08 Sep

Vaping Debate Rages in Australia as Critics Accuse Government of Smokescreen

When parliament conducted an inquiry into vaping that concluded e-cigarettes should remain effectively banned in Australia, the paediatrician turned MP Mike Freelander said the lobbyists came knocking.

“We were lobbied quite heavily prior to and during the inquiry by a number of agencies including those promoting the tobacco industry and some medical professionals who argued for legalisation on the basis of harm minimisation,” the Labor MP says.

“In the last few months there has been more activity … but I think our inquiry came out with the right result and I don’t want to reopen it.”

The increase in lobbying – including Philip Morris engaging Capetal Advisory, revealed by Guardian Australia this week – comes as tobacco companies take a stake in vaping, the great disruptor of the traditional cigarette market.

Philip Morris International has its iQOS – which stands for “I quit original smoking” – “heat not burn” smokeless cigarette device and in December 2018 Marlboro cigarette maker Altria Group announced it would pay $12.8bn to take a 35% stake in Juul Labs, the maker of one of the most popular brands of e-cigarettes.

“One only needs to see the lobbying to know it has a commercial aspect,” Freelander says. “It’s a bit sad to see in what is a public health issue.”

But despite most parliamentarians on the inquiry finding that e-cigarettes should continue to be controlled as a therapeutic good, several Liberal MPs including Trent Zimmerman, Tim Wilson and Andrew Laming were persuaded, forcing the health minister, Greg Hunt, to order an independent study.

Alex Wodak, a physician and director of the Australian Tobacco Harm Reduction Association, said the MPs were “shocked to find how strong the case is for making the easy switch from high-risk cigarettes to low-risk vaping”.

Wodak cites that in the UK – where vaping is 6% of the market compared with 1% in Australia – the decline in traditional smoking has accelerated, while rates remain flat in Australia. In Japan, sale of traditional cigarettes is down 31% in three years after the introduction of e-cigarettes such as iQOS, he says.

The association is a charity set up by four independent Australian medical practitioners which received funding from two vaping businesses for “initial legal and website costs” but now says it does not accept donations from tobacco companies, their subsidiaries or the vape industry.

E-cigarette use also appears to have negative impacts on lung health, and potentially contributes to respiratory and cardiovascular conditions Parliamentary inquiry

Wodak, who led the St Vincent’s hospital alcohol and drug service for 30 years, compares the public debate on vaping with other harm reduction efforts greeted with “ferocious resistance”, including using methadone to treat heroin addiction, condoms to prevent the spread of HIV, supervised injecting rooms, and pill-testing at music festivals.

“It’s always an argument between abstinence – from people who wish something would disappear from the face of the earth – and pragmatists who mightn’t like it but know since it exists we’ve got to deal with it,” he says.

The Liberal-National Coalition government has commissioned a public health assessment of electronic cigarettes from the national centre for epidemiology and population health at the Australian National University, with the first task to test the theory it helps “hardened smokers” quit.

A spokesman for Hunt said the government’s position on e-cigarettes “remains unchanged and the minister is firmly opposed to changing the current laws particularly in light of recent statements by the US FDA about an epidemic of addiction among teen users”.

In Australia there is unanimous opposition to vaping among the peak health groups, but Public Health England has declared vaping to be 95% safer than traditional smoking. Nevertheless two recent deaths – in Illinois in August and Oregon in September – have put safety back under the microscope.

The US Food and Drug Administration and the Centre for Disease Control is investigating a link between e-cigarette use and severe respiratory disease.

The parliamentary inquiry found that e-cigarette vapour “has been found to contain dangerous substances such as heavy metals and formaldehyde”.

“E-cigarette use also appears to have negative impacts on lung health, and potentially contributes to respiratory and cardiovascular conditions,” it said, citing submissions from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia.

Chris Zappala, vice president of the Australian Medical Association and a respiratory physician, says there is “no question liquid nicotine has a harmful effect on the airways”, particularly of patients with asthma or other chronic diseases, and that e-cigarettes “could to lead to normalisation” of smoking.

The only way to safely regulate these products is to legalise them Kirsten Daggar-Nickson

Imperial Brands has said it is “deeply troubled by reports linking illnesses to the use of vaping products” but noted the cases were linked to vaping liquids containing THC (tetrahydrocannabinol), the principal psychoactive constituent of cannabis”, not found in its products.

“The only way to safely regulate these products is to legalise them,” its head of corporate and legal affairs, Kirsten Daggar-Nickson, says.

In Australia the commercial sale of liquid nicotine used in vaping is banned, and can be legally obtained only with a doctor’s prescription.

Guardian Australia spoke to four vapers – none of whom had a prescription and all of whom found liquid nicotine could easily be purchased on the internet, particularly from the more liberal neighbouring jurisdiction of New Zealand.

Melbourne vaper and IT professional Martin Kingsley says: “The idea you can’t get liquid nicotine in Australia is ridiculous. It’s for sale at tobacconists under-the-counter. You can buy it here if you just don’t look like a narc.”

Tom Reed had been smoking for half his life when he quit around the time of his 40th birthday. After a few “half-arsed attempts” he was forced to “get real” after an injury when advised that quitting smoking would improve the effectiveness of surgery on his thumb.

Reed’s doctor rejected the idea, but he decided after doing his own reading that vaping would be better for his health than smoking and made the switch.

“I’d used e-cigarettes a few times before but I didn’t like it or really give it a chance,” he says. “After I made a commitment it was ridiculously easy.

“At first it’s a pretty poor substitute and you feel that you can’t beat the real thing, but it doesn’t take long for your taste to change. I had a cigarette on New Year’s Eve and thought it was pretty shit. It tastes bad; you feel it in your throat and lungs.”

Catriona Thoolen, a farmer and former United Australia party candidate, found quitting smoking difficult because her husband was reluctant to give it up but she says “this latest price rise is the end of our smoking”.

Thoolen says vaping “does the job” by fulfilling her nicotine craving, but her husband “doesn’t believe in it [because he says] it doesn’t feel the same”.

She suggests anti-smoking campaigners don’t like vaping because it delivers nicotine with the same hand-to-mouth action and is concerned that liquid nicotine will be subject to the same “sin taxes” as regular cigarettes.

Freelander is concerned that legalisation will increase its use among non-smokers. “[Vaping] probably is a little bit better for you but what about the increasing number of people addicted to nicotine? It’s a pathway to cigarettes.”

Wodak responds that the proportion of regular vapers who have never smoked is “very small” – less than 1% – and it “wouldn’t be possible for e-cigarettes to accelerate the declining smoking rate” if it acted as a gateway to real cigarettes.

Zappala says while “never-smokers” might be small as a proportion of the whole vaping population, large studies in the US and UK show “the gateway effect is real”, particularly in teenagers who are more likely to smoke after vaping.

He also rejects e-cigarettes as a cessation aid citing the fact that between a half and two-thirds of people who quit go cold turkey. The existence of other cessation aids means “it’s not like there are no other options”.

Wodak suggests contrary figures are inflated by counting the total number of people who have ever vaped, an “unrealistic” estimate that counts “transient” users who vape, even without nicotine, and later give it up.

Thoolen’s youngest son, aged 18, is one such vaper who has “never had nicotine” and now appears to be “losing interest” in e-cigarettes.

And Kingsley, who took up vaping to replace infrequent binges of one pack of traditional cigarettes a month, is also looking to quit.

E-cigarette use “creeps in insidiously”, he says. Where previously he smoked only on social occasions to accompany alcohol or drugs, Kingsley now finds himself vaping in his lunch break or going outside to “break up the monotony” of work.

He plans to quit over the summer break, citing the ability to dilute the amount of nicotine to suggest stepping down will be smooth.

Freelander suggests the evidence e-cigarettes help smokers quit is largely “anecdotal” and is disappointed Hunt has revisited the question after the “comprehensive” parliamentary inquiry report.

“There is no new evidence that e-cigarettes are healthy, the only new evidence is to the contrary. There are the cases in the US where it was found inhaled nicotine caused significant lung damage and death, and increasing concern here and in Europe.”

But Wodak welcomes the new study, labeling the government’s opposition to effective legalisation “very disappointing” and suggesting that “arguments based on misinformation” will dissipate, preventing deaths and all the other miseries of smoking.

02 Jul

San Francisco becomes first US city to ban sale of e-cigarettes

San Francisco voted to ban e-cigarettes in the first legislation of its kind in the United States

Supervisors approved a measure banning the sale and distribution of e-cigarettes in an effort to curb the rise of youth vaping. The measure will now go for final approval to San Francisco’s mayor, London Breed, who said she will sign the legislation, and stores in the city will be required to remove e-cigarettes from their shelves after the change goes into effect in seven months.

However, it will still be legal to purchase traditional cigarettes and marijuana products, including vapes for cannabis, in the city of San Francisco.

After decades of decline in youth cigarette smoking, the rise of vaping has led to a major boost in nicotine use for people under the age of 21. More than 4.9 million American teens used e-cigarettes in 2018, an increase of 1.5 million teens in just one year.

San Francisco is home to Juul, with more than a 50% share of the market making it the biggest producer of e-cigarettes in the country. Juul markets itself as a smoking alternative for adults seeking to quit, but the San Francisco supervisor Shamann Walton, who co-authored the legislation, sees it as a continuation of big tobacco.

“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”

Juul has continued to expand its headquarters, announcing the purchase of a new 29-story skyscraper to accommodate its “rapidly growing team” on the same day the e-cigarette ban first passed the committee.

A spokesman from Juul told the Guardian the company will continue to push back against the legislation and is reportedly developing a ballot measure in November to keep e-cigarettes available for purchase.

Juul and other advocates for vaping say the ban could result in more adults smoking cigarettes. “This full prohibition will drive former adult smokers who successfully switched to vapor products back to deadly cigarettes, deny the opportunity to switch for current adult smokers, and create a thriving black market instead of addressing the actual causes of underage access and use,” spokesman Ted Kwong said.

Juul has taken some measures to prevent young people from taking up vaping , including banning the sale of flavored pods and restricting bulk purchases to prevent sharing products.

Purveyors of Juuls, including vape shops and corner stores, have expressed outrage at the impact of the decision on small businesses in the city. Some argued that stores in Oakland and Daly City, just across the Bay, stand to see major profits from the decision as people travel to get nicotine products.

While the ban on e-cigarettes is clearly a blow to Juul, it is also a gesture directed at the US Food and Drug Administration, which has been slow to legislate the devices despite their explosion in popularity in recent years.

In December 2018, the US surgeon general issued an advisory calling youth vaping an “epidemic”.

“San Francisco is taking action to protect our kids,” the San Francisco city attorney, Dennis Herrera, said in a statement regarding the legislation. “This temporary moratorium wouldn’t be necessary if the federal government had done its job.”

28 Nov

Relaxing Vaping Laws Would Cut Smoking Deaths, Say MPs

The government is missing an important opportunity to cut deaths from smoking, says a committee of MPs who are calling for a cut in the tax on e-cigarettes. They are also urging the government to allow more advertising and to rethink the ban on vaping on buses, trains and in other public places.

A hard-hitting report from the all-party select committee on science and technology says the risk to smokers who continue with their habit far outweighs the uncertainty around the possible harms of vaping. Public Health England has said e-cigarettes are 95% safer than smoking.

“The blunt fact is that 79,000 people in England still die of smoking every year, which is sort of unconscionable, particularly when we know there is the means by which we can reduce the death toll,” Sir Norman Lamb, the committee’s chair, told the Guardian.

The report follows the publication of NHS figures showing the number of people engaging with stop smoking services has fallen by 11%, the sixth consecutive year there has been a drop. The Local Government Association, whose members have responsibility for the services, and the campaigning group Ash (Action on Smoking and Health), say local authorities are not being adequately funded.

The MPs’ report says it is thought that 2.9 million people in the UK are using e-cigarettes to try to stop smoking and “tens of thousands” are successfully quitting each year thanks to vaping.

Lamb, a former social care minister, said he had a particular interest in helping people with mental health issues, whose smoking rates, at about 40%, were higher than the rest of the population.

“It is really shocking that a third of mental health trusts within our NHS ban e-cigarettes,” he said. “When people are patients, it is a golden opportunity to influence behaviour, yet our NHS is failing to follow the evidence.”

The report acknowledges that not enough is known about the possible harms and calls for more research into e-cigarettes and the “heat-not-burn” tobacco products that are becoming available.

But it dismisses concerns, which have been very vocal in the US, that children will try e-cigarettes, get hooked on nicotine and start to smoke. The US has also seen an outcry over Juul, an ultra-cool brand of e-cigarette that looks like a flash drive and has taken off among schoolchildren. It is now on sale in the UK.

The argument that e-cigarettes are a gateway to smoking “just doesn’t hold water”, said Lamb. Children try them, “but the numbers that continue are tiny”.

The committee is pressing the government to relax the regulations around e-cigarettes, which in many respects are controlled like ordinary cigarettes.

“Smoking remains a national health crisis and the government should be considering innovative ways of reducing the smoking rate,” said Lamb in a statement. “E-cigarettes are less harmful than conventional cigarettes, but current policy and regulations do not sufficiently reflect this and businesses, transport providers and public places should stop viewing conventional and e-cigarettes as one and the same. There is no public health rationale for doing so.”

The report calls for the government and the medicines and healthcare products regulatory agency to work with the industry on ways to streamline the process for e-cigarettes to obtain a medical licence so they can be prescribed on the NHS.

It wants to see the rules lifted on the tank size of devices. “The limit on the strength of refills makes some users have to puff harder to get the nicotine they seek and may put some heavy smokers off persisting with them,” says the report.

While Lamb points out that he was a Remainer, he says that Brexit offers an opportunity for the UK to make its own rules on e-cigarettes and not be bound by EU regulations. He wants a review of the ban on “snus”, oral tobacco wads that are banned across Europe with the exception of Sweden, where they are made and where only 5% of people smoke.

“While the report may be seen by some as radical in recommending action to facilitate the use of e-cigarettes, from the point of view of a scientist working in the field it is a welcome and common sense translation of the evidence base into a programme of action. I hope it will have a major impact on the evolution of policy,” said Prof Robert West, the director of tobacco studies at UCL.

Daniel Pryor, of the Adam Smith Institute, said the report was “fantastic news for public health and consumer choice”. Permitting advertising to consumers was an important proposal. “The majority of UK smokers don’t know that e-cigarettes are significantly safer than smoking, and this situation is getting worse,” he said. “Taxing e-cigs and heat-not-burn products based on their relative risk would be a smart move, but contrasts with worrying rumours of a proposed vaping tax from the Treasury.”

11 Dec

Why Can’t Scientists Agree on E-Cigarettes?

Earlier this year, Michael Gove claimed Britain’s had enough of experts. Now I don’t agree with Gove on much, but when it comes to e-cigarettes, he may have a point. We’re bombarded with stories about these products, but most just add to the confusion, with perceptions of vaping risks rising year on year. Just recently the Sun informed us that experts are saying “e-cigs are just as bad for your heart as smoking fags”, but read a couple lines down and you’ll find other experts reasserting the claim that e-cigarettes are 95% safer than tobacco. So which is it? Why can’t the scientists agree? And will they ever?

Cochrane is a global non-profit group that reviews all the evidence on healthcare interventions and summarises the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to first read every study out there. This week, the latest Cochrane review of e-cigarettes was published. While the conclusions are limited because there aren’t many high quality studies available yet, overall the evidence suggests that (1) e-cigarettes with nicotine can help people quit smoking, (2) they don’t seem to have any serious side effects in the short- to mid- term (up to 2 years), and (3) in some cases, switching to them leads to changes in your blood and breath that are consistent with the changes you’d see in people who give up smoking altogether.

This is good news. But other systematic reviews and studies have drawn very different conclusions, and I’m going to try to shed some light why that is.

Can e-cigarettes help people quit?

Our Cochrane review suggests they can. But a review published in the Lancet Respiratory Medicine earlier this year, which received a lot of attention, suggests they actually make it harder. The reason for this difference is the types of studies the authors include.

Randomized controlled trials are the best way to see if a treatment works. As Ben Goldacre, author of Bad Science, explains, by randomly assigning people to one intervention or another and measuring the outcome in the same way across both groups, you can rule out alternative explanations for differences between groups. The reviews that find e-cigarettes help people quit smoking only include randomized controlled trials. The studies that find that e-cigarettes stop people from quitting aren’t randomized controlled trials – instead they survey smokers and ask if they are using e-cigarettes. Then, some months later, they ask the same people if they are still smoking. We don’t know if the results from these studies reflect the effect of vaping, or if something else about the vapers makes it harder for them to quit. For example, it might be reasonable to imagine they are more dependent smokers, which is why they vape as well as using regular cigarettes. This would make quitting harder.

Are they safe?

The issue here isn’t so much the study type, but the way you ask the question. By ‘safe,’ do you mean completely without risk? No, they’re not – not much is. We’ve seen stories about people catching fire and puppies with nicotine poisoning. Plus, in general, it’s not a great idea to inhale chemicals into your lungs if you can avoid it. Experts basically agree on that – I’ve yet to come across a tobacco researcher or policy maker who would recommend you start using e-cigarettes if you aren’t already a smoker.

The crucial question here is – safe compared to what? Cigarettes are uniquely deadly. They kill one in two people who use them regularly. So, if you’re asking whether e-cigarettes are safer than regular cigarettes, most experts would, after briefly hesitating, lean on the side of yes. The hesitation is there because e-cigarettes are new to the scene. We don’t know their long-term safety profile, so we have to look for clues elsewhere – for example, studies that measure side effects of short-term use and studies about how e-cigarettes affect your blood, lungs and heart. Interpreting these measures is complicated. For example, a recent study found that vaping affects the same blood vessel in your heart as smoking regular cigarettes. This isn’t necessarily surprising – we know nicotine, the active agent in both, affects this vessel. We also know that nicotine isn’t responsible for the harms associated with smoking. So how to interpret these results? The gamut of expert reactions ran from “[e-cigarettes are] far more dangerous than people realise” to “vaping carries a fraction of the risk of smoking.” When it comes to long-term safety, experts are making their best guesses in the absence of solid data, and that’s where room for disagreement creeps in.

So what’s next?

The good news is there’s lots of research going on – finally. The most recent update of the Cochrane review found 26 studies in the pipeline that will help answer questions about the safety and effect of using e-cigarettes to quit smoking. The more studies we have looking at a question, the more certain we can be about the answer. The irony is that until we have the answer, narrow interpretations of the results of individual studies risk doing further harm, undermining public confidence in science and possibly discouraging quit attempts. Fundamentally, tobacco researchers on both sides of the argument want the same thing – to reduce death and disease. We’re in the same boat. If you’re reading this as a member of the public, please don’t be put off by the conflicting headlines – we all agree cigarettes are bad for you, most of us agree vaping is probably much safer than smoking regular cigarettes, and if you’re a smoker we all really want our research to help you to quit. Don’t let us get in the way.

05 Jun

Majority of Vapers Have Quit Tobacco – Survey

More than half of the estimated 2.9 million people in the UK who use e-cigarettes have given up smoking tobacco, a survey suggests.

But many people overestimate the relative health risks of vaping, which may have contributed to a slowdown in the numbers turning to e-cigarettes. Nine million people in the UK still smoke tobacco.

The number of people vaping or using e-cigarettes has quadrupled in the past five years, the annual Smokefree GB survey by Action on Smoking and Health (ASH) found, with many people turning to them for help with quitting or cutting down on smoking tobacco.

For the first time, more than half of vapers said they had quit smoking. Most of the remainder continued to both vape and smoke tobacco.

Ann McNeill, professor of tobacco addiction at King’s College London, said the finding was encouraging. “This year’s Ash survey finds that around 1.5 million vapers are ex-smokers, for the first time a larger number than those who continue to smoke,” she said.

“This is encouraging news as we know that vapers who continue to smoke continue to be exposed to cancer-causing chemicals. The message for the 1.3 million vapers who still smoke is that they need to go further and switch completely.”

But vaping’s rate of growth has slowed considerably in the past couple of years, and the survey found many people overestimated the health risks of vaping compared with tobacco.

In 2015, Public Health England concluded vaping was about 95% less harmful than smoking. But more than a quarter of respondents (26%) said they believed e-cigarettes were equally or more harmful than the traditional equivalents, with only 13% saying they were much less harmful than smoking.

Deborah Arnott, the chief executive of Ash, said: “It’s excellent news that the number of vapers who have quit smoking is continuing to grow, but there are still 9 million smokers compared to only 1.5 million vapers who don’t smoke at all.

“The rapid growth in e-cigarette use has come to an end while over a third of smokers have still never tried e-cigarettes, saying the main reasons are concerns about the safety and addictiveness of e-cigarettes. It’s very important smokers realise that vaping is much, much less harmful than smoking.”

The findings were based on an online survey by YouGov of 12,969 adults, weighted to be representative of the UK adult population.