Harm maximisation

Bit busy at the moment but there are a couple of harm reduction-related stories that you might be interested in.

Via F2C, I see that the BBC has implied that e-cigarettes might have killed a man in North East England.

Gateshead doctor calls for research into 'e-cigarettes'

A doctor from Tyneside has called for more research into "electronic" cigarettes following the death of one of his patients.

The wording of this non-story is extremely vague for the very good reason that there is no evidence that e-cigarettes did—or could—contribute to this man's death. El Beeb doesn't mention that the deceased had been a heavy smoker for decades, nor that the doctor involved—Dr Robert Allcock—is not any old GP, but is on the advisory panel of Smokefree Northeast and campaigns for various anti-tobacco policies. UKVapers has a more sober assessment of the story here.

And via Snus Central, it seems that another alleged health group is turning the screw in its efforts to keep people smoking cigarettes:

The Swedish snus eStore owned by World Wide Snus AB has been shut down and its assets seized. At the time of this writing, we're told a cancer organization in Finland filed suit against the Swedish snus store for allegedly selling snus to customers in Finland. This cancer organization apparently won the suit.

Latest information is that Finland presented the findings to Swedish Customs. On Tuesday, March 22nd, the Swedish Customs Service and local Police raided the SnusWorldWide.com facilities and seized them along with the inventory and other contents. World Wide Snus AB's bank accounts were simultaneously frozen.

If I'm not mistaken (let me know in the comments) this represents enforcement of the existing EU ban and is not a new restriction. It is illegal to export snus from Sweden for sale in any EU state—and that includes mail order and internet sales. Nevertheless, it is interesting that a "cancer organisation" would go to such trouble to prohibit a product that does not cause cancer.

Hopefully, the EU will see sense and repeal this absurd and counter-productive ban when the new Tobacco Products Directive is issued. In the meantime, Finns will have to buy their snus illegally, or from the US, or get back on the cigarettes.

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Prohibitionists march on in New York

When the hysteria about Skoal Bandits set the wheels in motion for the banning of snus back in the 1980s, Ann McNeill wrote an editorial for the British Journal of Addiction in which she said:

“Some find it hard to justify the ban on oral snuff when cigarette smoking, which is undoubtedly more dangerous, is still permitted. The answer is simple. Prohibition is only feasible if relatively few people use a product.”

This was unusually candid, and true. The resulting ban on snus turned out to be a public health disaster since it prevented smokers from switching to a product that is at least 90% safer than cigarettes (and quite probably 99% safer). Not all anti-tobacco campaigners have admitted they got this one wrong but, to her credit, Ann McNeil is one of them and she has publicly stated that snus should be decriminalised.

Still, it is easier to ban a niche product than it is to ban a widely used product. No wonder, then, that those with a prohibitionist mentality went after snus and are now going after e-cigarettes. The fact that both of these products are excellent substitutes for cigarettes and are virtually harmless seems not to enter into it. As the American Council on Science and Health said in its Top Ten Unfounded Health Scares of 2010:

The chemical components found in e-cigarettes pose little danger to human health, and should not be considered toxins or carcinogens. It is irresponsible for public health organizations such as the CDC and the AHA to denounce the use of e-cigarettes as an effective smoking cessation method. In doing so, they only continue to promote the use of regular cigarettes for the majority of smokers who failed to quit using traditional approved cessation methods.

And yet, the prohibitionist crusade marches on in New York City. Some day someone will write a book explaining how New York went from being a world-wide symbol for liberty to being the pitiful nanny state it is today. The unsavoury, bloated, authoritarian figure of Michael Bloomberg will no doubt loom large in the story, but even he can't be held directly responsible for this insanity:

A01468 Summary:

BILL NO: A01468

Prohibits the sale of electronic cigarettes to minors; prohibits distribution or sale of any item containing or delivering nicotine that is not defined by law as a tobacco product or approved by the United States food and drug administration for sale as a tobacco use cessation or harm reduction product.

The above comes from a Bill to ban e-cigarettes. I understand that it will be voted on tomorrow. The justification for this legislation is...

Given the unregulated nature of this product, there is no way of knowing the amount of nicotine in each cigarette, the amount that is delivered with each inhalation, or the contents of the vapor created in the process.

Gee, if only there was some way of dealing with an unregulated product without having to ban it. Of course—and this comes completely out of left-field—you could just regulate it, thereby guaranteeing the quality of the product whilst guaranteeing that e-cigarette users don't have to go back to smoking a proven health hazard.

Call these people anything you want. Just don't call them health campaigners.

(Vapers Club has the links if you want to let the NY authorities what you think of banning e-cigarettes.)

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E-cigarettes banned because they are 'confusing'

Kings County, in Washington State, has banned the use of the e-cigarette in public places because it "threatens to undermine the social norming impact [of smoking bans]" and because e-cigarettes "cause confusion". This is an intriguing and dangerous development in 'tobacco control' since there is no evidence that e-cigarettes pose a health risk to the user, let alone to those around them.

I put the words 'tobacco control' in scare quotes because while this is undoubtedly a matter of control, it is no longer a genuine tobacco issue, let alone a smoking issue. Just as the anti-smoking movement became an anti-tobacco movement, so the anti-tobacco movement has become an anti-nicotine movement. When you have people campaigning against a product because it looks like a cigarette, it is difficult to sustain the delusion that we are not in the grips of scientifically illiterate, hysterical and—above all—moral crusade.

The Board of Health states that because e-cigarettes resemble cigarettes, they might cause "confusion and concern [to] the owners of those establishments who seek to comply with the Smoking in Public Places Regulations." Apparently, the possibility of causing confusion is now a legitimate reason for making an activity illegal in the United States of America.

The Health Board overstates the similarities between e-cigarettes and their combustible cousins. E-cigarette vapour dissipates within seconds. They leave no smell. Many of them are multi-coloured and look about as much like a cigarette as a pencil does. Above all, they don't cause cancer, but that doesn't deter those who want to ban e-cigarettes entirely from promoting a campaign that will lead to e-cig users returning to the real health hazard they had successfully given up.

Like all new products, e-cigarettes are bound to attract curious glances at first but this will disappear once people are familiar with them. Maybe some people will react with confusion and concern, but—and this is the real point—so what?

Ladyboys cause confusion and concern. Kerry Katona causes confusion and concern. My tax returns cause confusion and concern. It's not the government's business to protect sentient beings from confusion and concern. If the state must take a role in the e-cigarette issue it should be to quell the confusion through honest information and alleviate the concern with facts. And the facts are that e-cigarettes are, at worst, 99% safer than cigarettes, they create no secondhand smoke and they seem to be a damn fine substitute for smoking.

The idea that the government has to act to uphold "social norms" is particularly sinister. Quite simply, it is not for the government to decide what is normal and what is abnormal. Civil society decides what is normal and the concept of normality varies from person to person and community to community. And so it should.

A system that allows different people to plough their own furrow has been working just fine for years, thanks. And even if we did require a one-size-fits-all benchmark for normality, it is unlikely that we would turn to the inherently freakish collection of politicians and single-issue campaigners to provide it. You uphold your social norms and I'll uphold mine. K?


(For you early risers, I'll be making a similar point but less well and with more hesitation on BBC Radio 4's Today programme tomorrow. Or not, depending on what hits the cutting room floor.)

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On e-cigs, snus and harm reduction

I've got an article up at Spiked today on the subject of the possible prohibition of e-cigarettes. With the exception of The Independent, the British media have ignored today's study in Tobacco Control which recommends taking e-cigarettes off the market while their safety is tested (and if you think they'll ever come back on the market, I have some magic beans you might be interested in). This being Tobacco Control, the study isn't available online, but I describe the main findings—which are few—in the article. Michael Siegel also discussed it on his blog yesterday.

The simple truth is that not one death has been attributed to the use or misuse of e-cigarettes since they appeared in 2004. Niche product though it may be, this is a sufficient length of time for any action against it now to be viewed as reactionary rather than precautionary. In the same six years, some stop-smoking drugs have been shown to have killed many people, and of course several million more have had their lives cut short as a result of cigarette smoking. And yet it is the e-cigarette that faces the chop.

Do have a read...

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E-cigarettes look set to be banned

So it looks like they're going to ban e-cigarettes in the UK. The fools.

Michael Kitt at ecigarettedirect.co.uk has received a letter from a Trading Standards Officer who has (apparently) been told by the Medicines and Healthcare products Regulatory Agency (MHRA) that they  will be opting for what they always said was their preferred option and banning all nicotine products. There are are—of course—two major exceptions: the most hazardous nicotine products (smoked tobacco) will continue to be on sale, as will the least effective smoking cessation aids (pharmaceutical nicotine).

From the letter:

I have been in discussions with other Trading Standards authorities and have found out that the consultation is almost complete. The outcome will be that as of a date (yet to be announced) there will be a 21 days period and then these products will be outright banned in the UK, unless the traders apply for certification as a medical device from MHRA. This process could be complicated and costly so it is expected that many traders may cease trading.

What this means for vapers like Leg-Iron is that it's back to the cigarettes. The least harmful nicotine delivery device is to be withdrawn in favour of the most harmful. And in the boardrooms of Pfizer and Philip Morris there was much rejoicing.

How has it comes to this? As I said at the International Harm Reduction Conference back in April, I think it comes down to a combination of fanaticism and pharmaceutical pressure.

Americans for Nonsmokers’ Rights - in a press release titled Electronic Cigarettes are NOT a safe alternative! - criticised the e-cigarette specifically because it mimics the act of smoking and because it contains nicotine.

Only pharmaceutical nicotine products escape criticism, partly because they are marketed as a medicinal cure for a ‘disease’ and partly because they administer nicotine without providing pleasure.

This has led to a somewhat inconsistent view of nicotine, described as being perfectly safe in pharmaceutical products but highly toxic in e-cigarettes, snus and other tobacco products. The EPA describes it as “acutely toxic (Category 1) by all routes of exposure (oral, dermal and inhalation)” while the MHRA says thats “nicotine, while addictive, is actually a very safe drug.”

Five years ago, when I began researching Velvet Glove, Iron Fist, I was wary of making too many claims about the influence of the pharmaceutical lobby. Although Big Pharma (or, more accurately, the pharmaceutical companies who happen to make nicotine products) have funded the anti-smoking movement lavishly over the last twenty years, there were anti-smoking fanatics long before they got involved and, for the most part, the movement's prohibitionist agenda has remained unchanged. While it is important to be aware of the conflicts of interest, especially when nicotine replacement products (NRT) are being touted, people like John Banzhaf and Stanton Glantz were going to be saying the same things with or without Big Pharma's cash.

But I have been saying for some time that the anti-smoking movement's attitude towards the e-cigarette would be the litmus test of pharmaceutical influence. There is no doubt that Big Pharma is seriously worried about the e-cigarette's impact on their sales, as an industry report suggested:

E-Cigarettes Will Revolutionise the Face of Tobacco Smoking and Could Pose a Threat to the Smoking Cessation Market

In February, the Department of Health (of which MHRA is a part) went further than ever before in pushing pharmaceutical nicotine, not just as a smoking cessation aid but as a long-term substitute. Needless to say, this change of emphasis suits the makers of nicotine products just fine. 

In the e-cigarette, we have a product that is—at the very least—99% less harmful than cigarettes. In all probability, it is 100% safe (because, as MHRA say, nicotine is "a very safe drug"). Furthermore, there is considerable anecdotal evidence that e-cigarettes are more effective as smoking cessation aids than anything sold by Big Pharma. It is certainly reasonable to say that they require some regulation, if only to prevent contaminated or substandard products going on sale, but to ban them entirely is sheer madness. As Paul Bergen says over at Smokles:

There is good reason for some sort of standards for any widely used product. This is just a very bad way of going about it.

If cigarettes did not exist and e-cigarettes were some unique nicotine delivery device then this approach would not be entirely out of sorts. It would still be unusually demanding in its short time frame for compliance but the worry would center more around commercial concerns than concerns of health.

However we have been repeatedly reminded by national authorities that too many people are dying from smoking, implying that these same authorities think this is not a good thing, and also implying that they would support actions that would bring down those mortality figures.

Quite simply, the ban on e-cigarettes—like the ban on snus—is going to result in more people dying of smoking-related diseases. It is a victory only for those with a bone-headed prohibitionist mindset, it is a victory for the precautionary principle and it is a victory for big business. No organisation that supports the ban can seriously claim to be working in the interests of public health.

If and when this ban is confirmed, will we hear objections from ASH? After all, ASH claims to support harm reduction. There must be some amongst their number who joined the movement because they wanted to help people quit smoking and save lives. Will they speak out or will they keep quiet in deference to the companies who pay for their conferences?

H/T: Kate at Vapersnet.org 

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Talking e-cigarettes and the rest

Last week I did an interview with e-cigarettedirect.co.uk, discussing thirdhand smoke, the Nazis, John Banzhaf, Big Pharma, tobacco harm reduction and more. You can read that all here.

I'm also grateful to James at ecigarettedirect.co.uk for pointing me to this document, titled Smoking Cessation Report 2009-2015. It's produced by Visiongain for the pharmaceutical industry. At $2,500 a copy, I won't be buying it, but its table of contents are tantalising, especially Chapter 6 which looks at the challenges facing Big Pharma (my emphasis)...

6 Issues Affecting the Smoking Cessation Market
6.1 SWOT Analysis for the Smoking Cessation Market
6.2 Strengths of the Smoking Cessation Industry
6.2.1 Innovation in Smoking Cessation Therapies
6.2.2 Innovative Marketing Techniques
6.2.3 Manufacturers are Providing Support Plans in Combination with Pharmacotherapy
6.2.4 OTC-Switching
6.3 Weaknesses of the Smoking Cessation Industry
6.3.1 Drugs Do Not Replace the Tactile and Oral Sensations Obtained from Smoking
6.3.2 Currently-Marketed Smoking Cessation Therapies Have High Relapse Rate
6.4 Opportunities for the Smoking Cessation Market
6.4.1 Smoking is Prevalent Worldwide and Slowly Increasing
6.4.2 Countries with Untapped Smoking Cessation Market Potential
6.4.3 Growth of Emerging-Economy Smoking Cessation Markets
6.4.4 Health Effects of Tobacco
6.4.5 Economic Impact of Tobacco
6.4.6 Framework Convention on Tobacco Control (FCTC)
6.4.7 Government Smoking Cessation Programmes
6.4.8 Increasing Tobacco Taxes
6.4.9 Smoking Bans
6.4.10 Warning Information on Tobacco Products
6.4.11 Bans on Tobacco Advertising, Promotion and Sponsorship
6.5 Threats to the Smoking Cessation Industry
6.5.1 Concern over Side-Effects of Smoking Cessation Drugs
6.5.1.1 Champix/Chantix Showed Potential, but then Hit by Safety Concerns
6.5.1.2 Side-Effect Concerns for NRT and Bupropion
6.5.1.3 The Result of Side-Effect Concerns
6.5.2 Lack of Reimbursement for Smoking Cessation Therapies
6.5.3 Traditional Smokeless Tobacco
6.5.3.1 Snus and Gutkha
6.5.3.2 A Possible Impact of Greater Smokeless Tobacco Prevalence
6.5.4 The E-Cigarette
6.5.4.1 What are E-Cigarettes?
6.5.4.2 The E-Cigarette Market
6.5.4.3 E-Cigarettes Will Revolutionise the Face of Tobacco Smoking and Could Pose a Threat to the Smoking Cessation Market
6.5.4.4 Will E-Cigarettes Compete with Smoking Cessation Therapies?

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E-cigarettes could be taken off the market this year

The UK's National Institute for Clinical Excellence (NICE) has formally supported a policy of tobacco harm reduction. This has been seen in some quarters as good news for users of e-cigarettes. I'm not so sure. It is possible that e-cigarettes could be approved and regulated, but it is also possible that they might be banned for good. 

A public consultation has been launched which emphasises the dubious findings of the FDA:

We know from work done by the Food and Drug Administration (FDA) in the United States that laboratory analyses of e-cigarette samples were found to contain carcinogens and toxic chemicals, against which general product safety legislation could not protect.

The UK has previously banned snus and Skoal Bandits, despite undeniable evidence that they are far less harmful than smoking and possibly not harmful at all. When NICE talk about tobacco harm reduction, they are really talking about pharmaceutical nicotine products. E-cigarettes have no real support amongst public health professionals and are very unpopular with John Banzhaf and others in the intensive care wing of the anti-smoking lunatic asylum.

Will e-cigarettes go the way of snus? It's too early to say. For now, the government's objective is to get them off the market. The consultation ends in May and NICE favours doing this within 21 days of a decision being made. Once taken off the market it could be years, if ever, before they return. In the meantime it will be back on the cigarettes for Britain's vapers. Some harm reduction strategy that would be.

The consultation reads:

In order to ensure there is no risk to public health from unlicensed products on the market that have not been assessed for safety, quality and efficacy and in the light of the developing extent of their use and familiarity we are consulting to elicit views on whether and how to bring all products containing nicotine into regulation.

Option 1 – Whether products containing nicotine should be considered by the Agency to be medicinal products by function and, if so, whether all unlicensed NCPs should be removed from the market within 21 days. Currently, MHRA operates a strict practice regarding the period of notice operators are allowed to comply with under the Marketing Authorisation Regulations following the classification of a product as medicinal. Given that these Regulations do not make explicit provisions for a staged withdrawal from the market of an unlicensed medicinal product, immediate cessation of the sale or supply is usually required by the Agency, with written confirmation of the same within 21 days.

Option 2 – Whether products containing nicotine should be considered by the Agency to be medicinal products by function and, if so, whether a notice should be issued to manufacturers that all marketing must cease by a certain date e.g. June 2011. After this date enforcement action would be taken against manufacturers not holding an MA for any such product on the market. This would effectively allow manufacturers a year from the end of public consultation to produce relevant evidence to support an application for an MA, submit it to the MHRA for approval and get the newly licensed products on to the market.

Option 3 – Do nothing and allow these unregulated products containing nicotine that have not been assessed for safety, quality and efficacy to remain on the market.

The MHRA’s preferred option is option 1, which is in line with current practice.

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Bullies and Banzhaf

I haven't yet mentioned Brian Monteith's book The Bully State, which is a rollicking good read. I reviewed it in the current Spiked Review of Books:

Readers who have not visited Britain for several years may be shocked by the lurch towards authoritarianism described in this book. Those who have witnessed the creep of the bully state first hand will be enraged, amused and informed in equal measure. Californian politicians can simply use it as an instruction manual.

Go have a look. And speaking of bullies...

Chubby ambulance-chaser John Banzhaf has called on e-cigarette users to sue e-cigarette makers. In a typically narcissistic press release, the ASH founder invites vapers to "possibly share in any damages awarded to users of this new product which the Food and Drug Administration (FDA) has declared 'illegal'."

Smokles provides an accurate character assessment of the litigious lard-ass:

I can think of no other example where the signatory of the letter refers to himself in the third person so many times and so magnificently. (In nine out of the thirteen paragraphs of his release, he refers to himself at least once, and even bestows upon himself a title: the Dean of Public Interest Lawyers).

You just have to wonder how this blowhard survived grade school.

Since nearly all e-cigarette users are very happy to be vaping rather than smoking, Banzhaf is once again displaying a certain detachment from reality with this press release. Judging by some of the comments at the e-cigarette forum, the ASH founder is going to struggle to find many takers:

Yeah, i'm sure we are going to turn on the hand that feeds us ... not.

That may be in his repetoire, being the disgusting turncoat sell-out pork belly that he obviously is, but it sure as diddly isn't in the most decent people's plans.

Similar sentiments are on display on the Tobacco Facts website which hosts the press release:

I wish these anti-smoking fanatics realized that by attacking e-cigarettes they’re actually supporting big tobacco.

They might be supporting big tobacco. They're certainly supporting the pharmaceutical industry, as Michael Siegel points out:

Interestingly, ASH is not promoting lawsuits against the pharmaceutical companies who market nicotine replacement products without informing their customers that these products contain detectable levels of carcinogens. Why this double standard?

Perhaps the answer lies in the fact that ASH is heavily funded by Big Pharma.

ASH is funded heavily by Big Pharma (specifically, by Pfizer - the maker of Chantix). If e-cigarettes really take off, they represent a huge threat to the profits of pharmaceutical companies, and in turn, they represent a threat to future funding of ASH. This conflict of interest is significant, but ASH has failed to disclose it in any of its statements about the dangers of electronic cigarettes, or in its propaganda designed to encourage vapers to sue e-cigarette companies.

Indeed ASH is funded by Pfizer (makers of Chantix, Nicorette etc.). It received $50,000 from the company in 2006 and is currently sharing the spoils of a $47 million grant made to various anti-smoking organisations. 

Banzhaf himself does very nicely as head of his charity, pocketing $226,000 in the last year their accounts were published. And although the FDA has concluded that Pfizer's stop-smoking drug Chantix is linked to suicide, Banzhaf is not involved in any of the lawsuits against Pfizer, nor will you find the word Chantix anywhere on ASH's website. 

Funny, that.

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Michael Kitt on the e-cigarette

Back in September, I mentioned that the e-cigarette company cheapelectroniccigarettes.co.uk had offered to donate 10p from every product sold to Cancer Research UK. I said at the time:

ASH (UK) have not, so far, demanded a ban on e-cigarettes (unlike their American namesakes). Since ASH receives substantial funding from Cancer Research, these new donations from the e-cigarette industry should ensure that things stay that way. Or will pressure from American fundamentalists and Big Pharma prevail?

It seems to have been the latter, since Cancer Research turned down the donation. Shortly afterwards, I interviewed the company's owner Michael Kitt to ask him about the proposed donation, the current state of the e-cigarette industry and what he expects to happen in the future. This is a transcript of that interview:

 

CS: Essentially what is the difference between the pharmaceutical nicotine inhaler and the e-cigarette?

MK: Very little. I’m not 100% sure about the technical differences but the e-cigarette uses more electronics to generate the smoke and atomise the vapour into the lungs. The inhaler, as far as I’m aware, is just a direct air pull through.

CS: Almost like an asthma inhaler?

MK: Almost. It’s along those lines, but without the aerosol. Like the ones you just suck on. What it does differently to the inhaler is that it provides a psychological experience. You’re not as aware that you’ve got an electronic instrument in your hand. You’re seeing the smoke coming out, you’re feeling the throat hit. You’re experiencing everything really. That’s why I think it’s going to take off better than the nicotine replacement therapies.

CS: What do you think the chances are of regulation? Could the e-cigarette even be banned?

MK: I think they’ve got a job on their hands to ban it. The FDA has made a mistake in the way they’ve tried to clamp down and say “No, it’s bad for you” because they seem to have done it with very, very little proof and a very biased report. I think it was 19 samples and one of those samples had an ingredient in that they consider makes it unsafe. And yet they’ve approved that same ingredient in cosmetics and food and loads of other things.

CS: Would you accept there’s a need for some regulation?

MK: Definitely. There’s too many questions and inconsistencies with what we do. There’s no real regulation about what’s got to be on the box. There’s no real regulation about any warnings that need to be given and, at the end of the day, nicotine is a poison.

CS: Would you like to see it available only to people over the age of 18?

MK: I think it needs to be. I don’t think many people under that age will buy them anyway because of the cost. Not many kids get £50 pocket money.

CS: What about the issue of flavouring? Various anti-smoking groups have said they’re flavoured to appeal to young people.

MK: They have, haven’t they? I suppose it’s the same principle as why do they allow flavoured alcohol? That’s not marketed to young people. Just because I’m 30 years old doesn’t mean I don’t like the taste of chocolate. I don’t think that’s purposefully trying to target it towards children. But the other regulatory side - child-proof containers and so on - needs to be clamped down on quite heavily. There’s nothing there at all at the moment.

CS: How many players are there in the UK market?

MK: There’s five manufacturers. As for dedicated electronic retailers, I think we’re the only one really dedicated that’s doing multiple brands. There are a few others who are selling them on Amazon, some people - like Click Shop - are mixing them in with lots of other products. CigZag are just about coming online.

CS: Where are they made, mainly China?

MK: They’re made in China, yeah.

CS: Who invented them?

MK: It was a guy who patented the Ruyan Jazz disposable one who actually owned the patent for the technology and then other licenses have come off that to produce the mini ones and what have you. NicoCig actually produce the Ruyan Jazz in the UK.

CS: When was it patented?

MK: 2003, 2004.

CS: So it really is very recent.

MK: Yeah, it’s not been long at all.

CS: And what are the messages coming out from government in the UK? Are there any?

MK: Not really. It’s still very under the radar. It’s purely, from what I can gather, being aware of the product. When I take mine out of a Friday or Saturday night, the number of people who ask about it is amazing and - so far - there’s been no negative reaction towards it. It’s difficult to explain how positive most people are about it. I saw a study once that said 98% of smokers would consider an alternative if it gave the whole package - if it was healthier obviously.

CS: And are you a smoker? Were you a smoker?

MK: Yes.

CS: So you smoke tobacco and these?

MK: No, just the e-cigarette now.

CS: And you gave up using these?

MK: Yes, but we can’t promote that!

CS: No. Unfortunately not. Your name came to my attention because you offered a donation to Cancer Research. I found it very interesting that they turned you down, and it makes me think that they’ve got it in for the e-cigarette.

MK: Possibly. I didn’t think they would decline it, but they did and that’s up to them really.

CS: Why do you think they turned down money that they could have used for cancer research?

MK: I think there’s a bit of pressure coming from some anti-smoking groups there, to be honest. They do accept donations from the people who make Nicorette, I believe, and other nicotine replacement therapies. So why they wouldn’t accept donations from us is up in the air. We don’t know anything for sure but I would hedge my bets towards them getting some pressure from someone. Whether it’s the anti-smoking groups or the government, I don’t know.

CS: The anti-smoking movement as a whole has a ‘quit-or-die’ approach; an ‘all or nothing’ approach. They would never encourage people to use chewing tobacco, low yield cigarettes or any tobacco product at all, with the exception of pharmaceutical products. The pharmaceutical industry is one of the world’s most powerful industries, whereas the e-cigarette industry is very small. It’s a bit under the radar and, presumably, you’re not particularly co-ordinated - as an industry - to defend yourselves?

MK: There’s the electronic cigarette association in American. They almost act like a regulatory body, to make sure the products are promoted in the right way. They’ll only accept people in that are not promoting them as smoking-cessation devices and aren’t making false claims about the health benefits. But over here [in the UK], as of yet, we’ve got nothing along those lines.

CS: ASH (US) has been extremely critical of the e-cigarette and wants to see it banned entirely. In the last few years, the way the media have reported things like ‘third-hand smoke’ has been completely uncritical and it’s easy to imagine that ASH (UK) could come out and say “Here’s this new, unregulated device which pumps out poisonous nicotine and diethylene glycol - as used in anti-freeze!” and it needs to be banned. Do you think that’s likely?

MK: I think it depends how much influence the American ASH and the worldwide ASH have over them. If it they have to do it, I think they probably will. But that’s just another argument for some kind of regulation. If the e-cigarette is regulated and if there are details about what needs to be provided in the same way that normal cigarettes are retailed then they should be happy as far as I can see.

CS: But doesn’t regulation require the product being taken off the market for years? Eight years is what they’re saying in America but it could take much more than eight years. If you want to do a study on lung cancer, you’re talking about a wait of at least 20 years, probably more like 50 years.

MK: Yeah. And you’ve got to have people smoking for that long.

CS: So to make sure the e-cigarette is 100% safe, you’ve got to have the product off the market for up to 50 years.

MK: Potentially.

CS: Which could be a major problem for you!

MK: It could be but I don’t think it would ever get that far. If you look at mobile phones, for example, they’ve only been around for 10, 20 years now. We still don’t know what effect they have on the brain but they don’t take them off the market, otherwise they’d have no test subjects to test them on. And if the e-cigarette needs to be studied, it has to be studied while it’s out in the market. They can’t study it while no one’s using it!

CS: What about the claim that it’s a gateway to smoking?

MK: Again, it’s difficult because of the price of it. I can’t see young people spending £50 on a starter kid when they could get a pack of fags for £5. The argument they’re trying to make is that they’ll steal it from mum’s purse, but actually it’s more difficult to steal it from mum’s purse because there’s only one. Mum will notice that it’s gone missing more easily than the one cigarette missing from a packet of twenty.

CS: I’ve seen two figures online. One said that 79% of users have quit smoking successfully using the e-cigarette. The other said 72.5%. You can’t market the e-cigarette as a smoking-cessation device, I know, but is there any research underway to seriously get a figure on how effective it is for people who are trying to give up?

MK: Not that I’m aware of. There was a study done in South Africa that said 45% had quit smoking altogether within 6 months of taking up the e-cigarette.

CS: Why can’t you use these figures?

MK: Because there’s no medical backing to them. Without spending thousands or possibly millions on proper medical, clinical trials, there’s no clinical backing behind the figures. I can quote the ten or fifteen people a day who phone us up saying that they haven’t smoked for so long and that they’re very happy with it. Emotionally, that’s very nice but we can’t market those figures.

CS: Although you can’t market it as a smoking-cessation aid, from what I’ve read it seems to be a genuinely effective device. It’s all anecdotal at this stage, but they appear to be much more more effective than the pharmaceutical products, which have a failure rate of about 95%. And it makes you wonder how much power the pharmaceutical companies have over the anti-smoking groups, because I bet if 'Big Pharma' had invented the e-cigarette, it would be seen as the breakthrough of the 21st century.

MK: Absolutely. I don’t which way it will go and whether tobacco companies will start making them themselves.

CS: Could they do that? What’s the patent situation?

MK: If they get the license, there’s nothing to stop them. They’ve got the budgets to do it. They’ve got the facilities and the equipment. I can’t see why they couldn’t. It’s a question of whether they want to go down that route.

CS: What I find fascinating about the whole situation is that your competition in the nicotine market is the tobacco industry and the pharmaceutical industry.

MK: Two pretty big industries!

CS: Two very big industries but also two industries that are fighting each other. And they’re coming together...

MK: To fight this common enemy!

CS: This new, ‘rogue’ industry...

MK: ...which is a danger to their whole business model. It wasn’t that long ago that people thought nothing could ever cripple the tobacco industry, but if it’s done right there’s no reason why the e-cigarette couldn’t. I’ve tried it and have had great success with it and I know other people who’ve tried it and had great success with it. It is a great little product but it’s such a new industry and a new product that there’s so much needs to be done to get it into the mainstream.

CS: Are you allowed to advertise in the normal ways?

MK: There are some restrictions. You can’t advertise on things like Google Adwords, just as you can’t advertise tobacco products, but we could advertise on the radio.

CS: And what would you do if tomorrow the papers were full of stories about this new “terrifying” product that was “poisoning the air”?

MK: I don’t think it would damage us, to be honest. People aren’t stupid and since Google came along, people can look into a product.

CS: But in America, these scare stories have worked. Some places have banned them outright, others have banned them in public places.

MK: Yeah, but anyone who is seriously interested is going to go online and read the same stories that we’ve both read and probably come to the same conclusion - that it can’t be any worse than tobacco, and that’s all it needs.

CS: One thing I noticed when I went on one of the e-cigarette forums, is that when people start using the e-cigarettes, a lot of them very quickly become opposed to people smoking normal cigarettes. Maybe it’s the old thing about ex-smokers being the worst, but have you noticed this?

MK: I have noticed that actually.

CS: Is that something you feel yourself?

MK: I’ve noticed so much of a change in myself. I notice my clothes not smelling and I notice breathing easier and what have you. I’m not sure it doesn’t just come from pride though, and being able to say they’re a nonsmoker. It probably is the same mentality as when people give up and they become very anti-smokers.

CS: I like the term ‘analogue cigarettes’ for normal cigarettes

MK: Yeah! The digital switchover!

cheapelectroniccigarettes.co.uk is a UK based reseller of innovative electronic smoking products. There are more details on their website. 

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E-cigarettes - safe for now

Last month I posed the question of whether British anti-smoking groups would follow in the foot-steps of their American cousins and call for e-cigarettes to be banned. 

As I mentioned, ASH (UK) has a remit of encouraging safer forms of nicotine use (they support the legalisation of snus, for example). Furthermore, the amount of money British anti-smoking groups receive from pharmaceutical companies is a trickle compared to the river of cash spent in the US by GlaxoSmithKline, Pfizer and Johnson & Johnson (the latter, via the RWJF).

This question has now been partly answered by an ASH (UK) fact-sheet [PDF] which states the organisation's position:

ASH supports a harm reduction approach to tobacco, that is, we recognise that whilst efforts to help people stop smoking should remain a priority, many people either do not wish to stop smoking or find it very hard to do so. For this group, we believe that products should be made available that deliver nicotine in a safe way, without the harmful components found in tobacco.

Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe.

Therefore, e-cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are likely to be a safer alternative to smoking. In addition, e-cigarettes reduce secondhand smoke exposure since they do not produce smoke.

This is level-headed stuff and is good news for smokers who wish to quit. There is an abundance of evidence (albeit anecdotal) that the e-cigarette is the most effective smoking-cessation device yet invented. Banning it would be madness from a public health point of view. 

ASH (UK)'s assertion that e-cigarettes do not create secondhand smoke is a statement of the obvious, but is nonetheless welcome since their American namesakes have been making laughably hysterical claims to the contrary, such as this, from the ASH (US) website:

A new device for addicted smokers who want to be able to get their nicotine fix by “smoking” in places where smoking is prohibited, and do so by exhaling a cloud of “smoke” made up of a chemical which is both toxic and addictive.

This new product, already being sold and used in many U.S. cities, is called an e-cigarette...

If you don’t want people sitting next to you – in a waiting room, restaurant, bar, or any other area where smoking is now prohibited – using one of these devices to get around smoking bans, and forcing you and your loved ones to inhale deadly nicotine – please help now!

We should be thankful that ASH (UK) haven't sunk to this level of fear-mongering. Nonetheless, they have three reservations about e-cigarettes.

1. Most deliver a low dose of nicotine which may not give a typical smoker a sufficient ‘hit’ to satisfy cravings, discouraging smokers from continuing to use them.

2. Because the products are unregulated there are some concerns about their safety since few manufacturers disclose the ingredients of their products.

3. So far, there have been no clinical trials to prove that they can help people to stop smoking. In the absence of such evidence, ASH therefore recommends that people who want to quit smoking should use nicotine replacement therapy or other proven pharmacological aids such as Champix (varenicline) or Zyban (bupropion).

I don't believe that the first point is valid. E-cigarettes offer high, medium, low and zero nicotine cartridges and I haven't heard users complain that the high nicotine cartridges are insufficient. Besides, users can take as many drags as they need to increase the dose. ASH's criticism could more accurately be aimed at pharmaceutical nicotine devices like patches and gum.

The second point is moot. Already, we are getting a clear indication that there are very few ingredients in the devices and that none of them - nicotine included - are harmful at the doses found. Nevertheless, regulation is required and is welcomed by the e-cigarette industry. As ASH points out: 

...e-cigarettes are subject to general consumer protection laws and it is the responsibility of trading standards officers to rule on their safety.

That should be sufficient regulation.

The third point is also questionable. It is true that clinical trials have not yet shown e-cigarettes to be effective as smoking-cessation devices, but then they are not being marketed as such. On the other hand, they have not been shown to be harmful. The same cannot be said for Champix and Zyban which, between them, have been linked to 317 suicides or attempted suicides. 

In July, the FDA ruled that black-box warnings must be put on both these products:

FDA: Boxed Warning on Serious Mental Health Events to be Required for Chantix and Zyban 

The U.S. Food and Drug Administration today announced that it is requiring manufacturers to put a Boxed Warning on the prescribing information for the smoking cessation drugs Chantix (varenicline) and Zyban (bupropion). The warning will highlight the risk of serious mental health events including changes in behavior, depressed mood, hostility, and suicidal thoughts when taking these drugs.

This leaves consumers with a choice between a product that has not been clinically proven as a stop-smoking device but is safe, and two products that have been proven to cause psychotic disorders. That ASH (UK) is recommending the latter may seem perverse, but at least they are still allowing a choice.

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Pigeon amongst the cats

Now this should be interesting...

E-CIGARETTE COMPANY DONATIONS TO CANCER RESEARCH UK

UK Electronic Cigarette company cheapelectroniccigarettes.co.uk are today launching a scheme which will see 10p of every product sold being donated to Cancer Research UK.

Owner Michael Kitt stated, “We sell a lot of electronic cigarettes all over the world and feel that it is only right that we also support a charity which has the same vision as us – creating a smoke free environment around the world by offering clean smoking without tobacco, tar and the thousands of other chemicals found in traditional cigarettes.”

What to make of this? As a commentator over at Smoking 2.0 says:

Are they mad?

Anti-tobacco want e-cigs outlawed too.

CRUK receive money from pharma companies who are in direct competition with e-cigs.

Anti-tobacco certainly want e-cigarettes banned in the US, and have already succeeded in Australia, but what is the situation in the UK? One of ASH's stated objectives is "harm reduction", of which they say:

One way of reducing the harm caused by tobacco may be to facilitate the switch from smoked tobacco products to the use of ‘clean’, non-tobacco, nicotine products.

For years, ASH have officially supported the legalisation of snus, saying (in 2004) "there is no logic to the banning of snus, when cigarettes, which are far more deadly, are on general sale".

ASH director, Deborah Arnott, said in 2006:

"We currently have a situation where the safest form of smokeless tobacco in the EU is banned, and that's the form on sale in Sweden [snus]."

More recently, she claimed that:

"ASH is not fundamentalist about nicotine.''

This year, ASH's Martin Dockrell reiterated the point that nicotine itself is not harmful:

"Think of cigarettes as the dirty syringe of nicotine addiction. If you could get heroin that didn't cause any harm, what would be the problem? If you could nicotine that didn't harm people's health, what would be the problem?

I think we would like to see faster, stronger nicotine delivery systems available to smokers."

The truth is that ASH (UK) have never been "fundamentalist" about nicotine. They were set up in 1971 with a mission to reduce harm and although it is one of their most low-key campaigns, they do want to see the EU ban on snus overturned. With their objective of tobacco harm reduction, it is difficult to see how they can oppose the e-cigarette which is, undoubtedly, a "faster, stronger nicotine delivery system".

ASH (UK) have not, so far, demanded a ban on e-cigarettes (unlike their American namesakes). Since ASH receives substantial funding from Cancer Research, these new donations from the e-cigarette industry should ensure that things stay that way. Or will pressure from American fundamentalists and Big Pharma prevail?

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