Thursday, 16 July 2015

Four poor lies presented arguing for strict e-cigarette regulation

Tom K. Grimsrud
Tore Sanner
Thought I'd share some news from the ongoing e-cigarette debate here in Norway today. Remember our friends Sanner and Grimsrud that recently published an article in the Journal of the Norwegian Medical Association, in an attempt to convince politicians and medical professionals that e-cigarettes are the devils work and needs to be regulated to death? Well, now they're apparently trying to target the public with their lies and misinformation. They've published an article in Norwegian newspaper Aftenposten's readers options section titled "Four good reasons to regulate e-cigarettes strictly" (Google translation is not that good, but you get the main points). 
There is relatively little and uncertain evidence of the usefulness of electronic cigarettes, while the indications of the potential hazards are numerous.
Yup, this is actually the ingress of their article, and it gives us a pretty good idea of what to expect from the rest of it: lies, lies, lies. They've pretty much decided to turn reality upside down and publish it as truth. I'll skip to their four "good" reasons:
1. "The use of e-cigarettes can normalize smoking and cause the decline in the proportion of smokers who quit. Many think it is worrying that users of e-cigarettes also recruited among never smokers and former smokers."
- Yeah, right... where do I start? First of all smoking is still pretty normal. Stop telling people that it's not. This is of course reality upside down. Vaping will normalize quitting, and eventually it will denormalize smoking. Then there is the fact that Sanner and Grimsruds biggest hero, Stanton Glantz, recently showed us that the quit-ratio has increased since e-cigarettes came along. Finally, their own sources (which they used in the article I mentioned in the beginning), this ASH-report to be specific, tells us that recruitment among never smokers is negligible. So, not a single true word in reason #1 there.
2. Among the never smokers that the e-cigarette appeals to, it is particularly many young people. If e-cigarettes are freely accessible, we can get a significant increase of young users with nicotine addiction and behaviour similar to smoking.
- Same lie as the first one actually. They keep saying that e-cigarettes appeal to never smokers, but again, it turns out it is not. But this one also reveals Sanner and Grimsruds real problem with vaping: behaviour similar to smoking. 
3. There is a danger of double use by enabling users to continue or just cutting down on the traditional cigarettes, and using e-cigarettes as in addition to this, believing that it is beneficial. However, only full cessation seriously reduces disease risk. Unless e-cigarettes are a step towards becoming completely tobacco free, like nicotine patches and chewable tablets are, the e-cigarette is unlikely to have any appreciable effect on disease risk.
- There are millions of people that have started out as double users before quitting completely. Some vapers might never quit completely, true, but that is not a good reason to deny people the option to try, now is it? They are trying to make it look like the e-cigarettes keeps these people smoking, which doesn't make sense at all to anyone who have tried vaping. In fact, try to google "vaping accidental quitter", and you'll find that a lot of people actually plan on double use, using e-cigs for situations where they're not able to smoke, but they end up quitting completely instead. Also, notice that Sanner and Grimsrud are recommending patches and tablets now... so maybe the nicotine isn't their problem anyway, maybe it's still that dreaded behaviour similar to smoking?
4. Although nicotine itself is not considered carcinogenic, recent studies suggest that it may contribute to cancer development and worsen the severity of cancer. Users of tobacco products such as cigarettes and smokeless tobacco have reduced efficacy of cancer treatment, and they have a poorer prognosis. Nicotine is a likely contributing factor in this picture. It may take decades before such long-term effects of e-cigarettes can be uncovered.
- So, if it turns out that nicotine promotes cancer (which I've only seen one study done on rats indicating), why on earth would that be a reason to deny everyone that do not have cancer a fantastic opportunity to quit smoking and by that avoid cancer? Makes absolutely no sense to me. I addition to that I believe this is one of the studies that Sanner and Grimsrud usually refers to when it comes to this. Have a look at how it concludes: Although nicotine might play a role, the mechanisms warrant further investigation. The study shows that users of snus (smokeless tobacco) have a moderately increased cancer-specific mortality, but keep in mind that snus is also tobacco and this study did not investigate what could have caused the increased mortality. They merely pointed out nicotine as a possibility. If you read the whole report, or just the discussion in the end, you'll see that the study has a lot of limitations. Actually it makes a lot of sense that Sanner and Grimsrud likes this study, as it contains a lot of uncertainties, unconfirmed theories and questionable conclusions... exactly what Sanner and Grimsrud wants to base their regulation scheme on.

So, there you have it. Four poor lies presented arguing for strict e-cigarette regulations. Luckily both this last article in Aftenposten and the one from Journal of the Norwegian Medical Association have been heavily criticized in the comments section. Not only by the vaping community, but also by medical professionals and scientists who have done studies on nicotine themselves. Sanner and Grimsruds pretty weak attempts to defend themselves have also been answered and it seems like they've given up on it. It's also worth noting that these articles are published by the authors themselves in sections where the readers can express their opinions, which indicates that the publications themselves probably haven't found their articles newsworthy. It's a shame however that this isn't made clearer, especially in the last case where the target audience is the public who tends to read the headlines and possibly the ingress.  
 
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