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.

Responsible vapers can give us reasonable regulations

Keep your vaping equipment in a safe place.
photo credit: Ozont via photopin cc

As vaping and electronic cigarettes appear in the media more and more frequently, the general public is starting to get more and more aware of them. Here in Norway at least, vaping is still pretty uncommon and until recently I've had to go to the mirror to see a vaper in this town. A while ago, say a year or so, most people here still had no personal experience with e-cigarettes and had no opinion about it... most people did not even know of their existence. Recently, I've noticed this starting to change. Still, I don't see a lot of people vaping when I go out, but I get the feeling that most people I talk to nowadays has heard of e-cigarettes, read about them in the news or know someone who uses them. Now keep in mind that electronic cigarettes with nicotine, and e-liquid with nicotine is banned here. We are allowed to import for personal use but still this means we are probably lagging a fair bit behind when it comes to e-cigarette awareness here.

Now it is still a fact that most people neither smoke nor vape. Most non-smokers however have an opinion on smoking as smoking not only affects the smoker but also everyone else who happens to be around. So the vast majority of non-smokers have negative attitude towards smoking (and smokers). Well some people don't really care I guess, so we might call them neutral, but I think it's pretty safe to say that almost none of the non-smokers have a positive attitude towards smoking. And, our politicians, who will write the laws on vaping is no exception. Most of them are also non-smokers, with the same attitudes as the rest of the population.

So where am I heading with all this? Well, as I said, most people still haven't really made up their mind when it comes to vaping and e-cigarettes, but they will soon. As vaping gains popularity it will become more and more visible to the general public. Non-smokers are unlikely to gain any first hand experience with vaping, so their attitude towards it will be largely influenced by the media, by the way e-cigarette manufacturers and vendors advertise their products and (until the TPD is turned into law) are able to show responsibility by self regulating, but maybe most of all by the vapers turning up around them. We, as vapers, are in a way responsible for the way the rest of the population feels about vaping, and whether the negative attitude towards smoking is transferred to vaping. Responsible vapers and a responsible e-cigarette industry will also influence how the media covers the topic.

Being a responsible vaper isn't very hard. It hardly requires any effort at all, it's all just common sense. Some examples:

• Don't leave your vaping gear and e-liquid unattended in reach of children. Children love to play with things, and will see your gear as toys they can explore. E-liquid with fruity tastes will of course smell and look tempting as well and we do not need reports of nicotine poisoned children.
• Pets are like children. They play around with all kinds of stuff they find around the house and there has already been reports of cute little puppies dying from chewing on e-liquid bottles. We don't want that either.
• Show respect for rules and other people. If you want to vape inside a bar, a restaurant or in other peoples houses, ask first if it is ok. And if you get a no, respect that. If you do, and politely give the owner of the bar, house or restaurant some pointers on where to get more information about vaping, next time you come back they may have changed their mind.
• Don't blow your vapour straight into peoples faces... unless they actually ask to smell it :) Even though we, as vapers, and many others as well, find the smell of a lot of our vapour pleasant, not everyone does. Some people may also have unpleasant reactions to the vapour.
• Take some time think about how you want to present e-cigarettes and vaping to others, and learn to know the limitations of you knowledge. A lot of sceptics have read the scaremongering in the media and will present it as facts a discussion. If you're in such a discussion and lack the knowledge to prove them wrong, don't go there, cause it will look to bystanders that the sceptic is right. I find that in such cases it is better to tell the sceptic that he is entitled to his opinions, but I know what I a have experienced and that makes me 100% sure that vaping is a better alternative for me than smoking. If you show respect for their opinions, chances are they will show respect for yours and bystanders will most certainly do.

Responsible vapers will affect the reputation of vaping while failure to vape responsibly will damage it. It is all about showing respect for other people, handling equipment and e-liquid in a way that doesn't hurt anyone and acting like responsible adults. If vapers do this (and in most cases I think they do), the general attitude towards vaping will be positive, and the chances of winning the fights to come will increase drastically. In the end responsible vapers can affect the general attitude towards vaping and give us the reasonable regulations we want.

The fight for reasonable e-cigarette regulations in Norway starts NOW!

The Norwegian Ministry of Health and Care services are, according to Norsk Dampselskap (Norwegian union of Vapers), working on a draft for new e-cigarette regulations and this draft will be sent out for consultation to relevant institutions and organizations, SIRUS (Norwegian Institute of Drug and Alcohol research) being one of them of course. Hopefully Norsk Dampselskap will also be on the list. It will also be possible for individuals to speak their mind. Exactly when this draft will be ready is not known yet but research director at SIRUS, Karl Erik Lund, writes in an email that they expect to be given some pointers about the direction this work is heading soon, and maybe also know more about how the ministry will follow up on the EU TPD. He still expects it will be a while until we know the details in the draft though. 

As Norway is not a member state of the EU the situation here is slightly different than in the member states. Most such EU directives are implemented due to the EEA, but it is possible for Norway to make reservations regarding the parts that concern electronic cigarettes. This is probably what the next battle of the e-cigarettes here in Norway will be about. For this to happen, the Norwegian government must be convinced that there are considerable gains in public health by making such reservations, and the best way to make this happen is to educate. Again, the knowledge and the stories of the vapers is of enormous value in this matter.

Norsk Dampselskap is currently working hard to recruit as many members as possible to gather more strength, as they will of course be very active in this debate. And the more members they have the heavier their arguments will be so I urge all Norwegian vapers and e-cigarette supporters to support NDS by becoming a member. You can use the form here: http://goo.gl/NZU86D. Doing this is one of the best ways you can support the case here in Norway. The fight for reasonable e-cigarette regulations in Norway starts NOW!

Wales wants to ban e-cigarette use in public places, because the Health Minister is worried

Yesterday the Welch government announced plans to ban the use of electronic cigarettes in enclosed public places. This was reported by BBC News yesterday (http://www.bbc.com/news/uk-wales-26837682) and commented by several bloggers, the excellent Ashtray Blog being one of them (http://goo.gl/6ys08n). They also published a great summary of vapers comments on this today (http://goo.gl/k0r6Yr). And their reason for this plan? To avoid normalization of smoking and protect public health.

Reading Health Minister Mark Drakeford's comments on this makes me wonder if they have done any research or reading on the matter: "I have concerns about the impact of e-cigarettes on the enforcement of Wales' smoking ban. That's why we are proposing restricting their use in enclosed public places. I am also concerned that their use in enclosed public places could normalise smoking behaviour. E-cigarettes contain nicotine, which is highly addictive, and I want to minimise the risk of a new generation becoming addicted to this drug." In other words, the gateway argument and the re-normalization argument, presented without any scientific evidence at all. Not very surprising as the all the "evidence" supporting these arguments have been proved worthless countless times lately, so he wisely refrains from backing up his arguments in any way. What I read from all this, is that they plan to ban e-cigarettes, a technology with the potential to save the lives of millions of smokers, because the Health Minister is worried.

On the positive side, The Daily Mail had a very good article on the subject today: Craziness of the e-cigarette health police: 'Nanny state' Welsh Assembly considers ban in public spaces. I recommend reading it, as it kind of picks apart the arguments presented as reasons for the proposed ban. I particularily like this statement: "Women, it has to be said, look dead sexy puffing on their e-cigs, with their smoky Bette Davis eyes." Might not be the strongest pro-e-cig argument, but amusing at least.

Now, this ban obviously is a step in the wrong direction for Wales, but, it is still not approved, and the Welsh have an opportunity to speak their mind on the matter as there will be public consultation on the ban: http://goo.gl/BI5JE. Thanks to James from the Ashtray Blog for this link. Hopefully a lot of vapers will turn up and bring the Welsh government to reason.

Did you get fooled yesterday?

April, Fools!

Yesterday was the 1st of April and as usual a lot of the newspapers wrote some bogus stories to fool their readers. Some bloggers did as well. The Ashtray blog for example reported that the EU would do a massive turn-around and start recommending e-cigarettes: http://goo.gl/yh0gpC. VapeSquad wrote that the FDA had announced that their whole campaign against e-cigarettes has all been an elaborate April Fool’s joke: http://goo.gl/56WNvl. I'm sure there were others as well.

Did you get fooled yesterday? Please leave a comment and tell us if you read some bogus story yesterday, and if it fooled you or not. Don't worry, you can be anonymous if you want :)

Norwegian government reveals tobacco ban, e-cigarettes to be legalized

"New ideas, better solutions" says the banner behind
prime minister Erna Solberg

On a surprise press conference this evening, Norwegian prime minister Erna Solberg revealed the Norwegian government's plans to implement a total ban on all tobacco products in Norway from 2015. "With the new electronic cigarettes there is no need for the deadly tobacco cigarettes any more", Solberg said and explained how the electronic cigarette will replace tobacco cigarettes in Norwegian stores from January the 1st 2015. "We want Norway to be the first tobacco free country in the world and electronic cigarettes will be our solution to this. However Norway cannot afford to loose all this tax money money over night so licences to distribute and sell electronic cigarettes will be auctioned out kind of like we do with frequencies for radio dustribution. The details for this is not worked out yet but will be released before August".

When asked what made the goverment choose a tobacco harm reduction strategy that is so dramatically different from what the EU has gone for she responds: "Well we had a look at the calendar and decided that this is a good day to say that enough is enough. We don't want to waste any more time watching smoking rates slowly go down when we have the means to make them drop dead".

The planned changes in the tobacco law still needs final approval in the Norwegian parliament but all goverment parties have said they will vote in favour. Nothing more was said tonight about how regulations will be done regarding nicotine content, allowed devices and so on, but Solberg promises more details on this in the near future. Maybe we will know more already tomorrow as the goverment has scheduled a new press conference at 16.00 tomorrow. I hold my breath in anticipation.