Worth reading this weekend (December 11th)

Weekend again! Yay! I know I complained about too much to do before Christmas last weekend. This week I haven't done any of the the preparations I should have done so my goal is to at least get started this weekend. Like that's going to happen :) Here's this weekends recommended reading, for those of you that have done all the shopping and have time to sit down and just relax:

• Yesterday Aaron Biebert spoke at the White House OMB and the offices of several lawmakers in Washington D.C. His speech was published on Facebook and well worth a read: Speech to White House OMB.

• Another study finding Diacetyl in e-liquids got a lot of attention in the media. Both Dr. Farsalinos' and Michael Siegels response to this is worth reading, as is this excellent article: New e-cig study reveals crisis in journalism

• Finally, someone linked this on Facebook. I guess it's a couple for years old, but still very very relevant: The myth of nicotine addiction

 Have a nice weekend!

Do we really have a tobacco epidemic?

I don't believe I can even count the times I've read or heard about the tobacco epidemic and the worldwide tobacco problem since I started this blog and really got into keeping myself up to date on the vaping debate and harm reduction. Last week I wrote that Norwegian smoking prevalence is dropping faster than ever and the fact that it looks like Snus, and lately e-cigarettes, have been playing quite a big role in making this happen. Now, obviously, both Snus and e-cigarettes (can) contain nicotine, and Snus is even made from tobacco. Still I would argue that none of these are part of the problem, but rather part of the solution to the tobacco problem. So how can a tobacco product be the solution to the tobacco problem? I guess this very question is usually asked by "the other side", along with another question: How can we solve the nicotine addiction problem with nicotine? I bet most of you can answer that question, and I bet most will start out with something like this: "You see nicotine is not really the problem...". So what is the problem then? How many of you would answer "tobacco" to this last question? I'll have to admit I've answered that quite a few times.

Yesterday a commentary (in Norwegian) by Håkon Olav Leira was published in Tidsskriftet (Journal of the Norwegian Medical Association) titled "E-cigarettes - an important measure against harm from smoking". Being an MD, PhD, Post doctor and actually treating patients with smoking related issues on a daily basis means Leira knows what he's talking about. (Have a look at his public linkedin page if you're in doubt)

E-cigarettes can be a good alternative to regular cigarettes, which can save many years of life lost and money better spent elsewhere. Sadly, the minister of health and central health communities wants to restrict access.

I treat patients with severe smoking-related illness on a daily basis, provide advice on smoking cessation and reduction of cigarette consumption, and have been thrilled with the possibility of now being able to offer yet another means of smoking reduction, e-cigarettes. My impression from my own practice is that e-cigarettes and smokeless tobacco are more attractive to experienced smokers than patches and nicotine gum.

Therefore I'm puzzled by the significant resistance our Minister of Health, Public Health and experienced colleagues have shown towards legalizing e-cigarettes. Most recently in the discussion taking place in this journal this summer e-cigarettes was presented almost as a stimulus to continued smoking. The fight against tobacco is in this discussion turned into a fight against all nicotine, where we run the risk of winning the battle but lose the war.

The discussion he's talking about is the discussion that followed Sanner and Grimsruds attack on e-cigarettes, where they were challenged over and over again to produce any evidence of nicotine harm and the gateway theory, but in my opinion failed horribly. It all ended with them saying that it's not possible to prove nicotine is addictive because addiction is a complex problem. Then they accuse me of conflicts of interest because I have some ads on my blog. In the same comment, they state that the fact that the authors of the only source they point to in this question was kicked off the FDA TPSAC by a federal judge due to severe conflicts of interest... does not change anything at all. Go figure.

Anyway, back to Leira's article. After telling us that the Directorate of health estimates that smoking causes 8000 deaths, 150 000 – 180 000 lost "Quality Adjusted Life Years" and costs 80 billion NOK every year it's time for some math:

In an article in "NRK Ytring" in August 2014 the president of the Medical Association (NMA) and director of the Institute of Public Health (NIPH) state that we should phase out smoking tobacco within 2035. In a follow-up article in "Bergens Tidende", the Minister of Health, Høie, was quoted saying that he envisions that with active policy measures, the smoking epidemic is over in 2050. If we multiply 150,000 lost QALYs and 8000 deaths per year with the NMA/NIPH's 20 years and the Minister of Health's 35 years of waiting, this gives us roughly 150 000 to 200 000 deaths and 3 million to 4 million lost QALYs.

Those are some pretty big numbers for such a small country. He then makes a very important point:

To put it very simply: It is the smoking of tobacco that is dangerous, much less tobacco itself. Tobacco is not harmless, but cancer occurs primarily when organic material is heated to 700 ° C in cigarettes and pulled into the lungs. Although tobacco has been in use for 500 years in Europe, lung cancer was a very rare form of cancer before the invention of the cigarette manufacturing machines in the late 1800s.

You see, the world does not actually have a tobacco problem, it has a smoking problem. So instead of asking how a tobacco product can be the solution to the tobacco problem, we (or they) should be asking: "How can a tobacco product be the solution to the smoking problem?" The answer, of course: Make sure you don't light it!

Leira finishes his commentary with some advice to the Minister of Health, quite different from the advice Sanner and Grimsrud gave in their article earlier on, which can be summarized as "regulate the hell out of vaping to make sure our eyes are not bothered with anything that remotely resembles smoking".

E-cigarettes contain controllable chemical substances and may, in principle, not contain any harmful substances beyond nicotine. Today, e-cigarettes are banned from being sold in this country and therefore unregulated, and we risk that many will import dangerous models from rogue manufacturers. We should rather do as the UK, who after a review of current research will allow e-cigarettes next year. According to the news the government may come to allow a tasteless version next year, but this will unfortunately not appeal to the group who need it the most. Similar devices are already legally sold under medical license, and have negligible prevalence.

Therefore, my advice to the Minister of Health is: Allow the sales of e-cigarettes with flavours and make them subject to content control, preferably through the Norwegian Medicines Agency. Encourage smokers to replace cigarettes with snus, e-cigarettes or nicotine gum. And finally: increase taxes on smoking tobacco and lower taxes on the replacement products. The goal for the health authorities must not be a tobacco-free society by 2050, but a cigarette and smoke free society much earlier.

I don't think I agree with the part about content control through the Medicines Agency, but apart from that, Leira makes an extremely important point in what our goal should be. Neither nicotine nor tobacco is the problem in itself, but the way it is consumed makes it a problem. Recognizing this will give the Minister of Health some invaluable tools and ability to come up with policy measures that will end the smoking epidemic much earlier than 2050, dramatically cutting down those horrible numbers I mentioned earlier.

I've heard lots of stories from fellow vapers about doctors with very positive attitudes towards vaping, after seeing the effects it has on their formerly smoking patients. It's great to see one finally going public with this, something I've been missing. It's the doctors treating former smokers on a daily basis that really see, and in many cases are even able to test, the effects vaping has on real people. I'd like to encourage them to do the same thing Leira has done: Share your thoughts in public! I'm sure a lot of doctors have the same experiences as Leira, and it's important that our politicians gets this information before it's to late.

Review: Bellus RTA by UD

Not long after I reviewed the Goblin mini by UD, they released the Bellus, and people seemed to like it a lot. At least people in some of the facebook groups I'm in embraced it, saying it was the best thing since internet porn. As I've stated earlier I loved the Zephyrus from Youde and obviously I was pretty pleased with the Goblin mini as well, so I had high hopes for the Bellus. If this thing performs like the Goblin mini and has the looks and capacity of the Zephyrus... well then it's would be the shit right? Let's see...


In the box
The Bellus comes in a nice presentation box, with some drawings on the back showing the different parts and explaining how to fill it. You also get quite a few spare parts.

• The RTA
• A spare tank section
• Spare o-rings
• Spare screws for the build deck
• A single coil adapter (blocks one of the air holes if you want to do single coil builds). 
• Spare rubber ring for blocking the fill holes on the top (I have no idea what to call it).
• A couple of pre-wrapped coils, guess around 1.2 Ohms as I've set them up in a dual coil setup that comes out around 0.6 Ohms. 
• Some cotton. 

Specifications

• 304 Stainless Steel
• Pyrex Glass tank
• 5ml capacity
• Dual or Single coil setup
• Spiraled drip-tip and chimney
• Adjustable airflow
• Top filling
• 2-post build-deck
• Outer Diameter: 22mm
• Height: 45.5 mm (without drip tip & 510 thread)
• Net Weight: 56g (with drip tip), 50g (without drip tip)

Looks and feel
Just as I think the Zephyrus looks great, I also think the Bellus looks great. They're pretty much exactly the same size (I think the Bellus is around 1mm higher), except for the driptip that is a bit longer on the Bellus. Of course you can just swap those if you've got both, or use one of your favourite tips. I haven't really bothered to try any other, but I guess most will fit. It's a very clean design, nothing to fancy.

Might also be worth mentioning that the pyrex tank section on this is exactly the same as the one used on the Goblin mini, so you can get them in different colors as well. You can also get the RTA itself in black now, which I think looks pretty awesome.

In use
The Bellus has a 2 post build-deck, which I love. Gives you a bit more room even if it is quite a small deck. Now I haven't tried that many different builds on this, but I guess you can't fit huge clapton coils in there and you should probably stay on max 2.5mm diameter coils. I also like the "snap-on" design of the deck. I haven't really seen this design before. When you're happy with your build, the deck is just pushed into the housing at the bottom of the tank, and there is really only one way to make it fit. If you keep your coils on the same height as the post holes they should be perfectly aligned with the air holes. When it comes to wicking, all you have to do is trim your wicks at the right length (search the internet, or trial and error) and they will be pushed down towards, or into, the juice channels when you push the deck in place. The locking ring at the bottom keeps the deck in place. There is also a single coil adapter included if you want to do single coil builds. This is just a rubber/plastic part that will seal off the juice channels and airflow on one of the sides.

A great thing about this design is that you can access your deck without draining the tank, just turn it upside down and pop the deck out. This of course means you're free to inspect your coils, change your cotton or recoil without wasting juice. Very nice if you manage to burn your cotton, or just want to change your coils for whatever reason. Love it.

Filling this tank is done through the top. The design is a bit different than on the Zephyrus, which had some rubber thing that you pushed into the fill hole to seal them off. On the Bellus there is a rubber ring fitted in the top cap that will seal the holes once the cap is back on. Easy to fill and as long as the tip of whatever bottle you use to fill it fits in the holes it shouldn't be to messy either. If you manage to spill some juice however, it will go down your chimney as you can see... so don't do that. Good threading on the top-cap so it screws on and off pretty easily and it doesn't come loose once it's tightened down.

Airflow is controlled by just twisting the airflow ring either way, opening up or closing the 32 holes in it. Fully open I find it gives more than enough air for the builds I've tried so far. Perfect fit as well, not to tight so easy to turn, and not too loose so it will stay wherever you leave it.

I've had no leaking issues with this tank. You might have some juice coming out of the airholes when filling it, but once it's filled and I've started vaping, I've had no leaking.

Performance
Again, this is the best part. UD delivers once again. Great flavour and vapour production, on par with the Goblin mini at least. I think the Zephyrus is one of the best, if not the best, sub-ohm tanks when it comes to flavour. I'm starting to think that the spiralled driptip actually has something to do with this. On the Bellus you get the same drip-tip design, but here you also get the spirals in the chimney, all the way down to the chamber. You also have the airholes pointing directly at your coils... and all this seems to work really really well. If you liked flavour of the Goblin mini, you're going to love this one as well.

Pros and cons
+ Insane flavour
+ Fantastic vapor production
+ Looks great (you can also get tank sections in different colors)
+ Top filling
+ Build deck accessible without draining the tank
+ Easy to build and fill
+ Good airflow design
+ Good juice capacity for a relatively small tank
- Not much, really. If I'd have to say something it would be that the deck is a bit small, limits your build options a bit.

Conclusion
Try one, you'll love it. Not much more to say, really. I think the list price is around $35, but you can get them somewhere between $20 and $30 a lot of places, which is money well spent. Has quickly become one of my favourite RTAs.


Big thanks to Gearbest for sending me this Bellus for review.

Disclosure:

• All my reviews are my honest opinion even if I am affiliated with the company manufacturing or selling the product. 
• The device was sent to me free of charge for the purpose of this review.
• This review does not contain affiliate links.

Worth reading this weekend (December 4th)

Damn, this week just started and it's already weekend again? I have a feeling I'll end up spending December 23rd at a shopping mall, desperately searching for something that will make my loved ones happy. Actually when I think about it that's what I usually do on the 23rd, thinking that next year... next year I'm going to buy all the presents in July. Yeah right, like that's going to happen.

Anyway, when you're done playing around with the Norwegian smoking statistics I posted a link to earlier today, here's some more goodies you can enjoy this weekend:

• Actually I'm not sure you'll enjoy reading this first one, as it is quite sad. Norbert Zillatron reports from Germany and it doesn't look good: Vapemail from Germany. Might make you cry, but still worth reading.

• Next up, Dick Puddlecote's piece on Modern Day Follies might also make you cry... or laugh.

• Michael Siegel gives you the truth as usual, exposing no less that three lies in one letter by the American Academy of Family Physicians: Once, Twice, Three Times a Liar: AAFP Letter to Congress on E-Cigarette Predicate Date Lies Three Times, Yet Still Fails to Make Its Point 

• Last but not least, I also enjoyed this one: Meet the Women Taking Back Vaping From the Bros

Have a nice weekend!

Smoking prevalence in Norway dropping faster than ever

Yesterday I came across this blog post, which apparently an answer to someone asking for data on what happened to smoking trends in Norway when Snus became widely available in 2000. The post links to the Norwegian statistical institute (SSB) and their report on smoking habits, released in February this year.

Smoking habits in Norway, trendlines added by Atakan Befrits

As you can see prevalence has been dropping from 1973, but started dropping faster around 2000, and then even faster around 2009.

I haven't found any good statistics on vaping, I'm not sure they even exist yet, so I don't think we can be sure that vaping can be attributed the increased decline from 2009, but I wouldn't be surprised. But to be fair, from these data we can't really say for sure. What the data does show however, is that vaping has not led to an increase, or a graph that flattens out, like we would have seen if the gateway theory was valid.

I've never used Snus (for some reason SSB calls it snuff, which I believe quite a few will associate with something else), but I can't really remember that Snus was not available here in Norway. So to be honest I'm not sure why Befrits says it became widely available in 2000, and I couldn't find data from before 2008 on the SSB web-page. However, the Norwegian Institute of Public Health have some more data in their Public Health Report from 2014 (in Norwegian):

Daily smoking and use of snus 16-25 years old, 1985-2013. Shows "Men, daily smoking", "Women daily smoking", "Men, daily use of snus" and "Women, daily use of snus", in that order on the top.

Same as the above graph, but for people aged 16-74.

As you can see, the use of Snus, especially among young people, really started increasing around 2000. At the same time, again especially among young people, smoking prevalence starts to drop dramatically. This strongly indicates that Snus, which like e-cigarettes is a much lower risk product, is replacing smoking. Also notice that from around 2008-2009 the Snus graph, especially among men, is still increasing but not quite as fast as between 2000 and 2007. Still, from the first graph (and Befrits trendline) we see that smoking prevalence is dropping even faster from 2009. This makes it even more reasonable to believe that vaping has played a part here, but again, a lot of other factors, like anti smoking campaigns, needs to be taken into consideration here. Looking forward to seeing the next report from SSB that is to be published in January 2016. Hopefully they might have some numbers on vaping as well.

It's also interesting to see that prevalence is dropping the most among young people:

Personally I believe this shows that people are very aware of the dangers of smoking, and it seems also that they are aware that Snus is better for your health. I know a lot of former smokers that have used Snus as an aid to quit smoking. In other words, most people seems to understand, and use harm reducing products.

As I said it's a bit difficult to see how vaping and e-cigarettes have contributed to the decline in smoking prevalence here in Norway, as the data on vaping is quite limited. Most people (95%) have heard of e-cigarettes and 15% have tried them according to SSB. E-cigarettes were included in the yearly survey that SSB does on smoking from 2013. The Norwegian Institute for Alcohol and Drug Research (SIRUS) released a report on e-cigarettes earlier this year with some more numbers estimating around 50.000 weekly users in Norway and around 500.000 have tried e-cigarettes. Their numbers also shows that e-cigarettes are mainly used by smokers, to quit or reduce smoking.

It's good to see that we're moving in the right direction, and even if it's not surprising, it's great to have these numbers to show anyone claiming that vaping will lead to more smoking. On the SSB web-page you can even get more numbers and generate your own graphs. Looking forward to seeing the next report from SSB released in January next year to see how the graphs develop. And it might be even more interesting to see how the TPD will affect this when another year has passed... if we're not able to stop it that is. Not all hope is lost yet... on the 12th of December we hit the streets to convince our politicians that the TPD is not the way to keep those numbers going down as fast as possible.