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:
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June 29th, 2014

Regulation for tobacco harm reduction – four pillars


Four Pillars

In my last post on regulation I set out some general ideas that I think should guide and constrain the regulation of e-cigarettes.  From my presentation at Global Forum on Nicotine in Warsaw, here’s a suggested four pillars for regulation of e-cigarettes and other low risk products. >> read the full post

June 4th, 2014

Arguing about e-cigarettes – a Q&A

e-smoking ban-resized-600

Danger: Prohibitionists on the march

Here is a set of questions and answers on e-cigarette science, policy and politics.  Please use the comments to suggest other questions, better answers or to pick me up if I’m wrong.

>> read the full post

May 29th, 2014

Letter to WHO on low risk alternatives to smoking: a reader’s guide

Gent smoking

If only I was reading this in 2014….

A very positive development today, which I am pleased to say I had a hand in organising. 53 specialists in nicotine science and public health policy have written to Dr Margaret Chan, Director General of the WHO about tobacco harm reduction. The letter appeals for WHO to adopt a positive, proportionate and rational approach to products that provide very low-risk alternatives to smoking. In short, it calls on WHO to recognise this approach, tobacco harm reduction, is an important part of the solution offering great promise for public health, and not part of the problem.

I thought it would be good to have commentary on the text of the letter: so here is my ‘reader’s guide’.  The letter  text is picked out as quotes in boxes with a commentary beneath each section.  Note: the commentary and interpretation are mine, and only the text is endorsed by the signatories >> read the full post

May 29th, 2014

53 public health specialists write to WHO about alternatives to smoking – here’s the letter

Here below is the text of the letter sent to WHO this week, and full list of signatories (as a PDF here).  Now published on the next page – a reader’s guide to this letter.

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May 23rd, 2014

Public Health England goes positive on e-cigarettes

Cover page - click to access report

Sensible, balanced, reasoned

This is rather good. Public Health England commissioned a background paper on e-cigarettes from Professor John Britton and Dr Ilze Bogdanovica of Nottingham University and UK Centre for Tobacco and Alcohol Studies.  It is a relief to read good, evidence-based, optimistic reasoning from top figures in public health, and to have this commissioned by England’s main government public health agency. I’m sure there are things that I might have said differently in the report, but I can’t disagree at all with the positivity and vision of the summary and conclusions.  >> read the full post

May 20th, 2014

People using e-cigarettes to quit smoking 60 percent more likely to succeed than those using NRT sold over the counter

AddictionThe survey of e-cigarette use published today is great news for those of us who long suspected that e-cigarettes are effective in helping people stop smoking.  So now we have a population study (i.e. a survey of real users’ experience, not a trial) that shows very positive results for e-cigarettes, but also showing NRT users have no better success rates than those quitting cold turkey, at least without behavioural support.  This is part of a pattern of positive results from UK survey data… >> read the full post

May 7th, 2014

Updated info post: TPD – provisions relating to e-cigarettes

Sounds impressive!

Updated 7 May 2014. The articles and paragraphs have been renumbered to take account of inserted articles and paragraphs. Article 20 relates to E-cigarettes.  This is the full Tobacco Products Directive 2014/40/EU  as published in the Official Journal of the EU).  It will enter into force on 19 May 2014, with several compliance dates of 20 May in 2016 and 2017. The text below is designed to help you work out more easily what will apply to e-cigarettes, liquids and vaping devices.

Article 20 is divided into 13 paragraphs and cross references several other articles.  It is also supported by a set of recitals. The following are the broad themes and structure of the article – click on these to navigate to the relevant text:

>> read the full post