E-cigarettes helped up to 22,000 English smokers quit in 2014

Researchers from University College London have taken an in-depth look at smoking cessation data and the role of e-cigarettes. The findings trumpet the praises of e-cigarettes as an aid to quitting conventional cigarettes, although their trumpets are slightly more muted than those from other quarters.
[Man smoking an e-cigarette]
E-cigarettes divide the scientific community. Recent research delves into the data for answers.

Over the past few years, for better or worse, e-cigarettes have barely left the headlines.

As of early 2014, there were 466 brands and 7,764 unique flavors of e-cigarette products.

From 2003-2014, the sale of e-cigarettes has grown exponentially year on year. This surge has prompted much debate and investigation.

Health concerns over carcinogens and worries that e-cigarettes offer a newer, softer route into the world of tobacco smoking have dominated popular news.

Despite the clear and unabashed prevalence of this new trend, data and analysis regarding its effectiveness as a smoking cessation aid is difficult to dissect.

The tough data of quitting

Reliable information is hard to come by, partly because the habit of smoking is a fluid issue; some people smoke occasionally, some smoke both cigarettes and their electronic counterparts, others fluctuate between the two, and others might intermittently use other nicotine replacement aids, like patches or gum.

To further muddy the murky waters, some smokers quit tobacco but then take up e-cigarettes as a way to prevent relapse. And when has a quitter quit? After 3 clear months? Or maybe 12 months of abstinence? The variables to consider are bewildering.

The team from University College London (UCL) delved into questionnaire data taken during the stratospheric rise of e-cigarettes; they recently published their findings in the journal Addiction. According to author Prof. Robert West:

“E-cigarettes appear to be helping a significant number of smokers to stop who would not have done otherwise – not as many as some e-cigarette enthusiasts claim, but a substantial number nonetheless.”

The team found that 16,000-22,000 people in England (who would have otherwise continued smoking) stopped smoking courtesy of e-cigarettes. These results seem like positive findings, and to a certain extent, they are. However, they are substantially less than the numbers given by some e-cigarette supporters and manufacturers; plenty of questions remain.

Smoking statistics

Below is the rough train of thought that the UCL team used to arrive at the report’s findings:

  • In early 2014, 19.3% of people over 16 years of age in England smoked, equating to 8.46 million people
  • During 2014, 37.3% of the English smoking population attempted to quit at least once (3.16 million people)
  • Of those individuals who tried to quit, 28.2% or 891,000 people, used e-cigarettes rather than nicotine replacement aids, such as patches, or counseling
  • At the 1-year mark, success rates for quitting without any assistance, including nicotine replacement, is roughly 5%
  • Questionnaire data has shown that using an e-cigarette in a quit attempt increases the chances of success by around 50%, compared with no help or buying nicotine replacement items from a shop (in the UK, nicotine replacement therapies purchased from a shop have been found to have no increased success rate, unless they are accompanied by professional support)
  • It is therefore estimated that 2.5% of the smokers who used an e-cigarette in their quit attempt in England (22,000 individuals) succeeded who would have failed if they had used nothing or nicotine replacement from a shop.

The results seem to show that e-cigarettes, at least as far as quitting smoking conventional cigarettes is concerned, have had a positive impact on the problem. But there are still multiple unanswered questions to bat around.

Deepening e-cigarette queries

Although the UCL team has access to reams of data, there will always be questions that cannot be answered without further, more pointed information mining. One question, raised by dissenters, is that of non-smokers being tempted into smoking tobacco by the lure of e-cigarettes. The UCL team rejects this:

“Regular use of e-cigarettes by never smokers is extremely rare, and the decline in smoking prevalence in young people has been as great or greater than in previous years.”

Other questions that the authors hope to answer in the future include the issue of whether using e-cigarettes while continuing to smoke might reduce the number of attempts at quitting further down the line.

Prof. West also asks whether smokers who quit using e-cigarettes might be more or less prone to relapses. These questions, and others like them, will take many years and great silos of data to illuminate.

Medical News Today recently covered research that pointed in the opposite direction and asked whether e-cigarettes might reduce chance of smokers quitting.

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Dangers Of Vaping Centered On Bad Products

are ecigs bad for you

The news media loves to talk about the dangers of vaping, even the fictional dangers that don’t scientifically exist. This isn’t a surprise, or at least it shouldn’t be. We all know that the media has a much better time with their ratings if they are scaring people. Just imagine you see a teaser for the news. It has ominous music and the narrator says “ecigs are very trendy, but the dangers of vaping are real and we’ll tell you about them tonight on the 10 o’clock news.” Think people are going to tune in to find out?

Of course they are. That’s just how the media game works and it is something you pick up on quite quickly if you just pay a little attention. That’s how the “if it bleeds, it leads” phrase became so well known. When that average American does turn on his or her nightly news broadcast feature about electronic cigarettes, they will undoubtedly be flooded with a bunch of scary threats. Lots of rumor and assumptions will come up and very soon they will end up thinking that the dangers of vaping are terrible. At the least, they’ll think that the benefits are far outweighed by those dangers.

There will obviously be comparisons made the analogue cigarettes, but they’ll stress the similarities. They’ll tell you how you are still ingesting nicotine and they’ll paint it in a way that leads you to believe nicotine is bad for you. In fact, that isn’t really the truth at all. They may tell you that there are dangers of second hand vaping, just like second hand smoke. Once again, that isn’t the truth either and nobody has scientifically proven that it is. All of these claims about the dangers of vaping are made by connecting dots that don’t really connect. But there is one danger that we know exists, and that is the one you should really be focusing on.

 

Real Dangers Of Vaping Products Exploding

Dangers Of Vaping Bad Products


Batteries are at the heart of the dangers of vaping, but it isn’t as if you should stop vaping (or not start at all). While the dangers of second hand vaping is pretty much a myth, there is real solid proof of this phenomenon of ecig batteries exploding.

We won’t paint a pretty picture here, because the reality is that it is beginning to get out of hand. Just in last week we have seen numerous news reports of people being injured by exploding ecig batteries.

But the news of an explosion that injured a mother of two in England and the one that injured a teenager in Canada are related. Just like they are related to the man in New Hampshire who suffered burns due to an ecig exploding. All of these incidents have to do with the real dangers of vaping; buying bad products.

We don’t mean bad products because they are overpriced. Nor do we mean to say they just don’t taste good or don’t produce the amount of vapor you want. No, we mean bad products because they don’t go through proper quality control. While most electronic cigarettes are made at least partly in China, there is a mammoth difference between purchasing from a reputable brand and something on a non-branded site or simply from ebay. It may be cheaper, but it heightens the dangers of vaping exponentially.

It’s true that sometimes there are faulty products and that can happen in any industry. But there is also a reason we don’t see anything negative like this in the news about any of the top brands we recommend. These are companies that have a reputation to uphold and so they take all the necessary precautions, and even the precautions that aren’t necessary. Whether driven out of a concern for their consumers or a concern for their public image, you’ll be hard-pressed to see anyone working harder to make sure that the product you buy doesn’t fail in such a dramatic way as to explode or otherwise put you in danger.

The other thing that is going on is the serious concern regarding counterfeit ecigs. Fakes are everywhere. The dangers of vaping have been exacerbated by the sheer volume of clone ecigs on the market. You will find cloned ecigs and vaping products all over the internet and sometimes even in vape shops. How bad is the problem? Here are some numbers that will shock most of you.

There are a handful or world-class ecig manufacturers in China. Eight Aspire, Kangertech, Smok, Innokin, Joyetech and a few others are exceptional. They make some of the best vaping products in the world. They have strict quality control and use only the best materials. These companies are located in an industrial area of Shenzhen, China. Within that same are are 600 ecig factories. 600!

Most of those factories are producing terrible knockoffs at rock bottom prices. The fakes look just like the real thing. They are being sold online through a number of retail and wholesale websites. Even vape shop owners are being fooled by some of these products. This is a serious problem and results in a lot of bad press for the industry when one of these clone ecigs is the root cause of some well publicized ecig accident.

If you are interested in a Kanger, Aspire, Joyetch product, you need to buy from a reputable source that knows what they are doing. The vaping business is booming and pretenders and fakes are trying to cash in as are the brands that are just blatantly selling junk! With no regulation in place it is buyer beware.

The real culprit here is greed. The dangers of second hand vaping aren’t real, nor are all these other accusations that just stoke people’s fears. No, the dangers of vaping lie in cheap ecigs. That’s why the FDA should be worried about cheap ecigs instead of fruity ecig flavors. As a consumer, make sure that these harrowing stories in the news don’t put you off from making the switch to vapor. All you have to do is make sure you buy from the right sources and you’ll be well on your way to leaving traditional tobacco cigarettes behind you, as well as ridiculous claims about the dangers of vaping.

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E-quitting

e-cigarette.web

A five-year, first-in-Canada study, led by McGill cardiologist Dr. Mark Eisenberg, is exploring whether vaping really is the magic ticket to finally breathing free and easy.

By James Martin

Although the holidays may seem like a distant memory, statistically speaking, most of us are still sticking with our New Year’s resolutions. (For now. Let’s not talk about how many of us last until July.) For many, that means quitting smoking — and they’re hoping that electronic cigarettes will help. According to the U.S. Centers for Disease Control and Prevention, nearly half of all American smokers have tried e-cigarettes to help them kick the habit. But Dr. Mark Eisenberg wants to know: Is vaping really the magic ticket to breathing free and easy?

Dr. Eisenberg is passionate about getting people to butt out. He gives a lot of smoking cessation talks — just last month, he spoke at the Jewish General Hospital, where he is staff cardiologist — and has noticed that, invariably, reformed smokers come up to him afterward to sing the praises of e-cigarettes, those increasingly popular handheld battery-operated vaporizers that mimic conventional cigarettes.

“This is just a first step," says Dr. Mark Eisenberg of his five-year study." But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”

“They say, ‘I smoked for decades and I’ve tried everything — nicotine gum, patches, Zyban, Champix — and I couldn’t stop. Then I picked up an e-cigarette and I never smoked again,’” recalls Eisenberg, who is also a professor in McGill’s Faculty of Medicine and director of the Joint MD/PhD program. “Anecdotally, we have many, many cases like this.”

What doctors don’t have, however, is hard data to back it up. That’s why, this month Eisenberg will start a five-year clinical trial to look at how effective e-cigarettes are at aiding smoking cessation. It’s not just smokers and physicians who are interested in such clarity — so are lawmakers. Under Canada’s Food and Drug Act, e-cigarettes containing nicotine cannot be imported, advertised or sold without Health Canada’s approval; nicotine-free e-cigarettes are not restricted. Although Health Canada has yet to grant such approval, nicotine-loaded e-cigarettes are nevertheless widely and openly available in Canada.

The study, which is funded by the Canadian Institutes of Health Research (CIHR), will follow 486 outpatient smokers at 19 sites across Canada. The smokers will be randomized into three groups. One group will be given e-cigarettes that contain nicotine and counselling. The second group will receive e-cigarettes that do not contain nicotine, and counselling. The third group will only receive counselling. The researchers will supply the smokers with e-cigarettes for 12 weeks, and then follow up with them after six months and a year, observing whether they graduate to total non-smoking, continue with the e-cigarettes, or return to conventional cigarettes. Although some reformed smokers may fall off the wagon after a smoke-free year, Eisenberg clarifies that “statistically significant results at 12 months would still be important evidence” for the efficacy of e-cigarettes as a cessation aid. All 486 patients will not be enrolled simultaneously, with the study expected to roll out over the course of five years.

“The ultimate goal is to use the e-cigarette as a transitional tool in going from smoking conventional cigarettes to not smoking at all,” says Eisenberg. He notes that, at least in the early stages, e-cigarettes are about “transferring the addiction. You’re getting people onto something else that is giving them their nicotine, so they may never quit. E-cigarettes also provide other physical and social aspects because they feel like a cigarette; a pack-a-day smoker makes that hand-to-mouth motion more than 70,000 times a year, for example. That’s a difficult thing to break away from, and a nicotine patch doesn’t provide it.

“We have great hopes that e-cigarettes will be helpful for people trying to quit smoking,” he adds. “Even if they just switch to smoking e-cigarettes that would be better than continuing to smoke conventional cigarettes for decades. I’m not saying that e-cigarettes are safe, but they’re much safer than conventional cigarettes. They’re not going to give you lung cancer. They’re not going to give you heart disease. They’re not going to give you emphysema.

“But what we’re really hoping for is that e-cigarettes lead people to not smoking altogether.”

(This particular study, Eisenberg notes, is not designed to investigate safety concerns, such as whether e-cigarette vapour contains trace elements of harmful substances. Other than their smoking habits, the trial’s participants are healthy, he explains, “so the chances that they’d have adverse effects over a short time like the course of one year are quite low.” The researchers will, however, track whether the smokers are hospitalized for any cardiopulmonary issues. They will also gather data about benign side effects, such as throat irritation.)

E-cigarettes are already big business, ringing up an estimated $500-plus million in sales in the U.S. alone — and that’s without being able to make any claims about helping smokers kick their habits. Eisenberg says that the e-cigarette industry itself isn’t clamouring to make such claims: “They don’t want to be regulated by the Food and Drug Administration [in the U.S.] and Health Canada, so they don’t want to support clinical trials,” he says. “And they don’t need to: Smokers are voting with their feet by buying e-cigarettes to help them quit smoking.” Governments, however, want more than anecdotal evidence.

“This study alone would not be enough for Health Canada to allow companies to market e-cigarettes as smoking cessation aids,” explains Eisenberg. “That said, if this trial shows that there is a substantial reduction in smoking traditional cigarettes, then Health Canada will have to rethink their policy.

“This is just a first step. Then we would need multiple big trials in multiple populations. We would need to use tapering [of nicotine levels] studies, and we would need to use interventions that are longer than 12 weeks. But the fact is that smoking is still the single most reversible cause of mortality in Canada — so it’s an important first step.”

Posted on Wednesday, February 3, 2016

VapeCon International Expo in Riverside, CA (VC Official Recap)

Published on 22 Jan 2016

Vape Capitol’s Official Recap of VapeCon International in Riverside , CA.

Headlines about e-cigarettes don’t mean they’re ‘not safer than tobacco’

If your New Year’s resolution was to stop smoking, and you were looking for support to help you quit, then recent headlines suggesting e-cigarettes ‘aren’t any safer than tobacco’ might have raised an eyebrow or two.

Since Christmas, we’ve seen three sets of critical headlines about e-cigarettes, each looking at a different aspect of a device now used by millions across the UK.

But how accurately do these stories reflect the scientific evidence? What do we really know about how safe e-cigarettes are? Can they really help you quit? And do candy flavours attract kids?

If you were to go on the media reports alone, you’d be forgiven for being alarmed.

But as is so often the case in the reporting of science and risk, taking a deeper look behind the headlines reveals a very different story.

Just because they’re not “safe” doesn’t mean they aren’t “safer”

The first study to make the headlines suggested that e-cigarettes were ‘as harmful as tobacco’. After studying cells in the lab, the researchers found some indications of increased levels of DNA damage and cell death in those treated with e-cigarette vapour.

This led one of the researchers to tell the media, “I believe [e-cigarettes] are no better than smoking regular cigarettes.” (More on this statement below).

The most important thing to remember here is that this was a study looking at the effect of chemicals on cells in a lab. Although this can be useful, it obviously can’t give a clear idea of what the impact would actually be in your body. So any claims of impact on health based only on lab studies will always be far-fetched.

The study also looked at an extremely high concentration of vapour. As the researchers admitted at the time, “it was similar to someone smoking continuously for hours on end, so it’s a higher amount than would normally be delivered.”

It boils down to this: the study showed that it might be worse for your cells to be exposed to e-cigarette vapour than the air in a lab. So e-cigarettes might not be 100 per cent harm free. Andprevious studies have shown there may be some dangerous chemicals present in vapour – so this isn’t a surprise. And there’s little in life that really is ‘safe’ – even drinking too much water can kill you.

But here’s the big caveat. The researchers also treated some cells with tobacco smoke. These died within 24 hours. Those treated with e-cigarette vapour were still alive to experiment on 8 weeks later.

So, contrary to the headlines, this study actually suggests that using e-cigarettes may be far less dangerous than smoking.

You’d never believe that from the headlines though.

There were a few great critiques published shortly afterwards, (notably this one in the Guardian) and the press release was amended (more than a week later) to include the following correction:.

Contrary to what was stated or implied in much of the news coverage resulting from this news release, the lab experiments did not find that e-cigarette vapor was as harmful to cells as cigarette smoke. In fact, one phase of the experiments, not addressed in the news release, found that cigarette smoke did in fact kill cells at a much faster rate. However, because similar cell-damage mechanisms were observed as the result of both e-vapor and regular cigarette smoke, Dr. Wang-Rodriguez asserts, based on the evidence from the study, that e-cigarettes are not necessarily a healthier alternative to smoking regular cigarettes. As stated in the journal paper and the news release, further research is needed to better understand the actual long-term health effects of e-cigarettes in humans.

But we’re concerned that, as far as public perception goes, the damage may already have been done.

How can you tell if something helps people quit?

So the scientific evidence on e-cigarette vapour to date suggests it’s far safer than tobacco smoke.

But can e-cigarettes actually help you quit?

Here we come across the second set of unfortunate stories, after a systematic evidence review and meta-analysis published last week claimed that those using e-cigarettes seemed to be less likely to quit smoking than those not using the devices.

But, again, there are a number of serious problems with the review.

Systematic reviews and meta-analyses are usually extremely useful, because they pull together all the evidence in one area, to paint a fuller picture than one study alone.

However the relationship between this picture and reality depends entirely on the quality and relevance of the original studies that are included. In this case, since there haven’t been many high-quality trials exploring whether e-cigarettes help people quit smoking, the researchers included a range of different types of studies.

The gold standard of evidence is the randomised control trial, which, in this case, would compare a group of smokers trying to quit using a nicotine-containing e-cigarette, to a similar group using nothing (or an e-cigarette without nicotine). But here’s the problem – there have only been two published studies like that.

A 2014 meta-analysis of these found people using nicotine via an e-cigarette were more likely to successfully quit than those using e-cigarettes without nicotine.

Last week’s review included both of these randomised trials alongside a range of other ‘real-world’ non-trial studies of e-cigarette use. This is a big problem. Whatever their strengths individually, these studies didn’t use consistent measurements – neither of e-cigarette use, nor of whether people had actually quit – so the studies aren’t necessarily comparable. And so including them together in a meta-analysis is questionable, at best.

Even so, when the analysis only included studies where people were actively trying to quit (as opposed to using e-cigarettes for other reasons) the results became inconclusive – people who said they’d ‘ever’ used an e-cigarette weren’t any more or less likely to succeed.

Furthermore, some of the studies included only looked at current smokers and asked about e-cigarette use. This would exclude anyone who had used an e-cigarette but successfully stopped smoking.

Quitting smoking can be incredibly hard. Someone trying an e-cigarette once probably wouldn’t have any better chance than if they hadn’t. Whatever support aid is used it would need to be as part of a concerted quit attempt and used enough to deliver sufficient nicotine to wean yourself off tobacco, and preferably alongside specialist support from a Stop Smoking Service to get the best possible chance of quitting.

E-cigarettes aren’t a magic bullet, but that doesn’t mean they couldn’t be a useful weapon in our arsenal against tobacco. The evidence for quitters using these products both within the Stop Smoking Services and without points towards this being the case in the UK.

The impact of advertising and flavours on kids

Whether or not they’re ‘safe’, or help people quit, another big concern about e-cigarettes is that they could encourage children to start smoking – either by exposing them to nicotine (the ‘gateway’ argument) or by making smoking seem more normal again (the ‘renormalisation’ argument).

The first of these arguments isn’t supported by the evidence to date: surveys across the UK last year found that young people who hadn’t smoked weren’t using e-cigarettes.

But a small study published this week found young people rated printed adverts with flavoured e-cigarettes more appealing than those without flavours, leading to headlines suggesting children are being lured in with sweet flavours.

But when you dig into the detail, again it’s a more complex picture – the young people in this study, including those who saw the flavoured e-cigarette adverts, had negative views about e-cigarettes, and said they didn’t intend to buy them. And, perhaps more importantly, it didn’t find any evidence that e-cigarette adverts increase the appeal of regular cigarettes.

There are now measures in place to protect young people (e-cigarettes cannot be sold to under 18s, and further legislation heavily restricting advertising will come into force in May) but it’s still important to continue looking at how e-cigarette adverts might appeal to children, and to track use of both e-cigarettes and tobacco cigarettes to make sure there isn’t a negative impact from these products.

However, Linda Bauld, Professor of Health Policy at the University of Stirling (and our Cancer Prevention Champion), said the study “should provide some reassurance to those who say that e-cigarette advertising will result in a new generation of tobacco smokers.”

Where does this leave us?

When you look at the bigger picture, rather than the headlines, the evidence so far actually points towards a positive role for e-cigarettes in helping combat the biggest preventable cause of cancer. However none of the questions posed here – on safety, effectiveness and impact on children – have full answers.

As we’ve said before we need years of good quality science before we can definitively answer these questions, and at Cancer Research UK we are working towards that. But for now the evidence we have suggests e-cigarettes are far safer than smoking tobacco, they might help you quit and non-smoking children aren’t being lured into using them regularly.

While the evidence on e-cigarettes continues to accumulate, and the media controversy rages on, if you’re looking for evidence-based inspiration to quit smoking in 2016, speak to your GP or localStop Smoking Service, or check out our website… but maybe keep reading the headlines with an appropriate dose of scepticism.

Nikki Smith is a senior health information officer at Cancer Research UK

http://scienceblog.cancerresearchuk.org/2016/01/20/headlines-about-e-cigarettes-dont-mean-theyre-not-safer-than-tobacco/

You Are Being Lied To – A Billion Lives

The truth is coming. Get updates at http://ABillionLives.com

Another View: Taxing e-cigarettes will backfire on public health

A man exhales vapor from an e-cigarette in New York. There are moves in California to tax and regulate e-cigarettes the same as tobacco products.

CONGRESS NEEDS TO FIX FDA VAPOR RULE

By Phil Kerpen

After a lengthy and heavily contested regulatory process, a final rule deeming vapor products to be subject to pervasive FDA regulation is currently in the White House Office of Management and Budget for a final review before it is published and takes effect this year.  Leaks of the purported final rule suggest it remains deeply flawed and will impose a draconian, one-size-fits-all model that risks disrupting the fast-growing vapor industry and denying access to products that pose vastly less health danger than conventional tobacco cigarettes.  Unfortunately, in the final negotiations over last year’s omnibus bill a provision addressing this issue was dropped, but that should not be the last word on the issue from Congress.

Mitch Zeller, the FDA’s top tobacco regulator, told Congress “If we could get all of those people [who smoke] to completely switch all of their cigarettes to noncombustible cigarettes, it would be good for public health.”

Indeed, vapor products are displacing regular cigarettes.  The most recent data from the CDC show the percentage of the adult population that smokes has dropped six consecutive years, from 20.6 percent in 2009 to 14.9 percent in the first half of 2015. An estimated two million ex-smokers are using vapor products.

So we’re on the right track, and Zeller warned: “Let’s not lose our focus on what the primary cause is for those 480,000 avoidable deaths each year—it’s primarily burning, combusting cigarettes.”

Unfortunately, his agency is poised to do precisely that with its deeming rule.

“This is not really regulation. It’s prohibition,” says Boston University community health sciences professor Dr. Michael Siegel.

He’s referring to a feature of the rule that sets a grandfather date of February 15, 2007 – effectively denying grandfather status to nearly every vapor product on the market and forcing each to go through a lengthy approval process or be pulled from the market within 24 months.

That date and timeline were established by the Family Smoking Prevention and Tobacco Control Act, passed by Congress in 2009 – and it grandfathered all but the very newest cigarette products.  By now deeming vapor products subject to regulation seven years later, the FDA is subjecting these safer products to more draconian regulation.

Jan Verleur, co-founder and CEO of VMR Products, a major manufacturer of vapor devices, said: “It’s essentially a death sentence for industry. It could be held up in litigation for many years.”

That’s only slight hyperbole.

Once the rule is final, manufacturers would be required to submit to the FDA, for each product, a Premarket Tobacco Application (PMTA) or a Substantial Equivalence (SE) report.  The PMTA process is complex and expensive and would be challenging for all but the largest manufacturers – the major tobacco companies – to navigate.  The SE choice depends upon showing that a predicate product is already approved, but vapor technology is new and rapidly evolving, ruling this option out. The investment driving that innovation would be chilled by time and expense of submitting every product for regulatory approval – and the agency already has a substantial backlog.

The solutions are simple but will require Congress to act quickly, because the rule currently sits at OMB and could be published any day.  On the next appropriate must pass vehicle Congress should include language that either delays the rule completely or fixes its most egregious flaws – the imposition of an inappropriate grandfather date and an insufficient approval period.  Failure to do so will result in regulating vapor more strictly than cigarettes, destroying thousands of small businesses, and, tragically, likely increasing tobacco-related sickness and death.

http://www.americancommitment.org/content/congress-needs-fix-fda-vapor-rule

Trends in e-cigarette use in England