Wednesday 20 July 2022

Delusional anti-vaping ignoramuses

Australia is a basket case when it comes to vaping. Reading newspaper op-eds from Down Under, you would think the country had been completely cut off from the rest of the world. Its health establishment is so detached from reality that all you can do is laugh at it.

So let's do that, starting with this amazing editorial from a chap called Dr Sukhwinder Singh Sohal and a lady called Dr. Kathryn Barnsley. The former is a medic. The latter is best known for working for various anti-smoking pressure groups in Tasmania and recently did a PhD in Tasmanian tobacco control.

They begin by noticing that the prohibition of e-cigarettes in Australia has been accompanied by a black market in e-cigarettes. This is a stupefyingly predictable outcome of prohibition, but as far as the two doctors are concerned, the ban would have worked fine had it not been for a shadowy force at work…

"The advocates for unregulated e-cigarette sales, say that it is causing a black market".

It is almost certainly the industry itself which is fuelling the black market.

The tobacco industry use smuggling to open new markets. This is what they are doing with e-cigarettes.

I don’t know why the first line is in speech marks (or why there’s a comma in it). As far as I can see, nobody has ever said this. Nobody is arguing for unregulated e-cigarette sales and the only countries that have unregulated e-cigarettes are countries that have banned them.

The claim that the tobacco industry is smuggling e-cigarettes into Australia desperately needs a citation or some shred of evidence. It seems rather unlikely as it would require blue chip, listed companies who have to publish their accounts to have extensive contacts in the criminal underworld. On the face of it, this is an unnecessarily high risk strategy for the sake of the nickel-and-dime rewards of flogging a few vapes in Australia when they make so much money operating in the legal market.

In any case, most vapes are not made by the tobacco industry. All the products shown in the tweet below by the outraged prohibitionist Simon Chapman are made by HQD, an independent company.

The photo below comes from an article published in May which says that over $1 million of illegal vapes have been seized in New South Wales since the start of the year. The only brand with any connection to ‘Big Tobacco’ is Juul (Philip Morris has a minority stake in the company).

In the highly unlikely event that tobacco companies were smuggling e-cigarettes into countries that have banned them, you’d think they’d smuggle in their own brands.

To be clear, I very much doubt that independent vape companies are in the international smuggling game either. We can safely assume that smugglers bring in whatever vapes they can from wherever they can.

Big tobacco has directly engaged in smuggling all over the world, including Asia, Europe and Canada. In Canada, they also used it to argue for tobacco taxes to be reduced. A University of Bath report says "Growing and diverse sources of evidence indicate that the tobacco industry remains involved in tobacco smuggling and that TI cigarettes account for around two-thirds of the illicit cigarette market".

Tobacco companies have sometimes been accused of ‘facilitating’ smuggling by selling more cigarettes in certain countries than domestic demand requires, knowing that they might be smuggled to other countries. I don’t really a problem with that. The cigarettes were sold legally and what happens to them after they leave the warehouse is not their responsibility.
Others would say that the companies were complicit and should try harder to control their supply chain. Whichever view you take, I don’t think anybody is suggesting that the companies are physically smuggling cigarettes themselves.

The big tobacco plan is to get as many people addicted as possible, especially children and adolescents, because the nicotine alters their brain structure, makes them addicted, then they will clamour for vapes to be "legalised" as a recreational drug.

This is becoming a bit of a fever dream. No country is going to legalise e-cigarettes because children want to vape. If anything, that would make the government double down on prohibition, as has happened in Australia. This is a terrible plan! It’s a good job there’s absolutely no evidence for it.
As for nicotine changing people’s brain structure, do you remember being told this as a child in your anti-smoking class? Have you ever heard this mentioned as a side effect of nicotine replacement therapy? No. It is nonsense based on rodent studies. As Clive Bates, former director of Action on Smoking and Health says:
“Over the last 60 years, millions of adolescent nicotine users have grown up as smokers and either continue to use nicotine or have quit.  The problem for the Surgeon General and others is that there is no sign of any cognitive impairment in the population of former teenage smokers and many of today’s finest adult minds were once young smokers. If a detrimental cognitive effect of nicotine existed in the human population, it is inconceivable that we would not already have seen extensive evidence of it from the study of smokers, non-smokers and ex-smokers over several decades.”

There are many things we don't know about the health effects of e-cigarettes because it is too early in the pandemic to ascertain.

We’re two and a half years into the pandemic. Is that early? What’s the pandemic got to do with it anyway?
There are many things we do know about the health effects of e-cigarettes, none of which are mentioned in the article. Crucially, we know that they do not emit smoke. We know that they do not emit carbon monoxide. We know that the Royal College of Physicians - amongst others - concluded that the long-term health risks are “unlikely to exceed 5% of those associated with smoked tobacco products, and may well be substantially lower than this figure”. We know that the lifetime cancer risks are estimated to be less than one per cent of that associated with smoking. And we know that e-cigarettes have been around for over a decade without a single recorded death being attributed to a conventional, regulated vape device.

However, e-cigarettes will likely cause head, neck and oral cancers, cardiovascular disease, strokes, pediatric injury, and are likely to exacerbate COVID-19 respiratory symptoms.

This is quite a series of assertions coming from people who have just said they don’t know much about the health effects of e-cigarettes. It falls under the category of ‘asserted without evidence and can be dismissed without evidence’.

Indeed, in a recently published study, we confirmed that electronic cigarette condensates increase the expression of SARS-CoV-2 (COVID-19) receptor on human lung cells.

The only study that meets this description is this hastily written effort published on 20 March 2020. Not exactly ‘recently’ in the context of COVID-19 and it was highly speculative, saying that ‘smokers may be more susceptible to infection by SARS-CoV-2, and possibly Covid-19.’ As it turned out, this couldn’t have been more wrong. Since then, many dozens of studies have shown that smokers are less likely to be infected with SARS-CoV-2, although that hasn’t stopped these two authors penning such articles as ‘Covid-19 and smoking: the elephant in the room?’ and their understated masterpiece ‘COVID-19, propelled by smoking, could destroy entire nations’

In Australia, e-cigarettes can be prescribed by a doctor and dispensed by a chemist, for people who are interested in quitting smoking.

Indeed that is the only way Australians can get hold of them, but it is too much for Drs Sohal and Barnsley.

Unsurprisingly few doctors will do this, as there are many other drugs, proven to be relatively safe, and which have been approved by the TGA, and services available to help people quit.

Furthermore, the evidence on successful quitting using e-cigarettes is very thin.

This can only be described as a lie. There is a wealth of evidence showing that e-cigarettes not only help smokers quit but are more effective than nicotine-replacement therapy. This has been shown in numerous observational studies such as this, as well as evidence from entire countries such as this. Impressively, e-cigarettes lead to quitting even among smokers who express no interest in quitting. There is a growing body of economic research showing that e-cigarettes and cigarettes are clear substitutes, with suppression of one leading to consumption of the other. Last but by no means least, there are randomised controlled trials (RCTs) like this and the Cochrane Review of RCTs which found that e-cigarettes help smokers quit.
If this evidence base is ‘very thin’, how should the evidence base for the claim that vaping causes head cancer and pediatric injury be described? Microscopic? Invisible?

One 2022 study concluded, "The use of e-cigarettes as a therapeutic intervention for smoking cessation may lead to permanent nicotine dependence."

E-cigarettes are not designed to wean people off nicotine. They exist to give people a much less harmful way of consuming nicotine. If you don’t know that, perhaps you should keep your opinion of tobacco harm reduction to yourselves?

Doctors prefer evidence.

You’d hope so, wouldn’t you? And yet surveys consistently show that doctors are woefully misinformed about e-cigarettes and most of them wrongly believe that nicotine causes cancer. Just this week in the UK, an over-confident doctor went on TV and claimed that vaping causes ‘popcorn lung’. Vaping has never caused a single case of this rare disease.

And as patients, we prefer doctors who follow evidence-based medicine. Not quacks who have been "bought" by industry".

Who are these mercenary shysters? We should be told. Alas, the authors do not name names, presumably for fear of successful litigation.

Numerous researchers agree that the development of electronic cigarette-related illnesses will outweigh any short-term benefits, but the evidence for short-term benefit is lacking. Of utmost importance, we amongst an array of other scientists have repeatedly shown electronic nicotine delivery devices to be toxic and in no regard a "safer" option for smoking tobacco.

It is a shame that these ‘numerous researchers’ are not identified because it would be interesting to see their work. Looking at the thin publication CV of Kathryn Barnsley, I can see no studies showing that e-cigs are toxic. Dr Sohal has co-authored a number of journal articles about e-cigarettes but these are mostly glorified opinion pieces containing no original research and a good deal of scaremongering.
I’m not aware of any study by anyone showing that e-cigs are as dangerous as combustible cigarettes. Even anti-vaping headbangers like Martin McKee and Stanton Glantz acknowledge that vaping is at least somewhat safer than smoking.

Tobacco manufacturers can lawfully insert anything they choose, however toxic, in their products and the same applies to electronic cigarette manufacturers.

No it doesn’t. Here is a non-exhaustive list of some of the ingredients that cannot be put in e-cigarettes in the UK, for example:
  • Diacetyl

  • Pentane 2,3 dione

  • Diethylene glycol

  • Ethylene glycol

  • Formaldehyde

  • Acetaldehyde

  • Acrolein

  • Metals, including cadmium, chromium, iron, lead, mercury and nickel

  • Preservatives liable to release formaldehyde.

  • vitamins or other additives that create the impression that a tobacco product has a health benefit or presents reduced health risks;

  • caffeine or taurine or other additives and stimulant compounds that are associated with energy and vitality;

  • additives having colouring properties for emissions;

  • Substances classified as carcinogenic, mutagenic or reprotoxic (CMR categories 1 and 2)

  • Substances classified with specific target organ toxicity for the respiratory tract (STOT category 1)

The sensible thing for Australian regulators to do would be to legalise e-cigarettes and produce a similar list, rather than tolerate Aussie vapers inhaling whatever the people who run the black market give them.

We do not believe that substantial evidence exists for electronic cigarettes to be used as a tool for smoking cessation.

In fairness, it has already established that you don’t know what you’re talking about and that your opinions are worthless.

The risks of electronic cigarettes are far too great for them to be deemed safe to be prescribed by medical professionals.

Let’s leave that the judgement of medical professionals, shall we? Even in Australia, some of them must know more than you.

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