As Ash Wednesday approaches we are bound to get the annual deluge of quit-smoking features in the media. Recent years have seen this shift to focus on vaping versus smoking. Understandable as that’s a ‘burning issue’ in the minds of sub-editors who can’t resist a bad pun or dad joke.
It’s more disturbing to see interviews with well-known politicians who are completely uninformed on the issue. Of course not being informed ever held a politician back from expounding with great certainty on any subject and Monday on Newstalk we had an example of this ‘showing your ignorance’ from Regina Doherty, who claimed “We know vaping is as dangerous as smoking, the outcomes are the same” The lack of pushback from the presenter was more disturbing, was he as ignorant as she or just not willing to contradict her? It was a huge contrast to an interview with a petrol industry rep who claimed climate change was a scam. Of course the pushback was instant. This was probably a ‘dead cat’ from the industry rep which the presenter fell for as the subject being discussed was windfall taxes or nationalization of energy companies. Once this dead cat was tossed, that was ignored for the much more salacious content, and all hope of a sensible discussion on energy companies’ responsibility in the huge profiteering was forgotten. Well played sir.
if you take health advice from failed politicians, that’s on you,
Now if you take health advice from failed politicians, that’s on you, but the worrying part is she had formed this opinion based on the vibe she was picking up in the media. This shows how poorly our public health is at getting the facts out.
Yes, it’s easy and fun to laugh at the ignorance of our politicians but we shouldn’t. We should instead ask why are they so misinformed? Do they not have people to research this stuff for them? Well of course they do, €15,000,000 worth of them. By the way, if they call me I can give them accurate advice and information for a much smaller sum, say half a million should cover my time and effort. In fact, they could just read this blog for free, though I would prefer the renumerated employment.
A better example of this annual anti-smoking push was in the Examiner on Friday when an article on vaping gave a much more balanced view.
It’s paywalled so I don’t have access to the entire thing but what caught my eye was the statement that while “e-cigs may help people stop smoking, there is a risk of continued use” which is verboten it seems. Only nicotine abstinence is an acceptable outcome. This may explain the failure rate of NRT if we keep focusing on quitting nicotine, we risk failing to end the scourge of smoking. We are pushing the impression that nicotine, not smoke is the culprit. Why wouldn’t a smoker continue smoking if he has failed to quit nicotine, it’s familiar, available, and in spite of the notion that it isn’t, it is still socially acceptable.
While the ideological view that abstinence is the only option is understandable, the huge relapse rate for NRT has given public health a poor impression of clean nicotine as an alternative to smoking, despite this being their own fault for setting nicotine abstinence at far too early a time. 12 weeks is the recommended course of NRT. Of course, they suggest you try again and another 12-week course should do the trick. Maybe the failure is not in the NRT itself but in the endpoint emphasis.? Perhaps if instead, they told people to quit or replace smoking with a clean source of nicotine such as NRT, e-cigs, or nicotine pouches, the rate of smoking would plummet.
The job of informing the public falls on public health and as far as smoking is concerned should be the remit of ASH Ireland. The last review they did was in 2019 so not exactly on top of their brief. In fairness, ASH Ireland has been a bit sidelined by the Heart Foundation so let’s see what they are doing. Ahem, they did the last report with ASH so 2019 again. Newcomers to the game the Ireland Policy Group on Tobacco have Prof Des Cox writing articles like this, I doubt they are going to make much effort to correct misinformation, As this article has 3 demonstrable false claims, you could say they are just as bad or good at misinforming.
I would call this a dereliction of duty, it could be claimed that it’s close to malpractice as it denies smokers the information needed, instead allowing misinformation to run riot. They did not do this with anti-vaccine misinformation so you have to assume it’s deliberate. In fact, as a lot of the misinformation comes from public health we know it is..
P.S. Oddly my spell checker offered tobacco as a synonym for smoking. They are all at it.
So Healthy Ireland has published their annual survey of the Health of the Irish. The data from Healthy Ireland Surveys are used to underpin policy development and implementation. So it matters, and how it’s interpreted matters more. It’s a survey of 7450 people which started out as a face-to-face interview but switched to a phone interview when the pandemic hit. Last year we saw a slight rise in smoking rates of 1%, within the margin of error and confounded by the change of method. However, this year’s results show the same 18% smoking prevalence so this is a trend, albeit a small one. Interestingly the use of E-Cigs fell to 3 %.
Let’s look at the results back when we had the lowest smoking rates recorded, 2019. Smoking had fallen from 23% to 17% in 4 years. With the smokers being replaced by vapers. If this trend continued we would have been down to 15% or lower by now.
So what happened to stall this decline in smoking? Well the pandemic didn’t help, but the obvious conclusion is as vaping rose, smoking fell, and as vaping fell, smoking rose. Did smokers find they didn’t work as smoking replacements, or get scared off by the constant campaign of disinformation from public health and a media in search of clickbait?
Coincidentally the Office of National Statics in the UK has published its smoking data today. Over there smoking is now 13.3% with 7.7% using an e-cig occasionally or daily.
Here in Ireland smokers who have successfully quit have mainly used willpower but a significant portion used aids to help them; 22% of those who used an e-cig succeeded, and only 10% who those who used NRT or other pharmacopeias successfully quit. You know; the stuff public health tells us works best while saying there is poor evidence e-cigs work.
So it’s not that e-cigs ‘don’t work’.
As the main difference between us and the UK is public health’s attitude to vaping I think we can give weight to the argument that our public health, and tobacco control, in particular, is the main cause of our smoking rates remaining stuck or increasing.
Prior to the big anti-vaping campaign, we had the lowest rate of smoking among youth historically, after the much-publicized EVALI panic of 2019 to 20, along with our tobacco control making stupid statements left, right, and center we had a rise in smoking among youth and adults. We know that most people are misinformed as to the relative risk of smoking and vaping with most believing that vaping is more or equally as harmful as smoking.
Despite best available evidence showing #ecigs are less harmful than #smoking, widespread misperceptions they are = or worse. Only 2 countries have >50% of pop aware. And majority of people don't think switching from cigs to #ecigarettes would improve health @ITCProject#ecig2022pic.twitter.com/rHlF8PT9ak
Tobacco control, oh hell let’s call a spade a spade, the Irish Heart Foundation is tobacco control in Ireland, and most if not all the calls for vaping bans come from them. In what must be the most self-defeating move other than Putin’s invasion of Ukraine, they have led the charge against vaping. For an organization that claims “reducing smoking rates and supporting people to stop smoking must be a key focus of health policy.” ignoring the clear evidence that vaping helps smokers quit, that vaping carries a small fraction of the risk that smoking does, and the glaring fact that we have a smoking rate of 18%, the IHF concentrates its efforts on discouraging the use of e-cigs and attempting to prohibit the most effective method of cessation for smokers who find cold turkey leaves them cold, risking prolonging the prevalence of smoking beyond what is necessary.
Can they admit their error and change? Or like the now-banned cigarette vending machines, should tobacco control carry the sticker “Change is not possible“
The real villains in this effort are the media who accept every anti-vaping press release and give air time to the likes of Luke Clancy, Des Cox, and Chris Macy without even doing basic research as to the truthfulness of their statements. They let these people go unchallenged by any journalism, instead depending on people from NNA Ireland or the convenience stores association or anyone who is willing to do their job for them. The problem is the white coat and stethoscope are given to tobacco control, and we who advocate for harm reduction are presented as amusing contrarians.
A press release from some cardiologists in the USA gets huge coverage, never mentioning it is not a peer-reviewed study or the fact that it has a major flaw in its methodology, yet the Cochran conclusion that there is high-certainty evidence e-cigs are effective as cessation aids gets ignored. Even to the point, we have Clancy on the radio the following week saying there was no real evidence of this. Of course, the journalist didn’t bring up the Cochran data.
And so we have the problem, only ‘news’ that fits the narrative the IHF push gets airtime, and everything else is buried. If it bleeds, it leads. Today we had some coverage of the Healthy Ireland survey but not a peep about the remarkable figures from the UK. We got coverage of the FDA figures on e-cig use by youth in the US. when that came out, but we didn’t get the full picture, no one mentioned the drop in youth vaping there or the smoking rates. That wasn’t in the press release.
The IHF reaction to the HI report is here from June Shannon and contains this gem from Mark Murphy. “Moreover, given the gateway effect that e-cigarettes pose to eventual smoking, the fact that those under 25 years of age are the highest users of e-cigarettes is concerning. To halt and reverse these deeply alarming trends, bold measures such as increasing the legal age of sale of all tobacco products, including e-cigarettes, from 18 to 21,”
Meanwhile in the UK;
Statistician’s comment;
“This year, we have reported 13.3% of adults aged 18 years and over in the UK were smokers in 2021; this is a decrease from 14.0% in 2020. This is the lowest proportion of current smokers since 2011, when we began recording smoking prevalence from the Annual Population Survey (APS).
The decrease in the proportion of current smokers may be partly attributed to the increase in vaping and e-cigarette use. Data from the Opinions and Lifestyle Survey (OPN) have shown regular use of a vaping device has increased in 2021 and the highest usage was among those aged 16 to 24 years.”
The contrast between Mark Murphy’s statement and the statistician’s comments on the UK figures is remarkable. You wonder which one is actually in the business of reducing smoking rates and supporting people to stop smoking.
“I’m not angry as much as I’m disappointed in you” has been the most feared reaction from any Irish mammy. After the report from the Public Health Committee (Tobacco and Nicotine Inhaling Products Bill), I have to admit it was my first reaction. They didn’t even ask the main stakeholders in this bill, the users of vaping products, to give evidence. The NNA Ireland has reacted to this report, you can read that here
They felt we should put up with what they decided and be thankful they are looking out for us.
They claim the aim of this bill is “to ensure a smoke-free future for younger people growing up today and to assist smokers who wish to quit a life-long addiction” and “achieve a Tobacco Free Ireland by 2025 which would mean a reduction in smoking levels to less than 5% of the population by 2025.”
This is not going to happen, smoking prevalence is currently around 17 to 19%, and theirs’s not a snowball in Hell’s chance we can reduce it by 13% in 3 years, as it stands the closest we can get is 2035 even with the current slightly favorable legislation for e-cigarettes. Without that, we are back to the tobacco control policies that would result in a date of 2052 before we reach a daily smoking prevalence of 5%.
Apart from the fact most people don’t want to quit a lifelong addiction, they want to avoid the illness and shortened lifespan associated with smoking, the fact that they specifically say smoke-free should make smoke-free products a benefit. The committee doesn’t seem to realize this or doesn’t care.
Setting out the rationale for this bill they state that “tobacco costs the Irish exchequer €10.6 billion every year and that 6,000 deaths a year are caused as a result of smoking”. As the only tobacco product available in Ireland is combustible tobacco, we can take it that this cost is entirely attributed to smoking. The committee in their wisdom focus on non-combustible products.
The committee agrees that a restriction on nicotine products for those over 18’s should be enacted. How we got to 2022 without this in place is a mystery, it’s the one thing all parties agree on and should have been implemented in 2016 when the TPD was transposed into Irish law. This needs to be done as soon as possible. Adding another layer to the legislation, especially a flavor ban will only delay this as that will involve a consultation with the EU. The EU is also erroneously considering this and the whole bill may end up lingering until the EU decides. Leaving Ireland the only EU state without an age restriction.
The committee cast doubt on the efficacy of vaping as a smoking cessation method by citing a study that showed
“that after one year, 18% of e-cigarette users were abstinent from smoking versus 9.9% of NRT users. The same study found that among those abstinent after one year, 80% of those in the e-cigarette group were still using an e-cigarette versus 9% of NRT users still using NRT.”
That’s twice as effective as NRT, remember that while 80% of e-cigarette users were still using e-cigs at follow-up, 90%NRT users had quit all nicotine. 100% of both groups were still not smoking. That should be the focus.
The Royal College of Physicians of Ireland said;
“We do not feel there is a sufficient body of evidence to show people can successfully transition from e-cigarettes to nothing, whereas there is evidence for NRT and other safe, effective products that have been shown to help people to quit tobacco.”
Why is transitioning to nothing the goal, when smoking not nicotine is the cause of all the harm? Why abandon the huge reduction in disease in pursuit of nicotine abstinence? This is ideology, not public health care.
“The Committee also noted evidence which found e-cigarettes might increase the odds of erectile dysfunction and stroke at middle age and numbers of people with difficulties with their eyesight as a result of electronic cigarettes.”
Jesus Wept! ED and blindness? There is no evidence of this anywhere outside the fevered imaginations of tobacco control. The committee is either gullible or working from bias if they believe any of this.
“The Department also told the Committee that there is also evidence that smoking during adolescence increases the risk of developing psychiatric disorders and cognitive impairment in later life”
This is nonsense, if it were true we would see it in the age cohort that grew up in the ’50s and ’60s when smoking was at its most prevalent. We don’t, because this claim is based on in vitro studies and mouse modeling where cells in Petri dishes or mice in cages are exposed to levels of nicotine unsustainable by human users.
Of course, the Public Health England finding, that vaping was 95% safer than smoking was attacked, claiming it was methodologically unsound and outdated. No mention of the fact the Royal College of Physicians in the UK also backs this figure as a good estimate of the potential risks based on the currently available evidence. They also revisit this estimate annually and have seen no reason to change it.
“The Irish Cancer Society told the Committee that a mixture of affordable alternatives and practical hands-on peer and behavioral support is required in order to make it possible for people to quit cigarettes”
This is exactly what specialist vape stores provide. The ICS claim only Quit.ie can provide this, and they do their best, with a helpline, a quit kit of leaflets, and once-a-week clinics in 9 towns. There are approximately 200 vape shops open 6 days a week, offering advice and support to smokers looking to switch at zero cost to the exchequer. Perhaps the HSE would do better to cooperate with this free resource rather than try to eliminate it.
And eliminating it is the clear goal here as banning flavors is the main point the committee makes.
The committee wants a full ban on all flavored vaping products apart from tobacco. The rationale for this is the old trope of ‘Kids like flavors ergo flavors are for kids‘. The department of health did say a balance has to be struck between keeping children from using these products and the needs of adult smokers who use e-cigarettes.
The report cites Finland and Estonia as examples of countries that have banned flavors without any significant decrease in e-cig use, noting that in Finland black market products are available and users use food flavorings as substitutes. So either they are endorsing black market supply as a safety valve to the damage this ban could do or they are oblivious to the effect this has on the policy they recommend. Neither do they mention that Finland has access to Snus, a smokeless tobacco product that is credited with giving Sweden its smoking prevalence of under 5% (Familiar figure, wonder where I’ve seen it before?) No one mentioned the fact smoking rates went up in Finland after the flavor ban or that vaping was as low as 2% and has remained at that. The smoking rate was at 11% and has stagnated there since then. Estonia repealed its flavor ban and removed the tax it applied to vape products. No one mentioned that either.
A ban on flavors is a body blow to vaping business and its customers, flavored products are the choice for most vapers who are former smokers looking to escape the taste of tobacco. Without flavors, the market falls entirely to the suite of products produced by tobacco companies, (mainly tobacco, menthol, and mint pod systems), who have the financial clout to accommodate the reduction in sales. Not that they will shed any tears as most of that reduction will be compensated for by sales of combustible cigarettes. This is what happens when flavors are banned; cigarette sales rise. If the committee had intended to increase the rate of smoking they are doing a good job, however as they claim to want to achieve a smoke-free – sorry tobacco-free society, they are causing more harm than good. Idiots.
On top of this, they want to add plain packaging to vapor products. We all agree guidelines are needed to avoid overly childish-looking packaging, but plain packaging has a specific meaning in law. It mandates a single specified font, a single specified color, and specific graphic warnings. I have no idea what graphic warning will apply to vaping products as there is no recorded disease attributed to nicotine vaping and featuring anything else would be misinforming the public.
Perhaps;
Warning! Shinyitise is a known side effect of vaping.
“The Irish Heart Foundation told the Committee that another consideration was the health effect of second-hand aerosols from e-cigarettes”.
There is none and that should be the end of that. Even they admit there is no evidence, apart from the oft-promised ’emerging evidence’.
“Similarly, e-cigarette consumption in the public realm can also normalize these products for younger people.”
Yes, it’s called normalizing NOT SMOKING! That’s also known as denormalizing smoking.
To support its argument the committee cited the WHO statements on e-cigarettes. Clive Bates has torn that apart here and the SCHEER report which I tore apart here If I can see the problems with that, why can’t the TDs who shamelessly put their names and faces to this report. BTW I suspect is as much as they contributed to the final report. It reads like it was written by the Tobacco Policy Group. An arm’s length government quango that was set up to oversee Ireland’s Tobacco-Free Policy.
The Committee also heard that there may be a need to introduce no-smoking zones outside school gates and hospitals. The committee seems blissfully unaware of the smoke-free campuses that currently exist on all hospital, school, and college grounds and which naturally includes e-cigarettes. Yes, these are voluntary and as a senator of the Oireachtas once told me “You can just ignore that!” Perhaps they want the force of law applied. That’s going to make all the difference.
When e-cigs were driving down smoking rates to a historic low, the Irish Heart Foundation and the Irish Cancer Society along with the Royal College of Physicians of Ireland all went on the attack against vaping, using the unconnected THC-related events in the US and cautioning people against vaping. People do listen to this and in due course, people went back to smoking. Though it has to be said, there was also a pandemic, and data was confounded by the restriction on gathering. Even Healthy Ireland cautioned against using the resulting 1% rise (within the margin of error) as evidence of a resurgence of smoking prevalence. So maybe people don’t listen to this nonsense anymore.
Tobacco Control ignored this warning from HI and instead sought to use this blip as evidence of a need to restrict safer products while keeping the most deadly form of nicotine consumption as available as ever.
That’s not exactly accurate, they do want to ban vending machines and sales of all nicotine products at festivals and from temporary structures. Of course, smokers can still buy 3 or 4 packs when going to a festival so it’s more about inconveniencing smokers than helping them.
It becomes obvious at this stage that the various so-called health bodies are not trying to reduce the health burden of nicotine consumption which they do not bear, that falls on the smoker, they are desperately trying to keep it as harmful as possible. They need cancer and emphysema and heart attacks to justify their jobs. They need sick and dying smokers to exploit for their campaigns in their misguided crusade toward a nicotine-free world.
Like some form of Munchhausen Syndrome by Proxy, tobacco control need the harms of smoking to keep itself in the spotlight.
If they were concerned with the health toll of smoking they would use every available tool to reduce this. Instead, they want to continue with a set of policies that have reached the end of their usefulness. Instead, they discourage the uptake of safer alternatives as much as possible and blame the resulting rise in smoking on the safer alternative.
If they get their way with this set of proposals and we see the inevitable rise in smoking, will they express regret? Admit their error? Reverse course? Of course not, they will double down on what has failed and blame everyone but themselves for the reversal of the decline in smoking. All the while trousering the funding they will beg for ‘to fight the scourge of nicotine-related illness.
So what can be done? Well, that got me thinking and I think there’s another blog post in that.
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.
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?
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.
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.”
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.
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;
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 reduce risk might provide a false sense of security and lead to reckless behaviour 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” mould 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 is cited at 2.2% among adolescents. These are products illegal to purchase, have no advertising, no flavours, 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?
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 behaviour among the ‘good kids’ As the urban dictionary defines an epidemic; “A disease or behaviour 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’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 andtechnical information on electronic cigarettes. The aim of this scientific Opinion is to feedinto the Commission’s reporting obligations under Article 28 of the Tobacco ProductsDirective 2014/40/EU (TPD) and also help the Commission in assessing the potential needfor legislative amendments under the Directive or other regulatory/enforcement measures.
The Opinion addresses the role of electronic cigarettes, focussing into potential impacts onthe EU context, in relation to:
1. their use and adverse health effects (i.e.; short- and long-term effects) risksassociated with their technical design and chemical composition (e.g.; number andlevels of toxicants) and with the existing EU regulatory framework (e.g. nicotineconcentration and limits)
2. their role as a gateway to smoking / the initiation of smoking (particularly focusingon 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, asappropriate, the existing provisions concerning e-cigarettes under the TPD (in particularArticle 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 time–frame 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)”
“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.”
“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 ASSUME, you 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.
“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.
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 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 Coronavirus 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 C19. This is typical of Luke’s misinformation. The entire article is similarly vague in 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 stay just short of straight out lying, demonizing vaping.
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 organizations 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’s assertion, nicotine’s effect 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
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’.
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 percent reduction in risk of being hospitalized with Covid-19
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 phenomenon, smokers are underrepresented in Covid 19 patients. I could link the study alluded to by the IHF and Luke Clancy but as it’s 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 there 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.
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.
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.
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