bekivapes

My journey into vaping

Day 123: My response to the Public Health Matters blog

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Our advice to smokers remains to stop immediately, completely and permanently. That’s the first point in the blog, and most smokers will at that point click away in disgust. Every smoker who has tried to quit using the methods that are endorsed by Public health are products of those past quit attempts. The problem with that picture isn’t the failure rate of NRT (although that is shocking) so much as the human cost; when we relapse to smoking we feel shame, guilt, self-hate and social stigma. All of the negativity piled up against the smoker by the “de-normalisation” of smoking comes flooding home to roost once again. The “weak willed spineless” relapsed smoker grows an even thicker skin against the anti-smoking message.

E-cigarettes haven’t been around for very long, so no reliable long-term studies of the risks they represent are available.With the regulation we currently have, as consumer products, it is hard to give smokers the reassurance they need about how safe e-cigarettes are or how effectively they deliver nicotine.

This is counter productive to a positive harm reduction message. How long do we have to wait until long term studies are done? Five years, ten years, fifty years? Carl Phillips:

“.. discouraging a smoker, even one who would have quit entirely, from switching to a low-risk alternative is almost certainly more likely to kill him than it is to save him. Similarly, a strategy of waiting for better anti-smoking tools to be developed, rather than encouraging immediate tobacco harm reduction using current options, kills more smokers every month than it could possibly ever save”

We need information based on current knowledge. Like Dr Farsalinos’ study on how effectively these devices deliver nicotine. It isn’t true that we need more long term studies to know that they are safer than the product which they are replacing. Given the risk of smoking versus the possible risk of smokeless alternatives it is surely up to the individual to decide which legal consumer product they would prefer to use. Rather than repeat, “we don’t know,” just give the risk v benefit as we see it now, with a warning that this may change with ongoing research. That was good enough for me to make the switch. To paraphrase Carl Phillips again, even if the risk from vaping is found to be only 95% better than that of smoking, the health benefits still outweigh the net health costs of switching for life. The likelihood of it being a worse risk to health than smoking is so small as to be ludicrous.

The current diversity of unlicensed e-cigarettes and the variability of their contents also presents a challenge.

The word “unlicensed” is unnecessary in this sentence. E-cigarettes are currently covered by more than 17 regulations, including Trading Standards and CHP regulations. By describing them as “unlicensed” the corollary is that they are dangerous. That is harmful to the harm reduction message.  The diversity of e cigarettes is part of the mechanism which is helping smokers switch. The variability of their contents is also by design although mentioned here as a negative. Nicotine levels in e liquid is tested in UK laboratories to ensure that the strength on the label is accurate. Tests reveal that the standards are being upheld.  I did not know, nor did I care, what nicotine dose I was getting using lit tobacco. I use my personal vaporiser in the same way, self titrating my nicotine levels. Absorption of nicotine from e cigarette use is on a par with that of NRT. It is implausible that a vaper would overdose on inhaled nicotine from vapour. A smoker knows the symptoms of overindulgence and simply stops use. A vaper does the same.

PHE supports the regulation by the MHRA of nicotine-containing products – including e-cigarettes – as medicines, to give people access to safe products that are also effective.

At this point however positive the rest of the bog is, Public Health have lost my support for their position. Cigarettes are not medicines. E cigarettes which are currently working well to replace cigarettes are not being used as medicines. Medicalising my nicotine use goes back to shaming me for being weak willed enough to want to use nicotine. The twin track approach – with the EU TPD strangled consumer products and MHRA approved horrors as the only choices – is only mentioned in comments to the blog. This is a disaster in the making. Everything I find effective will be illegal to purchase in two years. I won’t even be able to make my own juice.

the nicotine delivered by these products is highly variable.  Without reliable standards, smokers may find their attempts to cut down or quit undermined by products which fail to reduce nicotine withdrawal adequately.

That really isn’t true at all; a vaper would up the nicotine level, or change devices. This is why the diversity works, and why the community of vapers is such a huge part of what makes vaping work. It’s also why pioneers like Louise Ross will (I’m certain) be very successful supporting new vapers. Anyway we have reliable standards of nicotine content in juice now. It’s also not the case that vapers vape to relieve withdrawal – nicotine isn’t as addictive as tobacco. If it were nicotine that was the only part of what makes vaping work, then NRT would be as effective. In a recent blog post Caerulea reports after a PH event. In one presentation John Britton showed an image of a woman smoking, with the caption “NRT doesn’t do this.” She says:

[That] moment [] made me say ‘Shit – they’ve got it! They’ve finally got it!’ and grab Dave Dorn’s arm, this was from John Britton, and the caption is his, not mine. A happy smiling smoker. An attractive, normal woman. Smoking. They admitted that NRT just is not going to cut it. It has an image problem. He looks at us with our vibrant and strong community and then states ‘There is no NRT community’ to the room – and the room laughed!

The people in the room may have “got it” but to me the message being put out elsewhere seems to tell a different story.

We need to develop an appropriate response that is firmly rooted in the evidence

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“Light touch” or “right touch,” licensing them as medicines is a retrograde step. The evidence doesn’t support this inappropriate response.   Meanwhile the spread of negative propaganda goes on unchecked, which means that the people who are losing are the potential future vapers. I think that the correct approach would be to strengthen the current consumer regulations under which vaping is regulated, and let vapers carry on as before. We do have the right vested interests in making sure that the products we use are safe and effective.

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Author: Beki

A Mad middle aged woman who lives in the middle of nowhere, Scotland with a parrot, two Jack Russells, some koi, and a tank full of tropical fish. I have M.E. but that's really not important. I draw, paint, write, game, garden, blog and enjoy a good vape. I have three lovely grown up offspring, and 2 ex-husbands. I do genuinely have the legal title of 'Lady Rebecca Jane [SURNAME]', and am proud to support the restoration project which bestowed that title on me. I will happily explain where to find more information on this if you contact me.

4 thoughts on “Day 123: My response to the Public Health Matters blog

  1. Following the debate does get increasingly confusing with so much media coverage and many conferences.In reality I wonder whether much has changed since Mar 2010 when the MHRA launched their consultation on ecigs.The results were that virtually all the SFAC members wanted medregs,either immediately(fast death) or within a period of 15 months(slow death).All the people(vapers) wanted no change.

    The legislation has been decided – medregs and TPD regs – and PHE now want to start the ecigs debate.What are we actually debating – only whether vaping should be allowed indoors and which,if any, flavours?Having achieved total control over the product,they now seem to be asking us how to stop regulation making ecigs as ineffective as NRT.There are a few not unimportant TPD details to be decided – whether they think tweaking these will ‘make everything OK’ I don’t know.

    I can’t really see anything that PHE et al can do to undo the harm that the TPD imposes – unless they re-write Article 20 completely

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    • It’s even harder for me to follow coming into vaping so late in all this.

      The legislation that has already been decided is still open to evidence based challenge, whether from EFVI or through other routes.

      I seriously believe that the legislation in the pipeline will make ecigs less effective than NRT; it’s a public health own goal of epic proportions, however I don’t want to lessen the fact that they are doing now what I wished they had done before I knew vaping existed. They are starting to engage with vapers; they seem to be listening. Our best chance of getting the harm that the TPD will impose undone is to calmly provide the point of view of the people who are going to be most impacted by it; current and future vapers. It’s a straw to clutch and I’m grabbing it.

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  2. I think we have assumed for 4 years that TC are basically reasonable and humane people and that eventually they will ‘see the light’.Some are,some are not and the battle within TC is still raging with pharma egging on the prohibitionists.

    If evidence was the key,we would not have the ban on snus.It will depend on getting enough powerful TCers on our side to defeat the hawks.The problem is that the pro-ecig TCers are also pro-medregs.They hope that medregs can retain the appeal and choice that attracts smokers whilst eliminating that appeal to non-smokers.

    Medregs can’t do this,not least because of the cost and the time required.TCers know this so hope MHRA will apply ‘ligh-touch’ – only their proposal for light-touch still made regulation prohibitively expensive and time-consuming and,of course,the MHRA are heavily influenced by pharma.

    TC are expert at manufacturing evidence to suit their agenda but expect a lot of anti evidence before the Commission’s final review in May 2016.In EU terms,the UK is the most enlightened of the MSs – our doves could get wiped out

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    • I’m so much in agreement with you on this that I’ve been up till stupid AM writing a post on exactly how bad medregs will make our gear. And what will happen as a result. It’s not a pretty picture.

      I do see an unfreezing in PHE that just wasn’t there before; some of the major dissenting voices are beginning to show themselves up as …. actually see http://theindefatigablefrog.blogspot.co.uk/2014/05/the-war-with-fnools-pt-2.html which I am in absolute and total agreement with. There are public health voices telling the story of why snus was the first anti smoking own goal, now I’m putting the case as to why I believe the current legislation is still an own goal.

      I have also had a twitter conversation or three over the last week which convinced me that this little mini series that isn’t a series was a really good idea.

      Bear with me.

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