March 6th, 2015

Public health experts talking sense about e-cigarettes and vaping

Public Health England recently published some excellent video commentaries on vaping and e-cigarettes by genuinely thoughtful and engaged public health experts – I have collected them here.  These are intended for an English audience, but they deserve a much wider airing because they show what public health could be like if it actually approached the subject with an open and enquiring mind, regard for evidence and an attitude of humility and empathy.

Expert commentaries

Professor Ann McNeill, Kings College London
Distinguishing between vaping and smoking

 

Professor John Britton, University of Nottingham
Protecting bystanders

 

Deborah Arnott, Action on Smoking and Health
Protecting children and young people

 

Professor Robert West, University College London
Supporting smokers to stop

 

Ian Gray, Chartered Institute of Environmental Health
Impact on compliance with smokefree laws & policies

 

Contrasting commentaries

For each of the expert views put forward, a ‘contrasting view’ is presented. The contrasts are primarily about doubts or caution about hypothetical risks in most cases.  In the case of Andy McEwan and Peter Astley their presentations aren’t really a contrast at all. But I think these give useful idea of the strength of argument and evidence that stands behind the concerns of some in public health.

Cecilia Farren, GASP (a consultancy)
Contrasting view: Distinguishing between vaping and smoking

 

Andrea Crossfield, Tobacco Free Futures:
Contrasting view: Protecting bystanders

 

Professor Gerard Hastings, University of Stirling:
Contrasting view: Protecting children and young people

 

Dr Andy McEwen, National Centre for Smoking Cessation and Training
Contrasting view: Supporting smokers to stop

 

Peter Astley, Warrington Borough Council
Contrasting view: Impact on compliance with smokefree laws and policies

32 comments to Public health experts talking sense about e-cigarettes and vaping

  • J. Nolan

    I have been able to steam to a tobacco free life. All of the people are correct in some part of the side that they see it from, but when you are part of the group of people who propagate flawed data are just as bad who put it outout. It’s all about tmoney. ney

  • festus

    Great article, couldn’t agree more. Thanks

  • Joyce

    It is not so common in our country Kenya.

  • […] Louis County says no to public vaping During a public hearing at the county courthouse in Duluth, Iozzo pleaded with the board not to […]

  • […] RT @lpoznikoff: @CehNehDeh [email protected] speak to real experts on tobacco harm reduction. http://t.co/LntQUElvvY and David Sweanor for real sto…  […]

  • Clive this is a great assembly of information.

    I want to take a moment to comment on one of the ‘counterpoint’ videos. Specifically that of Celia Farren. I note the prior comment regarding her lack of substantiation behind her claims, but I don’t believe she needs substantiation.

    Instead, what I see presented is a very forthright and honest display of the *emotion* behind the reticence of PH grandees to accept vapor products. It *is* true that they fought a difficult campaign against cigarettes to get this far. For them, the notion that there is something else that triggers such a visceral distrust is telling. After all, who wants to see one’s life’s work threatened. I hope that folks like Celia have just enough of an open mind so as not to succumb to the proof against any argument: contempt prior to investigation.

    Contrasting her views against the others in the field who appear to fairly well exude contempt (they need not be named), I hope we may find opportunity with her position.

    Thank you for the compilation. It presents a clear range of ideas and may illuminate opportunities for progress.

    Cheers,
    -bruce

    • mark entwistle

      I am glad you see the piece as an opportunity, and hope you are right. It seems to me though that these videos show that tobacco control is a barren land where no innovation can grow. All three f the counter positions specifically state that they have no evidential basis for their position, it hold it anyway. I tend to agree that they are likely honestly held opinions, ut struggle to see how this makes any difference as opposed to them being outright liars. To borrow from Clive, they are just useful idiots. Attaching honesty to these opinions only serves to highlight that these people are not fit for purpose. in particular Farrens comment about trolls really emphasises how bleak it is I tobacco control. That is us she is talking about, the people whose victory over tobacco she should be celebrating and learning from, rather she has swallowed the line that the egregious ones you would not name, have sold to her. It I utter bollocks, and predicated on a war on the tobacco industry that has nothing to do with vapers, or foe that matter smokers.

  • Spinster

    Thank you! I am so so grateful to these experts for speaking the truth and helping stem the endless tide of FUD about ecigs.

    The contrasting views are interesting.

    I enjoyed watching Cecilia Farren and Andrea Crossfield having to admit that if smokers switch to ecigs that is a good thing. I think this is a big sign of progress. You could see their teeth gritting :-D Gerard Hastings’ 5 minute evidence-free General Worry was hilarious. Cassetteboy could do something brilliant with this! And yes, the last two seem to be ‘on our side’.

    They have nothing, do they? It’s very clear.

    Thanks again for compiling these, it’s a great resource and I’ll be sharing it widely.

  • Irish Lass

    Interesting. Thanks for this, Clive. How fantastic to hear sense being talked by some in public health. Very noticeable that the alternative views are all “possible” effects and hypothetical “concerns” that are not backed up by any evidence to date. But even those presenting the alternative views all accept that e-cigarettes are a lot less dangerous than lit tobacco cigarettes – which is not at all clear in many of the articles that are being published or broadcast in the media. I wish that these sensible views could be more widely heard across the land – particularly that the risk to bystanders from the exhaled vapour is negligible. I am lucky – my family and friends all accept this and are happy for me to vape around them. But out in public, there are many who genuinely misbelieve that the vapour is deadly. Public education is vital. Winning hearts and minds (both of the public and of our politicians) IS important – and so far it seems that the ANTZ are ahead in the battle.

  • john

    Clive thanks!
    I think one reason why the TC mob are so inclined to focus on ‘hunches’ about non evidence based risks of vaping,is because the TC mob have been overstepping the mark re scientific evidence, for sometime, all in a good cause.

    New Scientist back in 2009 editorialized about the misuse of science to greatly overstate the risks of second hand smoke, in open air settings, all in the good cause of further restricting smokers:

    “A good thing? Perhaps – except that it looks as if anti-smoking campaigners have been distorting the facts to make their case. Some have claimed that a non-smoker exposed to tobacco smoke for just half an hour can permanently increase their risk of heart attack. Yet a new study suggests that such statements are not supported by science. Half an hour of passive smoking causes only transitory changes in heart function. It would take years of repeated exposure for the effects to become potentially lethal (see “Anti-smoking groups accused of distorting the science on the risks of heart attack”).

    Some might say, so what? If tobacco smoke is harmful, then surely anything that reduces people’s exposure to it should be welcomed. Not so. Using bad science can never be justified, even in pursuit of noble causes. It only gives ammunition to those seeking to undermine your case. When anti-smoking groups want to make their point they should stick to the solid facts. There are plenty of them.”
    http://www.newscientist.com/article/mg19626293.300-editorial-dont-mangle-the-facts-even-in-a-good-cause.html

    • Dodderer

      I think this is the irony for many of us.

      http://onlinelibrary.wiley.com/doi/10.1111/add.12550/epdf

      The supportive wing of TC make impassioned pleas for truly honest,evidenced-based research on ecigs despite having spent the rest of their careers producing the exact opposite regarding nicotine addictiveness,second(and higher)hand smoke,the effectiveness of pharma therapies and/or behavioural support,indoor bans and plain packaging etc.

      A truly honest TC academic would just leave things as they because nothing is going wrong and everything is going right.But this would diminish their relevance and cast doubt on current policy initiatives.

  • Jude

    I would like to comment on the claim that e-cig advertising is the same as the tobacco cigarette advertising in the past, and the reasons why the ANTZ think this is such a bad thing.

    First of all, vapour product companies cannot make any health claims, (ANTZ have seen to this), about vape products, despite the overwhelming data showing that they do indeed help people quit smoking, and have health benefits to the individual. So they are left with advertising more ephemeral aspects of their product, such as glamour, sexiness, freedom, etc.

    Secondly, the anti-smoker zealots have spent years and huge amounts of money, (taxpayer money mostly), putting out propaganda labeling smokers as dirty, filthy, addicts, to the point where many smokers have internalised this message, and have become self hating. Then along comes a product that allows them to see themselves in a positive light, and free from the hatred directed at them as smokers, and this has got up the noses of those bullies and narcissists in tobacco control, that don’t want to lose their scapegoat. This is also why they have switched from making tobacco the demon to nicotine now being their focus, despite the fact that it is a very safe substance and causes no significant health issues for users or anyone else.

    The biggest lie is that this has anything to do with children taking up vaping, “think of the cheeldren” is simply the well worn vehicle used to push a much nastier and corrupt ideology.

    This whole propaganda campaign against vaping, to me, falls into two distinct categories, the first is the all time favourite, the desire for money and power. The second is the mentality of the bully and narcissist, which many in tobacco control exhibit. They want to have a scapegoat, and smokers have provided this scapegoat. They are trying their damnedest to try to continue the use of smokers as scapegoats by attacking vaping as if it were simply smoking by another means. When they fail at this, they will start looking for another scapegoat, which will be drinkers, fatties, etc etc etc. The type of bully and narcissist, that infest much of tobacco control and public health, are the disease, and are corrupting public health with their lies and toxic ideology. They are the cancer that needs to be cut out before it kills the host.

    • Clive Bates

      What surprises me is that anyone is surprised that ecig advertising sometimes looks like cigarette advertising. They are selling a recreational nicotine product to smokers. The more effective the advertising is, the more likely that smokers will respond and try vaping or stay vaping – with a public health and individual wellbeing dividend that the ANTZ don’t seem interested in. It is better to see vape advertising as clever anti-smoking advertising. It’s not obvious that health messages are the most effective way to sell products like this – NRT ads always look sterile and worthy to me (though I’m not in the target market). Making people feel good and aspirational about vaping with glamour, sexiness, freedom etc might be a way to encourage them to try and to switch. The fact that this might look like cig advertising of old is an irony, but it is actually anti-cig adverting and builds brands of products that are alternatives to cigs. Due to brand stretching bans these ads can never build cigarette brands.

      • Jude

        You make a good point Clive, as an ex-smoker, the ads for pharma NRT never interested me, because their products didn’t address the reasons I smoked in the first place, and I didn’t want to “quit”. I never swallowed the view of smokers as “dirty, filthy addicts, who are evil and want to harm others”, so the propaganda that portrayed smokers in this way, (most of it in Australia), had absolutely no impact.

        I wasn’t “sick” and in need of “treatment” as a smoker, so NRT, (which is sold as a treatment), I had no use for at all.

        As for making people feel good and aspirational about vaping, and encouraging them to make the switch, this is the last thing the ANTZ want, they want smokers to suffer, they want to keep their whipping boy, this is what turns them on, its how they get their jollies. Anything that gives smokers an alternative, especially a safer alternative, that is enjoyable, and moves away from the “quit our way and preferably with great suffering or die” ideology, is heresy to the high priests of “tobacco control”. Unfortunately, the ANTZ desires are very useful to the producers of pharma NRT, the producers of tobacco cigarettes, and the parasitical governments that suck out all that lovely tax revenue from smokers. Why would any of these vested interests groups want smokers to escape the trap?

      • mark entwistle

        It is no surprise Tha it looks vapour product advertising looks like cigarette advertising, because they both just look like advertising. Coffee. Chocolate, cars, perfume, jewellery and countless other lifestyle products are sold in this manner. To simply reduce the argument to vapour and cigarettes is dishonest.

        • Jude

          This is true Mark, but its only vapour products that are threatening the ANTZ ideology, or the pharma and tobacco industry, not to mention government tax revenue. Its hardly surprising that they are using every excuse, however ridiculous, hypocritical, or dishonest, to try and shut vaping down.

  • Jude

    Having watched these videos, (thank you Clive), I see the problem as one of self appointed “experts” and paid lobbyists, arguing among themselves about their beliefs and hunches, based on their ideology, and those who have more integrity and argue their case based on actual evidence.

    What does this mean for ordinary people that vape? It means that once again we have a bunch of people that believe they have the right to control the behaviour of others, and in the case of the ideologues, that they have the right to do this because they feel that their ideology trumps the rights of us ordinary people to live their lives as they see fit.

    As an ordinary vaper, I have to take a stand on this issue. I have decided to ignore the bloviating of the ideologues and vape where I choose to, (with consideration given to property owner’s views, and for other ordinary people, in other words just good manners). For example : I was sitting outside a local cafe, in the open air, on the footpath, (the foot path is not owned by the cafe owner), and vaping. There was only one other person sitting at the same table, a friend who also vapes. A person passing by stopped to tell me, (unsolicited), that I was not allowed to “smoke that thing” as it was against the law. I asked “what law”, and told the person to go away and stop bothering me. The person became irate that I was not bowing to their view, went inside the cafe and complained to the owner. Who explained that they did not own the footpath, and that there was no law preventing people from vaping on the footpath or anywhere else. The person went away disgruntled.

    This story illustrates what ordinary people who vape, face on a regular basis, because of the propaganda pushed by the ideologues, (without even mentioning the constant comments about vaping being just as dangerous as tobacco smoking).

    If those in public health, that support vaping as harm reduction, continue to allow the propaganda and ideological nonsense about vaping to go on, unquestioned or questioned only among themselves, but not publically, vaping will end up having little or no value to those who want to quit smoking, and they will simply continue to smoke. Those that support vaping need to stop pandering to these ideologues, and stop giving their ridiculous arguments air space.

  • Anonymous

    To make the situation even clearer, these are Reid’s words as reported by Simon Clark

    “Less encouragingly, he (Reid) went on to say that the threat of “passive smoking” was not the reason the government wanted further restrictions on public smoking. The real reason, he explained, was to encourage smokers to quit so the government could meet its target of reducing the smoking rate to 21 per cent by 2010. (That is why, despite our best efforts, the issue of passive smoking remains a sideshow to the main event.)”

    As with passive smoking, the health risks of ecigs, almost non existent, will not be the true reason for the inevitable excessive regulation, taxes and bans. Well they did get the smoking rate down to 21% by 2010. It had been 21% since 2007, the year of the ban. And then vaping got it down to 19% over the last two years. But they still won’t leave us alone.

  • Jonathan Bagley

    I may now be a vaper but I won’t be forgetting the lies and duplicity the Anti Tobacco Industry indulged in to bring about the smoking ban in all indoor non residential buildings, secure mental hospitals and now, prisons (more accurate than “ban in indoor public spaces”).

    Ian Gray is incorrect to claim that the evidence for the harm from passive smoking is overwhelming and accepted world wide. For example, as late as August 2006, it was not accepted by our own HSE. The sorry tale, including the usual Establishment corruption, is recounted here

    http://www.freedom2choose.info/news_viewer.php?id=290

    It was not accepted by Professor Sir Richard Doll who famously, on Desert Island Discs, said that any risk from passive smoking is negligible.

    The House of Lords select committee on economic affairs didn’t accept it either

    http://www.publications.parliament.uk/pa/ld200506/ldselect/ldeconaf/183/18309.htm

    One of those giving evidence was Doll’s colleague, Sir Richard Peto

    “Sir Richard Peto did suggest that ex-smokers might be more at risk from ETS than those who had never smoked at all, but the general tenor of his evidence indicated that the risks are uncertain and unlikely to be large.”

    The list is endless. Former cabinet minister Dr John Reid and his advisor Julian Le Grand

    http://takingliberties.squarespace.com/taking-liberties/2008/2/16/senior-health-advisor-agrees-with-forest.html

    Neither the Government nor Public Health or Anti Tobacco Industries can be trusted to act with integrity on any matter related to smoking. They’ve demonstrated that very clearly. The chance that vapers, in 5 years time, will be using their current devices, filled with untaxed liquid, in pubs and restaurants, is precisely zero.

  • Very interesting looking at all these videos together. My impression is that on the one hand there are people such as myself who are reporting what has been found so far in terms of behaviour, social trends and toxicology and on the other there are people who have concerns, not based on evidence but on their models of behaviour and society, about what may happen in the future. Both are honest and understandable but I think in most cases evidence trumps hunch.

    • Clive Bates

      Robert, I think the issue is professionalism. It is fine for people to harbour vague concerns, doubts about the future idiosyncratic ideas about human behaviour and society… as long as they keep it to themselves. The problem comes when they take those views to the public, appearing as experts on a stage provided by a government authority that allows them to influence the behaviour of others and to contribute to shaping the policy environment. Then it is not acceptable to ignore the evidence that their hunches are wrong.

    • mark entwistle

      If you are correct in saying that the contrasting views from Tobacco Control are honest, then you have to admit that it is not fit for purpose.

  • David Sweanor

    This is a terrific resource. Public Health England deserves much praise for putting together these videos, making the current state of the science and the policy debates broadly accessible. Congratulations, too, to all those who participated in this effort by agreeing to be filmed.

    The issues surrounding the availability of less hazardous alternatives to cigarettes has, for reasons I hope cultural anthropologists will one day explain, been very divisive and caused a lot of propaganda, biased research and shouting matches. All of which makes good policy harder to achieve. But there are reasons for optimism about our ability to avoid having nicotine policy discussions become yet another culture war when we see serious players in the anti-smoking community making as coherent an argument as possible for the differing views of these issues in a polite and respectful way. People can only make as good a decision as the information available to them allows, and this is an important and well-presented debate.

    Kudos to all involved . . . nice to see that The Enlightenment lives on!

  • an eternal time I smoked and steamed came across the 14 months ago. It was the best decision for me . no cough , no more smoky smell on the body , the apartment is no longer smells like ne pub.

    100 % better well-being steam by switching to that. And it’s nice that there are many people who make their own image on the e – cigarette and did not fall for the speeches of some politicians and media people . The increasing number of steamers , even in my family, I confirmed that.

  • mark entwistle

    I think Celia Farren about sums up the “opposing” view. Barely coherent (what is all the hearts and minds stuff), predicated on not liking the look of smoking. No actual evidence to support her arguments, by her own admission her entire view point us based on a gut feeling, finally ad hominem attacks on vapers. Is it really right that she should be doing a funny accent to quote a member of the public? Is this seriously the caliber of person legislators are taking advice from?

    As for Andrea Crossfield, she admits twice in her piece that there is no evidence at all to support her concerns. Then states categorically that vaping is not safe alternative to smoking. She goes on to say that vaping should not be normalised but does not say why. I believe she is actually advocating that the public should be lied to.

    Gerard Hastings appears a deeply arrogant man who is in love with his own intellectual capabilities whilst holding those of the rest of the planet in contempt. Again the normalisation argument comes up but without any real explanation as to why it is a bad thing. Implicit assumptions that we all agree that nicotine use is bad seem to be the only justification for his argument. Also implicit is that young people just blindly do what adults say or do. This is nothing short of stupid. If that were the case we would all still be racist homophobes like my grand parents. In light of the smoking debate though, young people start smoking, or at least I did as a visible symbol of my reaction against what adults were telling me to do. I have a feeling that tobacco control activism reinforces this attitude. I would be interested to find out how many young people start smoking because of the constant pressure from the adult world not to. I would also like to see where these people stand on the idea that, given what we know about eCigs, if every one who currently smokes switched and all nonsmokers started vaping we would have a population level health gain.

  • bakerb (@bakerbee1)

    Excellent to have this all in one place. Thanks Clive.

  • Mark Magenis

    A wonderful collection, these need spreading as much as possible.

  • Dodderer

    The battle not to treat ecigs as exactly the same as lit tobacco seems to be turning in the vapers’ favour.This leads on to the questions of which of lit tobacco’s restrictions will and should apply and what else.Article 20 is a mixture of tobacco,general product and medicines rules,restrictions and regulations – advertising(tobacco),safe packaging(general) and dosage(medicines) etc.There still seems very little emphasis or thought in the Public Health sphere on maximising the benefits as opposed to minimising the risks.

    • jredheadgirl

      “The battle not to treat ecigs as exactly the same as lit tobacco..”

      Don’t you mean to say smoking? Vaping tobacco is also another viable THR alternative. I should know, that’s how I quit smoking. Many people also use snus as an alternative.

      Tobacco is not evil.

      • Clive Bates

        Isn’t ‘lit tobacco’ the same thing as smoking? I completely agree about the demonisation and casual lumping together of all types of tobacco. Europe’s greatest tobacco and health win comes from snus. Heat not burn tobacco might widen the appeal of low risk alternatives to smoking to include people not attracted by vaping. Tobacco lozenges might do better if not demonised. From my POV we need the availability of the greatest range of products wth risks much lower than smoking.

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