Norway's biggest Stanton Glantz-fans strikes again!

It's been a while now since I've seen our dear Stanton Glantz spread his anti-vaping propaganda all over the internet. Maybe that's also the reason why a couple of his (apparently) biggest Norwegian fans decided to take matters into their own hands, trying to convince Norwegian politicians to regulate e-cigarettes to death by publishing their own far fetched version of reality. Tore Sanner and Tor K. Grimsrud has published an article in "Tidsskriftet for den norske legeforening" (Journal of the Norwegian Medical Association) that is so full of misinformation that I think the fact that these guys still can call themselves professor (emeritus) and dr. med., respectively, is no less than a tragedy. It's not the first time Sanner and Grimsrud publishes anti-vaping propaganda by the way. I've written about a couple of publications earlier here and here.

I'm not sure how good the google translation of the article will be, but I'm sure you'll be able to pick up the most important points. I'll translate and comment them here anyway. Let's start from the top shall we? Well actually there is some description of how e-cigs work first but then they start out with this, just to set the mood:

It is predicted that the current major tobacco manufacturers will soon dominate the market for e-cigarettes and sales in ten years will exceed the sales volume of conventional cigarettes.

Well, that doesn't seem to be happening in the real world now does it: http://goo.gl/CiLBBB. The source of this prediction is apparently an article from 2014 (with our dear friend Neal Benowitz who was thrown of the FDA TPSAC because of conflicts of interest as a co-author by the way). Actually this prediction might not be far from the truth if Sanner and Grimsrud gets it their way with heavy regulations that will favour Big Tobacco and kill all the competition, but if they don't it seems a lot more likely now that the independent vaping industry will dominate the market.

Then there is a whole paragraph on accidents and health effects where they talk about fires, poisoning, diacetyl, formaldehyde, acute effects of vaping and harmful effects of nicotine. They even throw in some words about e-cigs being used to do drugs, just so everyone will understand how dangerous this is. I haven't had time to go through all their references on this but when reading the next paragraph on passive exposure I noticed one of the passive exposure studies criticised by Dr. Farsalinos (Ballbè et al) was referenced so I bet most of their sources have been debunked thoroughly already. So I'll just skip that part. As for the e-cigs-used-to-do-drugs-part, I've covered this before here.

Moving on to the parts that worries me, frustrates me and makes me the most angry. Because these guys are not done with the gateway theory yet:

In a new Swedish study found that youth who had tried smokeless tobacco when they were 12-13 years old, had 3.4 times higher risk than others to be smokers when they were 17 to 18 year old. It is tempting to imagine that nicotine dependence has played a role here. In light of this, we must assume that young people who start with e-cigarettes also have an increased risk of later start smoking.

This shows how little contact the authors have with reality. Calling themselves experts on smoking and cancer and whatever, they still fail to mention that nicotine in itself is not very addictive. And even if it was, there is still no plausible reason why anyone would switch from a harmless, great tasting product to a deadly one that tastes like shit. It just doesn't make sense, and reality confirms this. The anti-vaping movement has been trying to convince us that e-cigarettes is a gateway to smoking for years, and they've spent an enormous amount of money on so called research to do this. But still they haven't found the only proof they need: A smoker that started out vaping. To me it seems like most of them has given up on this by now, focusing on the enormous amounts of young people that will start vaping and what horrible effects it will have on them, but Sanner and Grimsrud are a couple of stubborn bastards. But make no mistake, they also worry about never-smokers starting to use e-cigarettes, especially young people and kids: 

When e-cigarettes hit the market, it was mainly those already smoked, who tried the products. Later the use spread to never smokers, particularly young people. In 2013 6.8% of the population in the US used e-cigarettes. The use among young adults (18-24 years) was the highest, 14.2% of this age group used e-cigarettes.

According to a survey conducted in the UK 3% of the population used e-cigarettes regularly in 2010, while the proportion in 2014 was increased to 18%. 6% of children in the 10-11 age in Wales had tried e-cigarettes.

Let's have a look at a couple of their sources for this information, a study by McMillen et al and an ASH report from 2014. The study states in the result summary: "However, 32.5% of current electronic cigarette users are never- or former smokers." In other words this study does not differentiate between never-smokers and former smokers (quitters), which obviously (to anyone but Sanner and Grimsrud at least) makes it totally irrelevant in this context. What about the ASH report then? It states this in the summary:

Electronic cigarettes are proving more attractive to smokers than NRT while providing them with a safer alternative to cigarettes. There is evidence that they can be effective in helping smokers’ quit and little evidence that they are being used by never smokers.

So we really should worry about never-smokers starting to vape, shouldn't we? Sanner and Grimsrud presents numbers showing that e-cigarette usage is increasing like it is something very worrying. What they deliberately fail to mention is that this increase represents smokers trying to quit. Actually a big bunch of them has succeeded as well. I say deliberately fail to mention this, because if they really didn't know this it means they haven't even read their own sources. Even as little as I trust these guys I still think they've done that. They should also be interested in this years ASH-report that, again, confirms the fact that never-smokers don't start vaping: 

Regular use of the devices is confined to current and ex-smokers and use amongst never smokers remains negligible.

Sanner and Grimsruds conclusion is (no surprise) built an all these false conclusions drawn from more or less irrelevant and unreliable sources. Actually it looks to me that some of these sources have been included just for one single number or percentage, while ignoring the fact that they conclude totally opposite to Sanner and Grimsrud.

What we fear is the increased use of e-cigarettes among young people. Many can later start smoking, which can be seen among young people who have used snus. To prevent a "normalization" of smoking, we believe it is important not to allow the use of e-cigarettes in places where it should be smoke-free. Moreover, plain packaging is required, in the same way as for tobacco products. The price has the greatest impact on young people, and it is important that a sufficiently high fee is imposed on e-cigarettes.

As you can see, their suggestion is to hand the white market over to big tobacco, and make sure a totally unregulated black market emerges that will contain all the product that really work plus a good portion of dangerous ones. As if taxing e-cigs as we know them to death wasn't enough, they've even added plain packaging to make absolutely sure we minimize control, safety and tax income in addition to keeping as many smokers as possible smoking. Good God...

Norwegian Institute of Public Health completely missing the point

Per Schwarze, Department 
director for Air Pollution 
and Noise, Norwegian Institute 
of Public Health, who published,
the answer to Dr. Farsalinos

Last week the Norwegian Institute of Public Health (NIPH) published their report on "Health risks associated with the use of electronic cigarettes". The biggest problem with the report is their focus on nicotine and their claims that since the amount of nicotine in the air in an e-cigarette users home and and a smokers home are statistically similar, we can expect that nicotine from passive vaping and passive smoking will cause similar harm. This in itself is actually true. It will cause the same amount of harm: NONE! It is not the nicotine in passive smoking that causes harm, and it does not cause bystanders to get addicted.

Dr. Farsalinos tried to explain this to NIPH last week, and yesterday NIPH published an answer to Dr. Farsalinos. As you can see they are completely missing (or ignoring) the point made by Dr. Farsalinos here, and keep focusing on how the data from different reports are different and that there is a chance that vaping exposes bystanders to similar amounts of nicotine as smoking does. They refuse to retract their report. But this is all completely irrelevant. Dr. Farsalinos did not want the NIPH to retract the whole report, but simply to retract the part where it says that this nicotine exposure causes harm.

I'm glad to see that Dr. Farsalinos does not give up, and that he published another answer to the NIPH on his blog. I think this one makes it pretty clear what he meant the first time, and I hope that the NIPH will have the guts to publicly admit that their focus on nicotine from passive vaping (and smoking) is in fact irrelevant and should not cause any worries. As I've said earlier, the rest of their report is pretty well balanced, even though I do think they use too much time and effort explaining possible harm from substances that they later conclude are probably present at levels so low that they will not cause any harm anyway. So in a way they have shown that they are reasonable people and acknowledge that one has to look at the levels of the substances when you consider the risks associated with them. Hopefully they will be able to see this when it comes to nicotine as well.

Let me make this very clear: There are studies indicating that passive vapers will absorb similar levels of nicotine to those absorbed by passive smokers, but that does not mean it will cause them any harm, or in fact affect them at all.

 
Get 15% off with discount code: giraffe15 

E-cigarette regulations, who wants it and why?

Ivo Vegter

We all know there is a lot of organizations and individuals out there calling for strict regulations or even bans on e-cigarettes. Looking at the proven benefits of vaping and the research done on them, e-cigarettes could (and probably will) save the lives of millions of smokers, by replacing the most deadly consumer product on the planet with a product that will do anywhere from 95 to 100% less harm to its users. So why is it then that some people and organizations are so eager to get rid of them?

Via the NDS (Norwegian Union of Vapers) official Facebook page I came across this great article by Ivo Vegter that sums up a lot of the reasons, and I though it deserves to be shared as much as possible: Only Big Tobacco and Big Pharma want e-cig regulation. It's a great read with a lot of good links to relevant information. Highly recommended by the Vaping Giraffe.

The tobacco industry is not unique. Both it and the pharmaceutical industry would like to monopolise the e-cigarette action. And government is only too happy to sacrifice public health to big business lobbyists. The truth is that they are safe to use and effective to quit smoking. If governments were consistent, they’d hand e-cigarettes out like condoms.

I totally agree Mr. Vegter. Sadly though, I think it's more likely that they'll ban condoms, arguing that they might be a gateway to unprotected sex.

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!

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.

The consequences of over-regulating, Part 2: Real life example from Finland

A couple of days ago I wrote about the Norwegian Cancer Registry claiming that Finland had managed to lower the number of lung cancer cases without the use of snus and e-cigarettes (http://goo.gl/SeSw3C). I found Finnish vaper jariollikka's comments on this post very interesting. According to his experience and the statistics he provided the use of snus in Finland has not dropped after it was banned in 1995. The sale of snus on the Finnish mainland that was banned in 1995, but it was still legal to import it from Sweden or other neighbouring countries, pretty much the same rules as we have both in Finland and here in Norway on e-cigarettes today. In 2010 Finland also banned importing snus via mail, so now you have to travel to Sweden to get some legally. As I commented on that case it's very interesting to see that the use of snus in the youngest group presented the statistics (http://goo.gl/L7mbhf, look at table 19) seems to get a boost in 2012. This is the weakest group economically and hence the group most likely to turn to the black market for economical reasons. And as jariollikka says, the black market in Finland is thriving and even the police that is supposed to stop this is also buying snus from the black market.

As I mentioned in the first post I wrote about this, a black, and of course totally unregulated, market rising will be one of the consequences of over-regulating a product that is already used by millions of people. The fact that both snus and e-cigarettes are products that the public believe, and science has shown, is life-saving for it's users will amplify this effect. So what was the effect of banning the use of snus in Finland in 1995? This article, http://goo.gl/bPMOT9, published in 2006 on adolescent snus use in Finland 1981-2003 aims "to study changes in adolescent snus use from 1981 to 2003, the effects of the total snus sales ban (1995) and snus acquisition". It concludes that the ban did not stop the use of snus, but instead the already increasing use they had in 1995 continued. It also concludes that the eradication of snus is very difficult, if not impossible in Finland as long as import for personal use is legal and it is still sold in the neighbouring countries (Sweden and Estonia). It shows that instead of slowing down the increase in popularity of snus among 16-18 year old boys in 1995, the highest numbers since 1981 were seen in 4-6 years after the ban. There is several possible explanations for this: It was still easily available due to the fact it was sold on the ferries between Sweden and Finland, increased discussion in the media, increased awareness of the health benefits and price. The fact that it was now forbidden may also have made it more attractive to youth (as I've argued before as well).

The study also shows very clearly how the snus black market in Finland is thriving. Have a look at Table 3 in the article. Although most people say they get snus from friends, family or when travelling to Sweden or Estonia, in the group of daily or occasional users 23.7% say they also get it from "under the counter" in kiosks, stores or service stations and 3.4% also get it from "street vendors". These are the ones I would definitely count as the black market, but also "strangers" and "somewhere else" could be a part of it. So one of the consequences of banning snus in Finland has been a black market. It's also important to notice that the wanted effect, that the use of snus would go down, was not achieved.

One statement in the study caught my attention especially: "In Finland, price policy as a “regulating instrument” is not available because the product is not legally sold". This is is a very important point: You have no way of regulating a black market. Not with prices, not with age-limits and not with safety control of the products. And as the study shows: "Even the youngest age groups are interested in snus if available". The findings leading to this statement is that they observed 12-year-olds experimenting and 1 in 10 of the 14-year-olds had tried it. 

I think this study is an excellent example of what will happen if you over-regulate a popular product with a large user base, that is also believed to be life saving by the majority of the public: You will end up with a totally unregulated black market and possibly dangerous products, more popularity among teens and even children and essentially no control of the situation. Can the EU Parliament learn from Finland's mistake?

The consequences of over-regulating

I picked up on this article via Scoop.it (Check out http://www.scoop.it/t/vapehalla guys, lots of good stuff there). Legal and public health experts Daniela Saitta, Giancarlo Antonio Ferro and Riccardo Polosa from the University of Catania, Italy have written an article (published in Therapeutic Advances in Chronic Disease on February the 3rd) where they are arguing that over-regulation of e-cigarettes is counter-productive and hypocritical. They write about the difficulties implementing good policies, mainly because of big tobacco and big pharma working against this, as this will lead to substantial losses in their sales of cigarettes and NRT.

So what would the consequences over-regulating e-cigarettes (and other smokeless tobacco like the Swedish "Snus" for that matter). We don't really need science and a lot of long-term research to dig into this matter, so lets just use some common sense and look into the future a bit.

While the sceptics are worried about the long term effects of vaping I have still never heard anyone claiming that they might be as harmful as cigarettes. Even the most sceptical say that e-cigarettes are 99% safer than regular cigarettes, but they are worried there might be some lesser harm that we'll see in the future. Actually some extremists might disagree but lets forget about these and stick to common sense for now. Lets cut the sceptics some slack and for now just say that e-cigarettes are 75% (or 50% for that matter) safer than normal cigarettes. What will happen if such a product is over-regulated?

The most obvious and most harmful consequence is that it will stop a lot of current smokers from switching to e-cigarettes and half of these will DIE from not doing so. We said that for now e-cigarettes are 75% safer, meaning (this is a bit absurd but stick with me ok) if these guys did the switch, only 12,5% would die from their habbit, which again means we saved a lot of lives, and the life quality of the survivors would be drastically increased. Now I just read that the number of smokers in the world is close to a billion (http://www.bbc.co.uk/news/health-25635121). Let's cut the sceptics some slack again and say that only 1% would have managed to quit with e-cigarettes (that are not able to without), but can't now that it's over-regulated. That means 10 million smokers, 5 millions of them will end up dead. With our 75% safer e-cigarettes 3.75 million lives could have been saved. But we were not talking about banning here, just over-regulating so say only half of these we're not able to quit, the rest managed with the regulated e-cigs. But that is still over 1.85 million lives saved... quite a big number. So even if we make completely absurd assumptions on the safety of e-cigarettes you see that the consequence of over-regulating is severe and works completely against the goal of harm-reduction. With this in mind, imagine what the real consequences are, when we look at the real safety of the e-cigarettes. Yeah, some might disagree but there is a lot of unbiased research out there proving they are virtually harmless, you just have to look for it. If you can't find it, it's because you don't want to find it, and I'm not going to go into the reasons people might have for not wanting to find it. I think my readers can figure that one out themselves.

So let's look at the consequences for the current vapers. I couldn't find a world-wide number right now but 2.5 million in the US, and I think I've read around 1.3 million in the UK so I think we can safely assume 5 million +. And it's expected to quadruple during 2014 (http://digitaljournal.com/pr/786599). I think some might revert to smoking, so that's lifes lost. But I think most will try to continue with e-cigs even if over-regulated. So what happens then? We'll get a black market. We'll have more dangerous products, that is unsafe batteries, unsafe atomizers and e-liquid with ingredients you probably shouldn't vape (and that is not put on the label). All of these potentially dangerous. There will be less research on the area, less tax-money and it would seriously tie down a growing industry that potentially could have offered many people work.

Then there is all those teens experimenting with e-cigs that I've written about earlier. Will over-regulating or banning e-cigarettes make them less attractive to young adults and children? Anyone answering yes to that question hasn't been a teenager, which would basically rule out most of my readers I would think :) I mean, I don't want my children to be addicted to nicotine, but I do that by educating them, not by forcing them. I don't live in the illusion that the fact that they are not allowed to buy alcohol until they are 18 will keep them from drinking until then. And I don't tell them they are not allowed to drink alcohol because it's illegal either, that would only make them want to try it. So I educate them, tell them how it works and tell them that IF they end up trying it, they can always call home and at least be safe. Try to think about what you found exciting when you were a teenager. Was it all legal? Did you stick to the rules at all times?

In conclusion we can see that over-regulating e-cigarettes (or as I said other alternatives to smoking) is in fact counter-productive and potentially very dangerous. And you really don't need all kinds of scientific reports and long term studies to see that either, just use common sense. I get a feeling that all this focus on empiric evidence for this and that in this matter is undermining value of common sense. So, now lets look at the consequences of the opposite, to NOT over-regulating e-cigarettes: We run a very small risk of discovering some minor harmful effect in the future and some children will probably start vaping (but ask yourself, could it be that those would have taken up smoking if they couldn't vape?). And we run the risk of saving millions of lives. I might have missed something so if anyone has something to add to this side of the scale that will make it tip the other way, please tell me.