2016 has been a lively year for tobacco harm reduction and, as you’d expect, the NNA has been extremely busy. This post can’t detail all that we’ve been involved with but we hope here to give you a flavour of our year. There is still much work to do going into 2017 and we are very grateful to all of you who have helped us to get this far: whether by signing up as a supporter, by sharing our posts, giving us advice, donating money or a stand at an expo. We simply cannot do what we do without your help. Thank you. No matter what skill set you have you can be an asset to the NNA, so please drop us a line if you can help.
Last minute victory in Wales
The Public Health (Wales) bill sought to ban the use of e-cigarettes in public spaces so we were delighted when the bill was defeated in March. The NNA, along with other groups and many scientists, had opposed the measure since it was first proposed two years previously. The sinking of the bill was a victory for NNA trustee Simon Thurlow and colleagues’ hard work - and a victory for common sense.
NNA Scotland is, quite possibly, too busy. Fortunately NNA trustee Andy Morrison’s load should be a lot lighter in 2017 because he’s now been joined by new associates Jamie Hollywood, Lorna Strachan and Robert Innes.
Andy was involved in organising the very successful Glasgow School of Vape 3. The day built on the previous Glasgow School of Vape events, bringing smokers,vapers and vendors together so that they could learn from one another. Other invitees this time included people from public health and stop smoking services and researchers from Glasgow and Stirling universities.
The Roy Castle Lung Cancer Foundation study: a study designed to identify the role that e-cigarettes can play in helping people who continue to smoke after a lung cancer diagnosis. Andy and a small group of e-cigarette users are assisting the researchers with home visits to see patients and offer ongoing support through the study. Andy is now assisting with a cardiovascular study too, organised along much the same lines as the Roy Castle one.
Scottish Parliament Event at Holyrood. A discussion about e-cigarettes and individual and public health. This was organised by the NNA and chaired by trustee Gerry Stimson. The panel featured Sheila Duffy (ASH Scotland), Dr Christopher Russell (Centre for Drug Misuse Research, Glasgow), Professor Linda Bauld (Stirling University),NNA patron Steve Christie, Mike MacKenzie (MSP), NNA trustee Paddy Costall and an audience of public health, vapers and vendors. The event was very lively and informative.
Ensuring that vapers have a voice in the ongoing debate: Andy is in regular communication with Sheila Duffy (ASH Scotland) and NHS Glasgow and Clyde and has a positive ongoing dialogue with MSPs and other representatives too. Andy also assists university students and academics on various projects enhancing their understanding of e-cigs and the politics surrounding their use.
A Billion Lives: Andy organised and presented at the UK premier of A Billion Lives in Glasgow, in October. This was well attended by press, public health and vapers.
The Department of Health and the MHRA
NNA trustees have attended various meetings with the Department of Health and the MHRA this year. Meetings centred on the Tobacco and Related Products Regulations and the WHO FCTC COP7. We followed up the Department of Health round table meeting in March with a written submission on the unintended consequences of vaping regulation, written by NNA associate Clive Bates (Counterfactual Consulting). NNA trustees have also been very engaged with local stop smoking services, in various parts of the country.
Consultations and briefings
January saw the publication of the excellent NCSCT briefing on electronic cigarettes for stop smoking services, which had been reviewed by NNA trustees Sarah Jakes and Lorien Jollye. The NCSCT has also asked the NNA to advise on and help disseminate some short videos on vaping, produced by the NCSCT for Public Health England. The first video is due to be released in January 2017 so please look out for it.
March: Sarah Jakes was appointed member of the NICE committee on guidance to stop smoking services.
September: The NNA responded to New Zealand's Ministry of Health on policy options for the regulation of e-cigarettes.
NNA trustees are advising on various studies, topics include: health professionals and their attitudes to e-cigs and NRT with cancer sufferers, the real world experiences of using e-cigs to avoid going back to smoking, the effects of e-cigs on people with stage 4 lung cancer and those suffering from COPD, effects of e-cigarettes on cardiovascular patients and a dentistry study.
All-Party Parliamentary group for E-Cigarettes
The NNA continued to be involved with the APPG this year.
Gerry Stimson and Lorien Jollye both spoke at the January meeting. Lorien focussed on the TRPR’s impact on smokers and new vapers and called for public health bodies to work together to mitigate the effects. In his presentation Gerry emphatically stated that all intervention, the TRPR included, should be judged against its contribution towards stopping smoking. Another of Gerry's key points was that “vapers and vape shops are the new front line in smoking cessation”.
The E-Cigarette Summit, November Andy Morrison and Sarah Jakes attended. Sarah was on the panel which discussed Communicating Research & Evidence.
The NNA was very fortunate to have been represented at the major events this year. It was really good to meet so many of our friends and supporters at them. The Vape Jam UK organisers gave the NNA and Vapers in Power a stand and also very kindly donated the proceeds of their raffle to us. NNA trustee Dave Dorn gave a rousing presentation, you can watch it here
Andy and Jamie attended Vape Collective,. They were delighted to get so many supporter sign ups and enjoyed sharing the marquee with ViP.
Vapefest: Andy and Jamie represented the NNA, sharing a tent with ViP again, and had a good time meeting up with old faces - and lots of new ones too.
The Vaper Expo organisers gave us a very generous donation too, money which we will put to very good use.
Thanks to a friend and supporter of NNA, Chinese e-cigarette manufacturer Innokin heard about the NNA’s work with stop smoking services and wanted to help. We do not take donations from anyone in the nicotine industries, so the best way for Innokin to help would be to help stop smoking services help smokers to stop smoking. This though is not as simple as it should be, because currently there are no medicinally licensed ecigs on the market which stop smoking services could prescribe, and it's likely that any that do gain medicinal authority will be bland cousins compared to those on the consumer market.
We were sorry that Alan Beard felt it was time to step down as Trustee. We were very grateful for the help he had provided to NNA.
We are delighted that Dr Heather Morgan has joined us as our newest trustee and also very pleased to announce that Andrew RT Davies, the leader of the Welsh Conservatives, will be joining the NNA as patron.
We’ve recently appointed a part time administrator, to take the pressure off our overworked trustees. This should lead us into an even busier year in 2017.
It’s wonderful that our list of supporters has doubled this year - but we always need more. It costs nothing to sign up as a NNA supporter and the more supporters we have the more influential we can be. You can sign up here and please consider asking your family and friends to sign up too.
A further shift will unlock greater potential On Tuesday during questions to the Under-Secretary of State for Health in Westminster, Nicola Blackwood replied to a query from Conservative MP Adam Afriyie about the use of e-cigarettes and, specifically, the negative outcomes that will undoubtedly arise from implementation of the EU TPD. The Government are very clear that vaping is significantly less harmful than continuing to smoke. Under the current regulatory regime, huge numbers of smokers are successfully using these innovative products as an effective quitting tool. We have already committed to reviewing the TPD and we will fully explore the opportunities that Brexit may provide, but until exit negotiations are concluded we remain a full member of the EU. We note and very much welcome Ms Blackwood confirming that there will be a review of the terms of the TPD. They were hastily-drafted and implemented largely from a position of ignorance by MEPs and their advisers in 2014, and we still maintain that many of the requirements are not only unnecessary but also harmful. In the intervening period since the TPD was formulated there has been a shift in perception – backed by a solid evidence base - of the benefits of vaping and tobacco harm reduction in general, so it is of great interest that a government minister is considering the TPD’s efficacy and legitimacy in a post-Brexit United Kingdom. However, there is another small but significant shift in policy required if the full public health potential of tobacco harm reduction methods is to be realised, and it is only the UK government which can affect the change required to facilitate this. It is still officially the government position that e-cigarettes, particularly, should only be used as a smoking cessation aid and not as a recreational product. Indeed, the Department of Health’s representative in the House of Lords, Lord Prior of Brampton, responded on Tuesday to his shadow Lord Hunt of Kings Heath’s support of e-cigarettes by saying that “better than vaping is not to vape or smoke cigarettes or anything else at all”. This is to fundamentally misunderstand the positive public health role that harm reduction can play. Lord Hunt – on the other hand – understands the debate very well in his position as President of the Royal Society of Public Health, one of many UK health organisations to enthusiastically embrace vaping. The Royal College of Physicians has argued that e-cigarettes should be “promoted as widely as possible”, while the government’s pre-eminent public health advisers Public Health England recognise the advantages of vaping and have consulted with consumer groups such as the NNA on the matter. Guidance from the National Centre for Smoking Cessation and Training has also rightly warned against being alarmed about recreational vaping, stating that “we are not a ‘stop nicotine service’ and if we think getting people off their e-cigarette is a good use of our time, we are ignoring a far more important opportunity to help people quit and to stay off cigarettes.”. With all this wise counsel from respected advisers moving in the same direction of travel, it is arguably time for the government to revisit and re-consider its stubborn policy towards recreational use of nicotine. As the NNA has consistently advocated, a vast number of people derive great pleasure from nicotine just as millions enjoy coffee containing caffeine – both judged to be on the same toxicity level by experts – yet we do not hear of government campaigns to wean the public, or even MPs themselves, off coffee. Smokers are not ill and do not require a medical intervention; in fact, for many the very idea is anathema and would deter them from switching to a less harmful alternative. The huge and swift success of vaping in the UK has occurred not because it is viewed exclusively as a smoking cessation device – quite the opposite – instead the success is attributable to vaping being an enjoyable, healthier pastime free from the pressure of real or imagined state coercion. If full nicotine cessation then ensues then so be it, however that should not be the sole consideration. Nicola Blackwood and Lord Prior have been presented with a largely cost-neutral free market solution to their goal of reducing smoker prevalence, they should seize it by embracing recreational vaping, like many of their most respected public health advisers have. In doing so, and eschewing the siren voices of those who value moral judgements over concrete health benefits by calling for regulations, restrictions and bans, they can unlock the full advantageous potential of e-cigarettes and tobacco harm reduction.
The report from the US Surgeon General on e-cigarette use among youth and young adults is just one more example (as if any more were needed) of the lengths to which the prohibitionist faction of tobacco control will go in order to promote its evidence-free ideological agenda. The report cherry picks 'scientific' claims of risk to young people, mainly from studies or analysis which have long since been debunked by experts in the field, and almost completely ignores the large body of science which details the benefits of e-cigarettes to smokers of all ages as either a cessation or harm reduction strategy. The fact that smoking prevalence among young people has declined dramatically concurrent with increased availability of e-cigarettes also seems to have escaped the Surgeon General's attention completely. This report and the policy recommendations contained within leave us in no doubt that regulators in the US care nothing for the lives of current smokers, or of those who will take up the habit in the future. It compounds the misperception that vaping is as dangerous as smoking and it will serve as protection for the incumbent nicotine delivery method, tobacco cigarettes. Well done America. For more detailed analysis of the report please read Clive Bates post here: Bad science, poor insights and likely to do harm - rapid reaction to the Surgeon General's terrible e-cigarette report
Yesterday I spoke at the first meeting of the All Party Parliamentary Group on E-Cigarettes that has been held since trade body UKVIA took over the secretariat. The meeting was in two parts, the first part being an overview of the public health challenges and the second being "industry views" - I found myself rather incongruously in the second part.
Professor Kevin Fenton led off the first part by detailing the work undertaken to date by Public Health England in this area and outlining the challenges we still face. These included public perception of relative risk and the appalling manner in which the media approaches the subject. Professor Peter Hajek then explained the role that researchers have played in this, and detailed some of the methods employed in order to portray what are often trivial or irrelevant risks as important indicators of harm. After a brief foray into the role of UKVIA and how their involvement with the APPG may relate to article 5.3 of the FCTC, George Butterworth then described Cancer Research UK's involvement in research, and in particular their role in analysing and, if appropriate, debunking poor, or poorly reported studies.
After a couple of questions the second part began with Charlie Hamshaw Thomas (UKVIA and Nicopure) praising the UK stance on tobacco harm reduction and also how far industry had come in delivering new and ever better products. Ian Green (IBVTA) then spoke about the challenges which 'Italian style' enforcement would pose to an industry which had spent considerable sums on compliance. A representative from Trading Standards in the audience was asked how they intend to approach the issue, and he replied by saying that their response would be proportionate given the other issues which they are expected to deal with, and would likely be complaint-led in practice.
My turn came to offer the consumer view and I presented the challenges which consumers face under the new regulations and also due to the very poor public perception of vaping. Points raised included nicotine concentration limits, advertising restrictions, usage bans, and the activities of prohibitionist groups such as the BMA and the WHO.
Finally, Andrew Allison of The Freedom Association was invited to speak briefly about the report they compiled which revealed the atrocious state of local authority vaping policies. Kevin Fenton responded by explaining that PHE are working with some authorities on changing this, and will continue to try to improve the situation.
I'm told that 9 parliamentarians attended the meeting, either in person or via their researchers. Some interesting and pertinent questions were asked although time was very limited as we only had an hour. Hopefully future meetings can focus in on the individual challenges identified so that they can be discussed in more detail.
Transparency was on the agenda at COP7, apparently there were concerns after COP6, but (almost) unbelievably, what they achieved was to make it less transparent than ever before.
Prior to COP7 I asked the UK department of health what the problem was with allowing the media and the public, including the tobacco companies, to observe (not participate) and report on the negotiations that go on there. The answer was that the tobacco companies would target and intimidate those delegations with whom they disagree, and go on to interfere in tobacco control policy in those countries. The public and media had to be similarly excluded because the tobacco companies would infiltrate them, or go disguised as them. Paranoid stuff.
I don't think it's a secret that the tobacco industry had numerous representatives in Delhi, as did other independent interested parties such as Asian vaper groups, and even experts on tobacco harm reduction who were there to try to correct the appalling claims made in the WHO report on e-cigarettes. On the first day of COP all of these people were excluded, together with the scant media representation.
The result of this decision was that all independent reporting of the machinations of COP was blocked, but more importantly, so was scrutiny of the actions of the delegates involved. This gave them free rein to attempt to bring in draconian restrictions on harm reduced products with no fear of being challenged by anyone outside of the hallowed halls of WHO.
Well it would have, if it weren't for the numerous leaks that emanated from the process and filtered through to the excluded groups milling around outside.
FCTC is a treaty which the signatories agree to pass into national law. Those present at COP meetings are deciding law in 180 countries. They are deciding the fate of millions of people like me, who smoke or vape and they're doing it on our taxes. And yet the only route of communication we have with the process is via a confusing myriad of snippets occasionally leaked. The idea that the policy positions of the numerous party delegations should be kept secret for fear of intimidation is absurd and undemocratic. These are national government positions for heavens sake. As I write this I still don't know what the official decision on vaping actually is, although rumour has it that the UK position of blocking any new lunacy has prevailed. Who knows. The situation is beyond disgusting and cannot be allowed to carry on.
COP8 will be held in Geneva in 2018, which is a comparatively short journey for the millions of vapers in Europe. I hope to see a large number of them there. If they will not open the doors to us voluntarily we will just have to do whatever we can to force them. Bring it on.
Along with Adjunct Professor of Law at the University of Ottawa, David Sweanor, NNA associate Clive Bates recently submitted a response to the New Zealand Ministry of Health review into legalising e-cigarettes.
As is customary, Clive and David’s work is exemplary and has been featured online at New Zealand news source Stuff in an article entitled “International anti-smoking campaigners' ten messages on e-cigarettes”. It is a concise guide to the many harm reduction benefits of e-cigarette use - and conversely the dangers of over-regulation - which we can highly recommend all interested parties read.
However, one of their observations is particularly well-drawn and will resonate with many vaping consumers. On the subject of bans on e-cigarette use, Clive and David had this to say:
"It is quite possible that banning vaping in public places or severely restricting it would have adverse effects on health."
Today the Chartered Institute of Environmental Health has called for a voluntary ban on smoking everywhere and anywhere that children play or learn. On the face of it that would seem like sensible advice - except it wouldn't be advice, it would be a command, albeit not one that is currently enforceable.
The Framework Convention on Tobacco Control is the World Health Organisation’s masterplan to eliminate tobacco use. Its main activity is the two-yearly Conference of Parties, and the next one – COP 7 – will be taking place in India this November. Preparation for the conference is now in full swing, and various documents have now been released. This includes the WHO’s latest report on vaping.
Yesterday, NNA trustee Lorien Jollye took part in a half day panel debate at the Royal Society of Medicine entitled “Regulation of Pleasure”.
It was an eclectic event which encompassed topics as diverse as illicit drug use and consumption of online pornography, and was attended by around 40 interested medical practitioners and students. Lorien’s contribution was to recount “My relationship with nicotine” and she received much interest from the attendees during the question and answer sessions.
Make no mistake about it, Action on Smoking and Health (ASH) are lobbying very hard to rally opposition against Lord Callanan's fatal motion, which, if it were passed, would kill the Statutory Instrument (SI) which transposes the TPD into UK law.
In the now (almost) immortal words of Professor Gerry Stimson, 'vapers and vape shops are the new front line in smoking cessation services'. Typically this is an informal process with vape shops doing their best to help their customers to understand the products and how to use them, and vapers talking to their smoking relatives, friends and colleagues about their transition from smoking to vaping. Any vaper will tell you that there is a lot of interest among smokers about the devices and techniques involved, but also simply in 'how you managed to do it' and 'what it was like'.
In his recent paper published in the journal 'Addiction' Robert West and colleagues tried to count the number of additional people who successfully quit smoking in 2014 and would not have done so if ecigs didn't exist.You can read the paper here. The conclusions drawn in this analysis have prompted a great deal of debate.
In a report covered by PGVG magazine it was revealed that in Belgium a drug administered to patients with pulmonary fibrosis in order to stabilise the condition will no longer be reimbursed* by INAMI (the Belgian statutory national medical insurance association) to those who have smoked in the last 6 months.
Recently Dr Chris Russell, Senior Research Fellow for the Centre for Drug Misuse Research, requested assistance from vapers in completing a survey on perceptions and experiences of using electronic cigarettes. The survey produced a somewhat mixed response! Sarah Jakes spoke to Chris last week to learn more.
It's been a busy year for NNA already - in addition to finally receiving charitable status after a year of trying we have been quite literally all over the place trying to spread the message about tobacco harm reduction and in particular vaping as a harm reduction strategy. Here is a brief round up of the year so far, and what we have coming up:
Here at NNA we we are very lucky to have an incredible group of associates who never cease to amaze us with the things they do in their own spheres to reduce the harms of smoking. This week a major talking point both here and in social media were the guidelines brought out last year by the National Centre for Smoking Cessation and Training (NCSCT) and recently promoted, which in short, has recommended that smoking cessation services offer the following advice to people keen to try e-cigarettes, and also those who have tried other methods and failed:
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