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.
An extract from an article by Neil H, posted on the ecigclick website HERE
The advocacy groups can’t do it all on their own – sure they have access to the politicians and some of those ‘jobsworths’ imposing the silly vape bans up and down the country – but we as vapers are the grass roots – the ones who can change reluctant landlords minds.
And to prove I’m not just talking the talk…I’m actually walking the walk…
Over the last few weeks I’ve been talking all things vape to landlords – managers and bar staff in a few of the pubs in my hometown of Leamington Spa and with I might add some success.
Obviously larger chains such as Wetherspoon can’t lift vape bans at local level – that’s down to the management team – however as vapers we are like it or not – not only pseudo advocates but the ones that can get those bans lifted by setting the right example.
You’ll see what I mean by that in a wee while.
OK let’s just show you what the New Nicotine Alliance campaign of Considerate Vaping Welcome actually means in the real world and how sensible conversations on vaping can and do change pub landlord’s minds.
VISIT THIS PAGE ON ECIGCLICK TO READ THE FULL ARTICLE
Featured image credit: Neil H
The NNA spoke directly to MPs in the Palace of Westminster on Wednesday, an important day for vaping consumers.
At the UKVIA Forum last month, NNA Trustees Sarah Jakes and Gerry Stimson featured on a panel chaired by Norman Lamb, Chair of the governmental Science and Technology Committee which is currently taking evidence on the use of e-cigarettes in the UK. An IBVTA member asked a question to the panel as to why the Committee had not taken evidence from consumers and the independent vaping industry. Sarah and Gerry both commented that this was, indeed, an opportunity missed, and Norman Lamb agreed to think on it. Less than 24 hours later invites were issued to NNA, IBVTA and UKVIA to come to parliament on May 9th to give evidence.
It was because of this that Sarah travelled to Westminster yesterday afternoon to speak directly to the seven cross-party MPs comprising the committee on the day, along with Fraser Cropper of the IBVTA and John Dunne of the UKVIA. The MPs raised questions concerning short fills, pointless TPD regulations, potential excise duties, advertising, e-cigarettes by prescription and vaping bans, to which Sarah expressed the NNA’s positions.
It was a very useful exercise and we were grateful to be able to bring the issues vapers face throughout the UK to the heart of Westminster and present them personally to elected officials. However, Sarah’s opening remarks emphasised that many of those problems are caused by failings in government policy in the past.
After highlighting misjudged parliamentary reactions to tobacco harm reduction – specifically towards snus in the 1980s and 1990s at domestic and EU level and by ministers who were not even aware that e-cigarettes were included in the TPD more recently – Sarah urged the more enlightened politicians of today to show further commitment to encouraging the use of safer nicotine products for those who choose to quit smoking.
With Brexit on the horizon, the NNA feels now is a perfect opportunity to show further leadership, not complacency, towards harm reduction. The government’s Tobacco Control Plan seeks to build on evidence from Public Health England as to the benefit to public health of risk-reduced alternatives and broaden the Royal College of Physicians’ call for vaping to be promoted widely. What better way could there be than to celebrate shackles being lifted once Britain leaves the EU by also unburdening an e-cigarette market bogged down by petty and pointless regulations on tank sizes, nicotine strengths and e-liquid bottle volumes?
We believe that members of the Science and Technology Committee are receptive to our ideas, but the wider Westminster legislative community needs to be convinced too. Yesterday was constructive in putting some forthright opinions across and we maintain that when it comes to repealing unhelpful regulations from Brussels as Brexit unravels, the counterproductive terms of the TPD towards vaping should be discarded and would be a simple, uncomplicated way of ‘taking back control’.
This is your organisation speaking directly to MPs to help influence government policy and we fully intend to continue doing so. You can watch the hour-long committee hearing here, we think you will enjoy it. And if you do, please remember we are volunteers working on a shoestring budget, so if you like what you see, share widely and consider donating – details here - to help us carry on doing what we do.
On Tuesday evening, the New Statesman hosted a panel-based event in a lecture hall adjacent to Parliament Square entitled “When might England become Smokefree?”. The subject matter was a report from Frontier Economics which calculated when the UK would achieve the government’s stated ‘smoke-free’ target of 5% smoking prevalence or less, under various scenarios.
The central thrust of this research - using trusted statistical data from the NHS and the Office for National Statistics as its base – is that if the recent dramatic downward trend in smoking prevalence seen in England since 2012 can be maintained, the 5% threshold could be reached up to 11 years earlier than if government were only to primarily focus on traditional tools like tax rises and increased regulations (see graphic). 2012, of course, is when widescale use of e-cigarettes began to take hold and the number of smokers in England and the UK markedly tumbled after a few years of modest decline.
The report was prepared for Philip Morris International, which was prominently declared, and it is always wise to be wary of future forecasting based on current trends as the Frontier report does. Notwithstanding this, it is still a useful exercise in the art of the possible and prompted an interesting evening of debate
Along with Dr Roger Henderson, columnist for the Sunday Times and Spectator, and Mark Littlewood, Director General of the Institute of Economic Affairs, Sarah Jakes, chair of NNA, was represented on the panel, which followed a short presentation of the report by Nick Fitzpatrick of Frontier Economics.
Sarah expanded on the NNA’s position on alternative products and how they can be beneficial to smokers switching by pointing out that no two smokers are the same. This is a crucial aspect of the debate that legislators and public health advocates always under-estimate. Just because smokers have previously bought into a tobacco market which has been almost totally free of innovation for many decades, it does not mean that safer alternatives will be taken up in great numbers if they are restricted to homogenous products which cannot satisfy a wide range in tastes and nicotine usage patterns.
It is apt that a company called Frontier presented the research for Tuesday’s event, because the use of nicotine in England and elsewhere is indeed at a new frontier between smoking and safer substitutes.
A cigarette is just a cigarette; but a reduced risk product can be a low wattage e-cigarette, a high wattage mod, a heated tobacco device, smokeless such as snus, as well as a plethora of other products such as dissolvables, patches, gum and other innovations which have yet to come to market. Each will play a part in achieving the government’s 5% smoke-free target if just one vital fact can be properly understood. The fact is that nicotine use is never going away.
The government’s tobacco control plan appears to recognise this and its aspiration to “maximise the availability of safer alternatives to smoking” is laudable. However, its insistence on continuing to resist the legalisation of snus in the EU suggests that the government’s words speak louder than its actions.
Repeatedly referring to high levels of smokers who claim they wish to quit - without recognising that it is a preference for many only if it can be done without hardship – merely leads to further ineffective and expensive policies of coercion which have been largely rejected by millions of smokers. Human nature dictates that punishing smokers away from smoking will be far less successful than offering them something more pleasurable to move towards.
The tobacco control plan claims to wish to see more uptake of safer nicotine alternatives, and this is to be welcomed. However, if the government truly wants to see a smoke-free England sooner rather than later, it will happen when smoking tobacco becomes an inferior choice than safer nicotine devices for smokers themselves.
The best way for government to achieve this would then be to remove pointless restrictions and bans on reduced risk products, encourage innovation and stop stigmatising people who choose to continue using nicotine. Embrace the fact that recreational nicotine use is here to stay, and that much-vaunted 5% target will become increasingly more in focus and therefore far easier to hit.
Image credit Paul Barnes
For immediate release
European Court official says ban on smoking substitute snus can be upheld
The European Union’s ban on the smoking substitute snus can be upheld according to the European Court of Justice's advocate general. In his preliminary opinion, ahead of the court's decision this summer, Henrik Saugmandsgaard said that while the evidence for the ban was not clear cut, the European Parliament had the right to impose the ban in 1992. He said that he did not find that the ban was “manifestly inappropriate”. (The opinion was released this morning.)
Reacting to the news the New Nicotine Alliance charity which is an intervening party in the case said that it was a bitter disappointment for EU smokers who could benefit from using snus to give up smoking. However it was pleased that the opinion recognised that there was a substantive case for snus.
“Widespread snus use has been behind the extraordinary collapse in smoking in Sweden where only 5% now smoke. In Norway the effect has been even more dramatic with only 1% of young women now smoking - down from 30% in just 16 years. And that is in a country where selling nicotine e-cigarettes has been illegal,” said NNA trustee, Professor Gerry Stimson.
“Smoking is evaporating where snus is widely used and yet the court now seems set to ignore the overwhelming interests of EU citizens,” said Professor Stimson.
“The European Union still has a big smoking problem with the latest EU figures actually showing smoking going up in France and Italy. The Scandinavian success with snus makes it imperative that this is tried out in the rest of the EU. Banning snus has been a crime against public health,” said Sarah Jakes who chairs the NNA.
There is a considerable underground market in snus across the EU with recent media coverage indicating significant use of it among professional footballers.
Issued on behalf of the New Nicotine Alliance
Trends in smoking
Norway 1% smoking rate: among young women smoking fell from 30% to 1% in sixteen years: Norwegian Smoking Data (select data using tick icons and then download to Excel). https://www.ssb.no/en/statbank/table/05307/?rxid=fba52324-e745-43b1-8740-058b118535f6 and bottom of Mirror article: https://www.mirror.co.uk/news/politics/hospitals-sell-e-cigarettes-sick-11975398
Norway Vaping Ban: Nicotine containing e-cigarettes have been illegal in Norway - although the government has now decided to legalize e-cigarettes. https://www.fhi.no/en/op/hin/risk--protective-factors/royking-og-snusbruk-i-noreg/#ecigarettes
Norway Snus Use: Use among young women in Norway grew from 5% to 14% in six years. For Norwegian snus data select data using tick icons and then download to Excel. https://www.ssb.no/en/statbank/table/07692/?rxid=fba52324-e745-43b1-8740-058b118535f6
Sweden Snus Use: 20% of Swedes are daily users of oral/chewed/nasal tobacco. See footnote on page 73 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146
Sweden Smoking Fall: Daily smoking fell in Sweden from 8% to 5% over the last three years. See page 27 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146
France & Italy Smoking Increase: See page 27 of EU Eurobarometer 2017. http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146
Health impact of snus
Action on Smoking and Health: “the contradictory, illogical law on tobacco… leaves cigarettes legal while snus, which is over 100 times less harmful, is banned.” http://ash.org.uk/media-and-news/press-releases-media-and-news/eu-ruling-on-smokeless-tobacco-shows-need-for-independent-tobacco-regulation/
World Health Organisation: Swedish snus is “considerably less hazardous than cigarettes”. Page 273 http://www.who.int/tobacco/global_interaction/tobreg/publications/9789241209519.pdf
European Union: “It is undeniable that for an individual substitution of tobacco smoking by the use of moist snuff would decrease the incidence of tobacco related diseases.” page 14 http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_013.pdf
US Food and Drug Administration: authorised snus after exhaustive testing. http://www.cspdailynews.com/category-news/tobacco/articles/fda-ruling-win-swedish-match
The Lancet: Global Burden of Disease Study, 2017: No evidence of harm being done by long-term use of snus ”for any health outcome” page1364. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)32366-8.pdf
Oral cancer: for snus “no overall association is seen for oropharyngeal cancer”. See section 3.1 Regulatory Toxicology and Pharmacology: https://www.ncbi.nlm.nih.gov/pubmed/21163315
Epidemiology: Two academic studies have shown that if snus were available in the rest of Europe it could save between 200,000 and 355,000 lives every year. Brad Rodu, 2004 https://www.ncbi.nlm.nih.gov/pubmed/15074568 Snus Commission report, 2017 http://snuskommissionen.se/wp-content/uploads/2017/06/Snuskommissionen_rapport3_eng_PRINT.pdf
Footballers using snus
Last Wednesday, the All Party Parliamentary Group for E-Cigarettes convened in Committee Room 18 at the House of Commons and the NNA was represented.
The subject of discussion was a very promising proposal to change the policy towards risk-reduced products on the parliamentary estate. Namely, that parliament – in keeping with the goal to “maximise the availability of safer alternatives to smoking” in the government’s latest Tobacco Control Plan – should be setting an example to businesses up and down the country.
The proposals – hopefully to be inserted into the parliamentary handbook for all members and staff – were to permit vaping in all outside locations and all bars and cafeterias, as well as single use offices and other offices, dependent on the agreement of colleagues. It was emphasised in the supporting documents that vapers should be expected to be considerate and mindful of the concerns of others. A common-sense approach, and one that the NNA can heartily endorse.
The NNA was invited to give testimony and our representative for the day – one of four from different stakeholders - was Jessica Harding. Industry was represented by Dan Marchant of Vape Club and the British Beer and Pub Association (BBPA) also provided a spokesman to explain the current position in pubs up and down the country. The last of the panel was a union official who spoke with a UNISON hat on as well as commenting on behalf of the Trades Union Congress (TUC).
Jessica acquitted herself very well, being the NNA’s expert on workplace policies in her role developing the Challenging Prohibition campaign. The representative from the BBPA also contributed with some useful insights into how the UK’s hospitality industry estates view vaping and the varying rules that licensees apply.
Jessica emphasised to the BBPA that their insistence on licensees being responsible for their own policies on their properties is one on which we can readily agree. As our position statement makes clear on vaping bans, “we do not support the statutory prohibition of e-cigarette use in public spaces, enclosed or outdoors”, but that is not to say we do not agree that property owners should be entitled to set their own policy as they see fit. The proviso to that is that property owners should be informed enough to assess what their policies should look like based on objective evidence rather than scare stories. We highlighted that large chains could be better informed on the subject rather than pronouncing from board level when local knowledge of clientele might be better for both the business and consumers alike, and we were pleased that our suggestions were received with an open mind.
Sadly, this was not the case with the UNISON/TUC representative. Faced with a panel of MPs who had a good working knowledge of the vaping debate, all referrals to health authorities who are supportive of e-cigarette use in workplaces was met with a stock response of “The TUC disagrees”. Quite why the TUC is qualified to disagree with, for example, the Royal College of Physicians wasn’t explained.
In his defence, the representative may well – as he stated at the start of proceedings – not have the power to change TUC policy, but it seemed clear that he attended with a refusal to open his mind to the potential positives of permitting vaping in workplaces and feed it back to his unions.
Worse still, to back up his argument, he responded to every citation of reasoned research into vaping with much-debunked misinformation that could only have been gleaned from the pages of newspapers which revel in creating scare stories. Almost without exception, all were mentioned in support of the TUC’s policy that vaping should be treated exactly the same as smoking. Nicotine is a carcinogen; we don’t know what is in the vapour; it is a gateway to smoking for children; if you’ve seen an article fostering doubt, it was referenced.
We found this to be very disappointing, especially since most of the concerns that were mentioned would have been published on media with which TUC supporters might be expected to roundly disagree with, and even openly despise. Therefore, for an organisation which is set up to defend workers’ rights to exhibit a perpetually closed mind in front of MPs - who are attempting to facilitate an open and evidential discussion - with the only outcome being that vaping union members will be denied access to harm reduction by their employers on the basis of myths and ignorance, was unfortunate.
We can only hope that some of the wise interventions from MPs at the session were conveyed back to TUC headquarters. We would also hope that current poor TUC guidance – expressed in this blog which is high on the list of Google results when searching for workplace vaping policies – might be amended now that the stance of the British Medical Association, a doctors’ union, has recently changed for the better.
If we are to see positive changes in public health surrounding nicotine use, it is important that all parties are amenable to open discussions, and that this will also involve organisations availing themselves of information with an open mind. Burying heads in the sand might make for an easy life, but it doesn’t facilitate progress.
The start of 2018 has seen a flurry of activity in the tobacco harm reduction sphere, with many potentially significant events taking place in relation to several different products. In light of this, it is worth revisiting the NNA’s stated aims to reinforce why we are central to this debate and supportive of Tobacco Harm Reduction in all its forms.
As our About Us page states, the NNA seeks to encourage “a mature public and organisational understanding of the potential of safer nicotine products for reducing cigarette smoking, including their safety and efficacy”. This is as true for tobacco-based solutions as it is for vapour-based ones and extends to other novel harm reduction innovations currently in existence or yet to come to market.
It is important to highlight this because there have been some who have been puzzled, for example, as to why the NNA were instrumental in a case challenging the EU’s ban on snus. The NNA is not, and has never been, solely devoted to promoting e-cigarettes and vaping even though many of our most prominent advocates have been drawn from that avenue out of smoking.
We have provided many updates to the snus challenge and are still optimistic that – with the snus case being merely one part of our work - we may be part of a sea change in attitudes towards harm reduction, a concept which is not new or confined to nicotine and tobacco, but instead has a long history of saving lives in HIV prevention, safer drug delivery and road fatalities amongst other areas.
Harm reduction relies on rejecting binary thinking and argues that often the best solutions are those which – although perhaps counter-intuitive – will deliver optimal results without heed to ideology or blind groupthink.
Our support for snus – undeniably a tobacco product – is based on the fact that it has been proven in jurisdictions where sale is permitted to provide a safer alternative to smoking and therefore to save lives. To reduce harm, in other words.
By the same token, heated tobacco has also been in the spotlight recently and the NNA also supports this increased activity to assess its efficacy. Early research suggests that it offers another promising alternative for those who have chosen to reduce their exposure to the risks of smoking but may not take to NRT or vaping.
In January, an application by PMI’s iQos for making a reduced risk claim was rejected by an FDA committee but it is expected that the right to market the product in the US will be approved. Market analysts are confident that claims of ‘heat not burn’ tobacco to be markedly less harmful than smoking will follow once the science has been evaluated, perhaps as soon as the end of this year.
Likewise, in keeping with the UK government’s commitment in its Tobacco Control Plan to assess evidence on novel nicotine delivery systems, the UK Committee on Toxicity reported at the turn of the year that heated tobacco is likely to be less risky than lit tobacco and exposes consumers to between 50-90% fewer harmful compounds. This is the essence of harm reduction which is why the NNA is supportive of further research to examine the potential in these products. Indeed, just last week the government’s Science and Technology Committee took evidence at Portcullis House about reduced risk products and included heated tobacco in its remit.
On the horizon are more opportunities for tobacco harm reduction, with novel products such as tobacco-free snus being available in some countries and rumours that these may be rolled out in the UK too. Other options such as dissolvables and nicotine films/strips may all contribute in the future to a diverse range of nicotine products which can deliver reduced harm while also satisfying what is a vast market for nicotine which is never going to go away.
The NNA exists to promote tobacco harm reduction - a term understood by governments, NGOs and even the WHO to describe ways of reducing harm from cigarette smoking without necessarily giving up the use of nicotine – and we will never shy away from that.
Anything from smoking fewer cigarettes through to total abstinence are harm reduction of varying degrees. There are no downsides if harm and risk are being reduced. To borrow a rhetorical turn of phrase from the Prime Minister, tobacco harm reduction means tobacco harm reduction, and the NNA is happy to add its support to anything which delivers that goal.
On 28th January, I was delighted to welcome friends up to Scotland to attend the Glasgow School of Vape in my home city. It was a lively event which attracted many keen vapers along with fellow NNA trustees, associates and supporters, plus a delegation from Cancer Research UK recruiting e-cigarette users for a study. However, the weekend was soured on hearing from those who flew in that Glasgow Airport has installed poor and misleading signage outside the arrivals terminal.
This is a ghastly message to send to new arrivals to my country and in direct contravention of guidance offered by Public Health England which states “it is never acceptable to require vapers to share the same outdoor space with smokers”. It is also, according to my guests, rigorously enforced by staff outside the terminal.
The signage at the airport is new so I asked to be contacted by the airport to talk to them about it. They called me, and I patiently listened while the representative explained their policy. I cannot be sure if he was having to defend it as part of his role or he was responsible for formulating it, but he insisted that he had read all the literature. I doubted that, so emphasised Public Health England’s guidance in case he was unaware of it. I could not understand why the airport authority believed it was proportionate to ban vaping in the open air and herd vapers into smoking sheds in the middle of a central reservation where the exhausts of diesel-powered buses were by far a more prevalent threat to health.
The airport’s representative assured me that vaping was permitted in some areas, such as the car parks and in the central reservation outside of the smoking shelter - which is still unreasonably precautionary - but their signage fails to communicate this. I asked if their signs could be altered to that effect or new signs be put up to make it clear, but they said this was “not practical”.
I found it baffling how the airport could spend a significant amount of money on signs which are misleading and could lead to adverse health outcomes but are unwilling to consider a small outlay to properly convey what they claim is true to their policy.
Lastly, I asked when their policy would be reviewed and if the NNA could be involved in giving advice. The response was that a review is slated for 18 months’ time but that consulting with us would be “a non-starter”.
This kind of blinkered and, sadly, ignorant policy-making is increasingly common which is why the NNA has recently committed to a campaign entitled “Challenging Prohibition”. Policies such as the one at Glasgow Airport are inadvertently sending a message that vaping is as harmful as smoking which has led to confusion and, subsequently, an increase in the mistaken perception that vaping should be avoided. Glasgow Airport may believe that they are doing the right thing, but they are unwittingly contributing to flawed understanding of risk reduced products which is arguably harming the public’s health.
It is true that Public Health England’s guidance is not necessarily transferable to Scotland, but NHS Scotland and ASH Scotland are both sympathetic to harm reduction policies and I’m sure would agree that Glasgow Airport’s policy is overly restrictive and not conducive to health, especially considering that Scottish hospitals are increasingly being more receptive to vaping by repealing blanket outdoor bans in their grounds.
It is also disappointing that the airport authority is not willing to revisit this flawed policy until a year and a half’s time. As tobacco control activists always tell us in relation to other measures, every day of delay before a control measure is adopted by government will result in hundreds or thousands of more young people taking up lit tobacco and more smokers continuing to smoke. The airport’s policy is irresponsible and should be reviewed as soon as possible, not in summer 2019.
The very last thing Glasgow Airport should be doing is forcing vapers into a smoking shelter, because they will be more likely to light up a cigarette. Yet that is exactly what their signage demands, and they appear stubbornly unwilling to correct it.
You can view our materials on Challenging Prohibition here, and we encourage NNA supporters to put these resources to good use by politely writing to establishments which have counterproductive policies such as that at Glasgow Airport.