The Public Health U-Turn on E-Cigs

A Report on the All Party Parliamentary Committee on E-Cigs (September 9th)

The All Party Parliamentary Committee on e-cigs met again yesterday Clive Bates and Oliver Kershaw of E-Cigarette Forum were the main speakers, and the committee focussed on the Public Health England report and its impact.

I’ve put together these notes for interested vapers and activists. As always, any mistakes are my own, and due to the pace of the meeting I haven’t been able to cover every single point raised.

The Public Health England Report: Impact

Clive Bates, former director of Action on Smoking and Health, told us this was an evidence review, a synthesis of the evidence that exists.

“It’s unique, the 1st open minded, objective evidence based review that has lead to evidence based conclusions.”

Clive emphasised that the studies finding included that:

  • e-cigs are primarily used by adults
  • there are no signs that it is a gateway to smoking
  • rapid falls in smoking have coincided with the rise of e-cigarettes

In addition, there have now been thousands of measurements of e-cig vapour, and we can conclude that harmful constituents in tobacco smoke are either not present/detectable or are only present in very low levels. So, Clive believes, it’s safe to assume that e-cigs are 95% safer than smoking.

Some have asked why we should make this claim. Clive argued that the claim sets the risk in the right ball park, and enabled smokers to understand the relative risk of using electronic cigarettes.

He also stated that while e-cigs are a market-lead phenomenon, in this case Public Health England has acted to support e-cigs in a ‘groundbreaking, landmark study.”

Oliver Kershaw, founder of E-Cigarette Forum, believed that the PHE review will be viewed as a turning point. It’s also a clear U-Turn for some in public health who were originally opposed or agnostic about e-cigarette. He believes that the industry now needs to be involved with Public Health England to enable it to achieve its objectives.

Mark Pawsey (Chair and Conservative MP) asked if anyone disagreed whether e-cigs were than 95% safer than cigarettes. There was silence until Tom Pruen of ECITA said that e-cigs could well be safer and that 95% mis-represented the residual risk.

Clive Bates sort of agreed, but argued that we can say that e-cigs would be at least 95% safer than cigarettes, although we would perhaps be better giving a range of 95 – 100%.

Martin Dockrell, head of tobacco control at PHE and the person who commissioned the study, clarified that 95% is a “reasonable estimate”. He also told us out that when he met the anti-nicotine, anti-vaping fanatic (my words, not his) Stanton Glantz, even Stanton estimated vaping to be in the region of 80% safer than cigarettes.

One attendee questioned the impact of flavours upon vaper’s health.

Docherty referred the questioner to Professor Peter Hajek, who agreed that there could possibly be some residual risk in the flavours which will need continued vigilance. Katherine Devlin of ECITA pointed out there is a lot of ongoing work into the toxicology of flavours, while Oliver Kershaw argued that the UK is streets ahead of the US in this area.

Later discussion (in the pub!) revealed that lots of work has been carried out in toxicology, however much of this has not been put in the public domain.

E-Cigs on the NHS

Earl Cathcart shared a lovely personal story how he had managed to go from 50 cigarettes a day to zero with the help of e-cigarettes. However, he wondered why the government should subsidise smokers with NHS e-cigs when they are already saving such a huge amount of money by switching to e-cigs.

Lorien of the New Nicotine Alliance believes that if the NHS supply e-cigs it would reassure smokers that e-cigs are safer than tobacco cigarettes.

She also pointed out that a decent e-cig kit would set some smokers back a week’s worth of tobacco. Coupled with a worry about whether e-cigs are safe or not that would stop a lot of smokers from trying them. If e-cigs were supplied on the NHS, smokers could take the risk of using them without losing a week’s worth of tobacco.

Louise Ross of the NHS stop smoking service, who we interviewed here, also suggested that the NHS could give out free samples to get smokers started on e-cigs. However, further discussion suggested that it was unlikely that the MHRA would ever approve a medical licence (necessary if the NHS is going to prescribe e-cigarettes):

  • the technology doesn’t exist to comply with medical licensing
  • the MHRA is being incredibly difficult and unhelpful
  • even large tobacco companies with huge budgets are failing to make headway

Update on the Tobacco Products Directive

Clive Bates argued that the TPD had been a massive failure in policy making, saying:

Every rule in the book has been broken.

Clive still has hopes for the Totally Wicked case, which might be heard soon. He believes there is a reasonable chance of success but the problem is that the European Court of Justice is very political. He still hopes for reasonable implementation of the TPD by UK government.

Other speakers noted that the ECJ has a very poor record of over-turning EU legislation.

Martin Callanan, (former leader of EU cons, now member of house of Lords), stated that the:

  • TPD was a “total balls up, a mess of a procedure”
  • End of process saw a massive compromise.
  • There is no prospect of it being changed.
  • ECJ – doesn’t have a strong history of overturning legislation.

Martin said he can only apologise – he managed to win some improvements in the legislation but not much.

However, as we noted at the time Martin Callanan orchestrated a strong resistance to e-cig components of the TPD with little support and despite political headwinds, and managed to get a majority of UK MEPs voting against it.

Martin also pointed out that MEPs at the time were bombarded with obscure gateway product studies with little (at the time) evidence to refute them, much of it orchestrated by Linda McAvan. The UK government at that time was not helpful, and the EU officials had a Taliban attitude to smoking and anything connected to it. (No mention was made of the UK government minister who accidentally voted to ban e-cigarettes).

Katherine Devlin asked if there were any mechanisms by which the UK gov could refuse to implement article 21?

Martin Callanan said no, with Clive Bates agreeing.

The Need to Involve More MPs

While there were at least two MPs and two lords present, it was noted that more MPs needed to be present at the meeting and involved in the debate. The MPs present promised to raise parliamentary questions and to try and get more MPs involved, but as David Dorn pointed out later we also need to contact our own MPs and get them involved.

Conclusion

There now appears to be cross party, cross house support for e-cigs, however, we do need to get our MPs involved. So please do contact your MPs and ask them to get involved.

While there was lots of complaints about the tobacco products directive, we do need to get past what’s been done and focus on implementation. Despite the impact of the tobacco products directive, we are more fortunate than the rest of the EU in that we have a government which appears to be focussed on providing a positive interpretation of the TPD and supporting e-cigarette retailers.

(In fact, Clive Bates illustrated this by pointing me towards a positive blog on e-cigs written by the Chief of the UK Civil Service. . With the whole of the UK’s civil service to run, he found it amazing that Sir Jeremy Haywood cared enough about e-cigs to find time to write a post on a government website in their support.)

Interesting fact of the day

Speaking to Gordon McFiggans, who is Professor of Atmospheric Multiphase Processes at Manchester University, I found out that from a scientist’s perspective the vapour from vaping is not vapour, or smoke, but clouds. He has promised me an interview to explain this further in the future.

Source: The Public Health U-Turn on E-Cigs

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