Angel or Devil?

I wish Juul hadn’t launched here in Ireland,

No really, they are more trouble than they are worth. Juul isn’t any different than the other so-called pod systems on the market but what they do have is a reputation. Some will call this brand awareness, I call it the ‘bad boy’ image. Do they deserve it? Probably not. As I said they are similar to any of the others who escaped this spotlight. That’s not the point. The point is rightly or wrongly Juul bring this negative image with them.

Of course, this isn’t Juuls fault, it’s the result of the USA’s reefer madness level anti-vaping hysteria. The manufactured panic seems to have found its poster bad boy in Juul and in demonizing it managed to make it the most popular product to demonize the whole vaping market with. I’m not sure it’s even the most popular vaping product though it draws huge media attention as this rubbish article in the Irish Times shows.

Applegreen starts selling Juul e-cigarettes

Applegreen have been selling pod systems long before Juul, Vype must feel left out.

Not just media though, our public health alphabet soup groups also get their knickers in a twist at the mention of Juul. Exhibit 1, page 10 of this sad and factually inaccurate report.

E-cigarettes and Heated Tobacco Products: An evidence review

Notice how there is no mention of the Juul’s main selling point in the American market, the 5% nic content or the fact that Juul in the EU cannot by law have more than 2%. Like everyone else they are restricted to max 2% nic., It seems for all the talk about nicotine being the danger, it’s the branding they hate. Again none of this is Juul’s fault, to be fair to them they started with a product for adults, marketed to adults and purchased by adults. Until public health caught on to the value of a single recognizable brand to focus their vitriol on. Ironically, they actually helped them by increasing brand awareness and in a “shooting yourself in the foot” moment made Juul a verb among teens. Exactly what they claimed they were trying to prevent.

Right now here in Ireland, there is enough anti-vaping hysteria in the media and enough anti-vaping lobbying going on without giving them a Juul shaped bullseye target to focus their campaign on. There must have been cries of delight when Juul announced a European launch from anti-vaping lobbyists because now they have a focus and loads of readymade propaganda from the States to recycle over here.

Juul may not add all that much that’s new to the selection of options but they are another option. The more options for smokers the better. If smokers want to use Juul that’s their right. If kids want to use Juul, well, currently that’s their right too, as our tobacco controllers forgot to include an over 18 age limit when imposing the TPD two years ago.

HSE TPD page.

It seems only Juul themselves thought to restrict adult products to adults.

Juul pulls vape products after retailer Challenge 25 failures

Anti-vaping hysteria is already in overdrive and Juul will only give them more ammunition to use. Not based on facts but on a brand and image that they themselves created.

As I said at the start, I which they never set foot here, our job as harm reduction advocates is hard enough.

So what could Juul do to counter this? Conform to TPD rules? Go beyond TPD rules? Restrict their marketing to in store only? They have done all of this but it has not reduced the fear mongering one iota.

You have to wonder what exactly makes them think that their product will outsell any of the others in the segment who so far escape the headlines and don’t impose self-regulation above the legally mandated ones?

Call me suspicious but I doubt the plan is to outspend the others by losing money until only Juul is left.

If I were CEO of Juul, I would be lobbying my arse off to get further restrictions on the competition, I, being an evil cut-throat capitalist would lobby for all vaping devices to be restricted to the exact specs of my product while securing all the distribution networks outside of independent shops because that’s the only way I can survive with the white heat of anti harm reduction bearing down on me. I would accept defeat in the fight against sin taxes, regulators always favor a product that raises revenue. In fact, I might mention to them that I wouldn’t be averse to my customers paying taxes. But that’s me and I’m evil.

Juul could just be willing to stake everything on a share of the inevitable reduced harm product market because they care about reducing the harm of smoking. After all, there are enough smokers to make that market worth a share of and if tobacco control keeps up the good work, it won’t be going anywhere soon.

And after all that I better add a link to Juul’s website, it’s only fair.

Over 18’s only ūüėČ

Easyway or the highway?

Just out today is Tobacco Free Research Institute of Ireland’s new research paper. Allen Carr‚Äôs Easyway to Stop Smoking – A randomised clinical trial.

Article as it appears in BMJ Journal Tobacco control.

A couple of quick observations. First, if this is science then I’m a Duck. They compared a ‚ā¨600 seminar versus a free email and text alert system. Do I need to point out the motivational effect of having sunk ‚ā¨600 in an attempt to quit versus a free phone app?

The other thing the trial showed was that education level was significant, the higher the education level the better the quit rate. In lower educated participants the difference between AC and Quit.ie was not statistically significant.¬† I wonder if this is because higher education correlates with lower smoking rates anyway and further motivates quitting when you’re the last man or woman standing in the rain having a smoke?

AC participants were instructed not to use any NRT or other medical intervention,, so using NRT in conjunction was only accounted for in the quit.ie group.  It was underused within the program by trial participants, which might account for some of the difference.

Of course, TFRII couldn’t just let this go without throwing shade at vaping. Even though no participants used e-cigs in the trial, they noted that having used e-cigs prior to joining the trial depressed quit rates in both legs. The big piece of the data missing is how long the participants had been smokers. They all smoked 5 or more cigarettes daily but as far as we know that could have been for the last 6 months, 6 years or 30 years. A fairly pertinent piece of information I would have thought. However, TFRII assumed age and years smoking was correlated so no point even asking. It’s one more question on a sheet of what I presume was 30 to 50 questions, it’s pertinence makes me wonder if it might have been worthwhile asking just for completeness.

Anyway, this is the usual level of poor work you get from tobacco control. At this stage, I’m surprised I’m still surprised by stuff like this.

The interesting thing is the conclusion;

The present RCT is positive and should encourage further trials and increase the likelihood that AC will take its place as a valid, effective and needed addition to available smoking cessation interventions.

Yeah so not being a licensed medicine having undergone rigorous trials isn’t a barrier for AC ? Probably because no pharmacopeia is involved which is fair enough, a sort of sure what harm can it do approach to our tax spending.

However, e-cigs because a pharmacopeia is involved, even if it’s a pharmacopeia already being indulged in daily by the user isn’t suitable because……?

No, I don’t get it either.

Way up north.

It’s good to be home.

Or is it….

While I was away in Poland, more on that later, this turned up in the Donegal Post

Vaping amongst Donegal’s young people cause for serious concern

It looks like Donegal has caught the vaping madness that has consumed America. Let’s take a look and see if there is actually a cause for concern.

many of these are young teenagers who are now addicted to nicotine as a result“.¬† That’s an evidence-free claim right there. This doesn’t bode well for the rest of the article. Chris Macey, Head of Advocacy at the Irish Heart Foundation agrees with this evidence-free claim. You would imagine the I.H.F. would have some real information but it seems they are as open to spreading panic as the rest.

Oh look, I could rip this to shreds bit by bit but what’s the point, it’s a collection of the usual bullshit we have seen repeated time and again. Shoddy journalism but paper never refused ink as they say. The real cause for concern is the Irish heart Foundation who should know better buying into this junk.

First lets set the facts straight. The claim that youth are vaping at worrying rates is pure speculation based on nothing more than people seeing some kids vaping. The facts are as shown in 2018’s Healthy Ireland survey.

Healthy Ireland Survey 2018

19% of 15 to 24-year-olds are current smokers, Of all smokers, vaping is 9%. So at the most 1 to 9% of these ‘kids’ vape. That’s maximum 1.9% of 15 to 25 year-olds. Of never smokers, vaping is at less than 1%. Not exactly a cause for concern, in fact, if switching to, or avoiding smoking lit cigarettes is the result, then this is a cause for celebration. As you can see we have a worryingly high prevalence of smoking in this age cohort. That should be the real concern. Kids experimenting with a much safer alternative should not. Of course, it’s not ideal, no nicotine product should be used by kids, they are adult products for adult users.

E-cigs should not be sold to underage customers, this is something everyone agrees with. Just not the HSE it seems. In Ireland, there is no restriction on selling vapor products to anyone. Yes, you read that right. The TPD should have been transposed into Irish law in 2016 and it was but for some unfathomable reason, the stipulation that ‘ENDS’ be restricted to adult users passed our HSE by. The one thing all stakeholders agreed on was the one thing no one bothered to implement.

I couldn’t believe this when informed so I rang the tobacco and alcohol control section of the Dep of health and asked if it was illegal to sell e-cigs to under 18’s. “That’s government policy” I was told. I then asked if there was specific legislation banning the sale of e-cigs to under 18’s. “No” was the monosyllabic reply. “WHAT? WTAF?” I replied, “are you saying that you never included an underage sales ban when implementing the TPD?” “Yes,” another monosyllabic reply. I thanked the man for his help and wished him a good day.

So there you have it.

Would a ban make any difference

What got me thinking was, would a ban make any difference?, as the Donegal Post reports;

“shops in south Donegal have of their own accord adopted an over-18 only policy. This of course helps to some degree. But it has also created an element of dealing by older students who have no difficulty getting served. They in turn sell the products on to younger teens. Some shops have also reported a serious problem with theft of vaping devices and flavoured products. “

Not exactly a ringing endorsement for bans.

The rest of the article is the usual long debunked junk, even dragging up the ‘popcorn lung’ meme. Not bothering to mention that popcorn lung has never been seen in a single smoker despite diacetyl being present in cigarette smoke at 100 times the levels found in diacetyl containing vapor juice. Or the fact that e-juice in the EU is prohibited from using diacetyl. Of course, the author qualifies the scary paragraph with ” debate as to whether e-cigarettes cause popcorn lung and other health problems. But the lack of certainty is largely viewed as being due to wide scale¬†vaping being a relatively new phenomenon.”

Yeah, the usual fear, doubt, and uncertainty trick.

EDIT:

Just as I hit Publish some new data turned up from ASH UK.

New research published today by Action on Smoking and Health (ASH) shows vaping remains uncommon among young people, and young people vape mainly just to give it a try (52%) not because they think it looks cool (1%). The findings come from an annual YouGov survey, commissioned by ASH, which examines youth use of e-cigarettes in England, Wales and Scotland (Great Britain).

Full study here;

Fact sheet: Use of e-cigarettes among young people in Great Britain

So still no ‘epidemic’ and no sign of that gateway, not even a gap in the hedge.

good times

By the way, drinking alcohol in the same age group is 66% but that’s not a cause for concern. 37% of 16-year-olds bought alcohol in a pub in the last month, 9% of 15 to 17-year-olds are current smokers. Not a problem worth a report in the Donegal Post though.

Plus √ßa change, plus c’est la m√™me chose

quote-the-more-things-change-the-more-they-remain-the-same-alphonse-karr-307319

It’s funny how things can actually be well past their prime and no longer function as they should, yet you hold on to them out of nostalgia for the ‘old days’, a fondness for them or a sense of loyalty. I can be a bit like that. I remember the first car I owned, bright yellow, fast and, if I’m honest, far too powerful for an upstart like me. After I’d sunk far more money into it than the thing was worth, I still couldn’t bring myself to give up on it. It felt like I was letting down an old friend.¬† In the end, I had to accept the fact that it cost too much and I was never going to fit a baby seat in the back of a Mazda MX5. Horses for courses and all that.

No matter how well something has served you, there comes a time when you have to admit getting to your destination is more important than impressing the onlookers.

Ireland has set its destination as ‘Tobacco Free’ by 2025, 5% of the population using tobacco. It’s chosen vehicle to get there? The World Health Organisation MPOWER Model.

Not a new model but a perfectly serviceable secondhand one that has a proven record. Or at least it would seem so. It has been used to reduce smoking to around 20% almost everywhere it’s been implemented, slightly better in some areas than in others but pretty much guaranteed to reduce tobacco use to 20%. You see the problem right? If your target is 5% then this horse isn’t going to stay the course. A better model is needed.

Better models are available, the Swedish model for example. Sweden has basically achieved a smoke-free generation with daily smoking rates at 5%. Not tobacco-free though as one of the main drivers of the Swedish model is SNUS a smokeless tobacco. It seems as if the 5% destination is to be arrived at then the key factor is making alternatives to lit cigarettes widely available and encouraging them. The argument against SNUS is that the cultural difference between Sweden and the rest of Europe means it wouldn’t work here.

In the UK they too have a similar bold destination in mind but a different model driving them. In a recent parliament debate on the UK tobacco control plan, this nugget came to light.

Sir Kevin Barron highlighted the gulf between the UK and Ireland, two countries with identical traditional tobacco control policies but with differing approaches to e-cigarettes. Between 2012 and 2016 smoking dropped by nearly a quarter in the UK . In Ireland, where e-cigarettes are viewed with suspicion, the smoking rate actually went up in this period.

The significant parts of this are the huge drop in smoking and the cultural and regulatory similarity between the UK and us.

Now, our own tobacco control plan, Tobacco Free Ireland has just published its own annual report Tobacco Free Ireland Annual Report 2017 which makes no mention of any harm reduction aspect to the policy. In fact, apart from an aside that vaping has been included in some voluntary smoke-free initiatives,  e-cigarettes are only mentioned twice in the report. Both times in relation to restrictions on them;  transposing the TPD regulations on advertising and standards. No mention of the possibility that they may be the best chance of reaching the magical 5% anywhere in the report.

They do mention the impression they made on the bystanders though;

The recognition by the WHO of the Department of Health’s outstanding contribution to tobacco control in its World No Tobacco Day Awards

So that’s a win ?

Smoking has risen since this effort started. This is the number of ‘current smokers’ in Ireland today I’ll say that again, smoking has gone up! Up! The plan isn’t progressing nicely, it isn’t just a bit behind its targets, it’s an abysmal failure.

You have to wonder how they intend to get to 5% if they continue with this effort?

Change the record.

We now have two examples of alternative nicotine products reducing smoking or tobacco use, one the Swedish example, a tobacco but smoke-free alternative and the UK example, a non-tobacco and smoke-free alternative. Both proven to work, both easy to implement. At no cost to the taxpayer unlike the NRT Champix merry go round.

You have to wonder why we can have a harm reduction policy that rightly informs the public of the safest way to consume cocaine Cocaine ‚Äď Reduce the Harms but cannot have a harm-reduction policy that would inform the public of the safest way to consume nicotine?¬† Fondness for the old ways? Impressing the bystanders?

Getting your retaliation in first.

This morning Luke Clancy turned up on the breakfast show on Newstalk radio. Luke is someone I have mentioned before, he’s head of the Tobacco Free Research Institute¬†of Ireland.¬† I didn’t expect him to come on to announce a Road to Damascus conversion to harm reduction but neither did I expect him to embarrass himself by promoting the virtues of the¬†¬†PLoS One¬†study. After all, TFRII has as one of their personnel, Dr. Shasha Li, an experienced teaching assistant on Mathematics and Statistics in Trinity College Dublin for 4 years . She holds an MSc in Finance and double B.A. degrees in Economics and Mathematics. She must have pointed out the serious flaws in the study and warned Luke not to get involved in this shitshow. He did and it was awful.

Luke is not a natural public speaker, he’s clumsy, ponderous and boring to listen too. He seems aware his argument is weak and almost sounds apologetic for making it. Still, you have to put bread on the table and honest work is hard to find. Luke will not balk at propaganda¬†to butter that bread.

The playback is here and Lukes bit is about 10 minutes from the end, no time stamps so apologies for not giving a start time.

Newstalk Breakfast 20 March 2018

“not as good as some of the agents we already have that people aren’t¬†using”

When presented with the findings of the study “E-cigarettes will do more harm than good” Luke dithered and claimed it was “another bit of evidence for someone like him with an interest in tobacco control.” “I’m interested¬†in whether¬†e-cigarettes will do more harm than good overall,” he says. He admits e-cigs are probably¬†helpful for quitting¬†but they are

“no better and not as good as some of the agents we already have that people aren’t¬†using”

If people aren’t¬†using these agents then are no bloody good at all. Other than in a theoretical sense. This is the thing about smoking cessation, it works best when it’s attractive to the consumer. It’s about as much use as a knitted condom otherwise.

The presenter then offers some dead air filler and waffles about¬† “we don’t know” and how it helps people quit but we don’t know how and, gathering his train of thought, gets back to the point, “Now we hear it’s a push factor for people starting smoking”

Do we really want our children addicted to nicotine?

Luke agrees this is a worry, e-cigarettes are likely to be less harmful, but that is not to say they are harmless, and worryingly nonsmoking young people are using them. They are still nonsmokers Luke so you shouldn’t worry at all, you should be delighted. Oh and the use of likely and not harmless is pure FUD, their’s no likely about it, they ARE less harmful, over 95% less harmful. The point of using these weasel words is to sow doubt and uncertainty. Time for fear to be added. He asserts there are several American studies which suggest¬†they are a gateway to smoking. He then asks do we really want our children addicted to nicotine? I dunno¬†Luke, do we? Because there is zero evidence that nicotine sans tobacco is addicting. Smoking otoh is addictive¬†perhaps¬†you would prefer they went with that option?

Luke then claims it’s not certain¬†e-cigs help people to quit and worryingly¬†e-cig use had increased. I’m not sure what the worry is. Luke is supposed to be fighting smoking which causes the harm and unless that’s increasing then e-cigs are not a worry. Luke knows well smoking is declining and declining fast. His worry is nicotine use which is addictive and therefore a bad thing. I just wish he would offer some evidence that nicotine is addictive but as there is none, well if wishes were horses…

Anyhow, enough of me ranting at Lukes idiotic non-argument, he won’t listen or change his mind until his paycheck depends on it.

The interesting thing is, this study¬†Quantifying population-level health benefits and harms of e-cigarette use in the United States¬†has been criticised widely and is so bad that outside of the circle-jerk of tobacco control publications and clickbait websites, oh and the Sun, it had been largely ignored. Its flaws are that obvious. As to why the TFRIoI would decide to push its agenda is anyone’s guess. It could be that Newstalk decided to examine the issue and called Luke for a comment but as both Luke and TFRIoI tweeted to flag this interview they seem very eager to get the message out.

Poisoning_the_Well_Large
Another fallacy

I suspect this flurry of activity is a reaction to this announcement;

UK LAUNCHES ‚ÄėVAPING AWARENESS MONTH‚Äô

They even have a celebrity helping to promote the campaign. Dr Christian Jessen

Yes, him off the telly. All tobacco control in Ireland have is Luke Clancy.

Get your retaliation in first. Even if you have nothing more than some bad modeling and false assumptions to go on, at least get a preemptive strike. Or as it’s also known Poisoning the Well.

Anything on the Telly?

A lighter version of Prime Time

Last Monday Claire Byrne Live covered Vaping in Hospitals in one of the segments of her show. For those who are not familiar with the show, Claire Byrne Live is a current affairs show on RTE, our national broadcaster. It’s a lighter version of Prime Time. That’s the one that wins all the awards, Claire’s is more magazine style, or the Daily Mirror version of Prime Time if you like.

clairebyrnelive

It includes video segments, newspaper previews and interactive elements, such as ‚Äúdemographically credible‚ÄĚ polls, as well as audience and panel debates. So not a lot of time for in-depth¬†discussion.

Monday’s show had The Beast from the East, Vulture funds, Vaping in Hospitals, Gender-neutral Bathrooms and a short film on dementia. You can watch it here; Claire Byrne Live

I was quite looking forward to this as vaping gets very little coverage on TV in Ireland and as the spur was Public Health England’s review of vaping, I thought this would give some positive coverage.

The piece started well with Declan Connolly telling his story of how he quit smoking using e-cigs and why he went on to set up a business selling e-cigs. He told his story well, had his facts correct and was concise and clear.¬† We then went to Dr. Patrick Doorley, head of ASH Ireland and in his answer to the question Claire asked, while tentatively holding an e-cig, “Where¬†do you stand on these?” He clearly stated, vaping was NOT smoking, it was almost certainly safer and the best thing a smoker could do for their health was to stop smoking. Pretty good but it went downhill from then on. “If you have not vaped before, admission to hospital is not the time to start”¬† He has however, no problem with smokers starting gum, patches or any other nicotine-containing product produced by the pharma industry at admission to hospital.

Actually Pat, admission to a hospital might be the best time to start vaping if you are a smoker, you have something which helps with nic delivery and you are in a supportive environment as you switch. Well, you should be in a supportive environment but Pat isn’t going to support your choice to vape. It still seems vapers and vaping shops are still the only support group for people looking to quit smoking.

You could see his lip curl in disgust.

Pat then went on to call it “an issue of respect“, “there’s¬†a massive nuisance¬†issue with vaping indoors.” You could see his lip curl in disgust.¬† “There are some people in wards who are unable to speak for themselves due to their illness, you have to respect that“. “But there’s¬†no evidence of any kind¬†of passive smoking effect from vaping”¬†interrupted¬†Claire. Pat then equivocated on the level of risk from passive¬†vaping. (There is none btw.¬†MYTH 4)

Pat used the 95% safer figure to imply a risk level of 5%. “5% of the harm of tobacco could be very significant” It certainly could Pat, significant enough to be the end goal of A Tobacco Free Ireland.

I am pleased that the target date of 2025 has now been set for Ireland to become tobacco free ‚Äď less than 5% of the population smoking.

That’s from Tobacco Free Ireland¬†Pat implies this is a huge risk, seemingly not understanding that 100% of people using a product with 5% of the risk is far less risk than 5% of people using the product with 100% risk. Pat is either misinformed or misinforming his audience. Of course, he played the “We don’t know” card as well. I just ticked another square on my vaping bullshit bingo card.

He then goes full advertorial for Varenicline (trade name Chantix and Champix) even giving a personal endorsement. Looking at the side effects of varenicline, I wonder what percent of the risk of smoking varenicline is? Side effects of Varenicline

Having given Pat his say Claire then turned to Allan Buckley of Vape Business Ireland, as far as I know, this is Allan’s first TV appearance, and he did well. Allan put the case for vaping without resorting to equivocation or misinformation. He did miss a few open goals, for example when asked if he would recommend an e-cig to a pregnant woman. he should have said, “if she was currently smoking then yes”. Of course, it’s easy for me to say, I wasn’t the one on the spot. Read the disclosure at the end to see why I sympathize with Allan.

Now my real problem with this segment isn’t the usual back ‘n forth argument over vaping. It’s the fact that this was billed as being about vaping in hospitals. ClaireByrneLive ran a poll “Would you like people vaping in hospital?“. 75% NO!, BTW. Not that the result matters, because no one has proposed vaping in hospitals, Pat’s fears for incapacitated people being enveloped in clouds of vapor, are all nonsense. This segment was inspired by¬†PHE Independent expert e-cigarettes evidence review¬†which has no proposal to allow vaping everywhere in hospitals, no mention of clouds of vapor filling wards or anything like it. What PHE suggest is that shelters be provided for vaping but not smoking, a petty and restrictive recommendation in my opinion as current shelters are outdoors and should be left to smokers. They suggest if it’s possible to provide indoor designated areas then that would be good. They see no reason why someone in a single occupied room shouldn’t be allowed vape and emphasize the necessity of supporting people who have quit or are trying to quit, no matter which method they choose!

This is not what Claire Byrne Live or Patrick Doorley discussed. I might give some leeway to Claire Byrne who is responding to tabloid headlines but Patrick Doorley is head of ASH Ireland. He must have read and read with interest, the PHE review, yet he chose to attack a strawman in an effort to add more fear to the agenda of Fear, Uncertainty, Doubt that the anti-smoking groups have resorted to in their fight against vaping. For all his concessions that vaping is not smoking and safer, Pat chose to misrepresent the evidence and pitch for nicotine free rather than smoke-free.

Is ASH Ireland a franchise of Pfizer?

If he truly believes that quitting smoking is the best option then he should support people who have quit, are trying to quit, or currently smoking by supporting them, no matter which method they chose. It’s their choice. Dr.Patrick Doorley saying he will support quilters who buy the product he selects is not public health, it’s aftermarket support. The kind of thing agents offer. (Four out of five doctors¬†prefer….?) Is ASH Ireland a franchise of Pfizer?

Disclosure; I myself was in the audience for this show and despite all this being on the tip of my tongue at the time I chickened out and kept my hand down. #keyboardwarrior

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 dodgy plasterwork. I like turning over the pages 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:

‚Äú2017 will be a trial-by-fire for bigger vape companies, and a death knell for mom-and-pop vape shops.‚ÄĚ

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 ‚ā¨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 and 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.

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.

 

 

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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.

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At swimdaily, two birds.

Philip Morris International has announced they are going to ¬†“build PMI‚Äôs 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‚Äôs 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;

‚ÄúWith 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 ‚Äėreduced Harm‚Äô products as the solution to the public health epidemic that PMI continues to drive and profit from.‚ÄĚ

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 ‚Äúre-engineered‚ÄĚ 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) who will either come on board the reduced harm train or continue to fight against us.

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