Vaping: the madness of the British?

My google search engine thinks Public Health England (PHE) is a vaping organisation.

“Vaping organisation UK”.  You can try it yourself.

E-cigarettes lie at the centre of PHE’s tobacco control strategy, probably drawing attention and commitment away from alternative strategies for reducing smoking rates.

In September 2017, PHE encouraged smokers to “stop smoking with an e-cigarette”.

E-cigarette promotion also featured significantly in the 2019 NHS “Stoptober” campaign.  “Try an e-cigarette”, urges Public Health England.

This page tells you all you need to know to get started.

Public Health England continues to defend its conclusion, based on the opinion of twelve experts, that “vaping is at least 95% less harmful than smoking” and that “more smokers [should be] encouraged to make the switch from smoking to vaping”.

(A commissioned report that repeats assurances about “95% safer” notes a number of significant limitations, including that “some of the studies [relied on] were tobacco industry funded”). See here, p 171.

 

Politicians are getting the message too.

The Independent British Vape Trade Association re-tweets Conservative Party MP Gareth Johnson who says:

“For the first time in my life, there is something that genuinely can help people to get off tobacco …the more people #vape, the fewer people smoke. We need to highlight that and celebrate it, and the Government should take that forward.”

How, exactly?

Through preferential treatment for the liquid nicotine industry, that’s how.  Bill Grant MP, a member of the industry-friendly Committee that inquired into e-cigarettes in 2018, tells Hansard:

“There should be a shift to a more risk-proportionate regulatory environment; where regulations, advertising rules and tax duties reflect the evidence of the relative harms of the various e-cigarette and tobacco products available.”

Pretty much what the vaping industry itself argued, when it fronted the House of Commons Committee.

What about winding back smoke-free laws, so that people with nicotine addiction can vape wherever and whenever they please?

In a document called “Use of e-cigarettes in public places and workplaces: advice to inform evidence-based policy making”, PHE urges organisations to exempt vaping from their smokefree policies.

According to PHE, “It is never acceptable to require vapers to share the same outdoor space with smokers”.

“[A] more enabling approach may be appropriate in relation to vaping to make it an easier choice than smoking. In particular, vapers should not be required to use the same space as smokers, as this could undermine their ability to quit smoking and stay smokefree” (p 9).

And since vapers require more frequent top-ups to maintain their “desired blood plasma nicotine level”, these differences should also be taken into account.

 

Two camps

Global tobacco control is now split into two camps, divided – irrevocably – by ideology.

Boiled down, traditional tobacco control advocates believe that the best way to deal with the tobacco snake is to cut off its head: to support smokers to quit smoking forever by conquering nicotine addiction.

Deal with addiction, and you’ll eliminate the ability of the tobacco industry to maim and kill – not to mention suck a lifetime’s wealth out of their predominantly socio-economically disadvantaged customers.

Tobacco harm reductionists, by contrast, have all but given up encouraging nicotine abstinence and seem largely focused on encouraging smokers to migrate to recreational nicotine products that will (hopefully) cause less damage to health over the long term.

For harm reductionists, the rhetoric of “saving lives” is powerful.  But under the surface, there’s a deadly serious economic contest as the nicotine and tobacco industries work the corridors of power.

As more public health leaders come out in favour of vaping, there’s a once-in-a-generation opportunity to re-normalise nicotine addiction and rescue recreational nicotine use from the poor image of smoking.

[US advertisement for Blu, an e-cigarette brand owned by Imperial Brands]

 

“No one likes a quitter, so make the switch today”

The e-cigarette industry is delighted with Public Health England’s support for e-cigarettes, seamlessly blending PHE messages into their marketing strategies, as illustrated here.

The UK Vape Industry Association, whose members include British American Tobacco, Philip Morris and Japan Tobacco International, feature Public Health England’s 95% safer claim in their advertising for VAPRIL – Vaping Awareness Month.

In one undercover investigation, 87% of vape shops in England sold e-cigarettes to people who were neither current nor former smokers, violating the Code of Conduct of the Independent British Vape Trade Association, a rival vape trade organisation.  You can watch the footage here.

But it’s not as if these industry codes actually mean anything.

And little point in government taking the high ground when their strategy for alcoholism is to promote light beer.

The Independent British Vape Trade Association, based in “the heart of Westminster” states that “The UK has remained firm in its belief that e-cigarettes should be promoted as an effective tobacco cessation aid”.

IBVTA members include “HealthySmoker”, “Puff in Peace”, “Sweet Cloud”, “Vlad the Inhaler Ltd” and “Liberty Flights”, as in “Liberty Flights Limited is working with the addiction centre at a leading London University on a study funded by a cancer charity, supporting clients who access drug and alcohol services.  The location for the study is an NHS Foundation Trust which provides care and treatment for people with mental health problems.

Liberty Flights Ltd is supplying vaping products and advice for a quit-smoking study.

Essex Vape Company is partnering with a local authority public health department and an NHS Foundation Trust on a smoking cessation program for pregnant women: a voucher scheme helps participants to access the company’s vaping starter kits.

Totally Wicked (“the world’s premier vaping retailer”) delivered “e-cigarette training” to staff involved in a quit smoking program funded by a city council, and provided free e-cigarettes and e-liquids to 1000 smokers.

One gets the impression that the vaping industry has a spring in its step in England, partnering with government, handing out free vapes.

Promoting nicotine has become the Lord’s work.

Although tank systems remain the most popular vaping products in the UK (77% in 2019, down from 83% a year earlier), branded, re-chargeable products with pre-filled cartridges are on the rise (see here, pp 1, 13).

The leading UK e-cigarette brands are Vype (18%) [British American Tobacco], Blu (15%) [Imperial Brands], Logic (11%) [Japan Tobacco], and JUUL [the dominant US brand but a new entrant in the UK market], with 6%.

The reality is that heated tobacco products, and e-cigarettes, are increasingly owned and marketed by transnational tobacco companies – the folks who trade in death on an industrial scale.  See for example here and here.

 

Not everyone shares the excitement of PHE’s approach.

Professor Martin McKee from the London School of Tropical Medicine states that PHE “seems to be doing everything it can to promote e-cigarettes”, exposing a new generation to poorly studied chemicals.

The prominence given to PHE’s “95% safer” claim, by the e-cigarette industry, has led to an “escalation of commitment” in which “evidence that supports the position being held is promoted, whereas that which challenges it is dismissed”.

Professor Jeffrey Gotts, lead author of a recent study in BMJ (see here) told the New York TimesPeople are conducting a huge experiment on themselves about what kind of lung disease you can produce from all these different chemicals that you’re putting into the lung.  And the bulk of the evidence is increasingly that these devices have new and unpredicted toxicity”.

Children, adolescents and teenagers tend not to feature much when tobacco harm reductionists open up about their preference for relaxing controls on e-cigarettes.

After all, they’re not supposed to be using these products, are they?

And yet, every year, arriving in Washington DC to teach, I’ve watched youth vaping rates rise.  From 2011 to 2015, use of e-cigarettes among high school students rose by 900%: from 1.5% to 16%.

In 2019, 27.5% of high school students (aged 14-18 years) were currently using e-cigarettes (4.1 million people), and 10.5% of middle school students (aged 11-13 years).

That’s the power of the “consumer led approach” to e-cigarette regulation that the nicotine industry and its public health followers now advocate.

It’s a fascinating example of regulatory capture.  Without the regulation.

10 thoughts on “Vaping: the madness of the British?

  1. To summarize your words, they hold in 3 points:
    – tobacco industries work the corridors of power.
    – we do not know the effects of vaping on health. (i.e. they are negative)
    – young people vape. (and that’s a problem)

    To demonstrate this you mainly focus on 2 papers:
    https://www.bmj.com/content/bmj/366/bmj.l5275.full.pdf
    https://www.cdc.gov/mmwr/volumes/68/ss/ss6812a1.htm

    I see that you don not talk about pharma insustries, who give millions each years to corrupt science and medicine, as this is not a problem.

    Despite more than one billion of $ spend in scientific studies of vaping risk, after more than 15 years and more that 40 millions of vapers around the world, the scientific evidence is “more research are needed to found why we have to ban vaping”

    On the first link, I read:
    “Juul had a dominant market position by 2018, accounting for more than 70% of US e-cigarette sales.”
    As you say yourself, open tank system is still the main vaping device used.
    How can people say such wrong things and pretend to be expert of the subject ?
    The rest of the paper is in the same way, they can’t analyse what they do not understand.

    The second paper is politically oriented. An other view of data will be found here:
    https://pubmed.ncbi.nlm.nih.gov/32533631/
    or for Australia here:
    https://stories.uq.edu.au/medicine/2020/clarifying-australia-s-youth-vaping-figures/index.html
    Where we see young non smokers almost don’t vape.

    Liked by 2 people

  2. Supporters & opponents of tobacco harm reduction generally agree on measures to reduce the supply & demand for tobacco. That’s a big chunk of tobacco control. There is still strong resistance to tobacco harm reduction as there also was for some years to other then new drug harm reduction interventions including methadone treatment for heroin dependence, needle syringe programs to reduce HIV spread among & from people who inject drugs and drug consumption rooms. But eventually harm reduction usually prevails. It’s not just Public Health England that estimated after carefully reviewing the evidence that vaping nicotine is at most 5% as risky as smoking. The UK Royal College of Physicians and an international expert group chaired by Professor David Nutt came to the same conclusion. The authors of this comment avoid indicating whether they estimate that vaping is less risky, as risky or more risky than smoking. How could vaping aerosol not be less risky when it contains about 300 chemicals at low or trace concentration compared to 7,000 chemicals in cigarette smoke at high concentration including tars, other products of combustion and carbon monoxide.
    This comment sneers at the suggestion that vaping helps smokers quit. Why was there no reference to a British randomised controlled trial published in the New England Journal of Medicine in 2019 showing smokers allocated to a vaping group almost twice as likely to quit compared to smokers allocated to Nicotine Replacement Therapy. Cigarette sales in Japan declined 27% within two years of Heated Tobacco Products being made available.
    Vaping and Heated Tobacco Products are also examples of disruptive innovation, like smartphones compared to landlines. Betting against effective drug harm reduction AND disruptive innovation is not brave. It’s foolhardy.

    Liked by 2 people

    • Oh dear. Here we go again with the 95% factoid, first conjured by the Nutt group, then repeated by PHE & the RCP, with all references in both going back to …(drum roll) .. the Nutt group who had this to say about the quality of the data they used ““A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria”. Has there ever been a more galactic qualifier used to calculate any estimate? I’ve traced the circular referencing of the Nutt paper here https://simonchapman6.com/2019/09/26/the-dirty-dozen-twelve-myths-about-e-cigarettes/

      Then there’s the small matter of the Nutt magic number being conjured in 2013 .. 7 years ago when our knowledge of the early respiratory & cardiovascular effects of vaping was almost non-existent and the products used were then today’s equivalent of a comparing Morris Minor to a Mack truck in power. See https://ajph.aphapublications.org/doi/10.2105/AJPH.2019.305424

      The NEJM RCT tells us almost nothing about real world use of ecigs. All subjects were self-selected volunteers attending a quit clinic & all received intense quitting support as well as ecigs or NRT, just like all vapers of course do in the real world (NOT). See https://simonchapman6.com/2019/01/31/what-are-the-limitations-of-the-randomised-controlled-trial-of-ecigs-v-nrt-just-published-in-nejm/

      Then there was the later NZ RCT which just booted NRT right out of the park. As I wrote:

      “after six months 93% of the patches plus nicotine e-cigs group were still smoking; 96% of the patches plus nicotine-free e-cigs group had not quit; and 98% of the nicotine patches group were still smoking. So the “value added” by using nicotinised e-cigs was just 3%. The authors described the impact of the patches + nicotine e-cigs group as having attained “a modest improvement” in smoking cessation.

      I cannot think of any prescribed drug used for any condition where the condition persisted after 6 months use for 93% of users and where anything but the language of failure would be used about such an outcome. Is there anyone who would hail a 93% failure rate for contraceptives, antibiotics, cholesterol lowering drugs, analgesia, malaria prophylaxis or anything else as even a modest success?” https://simonchapman6.com/2019/09/13/evidence-of-the-effectiveness-of-e-cigarettes-dismal-or-disrupting/

      Trite analogies used to buttress hollow arguments …

      Liked by 1 person

  3. It went wrong from the point you framed saving lives as ‘rhetoric’, which is strange given 8 million (adults) are dying from tobacco use every year, and a billion this century. If that is not the problem we should be trying to solve, then we have our public health priorities wrong.

    Liked by 2 people

  4. E-cigarettes in Canada and the US are devouring the combustible cigarette market. This is clear as daylight from sales and shipments data (which I study as a professional health economist). No-one claims that e-cigs are completely safe, but we must take PHE seriously when it describes them as having about 5% of the toxins of a combustible cigarette. Smoking rates in US high schools have fallen by 50% in two years, by about 40% in Canada (Monitoring the Future Surveys).
    Australia’s plans to clamp down on alternative nicotine delivery systems will hurt disadvantaged communities most – indigenous peoples, the LGBTQ+ community and those with poor mental health. Use rates are very high in these communities because nicotine soothes their maladies and anxieties. So let’s not judge these folks as if they were feckless, and let them have the chance to consume a product that alleviates pain, even if it is not completely harmless. The consumption of some legal pharmaceuticals (opioids?) is more dangerous than nicotine. So are the wine-tasting classes so judgmental, and why do they want to force a binary choice of ‘quit or die ten years younger’ when better options are available? To mimic the haughty title of this article, such a restriction might be termed “the madness of the Aussie ruling classes.”

    Liked by 2 people

  5. Funny you didn’t mention that the “unknown chemicals people are putting in their lungs” quote by Jeffrey Gotts was referring to kids who bought illicit THC adulterated with Vitamin E-acetate. Also those alleged uptick in teen vaping were from kids who used a device once. You aren’t well aquainted with telling the truth eh? Just pushing propaganda against smokers & ecig users. Why aren’t you calling out makers of patches gums and lozenges?

    Liked by 2 people

  6. Vaping is displacing smoking, wherever it is encouraged and permitted. Raising moralistic objections to this will ensure that lives continue to be lost. I spoke on a webinar last night with two smokers who can’t see the point of switching to a harm reduced product, partly because of anti-vaping propaganda like yours. They are not alone in this, and will continue to smoke. I applaud the stance of PHE and many other U.K. bodies that give smokers the Green Light to switch to a safer product. It’s about stopping smoking, not stopping using nicotine.

    Liked by 1 person

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