UK Government should refuse to implement Article 20 of the TPD in light of PHE report

The UK’s primary Public Health agency, Public Health England, recently published its review of ecigs in the UK. Its findings are now common knowledge, and, frequently in that document, Article 20 of the Tobacco Products Directive due for implementation in May 2016 is criticised. We call on the Department of Health and the UK Government to refuse to implement Article 20, as it will certainly result in nett harm to UK Public Health by preventing the uptake of effective ecigs by current smokers.

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https://www.change.org/p/uk-department-of-health-jane-ellison-uk-government-should-refuse-to-implement-article-20-of-the-tpd-in-light-of-phe-report?recruiter=419714218&utm_source=share_petition&utm_medium=copylink

We Don’t Need ‘Decades of Research’ to Know Vaping Is Safer Than Smoking

A chemical comparison shows e-cigarettes are far less hazardous than tobacco cigarettes.

If Holger did not mean to address the relative hazards of vaping and smoking, it is confusing, to say the least, that he opens the original article with this question: “Are e-cigarettes really any better than smoking a cigarette?” More to the point, an article about the potential health hazards of vaping that fails to talk about how those hazards compare to the well-established risks posed by smoking is irresponsible, especially since regular users of e-cigarettes consist mainly of current or former smokers.

For a smoker contemplating a switch to vaping, it is worse than unhelpful to say, as Holger does, that “e-cigarettes pose dangers to our health,” that they “carry their fair share of toxic chemicals,” or that they “have negative effects on lungs.” The relevant question is how the risks of vaping compare to the risks of smoking, and there is no question that they are much lower. By implying otherwise, e-cigarette alarmists may very well deter smokers from making a switch that could save their lives.

Holger claims to be agnostic on the question of whether vaping is safer than smoking, and he thinks this is a scientific position. It isn’t.

“Sullum is right that I had no intention of answering this question,” he says in his reply. “I don’t have the answer because the jury is still out. It could potentially take decades of research before we know the long-term effects of e-cigarettes compared to smoking.”

This seemingly cautious position is not only wrong but reckless. We already know, based on the fact that e-cigarettes do not burn tobacco or anything else, coupled with chemical analyses of the aerosol they produce, that they are much less dangerous than conventional cigarettes. According to what Public Health England (PHE) calls the “best estimate” of the difference in risk, vaping is about 95 percent safer than smoking.

Holger is unimpressed. “Even if e-cigarettes are ‘95% less harmful’ than cigarettes,” he says, “that doesn’t mean they are safe.” In a world where nothing is 100 percent safe, this mindless insistence on the complete elimination of risk is a menace to public health. An alternative to smoking that’s 95 percent safer is a huge opportunity that should be welcomed by anyone who wants to reduce tobacco-related harm.

Might the current estimate of the difference in risk be off by a few percentage points? Sure. That’s why it’s called an estimate. But such a correction would not affect the conclusion that smokers who switch to vaping dramatically reduce the health risks they face. That would still be true even if the estimate exaggerated the difference by a factor of two, although there is no reason to think it does. In fact, it’s possible that the actual risk reduction is higher than 95 percent. “Some flavourings and constituents in e-cigarettes may pose risks over the long term,” says Ann McNeill, co-author of the PHE report. “We consider the 5% residual risk to be a cautious estimate allowing for this uncertainty.”

It is true that we don’t know exactly what the long-term health effects of vaping are. Although propylene glycol and vegetable glyercin, the main components of e-cigarette “vapor,” are approved as safe food and drug ingredients, a widespread practice of inhaling aerosols containing these substances is relatively new. But contrary to what Holger implies, that does not mean we need “decades of research” to know whether smoking is more dangerous than vaping. Whatever the long-term effects of inhaling propylene glycol or glyercin, they cannot possibly compare to the long-term effects of inhaling the numerous toxins and carcinogens in tobacco smoke. Hence it is journalistic, medical, and public health malpractice to tell a smoker who is thinking about trying e-cigarettes that he should wait a few decades until the evidence is clearer.

Introducing the Aspire Proteus E-Hookah – Electronic Hookah Head Unboxing Demo

A quick vid blowing clouds with the smok x cube 2 and tfv4 quad coils and a dripper

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E-cigarettes: a consumer-led revolution

E-cigarettes are used by millions in the UK, but information about them is sometimes conflicting. So what is the current evidence on them?

The panel was unanimous: e-cigarettes may not be the key to reducing smoking, but they are certainly an important part of the solution. Photograph: Yui Mok/PA

It has been described as a ‘disruptive technology’ potentially capable of breaking our fatal relationship with tobacco. So the setting for a public debate on e-cigarettes – a museum part-funded by the tobacco industry, in a city home to the global headquarters of one of the largest tobacco manufacturers – was perhaps ironic. Yet on Wednesday evening, I found myself at the M-Shed in Bristol, watching just that: a debate about whether e-cigarettes could be part of the solution to the tobacco epidemic.

To mark the launch of a new Integrative Cancer Epidemiology Programme, linked to the Medical Research Centre Integrative Epidemiology Unit at the University of Bristol, Professor Marcus Munafò (Professor of Biological Psychology at the University of Bristol) and Professor Linda Bauld (Professor of Health Policy at the University of Stirling), both collaborators of mine, discussed e-cigarettes. Professor Gabriel Scally (Public Health Doctor and former Regional Director of Public Health for the South West of England) chaired the discussion.

Billed as a debate about whether e-cigarettes might be ‘the key to reducing smoking’, some in the audience may have expected a heated discussion. However, with this line-up of academics, influential in the fields of public health, tobacco and addiction, the discussion was evidence-based and measured. As for the motion of the debate, the panel was unanimous: e-cigarettes may not be the key to reducing smoking, but they are certainly an important part of the solution.

This may be surprising to some, given ongoing discussions surrounding e-cigarettes in the media. So what is the current evidence on e-cigarettes?

Although we don’t know the long-term health effects of e-cigarette use, they’re less harmful than cigarettes
Pretty much everything is safer than cigarettes. There is no other consumer product, which, when used as the manufacturer intends, kills every other user, taking from them an average of 10 years of healthy life.

It’s been said that “people smoke for the nicotine, but die from the tar”. E-cigarettes present a solution to this problem by providing a ‘clean’ (or cleaner) method of nicotine delivery. They deliver nicotine in a similar way to a cigarette (and much faster than other forms of nicotine replacement therapy; NRT), but don’t contain the other chemicals that ultimately kill cigarette users.

A recent Public Health England report stated that e-cigarettes are 95% less harmful than cigarettes, a controversial figure. However, as Linda pointed out, it’s almost irrelevant whether e-cigarettes are 95%, 90% or even 80% less harmful than cigarettes. What’s important, is that they are less harmful.
There’s no evidence e-cigarettes are as harmful as smoking
Read more
Yes, there are still some concerns about e-cigarettes and increasing levels of confusion and misinformation among the public around them. Evidence suggests that both adults and teenagers are more likely to report that e-cigarettes are equally harmful as cigarettes today, than they were a few years ago. Both Marcus and Linda speculate that these views may have been shaped by media reports fueled by disagreements between academics.

Horror stories of children drinking the liquid nicotine (a problem which can be alleviated by having stricter controls on safety caps) and fires and accidents caused by exploding devices (the frequency of which is still far lower than the risk of fire posed by cigarettes) have been reported in the media. There are ongoing concerns about the chemicals produced when e-cigarettes are used, some of which are the same as the dangerous chemicals found in burning cigarettes (although the amount of these chemicals is a tiny fraction of the amounts found in cigarettes). Finally, we can’t yet be certain about the long-term health consequences of vaping, simply because people haven’t been using them for long enough to know (just like we didn’t know for decades that cigarettes definitely caused lung cancer).

For these reasons, we should be careful to ensure that children and non-smokers don’t start using e-cigarettes – currently there is very little evidence that these groups are regularly using the devices. However, most academics and public health officials are in agreement that for current smokers, e-cigarettes are a safer alternative to smoking.

E-cigarettes can be an effective method of stopping smoking

Linda presented evidence on the effectiveness of e-cigarettes for smoking cessation. E-cigarettes seem to be somewhere in the middle of the range when it comes to helping smokers quit. Some studies show that they are more effective than either willpower alone or NRT bought over the counter, but less effective than behavioural support.

The type of e-cigarette used matters too. The early models (‘1st generation’ or ‘cigalike’ models) don’t seem to be very effective methods of smoking cessation – interestingly, these are predominantly the models being bought up by the tobacco industry. The 2nd generation e-cigarettes and tank models (which can be refilled with liquids) seem to lead to higher levels of quitting success.

The sheer reach of e-cigarettes is their most powerful weapon. While behavioural support for cessation, combined with NRT or varenicline, has been underused by smokers wanting to quit, the rise of e-cigarette use over the past five years has been unprecedented. There are now an estimated 2.6 million vapers in the UK. With such a large numbers of users, even modest levels of smoking cessation success from their use will have a large impact on cessation rates.

E-cigarettes are a consumer-led revolution
The speed of the e-cigarette revolution and its ability to galvanize a whole community of individuals who now define themselves as ‘vapers’ is impressive. Never before has a route out of smoking garnered as much support from its users. As far as I know, there are no online forums for nicotine patch users to discuss optimal patch placement, no celebrity endorsements for nicotine lozenges and no users of nicotine nasal sprays challenging European Union Directives.

Many vapers feel passionately that e-cigarettes have enabled them to quit smoking. Indeed, a passionate crowd was in attendance at the debate. When asked at the beginning to raise their hands if they had ever tried an e-cigarette, over half of the audience did so. This is in comparison to population surveys that report 1.5%, 16.5% and 58.5% rates of ever use among non-smokers, ex-smokers and daily smokers respectively.

The last question in the debate came from a member of the public who defined himself as a ‘vaper and ex-smoker’. He expressed his dismay that new the EU Tobacco Products Directive (TPD – due to come into force in May 2016) will impose strict regulations on e-cigarettes, including bottle sizes, tank sizes and nicotine strength. In order to continue selling e-cigarettes not meeting these new regulations, retailers can instead apply for their products to be registered as medicines. But this is an extremely costly route, likely to be impractical for the majority of e-cigarette retailers other than the incredibly wealthy tobacco industry. The TPD is currently being challenged by one e-cigarette retailer. However, if it goes ahead, there are concerns from vapers and those in the public health community, that it may mean the end of vaping as we know it.

Arguably one of the reasons why e-cigarettes are so popular is that they reflect a consumer-led revolution, built from the ground up. Users can personalise their product, and many see vaping as a lifestyle choice rather than a smoking cessation aid or a medicine. If strict regulation means fewer smokers switch to using e-cigarettes, this could be a huge public health opportunity missed.

Olivia Maynard is a tobacco researcher at the University of Bristol. You can find her on twitter @oliviamaynard17.

http://www.theguardian.com/science/sifting-the-evidence/2015/oct/23/e-cigarettes-a-consumer-led-revolution

How insurers are fleecing e-cigarette users

Admitting that you use e-cigarettes could cost you thousands of pounds in additional premiums. What basis is there for this price difference, asks James Daley

On what grounds are insurers choosing to categorise e-cigarettes along with ordinary smoking? Photo: ALAMY

It’s no secret that smoking tobacco isn’t great for your health. But when it comes to the world of insurance, it’s always been a little more complicated.

When you’re young, and buy your first life insurance policy, being a smoker can be costly. In fact, it’s likely to double your premiums. Same goes for any other kind of protection insurance – like critical illness cover or income protection.

But if you make it all the way to retirement as a smoker, it finally starts to pay back in your favour. Smokers can buy a better retirement income than their clean living peers.

The real reason my home insurance premiums jumped 23pc

As always, these prices are driven by statistics. Life insurance is more costly as a smoker because you’re more likely to die while your policy’s in force. And for exactly the same reason, pension companies will offer you more in retirement – because they expect to be paying it to you for fewer years than someone who doesn’t smoke.

The safe alternative to smoking?

But what about so-called “vaping” and electronic cigarettes? These have been the key to many heavy smokers giving up over the past few years – and a few months back, a UK government study even suggested it is 95% less harmful than smoking regular cigarettes.

So in the face of broadly positive press for e-cigarettes, why is it that the insurance industry has decided that they are just as bad for you as the real thing? What do they know that we don’t?

Take out a life insurance policy today and you’ll almost certainly be asked if you’ve “smoked any tobacco products over the past 12 months (including e-cigarettes)”. It’s a yes or no answer – and if you answer yes, your premium will be twice as expensive.

No evidence

If the life insurers were able to base their decision in statistics – this decision may be more defensible. But given that they don’t even ask people to specify whether they vape or smoke – they don’t even have the data. Not to mention the fact that e-cigarettes have only been around for about a decade – which isn’t enough time to compile any meaningful results.

It’s hard to see this as anything other than a cynical ploy to pocket a few extra quid

This is not the only anomaly to be found in a life insurance application form. Insurers routinely ask questions about alcohol consumption, family health history, and even your waist line. These are fairly intrusive questions – but are perhaps fair enough in terms of the clear links between these factors and an individual’s mortality. But insurers also ask if you’ve ever suffered from “stress”. Anyone who answers no to that question is surely not being honest with themselves. But anyone who answers yes may find their premium pushed up – as they’re shoved into the mental health problems bucket.

It’s time for the regulator to take a look at the way insurers set their prices – not just in life insurance, but in all areas of insurance. There are too many areas where the evidence is simply not clear enough to justify the way that insurers choose to treat prospective or even existing customers. One of my greatest bugbears is an insurer’s right to put your car insurance premium up if you’re involved in an accident that wasn’t your fault. Regardless of whether the statistics justify their reasoning, it’s simply not fair play.

James Daley is the founder and managing director of Fairer Finance (fairerfinance.com), the consumer group and financial ratings website. He is also a regular pundit on the BBC One shows, Rip-Off Britain and Watchdog, and a former editor for the consumer group Which?. Follow him on Twitter @fairerfinance

• Have a question for our experts? Emailmoneyexpert@telegraph.co.uk

http://www.telegraph.co.uk/finance/personalfinance/insurance/11942194/How-insurers-are-fleecing-e-cigarette-users.html

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Ecigs, Water Vapour and The Lungs: Should You Be Concerned?

Could water vapour from e-cigs collect in your lungs, and become a breeding ground for germs?

That’s the advice some health professionals are giving. And because of this, some smokers are still smoking, despite the fact Public Health England believes e-cigs are at least 95% safer than smoking.

Here’s a recent email I received:

Hi, James

Sorry to bother you, but I wonder could you give me some information, please? I have recently been diagnosed with COPD and, of course, been told to give up smoking.

When I asked the “Health Care Professional” about using e-cigs, she replied that despite recent findings that e-cigs were 95% less harmful than cigarettes, the inhalation of water vapour creates a pool of water on the floor of the lungs and is an ideal breeding ground for all sorts of “nasty germs”, and is therefore, subject to debate about the efficacy of using e-cigs.

I would welcome your observations on her comments and, indeed, any empirical evidence that you feel would be useful. Having been a smoker for more than 50 years, it would be difficult to stop and am looking for assurance that e-cigs would be able to provide the necessary stimulus that tobacco withdrawal would undoubtedly engender.

An Expert Opinion

Being a retailer, I can’t, of course give out health advice, so referred the person to Professor Riccardo Polosa.

Riccardo is an expert in respiratory medicine, clinical immunology, and tobacco addiction, Chief Scientific Advisor for Lega Italiana Anti Fumo (LIAF), the Italian Anti-Smoking League, and one of the world’s leading experts on e-cigarettes.

Here was his response:

“This is ridiculous! You would get more water vapour from a home nebulizer designed to deliver COPD medications than you would get from an electronic cigarette.”

“We’ve also examined the effects of regular electronic cigarette usage on people with COPD, and found that respiratory symptoms were never triggered by e-vapour; moreover, in these patients we have shown an overall improvement in both subjective and objective respiratory outcomes after switching from tobacco cigarettes to electronic cigarettes.”

“What’s more, PG in aerosol form is an effective antibacterial and antiviral agent that is likely to prevent infections of the respiratory tract. Ironically, far from creating an ideal condition for germs to multiply and spread, PG vaping could be a practical and safe way to prevent COPD exacerbations.”

Author:About James Dunworth

Main blogger at the Ashtray Blog, co-author of a University of Alberta study of “Electronic cigarettes as potential harm reduction products”, co-author of the book: “Electronic Cigarettes: What the Experts Say.” Works at ecigarettedirect.co.uk.

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