Turning over a new leaf.

I bought a new calendar today. One with big boxes to write stuff in and big enough print to see it without having to walk up to the wall. I already have a calendar app on my phone, one which syncs my social media and email appointments and audible reminders while presenting me with nifty quotes of the day.  But there is something familiar and convenient about a big picture with the whole month visible at a glance hanging on the wall and covering the dogy plasterwork. I like turning over the leaves each month, looking forward to the next pretty picture.

As I throw out the old one and look back on the last year, I thought it hasn’t been all bad. Nothing devastating happened. Which is a relief, as at this time last year things were a lot less optimistic.

The fear loomed large.

America was looking forward to the FDA’s deeming rules coming into operation, with Tim Mechling, of Mt Baker saying:

“2017 will be a trial-by-fire for bigger vape companies, and a death knell for mom-and-pop vape shops.”

Sadly many vendors did close their doors but at least the FDA extended the deadline and announce a new “continuum of risk” approach to nicotine products.

Over in Europe things stood still with Brexit dominating the agenda. Brexit proved to be no panacea to the TPD. It seems the UK is stuck with the regs for a long time yet.

We in Ireland expected little and got not less for once, a HIQA report almost endorsed vaping and the government announced they had no plans to include vaping in the smoking ban.

Italy taxed e-juice  at €4 per 10ml e-liquid. Italy’s monopoly on tobacco sales complicates the issue but it’s telling that actual tobacco product like BAT’s Glo and PMI’s Iqos get off with a very low tax imposition.

Down under, Australia held fast to its prohibitionist stance while New Zealand moved to sensible regulation.

But that calendar is now in the bin, I have a new one hanging in its place so let’s speculate what will fill it up.

Let’s get out the crystal ball!

crystal

This year will, I think, see Heat not Burn take the spotlight for regulators and tobacco control. Expect to see far more ‘studies‘ on HnB. Heat not Burn is probably not as safe as vaping or oral tobacco such as Snus but it may well be safe enough to offer huge health benefits for consumers. Both regulation and distribution already fit HnB better than they fit vaping which has had to build its own distribution from the ground up while fighting regulation designed for a different product, smoked tobacco. HnB has the backing of big tobacco and could expand far faster than vaping did, possibly gaining ground before tobacco control can whip up enough opposition, but importantly without disrupting the government’s income stream from tobacco. It also has the advantage of riding the coattails of vaping in reducing the opposition to reduced harm products and creating a space for alternative nicotine products.

Things will become slightly easier for vaping as more and more evidence of its effectiveness as a smoking replacement and less and less evidence of any harm is found. It will morph in form-factor slightly, as it becomes a much more mass market product, expect to see more pod or cartridge style products as vaping seeks to claim the hardened smoker and compete with HnB. The success of the JUUL e-cig by Pax Labs won’t go unnoticed and no doubt will result in similar devices. Though the regulations in the TPD may delay this, the need to compete with HnB and satisfy consumer demand for simpler products makes it inevitable. Overcoming the TPD limitations is going to be challenging.

The big hurdle to clear is public perception.

Without official endorsement by public health bodies, its going to be an uphill struggle to overcome the campaign of Fear, uncertainty and doubt peddled by the tobacco control lobby. The stubborn refusal of the WHO to acknowledge harm reduction in tobacco is frustrating. Nevermind the mocking comments from non-vapers looking for cheap laughs.

Vaping will still have to fight for space in the market both on the regulation front and taxation. I expect to see some moves to either tax or increase the tax on vaping products in their own right. Currently, vaping is covered by VAT and other consumer taxes but escapes the tobacco duty. This will come under pressure as revenue from lit tobacco falls, if HnB gets a license here then I expect that to be the point when full taxation will be applied to vaping.

The extension of smoking bans to vaping will continue to spread piecemeal as more and more bars and public spaces are lobbied by tobacco control to ‘set the lead on this’. It’s already happened on college campus despite the evidence and will be extended further.

I also expect to see much more consumer advocacy emerging as the success of the UK advocacy movement becomes apparent compared with the restrictions imposed elsewhere. Let’s just say I feel that one “in me water” for now.

 

 

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It’s Good to Talk.

This week I attended a thing in Dublin.  This thing to be exact. GFN Dialogues Hosted by the Irish Vape Vendors Association, this was an opportunity to hear the current arguments on nicotine from a few of the experts.

Now I’ve never been at something like this before and sort of expected dry presentations with pie charts, bar graphs, histograms and maybe even the lesser spotted stemplot. If graph porn is your thing, you would have been disappointed, Oh there were a few graphs and even some sets of stats but none of this was dry presentation. It turned out to be an entertaining set of presentations which ran for about 15 to 20 minutes each.

 

While that may seem a short time to cover the subject, once you see it set out in bullet points it makes perfect sense. It’s a simple argument.

  • Harm reduction works
  • If attractive to the consumer it works best
  • Smokeless nicotine reduces harm
  • Right now E-cigs are the most attractive reduced harm tobacco alternative.
  • Advantaging e-cigs will deliver a public health benefit.

David Sweanor covered the history of harm reduction using the example of how refrigeration reduced gastric cancer rates.  A simple example of technology reducing risk and providing a public health bonus.

Martin Dockrell showed how harm reduction is a proven strategy in public health and provided, using graphs,  evidence of the comparative harm reduction offered by the new nicotine products. Martin is an engaging speaker and made a convincing argument. Pondering why the simple message  “switching to smoke-free nicotine products reduces harm” isn’t getting through to the general public, he conceded that it was down to public health failing to promote this message in a climate of click-bait headlines; some of which came from elements in public health.

Sarah Jakes from the New Nicotine Alliance UK shared her story. A smoker who quit and relapsed several times, she discovered e-cigarettes and hasn’t looked back since. She went on to co-found the NNA and now works to represent consumers and advocate for tobacco harm reduction.

Gillian Golden represented the Irish Vape Vendors Association who hosted the event. Showing her ability to work right up to the deadline, she even included data from the Healthy Ireland Survey which was only published that morning. As 37% of people who quit smoking used E-cigs, more than quit using NRT, this event should have drawn interest among the stop smoking service providers.

 

 

dublingfn
Photo credit Vape Business Ireland

 

 

Opening to the floor resulted in some questions and some interesting discussion. Nothing you wouldn’t know if you are keeping up with the discussion but I presume as this was the first opportunity of this kind in Dublin, not everyone there would be. The ones who needed to hear this are the public health bodies, HSE, ASH, and the health charities.  I hope they availed of the opportunity. Hopefully, there will be further opportunities as this is only the beginning of the conversation here in Ireland.

[Edit] Videos of the presentations are now available on Youtube, you can watch them here along with presentations from the other GFN Dialogues.

Martin Dockrell at GFN Dialogue Dublin.

s

At swimdaily, two birds.

Philip Morris International has announced they are going to  “build PMI’s future on smoke-free products that are a much better choice than cigarette smoking“.

WOW! That’s big news, though not as big as it seems, as so far PMI have only one smoke-free product (they have three more in development, two heat not burn and one vapour product) and no one thinks they will stop manufacturing and selling smoke producing cigarettes in the immediate future. Naturally, this news wasn’t greeted with applause from tobacco control. Instead, they responded with the usual suspicion, derision, and downright rejection. Hey Ho, that was to be expected. What was surprising was the reaction to Derek Yach’s involvement.

The Vision – Foundation for a Smoke-Free World

As the one who led the development of the WHO’s Framework Convention on Tobacco Control, you would think his name would lend weight to this move. Instead, he gets accused of going to dark side , his effort dismissed out of hand and shade thrown his way by tobacco control.

It’s not like he is working directly for PMI, in fact, he claims his independence remains intact. “The grant terms, bylaws, and non-profit status of the Foundation preclude PMI or other tobacco industry representatives from involvement in Foundation governance, or from having any influence over the Foundation’s funding decisions, strategy, or activities“. That’s from the Press Release from  Foundation for a Smoke-Free World. It appears it’s an independent organisation which gets initial funding from PMI much more than it’s a front for PMI to influence policy.

However I can understand the scepticism, no one spends money without expecting something in return and as Cloe Franks, from the organisation Corporate Accountability International.says;

“With more and more countries implementing the lifesaving measures of the global tobacco treaty and institutions like the UN Global Compact severing ties, one has to wonder if this is simply another attempt by PMI to regain a lost foothold in international and public health arenas. At the very least, this is clearly an attempt to lock in e-cigarettes and other ‘reduced Harm’ products as the solution to the public health epidemic that PMI continues to drive and profit from.”

This caught my eye as it implies that e-cigarettes and other reduced harm products are not the solutions.  Of course, whether e-cigs or other smoke-free products are part of the solution or part of the problem is the subject of the debate. But the answer is less inherent in the products themselves as it is in how they are managed and presented. The wrong regulation could easily end up turning e-cigs into training wheels for smoking while the right regulation could turn them into replacements for lit tobacco. Like any technology, it’s less about what the technology can do and more about what we do with it.

The reaction of some e-cig advocates, one of suspicion and mistrust is a different matter. E-cig advocates have a vested interest in the promotion of reduced harm products but some fear this is PMI attempting to corner the market for their own products. It probably is. Though it’s just as likely it’s PMI attempting to prepare the market for their products among other products. I doubt PMI see the myriad of small e-cig producers as direct competition. Their targeted rivals are now as always, other Tobacco Co’s. PMI target customer is the smoker. If this initiative can sway current smokers towards reduced risk products and away from lit tobacco, they have stolen a march on the other tobacco companies.

doubt-and-fear-ahead

This open letter to PMI from a selection of tobacco control orgs demands they discontinue production, marketing and selling of cigarettes As though this would reduce the number of smokers or change the market in any way other than boost tobacco controls ego.

“Cigarettes cannot be “re-engineered” to make them acceptable in global commerce; they are inherently defective. There is no safe level of consumption, and they provide no necessary benefit to their consumers.”

So it appears tobacco control has set its face against any reduced risk product. As to not providing a necessary benefit? What kind of measurement is that? Very few products beyond food shelter and sanitation provide a necessary benefit. The rest are unnecessary benefits, some of which come with a cost. It’s the balance between cost and benefit that matters. The letter is nothing more than a reaction to this announcement because tobacco control fears its success.

If they do succeed not only will they have rebranded themselves but they will contribute dramatically to reducing the health toll of smoking. You can see why Derek Yach has been tempted to ‘the dark side’.

The rewards, if it works, are huge while the risk is nothing more than his reputation and one billion of PMI’s money. The fact that he has put his reputation on the line shows integrity on his part. The fact he has decided to concede a partial victory to the tobacco industry shows he is a pragmatist about achieving a smoke-free world. There isn’t a snowball’s chance in hell of a 5% smoking rate worldwide (or anywhere at all) without the option of reduced risk smoke-free products.

Derek sees a worldwide problem which cannot be solved by small mom and pop stores fighting both the tobacco industry and tobacco control. Even with the lax regulatory regime vapour products have existed in for the last 12 years, they have only achieved a small penetration into the smoking market. So small that tobacco companies don’t even register the figure. In the U.K. and the U.S., the best they have achieved is around 15% penetration. If a smoke-free world is to be a realistic option, it’s going to require the marketing strength of a multinational like PMI and the support of public health bodies and governments. This Foundation for a Smoke-Free World is the first step in that direction. It will require goodwill from the aforementioned public health bodies, tobacco control and governments. Whether it gets that is another matter entirely.

Another matter is will it make any difference? We have seen in Australia how evidence was ignored, warped and misrepresented to continue the ban on nicotine. No amount of evidence or support from reputable public health bodies could shift the ingrained suspicion and fear of nicotine. I fear the same fate awaits any research from this foundation. ” Paid for by PMI” might be nothing more than an ad hominem but it works with politicians and regulators.  If there is going to be an acceptance of harm reduction and adoption of reduced risk products it will depend on the work of advocates who promote the findings of foundations like this, who counter the junk science with reasoned arguments and it will also depend on PMI and JTI and BAT, who whether we like it or not dominate the market for tobacco products (and the sweet, sweet nicotine they confer) and will either come on board the reduced harm train or continue to fight against us.

We must welcome them cautiously but welcome them nonetheless, there are according to the W.H.O. 1.1 billion smokers worldwide, their’s room for everyone in the marketplace.

FDA change tactics in the war on tobacco

It’s a bit of this and a bit of that.

curates_egg_large

Last Friday the FDA gave us this Official Press Announcement It came a bit of a surprise not just because it came without warning or leak but because of its contents. As you know the FDA now has deemed authority over e-cigs and has insisted on authorization for any product not on the market before 2008. Fridays announcement has been greeted with applause by e-cig proponents as the cut off date for authorisation has been moved to 2022.  It also contained the announcement that a conversation around reducing and removing nicotine from cigarettes will be started. Also some stuff about the role for harm reduction in the fight against tobacco.

 

While the movement of the deadline is welcome, I don’t think it’s because of any change of heart. I suspect it’s more to do with the FDA realizing it’s won’t be able to achieve even a fraction of the process in the current time limit. They had no option but to extend the deadline or risk looking incompetent. The talk of harm reduction may just be a cover story.

The stuff about reducing nicotine in cigarettes is another McGuffin. It’s a wet dream of the anti nicotine zealots and probably just thrown in to shut them up. Only a fool would think it would achieve anything other than a black market in nicotine containing cigarettes or people lacing their zero nic cigs with e juice.

Oh, I get the argument, nicotine addicts people to tobacco which is mostly consumed by smoking which is the major cause of the harm. Therefore remove the nic and no one will get addicted and so no one will smoke.  It sounds logical enough but the flaw is those already addicted will either switch to another consumption method, bypass the low nic cigs and buy from the black market or smoke more. Then again I’m not sure tobacco control care about current smokers, I’m pretty sure the focus is on preventing future smokers and letting current smokers quit or die.

It’s not all bad.

Yet, this announcement had some positive stuff about harm reduction and encouraging people to move to lower risk products but I’m not persuaded this is anything more than a justification for moving the deadline. I don’t see any commitment to doing anything required to encourage switching. It will take a huge public information campaign to encourage this and undo the years of misinformation already planted in the public mind. Apart from the stick of no nic cigarettes, their’s nothing else. No allowance for new products or innovation, only current products may be sold without authorization. In other words, the market has been mothballed. Getting authorization is a nightmare, if SNUS can’t get a reduced risk status, what chance have e-cigs got?

OK, I’m being overly pessimistic, this is a move in the right direction. Once we see the promised list of product standards we will know how much of a move. Remember, nothing has changed but the date, All that’s changed is when not what or how.

Good stuff that gives hope.

“Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less harmful sources, needs to be the cornerstone of our efforts – and we believe it’s vital that we pursue this common ground.”

This, of course, is an approximation of the perfect scenario. Personally, I would have worded it as ” Envisioning a world where cigarettes are no longer the principal choice for adults who want or need nicotine and are replaced by safer reduced risk products which are the consumers preferred choice.” I think the idea of forcing people by removing product is doomed to failure. It creates the illusion that nicotine is the problem so switching to smokeless but nicotine containing products is at best still a huge risk and at worst pointless. It risks creating the impression that low nic cigarettes are safer than normal cigs and could lead to more people smoking. They are not addictive so what’s the problem? Right?

 “the agency also will seek input from the public on a variety of significant topics, including approaches to regulating kid-appealing flavors in e-cigarettes and cigars.”

This is something we expected, an attack on flavors, I’m not sure what ‘kid appealing flavors’ are. It’s the language of moral panic more than anything else. But they do have to acknowledge the ‘concerns’ of the alphabet groups who have been using this argument forever. The following line gives some hope.

“seek public comment on the role that flavors (including menthol) in tobacco products play in attracting youth and may play in helping some smokers switch to potentially less harmful forms of nicotine delivery”

At least they recognize the argument that flavors have a role in attracting adult smokers away from lit tobacco products.

I think as minimal as this announcement is IMNSHO it’s still a seismic shift in emphasis. It shows that at least in the FDA there is recognition of the current evidence based position and they are willing to go in this direction. Wheather they can bring the rest of public health with them remains to be seen.

For now, the pressure on e-cigs at the federal level has dropped, it will only increase at state and local level but the direction the FDA has indicated is a huge help in fighting that pressure.

 

 

If it ain’t broke…..

 

Crocodile tears.

Just today the BBC reported that “More than half of UK vapers ‘have given up smoking’.

Some 1.5 million vapers are ex-smokers, compared with 1.3 million who still use tobacco, a survey of 12,000 adults for Action on Smoking and Health found.

Good news for the people who said e-cigs would work as a complete replacement for lit tobacco products. Bad news for them too, as ASH point out;

But Ash said the message that vaping was much less harmful than smoking had not yet got through to all smokers.

I wonder why? No doubt those lamenting this misinformation will blame ‘the media’, not bothering to point out that the media get their information from the same people now crying crocodile tears over this. All the campaigning and lobbying to have e-cigs declared medicines, banned from public use and rushed press releases of every junk science ‘study’ that adds to the fear, uncertainty, and doubt couldn’t be the cause as it’s intention was good, right!                                            deboraarnott

DICK PUDDLECOTE covers this in his blog today, I’ll just leave this pic here!

 

 

 

 

 

 

And how are things at home?

Meanwhile back in Ireland, The IMO had their AGM. Offered the chance by Dublin GP Dr Garrett McGovern to “endorse” e-cigarettes as an effective tool and as a “far safer alternative to tobacco”, they instead voted to “recognise” e-cigarettes as a potentially effective tool for smoking cessation and a far safer alternative to tobacco.” The result of concerns raised by the IMO Public Health and Community Health Doctors Committee. I wonder what these concerns were exactly? Probally the usual, “we dont know enough yet” “gateway” and the rest of the tosh.

Still, as much as I suspect it was the inate concervatism of the medical establishment that caused this change, I also think they got it right, even if for the wrong reasons.

Lately their has been an effort by anti smoking groups to gain control of vaping, at least to control the narative around them. This rush to embrace e-cigs as effective cesation products is not in the interest of either vapers or smokers. It will not lead to an ease of restrictions or regulation, it will not lead to greater uptake by smokers, in fact the oposite is far more likly. Once e-cigs are seen as cesation products, then they either ‘work’ or ‘don’t work’. Which misses the point of vaping. It works as what it is; an alternative to smoking. If the side effect of that is less smoking then that’s a bonus but it’s not the point.

The IMO recognising that vaping has a role in reducing the prevelence of smoking but not endorsing them as cesation products might be the exact position e-cigs should hold in tobacco control. A potential allly but not a servant to tobacco control. I know that’s not what the IMO intended but it would be the right call.

 

 

HIQA tell it like it is

The HIQA ” Report on the results of the public consultation on the draft health technology assessment (HTA) of smoking cessation interventions” is published. Yes, it’s a hell of a title and it’s a hell of a document. 182 pages not counting the appendices.

It’s available on their website here; HTA of smoking cessation interventions

000cb99b-800

 

For those of you wondering who HIQA are,

The Health Information and Quality Authority (HIQA) is an independent authority
established to drive high quality and safe care for people using our health and social
care services in Ireland. HIQA’s role is to develop standards, inspect and review
health and social care services and support informed decisions on how services are
delivered.

“In January 2016, HIQA commenced a health technology assessment (HTA) of
smoking cessation interventions following a request from the Department of Health
for HIQA to examine the clinical and cost-effectiveness of a range of different
treatments to help people quit smoking. The aim of the HTA is to inform health
policy decisions about potential improvements to the provision of smoking cessation
services within Ireland’s public health service.”

The message the government got!

Tasked with this, they critically examined all the cessation methods, pharmacopeia and self-help, counseling, patches, lozenges, and e-cigarettes. They duly published a draft report and held a public consultation. At the time, the draft report was covered in the media as saying e-cigs work.  They were almost as effective as combination therapy and at half the cost. We all cheered and thought that this evidence would mean that e-cigs would now find a place in the tobacco-free Ireland toolbox. Not that we give a damn about a tobacco-free Ireland, it just means we get less stick for vaping.

So we sent in our submissions and waited for the set of recommendations.

Scratch that, we didn’t exactly inundate them with responses. Though the largest reaction was to e-cigarettes, only 13 of those were from individuals. 13! 48 responses and only 13 from individuals!

35 were from organizations, health bodies, charities, business orgs and such. Which means at best only 12 other people sent in a response!! I would call that bloody exasperating and downright disheartening. Oh well.

Of those  48 responses, most were negative both to e-cigs and also to the treatment with the most actual evidence backed success rate, varenicline in combination with NRT. Remember this was found to be the most cost effective and effective solutions in the draft report. It’s almost as if a large section of the country’s health charities don’t want to see a tobacco-free Ireland at all.

Anyway, what is interesting about this is the fact that in the draft report, HIQA found combination varenicline and NRT as the most cost effective and e-cigs a close second. When the recommendations to the government are published, it turns out their’s not enough evidence for e-cigs and the recommendations are to wait until there is. I suspect the strength of the negative responses had more influence on this than the research data.

Evidence-based ?

A complete synthesis of the available evidence in relation to the long-term health
effects of e-cigarette use is beyond the scope of this HTA. However, the work of
other public health bodies did not indicate that there was sufficient evidence of
harms to exclude e-cigarettes as a smoking cessation intervention in this HTA

This quote, the emphasis is mine, shows that someone in HIQA “gets it” and seems intended to scold the naysayers.

there is a concern that a policy decision for smoking cessation practitioners to
advocate the use of e-cigarettes by those attempting to quit may contribute to
increased e-cigarette use among people who have never smoked. This type of e-
cigarette use may act as a gateway to smoking combustible tobacco. It is difficult to
estimate the relative contribution of promoting e-cigarettes as a smoking cessation
aid to any growth in the use of e-cigarettes among people who have never smoked,
as it is likely to be influenced by a range of other factors, such as marketing of e-
cigarette companies and regulations on the sale of these products. Estimating the
proportion of people who would later switch from e-cigarettes to smoking (but would never have started smoking were it not for having been e-cigarette users) is even more uncertain.

They even access the gateway theory correctly, yet give it sufficient credence to reject recommending e-cigs. Cognitive dissonance?

Now we get to the real reason for the objection to e-cigs,

The underlying issue that connects all of these comments is the impact these
issues will have on the uptake rates of the most effective quitting interventions.

Yes, impact on incumbent players, remember that the draft report ranked e-cigs second in cost effectiveness. Of course one of those incumbent players is lit cigarettes but whatever.

In fairness to HIQA, they did an excellent job of evaluating the evidence, sifting through hundreds of reports, analyzing the data, rejecting reports that lacked credibility and offering the result in an impartial manner. My main fault with it is, it examines the issue through a medical lens. Harm reduction is mentioned and I get the impression HIQA wish harm reduction was part of their remit.

While considerations about harm reduction, including the potential role of e-
cigarettes among the subgroup of smokers who do not want to make a quit
attempt, are beyond the scope of this HTA, the feedback received on this issue
provides a valuable resource for smoking cessation policy-makers to consider as
part of the wider approach to tobacco control in Ireland.

Shame they didn’t force this point more, ahem, forcibly.

Page 31 is someone calling for outdoor bans on smoking, to be expected but infuriating as it has no benefit to anyone other than aesthetic. This is supposed to be about health measures.

Anyway, I’ve spent too much time on this already, it’s an excellent report, carefully worded and well researched. It holds it’s focus on it’s brief; government funded interventions and the cost-benefit assessment of them.

The biggest shame is that lobbying had such influence on the final report over the draft report. It certainly shows that making the effort to respond is important.

The message the public got!

Concerns vaping may act as ‘gateway’ to tobacco cigarettes

That’s the Examiner being used as an example of the kind of spin the report got. Pretty much the same in the Irish Times and RTE online. Here it is being discussed on RTE’s Drivetime;

HIQA report on e-cigerettes

Note the misrepresentation of the subject of the actual report in the title!

 

I thought it must have been the emphasis given in the press release from HIQA

HIQA press release

Yep, it’s right there. Not surprising as e-cigs drew the biggest response during the consultation period. What is disappointing is how their position moved from the draft report.

“HIQA’s analysis shows that increased uptake of e-cigarettes as an aid to quitting would increase the number of people who successfully quit compared with the existing situation in Ireland and would be cost-effective, provided that the currently available evidence on their effectiveness is confirmed by further studies,”

Again this shows the value of letting them know. Perhaps if hundreds or thousands of the current users of e-cigs had replied to the consultation instead of a paltry 13, we would have had a more positive result.

Lesson to be learned,

Use the opportunities given to tell them your story. No use complaining when it’s all regulated away from you if you made no effort. While this report is now finished, it’s only advisory and goes to the Joint Committee on Health and to the minister for further discussion and decisions. In other words, their’s one last chance to have your say. E-mail, write or personally contact the committee or its members. Tell them your story and emphasize how any move to further restrict e-cig access or use will have a damaging effect on you. Tell them how they helped you, it’s not about having e-cigs included as cessation therapies. It’s about not having e-cigs treated as smoking, taxed as smoking and restricted in availability to smokers.

Contact details here;

Joint Health Committee

And list of the members on this page;

Joint Committee on Health – Membership

 

 

Ashes to Ashes!

 

hny

“This time next year Rodney….”.

Yeah, we all do it, make resolutions which we immediately abandon. The big one is losing weight, followed by giving up smoking. Get a gym membership, join a slimming club, try an e-cig. No?

No! No, No! Not an e-cig! Not according to ASH Ireland who are “against vaping as a solution, saying that quitters should use patches or gum instead”. They went on a media blitz with this message on January the first, getting coverage in most national newspapers, radio stations and online publications. It was to be expected, this has been ASH’s position since e-cigs first turned up around 8 years ago and despite the lack of emerging evidence of harm and the emerging evidence of their usefulness as tools to reduce smoking prevalence. ASH has not budged. (They do on the other hand sing the praises of Plain Packs which they say are proven to reduce smoking despite the lack of empirical evidence. It seems projections are good enough if it’s a measure they like.)

Dr Patrick Doorley, Chairman of ASH Ireland said today;“The New Year is a good time for people to consider quitting smoking and I encourage them to do so. Many people quit for good at this time each year. For most people they will make a number of attempts before finally quitting – so I would encourage those who have tried before to try again. People can attempt to quit on their own, or call the National Quitline on: Callsave 1850 201 203.”

Not super encouraging for people thinking of quitting, it’s almost as if ASH aren’t that pushed if you do or don’t. Pat isn’t too bothered because he has put his faith in Plain Packs;

“In Ireland we have lost some time with the full roll out of the plain packaging legislation, however, the final legislative process will be completed in the New Year and it is vitally important that the Government then push ahead and get the plain packs on the shelves as a matter of urgency.”

 

Being the sceptical kind, I paid little attention to this apart from sighing and rolling my eyes when they turned up on the telly or radio. (I did this a lot, I do it a lot anyway but this week had me working overtime) However, by the next day, I did notice something, a slight change of tone, a small uncertainty in the condemnations. January the third, things got even stranger, ASH now were qualifying their initial warning and instead of “vaping doesn’t work” they were saying “there is some evidence but not enough…” Did someone somewhere have a word in their shell-like?

A week is a long time in politics and make no mistake, this is politics not health. On Jan the fifth  HIQA released the draft of their Health Technology Assessment on smoking cessation therapies. I’ll add a link at the end if you want to plough through it, it’s long, detailed and has lots of graphs and tables if that’s your thing.

I’ve gone through it and to be fair, it’s a pretty good if over cautious assessment of the current evidence on e-cigarettes. Heavy on the caution in regards to both their usefulness and the studies available. Stating that most were inconclusive at best and not supported by the real world evidence at worst. Here are some highlights pulled from the document;

if e-cigarette use in Ireland (26%) rose to the levels currently reported in England (45%), the number of prescriptions required could fall by nearly 40%

e-cigarettes and combination varenicline and NRT the most cost-effective strategies when individual therapies are compared to each other.

regulating vaping products as tobacco products may give the message that both are of similar risk

Any smoking cessation intervention must be made available in a way that promotes the autonomy of the individual by providing information on the risks and benefits associated with the particular intervention.

provision of inaccurate information on comparative risk is fundamentally unethical as it fails to allow consumers to make informed choices

Continuing increases in the uptake of e-cigarettes are likely to improve the cost-effectiveness of the overall mix of cessation interventions in Ireland, by increasing the number of successful quit attempts at an acceptable cost .

No quibbles with any of that. I noticed that a lot of the data on e-cigs,  smoking prevalence and smoker demographics is from UK or US sources because such data isn’t available for Ireland. Which raises the question, what the hell do the Tobacco Free Research Institute of Ireland do exactly?

However, it’s not all good. While mostly well done, the ideological bias shows through when they give credence to this kind of nonsense;

1.Although there is clear benefit to existing smokers from switching to e-cigarettes, there are concerns that if it becomes socially normalised, large numbers of people who have never smoked might take up smoking e-cigarettes

2.It is also possible that e-cigarettes will have a ‘gateway effect’ for non-smokers who take up e-cigarettes, and they may later migrate to tobacco cigarettes or marijuana.

3.Smokers who use e-cigarettes as a smoking cessation aid may in effect be swapping tobacco for another dependency,

1.No evidence this is happening so this is nothing more than a biased opinion which should have no part in a policy document.

2.Marijuana! OFFS! gateway theory is nonsense and needs to be buried with phrenology and Humourism. This is just reefer madness all over again.

3. Sounds reasonable until you realise tobacco dependence is a synonym for nicotine dependence so it’s not swapping anything, it’s replacing something with a harm reduction alternative. But “The tobacco control community are wary of accepting harm reducing products, such as e-cigarettes” and “If e-cigarettes make smoking socially acceptable, this could be seen as a retrograde step after decades of anti-smoking efforts”. 

Vaping is NOT smoking, how hard is it to understand?

There is a consultation process attached to this draft and if you want to add your voice, it’s available on the same page as the draft report linked below.

Anyway, the publication of this draft does give us a clue as to why ASH have had a full week of backpedalling on their New Years message.Here’s a free tip for the lads at ASH, it’s never a good idea to start with bold claims and then have to back down. It makes you look incompetent. If you’re explaining, you’re losing as they say.

I’m going to do what I do every year as far as resolutions go, I hope you take my advice and do the same. ASH might be better to not adopt this approach, I recommend they resolve to keep up with the literature and adjust position as the evidence indicates.It could save them further embarrassment!

nyr

 

Link to the draft report and the consultation paper