UK health body: Don’t treat vaping like smoking

Public Health England has recommended a lighter approach to e-cigarette rules and regulations in order to support vaping as a means of quitting regular cancer sticks. The body has published its new Tobacco Control Plan, which sets out the various ways it will help people kick the habit, with one of the primary goals to reduce the number of adults in England who smoke from 15.5 percent to 12 percent or less by 2022. Data would suggest e-cigarettes are significantly less harmful than normal smokes in the long-term, leading Public Health England to recommend we don’t create barriers that stop people making the switch.

New regulations related to the sale of vaping products came into force in the UK this May, many of which are good for the consumer. All e-cigarettes and e-liquid refills need to include safety warnings, for example, and be tamperproof. But the laws also take into account the addictive nature of nicotine, and thus impose strict restrictions on the volume of e-liquid refills and maximum nicotine concentration, among other things. Depending on what happens with Brexit, though, one day we might not be beholden to the EU’s Tobacco Products Directive. Public Health England believes this hypothetical scenario could present an opportunity to draft rules that acknowledge vaping, to some extent, as a healthier alternative to smoke.

The body also recommends that companies should not “routinely” include e-cigarettes as part of their no smoking policies. In other words, they should decide whether spaces actually need to be vape-free zones as well as smoke-free zones, rather than counting all methods of nicotine delivery as equal. As part of the Tobacco Control Plan, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) will also make sure its review process “is fit for purpose” so that more e-cigarettes might be approved and made available through the NHS as smoking cessation aids.


Blowing smoke? E-cigarettes might help smokers quit

People who used e-cigarettes were more likely to kick the habit than those who didn’t, a new study found.

Nicotine patches, gums and medications are known to aid smoking cessation, but there’s no consensus on whether vaping devices can help anti-smoking efforts. The U.S. research is the largest look yet at electronic cigarette users and it found e-cigarettes played a role in helping people quit.

“It’s absolutely clear that e-cigarettes help smokers replace cigarettes,” said Peter Hajek, director of the health and lifestyle research unit at Queen Mary University in London, who wasn’t part of the study.

Smoking rates have been generally declining for decades. Health experts have credited taxes on tobacco products and anti-smoking ads for the drop.

E-cigarettes have been sold in the U.S. since 2007. Most devices heat a liquid nicotine solution into vapor and were promoted to smokers as a less dangerous alternative since they don’t contain all the chemicals, tar or odor of regular cigarettes.

Researchers analyzed and compared data collected by the U.S. Census from 2001 to 2015, including the number of adult e-cigarette users from the most recent survey.

About two-thirds of e-cigarette users tried to quit smoking compared to 40 percent of non-users, the study found. E-cigarette users were more likely to succeed in quitting for at least three months than non-users — 8 percent versus 5 percent.

The research was published online Wednesday in the journal, BMJ. It was funded by the National Institutes of Health.

The rate of people quitting smoking in the U.S. has remained steady at about 4.5 percent for years. It jumped to 5.6 percent in 2014-2015, representing about 350,000 fewer smokers. It was the first recorded rise in the smoking cessation rate in 15 years.

While national anti-smoking campaigns likely helped, the results show e-cigarette use also played an important role, said lead author Shu-Hong Zhu of the University of California, San Diego.

Hajek, who wasn’t part of the research, said vaping devices shouldn’t be strictly regulated, but instead be allowed to compete directly with cigarettes. “That way, smokers can get what they want without killing themselves,” he said.

Earlier this month, a House panel renewed its efforts to prevent the Food and Drug Administration from requiring retroactive safety reviews of e-cigarettes already on the market.

Others warned that the long-term side effects of e-cigarettes are unknown.

“We just don’t know if moving to e-cigarettes is good enough to reduce the harm,” said Aruni Bhatnagar, director of the American Heart Association’s Tobacco Research and Addiction Center.

Chris Bullen, who authored an accompanying editorial , said although the long-term safety of e-cigarettes is unclear, any ill effects are “likely to be rare compared with the harms of continuing to smoke.”

The latest results strongly suggest that more lenient control of e-cigarettes could improve population health, said Bullen, a professor of public health at the University of Auckland.

“If every smoker was to change over to e-cigarettes completely, there would be a dramatic and almost immediate public health benefit,” he said in an email.

Doctors plead for e-cigarette reforms

Australia must make it as easy as possible for smokers to get their hands on e-cigarettes, doctors and a giant tobacco company have told federal parliamentarians.

Doctors who’ve become advocates for drug law reform say Australia must not “sacrifice” smokers who can’t quit by denying them a safer alternative.

They say Australia must follow the US and the UK and give smokers easy access to vastly less harmful e-cigarettes – or nicotine vaping products – so they can get their hit without the toxic smoke that does so much harm to the human body.

E-cigarette devices are legal in Australia but the sale and possession of the nicotine used in them is illegal.

Retired doctor Dr Alex Wodak, who now heads the Australian Drug Law Reform Foundation, has told a federal parliamentary committee that must change.

He cited a major study by a public health agency in England that found found e-cigarettes were about 95 per cent safer than combustible cigarettes.

Australia should facilitate easy access to a diverse range of products, such as flavoured nicotine liquids, that would appeal to smokers who want to quit, he said.

“It’s very important, in harm reduction and public health generally, to have your intervention (be) attractive to the people most at risk,” Dr Wodak said.

“I think having a vibrant vaping community network, through the distribution of vaping shops, is very important from a public health perspective.”

Colin Mendelsohn is an Associate Professor in the School of Public Health and Community Medicine at the University of NSW. He’s also a GP and tobacco treatment specialist who helps smokers quit.

He says Australia’s policy focus on abstinence when it comes to smoking is naive in the face of another option: harm minimisation.

“The reality is that many smokers are unable or unwilling to quit. We can’t just sacrifice them,” Dr Mendelsohn told the committee.

The committing is hearing from experts about how the health risks of e-cigarettes and combustible products compare, and how such products should be regulated.

On Wednesday, it heard smoking rates had fallen in the e-cigarette-friendly UK and US, with one 2014 EU study finding that more than 6 million Europeans had quit tobacco with e-cigarettes.

It also heard that almost all e-cigarette users, or vapers, were former smokers, and there was no evidence that young people who’d not formerly smoked were suddenly turning to vaping.

In 2015, the first large-scale Australian study found two thirds of smoking Aussies would die from smoking-related diseases.

In February, Australia’s medicines regulator, the Therapeutic Goods Administration, decided to maintain a ban on nicotine e-cigarettes, arguing they could have a negative impact on tobacco control and may “re-normalise” smoking.

But for traditional tobacco giant British American Tobacco – which is now making “smokeless” products – it’s about building a new market which also happens to be safer.

“My company aims to become a leader in the market globally,” the tobacco company’s principal toxicologist for vaping products, Dr Sandra Costigan, told committee members.

She said the tobacco giant wasn’t “keeping all our eggs in one basket … the smoking basket”.


British “light touch” TPD starts to evaporate despite MPs’ support for vaping

Across the Atlantic, US town councils continue to crack down on vapers under the guise of anti-smoking regulation. At least two more bans were introduced this week, one restricting vape purchases to over-21s and the other making it illegal to use e-cigarettes in an Arkansas city’s public parks.

MHRA launches TPD crackdown

The European Union’s assault on e-cigarettes, enacted by Article 20 of the Tobacco Products Directive, has been widely slammed as an unscientific and potentially dangerous law. However, vapers in the UK have been reassured by the fact that the government has taken a fairly lax approach to enforcement. That may be about to chance, as the Medicines and Healthcare Regulatory Agency – which is responsible for “interpreting” the TPD standards – announced a tightening of the rules on Wednesday.

It seems that the MHRA is not amused at some of the loopholes which have emerged since the TPD came into law. One example is tanks that come with a TPD-compliant 2ml glass fitted, but a larger one included in the kit. Another is a well-known tank which has a 2ml capacity when fitted with a special “fat” coil, but becomes 4ml with a standard coil installed. From now on any component that changes the liquid capacitywill need to be separately notified – and it goes without saying that it’s going to be instantly rejected.

There are also rumours that the MHRA are unhappy with zero-nic flavoured liquid being sold together with a nicotine shot.

British vapers have been reassured by regulators and public health that a “light touch” approach would be taken to the regulations, so advocates are now disturbed that MHRA are tightening the screw so soon.

BAT Vype ad withdrawn after pharma complaint

British American Tobacco have been forced to withdraw an advert from their UK website following a complaint from Nicorette manufacturer Johnson & Johnson. The advert was for their new Vype Pebble product, a compact e-cigarette using proprietary liquid cartridges. J&J made four specific complaints; the Advertising Standards Agency upheld three of them fully and one partly.

The partly-upheld complaint was that BAT described the Pebble as “small and mighty”. The ASA accepted that “small” is a reasonable and factual description – it’s only three inches long with a cartridge fitted – but weren’t convinced by “mighty”.

J&J’s other three complaints related to the style of the video and the wording of a special offer. One of the oddities of the TPD is that companies are allowed to advertise their products on their own website, but the advertisements aren’t allowed to be promotional – they’re limited to factual claims. The ASA ruled that the video embedded in the advert was stylised, rather than factual, and the wording of a “Buy five, get one free” offer was intended to encourage people to buy the product. This interpretation of the law puts serious obstacles in the way of anyone who wants to advertise vapour products in the UK.

US vape bans continue to spread

Two more US towns imposed restrictions on vapers this week, as tobacco laws impacted on harm reduction alternatives. Firstly Powell, Ohio, joined the “Tobacco 21” trend, banning the sale of tobacco products to people who’ve been old enough to vote or serve in combat for three years. As usual the definition of “tobacco products” includes any e-liquid which contains nicotine. The law was passed by a 7-0 vote on Tuesday despite at least one councilman expressing reservations about it; supporters of the change included the American Lung Association.

Also on Tuesday the city of Van Buren, Arkansas passed an ordinance making it illegal to smoke or vape in the city’s six public parks. Officially the new law is to “preserve and protect the public health, safety and welfare”, although there has never been any suggestion that second-hand smoke could be dangerous in an outdoor environment. However city officials suggested the real reason is that in the current political climate it’s easier to obtain funding for tobacco-free parks.

British MP promotes e-cigs in parliament

During a parliamentary discussion on tobacco control on Wednesday, Labour MP Kevin Barron was asked if he was aware that the EU’s Tobacco Products Directive made it harder to access vapour products. Barron responded that vaping is 95% safer than smoking, that “this is a fact” and e-cigarettes will be included and supported in the UK’s new tobacco control plan. During the discussion it was pointed out that vaping is also a social justice issue, as many low-income people are smokers and vaping is considerably cheaper.

A Conservative MP reminded Barron that the TPD was introduced and pushed through by a Labour MEP, Linda McAvan. Barron acknowledged that he was aware of this, but reaffirmed his support for vaping.


E-cigarettes needed to get more adults to quit smoking

Some tobacco control activists are so blinded by a commitment to destroy the tobacco industry that they can’t see the potential of a life-saving, harm reduction alternative, e-cigarettes. The absurdity of allowing the widespread availability of the most dangerous consumer product ever invented while effectively banning a much safer substitute defies logic and will only protect the incumbent cigarette trade. Yet this is what some activists are advocating.

federal parliamentary inquiry on e-cigarettes is under way and a Senate inquiry is about to begin shortly based on a bill submitted to the Senate last week. Tobacco control activists want to leave the regulatory framework now in place unchanged, preventing the use of e-cigarettes in Australia.

Policy should be based on evidence, not fear mongering, exaggeration, misrepresentation of evidence and rhetoric. Most importantly, any assessment of vaping should be compared with the risks of smoking, which vaping is designed to replace.

E-cigarettes have only a tiny fraction of the risk of smoking. It is well known that almost all the harm from smoking is caused by the products of combustion, which are absent from vaping.

Claims that the widely accepted view that e-cigarettes are 95 per cent less harmful than smoking is based on guesswork is a misrepresentation of the comprehensive reviews by Public Health England and the UK Royal College of Physicians which arrived at this estimate after reviewing the published scientific evidence including chemical analysis of e-cigarette vapour, toxins measured in users and clinical trials. The college said: “Although it is not possible to estimate the long-term health risks associated with e-cigarettes precisely, the available data suggest that they are unlikely to exceed 5 per cent of those associated with smoked tobacco products, and may well be substantially lower than this figure.”

The levels of toxins in vapour are substantially lower than in cigarette smoke and according to Public Health England, “there is no doubt that smokers who switch to vaping reduce the risks to their health dramatically”.

One study found that more than 6 million smokers in the European Union alone reported using e-cigarettes to stop smoking and a further 1.5 million have quit using this method in the United Kingdom. E-cigarettes are now the most popular quitting aid in the United Kingdom and United States.

Should e-cigarettes be banned until long-term safety data is available? By this impossible standard, no new drug or treatment would be allowed until 20 or 30 years of continuous testing. While we do not yet know everything about these products, we know enough to be sure they are much safer than smoking. Just like with new medicines, decisions to market products are based on the best available, inevitably incomplete, evidence. We should act on what we know now, not be paralysed by unrealistic expectations.

Vaping products are consumer goods designed to replace an existing, far more harmful, consumer product. As such, they can be effectively managed by existing consumer laws, which would regulate quality and safety, advertising, sales to minors and restrictions on use. On the other hand, Therapeutic Goods Administration regulation would impose onerous and expensive barriers to the industry.

The involvement of the Tobacco industry is no argument against e-cigarettes. Big Tobacco has been forced to compete in this market to avoid becoming redundant from this new technology. There is no evidence that the tobacco industry wants people to smoke and vape. The priority should not be to destroy the tobacco industry, but rather to save lives and improve public health. The tobacco industry may be part of the solution if it is encouraged to move out of selling tobacco cigarettes and into less harmful alternatives.

Banning e-cigarettes is counterproductive to good public health outcomes.

Traditional tobacco control strategies have served Australia well for many years. However, adult smoking rates have stalled in Australia over the last three years for the first time, while continuing to decline in other countries where e-cigarettes are widely available. Innovative solutions like e-cigarettes are now required to kick start progress once again.

The lives of many thousands of Australian smokers depend on it.