Tobacco: preventing uptake, promoting quitting and treating dependence
In a world where tobacco harm reduction, specifically vaping, is stigmatised daily by policy-makers and scientists desperate to search for harms and dangers of a technology that, if adopted and supported worldwide, could have already slashed rates of smoking, the new NICE guidance Overview | Tobacco: preventing uptake, promoting quitting and treating dependence | Guidance | NICE published 30.11.21 is a welcome breath of fresh air. Although conservative and cautious, as NICE guidance has to be, based on evidence rather than testimony or optimism (as my Stop Smoking Service’s vape-launch was in early 2014), this provides a clear message to the rest of the world that here in the UK at least, there is support for the use of vaping to stop smoking. Vaping for recreational purposes is not considered, of course; that is outside the scope of the guidance, but longer-term nicotine use is addressed, and that is welcome.
NG209 provides a disclaimer about medically-licensed products:
"At the time of publication (November 2021), no nicotine-containing e-cigarettes were licensed as a medicine for stopping smoking by the Medicines and Healthcare products Regulatory Agency (MHRA) and commercially available in the UK market. All nicotine-containing e-cigarettes in the UK that are not licensed as a medicine by the MHRA are regulated by the Tobacco and Related Products Regulations 2016, and cannot be marketed by the manufacturer for use for stopping smoking."
Whether a product ever gets a medicinal license remains to be seen. The barriers are high and the costs even more so. Opinion is divided on whether this helps get more ‘respectability’ for the category, but it cannot be denied that being able to prescribe to young smokers, or those in hospital, could be a benefit.
The NICE take on nicotine is something that other countries’ medics, researchers and policy-makers could well heed:
Provide the following information about nicotine:
The references are about licensed nicotine-containing products, because that’s where the evidence is found, and the emphasis on relative harms of smoking and non-combusted nicotine use serve to strengthen the argument for nicotine without the smoke.
"Provide the following information about the effectiveness and safety of medicinally licensed nicotine-containing products:
The language used by NICE makes a positive and welcome contribution to de-stigmatising the use of nicotine, and the term ‘dependence’ has begun to replace ‘addiction’. Even more importantly though, there is a distinct move towards an open-minded and person-centred approach, not regarding vaping as an option of last resort. It also recommends that extra information on how to make that first step wouldn’t go amiss.
"Offer behavioural support to people who smoke regardless of which option they choose to help them stop smoking. Explain how to access it.
Advise people (as appropriate for their age) that the following options, when combined with behavioural support, are more likely to result in them successfully stopping smoking:
A criticism that I would raise is the assumption, below, that youth vaping leads to youth smoking. This confuses correlation with causation and should be corrected; many factors influence the uptake of smoking and must be taken into consideration.
"The committee wanted to discourage e-cigarette use among young people and young adults who do not smoke because evidence shows that use of e-cigarettes is linked with a higher chance of ever smoking later in life. The committee members agreed that ideas about smoking and what is normal can start from a young age so the recommendation should also apply to this age group."
The simple statement below should be noted, especially where evidence reviews cherry-pick research to ‘prove’ that vaping does not help smoking cessation. If more was done to give people who smoke the confidence that vaping can help, and is not the same as smoking, more people would switch.
"They also agreed that offering behavioural support to people using nicotine-containing e-cigarettes would increase their chances of stopping smoking.
Evidence showed that nicotine-containing e-cigarettes can help people to stop smoking and are of similar effectiveness to other cessation options such as varenicline or long-acting and short-acting NRT.
There was a small amount of evidence about short-term adverse events of e-cigarettes that did not show that they caused any more adverse events than NRT, e-cigarettes without nicotine or no treatment."
On health harms, the guidance is clear that so-called EVALI outbreak was restricted in place and time, and the risks controlled by effective regulation.
"The committee discussed the outbreak of serious lung disease in the US in 2019, which US authorities identified was largely caused by vaping cannabis products containing vitamin E acetate. They also noted there has been a Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Update highlighting serious lung injury with e-cigarettes issued in January 2020 (E-cigarette use or vaping: reporting suspected adverse reactions, including lung injury). The committee discussed that the UK has well-established regulations for e-cigarettes that restrict what they can contain. Experts from the MHRA described to the committee the monitoring process for both short- and long-term harms of using e-cigarettes. Monitoring is ongoing and the evidence may change in the future, but the committee was not aware of any major concerns being identified."
The following paragraph could have been strengthened, in my opinion. Less harmful – good to emphasise, and I sincerely hope that the healthcare community takes note of this, instead of telling their patients that vaping is as bad as, or worse than, smoking. The caveat about only as long as they need is a mixed message. Some people will need that for life. I’ve seen too many people lapse even years later, and if vaping keeps them smokefree forever, that’s a win. However, pleasure from vaping (outside the scope of NICE guidance), should also be recognised, especially when put in the context of pleasure from enjoying alcohol, eating chocolate and drinking coffee.
"The [committee] agreed that because many of the harmful components of cigarettes are not present in e-cigarettes, switching to nicotine containing e-cigarettes was likely to be significantly less harmful than continuing smoking. So the committee agreed that people should be able to access them as part of the range of interventions they can choose to use. They also agreed that people should be given up-to-date information on what is known about e-cigarettes to help them make an informed decision about whether to use them. The committee agreed that with the limited data on effects of longer-term use, people should only use e-cigarettes for as long as they help prevent them going back to smoking. They also agreed that people should be discouraged from continuing to smoke when using e-cigarettes, even if they are smoking less, because there is no information on whether this will reduce their harm from smoking."
I was concerned about the guidance for healthcare professionals that they should talk to patients about:
No one really knows how long they intend to vape – as experience develops, minds are changed. An individual may decide to stop sooner than they really should, and risk going back to smoking, or they could choose to continue vaping for the foreseeable future. They will not know, within weeks of switching, how their choices will change. Also, there are certain or universally-applicable ways of stopping vaping; clinical experience in my service demonstrated that people are generally comfortable with reducing the strength of their vape, and stopping if that’s their choice, without any intervention from support services.
The statement below is a hidden gem, appearing as it does towards the end of a very long document. Not enough nicotine is one of the primary reasons for failure when trying to stop smoking. Even would-be quitters who use a vape tend to think they are better off with a non-nicotine vape, and wonder why they cave and grab a cigarette. Use enough, people!
"The committee discussed that it is more likely that people will not get enough nicotine to help them stop smoking, than get too much. They agreed that not getting enough nicotine is likely to increase the risk that the person will return to smoking, so they recommended that people should be encouraged to use as much as they need and told how to use the products effectively."
And finally, an appeal to the interests of commissioners and providers: a little extra effort could increase success in quitting, and save money in treatment costs for smoking-related illness.
Extra time may be needed to discuss e-cigarettes with people who are interested in using them. If these recommendations lead to more successful quit attempts, this may mean fewer appointments per person and substantial savings in downstream costs associated with smoking.
I believe that the committee worked extremely hard to get the balance right, and I’m sure that some members deserve a special round of applause for their determination to have the vaping category included. It would have been so easy to default to licensed medications only, thus missing an exceptional opportunity to push down rates of smoking, by recognising that switching to vaping will save lives.
Louise Ross, December 2021
On Tuesday the Office for National Statistics – the UK government’s official agency for assessing economic and social behaviour – released their latest statistical bulletin on smoking prevalence. It made for interesting reading:
The number of vapers in the UK has not changed much since previous assessments, but smoking prevalence continues to decline at a significant rate.
Many of the direst predictions of the effect of safer nicotine products – not just here but in other countries - have often focussed strongly on the possibility of a ‘gateway’ from vaping to combustible tobacco use, especially amongst youth. However, in the UK where regulations on reduced risk products are arguably the most liberal in the world, this is simply not happening.
These figures seem to endorse the government’s willingness to allow vaping and other safer nicotine delivery systems to flourish. Who knows how many dual users have now transitioned entirely to vaping amongst that static population of 3 million e-cigarette users? Additionally, how many of the statistically significant number of smokers have switched to other safer products not studied in this analysis such as heated tobacco and tobacco free nicotine pouches which are now sold in UK supermarkets?
One thing that seems certain is that if anywhere was to see a big gateway effect from widespread use of vaping products and other alternatives, it would be here in the UK. But there is no apocalypse as predicted by negative soothsayers, it would appear that normalising alternative products merely normalises switching away from smoking.
It is also worth noting that this decline is in the face of some atrocious media headlines and heavy funding of bad news from conflicted sources. One can only conclude that if the fear merchants would stop spreading myths and half-truths to the British public, the declines could be even more impressive than they already are.
So, it seems that the end is not nigh at all if a government supports tobacco harm reduction; these statistics suggest the complete opposite is true.
It is a shame that other nations are not enlightened enough to recognise the benefits of vaping and other reduced risk products, and that their governments refuse to take their blinkers off and look at the overwhelming scientific evidence in favour of alternatives to smoking. The ONS has just added to that evidence and there must surely come a time when common sense prevails not just here but in other jurisdictions too.
If anything, this news should encourage the UK government to be even bolder and further relax restrictions on safer nicotine products to make them more visible to the 52.7% of smokers who the ONS has concluded want to quit. Outside of the EU, this is an eminent possibility for the UK, and we hope that the opportunity will be embraced.
Franklin D Roosevelt is famously quoted as saying that, sometimes, there is nothing to be feared except fear itself. This latest evidence shows that this is especially true of tobacco harm reduction policies.
It has come to our attention that Kind Consumer – the company behind medicinally licensed smoking cessation device, Voke – is exploiting deaths attributable to black market THC liquids in the USA to promote its product.
A slide presentation to investors by the company made the claim that Voke is preferable to e-cigarettes because there have been “numerous recent cases of lung disease and death in individuals who use vape products”. This is completely untrue of legal vaping products and we unreservedly condemn their approach.
We realise that business is business and Kind Consumer wish to differentiate their new product from vaping, but repeating information that they know very well is false is not the way to do this. It is especially scurrilous when you consider that they are using the fraudulent information to raise significant levels of funding to the tune of tens of millions of pounds.
There is room in the safer nicotine market for many players, and we would ordinarily welcome Voke adding a new option for smokers wishing to quit. However, they should not be trying to build their success by shoving vaping under a bus.
Kind Consumer should instruct their fund-raisers and marketers to abandon this approach. It is unhelpful and shameful opportunism. If their product has merit, they should not have to sink to employing baseless scare stories which have deterred large swathes of smokers from switching away from lit tobacco.
As we said in September last year on this subject:
We … condemn the many bad actors who are fanning the flames of this false panic. Whether it is journalists chasing click-bait or ideologically driven harm reduction sceptics in the UK health community, they are actively deterring many thousands of smokers from either opting to switch to a far safer form of nicotine consumption or guiding those who may be using e-cigarettes to move back to smoking, based on no proper evidence whatsoever.
This is not a game. Their crass conflation of vaping with illicit, unregulated and deadly illegal drug-containing liquids will cost lives and they should be thoroughly ashamed of themselves.
It is sad to see Kind Consumer endorsing such a shabby business model and we hope that they will ensure that it is not pursued any longer.
There is much talk of further measures to control the outbreak of Coronavirus, but closure of vape shops should on no account be considered.
We are living through extraordinary times, with restrictions on personal freedoms – understandably - not seen since the second world war. It is essential that all of us observe the advice of the government, but the NNA hopes that if a rumoured ‘lockdown’ were to happen, vape shops would be excluded on public health grounds.
We have seen other countries such as France and Italy recognise this by exempting premises supplying vaping equipment and liquids from their general order for businesses to close. They have acted wisely, and we would urge the UK government to follow their lead.
These are very stressful times and access to safer nicotine products must be maintained. Supermarkets do sell some vaping products, and - while they are very helpful to many former smokers - they are expensive, with little variety, and do not cater for a large sector of society. Vaping has made a large contribution to the UK’s public health by attracting smokers away from combustible tobacco, and furthermore preventing relapse. It is important that this continues.
Vape shops are typically low key and do not attract crowds, so there are sensible social distancing measures which can easily be taken to ensure that vapers can continue to access the products they have found so useful in reducing risks to their health. There are online options for purchasing vape products, but it would be irresponsible to deny those who are not ‘net savvy’ the services that a bricks and mortar outlet gives them.
The NNA represents all current and future consumers of safer nicotine products, not industry, but we agree with trade bodies IBVTA and UKVIA who have both indicated that vape shops are a key resource and should remain open. The last thing we need during a public health crisis is to encourage another by closing off reduced risk options and leading many to return to smoking widely accessible tobacco.
We hope all our supporters stay safe during this difficult time and that availability of the supplies you need are considered as essential by government as we all know they are.
Last week we reported on a quite shameful ITV ‘investigative’ programme – broadcast during prime time – which smeared e-cigarettes and vaping products without editorial balance, and seemed to have been put together without any serious investigation whatsoever.
We said that ITV should be ashamed of the misinformation that they thrust on the public and described it as “scientifically ignorant scaremongering” which “misled millions of people with the message that they should just carry on smoking”.
Fortunately, genuine investigative journalism – not the unthinking tabloid kind exhibited last week by ITV - has not yet fully died in favour of ignorant and sensationalist clickbait, as The Economist has proved with this very astute guide to vaping, published last week.
See the video below for something far more sensible.
Last night, the ITV ‘investigative’ show Tonight broadcast a 30 minute probe into vaping which can generously be described as poor.
One wonders what the terms of commissioning were that resulted in a complete absence of balance and no information whatsoever being conveyed to UK viewers about harms in the US being exclusively caused by illegal black-market products involving contaminated liquids sold by criminals.
You would think that a responsible broadcaster would want to make that kind of vital and life-saving information available to viewers, but they didn’t. As ‘investigative journalists’, they could surely not have been unaware of this fact – as stated publicly by the US CDC - so we have to wonder at their motivation for producing something so slanted and irrelevant to the UK viewers they were broadcasting to.
Scant, and almost dismissive, attention was given to prominent UK voices such as Public Health England and ASH, while financially conflicted outliers from America were handed prominence without even a cursory examination of their pronouncements. An MP in the UK, however, was grilled extensively about non-existent conflicts which only proved that the presenters were catastrophically ill-informed about how parliament works.
Jonathan Maitland is a good broadcaster who has produced interesting shows in the past but came across in this programme as a gullible and incompetent researcher dancing to the tune of those above him who played him like a patsy.
Fortunately, social media has been harsh on the show, so whoever it was that decided on the gutter hit-piece that they delivered may hopefully realise they have misjudged the public mood in this country.
But more important is the fact that public perception of the relative safety of e-cigarettes has been nose-diving for years, precisely because of scientifically ignorant scaremongering such as the ITV broadcast last night. Public health officials in the UK are exasperated that the positive messages they give are drowned out by chancers out to make a buck on misleading information, click-bait and short-term notoriety.
ITV produced a show that was ignorant, lacked balance and that will harm many people’s lives, not just now but in the future. They should be thoroughly ashamed of themselves.
Professional journalists have long bemoaned the impact on news reporting that bloggers and social media have created. They criticise those channels for not having standards and lacking in objectivity when scrutinising important issues, yet their programme last night was so lacking in research and basic fact-checking that they have helped the country to realise that broadcast media is on the decline. They had a chance to prove that responsible investigative journalism wasn’t dead, but instead decided to jump in the coffin and nail it shut themselves with their own partial alarmism.
With their show, Jonathan Maitland and ITV have misled millions of people with the message that they should just carry on smoking, and that public health officials and politicians in this country should be ignored.
The British public deserves better than their shamefully bottom-of-the-barrel partisan propaganda.
For a long time now, the NNA has warned that bans on vaping in public and private places are harmful to the success that use of safer nicotine products can provide for the benefit of the public’s health.
It’s simple logic. The UK smoking ban in 2007 was designed by public health advocates to send a message that second-hand smoke is harmful to bystanders, and the same organisations have since sought to emphasise the threat of exposure at every opportunity. The result is that the wider public now believe that they can be harmed by smokers and, in turn, smokers believe that they are not only harming those around them, but also many now have adopted an acute belief that their habit is not doing them any good.
Most people have a great faith in policymakers to only ban behaviour if it has been proven to be harmful, so when vaping is banned in publicly accessible venues, there is an implied assumption that it is as dangerous as smoking. Why, after all, would state organisations and private venues act so drastically if that is not the case?
The NNA has argued against this huge downside to arbitrary – and often lazy - vaping bans consistently in the past few years to anyone who will listen. We gave evidence to MPs to that effect as well as urging public health groups supportive of reduced risk products to consider the negative connotations that such bans can have on the public’s understanding and to do more to counteract it. As recently as June, our Chair also suggested to industry at the ENDS Conference in London that they should be using their resources to campaign against vaping bans which damage public perception still further.
Now, it seems, public health research agrees with us. A newly-released study from the Indiana University School of Public Health sets it out very clearly:
Adults living in the states with an aerosol-free policy (including vaping in legislative smoking bans) were less likely to use ENDS (e-cigarettes) compared with those living in the states without an aerosol-free policy, controlling for individual- and state-level covariates (adjusted odds ratio = 0.79, 95% confidence interval = 0.64, 0.97). Stratified analyses showed that the association varied by age group; the statewide aerosol-free policies was associated with lower odds of ENDS use only in adults aged 25-59 but not young adults (aged 18-24).
In simpler words, where comprehensive vaping bans apply, adult smokers are less likely to take up vaping as an alternative.
The deficit in understanding of the safer nature of vaping in the UK has been spoken about for quite some time. Cancer Research UK has long expressed concerns that public perception about the relative safety of e-cigarettes compared to smoking is declining rather than increasing, and evidence submitted to the government’s Science and Technology Committee by the Royal Society of Public Health described the deficit in understanding very well:
Research has shown that perceptions of harm can indeed inhibit the use of e-cigarettes among smokers, and this barrier will only be exacerbated if the concerns of the public go unaddressed.
The most accessible message that the public sees about vaping is when a venue they frequent states that e-cigarettes are banned just about everywhere and treated the same as cigarettes. The subliminal take from that will always be that it is harmful both to vapers and those around them, and that there is no benefit to be derived from switching to a safer product. No amount of stressing the safer nature of vaping from public health groups will ever be as powerful an opinion-former to the general public as a prohibitive and dramatic “no vaping” sign or announcement on a public tannoy.
This unintentional and irresponsible implied negative messaging needs addressing urgently, and this new research emphasises just how damaging it is.
Sadly, the public health researchers in this case come from a deeply flawed viewpoint that stopping smokers from vaping is a good thing. However, their ignorance does not disguise the clear evidence from observed policies that vaping bans are actively deterring smokers from contemplating vaping instead.
What is required from more enlightened public health advocates is to be more pro-active in recognising the threats that vaping bans present. Our Challenging Prohibition campaign was designed to highlight negative messaging from organisations – public and private – who are blithely unaware of how their policies are harmful to the public, and often installed without any research and a distinct lack of care about the consequences.
We have a great opportunity in the UK to drive global acceptance of reduced risk products like e-cigarettes. To do that, it is incumbent on those in public health who are amenable to vaping – if they are serious - to redouble efforts towards recognising the threat of vaping bans and actively objecting to them.
This latest research succinctly shows that bans on vaping in public venues are an obstacle to adult smokers switching. It agrees with the NNA’s consistent messaging that bans are harmful and is now officially recorded in the literature. We hope that those in public health who believe in harm reduction will take this more seriously and dedicate resources to tackle the threat of bans which have no evidential, moral or health-related justification.
"Vaping welcome” artwork, kindly designed for NNA by Dan Pidcock, is available to download here.
Boris Johnson is now our Prime Minister. He has a lot to do, but one of his jobs should be to water down his predecessor’s misguided proposals towards e-cigarettes and other safer nicotine products.
On Monday, the Cabinet Office and Department of Health and Social Care joint-released their intentions in a Green Paper, reportedly forced through by outgoing Theresa May against her Secretary of State’s advice.
We are setting an ambition to go 'smoke-free' in England by 2030. This includes an ultimatum for industry to make smoked tobacco obsolete by 2030, with smokers quitting or moving to reduced risk products like e-cigarettes.
While it is welcome that the government has exhibited confidence in reduced risk products, these proposals are extremely problematic and fail to understand the regulatory landscape, as well as the appeal of products like e-cigarettes which have been so effective at drawing smokers away from combustible tobacco. They should be revisited, if not scrapped in their entirety.
It is implied that a first ever developed world ban on smoking is on the cards. This is not only a dangerously naïve idea but could further distance current smokers from considering vaping as an option. Many smokers are suspicious of vaping because they feel it may just be a tool that government might use to coerce them into quitting; these proposals simply reinforce that fear.
For years, we have seen perception of the relative safety of vaping decline, and an idea such as this may dispel that amongst some smokers, but many more will see this as use of a stick instead of a carrot and reject it.
It is the quit or die mantra all over again but with added menace. Before, smokers were told they should use pharmaceutical products or else be abandoned to a lifetime of smoking, but they were free to make that choice. The suggestion now is more sinister. They are being told quit or we will force you to quit because we will make your chosen products illegal.
One reason that e-cigarettes have been successful since they went mainstream about seven years ago is that they are not seen as coercive. Smokers feel they are making their own choice rather than being forced into it. The same effect has been seen in Scandinavia where snus has transformed nicotine consumption to the point that lit tobacco use is becoming a rarity. Government has not encouraged the use of snus, nor mandated it, but smokers have chosen to use far safer snus instead.
If politicians want to see increased uptake of safer nicotine substitutes for smoking, they should do so by optimising the choice of alternatives such as e-cigarettes, snus and heat not burn products, not by the blunt tool of coercion and prohibition. A policy like that suggested in the Green Paper would instantly remove the allure of safer products for many smokers.
There are other impracticalities too that have either not been considered or ignored.
A demand that the tobacco industry force people onto safer products can only work if government institutions and public health acknowledge the role that the industry can play in this transition. Yet currently, industry is prohibited to even talk to policymakers and the public health community has spent the last decade attacking not only the tobacco industry for producing risk reduced products, but also portraying it as a sneaky covert campaign to further prolong smoking.
So are these public health organisations now going to come on board and engage with industry as to how to make these proposals work, because if not the proposal is dead before it has even begun.
Are we going to see UK public health groups now standing up to their global counterparts in defending industry and the reduced risk products they make because government has mandated that industry should focus on them? We very much doubt it.
Even if they do, how will this play internationally? The WHO and FCTC has set itself against harm reduction. If our public health organisations truly support this initiative, they have a reckoning ahead of them. They will have to divorce themselves from the overwhelming opposition from global tobacco control institutions and say they are now engaging with Big Tobacco, by order of the UK government. This is not remotely likely.
Will a set date of 2030 for prohibition remove objections from the WHO about involvement of tobacco companies in supplying vaping products to attract smokers? If tobacco companies were full square behind the government’s proposals, would this change the landscape between industry and NGOs? It’s another no.
E-cigarettes have become popular because they are not a medicine and are not seen as a government-mandated solution. Smokers do not see themselves as sick, they do not require treatment, so the use of coercion will only turn smokers off the products and prohibition will simply create a big black market in tobacco. France is not far away as we have seen before with high taxation.
A better policy from the government – if it truly wishes to tempt smokers from combustible tobacco – would be to stand up strong at COP9 in The Hague next year and strenuously defend reduced risk products against the contrived hysteria which is prevalent the world over and perverting debate about safer products globally. On a local level they could instruct their civil service to object to the EU ban on snus and demand that it be lifted now rather than later.
Reduced risk products have a huge role to play in moving towards a smokefree society, but they will not be helped by government committing to a blunt and misguided policy such as this.
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.