First, do no harm, actually, first get the underage use ban implemented

So things have been quiet on the harm reduction front lately. There was some talk of drug testing at festivals, which came to nothing, but at least the HSE has started a campaign to reduce the risk of using illegal drugs.

I love this.

That’s Brian from the Magic Roundabout, isn’t it? They couldn’t have chosen a better mascot for this campaign in fairness. Good work by the HSE here.

On the tobacco harm reduction side of things, not so much. The prevailing attitude seems to be harm reduction is not for smokers, those fools can quit or die, either way, we don’t care.

Yes, that may seem harsh. I mean my assessment of public health policy. Public Health Policy toward smokers is actually harsh.

There’s been some coverage of the FDA’s outrageous removal of Juul from the market and our tobacco-concerned fellows felt they should be heard about this. Seizing the opportunity to comment further on vaping they decided the best thing was to welcome the removal of Juul and call for the removal of all disposable vapes from the Irish market. Yes, they did think Juul was a disposable device. The article in the Journal had described it as such, though within 3 hours they had miscorrected this to semi-disposable. I guess someone tried to point out the error and I would guess it wasn’t the Heart Foundation.

Edit; since writing this they have changed it again to acknowledge that Juul is in fact not a disposable at all. Working on the fly is hard, right guys?. The original text is still on this news gatherer site; Newsbreezer

Nor did they mention that Juul is not available on the Irish market, they came and went ages ago, so I don’t know how this concerns the IHF. (Again I have to wonder where is ASH Ireland? Isn’t this their bailiwick?)

Disposable vapes will ‘get a whole new generation of people addicted to nicotine, expert warns.

Professor Colin O’Gara at UCD School of Medicine is head of addiction services at St John of God’s Hospital and has a Ph.D. in genetic influences on smoking cessation. I went down the rabbit hole of ‘genetic influences on smoking cessation ‘ and it looked to me like a good argument for the wide availability of safer nicotine products. Though for some reason the whole field is based on achieving nicotine abstinence to reduce smoking, it hasn’t occurred to them that as all the articles say right at the start, ” smoking is still the main cause of x y and z” or some variation thereof, that maybe removing the smoke and leaving people to access to nicotine would remove the harms, avoid the costs of pharmacopeia intervention and save them the work of figuring out which genes to nuke with chemicals to get people to the nirvana of smoke-free. They could study which genes are involved at their leisure as it’s an interesting avenue to explore but while smoking kills so many people, perhaps we should address the smoking part with greater urgency.

O’Gara’s work in addiction has shown him the benefits of vaping for long-term smokers and he insists that the issue isn’t black and white.

He at least sees the benefit of safer alternatives though doesn’t see it as an option for people who would instead smoke as he seems to genuinely believes that if they didn’t vape they would remain nicotine-free and I duno, take up accordion lessons.

However, Mark Murphy disagrees, believing that the availability of e-cigarettes will do more harm than good in terms of nicotine addiction.

Mark Murphy is advocacy officer of the Irish Heart Foundation, he was delighted with the Juul ban as Juul was the first and seemingly main cause of the teen vaping epidemic, according to him.

“These companies market e-cigarettes as this great healthy alternative that saves people’s lives because it stops them smoking, meanwhile they are the ones who are profiting from the same smokers whether they transition to vaping or not,” he said.

Not sure what his objection is here, maybe he thinks someone else should profit from the smokers rather than the ones selling the safer product, perhaps a pharmaceutical company would be more deserving of these profits. He seems unaware that the vast bulk of vaping products are from independent companies, not tobacco companies. He doesn’t mention that the ones profiting most are our government which stands to lose if vaping replaces smoking.

“Disposable e-cigarettes have this quite reasonable value when compared to tobacco which is ideal for young people who don’t have a lot of disposable income,” Murphy said.

Yeah compared to a pack of cigs, they are good value, that’s a very good thing as it makes the safer option affordable. However, it isn’t the bargain Murphy thinks it is. For the price of 3 of these, you can get a reusable vape and a bottle of juice which will last 5 times as long. You can use it for years at a cost of a bottle of juice every few days.

“It’s disingenuous for e-cigarette companies to say that these devices are only used by former smokers who are trying to quit when they make it so appealing and so attractive and easily available to young people.”

What’s disingenuous here is Murphys’ claim that appealing, attractive, and available are bad things, especially as our government has spectacularly failed to put an age restriction on vaping products. Nor does Murphy call for the current bill implementing an age restriction to be passed without delay.

He describes disposable vapes as ‘colorful and brightly packaged’ as if this was why they appealed to kids. Oddly Juul was only available in black with minimalist pastel packaging and they claimed it was the seek appearance and modern packaging that caused it to become popular with kids. I suspect if they came in OLIVE DRAB Murphy would claim they were being marketed as cool tactical gear!

The Irish Heart Foundation supports a ban on e-cigarette flavours, the introduction of plain packaging on e-cigarettes (similar to current packaging laws for cigarettes) and to increase the age necessary to buy e-cigarettes to 21.

Ahh, maybe this is why no mention of an age restriction at 18. The IHF wants the safer product restricted to 21. Perhaps they also think safety belts and airbags should be restricted to full license holders as youth should only start with the most deadly form of personal transport

As long as combustible cigarettes are available, legally or illegally, the safer alternative must be more available, more affordable, and more attractive. Anything else is a dereliction of Public Health’s duty of care .

“When it comes to most of the major cigarette brands, like Vibe and VIP, they are owned by major tobacco companies like British American Tobacco,” Murphy continued.

OK, I kinda get what he is struggling to say but for clarity, it’s Vype, not Vibe, and neither they or VIP are cigarette brands. They are not even the major brands of e-cig. Vuse and Logic are the big ones in convenience stores and in specialist shops Aspire, Smok and others are the big brands. None of the vape stores’ big sellers are owned by tobacco companies. The vast majority of e-cigs used are independent products. The subject of the journal article, bright disposable vapes which resemble highlighter pens, are not produced by any tobacco company.

We know the health toll of smoking, and we know how it destroys lives, and as long as it remains available we should, like the HSE’s current drug harm reduction campaign encourage safer use. In this case, the drug is nicotine. We have the safer option, all we need to do is encourage current smokers to switch without encouraging non-smokers to start. As long as combustible cigarettes are available, legally or illegally, the safer alternative must be more available, more affordable, and more attractive. Anything else is a dereliction of Public Health’s duty of care There is a balance to be achieved, not an impossible task but one which faces the obstacle of ideological opposition to anything that isn’t a pharmacological product.

Colum Bourk TD FG spokesman on health says;

“if a product is to be promoted for a medical purpose, such as stopping smoking, it should be authorized by the Health Products and Regulatory Authority (HPRA). There are currently no e-cigarettes on the market in Ireland authorized by the HPRA”

And he is not wrong. However e-cigarettes are not promoted for medical purposes, they are sold as safer alternatives to combustible cigarettes. If people chose to switch and thereby stop smoking that’s a bonus. One we should not discard lightly, nor should we insist that a secondary effect makes it a medical product. You have to stretch the definition of medical to make that fit. All this shows is Colum Bourk hasn’t a clue what he’s talking about and needs to be better informed.

The Journal did cover the main problem with disposable vapes, waste. This is the main issue that needs dealing with. These products should be recycled properly, and some system to encourage that is needed. This might be something distributors could deal with. I don’t see vendors being able to sort it as this category of products is sold in too many non-specialist shops. Ideally, a refundable deposit would be the best solution.

Oh and an age restriction, the same as combustible cigs. That’s long overdue.

Have you stopped beating your wife?

So, how to write this without excessive swearing? I’ll have a go but be warned some profanity may follow.

At the moment the Public Health Committee is hearing presentations from relevant parties on the proposed legislation to further regulate E-Cigarettes. This proposed legislation, the General Scheme of the Public Health (Tobacco and Nicotine Inhaling Products) Bill 2019 is something everyone supports without much reservation. It’s proposed to add an over 18 mandate to purchase or sell vaping products, ban sales of tobacco products including e-cigs from vending machines and temporary facilities, and a licensing system for the sale of e-cigs. No one thinks any of this is a bad thing. In fact, the loudest calls for an under 18 prohibition have been the vaping retailers themselves.

If only someone could have done this before now, someone like say, the government that contributed to the TPD at the time, the government that transposed the TPD into Irish law and amended it twice since then. If they had thought this was so important, why didn’t they do it at any of those opportunities?

We have had three debates by the committee so far, the first introducing the bill and answering questions on its measures and implementation. https://www.oireachtas.ie/en/debates/debate/joint_committee_on_health/2021-11-03/3/

Clair Gordon of the Dep of Health clearly explained the current legislation covering e-cigs, including the stipulations implemented under the TPD and what the new proposals would mean. She explained the thinking behind these and why a flavor ban hadn’t been included. She needn’t have bothered as none of the TD on the committee listened to her. They insisted on asking the same already answered questions and one, in particular, took the opportunity to display his barstool wisdom, including a long, drawn-out anecdote about his TV viewing habits.

The next session gave the Irish Heart Foundation and the Irish Cancer Society their day in the sun.

This is where the shitshow starts. https://www.oireachtas.ie/en/debates/debate/joint_committee_on_health/2021-11-17/3/

I didn’t expect the IHF or CS to embrace e-cigs but I was somewhat shocked at the outright hostility they showed, especially Avril Power who seems particularly exercised by flavors and attractive products. What surprised me was how selective the evidence they presented was, even going so far as to call the 95% less harmful figure from PHE ‘tosh’. OK, in fairness it was Senator Annie Hoey of the labor party who use that term but she was parsing what the IHF and the CS gave in answer to her question as to how much less harmful e-cigs were. They didn’t correct her. It was also noticeable that they kept insisting that the BMJ and Lancet were reputable journals as if they were trying to convince themselves. Funnily enough they never once mentioned the gold standard of reputable science, Cochran.

I’m going to put a few quotes here from the discussion as they will be pertinent when I get to the meat of this. Bear with me gentle reader, I am trying to keep the adult content out of sight of the casual viewer.

Avril stated, “Let us not forget that all the major e-cigarette companies are owned by big tobacco.”

This is false and she should know better, maybe they only count gas station sales, which due to the distribution model convenience stores mostly stock the product from the tobacco co’s. Far larger companies are holding substantial market share, Smok, Aspire, etc all have a much larger presence and sales than the tobacco brands but are not sold by convenience stores.

Dr. Chris Macy; “We spend between €11 million and €12 million a year on helping smokers to quit.” We will come back to this later.

Mr. Paul Gordon of the Cancer Society “The cost for people who are not on a medical card is about €36 per week for patches or about €26 per week for gum. People are not necessarily moving to e-cigarettes because they find them more effective.”

Apart from the fact they do find them more effective. Twice as effective in fact. https://evidence.nihr.ac.uk/alert/e-cigarettes-helped-more-smokers-quit-than-nicotine-replacement-therapy/

Monkeys flinging feces

Oh, dear, brace yourselves;

The third session was held last Tuesday and the transcript isn’t online yet but you can view the whole thing here on the Houses of the Oireachtas Twitter account. On a positive note, the fact they put their work in public view so efficiently is something we should praise. https://twitter.com/i/broadcasts/1vOGwyRZgMLxB

The naked, aggressive, hostility shown to the representatives of the independent vaping industry was sickening to watch. Grilling them as to the veracity of their facts is one thing but this was a relentless barrage of ‘have you stopped beating your wife?‘ style questions.

David Cullinane can be a good interrogator when he knows what he is talking about, he is assertive and relentless.

When he is clueless and working from his personal opinion, his style comes across as disrespectful, ignorant, and badgering. His questioning of the IVVA reps fell firmly into the latter camp. He should apologize to them without reservation. He started by asking if we accepted that the Heart Foundation and Cancer Society’s primary purpose was the promotion of public health. Oddly enough the Cancer Society doesn’t make this claim. https://www.cancer.ie/about-us/about-the-irish-cancer-society/our-mission-and-vision Neither does the Heart Foundation. But he was looking for a ‘gotcha’.

Remember when Chris Macy told us the cost to the exchequer for stop smoking interventions was 11 to 12 million? Well, Declan Connelly told the committee that independent vape shops helped people to quit smoking while also providing revenue to the exchequer. David chose to compare this to the tobacco industry tactic of emphasizing the tax losses if smoking was reduced. Realy David? You would prefer if people didn’t quit unless it was at a cost to the exchequer? He also countered Declan’s statement that vape shops help people quit smoking on a daily basis with what he claimed was a report. He presented the results of an opinion poll. Ahem, an opinion poll is not a scientific report, the clue is in the name, it’s an opinion. God, he must have been struggling to find anything to create the impression that the people who successfully quit using e-cigs don’t exist.

The next villain in this fiasco is Róisín Shortall, usually a well-informed and articulate speaker who again chose to badger people, refused to listen to the answers, and engaged in more ‘gotch’ type questions. She interrogated the speakers about how they implemented their own voluntary ban on selling to under 18. Remember this is voluntary and not a legal requirement. If she had asked in the context of how best to make the proposed ban work for online sales, I would have said “there’s someone who understands the difficulties implicit in the law we are proposing, but no, Róisín instead sought to find a moment where she could shout Gotcha! Ha! So much so that Alex Pescar had to point out she was asking him to do something which the government didn’t do.

I’m not sure exactly why e-cigs should be subjected to any more cumbersome restrictions for online sales than any other adult-oriented product, whether that’s alcohol or over 18’s movies on Netflix. It was encouraging that the IVVA were the ones to make suggestions as to how this could be improved, though Róisín wasn’t interested apart from finding flaws in the voluntary system that exists now.


Neasa Hourigan of the Green Party didn’t exactly cover herself in glory either. When the opportunity arose to engage on something firmly in the bailiwick of the Green Party, the excess waste and landfill created by limits on container size and the disposal of disposable vaping devices, (brought up by the IVVA btw) she ignored this and instead continued to focused on flavors, She couldn’t understand why any grown adult would like or want flavors. She can’t understand how something being ‘nice’ (her word) had anything to do with smoking cessation. The sheer ignorance of thinking that unless it’s unpleasant, it cant be ‘good for you’ The Green Party is really leaning into their image of the Killjoy Party.

I won’t bother with the low-grade idiots who kept asking questions previously answered, told stories like your auld uncle, which you heard the last time you met them and demonstrated that they never listen to anything but instead prefer the sound of their own voices.

The obvious bias based on ignorance and refusal to hear any argument other than the one they want to hear, even when that comes from the Department of Health was shocking.

Fuck them and the fucking donkey they rode in on.

There’s another session scheduled for the first of March when the section of the vaping business concentrated in convenience stores will make their submission. I’m not sure there’s any point in watching it. It’s just outside lent so you won’t even gain an indulgence for subjecting yourself. Watching political grandstanding is not enjoyable and when it’s something that has the potential to save people from smoking being used as a stick to beat ‘industry’ with, well count me out.

Thank god NPHET had the reins during the pandemic, if we were depending on the elected reps to get even close to the right strategy we would all be dead now.

Conspicuous by their absence at this meeting to discuss tobacco legislation was https://ash.ie/ ASH Ireland.

Do you know who else was absent from any of the presentations? Consumers; The people most affected by this legislation. Why this is I don’t know. The NNA Ireland made a written submission but didn’t get invited to make an in-person presentation. I guess the legislators don’t give a flying **** what the people who use the products want or know unless it’s an IMRI poll that vaguely supports their prior position.

The NNA Irelands submission is published on its website, worth a read as it makes a sound case for the place of vaping in reducing the health toll of smoking and suggests some ways to maximize this without encouraging non-users. https://nnai510701598.wordpress.com/2022/02/18/submission-to-the-public-health-committee-on-behalf-of-the-new-nicotine-alliance-ireland/

Annalizeing*

A few weeks ago Public Health England released their annual report on vaping in England. https://www.gov.uk/government/publications/vaping-in-england-evidence-update-february-2021/vaping-in-england-2021-evidence-update-summary

They release this report every year, (the clue is in the name), and since the first one, very little has changed. No evidence of a gateway, still about 95% safer, can still help people stop smoking, ect. The only thing of note is the shift from ‘yet no evidence of harm’ to ‘still no evidence of harm’.

Meanwhile in Ireland, our Health Service Executive released their annual report on vaping in Ireland, so I thought I would compare and contrast. Except the first part is a lie, the HSE did no such thing, they don’t do an annual report. Healthy Ireland do include some data in their Healthy Ireland report but it’s fairly generalised. The tobacco control people, do report and do research but the stuff they release is so out of date it’s irrelevant. Anyway let’s look at what the HSE and the tobacco control unit did report on.

First, the HSE as it’s the easiest to mock, sorry, analyze. Here’s the ‘report’ This is a focus group of teens and it’s from pre-2018 as Juul wasn’t yet available as mentioned in the report. Juul has come and gone in the meantime, so HSE might have to do another report. I expect to see that one around 2025. It’s not a report based on data or research btw, this is nothing more than a report of a conversation between teens and ‘facilitators’ for which the teens received a gift pack. I hope it matched the HSE chief executives’ reward. breaking news

It’s obvious they intend this not for research purposes but to use in the war on nicotine. The set of recommendations do not follow the information gathered in the interviews.

  • Advertising banned: None had seen an e-cig advertisement outside of a vape shop or point of sale, so for this report social media posts by friends were counted as advertising. Some claimed to have seen an add for Juul but I suspect they saw one of the Truth Initiative’s anti-Juul adds from the description given.
  • Restrictions on flavors: The ‘kids’ said flavors were not the reason they vaped ( or rather thought they were not the reason some kids vaped, no one admitted vaping themselves)
  • The introduction of mandatory e-cigarette warning notices and posters on the addictiveness of nicotine at all retail outlets selling e-cigarettes: This isn’t even done for cigarettes!
  • And of course an immediate age restriction; which begs the question why now and not when the TPD was being transposed? I guess they just forgot.

The HSE even claim with a straight face;

The HSE has a legal obligation to monitor e-cigarette market
developments, including any evidence that their use is a gateway to
nicotine addiction and tobacco consumption among young people
and non-smokers. Although there have been some Irish studies of
E-cigarette prevalence among young people in Ireland, detailed
information is limited in terms of access, knowledge, the context in
which e-cigarettes are used, and their association with tobacco and
other drugs.

And they give us this? A marketing tool to be used to form policy? Policies such as “the installation of e-cigarette detection for Irish school toilets”? For real! This is not just a waste of time with no useful information but an insult to anyone with an interest in reducing smoking.


Another useless effort.

Let’s move on to the ‘serious’ research also from Feb this year and published with the title;

E-Cigarette-Only and Dual Use among Adolescents in Ireland: Emerging Behaviours with Different Risk Profiles

The study was carried out by the HSE’s Department of Public Health West and Planet Youth West. The HSE we know, Planet Youth West is a five-year pilot program, initiated and developed by the Western Region Drug and Alcohol Task Force.

Notice the theme here; teen use, no mention of adult smokers or vapers. I guess they don’t count. Anyway, as this is the serious one I’ll give it the serious attention it deserves.

It contains several things which I think are wrong so to keep this short, I’ll list the main issues and why I think they are wrong.

For established adult tobacco users with long standing nicotine addiction, the e-cigarette may be an effective harm reduction tool, a role which merits rigorous investigation for the benefits it could reap in this population. However, this argument is not relevant to adolescent users, who receive all the pernicious properties of nicotine without the proposed benefits of harm reduction.

If they just left it at that, I would think it was just a misspoken idea but they go on to throw further shade at PHE;

The public health message around e-cigarettes has been mixed—Public Health England promote a message that they are 95% safer than conventional cigarettes. This message is applicable to adult smokers with an established nicotine addiction, using them as a harm reduction tool. For most adolescents, e-cigarettes are not being used as an adjunct to quit a sustained smoking habit. Therefore, adolescents are being exposed to the harmful effects of e-cigarettes without the potential benefits of harm reduction. The public health message must be tailored accordingly. An unambiguous public health message on the harms of e-cigarette use among adolescents is required.

Here’s why I think this is wrong.

Never mind the blatant admission they would lie about the risk from vaping, I suppose as it’s a ‘good lie’ they think it’s acceptable.

Harm reduction does not depend on being harmed first, in fact, it works best when it avoids the harm completely but failing to do that it next works best by diverting from harm to reduced harm. This means the most benefit from reduced-harm products goes to the ones who never use the higher harm product. In fact, an adult smoker with an established nicotine addiction is going to get less than 95% harm reduction depending on how long they have smoked. The harm of smoking is cumulative, the earlier you stop the less harm is accumulated. An adult smoker who quits has already had harm done. On the other hand, never smoking and only vaping reduces the harm by about 95% right then. Never smoking or vaping at all reduces the harm to 100% obviously. Quitting smoking stops the harm from accumulating further and switching reduced the future harm by about 95%.

The flaw in tobacco control is the assumption that no one will ever use the harmful product or that so few will, that the harm from the reduced product being used will outweigh the original harmful product. The idea that things that improve reduce risk might provide a false sense of security and lead to reckless behavior is one of those things that sound right as long as you don’t think about it.—it’s contrarian and clever, and fits the “here’s something surprising we smart folks thought about” mold that appeals to, ahem, people who think of themselves as smart. This kind of argument has been used against every effort to persuade the public to adopt almost every advance in safety, including seat belts, helmets, and condoms. Even NRT was decried by public health at first. Most recently we have seen the WHO and our own medical experts, advising against masks using this logic, masks create ‘a false sense of security’ they said. But the numbers tell a different story: Even if safety improvements cause a few people to behave recklessly, the benefits overwhelm the ill effects.

To be fair the study itself isn’t completely useless, it does give us some insight into the use patterns of adolescent users. Its main failing is; if the gateway hypothesis is such a concern, why didn’t they include a question on whether the dual users smoked or vaped first? If they did I couldn’t find it. Which given the amount of concern and reference to an EU obligation to determine if a gateway was happening is a glaring omission. The authors themselves are aware of this but shrug it off with;

There are however limitations to this study, perhaps the most significant being that it is cross sectional. Therefore, it is not possible to establish a temporal relationship between exposure and outcome and not possible to infer causation

Ahh well, nothing that could be done then… except infer causation;

dual-use may represent a transition to tobacco product use, a process known as the gateway effect,
and longitudinal evidence for this effect is mounting.

It’s hilarious to see them decry the lack of data and then present data from 2018 as current. Might I respectfully suggest they get off their collective arses and do some actual research. I have said before that the level of research in Ireland is woefully underpowered. We check smoking rates approximately every 2 years and publish the results 2 years later. We complain about the fact that the UK doesn’t use the same metric as we do and therefore can’t be used for comparison. Because we use the US metrics even though we share very little in common with them in regulation or culture whereas we share the same tobacco regulations as the UK and a similar culture.

It’s also disconcerting to see the obsession with vaping when the data from this study shows smoking is still king for nicotine use, with 17% classed as current smoking.

Alcohol is the drug of choice for adolescents with 41% having consumed alcohol in the previous 30 days, that’s the same metric used for vaping. The only mention of alcohol is that it might reduce the ‘kids’ capacity to refuse to vape!!!

Even more concerning is the illegal drug use of Irish adolescents at 20%. Cocaine use cited at 2.2% among adolescents. These are products illegal to purchase, have no advertising, no flavors, come in the plainest of packs, and have had a huge campaign informing of the dangers of consuming. Why if none of this works do they think it will work, this time, for vaping?

https://www.emcdda.europa.eu/publications/joint-publications/espad-report-2019_en

In this study, there was a statistically significant inverse association between value for conventional social norms and conventional cigarette and dual-use. Those with higher value for conventional social norms were less likely to be conventional cigarette or dualusers but were not less likely to be e-cigarette only users. The lack of association with e-cigarette use is concerning and supports the hypothesis that e-cigarette use is viewed as a more socially acceptable behaviour, one that, unlike conventional smoking, society does
not attach the same negative connotations to.

Well that’s telling; it seems the concern is rebellious behavior among the ‘good kids’ As the urban dictionary defines an epidemic; “A disease or behavior that has started affecting middle-class white kids” No wonder we have headlines referring to the vaping epidemic and the Irish Medical News running an article this month last year on the ‘emerging epidemic ‘ Oh irony, you are a bitch.

*I’ll get me coat….

SCHEER NECK!

Scientific Committee on Health, Environmental and Emerging Risks (SCHEER)

Preliminary Opinion on electronic cigarettes

Yep this is now published; link here; https://ec.europa.eu/health/scientific_committees/consultations/public_consultations/scheer_consultation_10_en

I’ve given it the ‘quick read’ and will comment here. This is not a full response, that will be done using the mandatory template and within the restrictive framework SCHEER allow, this is just a commentary. Keeping my thoughts in one place kind  of thing. I’ll quote the bits and comment, to save your eyesight I will do what the SCHEER did and put my conclusion right up at the start;

SCHEER have produced a report that shows;

1 The TPD is working well to protect the health of consumers.

2 There is no evidence from human studies or epidemiological data that E- Cigs present any harm apart from mild passing irritation.

3 No real world evidence exists for a gateway theory

4 No real world evidence exists that secondhand exposure is a risk to bystanders

Yet SCHEER concludes;

1 The TPD needs strengthening

2 There is moderate to strong evidence for human adverse effects

3 The gateway is real and proven

4 Secondhand exposure is a risk.

This is ‘science’ based on quantity rather than quality. It defaults to assuming harm when no evidence is available and is designed from the assumption that e-cigs are a net harm, ignores the data which does not support this, and weights the scant evidence ( and I use that term loosely) of harm heavily. It also, in the absence of any data, defaults to opinion. No justification given for this.

This report will be a huge influence on the next revision of the TPD and judging by the contents it indicates, inclusion in smoking bans, removal of flavors, and some attempt to regulate the nicotine content of the aerosol as well as the liquid. Expect some limits on battery power.

This is tobacco control, not science, this report is policy support, not science. But we have been here before, this is how bureaucracy works.


OK Deep-dive from here on.

“The European Commission mandated the SCHEER to assess the most recent scientific and technical information on electronic cigarettes. The aim of this scientific Opinion is to feed into the Commission’s reporting obligations under Article 28 of the Tobacco Products Directive 2014/40/EU (TPD) and also help the Commission in assessing the potential need for legislative amendments under the Directive or other regulatory/enforcement measures.

The Opinion addresses the role of electronic cigarettes, focussing into potential impacts on the EU context, in relation to:

1. their use and adverse health effects (i.e.; short- and long-term effects) risks associated with their technical design and chemical composition (e.g.; number and levels of toxicants) and with the existing EU regulatory framework (e.g. nicotine concentration and limits)

2. their role as a gateway to smoking / the initiation of smoking (particularly focusing on young people)

3. Their role in cessation of traditional tobacco smoking

That’s the brief with specific reference to the TPD

While drawing-up the scientific opinion, the committee should take into consideration the most recent and up-to-date scientific evidence and technical developments and, as appropriate, the existing provisions concerning e-cigarettes under the TPD (in particular Article 20(3))”

This report could be described as an impartial and cold document, except for the fact they repeat all the negative bits several times while quickly moving on from positives without further expansion.  

2.1. Terms of Reference

their use and adverse health effects (i.e.; short- and long-term effects) risks associated with their technical design and chemical composition (e.g.; number and levels of toxicants) and with the existing EU regulatory framework (e.g. nicotine concentration and limits)

Notice the specific absence of any reference to real-world data on users or population effects. T of R are restricted to abstraction from design and ingredients.

However; ‘The SCHEER considers also human data on health impacts on users of electronic cigarettes from epidemiological studies or clinical trials’. Wondering if they are referencing the quick reporting system (Safety Gate) or data from other sources, i.e. the EVALI thing? Very poor not to include references to the data they base this on. If they are only using the data shown in the expanded discussion later in this doc, the conclusion makes no sense at all, as no evidence has been shown other than ‘possible concerns’.

The adverse effects of nicotine on the cardiovascular system appear particularly relevant for the SCHEER conclusions on the use of electronic cigarettes.’

Appear to be relevant if they are based on nicotine use but I suspect they mean data from smoking research in which case, irrelevant.

“The health impacts of electronic cigarette use are still difficult to establish due to the lack of long-term data from epidemiological studies or clinical trials. However, since 2016, the World Health Organization (WHO) has already noted that, while electronic cigarettes might be “less harmful” than conventional cigarettes, electronic cigarettes still “are harmful to health and are not safe”.

 This one is a puzzler, if there’s no data then the WHO reference is nothing more than a guess and should be irrelevant to any report tasked with evaluating the evidence. Are they implying the WHO has evidence that they are keeping hidden?

According to the literature, the level of evidence regarding the cardiovascular effects of nicotine contained in cigarettes and the related pathophysiological mechanisms is considered from moderate to strong, and it can be assumed that similar mechanisms exist regarding the exposure to nicotine from electronic cigarettes use”.

As I said, assuming here would be a mistake, Was no data on the effect of nicotine outside smoking available? Say NRT or Snus?

Therefore, further research is needed whether children and adolescents have higher risk than adults when regularly second-hand exposed {to aersol} within their home environments”

No extrapolation from exposure to smoking and adjustment for toxicant reduction here? Hmmm, they don’t seem to want the answer.

Based on human evidence, there is a moderate and growing evidence for harmful health effects for electronic cigarette users, especially, for cardiovascular disease.”

 Presumably, this is the Glantz reference mentioned in the sources. Pity they don’t mark each ‘claim’ with the reference it’s based on. I suspect this claim depends on a now-retracted paper. https://www.medscape.com/viewarticle/925461

“In the US a decline in past 30-day smoking prevalence between 2014-2017 was reported, which coincides with the timeframe of electronic cigarette proliferation in the US.”

This is the only reference to smoking rates !

It seems to have been ignored as ‘evidence’ because ‘Specific to youth, nicotine addiction and dependence leading to lifelong tobacco use is a major concern when considering electronic cigarette use.” ‘

Concerns trumps empirical data it seems.

Conclusion:

Overall, the SCHEER is of the opinion that there is strong evidence that electronic cigarettes are a gateway to smoking for young people. In addition, there is strong evidence that nicotine in e-liquids is implicated in the development of addiction

The evidence they refer to is modeling not empirical data because as they admit there has been a fall in smoking prevalence parallel to the introduction and increased use of e-cigs.

It is also interesting to note that a modified version of a popular pod device with a 76% US24 market share is now on the EU market, with technological adjustments. This product type compensates for the lower nicotine levels in the liquid, and the increased aerosolisation results in nicotine delivery per puff approximately equal to the American original using high nicotine levels in the liquid

This is a reference to Juul, and the modification referred to is a new wick material. Juul seemingly modified the device to comply with EU regulations while maintaining the quality of the US version. This is to be expected, products evolve, but the way it’s worded here makes you think the EU regulations were intended to cripple devices and Juul tried to circumvent this noble goal.. As they don’t give a source for this I will; https://link.springer.com/article/10.1007/s00204-020-02716-3

experimentation with electronic cigarettes as a smoking cessation device in the last quit attempt differed substantially across different European Member states, ranging from 5% in Spain to 51.6% in England – highlighting the differences across the EU’.

The wording here implies it’s the people that differ not the regulatory regime they live in.

This Opinion is restricted to the terms of references given by the European Commission. It covers electronic cigarette products complying with the TPD

Yet data from the USA and studies on products not available in the EU are included when it suits the narrative.

They really do have a bee in their bonnet about Juul. US reefer madness being imported, despite the exclusion of non EU products from the SCHEER brief.

6.3 European Regulatory Framework

The next section admits all their concerns and worries are covered by the TPD as it stands. Apart from the bits they don’t like about e-cigs; their appeal and success as a consumer product. Let’s face it this is what irks tobacco control the most, e-cigs are attractive to users, unlike NRT and medicinal cessation aids.

A survey conducted in 2017 and related to ~20,000 e-liquids marketed in the Netherlands, classified 19,266 e-liquids into the 16 main categories of the e-liquid flavour wheel, and among 16,300 e-liquids (85%) for which sufficient information were available, identified 245 unique flavour descriptions (Havermans et al., 2019). The categories containing the highest number of e-liquids were fruit (34%) and tobacco (16%), the latter preferred by dual users (using electronic cigarettes as well as traditional cigarettes)”

The objection seems to be not to flavors but to descriptions or ‘Branding’ as we call it. Not sure what information is gained by the last bit, perhaps that if they restrict flavors to tobacco, e-cigs will be ineffective as smoking cessation. Do they think this is a good thing to aim for?

The SCHEER is of the opinion, that mainly chemicals present in the aerosol are responsible for possible health effects for users of electronic cigarettes

This is terrible English, either something is responsible or it’s not, it can’t be responsible for possibly being something. And also, no shit Sherlock, did they think it was chemicals not in the aerosol that might be responsible?

The frequency of use of electronic cigarettes is increasingly rising particularly in the USA and Europe,” 

 Presumably, they mean prevalence of use. Though ‘regular and/or current use among adults ranging between 0.9% and 1.8%,’, is a low bar to describe as ‘increasingly rising’ over a 10 year period.

SCHEER then goes on to cite figures for ever-use without providing evidence that this is anything more than experimentation, the figures for prevalence would indicate that this is what it is.

They make no mention of smoking rates or any correlation between smoking and ‘use of e-cigarettes’. Again half a picture, not the full picture.

Having made a big deal of refusing to refer to vaping as vaping but instead as ‘use of e-cigerettes’

The consumption of an electronic cigarette is often described as “vaping”. The SCHEER does not use this term, as it may imply, that the consumption of electronic cigarettes are a “healthy” alternative to cigarette smoking and consumers may misperceive risks associated with the use of electronic cigarettes. The SCHEER prefers to use the neutral “use (users) of electronic cigarette”.

They now refer to “electronic cigarette smoking behaviour” I guess the rationale for refusing to use vaping (it implied a reduced risk) doesn’t apply to the use of smoking which implies equal risk.

As explained above, the EU TPD upper limit of 20 mg/ml does not mean that users will be exposed to lower levels of nicotine, as they can puff more intensely and adapt their device settings.”

This was not the purpose of the 20mg limit. The limit was based on the toxicity of nicotine and reducing the risk of possible poisoning by ingestion. Hence the 10 ml restriction on containers. You wonder if they understand the TPD at all.

Secondhand exposure is being judged on exposure, not the toxicity of what the exposure is to. Remember they assumed it was ‘established’ from smoking studies for nicotine.

To determine if metal nanoparticles (100 nm) were present in aerosol, samples were examined by transmission electron microscopy (TEM) and Energy Dispersive X-Ray Spectroscopy (EDS). Tin, chromium and nickel, silicate beads, and nanoparticles were found in cartomizer aerosol, in some cases probably greater than a conventional cigarette (Williams et al., 2013)

Is this the study on a now obsolete product no longer available on the market? Oh yes, it is! https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057987

these chemicals may confer a characterising flavour to the e-liquid meaning a clearly noticeable smell or taste as for maltol, menthol or vanillin, thus contributing to attractiveness of electronic cigarettes.”

They say this as though it were a bad thing.

Health effects for younger populations seems to be activeness. Also a bad thing in itself according to SCHEER. Oh, and perception of being less harmful.

“6.5.4 Human evidence for health impacts of electronic cigarettes.

“ The health impacts of electronic cigarette’s use are still difficult to be established due to the lack of long-term data from epidemiological studies or clinical trials. However, since 2016, the World Health Organization (WHO) has already noted that, while electronic cigarettes might be “less harmful” than conventional cigarettes, electronic cigarettes still “are harmful to health and are not safe”. Therefore, WHO suggested to “deter electronic cigarette promotion to non-smokers and young people; prohibit unproven health claims about electronic cigarettes; prevent/Bar/Ban involvement of the tobacco industry in the marketing and promoting of e- cigarettes”.

Again when faced with a lack of data fall back to opinion. I could use the old Dude meme here.

Palamidas et al. studied short term use of nicotine electronic cigarettes in healthy volunteers, asthmatics and COPD patients.”

No mention of the studies showing health improvements in COPD patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113943/

Oversight or evidence of ‘cherry picking’ ?

Table 8 summarizes the major cardiovascular effects of nicotine contained in cigarettes and pathophysiological mechanisms (Benowitz et al., 2016). According to the literature, the level of evidence regarding the underlined mechanisms is considered from moderate to strong. It could be assumed that similar mechanisms exist regarding electronic cigarettes use” 

 “Never ASSUME, because when you ASSUMEyou make an ASS of U and ME.”. No reference to nicotine in NRT or snus for comparison.

Evidence arising from both experimental and observational studies, support that electronic cigarette use may induce pulmonary toxicity, which is anticipated to emerge as a major public health concern” 

 Again ‘may’ and no reference to whether this effect is acute or chronic.

the carcinogenic potential of electronic cigarettes and the occurrence of head and neck cancers was revealed, albeit with a low level of evidence.”

So enough time to demonstrate a long-term effect, cancer, but not enough time for any conclusion as to anything else. Funny that.

Few studies have reviewed actual use of electronic cigarettes in pregnant women No health effects were reported.” No mention of the Irish study showing vaping expectant mothers had no adverse outcomes to their pregnancy. Again oversight or ??? https://www.rcsi.com/dublin/news-and-events/news/news-article/2020/02/new-study-investigates-outcomes-of-ecigarette-use-in-pregnancy

In case of NRT, it was concluded that NRT during pregnancy cannot be considered as a safe alternative to conventional tobacco smoking.”

This is the dumbest thing I have ever read and I hold no torch for NRT.

Health effects related to second-hand exposure to aerosol from electronic cigarettes  Particularly in relation to cardiovascular and other health effects of passive smoking secondary to electronic cigarettes use, it has been documented that the complete blood  counts of otherwise naïve passive smokers are not affected by such exposures

Which should be the end of that, but no.

Although the database on the long-term consequences of second-hand exposure to electronic cigarettes on human health is not reached, it is well established that passive smoking detrimentally impacts cardiovascular health, with recent meta-analyses revealing that such exposure increases CVD risk by 23% (Lv et al., 2015), including ischemic and coronary heart disease risk by 25-30% (He et al., 1999, Dunbar et al., 2013, Law et al., 49 1997).

 Oh look! A reference to smoking! Intended to flatter vaping? Hell no.

However, it is noteworthy that to date data on the long-term consequences of passive smoking of electronic cigarettes on human health are lacking.”

‘Are lacking’ here refers to the fact no adverse effects have ever been recorded.

They actually admit living in hope of someone getting sick!!

Indoor electronic cigarette use can lead to deposition of aerosol components on surfaces. In 6 a recent review Díez-Izquierdo et al (2018) analysed the reported concentration of nicotine, 7 nitrosamines and/or cotinine as components of third-hand smoke (THS) in indoor dust.”

Dear God third hand exposure!! This is getting silly now.

Safety Gate notification for electronic cigarette and related products from 2012 to 2020 By searching for the key-work ‘electronic cigarette’ on the Rapid Alert System for dangerous non-food products (now called Safety Gate, once known as RAPEX), which is the EU rapid alert system notifying Member states about risks to the health and safety of consumers (excluding pharmaceutical and medical devices), 54 entries were found. They come from 14 different MS, indicating that the potential risk is spread all over Europe. Considering the country of origin of the notified products, excluding a few ’unknown’, almost 50% was from China, 1 form the United States and the rest from EU MS.”

The products did not comply with the requirements of the Low Voltage Directive and the 6 relevant European standard EN 60335 EN 60960 and EN 62133-2 and their withdrawal from the market was established, in some cases paralleled by a recall of the products from end users

So the Safety Gate system works and this is actually about illegal products.

Assessment for second-hand exposure

 “Visser et al. (2016 and 2019) evaluated two specific second-hand exposure scenarios. The first scenario concerns a daily car trip of one hour in a small unventilated car of 2 m3 with two electronic cigarette users (puffing frequency 0.5 per minute, 1 hour of use). The exposed person is a child, sitting in the same car. This exposure scenario approximates the highest levels of exposure that may be expected in everyday situations. The second scenario concerns a daily exposure of four hours in an office-sized space (30 m3 ) with one electronic cigarette user (puffing frequency 2 per minute, 4 h of use).

It was concluded (by Visser et al., 2016 and 2019) that: The risk for local effects on the respiratory tract of propylene glycol cannot be excluded for scenario 1 (MoEs 17-18) and is low for scenario 2 (MoE 74-81). There is no risk for systemic effects (MoEs 535-1475).

Glycerol was not detected in exhaled air and therefore the risk for second-hand exposed persons is considered low.·

Local effects from nicotine exposure are not expected (MoEs 170-750. The MoE for systemic cardiovascular effects is 2.1 for scenario 1: adverse systemic effects are expected.

For scenario 2 systemic cardiovascular effects cannot be excluded either (MoE 6).· Aldehydes are not detected in exhaled air allowing the conclusion that there is no risk for adverse effects for second-hand exposed persons.  ·

 For TSNAs MoEs are 521 and 2297 for scenario 1 and 2, respectively.

A carcinogenic risk cannot be excluded for scenario 1 and is uncertain for scenario 2.”

So no evidence for risk but we won’t rule it out based on our sincere hope someone dies so we can ban them.

Conclusions

In cohort studies, mouth and throat irritation, dissipating over time, was the most frequently reported adverse effect in electronic cigarette users. The overall reported incidence was low.

Resort to WHO statements again, I guess when you have nothing else.

In its report on “Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)” published in August 2016 the WHO (WHO, 2016) stated: “Based mostly on the levels and number of toxicants produced during the typical use of unadulterated ENDS/ENNDS made with pharmaceutical-grade ingredients, it is very likely that ENDS/ENNDS are less toxic than cigarette smoke. However, ENDS/ENNDS are unlikely to be harmless, and long-term use is expected to increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease as well as some other diseases also associated with smoking. The magnitude of these risks is likely to be smaller than from tobacco smoke although there is not enough research to quantify the relative risk of ENDS/ENNDS over combustible products”.

Of course.

On risks for second-hand exposure

The overall weight of evidence is moderate for risk of local irritative damage to the respiratory tract. The lines of evidence are the following:  This irritation is mainly due to exposure to glycols. Glycols are identified as irritants. The model studies revealed low MoEs for irritative effects from propylene glycol.  MoEs for nicotine do not point at a risk for respiratory irritation. Exposure of bystanders to glycerol or aldehydes is negligible or orders of magnitude lower than for electronic cigarette users.  – The overall weight of evidence for risk of systemic cardiovascular effects in second-hand exposed persons due to exposure to nicotine is weak to moderate. The lines of evidence are the following: Heart rate and blood pressure effects were identified as hazards for nicotine. In the model calculations, the MoEs for cardiovascular effects are low. There exists a complete paucity of human evidence regarding the acute and long-term effects on cardiovascular and other health outcomes in children and adolescents.  – The overall weight of evidence for a carcinogenic risk due to cumulative exposure to TSNAs is weak to moderate. The lines of evidence are the following: Nitrosamines have been identified as genotoxic and carcinogenic. The MoEs calculated for the carcinogenic risk from TSNAs are low. Human evidence is lacking.

The key bit here is ‘human evidence is lacking’, in other words, there is no evidence from humans, it’s all speculation and modeling and mouse studies. No evidence, but we say there is a risk anyway, albeit it is mostly local transient irritation. I suspect the irritation is ‘seeing someone vaping’.

6.6 Role in the initiation of smoking (particularly focusing on young people) 

This section is quite good, it shows clearly that the main attractions of vaping are; flavors preferable to tobacco, seen as safer than smoking, and as a replacement for smoking. They admit the predominance of youth use is by current smokers. The big failing is not mentioning the smoking rate as a point of reference against e-cig use.

“In the EU, according to the “Special Eurobarometer ” (May 2017), the most frequently mentioned reason (61%) for taking up electronic cigarettes was to stop or reduce tobacco consumption. Other reasons included electronic cigarettes being perceived as less harmful, (31%), and lower cost (25%). Regarding the two most often-mentioned reasons, reducing tobacco consumption and being less harmful, more than three quarters of those aged 40 or over (76-78%) cite one of these as a reason, vs. 59% of those aged 15-24. Regarding product type, especially pod devices have become a more socially acceptable alternative to combustible cigarettes among adolescents and young adults, and have become popular among this age group as a result of (1) sleek designs, (2) user-friendly functions, (3) less aversive smoking experiences, (4) desirable flavours, and (5) the ability to be used discreetly in places where smoking is forbidden

That’s pretty much the product doing exactly what it was designed to do. Replace smoking.

 It all goes wrong in the conclusion.

Role as a gateway product or renormalisation of traditional tobacco smoking. One of the four core purposes of this scientific opinion is to assist the Commission in assessing the most recent scientific and technical information on electronic cigarettes with regards to their role as a gateway to smoking and with respect to the initiation of smoking particularly focusing on young people. Within this context there are two hypotheses that need to be tested, the gateway hypothesis (in which the use of electronic cigarettes lead never tobacco users to begin using other tobacco products) (Bunnell et al., 2014; Kandel and Kandel 2014) and the renormalisation hypothesis (in which the public acceptance of electronic cigarette use may lead to a renomalisation of tobacco use. (Fairchild et al., 2014)). Indeed, with adult and adolescent smoking rates decreasing due to tobacco control efforts, there remains concern if the expansion of electronic cigarettes may hinder tobacco control efforts and impact smoking rates as adolescents and young adults who were likely to never use any form of nicotine products start experimenting with electronic cigarettes and other forms of nicotine delivery.”

Once the ridiculous Kendal gateway hypothesis is mentioned this loses all credibility. This is a  theory that cannot be demonstrated in studies, therefore isn’t a scientific theory and in this case, is flatly contradicted by the previously presented evidence. Still, it’s part of their core purposes and they seem to have interpreted that as ‘something they should find to be true.’

Overall, the SCHEER is of the opinion that there is strong evidence that electronic cigarettes are a gateway to smoking/for young people. There is also strong evidence that nicotine in e-liquids is implicated in the development of addiction and that flavours have a relevant contribution for attractiveness of use of electronic cigarette and initiation.

So where are all the new smokers? Even SCHEER admits the fall in youth smoking is worth remarking, OK, they only mention it as an aside, but when you’re examining a ‘gateway’ maybe the lack of new smokers is something you should consider in the conclusion?

6.7 Role of electronic cigarettes in the cessation of traditional tobacco smoking and dual-use.

This section is a joke. Mentioning two RCT (Cochran themselves used 15) that show doubling of success using e-cigs over other methods SCHEER conclude

 “ Regarding the role of electronic cigarettes in cessation of traditional tobacco smoking, the SCHEER concludes that there is weak evidence for the support of electronic cigarettes’ effectiveness in helping smokers to quit while the evidence on smoking reduction is assessed as weak to moderate.”

Evidence they base this contrary conclusion on?

the most recent 2020 Surgeon general’s report on Smoking Cessation (Surgeon General 2020) concluded that “The evidence is inadequate to infer that e cigarettes, in general, increase smoking cessation”. Moreover the report also concluded that “the evidence is suggestive but not sufficient to infer that the use of e-cigarettes containing nicotine is associated with increased smoking cessation compared with the use of e cigarettes not containing nicotine, and the evidence is suggestive but not sufficient to infer that more frequent use of e-cigarettes is associated with increased smoking cessation compared with less frequent use of e-cigarettes.” In addition, the European Heart Network reported that there is not sufficient evidence until now that electronic cigarettes’ use is an effective mean for smoking cessation.

Again when you have no evidence to support the premise resort to opinion. Also note the wording, ‘is not sufficient evidence until now‘ Basic grammar would say “was not sufficient evidence until now” or “is not sufficient evidence, full stop.” I’m left wondering if that should be ‘was not sufficient evidence until now but now there is’ or…what?

7. MINORITY OPINIONS
None.

Yep, not one member of the esteemed committee thought to ask “Where are the new smokers? Where are the patients suffering from illness due to switching to vaping? Why is smoking prevalence declining in markets where e-cigs are available if e-cigs renormalise smoking?

I guess there are some questions not included in the brief or wanted at the meetings.

When prior assumptions trump current evidence.

So how’s everyone holding up in this time of tribulation? As nice as it is to be considered an essential worker, those of us who are..?? (is ‘surplus to requirements‘ a bit harsh?) ..stuck at home are the ones finding our limits for housework, gardening and digesting news. We are finding out how little time we want to devote to stuff we used to wish we had more time for.

As hard as it is, we are coping well sitting down, staying socially distant and obsessively washing our hands. All good humored and surprisingly compliant. Shows how important good information is.

Our public health system is stretched to it’s limits. Every available health worker is shoulder to the wheel fighting this pandemic. Well, all the useful ones are.

Their are exceptions who decided a campaign of misinformation was the best contribution to make.

On the first of March the HSE announced the first confirmed case of Covid 19 in Ireland. On the 6th of March the Irish Medical Times ran this; https://www.imt.ie/opinion/guest-posts/vaping-crisis-unfolding-public-health-disaster-06-03-2020/ . Warning of an Unfolding Health Disaster.! Not the Coronavirus pandemic but vaping. This Gish Gallop of an argument came from the University of Limerick’s Dr Suranga Senanayake.

Kinda makes you wonder if there was a touch of being asleep at the wheel about the IMT.

As we know Corona virus turned out to be exactly what was being warned of by the W.H.O. and doctors on the ground in China. Tobacco control being about as much use as an ashtray on a motor bicycle had nothing to contribute during this crisis but couldn’t reallocate themselves to something useful. Instead Prof Luke Clancy got himself and his Tobacco Free Institute of Ireland some attention in the Irish Times. In an article written by Luke Clancy himself, he claims “We know smoking and vaping are associated with an inflammatory process in the lining of the lungs, the very place that Covid-19 causes its most serious damage” In fairness to Luke he is careful with his words, implying stuff that is lacking in the data without directly claiming anything.

“In the US, the question of vaping as a cause of the high prevalence of illness in young adults has been raised but full data to confirm this is not available yet. It would not be surprising, as we know smoking and vaping are associated with an inflammatory process in the lining of the lungs, the very place that Covid-19 causes its most serious disruption and damage.”

With the weasel words “but full data to confirm this is not available yet.” to keep his arse out of the eighth circle of hell.

In a time when clear factual information is vital, Luke Clancy and his Institute decided instead to muddy the water

As Luke is well aware, the cause was tainted T.H.C., and it was last year. Nothing to do with with C19. This is typical of Luke’s misinformation. The entire article is similarly vague on details and strong on innuendo. In a time when clear factual information is vital, Luke Clancy and his Institute instead decided to muddy the water and staying just short of straight out lying, demonize vaping.

The Irish Heart Foundation decided that their share of the Covid spotlight was being stolen, so they put their oar in on smoking and vaping with this in the Irish Examiner. https://www.irishexaminer.com/breakingnews/ireland/smokers-not-cutting-down-despite-covid-19-risks-993412.html?utm_source=dlvr.it&utm_medium=twitter

This time a reporter has their name attached so the IHF could be misrepresented but I doubt it. “Quitting smoking helps build a person’’s natural resistance to all types of infections including coronavirus said Tobacco Free Ireland Programme lead Martina Blake”.

The Irish Heart Foundation’’s medical director, Dr Angie Brown, said

“nicotine itself might increase the risk of Covid-19 as it potentially affects lung tissue making it easier for the virus to enter cells.There is concern that vaping might also increase the risk of complications with Covid-19, she pointed out: “In the US, the question of vaping as a cause of the high prevalence of illness in young adults has been raised but full data to confirm this is not available yet.”

Funny how both the IHF and TFRII parrot the same mistruth with the same phrasing. Oddly the reporter didn’t catch this lie either.

But this is obvious” I hear you thinking, “Smoking must be a factor in catching Covid, it stands to reason.” It seems plausible and I would forgive any bar-stool virologist for saying it, but I will not forgive the TFRII or The IHF . They are charged with public health and in this case they are not just wrong but are demonstrably wrong and have failed to do research and due diligence before spreading theories with the evidential support of 5G mast conspiracy theories.

If either of these esteemed organisations had looked at the data they would know smoking reduces the risk of catching Covid19 and there is no evidence it increases the severity if you do catch it. In fact, contrary to Dr Angie Brown assertion, nicotine’s affect on lung tissue makes it harder for the virus to enter, nicotine is currently being looked at as a preventive measure for Covid. https://www.qeios.com/read/article/581

Heres some links to actual research;

French study; the study ‘strongly suggests that daily smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population’.

https://www.qeios.com/read/article/574

American study based on NYC stats; data from 4,103 Covid patients in New York City, a team of researchers found that a history of smoking was associated with a 29 per cent reduction in risk of being hospitalised with Covid-19 

https://www.medrxiv.org/content/10.1101/2020.04.08.20057794v1

And this from the BMJ. ‘the simple use of nicotine patches should be urgently considered and discussed’.

https://www.bmj.com/content/368/bmj.m406/rr-25

Notice the date, Jan 31 2020. I guess the IHF and TFRII don’t read the literature.

I can post several other studies showing the exact same phenomena, smokers are underrepresented in Covid 19 patients. I could link the study alluded to by the IHF and Luke Clancy but as its based on poor data and the specific one on smokers being of greater risk for severe symptoms had only 5 subjects, I won’t bother. I, unlike them, don’t do junk science. Which is why I offer no information on vaping, as their is zero data. I could risk an opinion that if nicotine proves a benefit in this case, then vaping is a good option for smokers and patches for everyone else but as this is currently only a hypothesis, I won’t.

Though Christopher Snowdon has some fun with the possibilities in his Spiked column, which I’ll link here. It’s a fun read. We need more fun in these times.

https://www.spiked-online.com/2020/04/23/smoke-fags-save-lives/

Envi, the green monster.

Ever wondered how the EU does business? Ever wanted to see how our elected MEP’s present themselves on a day to day basis? You can, you know. Because the EU being a transparent democratic institution, broadcasts its goings on on the web. https://multimedia.europarl.europa.eu/en/home That’s nice of them. It’s not exactly riveting viewing, in fact it counts as a sedative or possibly tranquilizer if consumed in large enough doses. Better to stick to small pieces at a time.

This week one of the highlights for me was the ENVI Committee Meeting, specifically item 16. Yes, we have a exciting life here in our house. No Netflix needed when the EU committees are available. https://multimedia.europarl.europa.eu/en/envi-committee-meeting_20200218-1430-COMMITTEE-ENVI_vd

In all seriousness, I watched this because item 16 was “an exchange of views on e-cigs by members” or some such title. They gave 40 minutes or so to the subject and to be frank very little was to be learned from this. Little apart from how poorly informed MEP’s are and that they seem to depend on crib sheets a lot, sheets which they seem to have received just as they walked in and hadn’t read or understood. I say most because their were notable exceptions. There were also exceptions who didn’t care what information they were provided, they were going on a solo run anyway.

I’ll recap the highlights and get to the point of this as quick as posible because I don’t want to inflict on you the suffering I went through watching this waste of time.

Cesar Luena Lopez from Spain chaired the meeting and introduced Andrzej Rys from Poland who brought us up to speed on e-cig regulation in the EU, he did a good job of covering how the EU’s regulation had saved us from the EVALI outbreak as happened in the US. However he failed to mention that THC was a major component of this ‘outbreak’ .

Next up was our own Mairead McGuinness, (VP EU Parliament). Mairead’s performance was disappointing to say the least, she reiterated all the anti points, youth use, health problems in the US, again not mentioning THC’s role. She puts on the green jersey and gives a mention of the Coombe study on pregnant smokers versus pregnant vapers but I got the impression this was for the home audience. Mairead knows the facts, her office is well informed and I was disappointed she never offered any of this information to the committee. An exchange of views should include some pertinent information instead of framing everything as a question.

This questioning seem to be the order of the day as all the speakers asked questions, none asked directly about the EVALI but one guy Peter Liese – Germany did directly ask if the commission had anything to offer about the US situation. I got the impression he knew the answer and was asking for it to be ‘read into the record‘. However even he didn’t mention THC or cannabis. Someone tried to shut him up but he insisted he had lots of time and continued. Fair play.

The chair studiously avoided answering his questions, instead saying CBD may be tainted with Vitamin E and CBD needed to be brought under the TPD or some guff. I’m getting suspicious that mentioning THC or cannabis has been forbidden by someone.

Veronique Trillet-Lenoir – France, Basically read her crib sheet and sat down. Obvious she hadn’t a clue because several of her talking points contradicted each other, e.g. e-cigs have contributed to a 6 % drop in smoking, followed by we should ban them from public places. Yeah, it almost sounds like you want to protect smoking.

Then Michele Rivasa from the Greens spoke. Oh lord! Not only did she not know anything about e-cigs but she wants a full ban, a flavor ban, a tax, whatever and generally she doesn’t like them. She did waive her arms about a lot and seemed to get quite excited. She’s the solo run I referred to earlier, at least I hope it was a solo run and not green policy because it came across as ill informed prohibitionism.

The rest just repeated the same questions we had already had and also studiously avoided mentioning THC or cannabis though all mentioned CBD. Hmmmm..

Then back to Andrzej Rys to round up the answers and offer some information to the muppets… sorry, MEP’s who attended. Again he defended the TPD as it stands, admitted the current panic is driven by the situation in the US and half mentioned cannabis, though he lowered his voice and quickly moved on after ths slip.

The EU is miffed about this as they want the tax revenue due on tobacco products.

One interesting piece of info from his answer was the fact the FCTC has classed heated tobacco products as E-Cigs. In a way they are right, it’s not smoking but it’s also not a vaping product in the sense e-cigs are. It contains tobacco so is an actual tobacco product. The EU is miffed about this as they want the tax revenue due on tobacco products. The EU is consulting with the ‘best people’ the FDA and the WHO as to the scientific evidence.

Not promising as all these are staunchly anti vaping. What can I say? If this is the level of ‘views’ then it’s not encouraging. Our MEP’s seem to be ignorant of any fact, fed nonsense by their advisers and have no hope of getting correct information as no one would mention the elephant in the room; THC pens. This is part of the wind up to the TPD3 so it doesn’t look good. Along with the push from various cancer, respiratory and lung bodies for an all out ban. Vaping could be in trouble come 2022.

Time to contact your MEP and set them right, remember TPD3 will be adopted by a vote of the EU parlament, we stopped medical regulation last time by contacting MEP and we will have to do it again. This time there are far more of us.

Was drink involved?

We all make mistakes, sometimes we are just under too much pressure, say a deadline we can’t make. So we just scribble some stuff and hope it gets by in the mix. I’ve done it lots of times and in fairness gotten away with it almost as often. I imagine if I were asked to make a presentation to a room full of academics at a conference I would pay some attention to what I was doing, spend long hours writing my presentation, checking it’s facts and rechecking. If notice was short I might dig out an old presentation and rejig it’s content, nothing radical and the safest option.

Well I’m never going to be asked to do this so I’m guessing at what might have happened, trying to find excuses for this;

I came across this on twitter when the ottawa Model for Smoking Cessation held their 12’th annual conference.

https://ottawamodel.ottawaheart.ca/sites/default/files/2020_program_-_web.pdf

They Invited Stanton Glantz as the keynote speaker. His presentation E-CIGARETTES: BACK TO THE FUTURE included the above slide. I have no idea what the entirety of his presentation was and tbf I may be misrepresenting him …No I’m not. Fuck it. The man is a danger to public health at this stage. For the last few years his output has been abysmal. Deeply flawed and unfit for publication. Not even mentioning his ‘me too’ moment. I, for the life of me, cannot figure why Ottawa thought he was the best option to make the keynote presentation. Which is why I harbor the suspicion the real speaker became unavailable and Stan was asked to stand in at the last moment hence his ridiculous bullet points. Note what atendeed would learn at the end of the presentation!

Of course their is another option, Stan was pissed out of his head.

Let’s look at that slide, “Combustion is not as important as we though” Oh for fuck sake! How in the name of all that holy can he make that claim? Everything we know about tobacco tells us that combustion, the burning of tobacco leaves is the reason tobacco causes most of the damage. This is not in dispute, it’s not even up for debate. Nothing comes close to combustion for creating a cocktail of carcinogenic chemicals. And not just in cigarettes, burning a piece of toast has the same result, burning fuel to heat your house, it’s why we have chimneys. How does he not get this? If I were PMI I would be using this on our government mandated warnings. “Tobacco causes several fatal illnesses but smoking isn’t as important as we used to think, smoke ’em if you got ’em”

Promoting progression to cigarettes” More evidence free claims. If this were true we would see a rise in smoking prevalence, we don’t ergo it’s false. Stan is just saying stuff at this stage. Not exactly a new thing for him but as part of a keynote speech, he should at least try to be somewhat circumspect in his claims. That way they can’t be dismissed as easily as I just did.

All look, sure what’s the point of going through this bullshit, Stan gona Stan and nothing we can do. However the real issue is that Stan got to Stan and got paid handsomely to do so by the UNIVERSITY OF OTTAWA HEART INSTITUTE who don’t seem to have a fucking clue what evidence based means. They claim they follow ‘evidence based smoking cessation treatment protocols‘ and yet here they are giving a platform to this charlatan. Why? are they stupid? Are they so enamoured of Stans reputation? his anti smoking one not, the other one.

Could it be that the OMSC is compromised in it’s ability to judge vaping? If they claim that industry corrupts evidence by funding even at third hand, how can they remain impartial and evidence based when they are funded by pharma?

To add insult to injury OMSC then proceded to block anyone tweeting contradictions to this garbage.

https://twitter.com/jkelovuori/status/1218698051205857287

Ironic as one of the commitments of OMSC is;

To acknowledge people as the main health resource; to support and enable them to keep themselves, their families and friends healthy through financial and other means, and to accept the community as the essential voice in matters of its health,”

Fuck ’em and the horse they dragged Stan in on would be the easiest reaction. But OMSC is a big deal and we can’t ignore them, well we can but health departments won’t. We have to continue to refute rubbish like this and in doing so make OMSC seem idiotic which is a pity, because OMSC should be our allies and friend.Instead they have chosen to be the enemy. Not our doing and not iridemiable. The growing body of evidence is on our side and eventually OMSC will have to admit ” Stan was drunk! What can we say” by way of apology as they ask us for help.

Focus you fack!

Breath deeply and count to 10.

Sometimes I can get slightly irate, sometimes slightly more than irate and sometimes, well let’s just say you don’t want to be around. It never helps when I’m in this state to hear the words “breathe deeply and count to 10 dear” to be honest I think it’s said to see if I will literally explode as opposed to figuratively.

Oh my, Monday!

I heard it said to me several times before I finally exhausted myself and fell into a fitful sleep. I had spent most of Monday cutting firewood, removing fallen trees after the previous nights storm. I was away from TV, radio and internet’s most of the day. So I missed the big presentation by the Irish Heart Foundation and Cancer Society on ‘E-cigarette packaging and Flavour research’. Once I did hear of it I checked it out and could not believe the bullshit that these two charities thought to pawn off as research. Ok OK, breath deeply and count to 10……….

Flavours and teen use of e-cigs is a hot topic right now and some research would help. This is what really offends me about this PR stunt. They did no research, they made no effort at research and they instead used the topic to take a swipe at e-cigs. Of course they bloody did. Using the example of American tactics, they weaponised kids and using leading questions got the replies they wanted. This is a despicable level of lobbying by orgs supposed to be in the area of public health. The heart foundation state “We campaign to influence Government policy in order to improve care for patients and to prevent premature deaths” Remember this when they rattle their can under your nose next time, they openly admit they campaign to influence gov policy. They do sweet fuck all to advance public health other than acidentialy. The Irish Cancer crowd claim ” to be the independent and informed voice of those affected by cancer. We represent people affected by cancer and make sure that people who shape cancer policy and provide cancer services hear their voice.” What in the name of all that’s holy has teen vaping got to do with cancer? Odds are it prevents teens from smoking and as such lowers the risk of cancer. This is misguided at best, downright self defeating at worst.

Lobbyists lobby

Anyway why would I be so angry because lobbyists lobby? Because they do it so shoddy that’s why! The ‘research‘ as they termed it turned out to be a sample of 16 kids from a single area, given a set of samples and asked to give their opinion. A focus group it’s called. Jesus wept. No indication whether any of the kids ever used an e-cig, no idea or clue what the full questionnaire was apart from the cherry picked stuff they use in the powerpoint slides they linked to as the ‘research‘ online. I’m not joking, they actually linked to a set of powerpoint slides when asked if the full research was available online.

The media coverage was of course fulsome, RTE’s main evening news show Drivetime covered it, giving the IHF an opportunity to push their agenda and the presenter claiming she had no knowledge of the Healthy Ireland survey from the previous week. Which she also covered. The IHF muppet claimed there were no figures since 2015, she let that one slide without question but when the VBI spokesman referred to the HI survey, she said “I’m not aware of those figures, where did you get them?”

The Irish Times also covered the story. Including this paragraph

 “Categorising the products into four types of flavouring, they said only one, associated with existing tobacco products, could be expect to appeal to current smokers or those looking to quit. The other three were linked to food, fruits and sweets, and were considered to be appeal to young people as they were often found in the foods and drinks that appeal to them.”

Except this is not what the ‘research’ says. I’ll quote with a screen shot of the actual presentation.

Can the reporter at the IT not read? Or was he lied to by the IHF when being given a quote? I have no idea, I suspect it was some idiot who lost his notes and tried to do it from memory without the common sense to check. Yes I’m being kind, I’ve calmed down since monday.

OK, while very little information can be gleaned from a sample of 16, it does tell us something, it tells us that branding and packaging is the biggest creator of perceptions around e-cigs and advertising adds to this. But this is not something unknown, in fact it’s exactly what the vaping retailers have been telling the regulators for over 5 years, asking for guidelines around packaging and urging advertising exclusion zones similar to those proposed for alcohol, another adult product. Why the gov have persistently refused to consider this is a mystery, almost as big a mystery as why they forgot to include an over 18’s clause in the TPD in 2016.

As a cynic I have to suspect these omissions were deliberate, designed to create a problem they could then rush in on a white charger to save us from. “I’m about to call a stop to this,” Simon Harris said. Of course it won’t be easy the minister told the gathered crowd, “their may be obstacles” but he was sure he could save us. “So industry we’re on to you. We know what you’re up to. And we’re going to work together in 2020. And to make sure we shut down this dangerous, dangerous situation.” Gobshite!

The minister said he did not believe the industry when it states that candy floss and bubblegum flavoured products are aimed at getting the “60-year-old man who smokes 20 a day” off tobacco. Several others have spoken about this mythical 60 year old as well, I wonder if they all think all smokers are over 55? Perhaps they do, after all if the presenter of a show which covered the Healthy Ireland survey is not aware of the figures why should a Minister for Health who currently oversees the largest number of trolleys recorded, and the largest budget overruns know anything about the facts. He doesn’t know his arse from his elbow, how can he know what the profile of a typical smoker is.

Who would know, is the Irish Heart foundation who run ASH Ireland, I have to assume they are the ones informing the minister on this issue as they didn’t feel the need to correct him. So they either mislead the minister or they failed to act professionally and inform him. Just for the record the profile of a typical smoker in Ireland is a person between 18 and 35, lower economic status and lower educational achievement. They started smoking at around 20 years of age and if current trends continue will smoke for around 35 years before quitting. That’s the bulk of smokers.

Oh hang on, I think I see it now, Simon is basing his 60 Year old not on a typical smoker but on the typical quitter. Which Simon see as the only customer for e-cigs. Not sure why Simon wants to continue this trend considering the health cost of smoking. Not sure why he refuses to see the benefit of attracting younger smokers and having them quit before damage has accumulated. Can’t think of any reason at all, at all,

Tax hike on cigarettes and tobacco worth extra €68.1m in year

https://www.irishtimes.com/news/politics/tax-hike-on-cigarettes-and-tobacco-worth-extra-68-1m-in-year-1.3657867

Forget about smoking.

This post may ramble a bit but bear with me, there’s a point to this.

With all the talk about vaping, vaping epidemics, vaping deaths, vaping illness, you would be forgiven for thinking that vaping had replaced smoking as the new cause of all the world’s ills. You pretty much can’t open a news paper, turn on the news or check facebook without some story about vaping. Most of them about the harms, the addiction, the huge use among youth and deaths from using e-cigs. Doctors claiming vaping is worse than smoking and alcohol combined, health bodies advising people not to use e-cigs and politicians calling for bans, plain packaging and ironically a call for regulations from the very politician who oversaw the first set of regs. A lot of these stories are repeats of stories from last week and one in particular is from as long ago as 9 years.

Collective amnesia.

I think some sort of collective amnesia has taken hold of our media, medical community and politicians. Discussing one of the calls for a ban on a radio show, I brought up the fact that smoking was still the most risky way to use nicotine. “Forget about smoking for a minute” replied the presenter. I was shocked tbh as without smoking their is no need for vaping or more specifically without the health toll from smoking, vaping is a bit pointless. However I do understand her urge to forget smoking, why confuse issues when smoking is no longer an issue in our new tobacco free society, right?

The leader of the opposition (or is he; ) 😉 Deputy Micheal Martin got up on his hind legs and in a leaders question asked the current Taoiseach about vaping and included this statement “We had been really succeeding in terms of getting young people away from the whole idea of nicotine addiction” I have to wonder if anyone is paying attention to the reality around them. Oh if you read the linked transcript, be warned, it’s full of misinformation, half truths and political grandstanding. I’d love to know who wrote it for him?

Over in America where this all started, they seem to be having the same memory problems. Though in their case there’s an excuse, the devils lettuce, jazz cigarettes or cannabis as we call it. For some reason the anti tobacco effort in the US seems to be entirely focused on vaping. Being driven to panic and knee jerk legislation. The Truth Initiative cite vaping and flavors as their top issues. This is an organisation set up to;

Truth Initiative is America’s largest nonprofit public health organization committed to making tobacco use a thing of the past.

Lets see if we really can forget about smoking. Is it a ‘thing of the past’? Are we now at the end game for a tobacco free society, 5%? Are young people turning away from nicotine addiction? Is vaping the threat it’s being presented as?

Well according to Action on Smoking and Health in the US, 13 people die every minute from a smoking related illness. Bear in mind so far around 30 people have died from vaping since 2008 and most of those confirmed as black market THC vaping. I know which one I would focus on but for some reason that’s best forgotten about.

In Ireland smoking is at around 20% prevalence. Smoking prevalence among youth, the 17 to 25 age group is 19%. That’s the people Michael told us we were so successful in getting away from nicotine addiction.

Vaping is 4% and among non smokers less than 1%. That’s the group everyone is losing their shit over!

So smoking is forgotten while the focus is on vaping. Why? Could it be because vaping is new and ‘visible’ while smoking is so common we hardly notice it anymore? Is it because, for the people driving this panic, smoking is actually down around the 5%? They don’t see people smoking among the circles they move in so for them it’s less of a concern? This is known as Salience and need a bit of unpacking.

From Wikipedia;

The salience (also called saliency) of an item is the state or quality by which it stands out from its neighbors. Salience bias (also known as perceptual salience) is the cognitive bias that predisposes individuals to focus on items that are more prominent or emotionally striking and ignore those that are unremarkable,

So that kind of explains why some people are freaking out about vaping, for them it’s new and scary and obvious, due to its newness. However the people paid to deal with smoking, the anti smoking groups should not have this bias, after all, they have the data available to them, they are paid to focus on smoking. Salience doesn’t excuse it for them. They don’t have the excuse of not being reminded of the prevalence of smoking. They don’t have the excuse of thinking because they see some few vaping that it’s an ‘epidemic’. If they are ignoring smoking to focus on vaping it has to be something more. Perhaps vaping is a new danger we should be cautious of? Unfortuniatly the anti smoking people don’t seem to be convinced of this because instead of telling us why it’s a new danger, they chose to lie about it.

You may ask why I accuse them of lying? Lying is a strong accusation, You need to be cautious about calling someone a liar. But when all of the claims about vaping being an epidemic, causing death and the rest are demonstrably false. You have to suspect they are lying, or stupid. If they truly had reason to think vaping was a danger they are duty bound to inform us, instead they only engages in deception, obfuscation, and a whole pile of ; ‘could’, ‘might’, ‘may’ and ‘we don’t know’.

So much so that someone pointing out the actual proven risk from smoking gets told ” Forget about smoking”

I guess once a moral panic grips a society, rational thinking goes out the window. It becomes a hysterical witch hunt. Which this seems to be right now. Claims without any evidential support are given free rein, Accusations of ‘colluding with the devil‘ or being a ‘tool of Satan‘ are tossed around. When fighting an enemy sometimes paranoia is a good thing but when you turn on potential allies then you have lost the plot or forgotten the reason your fighting in the first place.

Forgotten about the toll on health, lives and the human misery caused by smoking.