Friday, 5 June 2015

Norway's biggest Stanton Glantz-fans strikes again!

It's been a while now since I've seen our dear Stanton Glantz spread his anti-vaping propaganda all over the internet. Maybe that's also the reason why a couple of his (apparently) biggest Norwegian fans decided to take matters into their own hands, trying to convince Norwegian politicians to regulate e-cigarettes to death by publishing their own far fetched version of reality. Tore Sanner and Tor K. Grimsrud has published an article in "Tidsskriftet for den norske legeforening" (Journal of the Norwegian Medical Association) that is so full of misinformation that I think the fact that these guys still can call themselves professor (emeritus) and dr. med., respectively, is no less than a tragedy. It's not the first time Sanner and Grimsrud publishes anti-vaping propaganda by the way. I've written about a couple of publications earlier here and here.

I'm not sure how good the google translation of the article will be, but I'm sure you'll be able to pick up the most important points. I'll translate and comment them here anyway. Let's start from the top shall we? Well actually there is some description of how e-cigs work first but then they start out with this, just to set the mood:
It is predicted that the current major tobacco manufacturers will soon dominate the market for e-cigarettes and sales in ten years will exceed the sales volume of conventional cigarettes.
Well, that doesn't seem to be happening in the real world now does it: The source of this prediction is apparently an article from 2014 (with our dear friend Neal Benowitz who was thrown of the FDA TPSAC because of conflicts of interest as a co-author by the way). Actually this prediction might not be far from the truth if Sanner and Grimsrud gets it their way with heavy regulations that will favour Big Tobacco and kill all the competition, but if they don't it seems a lot more likely now that the independent vaping industry will dominate the market.

Then there is a whole paragraph on accidents and health effects where they talk about fires, poisoning, diacetyl, formaldehyde, acute effects of vaping and harmful effects of nicotine. They even throw in some words about e-cigs being used to do drugs, just so everyone will understand how dangerous this is. I haven't had time to go through all their references on this but when reading the next paragraph on passive exposure I noticed one of the passive exposure studies criticised by Dr. Farsalinos (Ballbè et al) was referenced so I bet most of their sources have been debunked thoroughly already. So I'll just skip that part. As for the e-cigs-used-to-do-drugs-part, I've covered this before here.

Moving on to the parts that worries me, frustrates me and makes me the most angry. Because these guys are not done with the gateway theory yet:
In a new Swedish study found that youth who had tried smokeless tobacco when they were 12-13 years old, had 3.4 times higher risk than others to be smokers when they were 17 to 18 year old. It is tempting to imagine that nicotine dependence has played a role here. In light of this, we must assume that young people who start with e-cigarettes also have an increased risk of later start smoking.
This shows how little contact the authors have with reality. Calling themselves experts on smoking and cancer and whatever, they still fail to mention that nicotine in itself is not very addictive. And even if it was, there is still no plausible reason why anyone would switch from a harmless, great tasting product to a deadly one that tastes like shit. It just doesn't make sense, and reality confirms this. The anti-vaping movement has been trying to convince us that e-cigarettes is a gateway to smoking for years, and they've spent an enormous amount of money on so called research to do this. But still they haven't found the only proof they need: A smoker that started out vaping. To me it seems like most of them has given up on this by now, focusing on the enormous amounts of young people that will start vaping and what horrible effects it will have on them, but Sanner and Grimsrud are a couple of stubborn bastards. But make no mistake, they also worry about never-smokers starting to use e-cigarettes, especially young people and kids: 
When e-cigarettes hit the market, it was mainly those already smoked, who tried the products. Later the use spread to never smokers, particularly young people. In 2013 6.8% of the population in the US used e-cigarettes. The use among young adults (18-24 years) was the highest, 14.2% of this age group used e-cigarettes.
According to a survey conducted in the UK 3% of the population used e-cigarettes regularly in 2010, while the proportion in 2014 was increased to 18%. 6% of children in the 10-11 age in Wales had tried e-cigarettes.
Let's have a look at a couple of their sources for this information, a study by McMillen et al and an ASH report from 2014. The study states in the result summary: "However, 32.5% of current electronic cigarette users are never- or former smokers." In other words this study does not differentiate between never-smokers and former smokers (quitters), which obviously (to anyone but Sanner and Grimsrud at least) makes it totally irrelevant in this context. What about the ASH report then? It states this in the summary:
Electronic cigarettes are proving more attractive to smokers than NRT while providing them with a safer alternative to cigarettes. There is evidence that they can be effective in helping smokers’ quit and little evidence that they are being used by never smokers.
So we really should worry about never-smokers starting to vape, shouldn't we? Sanner and Grimsrud presents numbers showing that e-cigarette usage is increasing like it is something very worrying. What they deliberately fail to mention is that this increase represents smokers trying to quit. Actually a big bunch of them has succeeded as well. I say deliberately fail to mention this, because if they really didn't know this it means they haven't even read their own sources. Even as little as I trust these guys I still think they've done that. They should also be interested in this years ASH-report that, again, confirms the fact that never-smokers don't start vaping: 
Regular use of the devices is confined to current and ex-smokers and use amongst never smokers remains negligible.
Sanner and Grimsruds conclusion is (no surprise) built an all these false conclusions drawn from more or less irrelevant and unreliable sources. Actually it looks to me that some of these sources have been included just for one single number or percentage, while ignoring the fact that they conclude totally opposite to Sanner and Grimsrud.
What we fear is the increased use of e-cigarettes among young people. Many can later start smoking, which can be seen among young people who have used snus. To prevent a "normalization" of smoking, we believe it is important not to allow the use of e-cigarettes in places where it should be smoke-free. Moreover, plain packaging is required, in the same way as for tobacco products. The price has the greatest impact on young people, and it is important that a sufficiently high fee is imposed on e-cigarettes.
As you can see, their suggestion is to hand the white market over to big tobacco, and make sure a totally unregulated black market emerges that will contain all the product that really work plus a good portion of dangerous ones. As if taxing e-cigs as we know them to death wasn't enough, they've even added plain packaging to make absolutely sure we minimize control, safety and tax income in addition to keeping as many smokers as possible smoking. Good God...

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  1. NDS has been permitted to comment on the article. Hope it reduces some of the harm.

  2. I was also permitted to comment on the article and another very interesting comment by professor Helge Waldum, who has been studying nicotine effects on rats for 2 years and found no harmful effects, has been added.

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