ASH UK: E-cigarettes will save the lives of children

ASH (Action on Smoking and Health) UK released some very interesting statistics on the 25th of April: http://www.ash.org.uk/files/documents/ASH_891.pdf. Their statistic material is based on a series of studies starting back in 2010 and repeated in February 2012, March 2013 and March 2014. In March 2013 an additional survey of children aged 11 to 18 was conducted.

ASH estimates there are 2.1 million adult e-cigarette users in Great Britain in march 2014. 700.000 of these are ex-smokers while 1.3 million continues to use tobacco. The study also concludes that 35% of British adults believe that electronic cigarettes are good for public health, while 22% disagrees with this. That leaves a pretty big number of people that still haven't got an opinion on this. I've written earlier about how vapers and their behaviour can affect what attitude these people will end up with towards vaping: http://vapingiraffe.blogspot.no/2014/04/responsible-vapers-can-give-us.html

Among adult smokers in the UK the number that has ever tried e-cigarettes has gone from 8.2% in 2010 to 51.7% in 2014. Regular use among smokers (dual-users) has gone from 2.7% to 17.7% in the same period of time. Among ex-smokers the number that has ever tried has gone from 3.7% to 11.8% and regular use has gone from 1.1% to 4.7%. This was a bit surprising to me, as this can suggest that over half of the people that quit smoking by e-cigarettes, also quits the e-cigarette use after a while. The study however gives no such conclusion as it has no data to support this since the "ever tried" term covers everything from people who has tried it once to people who has used them for months or even years and then stopped. The most interesting numbers, however, are these: Among never smokers 1.1% say they have ever tried an e-cigarette, but only 0.1% (virtually none) continues the use. There goes your gateway argument out the window.
 
Among ex-smokers the most common reasons given for use is a quit attempt (71%) or "to help me keep off tobacco" (48%). Among smokers "help me reduce the amount of tobacco I smoke, but not stop completely" (48%) and "to save money compared with smoking tobacco" (37%) are the most common reasons. The study also examined the variation in products used showing that re-chargeable e-cigarette kits with replaceable pre-filled cartridges (cig-alikes) are the most common type that people try first and also the most common one for continued use. However, ex-smokers (people who managed to quit completely) prefers more advanced e-cigarettes with refillable tanks. This could mean that these are more effective in helping people quit, but again, the study has insufficient data to conclude something like that. For more details on the various types of e-cigarettes used, see the study.

The most interesting part of this study, in my opinion, is the part where use among children is examined. I urge you all to read it. The conclusions made from this part are these:

• Understanding of electronic cigarettes among children is generally good.
• Among children who have heard of electronic cigarettes, sustained use is rare and confined to children who currently or have previously smoked.
• Few children expect to use an electronic cigarette soon, except those who already smoke.
• Frequent (more than weekly) use of electronic cigarettes by children was confined almost entirely to ex-smokers and daily smokers.

This means that e-cigarette use patterns among children looks very much like the ones for adults: They are almost exclusively used by children who already smoke. Among children that has never smoked, only 1% have tried an e-cigarette once or twice, and the study concludes there is no evidence of regular electronic cigarette use among children who have never smoked or who have only tried smoking once. In other words, electronic cigarettes have the potential to save children from a life-time of tobacco use, as the numbers also very strongly indicates that the gateway argument is totally invalid. The numbers provided by ASH in this studies shows that the rising number of children and young people who experiments with e-cigarettes should be viewed as encouraging rather than worrying.

FDA regulations, the devil in disguise?

Since the FDA released their proposal for new regulations yesterday a lot has been written about it, both in newspapers and by bloggers. Dr. Michael Siegel has commented in two excellent posts on his blog (http://goo.gl/FHSmkf, http://goo.gl/X6PVUP), Steve from Steve K's Vaping World has written a good article about it (http://goo.gl/D0HyAi) and ACSH has commented on their website (http://goo.gl/LRQYDU), just to mention a few. I highly recommend reading all of them.

The proposal looks to me kind of like the devil in disguise. They have given the industry some reasonable regulations that most will agree with, but then propose some other rules that when examined more closely turns out to have some devastating effects. When I first read about it it really didn't look that bad:

• An age limit of 18 years, which I think most of the industry agrees with and has already implemented on their own. (The EU TPD introduced no such limit to my knowledge).
• Labelling requirements, which is a good thing as well
• No advertising ban
• No flavouring ban
• No internet sales ban

I also saw some early comments yesterday, that this wasn't so bad, and in the short term it probably isn't. Business can carry on as usual for the time being. But then there is a couple of really bad ones:

• No marketing as "modified risk product" is allowed without FDA approval. This actually means you cannot tell the consumers what the real intention of the products are and that they are a safer alternative to smoking cigarettes. Vendors and manufacturers are then forced to market e-cigarettes as cool, sexy lifestyle products something that would be much more appealing to young non-smokers, and denied the opportunity to accurately target their real intended audience, the smokers.
• Premarket authorization, meaning that virtually everything on the e-cigarette market today (save cases and lanyards). And it looks like this means every single flavour of e-juice a manufacturer makes will need to be individually approved and even worse (or at least equally bad), if a manufacturer makes any product containing nicotine, all their products needs to be approved. There are only a few players in the market today that could possibly afford this, usually they go the name Big Tobacco. And even for the ones that can afford to get their current products approved, any innovation will be so expensive that they probably won't bother.

Another point I think should be made is that the FDA today (correct me if I'm wrong) has no authority to regulate the e-cigarettes. If this proposal gets approved they have full control of the market and the road to further regulations will probably be a lot shorter. As I said, in this proposal, some of the most feared regulations (advertising ban, flavouring ban and internet sales ban) were not put in. But once the FDA seizes control, I fear that they will tighten the grip in these areas as well.

Now this all looks bad, but as Steve K mentions, there will be a period of 75 days for public comments before the proposal can be approved so it's not written in stone yet. And if it's approved, who knows if the matter will end up in court again.

Danish Health and Medicines Authorities trying to scare the Danish people to death

Before Easter I wrote a post (http://goo.gl/4iQfP6) about the Danish Health and Medicines Authority being controlled by big pharma. I had a question mark at the end of my headline, but now I think that question mark needs to be removed. And the same goes for certain danish media. I'm not saying that big pharma controls the media directly but they seem to write whatever the Health and Medicines Authority feeds them with no questions asked, so in effect they write what big pharma wants.

An article (http://goo.gl/9uTbP9) in danish newspaper Jyllands-Posten from Monday reports some worrying statements from the Danish minister of Health, Nick Hækkerup. He wants to step up efforts to restrict e-cigarettes, and makes the following statement, with no reference to any scientific or other proof I may add: "We are talking about products, that can appeal to children and young people, and that can contribute to create interest for smoking regular cigarettes. Therefore I will contact the parties in the danish parliament (Folketinget) with the intention of discussing where we can step up our efforts". The statement is quoted from a written response to a question asked by the Danish Parliament's Health and Prevention delegation (http://goo.gl/fttKZu, in Danish, I doubt google translate will work here). Appearantly the gateway argument is not dead in Denmark, but common sense on the other hand...

The article then goes on with the following sub-headline: "Can cause cancer". The Health and Medicines Authority informs the journalist that there has been several adverse side effect registered, like irritation of the airways from short-term use, and allergic reactions. They also state that propylene glycol and glycerin is under suspicion of causing damage to the respiratory system and that some studies have found carcinogens in the products (editor: e-juice products). And of course, we must not forget that nicotine is addictive. Again, no reference to scientific proof whatsoever. This is exactly the kind of scaremongering big pharma wants, and gets, in Denmark these days.

At the end of the article there is another "think about the children" statement, and a lot of the parties in the Danish Parliament are willing to look into an age limit on e-cigarettes. Even a vendor of e-cigarettes supports an age limit. "Of course that is a good idea. I have children myself, and I wouldn't be happy if they started using e-cigarettes", says Frank Eskelun, the vendor in question. So... this is what it is all about then? An age limit? Well we all agree on that don't we? This is what the article should have focused on; responsible regulation of a product created for adults. So why all this scaremongering from the Health and Medicines Authorities and the minister of Health then? I'll go edit my previous post and remove the question mark to make it a bit clearer. I suspect they are starting to realize they will not be able to legally get rid of the competition, and now try desperately to scare people away from vaping. Scaring people to death just got a new, scarier meaning.

On the bright side, at the very bottom of the article, we get a clue to why the pharmaceutical industry is lobbying their asses off in Denmark at the moment: In 2010 1% of the Danish population used e-cigarettes, now the number is up to 5%.

photo credit: SodanieChea via photopin cc

Easter vacation and some recommended reading for vapers

Norwegians are strange people with strange habits. Every Easter, a lot of us load our cars so full of skiing equipment, candy and kids that they at least double the fuel consumption, and set out to find the last snow-covered patches left. I'm no exception, I'm both Norwegian and pretty weird. So for the next week there won't be any long posts, if any at all. I might do some short posts if something comes up, but no extensive analysis at least.

Before I take some days off I'd like to recommend some other great blogs and some of my favourite stories from last week:

• Clive Bates' blog is one I've been following for a while and he published his answers to the UK E-cigarette advertising code consultation: http://goo.gl/GeaUXb. As always Clives' writing is well thought out, well written and convincing.
• Steve K provided us with some more myth debunking this week: http://goo.gl/v9aadS. I highly recommend reading both his news summaries and articles.
• On the always excellent Ashtray Blog, James revealed some shocking news about how dangerous e-cigarettes really are: http://goo.gl/25uSlS. The Ashtray blog is also a great blog to follow for news about the situation in Wales at the moment.
• Cerebralrift had a great article about vaping safety worth reading: http://goo.gl/2YZkaj. If you liked my article about responsible vaping earlier this week (some of you must have, it holds the page view record on the blog by far), remember that vaping safety is also a part of vaping responsibly.
• Last but not least a couple of blogs always worth investing some time reading: www.redheadfullofsteam.com, Dr. Michael Siegel's The rest of the story and Vape O Sphere.

Happy Easter holiday to everyone and may your Easter eggs be brimful of goodies.... and don't try to vape the yellow snow.

photo credit: beetletoyz via photopin cc

Danish Health and Medicines Authority controlled by the pharmaceutical industry

Around half of the Danish Health and Medicines Authority's (Sundhetstyrelsen) funding comes directly, through fees, from global pharmaceutical giants. According to the Danish Medical Association (DMA, where most Danish doctors are members) this is a big problem and they demand new rules that will make the Health and Medicines Authority completely independent of the income from the pharmaceutical industry (http://goo.gl/qB7a3Q). Head of DMA, Mads Koch Hansen, condemns the relationship and says to Danish TV2 (http://goo.gl/a99IKZ): "A very large part of the country's Health and Medicine Authority's financing comes directly from the very industry that the authority is set to control, and who's products it's responsible for approving or discarding. But it is principally wrong that there is money going between the Health and Medicine Authority and the pharmaceutical industry. The Health and Medicine Authority should be economically independent, and the citizens should be able to have blind faith in the authorities' impartiality". From what I understand (anyone who reads Danish better than me, feel free to correct me if I got something wrong), DMA now suggests that the Health and Medicine Authority should be fully financed by the government and the fees that the pharmaceutical industry pays should be paid to a pool controlled by the government. Mads Koch Hansen says "this will ensure the necessary independence, and at the same time the companies (editor: pharmaceutical companies) pay for the work that is necessary to approve their products for use by the patients" (http://goo.gl/qB7a3Q).

LIF, a Danish organization for the pharmaceutical industry, says they do not understand DMA's concerns and that they think the system works fine like it is today. Ida Sofie Jensen, CEO at LIF, says that she has a hard time understanding the purpose of DMA's suggestion and that "this is the same as saying that something covert is going on, that a public authority cannot provide a service, without bribery or something ugly going on. We have definitely not seen indications of such cases". Well, I wouldn't say there has been no indication of big pharma being involved in allegations of corruption. Just an example for you: http://goo.gl/214tEj. A quick google search will give you a lot more. The Danish minister of Health and Protection, Nick Hækkerup, says he agrees with DMA that there should be no doubt that the Health and Medicines Authority should be independent and he is willing to continue the dialogue with DMA. However he sees no reason to question the authority's professional assessments is affected by the way it is financed today. 

Danish commentator and blogger Klaus K (http://www.180grader.dk/profil/Klaus_K) calls this whole relationship a corruption scandal (http://goo.gl/URfAZg), and mentions a lot of documentation showing how the pharmaceutical industry works to influence organizations like the Danish Health and Medicines Authority, by paying the right persons and making sure that whenever a doctor consults medical literature the same solution to every problem always appears: More medicine and more inefficient and expensive treatments. He points to the fact that after the Danish authorities seriously started interfering with peoples lifestyle, around 2007 when their current smoking laws was introduced, Danish people have gotten more and more sick (http://dengulenegl.dk/blog/?p=4412). In other words, the healthier the Danish peoples lifestyle is - the more sick they get. This means we seriously have to question the advice given by the Health and Medicine Authority, cause apparently, whatever their motives are, they are not doing a very good job at improving public health. 

And what does all this have to do with electronic cigarettes? Well, the Danish
Health and Medicines Authority is (of course) working against vaping and electronic cigarettes as well. They keep spreading fear around in the media, with reports of nicotine poisoning (http://goo.gl/bPjA10) and reports of carcinogens in the vapour (http://goo.gl/1AsU3A), backed up by the same junk science (commented by Dr. Farsalinos here: http://goo.gl/rJqAU3) that the pharmaceutical industry is sneaking into the medical literature that doctors are consulting. Hopefully the demand from DMA to get new rules on the financing of the Health and Medicine Authority will bring their poor results (and lies) into the spotlight in Denmark and force the politicians to do something. The Danish media, from what I have seen, has been fed a lot of scaremongering from the Health and Medicines Authority and reported it uncritically, but I hope this will make them investigate more and report more responsibly.

I'm sorry for all the Danish links in this article, hopefully google translate will work reasonably well. I'd also like to note that the statements cited is translated from Danish by a Norwegian (yours truly), so they might not be 100% but their essence should be correct.