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!).

There is so much wrong in such a short communication that it is hard to know where to start. I would like to draw out four types of error in this letter:

1. Framing errors. The authors appear to misunderstand the concept of harm reduction. It is not necessary for e-cigarettes to be completely ‘safe’ – they just need to be very much safer than smoking, and not that dangerous in absolute terms for them to have a valuable public health impact if they function as an appealing alternative to smoking. If the BMA officials had studied the experience of snus (smokeless tobacco) in Scandinavia they would understand this concept. In fact, BMA was one of the organisations that wanted this product banned in the rest of Europe, prompting a number experts in the field to write to the Secretary of State for Health to voice their opposition to a ban with evidence [1]. There is a similar framing error in the authors’ approach to acute toxicity of nicotine. Not only is their science obsolete and greatly overstates the toxicity [2] but their framing is wrong: we do not generally control toxic substances in the home by banning them or limiting container sizes to below sub-lethal doses: imagine having to buy bleach by the cupful. The approach taken is to classify, package and label the products appropriately – something that is easy to do, and the BMA could constructively support that instead of trying to reject the product outright on these spurious grounds.

2. Loss aversion and accountability for risks created by restrictive policies. The authors appear oblivious to the risks that their own policy prescriptions might create. Many of the restrictions they favour, and their public relations line, will have the effect of denying these products to smokers or persuading them not to try the products – and this comes with consequences. A very much less risky product (e-cigarettes) than the dominant, highly dangerous, incumbent (cigarettes) comes to market and the medical establishment moves in to oppose it. Surely it is obvious that this risks protecting cigarette sales, increasing smoking, denying smokers options that might work for them, and so contribute to more disease and death. In their focus on small or implausible residual risks arising from e-cigarette use, these authors have not symmetrically accounted for the lost opportunities and risks that their ideas might create. I have set out a more detailed account of this argument and wish to remind the BMA that it should be accountable for additional preventable smoking that arises from its hostile position [3]. As an example, the authors make a wholly unsubstantiated claim that flavours are added to increase appeal children – there is no evidence at all for that. In fact, flavours are important to adults, and particularly important in supporting a long term move away from smoking. To ban flavours risks compromising the appeal of the product to the intended market (smokers) and so leading to more smoking than there otherwise would be. The authors give no reassurance that they have considered this risk, yet it is more plausibly significant in sign and magnitude than any risks they cite.

3.Use of evidence in policymaking. The authors want “long term data affirming lack of harm”… but one wonders what would satisfy them, and whether this is simply a tactic to create an insurmountable evidential hurdle? What should be done in the meantime? The British doctors survey that demonstrated the effects of smoking unfolded over 50 years [4]. To make good judgements about risks in public health, a physician has to look at all the evidence, weight it by its value, and where there is remaining uncertainty to consider the uncertain risks and potential benefits on an even footing. A good evidential picture can be developed starting from the basic physics and chemistry of the processes involved, the toxicology studies on liquids and vapours, the long established and well studied history of nicotine use where there is no tobacco combustion (i.e. in NRT and snus), the absence of significant reported ill-effects or serious incidents, and expert opinion. These all combine to suggest that the risks arising from e-cigarettes in general are low, and the risks of nicotine itself, while finite, are very low. Cherry picking single studies out of context does not alter that. They also misrepresent the evidence on whether these products are effective at smoking cessation. There is not just ‘one study’ showing these products to be effective in smoking cessation – there are several trials and impressive survey data. The survey for ASH for example, suggests some 700,000 current British e-cigarette users are now ex-smokers, whilst use among adolescents and non-smokers is very low [5]. Surely the BMA can extract some evidential value from that? What, on the other hand, are the implications of ignoring it?

4. Missing humility and empathy. I understand modern medical training includes listening skills and recognises the importance of empathy with patients. I would like to commend this approach to the BMA. It is quite possible that millions of smokers are finding something that works for them and gives them immediate gains in welfare and self-esteem and significant improvement in long term health and mortality prognosis – at least that’s what many well-informed users say when they describe their experience. The tone from the BMA and the more reactionary elements of the health establishment is that the views and experience of users simply do not matter or are worthless anecdotes. I do not think this is right – not everything can be understood from RCTs and and thousands of user testimonies now point to huge welfare gains from this technology. I would advise any physician minded to take a dismissive view of e-cigarettes developments to look at some testimonies and remind themselves what the profession is all about. There are many available on the internet, and they make inspiring reading [6].

These issues have been raised before with the BMA and they have promised to consider them [7], but so far the organisation seems more concerned to defend its earlier positions, even though evidence and experience is increasingly leaving it looking scientifically vacuous, impervious to challenge and criticism and out of touch.

[1] Martin Jarvis, Peter Hajek, John Britton, Gerry Stimson, Riccardo Polosa, Karl Olov Fagerström, Michael Kunze, Karl Erik Lund, Jacques Le Houezec, Tony Axéll, Lars Ramström, Clive Bates. Letter to the Secretary of State for Health, Tobacco Products Directive and snus, 7 October 2013. Available online at: Why is the EU banning Europe’s most effective anti-smoking strategy?

[2]Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol 2014;88:5–7. doi:10.1007/s00204-013-1127-0

[3]Bates, C. Turning the tables on public health – let’s talk about the risks *they* create? 3 July 2014

[4]Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328:1519. doi:10.1136/bmj.38142.554479.AE

[5]YouGov for Action on Smoking and Health Use of electronic cigarettes in Great Britain April 2014.

[6]See examples and links at: Bates C. Where is the humility? Where is the empathy? 30 December 2013.

[7]Bates C. Letter to Dr Vivienne Nathanson, 25 February 2014, Response from Dr Nathanson, 4 March 2014. Unable to take any more, I write to Dr Nathanson of the BMA. A similar challenge has been made by the campaign group Sense about Science What’s the evidence for banning electronic cigarettes: we asked the BMA why they want them banned in public 12 December 2013

Update. I have now written to one of the authors enclosing this response suggesting they prompt a rethink of the BMA position.

Dear Dr Valentine

I have seen your letter on e-cigarette safety published on the BMJ web site and I have to say I believe it is misguided and irresponsible, and that this stance will cause far more harm than it prevents. I have posted a rapid response to challenge these views and wanted to make sure you were able to consider at least this counter argument. I understand scientists who specialise in this field have also submitted a robust rapid response, and no doubt that will be published shortly. For convenience, I have enclosed my response at the end of this email and posted it on my Counterfactual blog: Irresponsible and unaccountable: the BMA and its war on e-cigarettes.

The reason to contact you directly is to suggest that BMA carefully and systematically reevaluates its position, which is now a long way out of alignment with the expert community and bodies that take a specialised interest such as ASH and the Royal College of Physicians. Failing that, I hope you will at least respond to the criticisms made by me and others. BMA statements wield considerable influence and authority, but the BMA does not seem willing to accept responsibility or accountability for the potentially harmful consequences of the positions it takes.<

I am copying in Prateek Buch of Sense About Science, a group that tries to equip people to make sense of the scientific assertions and evidence in public discourse. Sense About Science has repeatedly raised questions about the quality of BMA’s evidence for the positions it holds on ‘tobacco harm reduction’ and e-cigarettes, but as yet has received no substantive response.

I would be grateful if you could share this with your co-author and committee chair, Dr Paul Nicholson, as I do not have an email address for him. I do hope you will seriously consider my suggestion for an in-depth review of BMA’s approach to these issues.

Yours sincerely
Clive Bates
Counterfactual Consulting
Former Director Action on Smoking & Health 1997-2003
Note: no competing interests.

Update. I was asked if this can be taken to the General Medical Council. Actually, if the BMA and its officers actually followed GMC guidance on ‘fitness to practice’ they wouldn’t be writing letters like this – and would have a lot more respect for their ‘patients’.  I guess handing out really bad advice and analysis to GPs is a bigger violation than just doing it in isolation unobserved in a GP surgery.  See key page below:

GMC guidance on Fitness to Practice

 

Update: more critical commentary is provided by Konstantinos Farsalinos and Riccardo Polosa in their excellent rapid response: Scientific evidence clearly indicates e-cigarettes are considerably less harmful than tobacco cigarettes.

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

  • Mark Bolton

    I dont smoke. I am astonished at the vigour the Nanny Staters are displaying trying to shut e-cigs down. I supose if they did contribute to harm minimisation it would leave the proffessional meddlers out of the fray. Might even have to get a proper job. My question is this ; have the studies so far given a ball park indication of how many smokers will quit? How many that switch to e gigs will be saved from chronic brioncitis – emphesema etc ? VIZ How embarasing will it look for the wowser brigade ?

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  • Irish Lass

    This is great stuff, Clive. Once again, thanks for your sterling work in supporting e-cigarettes against the nonsense that is being spread about them.
    It is sad that all this nonsense, being published over and over again, is having the effect that its perpetrators desire. Close relatives, despite being joyful that I have finally managed to stop smoking, still express worries to me about the safety of e-cigarettes and about how they are attracting young people into smoking. Gaaaaah!

  • mathiasdelaurentiis

    Hi,

    As a smoker, I have recently began researching E Cigs, Vaping, etc. I specialize in content that speaks to a general audience, often with humor and wit, without sacrificing quality or value.¿ It takes a lot of creativity to produce work that is informative and engaging (or at least not boring!).

    I recently wrote an article on the 5 advantages of electronic cigarettes.

    Feel free to take a look at it here: http://ecigs-europe.com/5-advantages-electronic-cigarettes/

    Greetz,
    Mathias

  • Sadly the “we don’t know what’s in them” and “gateway argument” are all too easy bandwagons to jump on. Even though evidence to the contrary has enough weight that if it were to be dropped on said bandwagons it would catapult the occupants into a lower Earth orbit!

    Time and time again where smoking and electronic cigarettes are concerned, the BMA show their ignorance of harm reduction. To reach a point where a long term smoker, having had numerous failed attempts at quitting with approved aids, finds their only option is to continue using conventional cigarettes is to put it mildly, ludicrous.

    My advice to Dr Chris Valentine and Dr Paul Nicholson would be rather than make lazy quotations from headline grabbing works, go and study all the available evidence – much of which is made available in this blog post by Clive – and come back with an informed opinion.

  • anthonyb

    I’ve only just read the “Safety of e-cigarettes still needs to be proved” and this bit “questions the safety of continued nicotine use”. right at the end made me smile.
    I’ve been using nicotine for 37 years. Which appears to me, to be continued use. And it is almost certain, that if I wasn’t getting nicotine from an e-cigarette then I would still be getting it from tobacco. I like my nicotine hit, in much the same way as those that can’t get going in the morning without their caffeine.

    • Irish Lass

      Yep, anthonyb. AND no-one in the BMA seems to question the safety of continued nicotine use if its in the form of approved NRTs like gum, patches, etc. Nope, its only nicotine from e-cigarettes that they are so worried about. Hmmmm….I wonder why?? Could it have ANYthing to do with the BMA’s close relationship with Big Pharma??

  • Bill Godshall

    Thank you once again Clive for confronting the perpetrators of false and misleading claims about e-cigs, smokeless tobacco and tobacco harm reduction.

    The irresponsible comment above by nisakiman is as inaccurate and mean spirited as the garbage coming from BMA. While the old anti smoking movement has been taken over by abstinence-only tobacco/nicotine prohibitionists, Clive and other real public health advocates in the anti smoking movement confronted and challenged those extremists.

    During the past fifteen years, Clive has truthfully informed all who would read and listen (and many of those who refused) that noncombustible tobacco and nicotine products are far far less hazardous alternatives to cigarettes, and has campaigned to make/keep those alternatives legal to make, sell and use.

    • nisakiman

      If telling the truth is irresponsible, then I plead guilty. My comment was not mean spirited, merely factual.

      Clive was part of the movement that perpetrated the myth of SHS, which Clive still supports, even though the manufactured ‘science’ behind it has been thoroughly discredited (not to mention that simple common sense should alert one to the outrageousness of the hysterical claims about it). This has led to all the bans, which have had massive economic and social costs, and has driven a wedge through society like nothing else.
      As Tobacco Control knew it would.
      It’s why they created the lie in the first place, so that smokers could be reclassified as untermenschen and cast out of polite society. It was all part of the plan, and to Clive’s (and the other drivers of TC policy) credit, the deception worked splendidly. Smokers are now legitimate targets for government approved discrimination and hatred.

      He may have experienced a Damascene conversion with regards e-cigs since he departed ASH, and he may even have expounded the benefits of THR before that, but having been one of the architects of the current pogrom directed at smokers, he has, in effect, ensured that vaping will never be acceptable to TC, and that vapers, if they survive at all, will be subject to the same restrictions and sanctions (and probably taxes, too) as tobacco smokers.

      Of course, Clive is not solely responsible for this situation, and I don’t doubt that he disagreed with some of the more dishonest and underhand tactics employed by TC, but he was part of the movement, and so cannot now disclaim responsibility for the current attitude.

      • peter huston

        You weren’t malicious and you speak the truth but are prey to the demonic possession of the God Extremus which controls all web dialogue.(And to some extent the lesser God Hatus Obamus which persistently crops up on almost every comment site.

  • nisakiman

    Much as I applaud your defense of e-cigs, Clive, you have to realise that you are in part responsible for the current demonisation of the genre. You helped perpetuate the lies and exaggerations which are a signature modus operandum of Tobacco Control, and now those chickens are coming home to roost.

    Anti-smoking ceased to be about health at about the time of the Godber Blueprint, and has since then been a religious jihad against smokers, an ideological war in which no prisoners will be taken. So it is not in the least surprising – in fact it was inevitable, given the dogmatism of the zealots – that vaping would be seen as a threat to the very existence of Tobacco Control. The very thought of ‘re-normalising’ the act of smoking, albeit with faux cigarettes, is anathema to the diehards. They would rather see people die (quite literally) than give up any ground they have gained.

    If the vapers win this confrontation (which I sincerely hope they do), then the whole sordid, sorry deception that is Tobacco Control will start to unravel. Once people realise that this has never been about health, then the lies will be uncovered. And THAT is why Tobacco Control are fighting e-cigs every inch of the way. As I said, e-cigs are a threat to the very existence of Tobacco Control (and all the perks that come with it), and the fanatics know it.

    On a lighter note, Clive, I came across this just recently:

    https://www.youtube.com/watch?v=_j48wwOZHo4

    You even get a cameo part at the end! Fame beckons! :)

  • sebt

    Great work – thank you so much from a happy ex-smoker who’s actively opposing all this unbelievable reaction to e-cigarettes, but without the benefit of your expertise and reputation.

    The BMA has to change their position. The effect of their stance on e-cigarettes is pervasive. Vapers and THR advocates are rightly worried about the “hard power” of regulation and legislation; but the “soft power” of the BMA’s status and influence is ubiquitous – and far less democratically justifiable.

    The BMA forestall government decisions by persuading individual, powerful organisations (such as the rail companies, football stadia, and the Commonwealth Games) to “voluntarily” ban e-cigarettes from their premises; usually with a sickly, patronising accompanying message about how socially responsible and health-promoting this makes them. This “message” then trickles out into smaller businesses and society in general.

    I wonder whether there’s been any scientific work done on the case of Spain? Anecdotal reports I’ve seen on forums suggest that vapers there have given up vaping in favour of cigarettes (or not taken up vaping in the same numbers as in e.g. UK or France), because of widespread disinformation. Some science on this phenomenon (if it’s real) would be the ideal backup to your arguments here.

  • TheDan

    Thanks for your never ending effort.

  • Thanks for a inciteful article, sadly its Public Health the world over, who are doing this smear campaign against vaping.

  • Douglas Hicks

    Was at Lords Cricket ground yesterday vaping in the smoking area. This is out of choice since I wish smokers to see me using my Ecig devices. A smoker (40 a day) came up and struck up a conversion with me about my vaping device (Kanger/Vision Ego battery) we talked for 20 mins. We covered all aspects of vaping, where to buy, battery size, filling tanks, flavours, etc. What struck me was two points he brought up 1. nicotine dangerous 2. Bubblegum and children.
    1. Nicotine – I thought why would a smoker worry about how toxic nicotine is? Well ” There is a similar framing error in the authors’ approach to acute toxicity of nicotine. Not only is their science obsolete and greatly overstates the toxicity ” Could the poor information, put out by the BMA, be stopping smokers from switching to lesser harm? I believe yes is the answer.
    Needless to say I gave him better advise than the BMA on Nicotine.

    2. Bubblegum – As i was vaping bubblegum he made the comment that these flavors attract children!! Where does he get this information from? BMA type orgs? I recited ASH survey data to him which he seemed to accept, no children uptake of ecigs.

    The BMA does have a lot to answer for.

    • Clive Bates

      Douglas – you raise a very important point. The public health industry is engaged in a massive smear campaign directed at vaping – inventing or exaggerating risks, positioning the companies as predatory and denying or obscuring any conceivable benefit. Given these people are often given de facto trust (by virtue of being doctors or cancer charities etc) then they are likely to be believed. The consequence is that smokers like the one you met at Lords are deterred or worried away from the products and continue to smoke.

      I have never seen a single one of them accept responsibility for this or even acknowledge that it might be a risk that them and their propaganda that is slowing the conversion from cigarettes to e-cigarettes. The don’t seem self aware enough to realise – but all this frantic ‘public health’ activity is protecting the market for cigarettes.

  • Duchemin

    Stupid letter .. Just à non sense…. I am french and I support ecig

  • […] 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 …  […]

  • Anthony Billingham

    “anecdotes are, of course, scientifically worthless” That’s cool Clive I can live with that. But I forgot to mention I was/am part of a scientific study at the Department of Epidemiology and Public Health at UCL. And I’m happy to report that I was classed as a non-smoker, even after vaping my head off before I went in for the lab. tests.

    • Clive Bates

      Of course what I really mean is that authentic anecdotes in large numbers are scientifically relevant if you are genuinely pursuing the truth. They often capture qualitative insights missed in trials or surveys for example, because of (respectively) the controls applied to isolate the effect of a single variable or the limitations of questions on a survey, which rarely ask ‘tell me you experience?’.

  • Anthony Billingham

    I don’t think there’s much more to add is there. I have not got anything, except that my first year tobacco free is nearly here. After 35 years a smoker. Anecdotal I know just thought I would add it anyway.
    And best of luck to ALEX on his journey.

    • Clive Bates

      Anthony – anecdotes are, of course, scientifically worthless. Except when there are thousands saying basically the same as you… in which case they enter a new category “important evidence wilfully ignored by people who find it inconveniently conflicts with what they are already sure they know

  • Andy M

    Thanks once again Clive for your tireless efforts on this subject which is becoming more and more important by the day as those who would wish to crush the e-cig revolution up their game so to speak.

    I am deeply saddened, that despite the efforts of current vapers to put the record straight and stop the madness, he likes of which you have outlined above, nobody but nobody seems willing to listen to the overwhelming evidence in support of e-cigs be it anecdotal or scientific.

    One point for “these people” to bear in mind. They may not even think about accountability for their actions, but in this digital day and age, they WILL be held accountable. Names are being named and records are being kept of just who said what & to whom with nice date/time stamps appended.

    Those of us who made the switch from smoking to vaping know what the benefits are and there is no way on this earth that ANYONE will be able to force us back to “quit or die”. We have already quit of our own volition and will not be taking the “die” option. The powers that be want to take the quit option away from us by interfering with our life-savers, however, we are already stock-piling the equipment & the consumables in preparation to break any laws that these killers may impose. The saddest part is this – we, the current vapers, will not suffer. It is those who have yet to make the switch who will be denied this life-saving miracle and because of what?

    Add to the above, the fact that these people will encourage yet another black market in the shape of dodgy e-liquids, and they will surely have death on their hands. They also seek to stifle the massive innovatory leaps in the technology of vaping. I for one will have no hesitation in pointing the finger at those responsible.

    Keep up the fight Clive – we are all most grateful for your efforts to date.

    Best Rgds.,
    Andy M.

  • Alex Beebee

    I found a link to this article via a link from an online forum…. one I only joined 3 days ago….

    Why only 3 days, well I have been a smoker for 38 years… yes 38. I have tried ALL of the ‘Stop Smoking’ aids that either the nurse, doctor or pharmacist could provide. Inhalers, patches, mouth sprays, gums etc…. Not one of these worked for me, beyond several hours, not one…

    Until last Friday I was smoking between 35 to 50 Roll ups a day… and have in the past smoked up to 60… Well at approx 4pm on Friday under pressure from my 12 year old daughter I bought a Vape pen, maybe not from the best shop and maybe not with the best sales advice, but that is a longer story.

    The simple fact is……. I have had only 1, yes 1 roll up since 4pm on last Friday, and that 1 was early Sat am when the battery was not charged on the vape pen I had bought.
    So after 38 years and up to 60 fags a day I have now not smoked for nearly 7 full days, something I have NEVER managed to do with the support of ‘Stop Smoking’ clinics and all the products they could provide. But I have done this using a vape pen / eCig something that various areas (I know find) seem to want to ban / regulate excessively or control.

    Why do I comment, well after 7 days, joining 2 online forums to learn more about vaping and having now purchased a “Quality” Vape pen from a shop which gave good sound advice, support and assistance I have still only had that 1 roll up , to me I have cracked it, in time I can slowly reduce the Nicotine level in the vape pens I am using and hopefully stop using them altogether.

    I read these articles (I guess by NON Smokers) who feel they know better, who wish to control, maybe tax, maybe profit from the current product structure supplied by the big Pharmaceutical Co’s…. I don’t know…. I can only surmise, but I am an ordinary bloke from the Black Country who feels there is something sinister behind the EU, Governmental, BMA’s position towards Vaping….

    To me and to my 12 year old daughter and 14 year old son, me using an eCig is without doubt a lesser evil than smoking 35 to 50 roll ups a day, yes if people wish to get pedantic there may be some ‘minor’ long term effects if it using a PG or VG base, maybe some risks from some of the flavour components used…. maybe other issues…. BUT I have effectively STOPPED SMOKING using an eCig and to me that is positive…

    Why can’t these doctors (likely non smokers) at the top of the tree be supportive?, why are they so negative? I could propose many possibles for this, but I will not do that here.

    Suffice to say it really annoys me that these so called (non smoker) experts should be spouting this kind of ‘Negativity’ without really having any substantive evidence, just using their lofty position on committees or associations as a soap box for developing their own careers / positions at the expense of me and others like me (the normal voting public) who may wish to stop smoking but have not been able to using other methods in the past, but now some light at the end of the tunnel appears and they wish to turn it ‘off’.

    • Clive Bates

      Hey! Well done… thousands of people recognise and celebrate this achievement. Please take heart – it is the ‘facts on the ground’ that will win this war. Cases like yours and thousands like it can’t be blanked by the health establishment forever. Perhaps Valentine and Nicholson will respond to you personally to explain why the risks outweigh the benefits, and that you should return to failed quit attempts with the products they approve of.

      • Alex Beebee

        Thanks for the support Clive, Melissa and others. Just popped back and saw the replies.

        I am VERY pleased to say I am now on day 19 of using an eCig and can positively say I have not even had a craving for a normal fag even once, something that using patches, gum, nasal sprays ever did…

        So after 38 years I feel I have ‘Officially’ stopped smoking.

        I have however come across many ‘negative’ comments from some smokers, all based on mis information! One even was convinced and I mean totally convinced by the ‘Chinese whispers’ that seem to proliferate that eCigs were far more dangerous than normal cigarettes and was concerned about me vaping near him in the smoking shelter!!

        On a positive note however, I have managed to convince 3 other smokers to try vaping and 1 of these had tried before but with a very cheap ‘Market Purchased’ device, now he has bought a more expensive quality device and has had it for a couple of days he seems good to go.

    • Melissa

      Congrats, Alex. I’ve been a year off cigarettes and it’s still tough. I started with ciga-likes and progressed to a nice mod and eliquids. It’s long road for those of us who have so many years of smoking under our belts. After 26 years of smoking, and consistent failure in quitting, I found what worked for me. Despite that, I still get a moment of nostalgia when I smell one. It was my stress crutch for far too long (not the best stress management tool in the shed). I wish you a smoke free future and better health. You’ll find vapers are a varied and supportive group of people. You aren’t alone.

    • Irish Lass

      Congratulations, Alex! I am so thrilled for you. I have been a smoker for over 40 years (!), smoking 2 packs a day for the last 10 or so years. Like you, I tried all the approved NRTs and none worked for me. I started vaping last November and was able to cut down to less than 10 a day almost immediately. Unlike you, I did find it difficult to stop completely, but e-cigs gave me the first real hope that I would be able to.

      And now I have been tobacco free for almost 9 days!! I still cannot quite believe it. I do still have cravings, but with the help of my e-cig I can resist them.

      E-cigs are a real breakthrough product. Vapers really need to fight the efforts of the zealots in public health (WHO, BMA, etc.) who are influencing politicians and the public against them, in spite of the scientific evidence that they are so much safer than smoking tobacco. If you want to help, please take a look at the European Free Vaping Initiative petition (Google EFVI) and, if you agree with it, get everyone you can to sign it.

      By the way, the Daily Mail ran a story on e-cigs yesterday that gave the most balanced view of them that I have read in the press so far. Maybe word is starting to get through?

  • Chris Oakley

    Via ASH daily news we learn this week that vaping is now officially banned on all BBC premises on the advice of the BMA.

    The BMA is a trade union,not an expert body. It is high time that journalists and politicians worked that out and treated it accordingly. Whilst many doctors are members for professional reasons it cannot be said to represent them on issues such as e-cigs as it does not have a mandate. It naturally attracts the more political and more extreme members of the profession.

    It is increasingly militant and does an excellent job of confirming to the world that passing a medical degree does not in itself indicate that a person is compassionate, well balanced, honest or intelligent. As you point out, along with the rest of our anachronistic medical establishment, it is irresponsible and unaccountable.

  • Alan Depauw

    Possibly the article’s authors have not benefited from the emphasis of modern medical training on listening skills and empathy with patients. Apparently they prefer to stick to the old ways: do as we say or on your head be it. They told us to quit using their prescribed treatment, or to die. Having chosen to do otherwise, as have the hundreds of thousands of smokers who gave up smoking thanks to electronic cigarettes, is, to their eyes, a crime of lèse-majesté against their august body of archaic belief.

    Fortunately the profession moves on! The number of health professionals who recognise the remarkable risk reduction benefit of the e-cigarette is now legion, at least here in France. One hopes that this is not an area in which their British counterparts trail.

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