June 9th, 2015

Wales vaping ban: silver lining may be larger than cloud

waronpoor

A war on vaping is a war on the poor

There’s an interesting development in the UK today: the Welsh Government has announced that it will ban vaping in public places and work places where smoking is banned (for reference population of Wales is 3m, UK is 64m).  But that’s not the interesting development.

What is of broader significance is that two of the largest health charities, Cancer Research UK and the British Heart Foundation, have come out in opposition – alongside ASH, ASH Wales, the Royal College of Physicians and the UK Centre on Tobacco and Alcohol Research.

Currently there is insufficient evidence to introduce a ban on the use of e-cigarettes in enclosed public spaces or workspaces. Cancer Research UK

At this time, we do not believe that a ban on the use of electronic cigarettes in enclosed spaces can be justified, based on the evidence currently available. British Heart Foundation

There is no evidence that smoking e-cigarettes in enclosed spaces poses a significant risk to other people, and on the basis of available evidence, the RCP anticipates that electronic cigarettes and related products could actually generate significant falls in the prevalence of smoking in the UK, prevent many deaths and episodes of serious illness, and help to reduce the social inequalities in health that tobacco-smoking currently exacerbates. Royal College of Physicians

It may even have a negative impact upon current smokers who may otherwise have attempted to quit or harm reduce, potentially damaging rather than enhancing public health. ASH

Banning the use of electronic cigarettes in public places should be an evidence-based decision. We urge Assembly Members and Ministers looking at this proposal to call on experts and academics to present the latest research. E-cigarettes are relatively new and more work is urgently needed to fully understand their long term effects on health. ASH Wales.

I completely understand his [Mark Drakeford, Health Minister] moral position when it comes to smoking but in my opinion he, and the Welsh government, are being misled by a barrage of anti e-cigarette propagandists. Here in England we have published survey results that show there is not a skerrick of evidence to support the argument that e-cigarettes encourage smoking. I would still argue that the opposite is the case; the benefits far outweigh the perceived negatives. Professor Robert West, University College London.

In the short video below, Nicola Smith of Cancer Research UK neatly summarises the position of her organisation on e-cigarettes.

 
To paraphrase their stance and comments: they argue that there is no evidence of material harm to bystanders, that there is nothing so far supporting a ‘renormalisation’ effect, and no sign of any gateway effects or large scale uptake by children.  However, they are mindful of the potential benefits to smokers – see ASH/YouGov data on who is vaping and why.

As always with legal bans, its not about whether smoking or vaping is allowed or not allowed in a particular place, it is about who decides. Unless there is evidence of harm to bystanders or some other serious effect, then there isn’t a principled case to have the force of law override the preferences of owners and operators of public and private spaces.  Many owners or operators would not allow vaping if able to decide themselves, but of their own volition. But others might see the advantage and allow it in the whole premises, in separate rooms or at particular times, such as ‘vape nights’.

Advantages of governments encouraging vaping

  1. Promotes quitting smoking, reduces burden of cancer, cardiovascular and respiratory disease [McNeill] – with consequent impact on health care system costs [e-cigarettes poised to save Medicaid millions]
  2. The precise extent of harm from long-term use is not known but from the toxicological evidence to date it would be expected to be 95% less than that of smoking tobacco cigarettes” [UK experts]. We do however know from Scandinavia that decades of nicotine use via low risk smokeless tobacco (snus) reveal only trivial health risks and huge population-level health benefits.
  3. Reduction in health inequalities driven by switching by poor smokers
  4. Improvements in well-being among smokers who switch
  5. Cost savings from vaping can have wider benefits on poor household budgets
  6. Important strategy for people with particular needs – e.g. those with mental health conditions such as schizophrenia [Louise Ross, Public Health England]
  7. No cost to public sector or burden on health care workers [Gerry Stimson: Consumer led public health revolution at no cost to taxpayer]
  8. No evidence for renormalisation of smoking – normalisation of vaping as an alternative to smoking is pro-health [Robert West] [Carl Phillips:How could ostentatiously not smoking — sending the signal “I used to smoke but I now think it is a bad idea so I vape instead” — possibly encourage smoking?“]
  9. No evidence of gateway effects – other than exits as young people stop smoking or never start [Alarmist survey on teenage vaping misses the point – reaction]
  10. Use by teenagers is very low, largely confined to smokers – and even where used by non-smokers they may have smoked had e-cigarettes not been available [ASH data, Linda Bauld]

Likely unintended consequences of a vaping ban

  1. It removes one advantage of vaping relative to smoking and so may discourage switching and encourage relapse
  2. It may drive vapers out with smokers and encourage them to start smoking
  3. Vapers and smokers are more visible to children outside pubs than inside
  4. It may degrade the potential to normalise vaping as an alternative to smoking
  5. Banning legal alternative increases passive tobacco smoke exposure.
  6. Ban provides official implicit endorsement of disproportionate risk perceptions about electronic cigarettes – makes them look as bad as cigarettes
  7. Legislation and policy-making without evidence or principle engenders distrust in tobacco policies, public health policies and government generally
  8. It stigmatises and punishes vapers for choosing the ‘wrong way’ to quit – implicitly classes vaping as a deviant behaviour rather than a public health success
  9. It might encourage vapers to smoke on their ‘nicotine’ break – smoking provides a faster nicotine hit

(hat tip to Uri for 5-7 and to Gerry Stimson for 8,9)

I am amazed that a government that prides itself on its concern for poverty, health inequalities and compassion should adopt such a negative approach to a ‘harm reduction’ strategy for nicotine use. How do they think that banning use of a product in public that is a low risk alternative to smoking will somehow reduce smoking?  What is the ethical case for being against people reducing their own smoking-related risk? It’s hard to see how the Welsh Government can have weighed the risks and benefits and come to this conclusion.


How should these issues be approached?

It’s different in England. Here are Public Health England’s five draft principles for policy and practice in this area – I like these…

PHE five principles

PHE is the English government’s public health agency.

31 comments to Wales vaping ban: silver lining may be larger than cloud

  • This is worth reading, slighty off-topic, but very revelant – from the Irish Examinar.

    How the cigarette kings bought the vaping industry

    http://www.irishexaminer.com/viewpoints/analysis/the-long-read-how-the-cigarette-kings-bought-the-vaping-industry-334866.html

    Clive, you get a mention in it.

  • robert harvey

    sadly I see this as the beginning of the end for e-cigarettes, in many peoples eyes this is a clear sign that the e-cig is just as bad as regular cigarettes, I foresee a rapid decline in the uptake and use of this by smokers thinking of getting away from cigarettes and their harmful Side effects.

    why bother with e-cigs if they are obviously just as bad as cigarettes is the message the government is giving.

    there will be a rapid fall in the sales of e-cigs and e-juice causing many manufacturers and outlets going out of business.

    it has taken 5 years to get where we are today with e-cigarettes sadly I see it being much quicker before e-cigarettes are no more.

    this will undoubtedly lead to many who have given up smoking in favour of vaping as I have for over a year inevitably going back to cigarettes as I and many others just like smoking and I found vaping as the safe alternative.

    its good there are some against this move but sadly they are outweighed by those that are in favour such as the british medical association, local health boards and many councils.

  • bex

    but what the government isn’t saying is how much is vaping saving the NHS because its getting people off tobacco because if they do that how many people like me cant for health reasons afford to go back to cigarettes because of their health there is no legit reason for them to do this it seems like they cant tax it so they’ll ban it

  • Anonymous

    Dragonmum said that Labour had their worst result ever in Wales.
    Not true, compared with Thatcher’s landslide in 1983.
    In 1983 Labour won only 20 seats with the Tories on 14. The % of votes cast was 31% Tory, 37% Labour.
    In 2015 Labour won 25 seats with the Tories on 11. The % of votes cast was 27% Tory, 37% Labour.
    In fact the big losers in Wales in 2015 were the LibDems, who lost 2 of their 3 seats.

  • RobC

    The proponents of this bill keep stating that it is not a ban on vaping, just in indoor public places, but as many of us know from experience, this will not end here.
    Once e-cigs are included in the smoking ban, the next phase, which is already gathering momentum, will be instigated and All smoking in OUTDOOR public places will be banned.

  • Dom

    Clive, can you link me to the PHE 5 principles on their website please. I want to use it for workplace policies.

    Thanks

  • Dodderer

    It will be a good test of the divine right of Public Health.The result will significant for the rest of the present UK and,possibly,beyond.

  • Simon Thurlow

    I have to admit it, that they have finally announced it has revitalised me. I have spent my time since this was first announced in April last year preparing for this day. As you know, I have been actively seeking out and meeting with AMs of all parties to discuss this very issue.

    Finally, they have announced their intentions and now (to quote a certain fictional character) the game is afoot.

    As you rightly point out, there is a silver lining. Already we have seen two Labour MPs breaking ranks in England to attack the proposals. In Wales, Plaid Cymru, Cons and Lib-Dems are united in their condemnation and want to see the evidence. I also know from talking to some Labour AMs that some of them are also very uneasy about this. They may not admit it publicly, but it is there.

    The real work starts now. The call for evidence will occur over the summer recess and we have to mobilise the entire ‘pro-ecig’ figures. I know you will have a lot to say about this. You have been itching to have your say to the Senedd for some time after all LOL

    FWIW, I remain confident that these measures by Drakeford can be overturned. The battle is not over, not by a long way. Everything that has happened up to now was just the initial skirmishes. The real battle is about to commence.

    It is my contention that Drakeford has really stuck his neck out on this one. As ITV Wales reported, it is very much a ‘gamble’ on his part. He has gone against public opinion (79% of responses opposed his measures) and it is make or break time for Drakeford now. If he continues of his current path, then the stakes are high. He will either succeed, or he will ‘car-crash’ his political career. Whilst I don’t wish anyone ill-will, if he stubbornly refuses to listen (and the signs are that this will happen) then sacrificing his political career ( and credibility) may become the inevitable outcome he may have to face.

    He has gambled on an ideology and underestimated the opposition to his ideological ideas.

    I’m not finished with this fight yet. If anything, I am re-energised by it. The next 3-4 months are going to be a fascinating time.

    Keep up the good work Clive :-)

  • Roger Hall

    The worrying intended consequence is that the likes of Glantz, Chapman and others will now use Wales as a justification for other countries to now ban e-cigs in public places. There’s a methodology at play here and all it requires is finding one willing regime (or should I say corruptible politician)where scientific evidence can be ignored, then use that country as the first domino for a chain reaction.

    • Jude

      You are unfortunately entirely correct in your views Roger. There has been a recent flurry in Australia of Chapman and his lickspittles, posting articles proposing ever more draconian and blatantly fascist laws in regards to vaping in Australia. Chapman uses the debunked junk science from the dodgy “Polish” study, to the totally debunked “formaldehyde” nonsense, to push his anti-vaping agenda. At the same time ignoring all the factual evidence showing the public health gains from vaping.

      I have no doubt at all that he will use the “Welsh ban” to push for similar here in Australia, where vapers are already at an extreme disadvantage from stupid laws in regards to bans on nicotine liquids, and even vaping hardware in my own state.

      Something interesting to note as well, the Australian versions of the Cancer Council, ASH, the Heart Foundation and the Australasian College of Physicians, all support banning vaping outright in Australia. None propose a ban on tobacco cigarettes though, hypocrisy and greed writ large.

  • Graham Jones

    I prefer to hold the view that we are governed by reasonably intelligent and rational people. Sadly, this ban indicates the opposite.

  • GunJack

    Imagine…popping into your local vape shop (in Wrexham, Caernarfon, Caerphilly or Cardiff), you fancy trying something a bit different to your normal juice…

    ..But wait, where are all the samplers gone off the counter-top??

    Oh yeah, sorry Mr vape-shop customer, you can’t try new flavours in here any more, you’ll have to just take pot-luck ‘coz you can’t vape in here any more…

    So, another “unintended consequence” rears it’s head – SME businesses losing customers which could be potentially disastrous for said businesses, more B&M shops close (despite already voluntarily NOT selling to under-18s), jobs are lost and more money leaves the Welsh economy as people resort to internet-buying from abroad (OK, England mainly, but you get the picture).

    I’ve long thought of Drakeford as a bit of a muppet, this proposed Bill does nothing to disprove that thinking…stroll on the Assembly elections..

  • Huw

    This smacks of little sibling(Welsh Assembly) going ahead with an action regardless of sensible advice just to prove that they can, will make the big decisions and are just as big and important as bigger sibling(Westminster Government)

    Grow up!!!

  • MJ

    one of the biggest downsides to the “smoking ban” is as you say “3…. smokers are more visible to children outside pubs than inside”
    When I was a kid and walked down the high street you didn’t see 10’s of people huddled in the doorway smoking – the pub doors were shut – no sign of anything unhealthy going on.
    When I take my kids down the high street now, every pub has a collection of smokers just outside their doors – these aren’t pubs with lavish beer gardens – they’re inner city pubs with no outside space at all.
    And the consequence – more kids see adults smoking so……

  • LVD

    @Jay: black-white binary thinking, tunnel vision,… and bullying, aggressing and haressing to make all this stupidity acceptable; that’s TC in a nutshell.

  • Jay

    The precedent of a disproportionate response to a perceived risk was set with the banning of smoking in all indoor places. There are now murmurings (no doubt to become a cacophony) about banning smoking outdoors – despite there being no health risk whatsoever. The Welsh Assembly is merely reflecting the hysteria surrounding smoking, deliberately manufactured by the tobacco control lobby to whom the end justifies the means irrespective of the collateral damage caused.

  • I might add one more harm that this brings. By passing laws restricting people’s freedom without evidence of harm, without even evidence of risk of harm, they are setting a precedent whereby you could virtually ban anything at all. I mean they are passing a law based not on harm, not even on risk of harm, but on the risk that there might be a risk!

    There is nothing that you could rule out from the “risk that it might be a risk”.

    • Pete

      Paul, they have already done that in the UK, its called the “Psychoactive substances bill” and its scary because it is so full of holes, it basically says “ban everything unless exempted”. It’s being sold as a “ban on legal highs” but they could apply it to practically anything, including vaping if it eventually escapes tobacco classification.

  • Steve Christie

    As I’ve said before!
    Here’s the thing!..ecigs biggest strength is being visible in indoor places, not hidden away. Many times I’ve been sat in a pub or cafe vaping. Smokers get curious, ask for information then, quite often, the next time you see them they’ve switched.
    A ban would kill this interaction off!
    THINK ABOUT IT!

  • Colin T Jones

    This is not about a health issue it’s more of a move to to do something diferent from westminster, for example, when Wales was able to govern itself, the smoking ban came into force in 2007, but the Welsh leaders thought it better to introduce it a year earlier, I was a truck driver at the time and frequently made trips into wales for making my deliveries which meant I could not smoke in the cab(workplace) and I had to put out my cigarette as I crossed the border,(yeh right) it is more about control, look, we were the first to introduce the smoking ban and they feel proud of that fact by quoting it at every chance they get, this is another move in the same vain and is going againt good advice of people who are deemed as experts in this field, it just goes to show that they were not ready to self govern and still arn’t.

    • Clive Bates

      There’s definitely a political motive at work: “have powers, must use them”.

      The challenge is to use powers wisely – if you are pleased with your new hammer, everything can soon start to look like a nail. The issue here is whether it is justified to use the coercive force of the law to override the preferences of those owning or managing public places or workplaces if there is no material harm to bystanders. That doesn’t mean there is no effect – and some places may wish to ban it on nuisance grounds to to improve the experience / expectations of non-vaping customers. But that should be for them to call – not the government.

      Clive

      • One of the troubling consequences of devolution in the UK is the empowerment of low-quality, provincial bureaucrats whose natural inclination is to impose state control over people’s freedoms and choices. It’s the more egregious that this Welsh Health minister has completely ignored the most compelling evidence contrary to his unilateral, personal crusade. We have seen Welsh health officials boasting about having banned e-cigs from Welsh sports stadiums. Why? Well it was a PR stunt – a distraction from their incompetent management of the entire Welsh health service, which as we all know is in crisis. Heck, even the former CEO of the Welsh Health Service recently had to come running back to England because the drugs couldn’t be afforded in Wales. I wish her well of course, but it signals something rather more important than banning e-cigs in pubs.

        We now face a situation where a minor nobody politician, Mark Drakeford, is planning to impose his personal agenda over every e-cig user in Wales, indeed every visitor to Wales wishing to improve their health via the use of e-cigs in a social context. For heaven’s sake, most of us agreed with the ban on real smoking in pubs and other public places, but to turn the screw even further on the very people whose health is improving via the use of e-cigs is an act of gratuitous legislative malice. And it’s all because the Welsh Government can, regardless.

        It’s a troubling neo-Stalinist, regressive, top-down form of government at its worst. “You think you know better than me, but I’m making a law to force you to agree with me across this entire nation of Wales, so up yours”. How is that “progressive” government? Incredible and depressing.

    • Dragonmum

      Which is why there won’t be a Scottish type move for self-government in Wales.Devolution only succeeded by a whisker – most of us have had enough of every document we receive having to be duplicated in Welsh, at great cost and ending up binned. Parish pump self-serving politics and the sacred Welsh language is their only concern. They’ve just found an extremely old dinosaur in Wales – they really only needed to look at the Senedd, plenty there!

  • Dragonmum

    I agree that the ineptitude of the WelshGovernment has at least served to highlight the support of the anti-smoking orgs for e-cigs, and will open up the debate to a far wider audience; however, being Welsh it hurts to see that you are governed by an Assembly that is prepared to ignore all the best and factually unassailable professional advice, and pander to the perceptions and prejudices of a puritanical minority who cannot bear to think that anyone should be allowed enjoyment. I honestly believe that it is precisely this attitude that eroded the Labour vote in Wales at the G.E and gave them the worst result ever. Yesterday was particularly bad for Health Wales, exposing Dickensian levels of neglect and abuse of the elderly, the despair of Welsh doctors is apparent, the meltdown that is the Welsh NHS has happened under Drakeford’s watch and he should now go. A Welshman forged the NHS, another has wrecked it sad!

  • Mark Cowell

    I’m just off to the pub where I can guarantee of the twenty or so regulars there, eight of us will be vaping and two will be going outside to smoke. The pub is on a main road I think the car exhaust fumes would put me off as much as the potential harm from passive smoking.

  • Uri

    Aditional public health harms from banning public vaping:

    1. Banning legal alternative increases passive tobacco smoke exposure.
    2. Ban encourages exaggerated perceptions of EC harm among smokers.
    3. Legislating w/o evidence can encourage doubting of other PH policies.

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