February 17th, 2020

New nicotine science and policy Q & A published

I have just published a new question and answer (Q & A) resource on nicotine science and policy.  It is available as a page accessible from the top menu of this blog and also at this address: Nicotine science and policy Q & A.  I am hoping to keep it up to date… the questions as they stand at present are as below.  My answers are on the Q & A page above – please visit, leave comments, suggestions for other questions, better answers or further reading.

The questions

1. Strategy – what is the purpose of tobacco and nicotine policy?
1.1 What are the goals of tobacco and nicotine policy?
1.2 What is ‘tobacco harm reduction’?
1.3 What products are involved?
1.4 Shouldn’t we aim for a nicotine-free society?
1.5 What is the ‘endgame’ for tobacco?

2. Safety and relative risk – what are the risks?
2.1 Are e-cigarettes less harmful than cigarettes?
2.2 Do the recent US cases of severe lung injury prove that e-cigarettes are very harmful?
2.3 What about long term effects – shouldn’t we take a precautionary approach?
2.4 It took decades for the harmful effects of smoking to emerge, won’t it be the same with vaping?
2.5 How much less harmful are e-cigarettes than cigarettes?
2.6 Is it fair to say e-cigarettes are likely to be at least 95% lower risk than smoking?
2.7 Do people understand the risks of vaping?
2.8 Isn’t this just the ‘light cigarette’ tobacco industry scam all over again?

3. Quitting smoking – do vaping products displace smoking?
3.1 Do e-cigarettes help people quit smoking?
3.2 Isn’t most vaping ‘dual-use’ of e-cigs and cigarettes?
3.3 What is the difference between NRTs, smoking cessation pharmaceuticals and vape products?
3.4 Should the healthcare system cover e-cigarettes as smoking cessation aids?
3.5 What about people who are disadvantaged and cannot afford to vape? Should they get support?
3.6 Should the healthcare system help vapers to go nicotine-free and quit vaping?

4. Youth – how should we address the uptake of adult products by young people
4.1 Why do e-cigarettes appeal to adolescents?
4.2 Is there a ‘youth vaping epidemic’ in the United States?
4.3 Is vaping a gateway to smoking?
4.4 Should flavours be banned to stop youth vaping?
4.5 Should e-cigarette sales be restricted to people aged 18 and over?
4.6 Does nicotine damage the developing adolescent brain?
4.7 What can be done to protect young people?

5. Regulation – how should governments handle reduced risk products?
5.1 Should e-cigarettes be banned?
5.2 Should e-cigarettes be regulated like cigarettes?
5.3 Should e-cigarettes be regulated as smoking cessation medicines with pharmaceutical regulation?
5.4 What is the right approach to regulating e-cigarettes?
5.5 What are the potential unintended consequences of vaping regulation?
5.6 Should different categories of vapour products like THC or nicotine salts be regulated in different ways?
5.7 Should regulators impose limits on the strength of nicotine in e-liquids?
5.8 Why does Juul use a high strength nicotine liquid in the US?
5.9 Should there be a special tax on e-cigarettes?
5.10 Does tobacco harm reduction undermine tobacco control?

6. Vaping in public places – should it be permitted and who should decide?
6.1 Do e-cigarette vapours pose the same risks to bystanders as second-hand smoke from cigarettes?
6.2 Should vaping be banned by law in public places and workplaces?

7. Marketing – what marketing freedoms or constraints are appropriate?
7.1 Are vaping products aggressively marketed to teens?
7.2 Should advertising for reduced-risk products be banned?
7.3 How to maximise the benefit to smokers and would-be smokers, while minimising recruitment of non-users?

8. Retailing – who should sell and under what conditions?
8.1 Where should e-cigarettes and other reduced-risk products be sold and not sold?
8.2 Should e-cigarettes be available only through pharmacies or on prescription or over-the-counter everywhere?
8.3 Should vaping products be available on-line?

9. Tobacco industry – pariahs, predators or player?
9.1 Are e-cigarettes a tobacco industry ploy to keep people smoking?
9.2 Should tobacco control authorities collaborate with tobacco-related industries in pursuit of public health objectives?
9.3 If tobacco companies want to reduce the harm caused by cigarettes, why don’t they just stop selling cigarettes?

10. Rapid responses to the biggest myths about vaping
[14 additional rapid-fire questions]

Postscript. Vaping – what people are getting wrong. The Economist

January 30th, 2020

World Health Organisation fails at science and fails at propaganda - the sad case of WHO's anti-vaping Q&A

WHO’s anti-vaping propaganda is so bad it discredits the whole organisation

On 20 January 2020, the World Health Organisation published a question and answer page on “ENDS” (Electronic Nicotine Delivery Systems) or e-cigarettes and vaping products for nicotine as they are more commonly known: E-cigarettes: how risky are they? (current live version)

Update (31 January 2019) – WHO’s amended version: almost certainly in response to severe criticisms, WHO published an update to its Q & A some time on 29 January.  The 20 January original version, (archived) which WHO heavily publicised (e.g. see Twitter thread) is the subject of this blog, not least because it allows debunking of some especially absurd anti-vaping statements.  WHO has not notified readers of the changes or issued any acknowledgement of correction or error. So for comparison purposes, I have compared the original and updated versions side-by-side in the final section of this blog: go to Update: what WHO has changed.  Much of my original criticism applies to the amended version, which mainly removes some of the most blatantly false and misleading statements. Update ends.

There are nine questions and every single answer provides false, misleading or simplistic information, and this remains true of the 29 January update.  It is a disgraceful travesty of science communication and policymaking advice and again puts in question the competence of the WHO – if there is still any doubt about this. But it is so bad that it even fails as anti-vaping activist propaganda – and that is a low bar.

I will briefly set out the nine questions in the original Q&A and the World Health Organisation’s answers in quote boxes, each followed by my assessment of the answer. >> read the full post

January 17th, 2020

Vaping is still at least 95% lower risk than smoking - debunking a feeble and empty critique

An empty and feeble critique misses its target and adds nothing

This paper turned up in my weekly search of PubMed.

Invalidity of an Oft-Cited Estimate of the Relative Harms of Electronic Cigarettes.
Eissenberg T, Bhatnagar A, Chapman S, Jordt SE, Shihadeh A, Soule EK.
Am J Public Health. 2020 Feb;110(2):161-162. doi: 10.2105/AJPH.2019.305424.

The commentary claims to show the “invalidity” of the statements made by Public Health England (PHE) and the Royal College of Physicians (RCP) regarding the relative risk of vaping and smoking – in short that vaping is likely to be at least 95% lower risk than smoking.  As this is an important harm-reduction risk communication, it is worth asking: how valid is this critique?

I thought this might be a better critique than it actually is. But somewhat to my surprise, it is very poor indeed.

Short version

At best, the authors try to show the absolute risk of vaping is not zero and that some harm is plausible. In doing so, they are refuting a claim that neither PHE or RCP make and challenging an argument not used by anyone sensible in tobacco harm reduction. However, not a single word of their paper addresses the supposed foundation of their critique – that PHE/RCP are wrong and the risks of vaping are likely to exceed five per cent of those of smoking. As well as a number of baseless assertions that are not even relevant to the “at least 95 per cent lower” relative risk claim (gateway effects, smoking cessation efficacy and second-hand aerosol exposure), there is just nothing in the paper about the relative magnitude of smoking and vaping risks. No analysis, no data, no evidence – nothing that discusses relative risk and why PHE/RCP are supposedly wrong. Niente. Nada. Rien. Nichts. Nothing.

New (20 Jan 2020). See concise comment on PubPeer here: A critique that does not even address its target

Anyway, despite being an empty and feeble piece of work, it does provide an opportunity to discuss some of the issues raised, so I will proceed with a critique.

Longer version

The authors’ supposed refutation of PHE/RCP rests on six propositions.  You can read the article here and I will respond to the authors’ main points in the order they make them. >> read the full post

December 15th, 2019

Brexit and vaping

In this post, I try to anticipate what Brexit means for the UK, for the Tobacco Products Directive and what that might mean for UK and European vapers. it’s in two parts because we need to speculate a little on how Brexit will play out and then how that will affect the TPD compliance in the UK as the TPD evolves from TPD2 to TPD3.

Part 1. Brexit: what next?  

Part 2. Brexit, Tobacco Products Directive and vaping – the outlook

>> read the full post

December 4th, 2019

Vaping policy - rapid questions and answers

Vape shop in Manila, Philippines Vaping House Manila Play,Chill & VAPE

I just filed a submission with the Philippines House of Representatives for its Joint Trade & Health Industry Committee hearings on e-cigarettes, to be held 10 December.

The full submission (PDF) starts with an introductory Q&A and then goes on to provide more detail about specific issues with some backup material. I thought the 15 questions and answers might be of more general interest, so I have reproduced it below.

>> read the full post