Interview with Karl Erik Lund, Research Director for the SIRUS tobacco unit, Part 1

I've mentioned Karl Erik Lund, Ph.d. and Research Director at SIRUS, several times already on my blog. He has been in the media quite a lot lately, speaking about his research on e-cigarettes, and commented on the politics that has evolved around them. Should they be banned, regulated as medicines, regulated as a tobacco product, can they save lives etc. I had some questions I wanted to ask him... so I sent him an email and asked if I could do an interview, which he happily (I hope) agreed to. This is the first part of this interview. Hope you guys find it as interesting as I do, and stay tuned for the second part tomorrow.

Vaping Giraffe: Could you first tell us, in short, what is SIRUS and what is your role/position there?

Karl Erik Lund: The Norwegian Institute for Alcohol & Drug Research is an independent research institution but at the same time an administrative government body under the Ministry of Health and Care Services. SIRUS conducts social scientific research, compiles documentation and provides information on substance use and abuse. Work is divided into three areas, each catered for by a dedicated research team: alcohol research; drugs research; and tobacco research. I have been the Research Director for the tobacco unit since 2006.

Vaping Giraffe: When did you first hear of the e-cigarette, and when did you decide to do research on them?

Karl Erik Lund: As an assistant editor in a scientific journal – Nicotine & Tobacco Research – I handled perhaps the first of several subsequent papers on e-cigs submitted from Dr Polosa and his pioneering research team in Italy, and this must have been about three years ago. Since then, I have followed the very heterogeneous research on e-cigarettes very closely. In October 2013 I published a comprehensive review (70 pages) of the international research on e-cigarettes concerning use, motives for use, results from animal studies, analysis of chemical substances, acute physiological consequences, effects in smoking reduction and cessation etc.
  
Vaping Giraffe: Could you tell us a little about your findings? How dangerous is the e-cigarette (with nicotine) compared to a normal cigarette?

Karl Erik Lund: Even if we do not have exact knowledge of any long-term health consequence that might occur, there is scientific consensus that e-cigarettes are far less risky than conventional cigarettes. We are not saying that vaporing is totally risk-free, but the magnitude of risk between inhaling tobacco from a cigarette that burns and clean nicotine thorough mist is probably huge.  

Vaping Giraffe: Are you familiar with other researchers in other countries that have come to other conclusions than your own? If so, do you think these are unbiased?

Karl Erik Lund: My impression is that most – if not all - researchers do recognize the large different risk potential between the two products, but some researchers tend to emphasize that some e-cigarettes still contain toxic substances more than they want to focus on the risk-reduction aspects. For researchers that aim for a totally nicotine-free society, a transition from tobacco to e-cigarettes have no value. It really depends on the perspective of the researcher – you are either in favour of a harm reduction approach in tobacco control or you are not.    

Vaping Giraffe: Do you, or SIRUS have any on-going studies concerting e-cigarettes you can tell us about right now?
 
Karl Erik Lund: Yes, we are about to launch a project in which we aim to study the culture of vaporing. What characterize the users, what are their motives, what impact has the ban on e-cigarettes on the in-group mentality and the way they communicate about e-cigs. Do e-cigarettes recruit youngsters who otherwise wouldn’t have started to smoke cigarettes? We will also monitor the use of e-cigarettes in population-based surveys over the next years. In addition, we will study changes in the nicotine market. What will happen on this market if the authorities decide to let e-cigarettes compete with tobacco cigarettes, snus and pharmaceutical nicotine? 

Vaping Giraffe: A lot of pro-e-cigarette people shake their heads when the authorities claim there is to little research done on the health effects of e-cigarettes to allow them. They say the research is done and available on the internet, most of it concluding that e-cigarettes are close to harmless both to the user and the surroundings. Can you comment on this?

Karl Erik Lund: I am really impressed by the level of knowledge of some members in the user organizations. They seem to be very on top of new research, and I learn quite a lot thorough reading posts on Facebook and other websites that organize vapers. I do understand their frustration when health authorities repeatedly claim that the scientific base still is too weak to lift the e-cig ban. On the other side, we have to understand how the health authorities work. In order to act, they want knowledge established thorough systematic reviews, long time observations and randomized controlled trials. The burden of proof has been put on the producers that do not have the skills or the resources to conduct such advanced research. The authorities have used – or some would say misused – the precautionary principle in order to keep a clearly risk-reducing and perhaps life-saving alternative out of reach for smokers. The costs of the precautionary principle are very high, and based on what we already know many feel it is enough for the authorities to act.      

Vaping Giraffe: What is SIRUS relation to the department of health and have the health authorities asked SIRUS to do any research on e-cigarettes?

Karl Erik Lund: The Ministry of Health and Care Services do support our research and our updates on e-cigarettes. We are instructed by the Ministry to initiate debates on harm-reduction alternatives, even if the anti-tobacco community might find this provocative. There is a lot of understanding for a tobacco harm reduction approach among politicians, policy makers and particularly among researchers. The tobacco control movement seem to be more hesitant and some are even very hostile.

Vaping Giraffe: Do you think e-cigarettes could solve the "tobacco problem"? And do you think the health authorities here in Norway will repeal the ban in time?

Karl Erik Lund: I am quite certain that e-cigarettes will make their way to the marked. The remaining question is what kind of regulation that will replace the ban. There are toxicants in e-cigarettes that do not have to be there, so we need regulation standards in order to improve product safety. The new government seems to be willing to assess the appropriateness of the ban, and the new Tobacco-Product-Directive in EU will also put a pressure on Norwegians policy on e-cigarettes. I do not think availability to e-cigarettes will solve the tobacco problem entirely, but I am quite certain that it might help. We have approximately 1 million smokers and 200 000 of those do not manage or do not want to quit using nicotine. Now, we are forcing this crowd to use the most dangerous device for nicotine uptake, even if we know that a very harm-reducing product exists. We also know that 10-15% of teenagers in future generations will start to use tobacco. It is not so much the efficacy of e-cigarettes as temporary aids to cessation, but their potential as long-term alternatives to tobacco that makes the virtual elimination of tobacco a realistic future target.