Chesterfield Royal Hospital unveiled a vaping ban in 2017 which has since been rescinded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 Their policy has since been rescinded but it’s clear that many other trusts are not taking any heed of government messages on reduced risk products.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
Hi just a quick apology in advance I'm not a very confident public speaker, my skill set lies elsewhere, but we're going to give this a go and Martin Cawley you're going to be busy after this, you're going to get a lot of people coming up to you because I'm a Scotsman and they're going to be saying to you “What the hell has he just said?”. Anyway, so back to the conference: I have to be honest when Paddy told me what the strapline for this conference was going to be, “rethinking nicotine” I was really really disappointed because I thought I knew everything there was to know about nicotine, and I've been proved utterly wrong. I've learnt so much from this conference and I'm grateful that they actually used that strapline. It really should be crystal clear to everyone now if it wasn't already that way beforehand that nicotine is not the problem, it's a very very big part of the solution. So I've rethought nicotine.
What's important now for me as a consumer is what you guys do when you leave here, as groups or as individuals. A lot of people are rightly looking to the UK as being a good place for harm reduction, particularly in this field but again, being a Scotsman we don't particularly like the UK and we've got a little saying that says “we're daein well but we're no daein great”. I'll translate that into English for you: “We’re doing very well but we're not doing brilliantly”.
So, I've just got a few messages here really for various sectors:
Tobacco companies: you’re very much still under the microscope from a consumer point of view. You're turning the heads and you’re doing the right things - you are heading in the right direction. However this is one of the latest devices - I won't say who it's made by - you are not getting it right, you are not talking to vapers.
This thing spits, leaks, gurgles all over the place. You need to speak to more vapers.
This thing spits, leaks, gurgles all over the place
E-liquid industry: we've got a real problem here with branding, IP theft, stuff like that and - this is thanks to my good colleague John Summers basically - this is a layer of s*** that we as advocates would rather not have to deal with and it's totally unnecessary, so sort yourselves out."
Public health: you need to do more, you need to look to the likes of Public Health England, you need to talk to Martin Dockrell and we really do need more from you. You get it and you're in a position of power, you can actually do something about it.
Stop smoking services: well a little story. I went to some of my local stop smoking services and I was appalled when I went in there and I asked a simple question: “ What do you do when a guy comes in and asks about electronic cigarettes?” and the response was “We can't help them”, more less, “ We can't help them”. I said to them “Well what do you do, throw them out the door?” and they said “Well no, we try to steer them down different routes, and so forth”. I said “Could you maybe send them to me, and I’ll give them a NNA business card?” and they said “No we won't do that, we refuse to do that”. You are just not doing the job, you are letting people down, it's shocking. My message to you is to be brave, look to Louise, the vaper’s and smoker’s angel.
Tobacco control: junk scientists that you employ and deploy, ultimately onto the media. We are sick of it. We are sick of the lies. We are sick of all the garbage that you spout out. Why don't youse look to Farsalinos first, get his opinion before this garbage gets into the press? Because, again, you are killing people, you're putting people off, please stop it.
Researchers: Professor Linda Bauld, who is unfortunately not with us this year, she came to me a couple of years ago and I was amazed at what she asked me to do: “Could you help us with a study?” and I said “Yes”. They listened to us, they listened to the vapers. Not only that, her researchers came to me and said “Teach me how to vape”. I was shocked, utterly utterly shocked at this- not only did they want me to show them to do it, they wanted to experience it. That is good research.
We then took it on - it was a really really difficult study to do - we were going into elderly people's homes where we had one researcher, one vaper - experienced vaper. I put together a team of about a dozen vapers and we split the job up between us. These people had an awful lot of underlying health problems and a lot of them were elderly. And one that stuck out for me was one that ….. we went through the process of taking through the different nicotine levels and the different flavours to try and find one that suited them. And we were always asked by the researcher “How do we think these guys are going to get on?” So while we were going through the levels of nicotine and you could see the face lighting up every now and again as we went up through the nicotine levels. We got to 18mg which is the limit in the EU at the moment - it’s not 20 mg by the way it’s 18, don’t fall into that trap because they won’t make 20mg nicotine, for fear of being done by trading standards and so forth. Anyway, we got to 18mg and he was just about getting there and he says “Yeah that's great” and I thought “You're not going to make it with that”, and knowing that I had in my pocket this little bottle here which is 24 milligrams, would have tipped him over the edge and sure enough I gave him a 65% chance of getting through the course, he didn't make it he relapsed back to smoking. It's shocking that I couldn't pull that out, it was heartbreaking, it was soul destroying that I had this in my pocket and I could not give it to him. That is wrong, I'm sorry to say it but that is so wrong, that needs to be sorted.
Consumers and advocates: stop the infighting, please. Your device is no better than anyone else's device. Heat not burn is there, it’s there to stay. Focus on the big picture - you are losing direction here - please stop the in fighting and get on with the job in hand.
Well, I think that's my five minutes up, just about. I was going to have a go at pharma but that can wait for another day. Thanks very much for listening.
Watch Andy from 27 minutes in
While the World Cup is currently taking place, the Scottish Government has marked the feast of sport taking place in Russia by scoring something of an own goal.
This week saw the publication of the Scottish tobacco control plan (TCP) led by Minister for Public Health and Sport, Aileen Campbell and – while there are many friendly references to e-cigarettes contained within it – it is somewhat schizophrenic when it comes to its approach to harm reduction overall.
NHS Health Scotland, which is referenced throughout the government’s plan, has come a long way with its position on e-cigarettes, from a deep mistrust and recommendations of vaping bans in all areas in 2014, to its current welcoming – if over-cautious – stance on the products.
The TCP document recognised that many smokers are now using e-cigarettes to cut down their combustible tobacco use or to quit entirely and boasts that stop smoking services are e-cigarette friendly. It even pledges “to develop guidance for health professionals and other relevant service providers so that they can offer basic advice on e-cigarette use as part of their support for smokers who choose to make quit attempts using e-cigarettes”.
This is all to be welcomed even though we feel that health professionals are not the best source of guidance on vaping products and that consumers should be consulted far more than we currently are. We have found that some stop smoking services are either unwilling or unable to support smokers who express an interest in e-cigarettes other than to nudge them down the path of licensed pharmaceutical products. For whatever reason, if the Scottish government truly wishes to reach a smoke-free future, they should be utilising the skills and knowledge of vaping consumers instead of placing faith in organisations who have scant understanding of the products.
We also welcome moves to allow use of e-cigarettes in prisons and mental health settings. It is a no-brainer when there is no valid reason to ban use of vapour products which carry no health risk to others. Indeed, they should be seen as a positive benefit in potential tinder box institutions where a large majority smoke but are being told they will not be permitted to do so in the future. We understand a need for strict control on devices that can be sold in such a febrile environment, but it is sensible for the Scottish government to recognise that the benefits of allowing vaping can more than compensate for the potential risks.
However, these mildly promising changes are undermined by a prevailing caution towards e-cigarettes which borders on paranoia. Nothing illustrates this more than the TCP’s stated intention to “consult on the detail of restricting domestic advertising and promotion of e-cigarettes in law”. Currently, e-cigarette manufacturers can advertise their products domestically where the same is not permitted for combustible products. This is a powerful incentive for smokers to switch to safer alternatives which the Scottish government, inexplicably, seems to want to eradicate.
We are concerned that the NNA has worked hard with NHS Greater Glasgow and Clyde (NHSGGC) over the years in overturning vaping bans in hospital grounds. It would be helpful if this were to be extended to all Scottish hospitals following the lead that NHSGGC were brave enough to make having listened to the evidence.
However, the Scottish TCP seems to want to make a debate of something which should be a given. The plan pledges to “work with health boards and integration boards to try to reach a consensus on whether vaping should or should not be allowed on hospital grounds through a consistent, national approach”. There should be no debate about this. If the Scottish government is serious about reducing smoking, a clear incentive should be evident, so the only acceptable policy is for health boards to emphasise the difference between vaping and smoking by allowing e-cigarette use wherever possible.
We are also disturbed that the Scottish Government implies changes in regulation towards non-nicotine e-liquids and other harm reduction products such as heated tobacco which, although research is still ongoing, were described as carrying a fraction of the risk of smoking by the FSA’s Committee on Toxicity in December.
This all appears linked to the suspicion that NHS Health Scotland has about recreational use of nicotine as expressed in their latest literature where they state that “e-cigarettes are useful for public health and health service purposes only as a potential route towards stopping smoking”. This is an idealistic view since the market for nicotine – as opposed to smoking – will never just vanish, so a more enlightened tone would be far more beneficial to the public’s health in Scotland.
The TCP places great emphasis on e-cigarettes being a health product rather than a consumer product which smokers can enjoy over and above combustible tobacco. The government’s report details the massive organic rise in e-cigarette use – which is simply because people enjoy using them – but then speaks of an aspiration to see the development of a medically-licensed vaping product. This entirely misunderstands the subject matter.
Smokers are not ill, they do not require a medicine. The entire reason for the success of e-cigarettes is because they are pleasurable. That is what is driving the huge boon to public health in Scotland as well as the UK in general. Scottish authorities can never begin to comprehend e-cigarette use if it refuses to understand it is because they are not medical products. The reason that Scottish stop smoking services are e-cigarette friendly now is not because of the success of tobacco control policies, but because they have had to react to where consumers were going without their government’s help. Rather than try to stop that, we should be heartily encouraging it. Less caution; more enthusiasm.
As NNA lead in Scotland, I will be writing to Aileen Campbell to express our concerns on this TCP, as it is hopelessly confused. We will also be responding as an organisation to any consultations which arise and will be objecting strongly to any further restrictions on products which have driven an unprecedented decline in smoking prevalence not just in Scotland, but the UK and also most of the western world.
It is well past time that this antiquated and blinkered view of harm reduction was altered so that the reasons for success of risk reduced products were recognised and – instead of booting the harm reduction ball into the back of our own net – we began passing it up the other end of the pitch instead.
I’d like to start with a little anecdote of something that I came across a few months ago. I got an Uber - it was fairly late at night and I’d been out with a friend.
We’d been drinking and vaping. He said “Oh, I’ve been vaping too, I’ve got an e-cigarette” I said “Oh, that’s interesting, what have you got, let’s see it?”. He said “Oh no, I don’t bring it out with me, I don’t bring it to work.” I said “Whyever not?”. He said “Well, Transport for London have banned vaping in private hire vehicles so I can’t use it and it’s too much of a temptation.” And I said “So, what do you do, when you go on a shift?”. And he said “Well, I always buy a packet of cigarettes before I start work”.
Now, If you don’t understand why he would do that then you maybe don’t understand how e-cigarettes work, and sadly, if you don’t understand how e-cigarettes work there’s a possibility you could work in tobacco control. Because a lot of these policies come about because of misinformation that has been spread mostly by tobacco control organisations. The Uber driver’s just fallen foul of a policy of misinformation where Transport for London have obviously picked up on all these stories you hear and imposed a ban. And the fact that it’s in his private property as well just makes it even worse.
Here are some recent examples of this misinformation: This is just in the last week or so because these are regular events, and the public will be reading these sort of things. In a BBC article, last week I think it was - it was a positive article but they quoted the World Health Organisation with a few desperate excuses as to why e-cigs are bad - and one of them was: “the users replacing the liquid in refillable e-cigarettes might spill the product on their skin, possibly leading to nicotine poisoning”. I was tempted to demonstrate - just get a 10 ml bottle and smear it all over my arm - to prove why this is a bit alarmist but I didn’t bring enough!
The European Respiratory Journal recently described vaping as “a one way bridge to smoking”. So, you’ve got vaping going up, smoking plummeting, but apparently this is happening the other way round. Two researchers from a well respected university stated categorically “we don’t know yet if vaping is safer than smoking”. A US researcher from San Francisco, that some people might have heard of, said that smoking triples the chance of a heart attack but using e-cigs as well increases it five fold! I mean, what sort of information does this send out to people about what e-cigarettes are all about and what vaping’s all about?
There are some public health people who are responsible, some have been here [in Warsaw] and they say positive things, but they are just being drowned out by what seems to be a coordinated effort of misinformation, quack science, doubt merchanting, diversion, all of these things. Consumers need to have meaningful and consistent advice if they are going to make their free choices. And public health at the moment simply isn’t offering that. Instead they are mimicking the tobacco industry that they’ve always said we shouldn’t talk to, because we shouldn’t trust them! So, if we’re not meant to supposed to trust tobacco companies back then, because they were handing out misinformation, why should we be trusting tobacco control?
When we are alarmed at imaginary dangers how can anyone trust those sort of people? I just think the public, and specifically consumers, should be better served by public health and tobacco control because at the moment they just can’t be trusted.
Watch Martin from 55 seconds in
The fifth Global Forum on Nicotine (GFN) has just taken place in Warsaw, Poland, and again the NNA featured prominently, as we highlighted in our May newsletter.
The plenary address given by NNA's Sarah Jakes, has already been published here and there will be further articles soon expanding on our contributions to the event.
Aside from this, there were many other positive reflections to take from the conference but also – as is always the case with this subject matter – other issues which need to be addressed.
This year’s event saw over 500 delegates attend, a new record, and this despite the European Network for Smoking and Tobacco Prevention’s Conference taking place at the same time in Madrid, resulting in the absence of many in public health who had attended in previous years. This is not to say that public health was not represented, they were, but they were presented with a conference which was one of the most optimistic yet and would have left with a healthy view of tobacco harm reduction.
Global participation appeared to be noticeably expanded this year which bodes well for the future. Contributions from - and presence of - public health experts, scientists, industry and consumers were evident from a wider range of territories and continents than before. The posters on display were the most extensive yet, taking up two long walls and then some.
Tobacco harm reduction, it seems, is becoming a hot global topic.
In the centre of it is the UK, which was widely praised by those in attendance for the enlightened attitude it affords vaping, in particular. Many attendees spoke of how the success on these shores had inspired others to pursue the same policies in their own jurisdictions. We at the NNA are proud to have been involved in advising our government and NGOs on harm reduction since 2014 and we are thrilled to see that our optimism is beginning to be shared by others throughout the world.
We understand that presentations are already available at the GFN website here and that video of the sessions will be uploaded shortly. We would have no hesitation in recommending you take time to view some of them if you were unable to attend yourself, they are sure to be a hearty resource.
In particular, we welcomed David Sweanor of Canada calling for more data on the seismic successes enjoyed by countries such as Iceland, Japan, France, Norway, South Korea and the UK so that the size and potential of disruption can be better understood. It was also good to hear more about the panoply of products available; which populations might benefit from them; and how there could be a better understanding of the industry, consumers and their interaction with public health goals.
It was also good to hear Martin Jarvis talk of the vital importance of harm reduction as identified by Michael Russell 40 years ago, and how Russell’s legacy should be celebrated as a breakthrough in understanding of the role of safer nicotine. Rather than condemnation of safer alternatives and personal attacks on those like the NNA who promote them, a better public health approach for all would be dialogue and an adherence to evidence.
The polar opposite approaches to the subject were no more acutely illustrated than by Dr Konstantinos Farsalinos, who had hot-footed from the Madrid event to report to GFN what he had heard in Spain from tobacco control. He spoke of how they view reduced risk as a danger and a threat, with delegates there making apocalyptic predictions which conflict wildly from reality. He suggested that delegates should not be in Warsaw, but instead in Madrid trying to rectify misperceptions.
The NNA and other advocates would like nothing more, but often when we try the doors shut, and ranks are closed. It should not be for consumers to beg for an audience with ivory tower public health, it should be up to public health to engage with consumers since we are the people who will thrive or suffer under their edicts.
We would suggest, instead, that next year those in tobacco control who were in Madrid bite the bullet, swallow their pride and prejudice, and come to Warsaw to see the enthusiasm and drive behind the tobacco harm reduction movement. Reducing harm from tobacco requires compromise and co-operation from all sides, not trenchant obstinance and blind adherence to coercive policies which have only offered chequered success.
The NNA will be present and correct at the next GFN and we can only hope that more from public health around the world will join us for meaningful discussion, rather than the unhelpful dismissal of consumers as a voice which has sadly plagued the debate amongst some.
In his talk there, Joe mentioned the scream test. I have a test of my own, I call it the ‘glaze test’.
It’s not always easy, especially when talking to a large group of people, to tell whether they’re really with me.
They tell me they’re passionate about helping people stop smoking and I don’t doubt them. They say they support e-cigarettes and I don’t doubt that either, but do they really understand?
So my test is to throw in a slide about Pleasure. Normally it will include a photo of Vapefest – happy people at an open air festival, celebrating nothing more than the one thing they have in common – their love of vaping.
I tell them about the colourful tents, the thousands of different devices and liquids for sale, the camping, the barbecues, the music and the friends who wait all year for this event just to see each other in person.
And as I look around the room I often see amusement or surprise. The fact that thousands of people come together to celebrate vaping is a revelation.
But in others I see eyes glazing over. It’s as if they’re saying ‘look, I’ve reluctantly come to the conclusion that vaping might be helpful, but enjoyable? Gimme a break’.
Often people are so fixated on the concept that smokers are nothing more than the pitiful victims of an evil industry, that they cannot process the idea that people can enjoy the use of nicotine.
I’ve lost count of the times that I’m told (by people who don’t use nicotine) that the only thing I enjoy is the relief from cravings. Well no, actually I enjoy the taste of my mango cloud, the feeling of the vapour as I inhale it and the sight of it as I exhale.
I value the friends I’ve made through vaping, and the knowledge that we’re a part of something important. Oh and the mild effect of nicotine of course.
Physical cravings are not the only thing that lead people back to smoking. Much more powerful for many people is the feeling of missing something, even decades after stopping smoking.
To understand this better, I’d like to read you something written by Liz Hilton. Liz is in her 70s, smoked for 50 years and has been a vaper for 7.
She started a YouTube channel called ‘vaping for the over 60’s’ and through her channel and blogs has helped many hundreds of smokers switch to vaping.
In her latest video, which she also says is her last, she describes her relationship with smoking and this is what she says:
“Smoking is deeply rooted in my psyche. And I believe it is rooted that way for many people. Smoking is a comfort for me. A way to fill a hole. A pleasurable activity, meaningful.
It is the marker of peak experiences, deep lows, celebrations, triumphs, a friend that accompanies me through my life. My best friend. How thoughtless it is for someone to tell me I must simply ‘quit’.”
I expect by now, that some of your eyes are glazing over. Some are probably making a mental note to ask whether I would agree that this friendship is an abusive relationship. In many ways I do agree.
But just as we would hope that anyone in an abusive relationship can find a new and better friend, so too can smokers.
Smoking is a personal journey which most smokers consider to be no one else’s business. Quitting smoking is also a part of that journey and can be a deeply personal act. It is unfortunate then, that at this crucial point, everyone seems to want to butt in and take over.
No doubt, some people who want to stop smoking appreciate help from a health practitioner. But for many others the medicalisation of cessation is in itself a barrier.
Asking for help, or being told you must seek it can be seen as a weakness, and addiction as a personal or moral failure. It doesn’t have to be that way.
Nicotine itself is a mild stimulant and also relaxant. Nicotine withdrawal is unpleasant, slightly uncomfortable, but not painful or sickness inducing. It is everything around smoking that is so captivating.
So when you offer me a patch you are offering a solution to what for me is the easy part. I’m expected to go cold turkey on the rest.
I choose not to.
My own relationship with smoking was similar to Liz’s, though maybe less intense. My relationship with vaping is somewhat different. If smoking is James Dean, vaping’s more like the Fonz: more fun and pretty harmless. Probably not quite as cool though.
What we’re seeing now is a revolution. People can take control of their own smoking without feeling ashamed, replace it with something equally pleasurable but less risky and be satisfied in the knowledge that they did it for themselves.
It’s empowering and it works.
So why does pleasure seem to be such an issue? I’ve seen many suggested explanations, all may play a role, some more than others.
There are fears that it might attract non nicotine consumers into regular use. We’d be burying our heads in the sand if we denied this could happen. It is almost inevitable.
But so far at least, the numbers are tiny and the minimal risk of harm is dwarfed by benefits gained by the people attracted to switch from smoking. Somehow that side of the equation often seems to be forgotten.
There are fears that vaping could be the ‘training wheels’ for future smoking. The mechanism for this isn’t clear. Nicotine isn’t like some other drugs, where users become habituated and seek ever larger doses. It baffles me what the attraction of smoking would be for anyone who wouldn’t have been attracted to it anyway.
For me, the most likely explanation is that pleasure plus minimal risk of harm equals zero incentive to stop.
Public Health England’s message is that it is better not to smoke or vape, but if that’s not an option – vape. I would argue that for me, the benefits of vaping outweigh the risks and so that statement isn’t true -and I think PHE understand that.
They may not endorse it, but they get it.
For others long term nicotine use in any form is a problem. If it’s not a problem for me I don’t see why it should be for them.
As Joe said earlier, Mike Russell’s words were prophetic. He understood that there was a potential for new nicotine products to become a long term replacement for smoking tobacco, and that for that to happen they must be, in his words, “as palatable and acceptable as possible”. Another word for that is ‘pleasant’.
Mike said that 27 years ago and yet vapers still today find themselves faced with moralistic opposition to their ongoing use of a mildly addictive, approximately harmless and ultimately enjoyable product.
A product which for many if not most has improved their health and extended their lives.
No doubt snus users will tell you the same story, and the heat not burn fans still have it to come.
It’s time that stopped.
At the beginning of May, the World Health Organisation issued a draft report on its approach to non-communicable diseases (NCDs), meaning illness arising out of making unhealthy choices rather than the traditional understanding of disease.
The report recognised the “lack of progress” towards tackling NCDs, spoke of fears that the WHO’s targets might not be met in this area, and invited responses to a consultation on the matter. The NNA submitted a response which addressed concerns raised by the WHO in their preamble.
“There are many proven interventions for the prevention and management of NCDs. However, for many reasons, implementation of these has been slow and progress disappointing."
“Thus, we have sought to imagine different ways of doing things and to formulate recommendations that are not overly technical but policy-friendly.”
Article 1(d) of the WHO’s Framework Convention on Tobacco Control specifically mentions “a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products” as part of its remit. With this in mind, and with the WHO seeking “different ways of doing things”, the NNA – a registered UK charity – submitted a response to the consultation which you can read here.
Quoting the Royal College of Physicians, Public Health England, the European Commission and even the World Health Organisation itself, we set out the case for a more robust role for reduced risk products within global tobacco control legislative policies.
We believe our submission was a useful contribution to the debate and drew on proven successes in various jurisdictions to promote precisely the imaginative solutions that the WHO’s report implied it was seeking.
However, to our surprise, when the WHO published the responses it had received, ours was included in a section entitled “feedback received from entities with which WHO does not engage”, insinuating that we work for tobacco companies and likening us to the arms industry! From this we can only assume that the WHO is refusing to read our suggestions or, at least, plans to ignore them entirely.
We wrote to the WHO on 22nd May to complain about our inclusion in that section on their page and to request an explanation but have yet to receive a reply. The New Nicotine Alliance does not accept funding from the tobacco industry, nor do we work to further the interests of the tobacco industry and our website clearly states that “NNA welcomes donations from individuals and organisations to support our campaigning work. We are however unable to accept such donations from manufacturers and distributors of nicotine products.”.
The NNA is a registered charitable organisation in the UK and we are therefore required to publish our annual accounts on the Charity Commission website. The WHO can clearly see our funding and should note that we are a group of mostly consumer volunteers working unpaid to raise awareness of tobacco harm reduction strategies from which many of us have benefitted ourselves.
Indeed, the WHO has often spoken about the need to engage with consumers like us. In its Jakarta Declaration, it spoke of how “participation is essential to sustain efforts. People have to be at the centre of health promotion action and decision-making processes for them to be effective”, so the fact that it now chooses to eradicate consumers from its decision-making is disappointing to say the least.
It is shameful that the WHO has decided to ignore the voice of consumers such as we are, and we will be raising this matter with the public health community in the UK and with legislators who are responsible for approving funding to the WHO. We feel that this is a gross abuse of authority on the part of the WHO and that they should swiftly reconsider.
Our submission is relevant to the subject matter, addresses the areas of concern raised by the WHO and adheres to the criteria that the FCTC declares in its articles of association. There is no valid reason why it should not be considered alongside those submitted by other NGOs and interested stakeholders.
To do otherwise betrays the lofty goals of the WHO and strongly suggests that there is an ideological agenda at play. We believe that this area of policy is far too important to be hijacked by such petty politics, and that smokers should be afforded a plethora of less harmful products should they choose to quit or reduce their consumption of lit tobacco. Accordingly, we are sorely disappointed that an organisation such as the WHO seeks to frustrate those choices for reasons that they will not disclose.
The public for whom the WHO claims to wish to assist deserve better than closed minds on the subject of tobacco harm reduction. The WHO should be looking to expand an embrace of its own article, 1(d) of the Framework Convention on Tobacco Control, and the strategies for health promotion outlined in its own Ottawa Charter, rather than distancing itself from these commitments.