September 16th, 2014

Memo to public health grandees: vaping, vapers and you

public health

No, you keep calm

Dear Public Health Grandees (you know who you are)

I consider myself a public health advocate and, though I’m not a vaper and have never smoked, I support vaping as a tobacco harm reduction strategy, with enormous potential to reduce death and disease globally.  It’s a good approach for public health as it doesn’t require prohibitions, coercion, punitive taxes or rely on fear and it goes with the grain of behaviour and what people want. I thought it might help you if I explained what I have learned about vaping and vapers, and why your relationship with them is so poor. You can also read very articulate views from vapers about your attitude to them at the links below. >> read the full post

August 27th, 2014

Appalling spin – a letter to a WHO spokesman

Original image removed at the request of WHO Legal Counsel

Updated: To say yesterday’s announcements from WHO were disappointing would rather understate the case.  The package of paper, press comment and tweets, looked at in the round was anti-scientific, unethical and harmful.  It led directly to a dreadful article in the Telegraph: ‘I thought my e-cigarette was a miracle. Turns out, I was smoking the equivalent of 40-a-day’ as an entirely foreseeable outcome of its onslaught against e-cigarettes.   It was made all the more galling by having to listen to WHO spokesman Armando Peruga on the BBC Six O’Clock Radio news talking complete nonsense.  Today I decided to write him a letter.

>> read the full post

August 26th, 2014

WHO on e-cigarettes – protecting cigarette sales and causing more disease and death

Original image removed at the request of WHO Legal Counsel

Following publication of WHO’s paper on e-cigs for the FCTC COP-6 meeting in Moscow the statement below went out to media from Professor Gerry Stimson. I agree with all of it, but think he is far too polite.  My initial reaction was as below (Update 15 Sept 2014: a more complete analysis is now available):  >> read the full post

August 23rd, 2014

Big Pharma anti-vaping ad complaint


I found this annoying and decided to complain

It’s perhaps a good sign that Big Pharma feels compelled to apply its boneheaded, plodding, utterly uncreative advertising skills to persuading smokers to use its inferior products rather than take up vaping. For a characteristically entertaining account of the righteous petulance of Big Pharma see Redhead Full of  Steam. Even so, I found this advertisement annoying, especially as e-cig vendors can’t fight back and likely to be counterproductive for health (if enough people followed its advice).  So I decided to see how they can be held to account. As it turns out MHRA is the regulator and it applies a code called the Blue Guide, Advertising and promotion of medicines in the UK.  So here is the complaint:

>> read the full post

August 9th, 2014

A critical commentary on the Glantz and UCSF e-cigarette submissions to the FDA

Screen shot FDA deeming regs page

Click to access the FDA page


It was a dire (though mercifully short) experience: I decided to provide a brief response to each of the many submissions to FDA issuing from UCSF under the direction of Professor Stanton Glantz.  Here is my contribution to FDA deliberations in PDF form: Critical commentary on the comments on the FDA deeming rule submitted by UCSF faculty and fellows (PDF)  The text and links are set out below.  I summarised it in the comment section of the FDA web site as follows:

The UCSF submissions show multiple failures of fact and interpretation; inappropriate framing; and dramatic systematic biases – emphasising minor or implausible risks while diminishing or ignoring entirely very significant potential benefits.

I might have added that the cigarette based business model of the tobacco industry could not ask for better allies.  Almost everything coming from UCSF on e-cigarettes will, if regulators acted on it, protect cigarette sales from competition, support a diminished market for e-cigarettes best suited to tobacco industry dominance, increase avoidable smoking and lead to more death and disease. Nice work! >> read the full post

July 31st, 2014

Briefing: the case for e-cigarettes

Shorter briefingIn response to my longer briefing, sometimes people say: well could you please state the case more concisely?  So here is a shorter briefing, starting with a one paragraph summary…

>> read the full post

July 31st, 2014

Briefing on e-cigarettes for policy makers

Longer briefing
I am occasionally asked for a briefing on e-cigarettes and related policy issues – so here’s one I produced recently, that I hope some readers of this blog might find useful – for example in talking to Directors of Public Health, NHS officials etc. This is the longer one… I also did a shorter one with more recommendations.
>> read the full post

July 18th, 2014

Irresponsible and unaccountable: the BMA and its war on e-cigarettes

If only the bars were to keep them in!

If only the bars were to protect us from them

A truly dreadful letter has appeared in the BMJ from two BMA committee members, Dr Chris Valentine and Dr Paul Nicholson, who write that Safety of e-cigarettes still needs to be proved and provide some terrible advice along with it that if acted on would cause more harm than it prevented. Valentine and Nicholson are respectively a member and the chair of BMA’s influential Occupational Medicine Committee, and should approach their work with a great sense of responsibility and accountability. Sadly, they have neither. I have provided a rapid response to the BMJ, concentrating on the more philosophical failures apparent in this short letter.  My rapid response (Safety of e-cigarettes still needs to be proved? BMA position needs to be challenged) is now published and reproduced below to allow for more expansive comment (with better formatting and fewer typos!).

>> read the full post

July 16th, 2014

Some hard messages for the tobacco control establishment – Peter Hajek

Brilliant!! No doubt in my mind – the best speech of the Global Forum on Nicotine conference by far. Professor Peter Hajek uses the conference keynote, the Michael Russell oration, to explain through the work of Michael Russell (1932-2009) and his protégés the case for tobacco harm reduction. He then tears into the zombie arguments (18′ 48 sec), ideology (22′ 38sec) and motivations (23′ 18sec) of the ‘tobacco control’ activists who oppose e-cigarettes, often for moral reasons (24’00 on), drawing the brutal conclusion that for them “evidence is just a tool to gain converts”. I really liked the lines about all the concerns of the tobacco control establishment do not matter unless they increase cigarette sales (27′ 14 sec). As he puts it: “Are you saying that if you allow e-cigarettes on the market it will somehow increase smoking?” – that’s the question that matters.  Mike Russell was a very smart guy with real rigour and edge, matched by a compassion for people and the risks they faced: he would have been very proud of Peter Hajek’s tribute.

July 3rd, 2014

Turning the tables on public health – let’s talk about the risks *they* create

I’m here to tell you what to do, not to take responsibility for it

I’ve had enough of the one-sided conversation about the risks associated with e-cigarettes… poisons, gateways, renormalisation, fires, explosions, MRSA, pneumonia, dual use, undermining tobacco control, nitrosamines, anti-freeze, particulates, heavy metals, dead dog, dead cat…. blah blah blah.

ENOUGH! The public health establishment is conspicuously failing to recognise the risks associated with its preferred policy responses to e-cigarettes: with not having e-cigarettes, with banning snus, with prohibiting vaping in public places, with confusing people about risks, with controlling everything.  They carry on as if these risks are zero or somehow not their responsibility – but they are all plausible and all end in more smoking and more cigarette sales. We need to press them much more assertively on the risks they create and the harms their ideas may do:

  • “do you accept these risks are plausible and can you see how and why they might arise?”
  • “what evidence do you have regarding these risks?”
  • “what make you so confident your policy ideas will not cause more harm than good?”
  • “at what level of risk would you stop advocating these policies, or at least call for more evidence?”

For almost every policy idea there is for regulating harm reduction, there is a realistic risk that it will make things worse for health. And for almost every theoretical risks from vaping, there is a more plausible theoretical benefit. Let’s consider the following:
>> read the full post