the way globally on tobacco harm reduction and this move by the ASA just emphasises that. The Tobacco Control Plan committed to “backing evidence-based innovations to support quitting” so permitting truth in e-cigarette advertising is not only the right thing to do, it is also a great example of joined-up thinking between the government and its public sector agencies. As understanding of safer nicotine systems improves, we hope to see other state-funded organisations take a similar path to eradicate the confusion surrounding reduced risk products in the future.
A guest post from Robert Innes, Associate of NNA
It is ironic, is it not, that the recent #COP8 meeting of The World Health Organisation Framework Convention for Tobacco Control should result in a flurry of accusations that members of the vaping community were using ‘violent’ language and tactics in their approach to vaping advocacy. This being an example: “But the problem we’re facing is that the interference from tobacco giants in public health efforts is becoming increasingly vicious in that they are now using the tools and language of tobacco control advocates to push their dangerous agenda”.
Dr. Vera Luiza da Costa e Silva, the Head of the Convention Secretariat seems to be talking about the tobacco industry. In fact, it is the vaping and tobacco industries, with emphasis on vaping, that is being referred to.
You may be wondering what this has to do with Dundee City Council's regulations on smoking and vaping: Geneva and Switzerland are a world away are they not?
Everything contained in the Dundee City Council’s regulations begins with the World Health Organisation Framework Convention on Tobacco Control. (WHO FCTC) More of this later…
A Quick Word on Violent Language:
I cannot speak for the tobacco industry. I do not have any connection to them whatsoever, nor do any of the organisations that I am familiar with, for example, The #New Nicotine Alliance UK (NNA UK) or the #International Network of Nicotine Consumer Organisations. (INNCO) These organisations represent vaping consumers on both a national (UK) and international level. They do not receive funding from the tobacco industry.
Yet, here they are, among others, being accused of using ‘violent' language in their advocacy. Indeed, they are being accused of, “…using the language of Tobacco Control…” OK, so ‘give a dog a bad name… Now sit back and have a good think about, #Hypocritical / #Misguided / #Cruel / #Nasty /#Punitive / #Nauseating / #Erroneous, as these adjectives apply to Dundee City Council’s regulations on smoking and vaping.
Hypocritical: The hypocrisy here is mind-blowing. It is alright for Tobacco Control to use ‘vicious tools and language,’ but not vaping advocates. (I cannot speak for the tobacco industry). Here Dundee City are forcing regulations on their workers that can only be described as nasty, cruel and vicious.
But the hypocrisy of these regulations does not just end at the above. You see, the Council threaten their workers with penalties for ‘smokvaping’: "Penalties which might even affect the worker's pension." The Regional Council, Tayside, have £56.3 million tied up in tobacco stocks – now, it must be noted that Dundee are the City Council, not the Regional Council, but, pension funds are often, ‘pooled.’
It would be very interesting to hear what Dundee City Council have done with their pension funds.
Cruel / #Nasty /#Punitive: You will note that these ‘vicious’ adjectives are much the same in meaning: Repetition is one of the main ‘tools’ used by Tobacco Control in their efforts to persuade unthinking individuals such as, apparently, those who make up most of the Dundee City Council.
So, what does Dundee’s smokvaping policy amount to…?
Please note that this attack is unfair on smokers as well as vapers. It is cruel, nasty and punitive to both.
#Misguided / #Erroneous: The Council have offered, repeatedly, the reason for their action. They do not want their employees to be negative role models for young people. Instead, the Council are being a negative role model, teaching them, through example, that being #Hypocritical / #Misguided / #Cruel / #Nasty /#Punitive / #Nauseating and #Erroneous is perfectly acceptable.
And as for ‘misguided,’ Dundee have been made patently aware that smoking and vaping are to be treated separately, and differently. The Convention of Scottish Local Authorities (COSLA) take a very clear stance on the issue. They state that, “The use of smoking terminology should be avoided when referring to e cigarettes… make clear the distinction between vaping and smoking and the evidence for the relative risks between users and bystanders.” Now, how does this compare to Dundee Council's position which states… “In this policy the term smoking means smoking in any form and by any means, the use of e cigarettes and using any other form of substitute smoking device.”
And yet Dundee Council claim to have ‘consulted’ COSLA. Perhaps a quick reference to a dictionary should be prescribed for the ‘honourable’ councillors.
Consult: to seek advice or information from; ask guidance from.
Ignore: to refuse to show that you hear or see (something or someone)
Dundee claim that they ‘consulted,’ leaving people to think that their policy is the result of, or, was influenced through this consultation. It makes the policy look legitimate, endorsed by COSLA. This, to me, is dishonesty…. dishonest… Do I have that in my sub-heading? No! Add, #dishonest
And it continues…
COSLA advise that councils should… “support smokers to stop smoking and stay smoke free – an enabling approach may be appropriate in relation to vaping to make it an easier choice than smoking.” Now, compare this to Dundee City Council’s stance… “The Council makes no distinction between ‘conventional’ smoking and use of e cigarettes. Any prohibitions involved cover all these activities.”
COSLA want smokers to choose (as do vapers). Dundee Council though have a prohibition agenda. (NOTE: This is nothing new for Dundee… In 1908, Stewart and Edwin Scrymgeour of the Scottish Prohibition Party were elected to Dundee Town Council) Prohibition must run in the political blood in some places.
And it, still, continues…
Not only do Dundee City Council imply they have the backing of COSLA, they pull the same stunt, with relation to vaping, with unions. A council spokesperson stated that, Dundee City Council had consulted unions. Again, an attempt to make it look as if the Council had union backing. But no. A spokesman for the UNITE union stated, “This is an attack on people who smoke. It’s not an easy thing to give up – and not everyone wants to either.” (Oh dear! He used the word, ‘attack… violent language: Tut, tut) The GMB stated, “We will vigorously defend any members who fall foul of this. Members should be able to choose what they do in their own time without fear of reprimand.”
From Geneva to Dundee:
But the real villains behind this appalling prohibition are the WHO FCTC. and their co-conspirators in the EU. What Dundee have done is right in line with the advice being issued from these quarters. They have failed in their attempts to get a large number of people to stop smoking through, #Hypocritical / #Misguided / #Cruel / #Nasty /#Punitive / #Nauseating / #Erroneous policies:
Bullying, intimidation and deceptions have all failed, and their recourse now is to enforce by producing even more, #Hypocritical / #Misguided / #Cruel / #Nasty /#Punitive / #Nauseating / #Erroneous policies.
image credit ©BBC
We are living in strange times when a tobacco company launches a £2m smoking cessation campaign in a national daily newspaper designed to urge smokers to quit, but that’s where we are today.
The Daily Mirror carried a four-page wraparound advertisement for Philip Morris’s new Hold My Light campaign and it attracted significant media attention, with the BBC focussing on it prominently throughout the day. NNA Chair, Sarah Jakes, took a trip to London to appear on BBC World News as well as commenting on local BBC radio regarding the subject.
It is an interesting initiative which has caused some consternation from public health groups who accuse Philip Morris of “stunning hypocrisy”. We can understand the concerns that in other countries the company is resisting tobacco control efforts and is still selling billions of cigarettes globally, but we live in the real world not an idealistic one.
The idea that the tobacco industry can only show its commitment to harm reduction by ceasing to make cigarettes entirely is extremely naïve and has no merit. Any company is obliged to pursue the best interests of its shareholders and investors, so it is understandable that sales of cigarettes will continue until such time as there is appetite in the market for a valid alternative.
It is a core belief of the NNA that the only way to get to that position is to make as many safer alternatives to smoking available to the public and to work towards encouraging innovation in devices which can tempt smokers away from the most harmful form of delivering nicotine. The market needs to change substantially before tobacco companies will be able to stop making cigarettes and we should be realists and accept that.
There have also been accusations that Philip Morris are using this as a way of putting their company into the public consciousness when tobacco advertising has been banned, but how many people – amongst them smokers – would have woken up today and been made more aware of the options they have at their disposal? In light of the recent slowdown in public perception of the lower risk of vaping, for example, this story could have a positive effect.
It is noteworthy that this campaign includes all options for quitting smoking including cold turkey and NRT and mentions no branding, nor seeks to push smokers towards any particular product. Yes, it is produced by a tobacco company but since Philip Morris is trailing in the e-cigarette market in the UK, any sales of vaping equipment would be more likely to benefit the independent market or rivals to their brand.
We are not convinced that some of the suggested supportive options for friends of smokers are that tempting – in fact they are rather contrived - but the campaign seems to leave those decisions up to the smoker and their friends and family to choose.
Overall we think it is a bright message and one where we agree with Kevin Barron MP:
“If the tobacco industry is willing to commit to a future based around e-cigarettes and other reduced harm products, we should take them up on the offer and allow Government and Local Authorities to partner with them for the financial and technical help needed to help smokers quit.”
There is no value in automatically gainsaying anything industry does. If this initiative comes up short the country will have lost nothing but, if it succeeds, there will be more former smokers who will have found a way out of the habit.
Lastly, it is very encouraging that Philip Morris have chosen the UK as the first country to try out this idea. Our government is renowned for being very progressive on harm reduction policies to drive down smoking rates and has enjoyed stunning results so far. This is a recognition that the UK is a world leader in employing risk reduction in health policy and that the future here is in non-combustible products. The reason that Philip Morris sells so very many cigarettes globally has a lot to do with regulatory environments; if alternative products are banned or subject to hostile policies, what else are they going to sell?
That isn’t the case in the UK and we hope that our government’s more enlightened attitude towards safer nicotine products continues, no matter who makes them.
We are hearing that, yesterday, the Italian grass roots consumer group Associazione Nazionale per i Vapers Uniti (The National Association of United Vapers) has written to the Deputy Chairman of the Italian Council of Ministers, Hon. Matteo Salvini, to protest the Italian government’s treatment of vaping products.
The ANPVU launched in April with its primary objective being to promote harm reduction and introduce smokers to safer ways of using nicotine. This has been difficult in Italy which enforces a blatantly anti-vaping agenda by way of policies designed more to raise tax than to encourage smokers to switch to less harmful alternatives.
Since the start of the year, the Italian government has applied taxation to e-liquid to such an extent that a 10ml bottle costs nearly double the price of a packet of 20 cigarettes. These taxes were applied retrospectively meaning that vaping businesses were left with a bill for paying duty on products they had sold well before the date of the new regulations, and the government has effectively monopolised sales of e-cigarettes and vaping-related products, so they can only be sold by tobacconists and specialized shops. Online sales of e-liquids have also been banned along with imports from other countries, all advertising is prohibited and there is even taxation on PG and VG.
The Italian government is not shy in admitting that it is doing this for purely financial reasons, to recover the loss of tax revenue on cigarettes that former smokers have stopped buying thanks to e-cigarettes. Italy’s Constitutional Court, incredibly, declared that “the recovery of revenue eroded by the electronic cigarette market” is a legitimate policy for the government to implement.
To say this is brazenly greedy and to the detriment of the public health of Italians is an understatement.
ANVPU President Carmine Canino has written to the government on behalf of Italy’s 1.3 million vapers to appeal to ministers to put the health of Italian citizens before tax revenue. Carmine writes:
“[Italian smokers] demand the right information, the possibility to easily access harm reduction products without being penalised financially, and to look to the English model for political conscience which should be replicated in every Italian parliamentarian.
“We await a rethink, a signal that makes it incontrovertibly clear that the first duty of our institutions is the citizen.
“Our concern as consumers … is that by persisting with the current tax, a smoker who wants to quit will still be faced with bad information, and the impossibility of finding liquids at a reasonable price.
“This sector is like a terminally ill patient who, at present, is afflicted by the disease of consumption tax.”
Canino finishes with a plea to the government to recognize the potential of the vaping sector to benefit public health and to promote it by regulating it sensibly, rather than putting economic concerns above the right of Italians to have access to healthier choices.
As fellow members of the International Network of Nicotine Consumer Associations (INNCO), we at the NNA applaud and support the ANVPU’s action on this and wish them every success. It is quite shameful that the Italian government can so blatantly put tax receipts above the health of their population, and we hope that yesterday’s letter may prick a few institutional consciences in Rome.
Ever since vapers in the UK began experimenting with this new technology over 10 years ago, we have been constantly surprised at how e-cigarettes have been attacked by the established public health profession. Why, when so many had found a way of quitting smoking as the government had been urging us to, were we being persecuted again?
Back in 2010, the MHRA – under the stewardship of Jeremy Mean - did its level best to have all devices banned within 21 days. It was only an extraordinary campaign by vapers, who submitted responses to the consultation in droves, which staved off the threat. The actions of these vapers prevented a ban which would have prevented the dramatic declines in smoking prevalence we see today.
In 2012, it was the EU which attempted to destroy vaping by originally proposing – with the backing of the UK government and UK health groups – to enforce a maximum 4mg/ml nicotine limit on e-liquid and full medicalisation of e-cigs, which would have created a dangerous black market in both equipment and liquid supplies. The EU had to back down in the face of thousands of angry letters written by vapers to their MEPs. If those proposals had been successful the decline in the number of smokers in the UK would not look like it does today as the market innovation in safer products would have been strangled and products would not have been as accessible to smokers.
It was vaping consumers lobbying their elected representatives – both here and in the rest of Europe – who contributed to making MEPs think again. Whilst the TPD is not perfect, and does need reviewing, it is far better than what could have been.
Painfully slowly, an establishment which only knew one way of tackling smoking, by abstinence only – the ‘quit or die’ method – began to realise that there were benefits in harm reduction.
Many organisations who were in full support of draconian EU rules on vaping six years ago are now supporters of tobacco harm reduction, often recanting on their previously strongly-held opinions on the dangers of e-cigarettes. This has often been as a result of dialogue between key people in these organisations and vapers. Many of them, as a result, are also now smeared in the same way as we consumers often are, as “shills” or “astroturf” - by the dwindling number of blind reactionaries.
The Behavioural Science (or Nudge) Unit, Public Health England and the Royal College of Physicians led the way with an appreciation of harm reduction as a policy, and slowly but surely other health groups followed. There is now – apart from a few scattered stubborn outliers – almost a consensus amongst public health opinion-formers that vaping is a valid route out of smoking, for those seeking a route.
The MHRA now regulate vaping products and have been largely sympathetic to the needs of consumers and vape businesses. Their previous heavy-handed approach has made way for an understanding that vaping has benefits that should not be eradicated by harsh regulation.
There was always one vital piece missing, but today’s report by the Science and Technology Committee, chaired by parliamentary grandee Sir Norman Lamb, an ex health minister, could be the catalyst for a step change in the UK establishment’s approach to e-cigarettes and other safer nicotine products.
The NNA represented vaping consumers – and arguably smokers who may wish to switch to safer products in the future – in giving evidence to this committee, and we fully welcome the report’s main recommendations as detailed in its press release:
• The Government, the MHRA (Medicines and Healthcare products Regulatory Agency) and the e-cigarette industry should review how approval systems for stop smoking therapies could be streamlined should e-cigarette manufacturers put forward a product for medical licensing.
• There should be a wider debate on how e-cigarettes are to be dealt with in our public places, to help arrive at a solution which at least starts from the evidence rather than misconceptions about their health impacts.
• The Government should continue to annually review the evidence on the health effects of e-cigarettes and extend that review to heat-not-burn products. Further it should support a long-term research programme overseen by Public Health England and the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment with an online hub making evidence available to the public and health professionals.
• The limit on the strength of refills should be reviewed as heavy smokers may be put off persisting with them—and the restriction on tank size does not appear to be founded on scientific evidence and should therefore urgently be reviewed.
• The prohibition on making claims for the relative health benefits of stopping smoking and using e-cigarettes instead has prevented manufacturers informing smokers of the potential benefits and should be reviewed to identify scope for change post-Brexit.
• There should be a shift to a more risk-proportionate regulatory environment; where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarettes, heat-not-burn and tobacco products available.
• NHS England should set a policy of mental health facilities allowing e-cigarette use by patients unless trusts can demonstrate evidence-based reasons for not doing so.
• The Government should review the evidence supporting the current ban on snus as part of a wider move towards a more risk aware regulatory framework for tobacco and nicotine products.
This is a significant document. The Science and Technology Committee carries a lot of weight and its membership is drawn from every political stripe in parliament.
Previously, there has been a slow drift towards an appreciation of tobacco harm reduction but only from advisory bodies like PHE and ASH. These bodies could issue guidance, but that guidance could be ignored by national and local institutions - and businesses were largely unaware of it. Today’s report is a government committee recommending a root and branch review of not only how vaping should be treated by facilities directly controlled from Westminster, but also how government should influence private companies and other non-governmental organisations to rethink their policies towards safer nicotine products.
Did vaping consumers also have a hand in bringing us to the point where such unequivocal support for harm reduction is being recommended by a governmental committee? Yes, we did. Quite apart from the NNA’s contribution to this report, we are 3 million strong now, and amongst our number there are vaping MPs, not to mention other parliamentarians who have seen first-hand from family, friends and constituents how switching to safer products can transform lives. Vaping is part of everyday life now and today’s committee report recognises that establishment policies have not kept up with that, so there is need for a change.
As our press release concerning today’s report states, the UK is a world leader in recognising the benefits of harm reduction, but we can do better. We fully welcome the Science and Technology Committee’s recommendations and would urge the government to implement an all-encompassing policy on encouraging safer nicotine use, a policy based solidly on evidence, not ideology and ignorance.
The full Science and Technology report is here
Our press release is here
NNA Chair Sarah Jakes’ oral evidence to the committee is here
NNA written evidence to the committee is here
Today has seen a flurry of media activity following publication of research by the University of Birmingham on the effects of e-cigarette vapour on immune cells in the lung.
The BBC selected a quote early in their account – presumably from the University’s press release – explaining how “researchers "caution against the widely held opinion that e-cigarettes are safe"”. This is somewhat of a straw man argument. It is wrong to say that there is a widely held opinion that e-cigarettes are safe, in fact it is frustrating – as Cancer Research UK has noted - that such a large and increasing proportion of the public believe that e-cigarettes are as harmful, or more so, than smoking. Today’s breathless headlines can only have reinforced these misperceptions in the minds of many thousands.
Additionally, no public health organisation in the UK claims that e-cigarettes are entirely safe, just merely less harmful than combustible tobacco. It is inconceivable that the lead researcher, Professor David Thickett, is not aware of Public Health England’s assessment that e-cigarettes are at least 95% less harmful than tobacco so it puzzling where this “widely held opinion” is supposed to have come from.
Considering the widespread media attention to this study, it is important to point out its obvious limitations. Firstly, it was an in vitro study and the researchers found that e-liquid becomes more toxic to cells after being vaped than before. However, the study does not show evidence of that toxicity or any other clinical significance in living subjects.
Secondly – and allied to the first limitation – the researchers fail to come to any conclusion on quantifiable level of risk. It is OK to say that cells in a petri dish react poorly to vapour but without an assessment of how that translates to increased chance of harm in humans, it is of little worth. Even Prof Thickett is quoted in some articles agreeing that e-cigarettes are far safer than smoking, all that is of debate is by how much. It is quite possible that the resultant level of risk would be well within the margins of the 5% that PHE has identified. Rather than proving that “PHE is wrong” as Prof Thickett claimed during a radio appearance today, this research does nothing to contradict the reduced risk claims of public health organisations supportive of the harm reduction prospects of vaping. In short, it is hard to see why this is news at all.
Lastly, and probably most importantly, the researchers did not compare their findings with the effect on cells of tobacco smoke. Without this comparison and coupled with the lack of an assessment of real world risk, this study adds nothing significant to our understanding of vaping as a substitute for smoking.
In fact, there are worrying signs that the project has been approached from an ideological point of view rather than one of seeking the truth. Prof Thickett was quoted in the Telegraph commenting that “a large number of e-cigarette companies are being bought up by tobacco companies” which should be irrelevant to someone presenting research, and more in keeping with activism, which would be a conflict of interest.
The NNA would always welcome good research into the effects of vaping – many of us are, after all, vapers ourselves – but today’s lurid headlines add nothing to the debate and have more likely harmed overall public health.
Smoking is enjoyable to many and there must be a strong incentive in order that smokers switch to safer alternatives, which all agree e-cigarettes are. Today, many hundreds or even thousands of current smokers will have been given one more reason to postpone the decision to try an e-cigarette and reduce their risk, thanks to exaggerated news reports concerning a study which challenged a false premise that e-cigarettes are widely considered safe, didn’t conclude any clinical significance, failed to identify a level of real world risk, and avoided a comparison with smoking which could have put the research results into context.
In pursuing a perfect scenario, all that has happened today is that a speculative study has enabled a click-hungry media to make great strides in harming the good of tobacco harm reduction and turning many smokers away from safer products.
You can listen to our Chair, Sarah Jakes, debate with the lead author on BBC Radio Essex at 1:10:00 here.
Objectives: to outline the experience of a nicotine consumer group (New Nicotine Alliance UK) in using legal mechanisms to challenge the ban on snus. Background: 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 and other tobacco-related disease in Europe. But the sale of snus is banned throughout the EU, except for in Sweden. Swedish Match, the leading snus manufacturer, initiated a challenge against the ban. NNA applied to join the action. The legal case: The NNA’s case to the European Court of Justice is based on EU law and the EU Charter of Fundamental Rights. Given the evidence that snus is substantially safer than smoking cigarettes, and that it protects against smoking, it is not only unethical but also contrary to EU law to deny access to this product - smokers have a right to access a product that helps protect their health. The ban on snus is disproportionate, and is contrary to the right to health. Progress: On 26 January 2017 the High Court in London ruled that the challenge should be heard at the European Court of Justice and that NNA could join the challenge as intervenor. On 25 January 2018 the case was heard at the European Court of Justice in Luxembourg. The case has been opposed by the governments of Norway, UK, Hungary, and Finland, and by the European Parliament, the Commission and Council. The preliminary opinion on the case by the ECJ Advocate General will be published on 12th April. Conclusion: The NNA legal case is the first time that a ‘right to health’ argument has been used to challenge a bad tobacco control law. We hope that this example might be a springboard for challenges in other countries.
Following our intervention Pfizer have amended their CGA and, whilst it’s not perfect, it is a big improvement. The revised CGA is here.
Open letter sent from NNA to Pfizer in response to Pfizer's Call for Grant Applications (CGA) on Addressing Education Related to Smoking Cessation and Tobacco Harm Reduction
18 July 2018
Dear Ms Romano,
I note that in the detailed notes for this CGA Pfizer state:
“The concept of harm reduction has emerged as a strategy to reduce the consumption of tobacco cigarettes”
Then go on to say:
“The health benefits of harm reduction alone have not been clearly established”
This is not a definition of the concept which anyone involved in harm reduction would recognise as being wholly valid. You appear to be defining tobacco harm reduction solely as a method by which people can reduce the number of cigarettes they smoke and thereby reduce exposure to toxins. I would agree that the reduction in risk in so doing is not necessarily proportionally equivalent to the reduction in exposure, however this is not a complete description of the concept of harm reduction.
Harm reduction also includes achieving complete tobacco smoking abstinence by switching to reduced harm products; indeed this is the approach to harm reduction favoured by Public Health England and included in the U.K. Government’s Tobacco Control Plan. There is decades of evidence surrounding the relative safety of Swedish snus compared with smoking, and in respect of e-cigarettes, the UK Royal College of Physicians has reviewed the evidence and concluded that the risks are “unlikely to exceed 5% of those associated with smoked tobacco products and may well be substantially lower than this figure”.
Additionally, this appears in the body of the document:
“..the importance of complete smoking abstinence vs harm reduction strategies for motivated quitters”
This implies that complete smoking abstinence and harm reduction are mutually exclusive and compete with one another, which simply is not true.
Despite the fact that the CGA states that “Pfizer has no influence over any aspect of the projects.." it is quite clear that Pfizer is attempting to influence the projects before they even start by providing such a misleading description of the subject matter to be researched.
I will be publishing this email as an open letter on our website so that any projects which emerge from this CGA can be viewed in the context of Pfizer’s input.
I welcome your comments.
New Nicotine Alliance (UK)
Charity registration number 1160481
World Cup fever may have gripped the nation this week, but the wheels of government keep turning regardless and – on the day of England’s semi-final – the NNA was once again in Westminster fighting the nicotine consumer cause.
The All-Party Parliamentary Group (APPG) on e-cigarettes met on Wednesday morning to discuss the topic of vaping regulation post Brexit and our Chair Sarah Jakes was invited to participate.
The meeting was chaired by Mark Pawsey MP, with Labour MP Kevin Barron and Conservative MP Adam Afriyie also in attendance. More parliamentarians would normally have been expected but what with the World Cup and Prime Minister’s Questions competing for attention on the day, the meeting wasn’t high on an MP’s packed agenda. However, the minutes will be available to MPs and their researchers who didn’t attend so it was important that we presented the NNA’s position on behalf of consumers.
Alongside Sarah were Dr Lynne Dawkins of London South Bank University, Helen Taylor from Cuts Ice, Damien Bove from Adact Medical, John Dunne from E-Liquid Brands and UKVIA and Daniel Pryor of the Adam Smith Institute who recently released a commendable report on the benefits of a liberal harm reduction policy.
The meeting centred around three questions:
1. What is the current impact of the regulations?
2. Which sections are most ripe for change?
3. What should the process of deregulation look like?
Sarah warned that the true extent of the slowed uptake of vaping could be hidden by the fact that so much stockpiling of non-compliant TPD products took place because of vendor fire sales prior to regulations coming into force, and that MPs should consider the danger that many will go back to smoking when heavily discounted stockpiles run out. We have yet to see data which is entirely post-TPD so the already clear damage that it has done to the government’s admirable commitment to reduced risk products may yet be revealed to be worse.
The controversial subject of short fills* inevitably arose, a concept created exclusively by the TPD by vendors serving a beneficial harm reduction market hampered by regulation which is backward-thinking and formed without a proper understanding of how and why smokers gravitate towards e-cigarettes.
Sarah emphasised that short fills would simply disappear if the pointless restriction on refill container volumes was removed, but that if that wasn’t possible, then they should be subject to standards, but that any standards should not be so onerous as to restrict supply.
Of course, short fills are an industry bug bear and – although we are mostly on the same page as the vaping market in many respects – we represent consumers and do not agree with disproportionate and heavy-handed regulations on them which would pile more bad rules on the car crash of the TPD. We also disagreed with the previous calls from industry for a “zero tolerance” approach to Trading Standards enforcement, as demanded by trade associations. Sarah made it quite clear that consumers don’t want further enforcement because enforcing bad law does not benefit vapers, dual users or smokers looking to switch.
We feel that industry would be better served in the long-run by encouraging a deregulation of the market rather than adopting short term positions to protect their investments in complying with damaging regulations.
When asked what parts of the TPD the NNA would like to see changed, needless to say we delivered a long list:
We were supported by all speakers, particularly Lynne Dawkins on the concentration limit and the effect of health warnings. Lynne described research her team had undertaken which had shown that vapers compensate for low nicotine strengths by inhaling harder and for longer, and that there is an associated increase in exposure to toxins, albeit still very much lower than exposures from smoking.
John Dunne was quick off the blocks on the question of what future regulations should look like, quite rightly stating that vaping regulations should be separate from those for tobacco products. Sarah insisted that a separate (from medicinal) route to market for consumer products should be retained and simplified, which would be far more beneficial to consumers what is currently law.
Throughout the meeting Kevin Barron and Adam Afriyie were passionate in their understanding of the clear benefits e-cigarettes could have if a regulatory framework could be found that would ensure they achieve their full potential. We couldn’t agree more.
The next meeting of the APPG will be in September, when we hope to get the opportunity to discuss the appalling failings of the World Health Organisation just prior to COP8. We’ll keep you posted.
*The regulations restrict the volume of nicotine containing refill containers (e-liquid bottles) to 10ml. Consumers find these fiddly, inconvenient, expensive and wasteful. A market quickly developed for ‘short fills’ and ‘shots’. A short fill is a larger bottle (typically 60-100ml) containing diluents and flavourings, but no nicotine, so it does not have to comply with the regulations. The bottle is not filled completely, leaving enough space for one or more ‘shots’ which are 10ml bottles containing 18mg/ml of nicotine, but no flavourings. The ‘shot’ is TRPR compliant but the ‘short fill’ is only subject to the normal consumer protection legislation. The consumer mixes the two together in the larger bottle and ends up with a larger volume of nicotine containing liquid at a cheaper price than buying the equivalent amount in compliant 10ml bottles.
I have just returned to my home in Mexico City after a 12-day academic visit to Queen Mary College (University of London). Even in my locality thousands of miles away, and elsewhere globally, the positive effects of health policies in the UK endorsing e-cigarettes as a substitute for smoking are widely known.
However, I would like to share how I perceived the vaping experience in London, as a foreign visitor and strictly from a vaper’s perspective.
I found it very disappointing that even with vaping being embraced by health authorities, the story is completely different when it comes to perception in public and private social areas, especially indoors. I understand that clouds are inconvenient to many non-smokers, but I still felt that permission to vape (whenever granted) was a gracious concession rather than a recognition of the hard, scientific fact that harms from second hand vapor are close to nil.
I was told that too many folks still associate vaping with smoking. Disgust with clouds is an inconvenience, not a health threat. So, why are there not far more vaping lounges or areas in pubs and in airports, for example? Or policies that welcome considerate vaping? Would this not be more consistent with declared public health policies?
The possibility to eliminate stigma, to be able to socialise comfortably while vaping (rather than being forced outdoors) is essential if a public health policy which encourages harm reduction is to succeed. Telling a smoker “your health will improve, and you will likely live 10 more years” is an abstract proposition because harms from smoking usually take decades to materialise. Telling a smoker “you can vape in some comfortable indoor spaces because your vaping poses no risks to bystanders”, is a much better approach which could lead to many more smokers trying e-cigarettes and eventually switching as a result.
The promise to be able to consume nicotine through a new gratifying habit in comfortable indoor spaces, without the stigma and the social shame, is a concrete immediate bonus.
An important example: vaping is treated exactly as smoking in Heathrow airport. This is very disappointing, since Heathrow is not only the entrance/exit gate to the UK, but a connection hub to millions of travellers worldwide. The message this is sending is that the health authorities of the “most vaping friendly country” still consider that vaping poses the same risks to non-smoker bystanders as smoking.
While some pubs allow for vaping indoors, I was always reminded to vape discreetly or even secretly. No vaping sections or lounges. Again, permission as a gracious concession.
This is a key issue in Tobacco Harm Reduction because it allows for the necessary socialisation that can make vaping pleasant and attractive (for us vapers and for potential smokers that could try it or switch).
The harms from involuntary exposure to second-hand smoke by non-smokers have served as justification to restrict (through increasingly intrusive bans and social stigma) the social spaces where smokers can smoke. This is what Tobacco Control calls “denormalisation”.
We must not allow this type of social stigma to be applied to e-cigarettes and vaping. Banning e-cigarettes in all indoor spaces makes vaping much less attractive to potential smokers and sends the wrong signal – that vaping is as dangerous as smoking - to smokers and non-smokers alike.
Despite British public health policies endorsing vaping, I still found far too many vaping restrictions in London that cannot be justified on medical or scientific grounds. In practically all my acquaintances and interactions, I detected a very widespread and dismal ignorance and indifference about vaping. Most people I talked to still conceive vaping as “some form of smoking”. Or that yes, it may be “less harmful” but it is “still not OK”. Also, most people still believe that nicotine is carcinogenic.
I cannot claim that my experiences are a sociological study with scientific methodology. However, I do sense that PHE and British health authorities have not done enough to translate their policy statements into public perception. For THR to work they must overcome this deficiency.
While the public health authorities in the UK should be applauded for their relaxed acceptance of vaping overall, they should be doing far more to correct these poor perceptions by those who formulate policies on vaping in public spaces. If they do not, a momentous public health opportunity is being wasted and their stated policy aims will ultimately fail to reach full potential.
Dr Roberto Sussman
Senior Researcher in Physics, National University of Mexico (UNAM)
No smoking sign at London City Airport