The ASH study covered in Norwegian Media

On Tuesday, Norwegian newspaper VG published a story (http://goo.gl/po6nD6) on the ASH study I've written about earlier (http://goo.gl/lEbFpZ). The article sums up the results of the study, which you can read more about in my previous post, and also has a couple of interesting sub-headings:

• Norwegian expert rejoice in the development
• Can expect the same development in Norway

The expert in question is of course again Research Director for the SIRUS (Norwegian institute for drug and alcohol research) tobacco unit, Karl Erik Lund. He says to VG that he thinks we will see the same development here in Norway if the ban on over-the-counter sales is lifted. Today there is around 50.000 e-cigarette users in Norway.

"Despite the fact that some people are worried that e-cigarettes will re-normalize smoking, we have not found anything that supports this. On the contrary the use of e-cigarettes can help people quit smoking as many use them to help quitting.", Robert West, professor and head of The Smoking Toolkit Study, is quoted. And Karl Erik Lund supports this. He says the development is undoubtedly positive from a public health view, and he adds that we have studies indicating that the use of e-cigarettes is not harmful at all from a physiological perspective.

Lund is very negative towards todays ban on over-the-counter sales in Norway. He says there has been observations of some products that contains toxins that can be harmful in high concentrations and over time, and therefore it is urgent to get regulations in place that will ensure a higher grade of consumer safety. However, "it is the long term effects of keeping the ban that will prove fatal", he says.

In Denmark, the use of e-cigarettes has also exploded, and their minister of health, Nick Hækkerup, has said that he wants to intervene, mainly because he is worried about the rising popularity among children and young people. (Read my post on this here: http://goo.gl/uxi9cP) Commenting on this Lund says that "all user surveys - in Norway as well - shows that e-cigarettes has little appeal to non-smokers. But as the use of e-cigarettes increases, we have to expect that a segment of young non-smokers will be recruited." And he goes on to make a very important point that I've mentioned a lot of times on this blog: "The question is if the experience these young people has with e-cigarettes will increase their desire to switch to conventional cigarettes. There is not much that suggests this. Why should someone abandon the e-cigarette in favor of conventional cigarettes that tastes rancid compared to e-cigarettes, is perceived as a lot more dangerous, are a lot more expensive, has a negative symbolic effect and can only be used outdoors?"

photo credit: MonicaGrigsby via photopin cc 

 

What does ASH Scotland really think about e-cigarettes?

Last week I wrote about the survey YouGov (yougov.co.uk) have done on behalf of ASH UK. YouGov also did a similar survey (http://goo.gl/szCYiz) for Scotland, and the results are pretty much the same: A dramatic rise in both use and awareness of e-cigarettes but almost no non-smokers use them. The conclusion, again: E-cigarettes are NOT a gateway to smoking traditional cigarettes.

On April 28th ASH Scotland commented on the results: http://goo.gl/BJzGSN. There you will also find a summary of the results. Although the numbers are a bit lower than in the UK survey the trends are exactly the same: More and more smokers try e-cigarettes and more people believe that they will be good for public health (31%) than not (23%). The most important finding however, as in the UK survey: "Current use of e-cigarettes amongst those who have never smoked is negligible (zero or nearly zero) and only around 1% of never-smokers report ever trying e-cigarettes."

ASH Scotland Chief Executive Sheila Duffy then comments on the results:

"Our interest is in helping people improve their health and so we welcome harm reduction as a principle. We believe that ‘vaping’ will prove to be less harmful than smoking – but not harmless, as some supporters suggest."

That's good. Even if most unbiased studies do conclude that e-cigarettes are pretty much harmless, there are in fact some that conclude that there may be some dangers from some products. And of course we cannot say that we are 100% sure there will be no long term negative effects from use. What we do know however is that they are a lot less harmful than cigarettes (and maybe even totally harmless or even beneficial ... we'll know more as time goes). And this is the important question to ask when we are talking about harm reduction: How much safer is it? Not: Is it totally 100% safe? From this statement it looks like Shiela Duffy and ASH Scotland has that right.

"We are calling for regulation of the market in e-cigarettes - and other new nicotine delivery devices - because nicotine is a highly addictive substance and the companies involved are under strong commercial pressure to recruit young people into using it.

To minimise the risk of drawing the next generation into nicotine addiction, we also want an under-18 age restriction on the sale of e-cigarettes in Scotland, as is already being planned for England and Wales, and we need restrictions on how these products are promoted."

I find it a bit strange that this is mentioned in a response to the results of this survey that clearly shows that non-smokers show very little interest in the products in today's regulations. I read this as a call for stronger regulation of advertising of e-cigarettes, which I think must be handled with care. Over-regulating in this area, for example by not allowing advertisers to say that the products are healthier than smokers and effective tools to quit smoking, dangerous. This means advertisers are forced to play other cards, mainly marketing them as cool lifestyle products, which would be more appealing to young people. I've written about this earlier: http://goo.gl/5CVeLO. However some careful regulations could be reasonable to prohibit advertising that targets children. The age limit, of course, is something we all want, and that most of the industry already has in place by self regulating.

"However, including e-cigarettes in the smoke-free enclosed public spaces legislation would require scientific evidence that harm from ‘second-hand’ e-cigarette emissions is likely. This is not the situation to date. But we support venues that have banned vaping to protect smoke-free environments."

This one is confusing. They say that there is no evidence that supports vaping harms anyone around the vaper, and they do not want it included in the smoke-free enclosed public spaces legislation for that reason. But then in the next sentence they support venues that bans them? The survey shows an enormous growth in e-cigarette use among smokers, and I believe one of the most important reasons for this is that smokers see vapers vaping around them, often in places where smoking is not allowed, like bars and restaurants, and then get inspired to try it themselves. Venues that allow vaping will be areas where adult smokers are directly targeted by the best advertising for e-cigarettes there is: The vapers story. Supporting venues that ban e-cigarettes will only work against this. Yes, someone might misunderstand from time to time, and light up a cigarette where they are not allowed to, but the staff on the venue can just tell them that only e-cigarettes are allowed, and that might even trigger another switch.

"There are particular concerns with the growing involvement of tobacco companies in this market because of their history of prioritising profits over people and misleading consumers. It is not in their interest for people to become free of nicotine addiction. We must defend Scotland’s vision for creating a generation free from tobacco and ensure that e-cigarettes work for this, not against it."

If they are really concerned about the tobacco industry winning the e-cigarette market, they should be really careful with calling for strict regulations, especially when it comes to advertising, but also regarding premarket authorization. As I commented on the proposed FDA regulations (http://goo.gl/D8GR6c), expensive premarket authorization and ridiculous restrictions on advertising will hand the whole market over to the tobacco industry, and kill most innovation that could have made e-cigarettes even better and safer than they are today.

From these comments, I must say I'm a bit unsure what ASH Scotland actually wants. It seems to me they kind of see the potential and they want the e-cigarettes to keep getting smokers rid of the cigarettes. But on the other hand they seem to call for regulations that will work against this. To be honest they look like they are very sceptical, but the numbers of the survey makes them unsure on what stance to take. Guess I'll have to do some more reading to get a better view of where they really stand.