NHS Lanarkshire chiefs are set to review their smoking policy at hospitals after new evidence on the benefits of ‘vaping’.
The smoking ban at Hairmyres Hospital, and other hospitals across the area, could be relaxed following a Health Scotland review, which showed that using e-cigarettes can help give up smoking tobacco.
NHS Greater Glasgow & Clyde have taken action based on the figures, and say e-cigarettes can now be used on hospital grounds by patients, visitors and staff.
However, the substitute will not be allowed within buildings, or at entrances or exits to hospitals and other health facilities.
Now, NHS Lanarkshire are set to consider if they should also allow the devices on hospital grounds following the new information.
NHS Lanarkshire’s director of public health medicine Dr Harpreet Kohli revealed that they are willing to review the policy if and when new evidence emerges.
Dr Kohli said: “NHS Lanarkshire introduced a no smoking policy which banned smoking on all our grounds and vehicles in 2008 and it was updated in 2014 to include electronic cigarettes as these devices are currently unregulated.
“There remains concern over their safety and efficacy.
“We’re aware new evidence is emerging in relation to electronic cigarettes and we will review our policy as required in the future in line with the evidence base.
“We fully support the Scottish Government’s Tobacco Control Strategy for Scotland which has tasked NHS Boards to become completely smoke free on hospital grounds.”
From August 2008, lighting up a cigarette has been banned throughout NHS Lanarkshire’s grounds under the revised No Smoking Policy.
The policy means people are no longer allowed to light up anywhere inside NHS Lanarkshire premises or within the grounds, including areas around hospital and health centre entrances and car parks.
But that does not mean they are entirely risk-free.
Prof Simon Capewell, of the Faculty of Public Health, said there were still many unknown factors.
“We don’t know enough yet about the long-term effects of vaping on people’s health, which is why we need more research.
“The best thing anyone can do if they want to quit smoking is talk to their GP: there’s solid evidence that NHS quit-smoking services help people kick the habit for good.”
But Prof John Britton, who co-authored the RCP report, says e-cigarettes are extremely positive for public health and should be “encouraged and endorsed”.
He said: “The public need to be reassured this is not a new nicotine epidemic in the making. E-cigarettes have very little downside and a lot of potential benefit.”
According to Public Health England, smokers should consider using e-cigarettes alongside NHS quit-smoking services.
Around a third of UK smokers try to quit each year, but only one in every six of those succeeds.
New EU laws are due to come into force in May that will set safety and quality standards for all e-cigarettes and refills. Manufacturers will be required to disclose the purity of their products to consumers.
Dr Tim Ballard, from the Royal College of GPs, said: “Moving forward we would be looking for clear evidence that making e-cigarettes available on prescription as part of a wider smoking cessation scheme is a wise use of both scant NHS funds and GP practice resources, before the College could get behind it.
“It is not just the cost of the product that needs taking into account, but the time and resources that are involved in assessing patients, and monitoring their progress over a prolonged period of time.
“We reiterate our calls for NICE to take a leading role in establishing whether making e-cigarettes available on prescription is the best way forward.”
A Department of Health spokesperson said: “The best thing a smoker can do for their health is to quit smoking.
“We know that there are now over a million people who have completely replaced smoking with e-cigarettes and that the evidence indicates that they are significantly less harmful to health than smoking tobacco.
“We want to see a wide range of good quality e-cigarettes on the market including licensed products whose safety, quality and effectiveness are independently assured.”
A collection of scientists and researchers are urging the Food and Drug Administration (FDA) to focus on the benefits of e-cigarettes and warn heavy taxation would be bad for public health.
Seven leading tobacco control experts took to the pages of the journal Addiction to examine the evidence on e-cigarettes. They found the devices cut smoking overall and could slash the number of deaths from tobacco.
“We’re concerned the FDA, which has asserted its right to regulate e-cigarettes, will focus solely on the possibility that e-cigarettes and other vapor nicotine products might act as a gateway to cigarette use,” says David Levy, professor in the department of oncology at the Georgetown Lombardi Comprehensive Cancer Center.
“We believe that the discussion to date has been slanted against e-cigarettes, which is unfortunate because the big picture tells us that these products appear to be used mostly by people who already are or who are likely to become cigarette smokers,” adds Levy.
The FDA is set to announce the regulations which could require all vapor products released after Feb, 15, 2007, (predicate date) to go through the onerous Pre-Market Tobacco Applications process.
The vast majority of e-cigarette businesses will not be able to bear the cost of this regulation and as much as 99 percent of products could disappear from the market if the rules are not altered.
An amendment to the spending bill from Reps. Tom Cole
and Sanford Bishop, which passed the House Committee on Appropriations 31-19, would alter the predicate date and save most products on the market. A vote by the House on the spending bill has not been scheduled. (RELATED: Vapers Win Big: House Committee Passes Amendment To Save E-Cigarettes)
“We don’t want to encourage e-cigarette use by youth and young adults who would not have otherwise smoked. However, the primary aim of tobacco control policy should be to discourage cigarette use while providing the means for smokers to more easily quit smoking, even if that means switching for some time to e-cigarettes rather than quitting all nicotine use,” the authors write in Addiction.
They also agreed with policy experts that slapping e-cigarettes with taxes equal to those of regular cigarettes will discourage smokers from switching to e-cigarettes, which are 95 percent safer. (RELATED: Utah’s E-Cigarette Tax ‘Boggles The Mind’ And Could Prevent Smokers Quitting)
“Increasing e-cigarette prices by taxing them the same way as cigarettes will discourage youth VNP use, but also discourage use by smokers, especially those of lower socioeconomic status, who are trying to quit,” says Levy.
The authors of the article include David T. Levy, Ph.D, of Georgetown University; K. Michael Cummings, Ph.D, MPH, of the Medical University of South Carolina; Andrea C. Villanti, Ph.D, MPH, Ray Niaura, Ph.D, and David B. Abrams, Ph.D, from Truth Initiative; Geoffrey T. Fong, Ph.D, of the University of Waterloo in Canada; and Ron Borland, Ph.D, of Cancer Control Victoria, in Australia.
The Vaper Expo UK now in our 2nd year, is one of the UK’s biggest and most recognised e-cigarette and vaping expo’s. Taking inspiration from internationally lead exhibitions, we have endeavoured to secure the best possible and most suitable venue here in the UK to host our own much needed trade and public vaping exhibition. The NEC Birmingham is one of the UK’s biggest and most respected exhibition venues and offers the space and amenities needed to bring together industry retailers, manufacturers, e-jucie manufacturers, wholesalers and distributors. Build new relationships with industry key players, explore the newest and most sought after manufacturers and products and build brand recognition at an event entirely targeted towards e-cigarette vendors and consumers.
The NEC National Exhibition Centre is the UK’s number 1 exhibition venue. Spread over 610 acres of land with over 200,000sqm of exhibition floor space available. This year we are located in hall 12 with 110,000 sqft of floor space available to us. The NEC is also the UK’s best connected venue with Birmingham International Airport and Birmingham International Train Station on site. All of the UK’s main motorways also lead directly to the venue making it accessible within a 4 hour drive of any where in the UK.
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The House Appropriations Committee passed an amendment Tuesday that could save 99 percent of e-cigarette products from prohibition.
The Food and Drug Administration (FDA) is set to announce its so-called “deeming” regs, which would require all e-cigarette products that came on the market after February 15, 2007 (predicate date), to go through the onerous Pre-Market Tobacco Application (PMTA) process — which could cost millions of dollars per product.
Since almost all vapor products on the market were released after February 2007, hardly any would avoid a PMTA and almost no businesses, with the exception of major tobacco companies, would be able to bear the regulatory burden.
Only one product in the last six years has passed the PMTA, according to House Appropriations chairman Rep. Robert Aderholt
The Food and Drug Administration (FDA) is in the final stages of announcing a new set of regulations for all electronic cigarettes (e-cigarettes) and vapor products. Free-market innovation has resulted in significant developments in the number and quality of these tobacco-free products that are helping Americans kick the unhealthiest habit known to man – smoking. The FDA’s proposal, however, threatens the very survival of the vast majority of the vapor product industry.
For large tobacco and pharmaceutical companies, this is great news. The FDA’s proposed regulations stand to benefit both industries, which represent some of the most well-funded and powerful lobbying interests in the United States.
Vapor devices compete with products marketed by pharmaceutical companies to help people quit smoking, like Nicorette gum and the nicotine patch. These nicotine replacement products have taken a hit in recent years as many consumers have turned to vapor products after pharmaceutical options have failed them.
The emergence of vaping also has Big Tobacco concerned. America’s largest cigarette companies have released e-cigarette products, but have thus far been unable to establish dominance in the market. Overly burdensome FDA rules could be just the ticket they need. Bonnie Herzog, a senior analyst with Wells Fargo Securities, commented last week that that the FDA’s proposal is “broadly positive for the big tobacco manufacturers since it will increase the barriers to entry.”
Under the FDA’s proposal, all vapor products on the market will have to retroactively undergo a “premarket” review process. For a single product application, the FDA estimates that a manufacturer will need to put out $330,000. Within the industry, the real cost is expected to easily run into the millions of dollars. Even with the lower cost estimate, the agency’s own economic analysis spells doom for all but a couple companies. That analysis predicts that approximately 99% of products on the market will not even attempt the application process, let alone gain approval.
The FDA claims that it does not have the authority to modify the premarket review requirement under the 2009 Tobacco Control Act, which gave the FDA the authority to regulate tobacco and nicotine-containing products. The agency says that the statute requires them to consider any product that has come to market since February 15, 2007 as a “new” tobacco product. The FDA calls this February 2007 provision the “predicate date.” It is this date that would needlessly roll back technology almost a decade and close businesses.
This week, members of Congress have an opportunity to change the FDA’s direction in a way that will benefit consumers, small business, and public health. On Tuesday, the House Appropriations Committee is scheduled to take up an agriculture spending package. Harm reduction advocates are hopeful that the committee will take up and pass an amendment to the bill to modernize the February 2007 predicate date for vapor products.
Changing the predicate date will not interfere with the FDA’s ability to establish rigorous safety and manufacturing rules for vapor products. The agency will retain their existing power to set product standards. If the FDA takes this route, any standard issued would apply to all products within the agency’s jurisdiction.
Without a modification of the February 2007 predicate date, Marlboro and Camel cigarettes will remain legal, but it will become a federal felony to sell tens of thousands of vapor products that are currently legally available and helping smokers quit. The status quo in the United States – smoking – will remain.
Approximately two-thirds of the vapor market is held by companies with no connections to Big Tobacco. That’s because the tobacco companies offer very few options to consumers looking to customize their quit journey. But given their ability to afford onerous regulation, Big Tobacco could be the only player left standing in the e-cigarette market.
Last year, attempts were made to change the predicate date by members of both the House and Senate. Congressional Democrats successfully killed the amendment and attacked Republicans for siding with Big Tobacco. They were misguided in that accusation. This shouldn’t be a partisan fight. Both parties should celebrate the prospect of a creation of the free market helping make cigarette companies a relic of the past.
The FDA’s current proposal will freeze innovation and kill jobs through unnecessary and costly paperwork. For the millions of Americans who try to quit smoking every year, Congress should act to ensure that overregulation does not prevent smokers from accessing effective and safer alternatives. Republicans and Democrats should welcome this much needed change.
Around 30% of current cancer deaths in the US are caused by tobacco. According to the World Health Organization, tobacco is ‘the only legally available product that kills up to one half of its regular users when consumed as recommended’.
Although nicotine is addictive, it’s tar that kills. A meta-analysis of 35 clinical trials found no evidence of cardiovascular or other life-threatening adverse effects caused by nicotine intake, and nicotine did not increase cardiovascular risk, even in patients with established cardiovascular disease.1
This is perhaps why e-cigarettes have been proposed as a harm reduction option when it comes to smoking. If all smokers switched to e-cigarettes, and if current estimates about the risk of these products are accurate, cancer deaths would fall to only 1–2% of users.2 Sure, it’s not advisable to regularly inhale nicotine, and my nine-year-old will not find an e-cigarette under the Christmas tree, but what makes e-cigarettes so controversial when it comes to public health?
Matter for concern
One key aspect is whether e-cigarettes represent a gateway to regular smoking, and are making tobacco products more acceptable again. According to the US Centers for Disease Control and Prevention, around 2.4 million middle and high school students in the US were current users of e-cigarettes in 2014. Yet studies suggest that one in three smokers who switch to e-cigarettes reduce their consumption, and one in nine quit for good – numbers that will only rise as manufacturers increasingly make the experience mimic actual smoking. Whether e-cigarettes are a potent weapon for smoking cessation, or are simply a way for big tobacco to remain in business, depends on which studies you read.
The chemical picture is even more complex. E-cigarette aerosol is not water vapour as is often claimed; it can also contain heavy metals and ultrafine particles, as well as carcinogens such as formaldehyde, acetaldehyde and acrolein (albeit at levels significantly lower than in cigarette smoke).3
Reproduced from M Goniewicz et al, Tob. Control, 2014, 23, 133 with permission from BMJ Publishing Group Ltd
The range of additives and flavours used by the devices also presents a challenge. Two years ago, one count came up with more than 3700 flavours available, including cheesecake and strawberry. Essentially, none of these flavourings has been tested to assess their risk to health; while many are food additives, just because they are safe when swallowed does not mean they are safe when inhaled chronically.
A good example is diacetyl, a compound found in 75% of e-cigarettes tested. The substance is quite well known – it is the butter flavour of popcorn. Although apparently safe when consumed, it is worth noting that inhalation of diacetyl has caused lung disease in workers producing the snack (known as ‘popcorn lung’).4While it is not clear whether the amounts inhaled by e-cigarette consumption could cause such conditions, diacetyl shows that there can be surprises when inhaling food flavours.
In a perfect world, we would embark on extensive trials of each and every one of these additives used. However, there are practical concerns that make this option difficult to achieve. Inhalation toxicity studies are very expensive, and rodent cancer tests even more so, costing around $1 million (£700,000) per substance in the current standard method. This would amount to $4 billion to test all the flavourings available. In addition, trials using rats are not always predictive of human physiology, and there is no generally accepted animal model of smoking-induced lung cancer.
It also takes four years to get the results from cancer studies and they notoriously err on the side of safety. For example, of more than 30 ingredients of coffee tested for carcinogenicity in rodents, more than 70% had a positive result. Does this mean we are regularly enjoying a brew of carcinogens? No – there is no such evidence. Some studies even show that coffee may reduce cancer risk.
In the short term, self-restricting the use of additives and using fast cell- and computer-based evaluations of safety will help clarify the safety of e-cigarettes. And in the medium term, controlled trials will be necessary. But if we wait for this evidence to emerge and prohibit or hinder the use of e-cigarettes, we would probably miss a tremendous opportunity to save lives on a large scale.
Thomas Hartung is Doerenkamp-Zbinden professor and chair for evidence-based toxicology at Johns Hopkins Bloomberg School of Public Health, US.
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