It’s been an interesting few days for smokers intent on stopping their habit.
Last week saw welcome new guidance from the National Institute for Health and Care Excellence (NICE) – the first to recommend that licensed nicotine-containing products (NCPs) can be used to help people cut down on the amount they smoke (as well as to help them stop entirely).
Today the Medicines and Healthcare Products Regulatory Agency (MHRA) has made its long-awaited announcement of its intention to license NCPs such as e-cigarettes, which have – until now – fallen outside both medical regulation and NICE’s guidance for quitting and cutting down.
This is good news. We’ve wanted to see e-cigarettes come under “light touch” regulation for some time – as it could ensure their safety, quality and effectiveness, restrict marketing that risks cross-promoting tobacco smoking, and stop them being sold to under-18s.
So we think it’s a great idea to bring e-cigarettes within MHRA licensing.
The ideal solution?
One thing everyone interested in reducing the toll of tobacco can agree on is that e-cigarettes are a controversial issue. Our recent blog article on the topic covered some of the unanswered questions about e-cigarettes, and generated a lively discussion in the comments section.
In the article, we raised issues about the contents of e-cigarettes, their safety and their long-term use.
But it’s important to get the balance right: it would be wrong to give the impression that there are no risks at all – hence the call for light-touch regulation and monitoring. Yet it’s important to remember that using these products is almost certainly safer by far than smoking tobacco.
In the debate about e-cigarettes it’s not the product safety that’s most hotly disputed, but their potential impact on a smoker’s motivation to quit, and on the progress made so far in reducing the UK’s smoking rates.
Tobacco is by far the most important preventable cause of cancer in the world. Smoking accounts for one in four UK cancer deaths, and nearly a fifth of all cancer cases – including those caused by exposure to second-hand smoke.
The good news is that quitting smoking significantly reduces the chances of developing one of the fourteen cancers related to tobacco use. The sooner you quit the better, but it’s never too late. But nicotine is highly addictive and many attempts to quit smoking fail.
Some argue that e-cigarettes are a huge opportunity to wean smokers off a deadly product by offering a nicotine “hit” without them having to inhale tobacco smoke.
The argument goes that, in a free market, consumers will always choose a safer product over a more dangerous one – so the better e-cigarettes can replicate cigarettes, the more they will spur a mass move away from tobacco smoking with little need for further public health interventions.
This is after all what we all want – an end to the death and disease caused by smoking.
But as well as this promise, e-cigarettes have several potential theoretical downsides:
- what makes e-cigarettes beautiful could also make them dangerous – their replication of the act of smoking could be too close to the ‘real thing’ to allow smokers to ever effectively escape their tobacco habits and potentially to revert back to smoking tobacco;
- using e-cigarettes in smoke-free areas could potentially give smokers less motivation to quit smoking the rest of the time;
- and their use in smoke-free places and in marketing images could have a knock on effect of ‘renormalising’ smoking, by confusing or contradicting the messages about the harms of smoking. This could undermine public health efforts to deter young people from taking up smoking.
At this stage we simply don’t have the necessary evidence to be able to say with any confidence which of these arguments – if any – is correct. But we have plenty of experience to warrant some caution.
A market flaw?
Sitting above these opportunities and risks is something we’re extremely wary of: the fact that the big tobacco companies are investing in NCPs.
For example Nicoventures – the company that owns one of the first of these types of products to be put forward for MHRA licensing – is owned by British American Tobacco, one of the four companies that control over 90 per cent of all global tobacco sales.
In a future post, we’ll be exploring the issues of conflicting interests that arise from this dual corporate ownership of cigarettes and their potential nemesis.
But for now, we’re remaining mindful of the first principles of internationally agreed public health guidelines: “there is a fundamental and irreconcilable conflict of interest between the tobacco industry’s interests and public health policy interest”.
Watch this space.
Alison Cox, Tobacco Control Lead
Susan Brew November 30, 2013
There is NO evidence that e-cigs are proving attractive to young people who would not otherwise try tobacco cigarettes.
There is now substantial evidence that e-cigs are effective at helping long-term smokers to quit smoking.
There is NO evidence that e-cig users who have quit smoking are even tempted to revert to smoking – let alone that any have done so.
Yes there should be regulation to prevent young people buying e-cigs, but there is substantial evidence to show that any regulation that goes further than that will damage the progress made by the e-cig industry.
Further regulation is not necessary, as the trading standards act and other consumer protection legislation already in place will be sufficient to ensure that e-cig construction, as well as cartomiser and e-liquid contents are as stated on the packaging. Nicotine may be a dangerous substance, but we don’t insist on further legislation for other dangerous substances such as bleach and alcohol. Warnings are already on all e-cig and e-liquid packaging.
Why is the tobacco industry investing in e-cigs? Because they can see the writing on the wall for tobacco. Already a 1% decrease in cigarette sales in the USA because of e-cigs. That is HUGE!!!
Stop opposing e-cigs and start getting behind them.
Please stop talking as though vaping were as bad as smoking – it is orders of magnitude less dangerous to both the user and the bystander.
Change photo randy cox November 29, 2013
Very nice blog. Its interesting to read. And my opinion, Electronic Cigarette is a good alternative choice for the smokers to quit off from their health defects.
brainyfurball November 13, 2013
I think I got my hopes up too soon with regard to ASH. Yes, they are acknowledging that young people are not being attracted to e cigs and yes they are hinting that e cigarettes are not a gateway to cigarette smoking – I am afraid that they are playing clever in that they recognise that the arguments being presented for medical and/or tobacco regulation are lost. So they say that the above are not happening, BUT, they now argue that we are unaware of the unseen dangers so e cigarettes must still be regulated.
Well, yes they must, but not under the banner of medicines and not as tobacco products. There is a need for regulation – e cigarette regulation. There is a precedent for this type of situation and that was with the advent of the motor car, where, in trying to regulate them, the powers that were, did so under horse and cart legislation.
RobbieW November 4, 2013
Will CRUK ever engage with users?
e-cigs could be greatest public health prize in a generation, why on earth do CRUK support a de facto ban.
The only logical reason is to support the profits of their major benefactors – shame on you CRUK, is there no one within CRUK with the moral courage to make a stand against this?
brainyfurball November 2, 2013
More good news. ASH have just said that, “Among children regular use of e-cigarettes is extremely rare. Children who
had heard of e-cigarettes were asked about their use and knowledge of them. What little use that is reported is confined almost entirely to children who currently smoke or used to smoke.”
And a great deal more. Has ASH realigned itself? Has the tide begun to turn?
Robert Innes October 25, 2013
Thanks for the link Alan. I m copying your comment onto my fb page. Hope you don’t mind. Good point Brian.
Alan Beard October 13, 2013
Recent smoking rate statistics have recently been updated to the end of September .
Shows a number of things
1 e-cigs useage in cessation attempts increasing at an ever faster rate (exponential)
2 Traditional NRT products reducing at about the same rate
3 E-Cigs now overtaken NRT overall in smoking cessation
People are choosing what they think is effective without any assistance from CRUK, NHS UKGovt Public Health .
change your standpoint CRUK
Alan Beard October 13, 2013
sorry bad link … its in Letters The Editor … 3 rd letter down entitled Better Than Tobacco
Alan Beard October 13, 2013
ASH and CRUK seem to believe this point of view as put forward by Ms Arnott (ASH) see http://www.economist.com/news/letters/21587764-armenia-ecuador-e-cigarettes-azerbaijan-3d-printing-germany-machiavelli-bon-jovi–(scroll down to 3rd letter)
This is a tissue of half truths and disinformation of which Ms Arnott has expertise
“Investment Analysts” believe costs will be” minor”- to whom? this simply reinforces that only big players will remain and only in a medicinal market SME would disappear. This would be a far simpler option for Govt to regulate BUT is it in the Public interest? , will it genuinely promote an increased move away from tobacco cigarettes ? The answer to both of these Q is a resounding NO
One area where I could agree with is for there to be a 2 tier Licensed and Non-Licensed approach . Licensed e-cigs could be promoted and advocated by NICE ,NHS etc this would benefit current smokers . However unlicensed ( but regulated) should remain for those who wish to continue their relatively harmless (to them or others ) activity .
Do the typical arguments about glamourising,re-normalising,encouraging children,gateway effects etc etc which have zero factual evidence disappear with medicinal approval ?
I really do wish that CR UK will revisit their position and use scientific not ideological argument over this
Brian Nightingale October 14, 2013
When they bang on about, “think of the children”, what about the children of smokers. These parents could be vaping instead of smoking. Poorer parents who smoke, would have more money to spend on their children. It seems that CRUK and other anti-smoking groups and charities like to pick and choose which particular children they will think of.
Most of us have children and grandchildren, whether we’re smokers or vapers, we want what’s best for them. Should my grandchildren ever start smoking which I hope they don’t, I would hope that e cigs would be freely available to them so they could switch to a safer alternative. I’m sure any caring parent or grandparent would want that.
brainyfurball October 8, 2013
Just read this on Yahoo News:
Cancer Research UK said it is the toxic cocktail of chemicals in tobacco smoke that kills half of all long-term smokers.
The lack of tobacco in e-cigarettes means they are “almost certainly” a much safer way of getting a nicotine hit than smoking cigarettes.
Do you think the message has got through, or is it just egg dripping off their faces.
Thank you! Thank you everyone who has contributed here… Now a new battle begins against the tobacco companies.. And hopefully CRUK will be on our side this time.
brainyfurball October 8, 2013
John October 8, 2013
HOORAY ! Thanks Robert for the info.
Liam October 7, 2013
You are Robert Innes and I am Spartacus.
brainyfurball October 7, 2013
Just noticed that my posts are now showing as brainyfurball. (My daughter invented that one many years ago when computers were young) I am Robert Innes.
Elaine Keller October 7, 2013
But I’ll bet you make an adorable and cuddly brainyfurball (at least in your daughter’s eyes.)
brainyfurball October 7, 2013
Robert Miller, good of you to point this out. Compare this statement to what ASH, CRUK and the rest were saying in 2008. The following is from Chapter 8 of the document, Beyond Smoking Kills…(Endorsed by,
Royal College of General Practitioners
Royal College of Midwives
Royal College of Nursing
Royal College of Obstetricians and Gynaecologists
Royal College of Pathologists
Royal College of Psychiatrists
Royal College of Physicians
Royal College of Physicians of Edinburgh
Royal College of Radiologists
Royal National Institute of Blind People
Sainsbury Centre for Mental Health
The Stroke Association
Scottish Public Health Observatory
South Asian Health Foundation …
This is taking up too much room. The list is endless.
“Currently pure nicotine products are not attractive to smokers as direct replacements for cigarettes as they
do not mimic the speed and intensity of nicotine intake that a cigarette provides. Regulation difficulties inhibit the development of more efficient and effective pure nicotine products. As a result, the most toxic nicotine products – cigarettes – are barely regulated while the safest products – medicinal nicotine – are highly regulated.
If they are to compete with tobacco products, pure nicotine products must be sold on equal terms or better: pricing should favour pure nicotine products over tobacco. Public education is also needed as many smokers (and health professionals) have a poor understanding of the relative safety of pure nicotine products including nicotine replacement therapy.”
The document also gives its definition of a ‘pure nicotine’ delivery device’ and the e cig fits neatly into it.
brainyfurball October 6, 2013
It is becoming more and more obvious that e cigarettes are beneficial in the war against smoking. Indeed, they are the most exciting development ever to have taken place. Is the silence of our medical practitioners further evidence of a powerful bullying culture inherent in health services?
Robert Miller October 4, 2013
You said in the article above:
‘what makes e-cigarettes beautiful could also make them dangerous – their replication of the act of smoking could be too close to the ‘real thing’ to allow smokers to ever effectively escape their tobacco habits and potentially to revert back to smoking tobacco’
Why would anyone would go back to smoking tobacco when they can enjoy an electronic cigarette that is better for their health and probably cheaper? E-cigs neither taste like or smell like smoking tobacco, they are simply a safer way to consume nicotine. The logic you applied in the statement above would mean that anyone who ever had a problem with alcohol in the past wouldn’t be able to enjoy a soft drink or a warm beverage ever again!
Your organisation should throw it’s full weight behind e-cigs. Millions of people in the UK have found that they help them stop smoking cancer causing tobacco and the sooner you realise that they are a force for good the better!
Robert Innes October 3, 2013
The tree is beginning to fall. OK so I am just a single worm gnawing at a tiny root – keep gnawing fellow worms. http://www.clivebates.com/?p=1526#more-1526
Robert Innes October 1, 2013
If it was my comment, “The tobacco industry are evil – they make money out of the suffering of ordinary folks the world over.”I was referring to the people behind the industry making profit from the suffering of others, then pointing out that CRUK, ASH and the rest are no better.
However, I could not agree more with what both yourself and Mike have had to say.
Just out of curiosity, (this is for anyone) have you any particular view on the following?…
I have been thinking about the concerns of some people that some regarding the relationship between Pharma and CRUK and Pharma and the tobacco industry.
Some comment, here and elsewhere, has hinted that there might be some sort reward or financial incentive for a charity, like CRUK, to adopt the stance it has. My question is, does it go deeper than just this? For example, CRUK collects a massive amount of money to do research, which is fine, but what is the end result, who benefits from this research? Well obviously, the pharmaceutical industry – and they have been given this fee of charge from a charity. This goes to the industry’s profits and therefore on to the shareholder. So, Joe Public spends £10 which pays for £10 worth of research, the results of which gets handed to a pharmaceutical company who make a drug, where they have saved the costs of research, which increases their profits, which they pay out to shareholders. Cosy! Then, along comes the e cigarette which the pharmaceutical industry is not too fond. To object directly would be too obvious so it pays some of the wealth it has been gifted, to get others to front its campaign? Cosy, if this is what is happening.
As for a relationship between Pharma and the tobacco lords is it …? …Big tobacco are worried. For years they have been making people ill. For years, Pharma has got society to pay dearly to try to make those people better again. Cosy! Then along comes the e cigarette (which Pharma would have loved to invent and medicalise – by claiming it as a medicine) which threatens this relationship. Now Pharma and Tobacco, big as they are, realise the advantages they have gained over the years by working together and have no desire to stop, so,….
Big tobacco buys into the e cigarette market while its pal, Big Pharma, gets the e cigarette medicalised. The only real player left after this will obviously be the tobacco company. Now here is the sneaky bit. Big tobacco makes its product less and less appealing – aided and abetted by legislation. More and more people resort to cigarettes. More and more people become ill, we are back to square one and so every one (of our main players) lives happily ever after – Even Joe Public continues to pay his £10 to CRUK and feels very good about it, blissfully unaware of what is going on.
Elaine Keller October 2, 2013
Robert: That’s a very cynical view of the current situation. Unfortunately, I can’t find any evidence that would prove you wrong. I didn’t use to be this cynical until I began advocacy work in this area and observed how opponents of tobacco harm reduction used logical fallacies, guilt by association, card stacking (omitting information that doesn’t match their theory), name-calling, and other propaganda techniques to drum up popular support for their fear-mongering viewpoint. I agree with Brian, that it is scary that, should the governments proceed in the direction they are pointing now, the market for e-cigarettes will be protected for the tobacco companies. And Pharma will continue to profit both from repeat customers who relapsed after using their smoking cessation products and from the diseases developed by those who were unable to escape from smoke by inadequate treatments from Big Pharma and inadequate substitutes from Big Tobacco.
And he is absolutely right that nobody asks his opinion. Consumers need to have a seat at the table when regulation of products they use are being discussed. Both the regulators and the manufacturers think they know best what we need.
Brian Nightingale October 2, 2013
This is what is scary. The e cig market will end up as a carve up between big tobacco and big pharma if certain people have their way.
The fact that I as a customer, not patient I should add, am perfectly happy with the quality and safety of the e cigs I buy at present doesn’t seem to matter. No one asks our opinion. It’s all being decided by people who are driven by greed, I’m thinking of Dalli who included e cigs in the TPD. Or ideology, those that want a smoke free world and dislike e cigs because it looks like smoking. Or those who think nicotine addiction, which is no different to caffeine addiction is some big sin. We’ve all come across those type of people on different forums. They’re extremists. Most people have common sense and will agree, harm reduction not quit or die is the way forward.
Mike October 1, 2013
This stinks more than the propaganda ads you’ve made using donation money given to you in good faith to fund cancer research, my blood was boiling when I saw you using children to read the scripts given to them saying things like “I like this one because it’s pink” and “I like the pictures!” etcetera.
I didn’t start smoking because I thought it looked cool, or because of the shape/colour of a cigarette packet, or because it had a picture of someone with throat cancer on it, I knew fully well that they caused death and disease too. I started smoking through experimentation, because it was easy to steal the odd cigarette from my parents packet, also because cigarettes were so cheap and it was easy to fool the staff at the petrol station that I looked 16 at the time. I also experimented with weed, LSD, magic mushrooms in my youth too and none of them came in a shiny packet or had “nice” scary pictures on them either.
You have it totally wrong why you “never smokers/anti tobacco campaigners” say smokers start, the gateway arguments etcetera. Rather than dream up excuses of why you think children and adults start smoking tobacco, your kind should research why smokers really start.
The only real way to get people off of tobacco is to continue to price it out of their and their kids range while keeping inventions like e-cigs that work to replace the habit to a much safer one.
An average e-cig starter kit costs around £30, through self regulation the suppliers said 18+, they use child safe bottle caps, chip compliance and pharma grade ingredients, existing trading standards laws ensure they provide good quality products, education of good safety practices when charging batteries, for example not leaving them unattended, in the sun, how to clean the contacts go a long way to ensure minimum venting incidents occur too.
Robert Innes September 29, 2013
Aha! If you post and it is waiting for moderation it does not appear when you return to the page. You have to load the page THEN RELOAD and it pops up – sorry everyone!
Robert Innes September 29, 2013
I have posted a response twice now but it looks like it has been moderated out. The language is ok. No individual has been slighted = I can only assume that we are getting too close to the truth for CRUK’s comfort. I will wait till tomorrow before trying again.
Robert Innes September 29, 2013
Elaine, Derrick, John – this is something which has been missing from this and other blogs. I hate to think of the effect on our culture and society which has resulted from the no-smoking campaigns over the last few years.
I have been horrified at the vilification that victims of tobacco have had to suffer. I have watched normally reasonable people turn into animals at the mere mention of cigarettes. Of course tobacco is evil, but the people who are hooked on cigarettes are not.
The tobacco industry are evil – they make money out of the suffering of ordinary folks the world over. So what if millions suffer and eventually die if they are making money? CRUK, ASH and the Pharma industry, and others, are now no better – they are prepared to see millions suffer and eventually die in order to protect their products; their positions and status.
I do not think that the fact that their dishonesty, their double standards, their vicious attitude which will continue to rub off on the whole of society will worry them one little bit
You have added a new and important dimension to the debate – well done!
Brian Nightingale October 1, 2013
Tobacco is a just a plant so I don’t think it is evil. Tobacco companies well may be evil but so are the people who would stand in the way of harm reduction through some misguided ideology. Especially when they are making money out of other peoples misery.
I have read parts of the godber blueprint. These people want a smoke free world. They’ve indoctrinated everyone from politicians to doctors to those ends. E cigs have put a spanner in the works for obvious reasons. I think they just wish e cigs would go away or wish they had never been invented. Which is why they want to limit their popularity and make them ineffective.
I do not wish to live in their squeaky clean smoke free world. It would be a hell on earth for many of us. I enjoyed smoking and now I enjoy vaping.
Elaine Keller September 30, 2013
I appreciate the compliment, but I do disagree with one thing that you have said. “Tobacco is evil” is an idea that was planted 30 or so years ago at the start of the propaganda campaigns to eliminate all forms of tobacco from the face of the earth. (Look up “Godper blueprint”.)
The true enemy isn’t people and it isn’t a product. We need to keep in mind that the true enemy is “morbidity and mortality”, aka “disease and death.” The plain fact is that all tobacco products are not created equal when it comes to the potential for imposing disease and premature death. There is a ton of evidence showing that inhaling smoke (from any product, not just tobacco) has a negative impact on lung health. Many people don’t know that cigar and pipe smokers (most of whom do not inhale) have 50% of the smoking related disease rates as cigarette smokers. If they inhale, risks are about equal to cigarettes.
Smokeless tobacco at one time did impose risks of head, mouth, and neck cancers. However, growing methods and methods for curing tobacco have changed. Modern western smokeless tobacco (ST) products such as chewing tobacco, dip, and moist snuff do not cause lung disease and, in the words of nicotine toxicity expert Dr. Neal Benowitz, “The lack of increase in common cancers in lifelong ST users indicates that nicotine is not a general cancer promoter.” Surprised? The head, neck, and cancer rates are highest among cigarette smokers.
As for heart attacks and strokes, Benowitz said, “Meta-analyses showing increased risk of MI and stroke in ST users are heavily weighted by CPS-I and CPS-II, which are older US studies with many methodologic problems. More recent Swedish studies and an NHANES study indicate minimal if any increased risk of CVD with ST.” These observations do not apply to ST products from Asia and Africa which often contain additional ingredients known to cause disease.
Sweden, where a type of moist snuff called snus has become popular, has the lowest smoking rates and lung cancer rates of any country in the EU. Smokers who switched to snus have no higher rates of “tobacco related” disease than former smokers who gave up all use of nicotine. I put quotes around “tobacco related” because the real situation is that these diseases are attributable only to smoking. The “public health” propaganda campaign has gradually substituted the word “tobacco” for “smoking” in policies and in practice.
Tom Gleeson September 29, 2013
“So we think it’s a great idea to bring e-cigarettes within MHRA licensing.”
However when it comes to canabis;
“It is not for Cancer Research UK to comment on the legal status of cannabis, its use or abuse as a recreational drug, or its medical use in any other diseases”
Southern Vaper September 29, 2013
No matter how they wrap it up they are playing with my health and my freedom of choice………..I will not back anyone who decides they will tell me I have no choice.
I also believe its wrapped up as it is to appeal and make the general public that dont know about ecigs get behind their decision when if they wrote what is really behind it which is £££££ not anyones health do we think it would be backed by the unknowing.
I have heard of people saying I tried them but it has been proven that they are not good so the cherry picked, made up and often dramatised info is working on those who dont really know about them.
After CRUK said they are a good thing and now really with the ban (or at least banning of anything that will work for people) it can only show one thing its all about the money or at least about the revenue losses.
I am appalled CRUK have the standing to make point and back what they said in 2008 but choose not to why?????
DO THE RIGHT THINK CRUK
Robert Innes September 28, 2013
Spot on Derrick! Now we are getting to the heart of the matter.