E-cig April Fools' jokes becomes reality?

Seems to me it's in the UK all the fun is happening at the moment. While most of the European vapers, Norwegians included, are struggling hard with stubborn, clueless, greedy public health officials and politicians, eager to make sure their sin taxes are not lost, the UK probably has the strongest public health support in the world right now. Since Public Health England did a U-turn, publishing their famous report concluding that e-cigarettes are at least 95% safer than smoking cigarettes, it seems to me that things are moving in the right direction. I'm not saying they're there yet. There are still some pretty big obstacles in the way, the TPD being by far the biggest one in my opinion, but when they're discussing whether e-cigs should be provided on the NHS they're obviously miles ahead of the rest of us. Back here in Norway we're still fighting our Health Minister that wants plain packaging... on snus(!). Great article on his failures here by the way (Google translates "snus" to "snuff", and you should be aware that "Sats" is a well known fitness center chain in Norway).

This morning I read the Ashtray blogs' post on E-cigarette Summit III, which I think will be an extremely interesting event. The one thing that really caught my attention was the paragraph on "The tobacco endgame":

Perhaps the most controversial presentation will made by the Royal Society of Public Health.

The society will ask if we should encourage all smokers towards safer nicotine products, making cigarettes as we know them today illegal.

The reason for this?

They feel that now we have e-cigs, there’s no need for tobacco cigarettes.

The funny thing is that I ran this post on the April 1st 2014. In my April Fools post I had our prime minister stating that "With the new electronic cigarettes there is no need for the deadly tobacco cigarettes any more". Pretty much the same that RSPH now suggests. A lot of people actually believed that post by the way, some French forums went all crazy about it. Now I do realize that there is quite a long way from RSPH calling for a ban on tobacco cigarettes, replacing them with e-cigs, to a government implementing it, but it's still quite interesting to see that someone is actually suggesting it. I don't believe the WHO has ever done that. They instead want to ban what could lead to the tobacco endgame. For this reason, Margaret Chan will now receive "Winston Man" David Goerlitz' medal "World Health Medal of Honor" back with instructions to "put it where the sun does not shine". Great gesture, David!

I have to admit I do think it will be a while until we see an actual tobacco ban. I'm not sure it would really be the way to go either, at least not yet. But who knows. Since April 1st 2014 quite a lot has happened, at least in the UK. The things we believed back then would never happen... well have a look at the Ashtray blog's post from April 1st 2014: Massive EU About Turn on Ecigs. Quite far fetched back then, but the U-turn that UK Public Health have done isn't that far away from what James' joked about back then.

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Norwegian Medicines Agency confirms private import of e-cigarettes still legal

Yesterday I wrote that the Norwegian Medicines Agency (NOMA) have implemented new rules on private import of pharmaceuticals here in Norway. The Norwegian Union of Vapers (NDS) had already talked to reliable sources that said e-cigarette import for private use would not be affected by these new rules, meaning we'd still be allowed to order e-liquid for 3 months use online. Some hours later the government confirms this in a press release. This means nothing has changed regarding import of e-cigarettes and e-liquid to Norway, and for now, we don't have to choose between being criminals or smokers. Thanks again to NDS for their efforts in this matter. I've translated the press release below:

A great many Norwegians are buying fake and illegal medicines online. To protect the public from exposure to substances that in the worst cases can be harmful, the government now introduce new rules for private import of medicines.

From October 1st, you can only privately import prescription drugs that have been approved in Norway. This means that the package text must be Norwegian. The requirement for approval in Norway follows from the EEA Agreement. The new rules also means that one can no longer privately import prescription medicines.

WHO estimates that 50 percent of medicines sold over the Internet are fake. This may mean that the medicines are ineffective, so serious illness may not be treated, or that they contain substances other than those described. At worst, they can be downright harmful.

Behind these shipments are often organized criminal networks and it is this business we want to put a stop to. Today Customs return these shipments to sender. This means that drugs often been resent. From October 1st, Customs will have the authority to destroy the drugs they confiscate. This way we get the false and illegal drugs out of circulation.

Those who for medical reasons need to get imported medicines that are not sold in this country will still be able to do it legally through a doctor. The doctor has, with these new rules, the opportunity to apply for exemption from approval when it is necessary for the patient to use medicines that do not have marketing authorization in Norway.

E-cigarettes are not covered by the new rules. It will still be allowed to import e-cigarettes to Norway after 1 October. Neither do the new rules do not affect the ability an individual has to bring these medicines into Norway themselves.

While I'm happy to see that e-cigarettes are not affected by these new rules, I still think the rules are the result of totally incompetent politicians not doing their job... at all. As you can see the rules were supposed to be designed to stop criminal networks from sending fake medicines into Norway, which would be great... of course. The problem is that they also ban the import of vitamins, minerals and dietary supplements while they're at it. I came across a good article (in Norwegian) on the matter yesterday (http://www.lillemaane.no/nyhet/252/), which questions how this could happen. It could certainly look like big pharma lobbyists have done some work here. An example: Vitamin D bought online costs 65 NOK for 6 months supply. Buying it here in Norway costs 1253 NOK, or 2136 NOK for the prescription version.

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Norwegian authorities bans private import of pharmaceuticals

Yesterday Norwegian newspaper VG reported yesterday that the Norwegian Medicines Agency have implemented a total ban on importing pharmaceuticals from October 1st... that's today:

It will now be illegal for Norwegians to order medications online sent from abroad, according to the Norwegian Medicines Agency. This applies to all prescription drugs and non-prescription (with one exception: if the drug is Norwegian with Norwegian label).

This means, it will not be possible any more to buy medication from pharmacies online, for example from our neighbours in Sweden, which I believe have been quite common up until now. There is a long list of stuff that we can no longer get shipped (from what I understand there are no changes in rules if one brings the products in themselves when coming from abroad): 

• Products containing pharmaceutical substances. 
• Products containing herbs.
• Products containing vitamins in daily doses exceeding maximum limits. 
• Products claiming to be medicinal. 
• Products for injection, excluding products which are CE marked medical devices or products regulated by the regulations on tattooing. 
• Products for use in eyes. 
• Homeopathic remedies. 
• Drugs. These are also governed by regulations on drugs and is not allowed to import privately. This also includes synthetic substances similar substances listed on the drug list, but not covered by drug regulation. 
• Doping assets. These are also governed by regulations on what is doping and is not allowed to import private. 

The Norwegian Medicines Agency have said earlier that e-liquids are classified as pharmaceutical products, so it certainly looks like this might stop us from buying e-juice online. However, the Norwegian Union of Vapers (NDS) quickly reacted to the news and started asking around. Actually the new rules were published some days before VG wrote about it so they've been working on it for some days now. Anyway, it looks now like e-liquid will NOT be affected by the new rules. The rules were made to stop the import of fake pharmaceuticals and it has not been the intention to stop the import of e-liquid, like many of us feared when we first heard about these new rules. There has been a lot of uncertainty.... and panic in the NDS Facebook group the last days but hopefully this info posted by NDS will help people sleep:

It has not been possible to obtain any written statement on whether e-liquid is affected or not. However, we have access to information from multiple credible sources that indicate that e-liquid is not going to be affected.
 
This means that we will continue as before even after 01/10/15 and look forward to constructive cooperation with Norwegian Health authorities on the regulation in Norway. We hope that the opportunity to be a pioneer in harm reduction and tobacco injury prevention will soon be seized.

So, for now: The rules for importing e-liquid to Norway are still the same today as they were yesterday, we're allowed to import e-juice for 3 months use ... as long as we're not enjoying it too much, and use it for smoking cessation only :) Thanks a lot all of the people in NDS and others who have worked with this case.

Vaping banned on train stations and platforms in Norway

Jernbaneverket (the Norwegian government's agency for railway services) released a press release yesterday saying that from September 1st smoking will be prohibited on all Norwegian train stations and platforms. 

"The prohibition applies to all forms of smoking, including electronic cigarettes."

As you can see they're obviously not aware that vaping is not smoking, including it in the ban as just another form of smoking. Disappointing...

 

I wrote an email to Jernbaneverket's head of marketing, Cecilie Pindsle, asking her on what was the reasoning behind including e-cigarettes in the ban. I've translated her answer below:

"The reason that we are including e-cigarettes in the prohibition is that as of today it is illegal to produce, import and sell e-cigarettes in Norway, and we do not know if the emission of vapor from e-cigarettes containing nicotine will lead to any health hazards. The authorities (the Directorate of Health) is now investigating e-cigarettes further, and as long as we have an unresolved status we choose as owners of the stations to include them in the prohibition - something we have the opportunity to do by virtue of general jurisdiction. In this way we avoid unnecessary confusion in the public regarding smoking on stations."

Again, a bit disappointing that they haven't really done any research on this matter. It is not illegal to produce, import or sell the equipment in Norway, only if it contains nicotine. And they've not looked into the hazards of second hand vaping either. However I understand that being a government organization they have to rely on the information they get from the Directorate of Health on the latter issue, so the Directorate of Health is to blame for that one. But the confusion argument is just lame in my opinion. Yes, some cig-alikes can be mistaken for cigarettes if you're not close to the user, but this confusion could easily be avoided when they put up signs or announce the prohibition on their speaker systems like they plan to do anyway. In addition to this the awareness of e-cigarettes in Norway is sky rocketing at the moment so I don't think anyone really would do this mistake... unless they deliberately want to of course.

I've written back to Cecilie Pindsle, pointing out the errors in their press release and reasoning behind the ban and urging them to reconsider. I haven't heard back from her yet and I don't have high hopes that I will either, but you never know. I'll certainly inform you if I do.

This might not seem like to big a deal for a lot of people, but it really is. This is a government agency banning vaping in a public space that they "own". Outside! I can live with bars and restaurants banning vaping, as these are not public spaces, but this is something totally different. I haven't heard of any bars or restaurants that bans vaping outside either for that matter. This is one step towards banning smoking in all public spaces, something I think will happen eventually. The big problem here is that vaping is viewed as a form of smoking and hence included in the ban, by a government organization. And the one's responsible for this is the Directorate of Health, that are not doing their job to be honest. They keep saying they do not know enough about, but it is their f...ing job to know enough.

On Facebook Norwegian vapers are speaking up against the ban on Jernbaneverkets page (https://www.facebook.com/jernbaneverket/posts/838022486208600) and I encourage everyone who haven't done so yet to post a comment there as well. But please be nice and informative when you do, don't go destroying the vapers reputation.

Will the fate of the e-cigarettes be decided in court?

In December last year the New York City council's Health Committee passed a bill that bans the use of e-cigarettes in all places that normal cigarette use is banned (bit.ly/1iJAS9h). E-cigarettes will be included in the Smoke-Free Air Act of 2002, and this will go into effect on the 29th of April, 4 months after the ban was passed. Yesterday, however, e-cigarette advocates led by Citizens Lobbying Against Smoker Harassment (CLASH) filed a lawsuit against the New York City Council, claiming that the ban violates the New York State Constitution (bit.ly/1hnryov). The lawsuit is not based on health claims, but on the advocates says that according to the constitution you cannot edit an existing law to include something that has nothing to do with the existing law. The New York Constitution states: "No private or local bill…shall embrace more than one subject, and that shall be expressed in the title."

The outcome of this will be very interesting, not only because it will decide whether New Yorkers can vape in bars and restaurants, but it also means that a court has to make a decision on whether e-cigarettes and cigarettes are in fact the same subject. But this is not the first time e-cigarette regulations has been discussed in a courtroom. The FDA has been trying to regulate e-cigarettes as drug-delivery devices (together with nicotine patches and gum), but has lost this battle in court: bit.ly/1g1hVuH. The courts ruling was that they could not regulate them as such unless health claims are made, and the court said that the FDA should regulate them as tobacco products. As far as I know, the FDA is expected to propose regulations for this but has still not done this. Why they haven't yet, I don't really know, but they are probably struggling to find any good reason to, as the majority of scientific evidence shows that there is none. The fact that the FDA wanted to regulate e-cigarettes as a pharmaceutical product, I think shows that they really do know that the e-cigarettes are helping people quit smoking and are virtually harmless. And then... what will happen if the New York court decides that e-cigarettes and cigarettes are not the same thing?

Other countries has also tried to regulate e-cigarettes as pharmaceutical products. In France, before the TPD was approved though, a court decided that e-cigarettes are tobacco products (f24.my/NUxNbv), a German court has ordered that e-cigarettes cannot be restricted (bit.ly/1gCz4B1) and in Hungary a court also ruled that e-cigarettes are not pharmaceutical products (bit.ly/1jvmNjU). Earlier I've also written about a court in Sweden that ruled against Swedish customs who wanted to classify e-cigarettes as a pharmaceutical product (bit.ly/NUH7MK). There are probably more examples as well. The courts around the world at least seem to agree that e-cigarettes cannot be regulated as medicines. But are they tobacco products? It'll be very interresting to see what the New York court decides on in that matter.

Here in Europe I also expect that we'll see that e-cigarette regulations will end up in court. French consumer organization Aiduce (www.aiduce.fr) say that the provisions in the TPD "are unjust, incoherent and detrimental to public health", and "As soon as it (the TPD) is transposed into national law, it will be challenged before the Courts" (bit.ly/1f08ACW).

It can look like the fate of vaping and e-cigarettes will be decided in courtrooms around the world. And that, I hope, will be a good thing for vapers and smokers who wants to quit. Most courts, have high evidence requirements. This means that they will look at all the scientific evidence, and the ones that provide the evidence might be dragged into the courtrooms to witness. It will be very hard for the regulators to provide scientific evidence backing up their regulations, and hopefully they will not be able to. And I look forward to see what happens if Aiduce go through with their plan, and the scientific data to support the 20mg/ml limit on nicotine content is examined by a court...

photo credit: SalFalko via photopin cc

The Norwegian Heart and Lung Patient Organization (LHL) asks employers to ban e-cigarettes

The Norwegian Heart and Lung Patient Organization
don't want me to vape at work.

In this article in Norwegian publication "Dagens medisin" ("Daily medicine") The Norwegian Heart and Lung Patient Organization (LHL) asks employers, and other owners of premises where people gather, to ban e-cigarettes in the same way smoking is banned. The Norwegian Health Department wanted e-cigarettes to be part of the Norwegian tobacco law when it was revised last year, but the suggestion was left out by a mistake. Turns out they forgot to ban e-cigarettes. This means that it is up to the employers themselves to decide whether or not e-cigarettes is permitted indoors. And now, LHL is asking employers to act as if the tobacco law included e-cigarettes. Their arguments for doing this? Not surprisingly they pull out their precautionary principles and that "we don't know enough about the e-cigarettes yet", which I agree with them on. They don't know enough about e-cigarettes yet, because the haven't taken the time to ask someone or just google it.

General secretary of the LHL, Frode Jahren, says that even though e-cigarettes are assumed to be far less harmful than normal cigarettes, there is people that will react to it and that one shouldn't need a law to tell us to use common sense show respect for others... but still he wants employers to implement rules to ban e-cigarettes everywhere indoors even if no-one reacts to the vapor. Where is the common sense in that?

Jahren is then asked this question: "Some will react to the use of perfume in public spaces as well. Should we ban everything we don't like?" Seems like the journalist might have caught the point here. Jahren responds saying that we don't know enough (editor: Wrong Jahren, you don't), and then he pulls out the normalization argument, which I wrote about yesterday: http://goo.gl/dYjyJk.

But, luckily, we have SIRUS here in Norway. Again, Karl Erik Lund comments on the case and tells the readers of "Dagens medisin" what we do know about e-cigarettes, and how "dangerous" they really are. He argues that if we should ban e-cigarettes because of the health risks, we also need to ban theatrical smoke. Lund also says that a lot of people have learned to hate smoke and their resistance towards e-cigarettes are based on feelings rather than reason. He concludes that the arguments for banning e-cigarettes by including them in the tobacco law is "pretty weak".

After reading the article I'm left with the feeling that a lot of these organizations are just the victims of ignorance. I really do think that LHL doesn't know enough about e-cigarettes and vaping, and that they do believe the gateway argument and the normalization argument. It's not that strange really, cause these arguments are the same as thos used by the Health Department here in Norway. And this is potentially a big problem. If the patient organizations stop thinking and just adopts whatever argument the health department give them, they become rather useless. A lot of these organizations have done a lot of great work, fighting for their members patient rights, but in the case of the e-cigarettes, I say they haven't done their job at all. And I'm sad to see that.

TPD approved today: The battle is lost, but the war is not over yet

I'm sad to see that the EU Parliament today approved the revised Tobacco Products Directive, including the dreaded article 18 concerning e-cigarettes. You can read the press release here: http://goo.gl/5TYkGZ. This means that we from 2016 will see a lot of regulations that will make the e-cigarettes less appealing and not as effective as today: a maximum permitted nicotine concentration level of 20mg/ml, ban on advertising and labelling regulations, maximum 2ml tanks (that are required to be leak proof) and 10 ml bottles of e-liquid to name a few. All of these regulations that will work against the goal of improved public health and protect the current tobacco and NRT markets. I've written about the consequences of this over-regulating before, and now, sadly the may become a reality: Part 1, Part2, Part 3 and yesterdays post on advertising bans. Also be sure to check out Steve K's Vaping World, and his post on this today. Steve is right... it's a cold day in Europe.

We might have lost the battle, but the war is not over yet. Notice this text in the paragraph in the press release:

Can the rules on e-cigarettes be revisited at a later date?

Monitoring and reporting on all developments relating to e-cigarettes – including market and health related developments – has been built into the new Directive. The information collected will provide a good overview of what additional legislative action, if any, is required, and the Commission will revisit the issue if necessary.

So let's make sure they see that it is necessary to revisit the issue, shall we? The Ashtray Blog has a great post today on the matter as well as some suggestions on what to do to turn this around:

Illustration by the Ashtray Blog