Where health meets politics: examining the pressure to restrict
e-cigarettes in order to protect the smoking economy
This is an online resource for materials related to ecigarette politics, legal issues, regulatory issues and health-related topics.
We aim to provide reference materials for EV (electronic vapouriser or 'ecig') advocates, and for those involved in the regulation and health debates. There are useful and in some cases unique information resources here, plus a news update / blog.
What's it all about - and why all the fuss? The answer to that question is simple:
"If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save five million deaths in people who are alive today. It’s a massive potential public health prize."
- Prof. J Britton, Royal College of Physicians
It is now very clear that preventing unhindered access to ecigarettes has no relation to health, since there is an overwhelming weight of evidence that tells us there are no issues requiring action in any country where consumer products are effectively regulated. Moves to block access to electronic cigarettes in such countries are based firmly on economic pressures and ideology. Policy-making is a trade-off between saving lives and maintaining current income streams, and the simple fact is that where you stand on life versus profits determines where you stand on the ecig issue.
Smokers who cannot or will not quit deserve safer alternatives. There is no possible excuse for preventing access to low-risk consumer products, and we will expose the political processes whereby industries such as the pharmaceutical industry and the cigarette trade protect their incomes to the detriment of public health.
We believe that, in time, more than half of smokers will switch, given the opportunity (since this has already happened in Sweden with an alternative product). Artificial restrictions on this process purely for the benefit of those who earn vast incomes from the smoking money machine are entirely wrong and hugely detrimental to public health.
"We have such a massive opportunity here. It would be a shame to let it slip away by being overly cautious. E-cigarettes are about as safe as you can get."
- R West
Smoking has created one of the world's biggest money machines - a machine that benefits innumerable people in multiple industries, organisations, and government departments. The smoking economy is worth more than one trillion dollars a year; it is immensely powerful and well able to protect itself. Its power is obvious from the way that, now a way to finally remove smoking has been invented, that solution is being blocked.
The effect of a technology change point
Technology advances, though, and life changes inexorably as a result. Progress can be slowed by those whose employment depends on smoking - but it cannot be stopped. There are massive public health gains here for the taking; our job is to help sweep aside those who are deliberately slowing progress.
If someone argues against THR then you can be assured that their employment depends, ultimately, upon smoking. Otherwise, no one would be arguing against something that will obviously save millions of lives when nothing else can do so.
The smoking economy is far too powerful to be easily defeated. However, we are at a technology change point: at such a break point the world changes, and no other factor can override that change. It means that nothing can stop electronic cigarettes now the technology is in use - only the timescale to full implementation can be affected by external factors, no matter how powerful they are. We know that this must happen within thirty years as it is always so; for maximum benefit to public health we should aim for a 20-year conversion period. Industries that benefit from smoking will fight hard to protect their domain from the ecigarette; but we already know the outcome. Nothing stops a new technology: it replaces the old system and nothing can stop it doing so.
The focus of this resource is to provide access to truthful information about THR, and specifically the EV (electric/electronic vapouriser or 'e-cigarette'). The volume of propaganda generated by commercial rivals and incumbents tends to obscure the facts. THR advocates who support free and unhindered access to the full range of e-cigarette products will help to enable the single most important advance in public health since the discovery of antibiotics: in one small country alone, full support for this approach has the potential to save millions of lives just among those alive today . There is a sharp contrast here with the current approach to the reduction of smoking morbidity and mortality, which has stopped being effective and cannot produce further significant gains due to the 20% Prevalence Rule .
Although smoking prevalence fell dramatically during the final decades of the 20th century, it slowed, and all progress stopped around 2008. There has been no progress at all in recent years. In many countries such as the UK, prevalence has remained static at around 20% of the adult population for many years.
"The rate of smoking in Great Britain has remained largely unchanged over the last five years."
- ONS, UK official statistics - see References page, Smoking.
Despite the huge sums spent on reducing smoking in the UK, the number of smokers has increased. A rough calculation - since such statistics are very well hidden indeed - is that, at the start of 2013, there were approximately half a million more UK smokers than five years before.
Just as technology has radically changed many aspects of our lives, it has now changed tobacco use, and this advance cannot be stopped. It can be slowed, perhaps considerably, by regulations designed to protect existing industries and government revenues; our focus is to assist the removal of such artificial impediments designed to slow the process of change and that are so massively detrimental to public health. The ultimate outcome is immutable but the timescale could be considerably prolonged by delaying tactics.
The prospect of stopping death and disease from smoking is now a reality for the first time, because we now have the tools to reduce morbidity to insignificant proportions. The THR approach is supported in Sweden, where male smoking prevalence will soon be just 5%, with the number of smokers falling by 1% per year, and consequently with the lowest smoking-related mortality of any developed country by a wide margin. We should be able to achieve the same or better with ecigarettes, since these are more popular with smokers than Snus, and because ecigs have the same or less risk than Snus.
Do smokers have rights? We think they do: smokers' rights. Equally important are ex-smokers' rights: the rights of those who are ex-smokers not to be forced back into smoking. This right is completely ignored by current legislative proposals; many ex-smokers only manage to avoid smoking by use of an EV, and removing their free choice in this area will inevitably cause many to revert to smoking.
Does the law have the right to compel people to smoke?
Smoking Harm Reduction
It should probably be pointed out that we are talking about reducing the harm from smoking here; tobacco is not really the problem, smoking it is . For that reason a more accurate term would be 'Smoking Harm Reduction' or 'SHR', and not Tobacco Harm Reduction / THR, which is now the accepted term for this area of public health improvement and is probably too well established to change.
"Three months of additional smoking poses a greater risk to someone’s health, on average, than a lifetime of using a low-risk alternative."
- CV Phillips
This is a crucial issue: once smoking prevalence is reduced to about one-fifth of the adult population (20%) in a country where it was previously at least double that rate, as is the case for many developed countries in the western world, then it cannot be reduced significantly further by continued application of methods that were successful up to that point. Combined with the 9 out of 10 failure rate of pharmaceutical interventions for smoking cessation, it means that the only way to reduce smoking significantly below 20% of the population for many countries is substitution: replacing smoking with alternatives such as the ecigarette. This is called THR.
This is not a theoretical concept, because:
Simple: to protect the smoking economy. Although there are almost too many to list, the principal beneficiaries are existing industries, government revenues and NGOs dependent on funding by industry. Legislation is designed principally to protect existing industries, but cannot be obtained directly by them; so they use front groups instead: pressure groups funded by industry who appear to be independent 'pro-health' lobbyists, but are funded by commercial interests. Because continuation of smoking has multiple benefits for government, they are implicitly involved in protecting it.
These are some of the important factors:
The most important of all issues to the pharmaceutical industry is to defend the unspoken principle that it alone decides health policy. It has an iron grip on health policy, services and provision, and this must be defended at all costs since it is the key to profitability.
People who claim they are legislating to protect public health are sentencing millions to death for the sole purpose of protecting existing industries. The use of EVs (electronic vapourisers or 'e-cigarettes') is likely to prove 1,000 times safer than smoking - it cannot possibly be less than 100 times safer and may even be 10,000 times safer. Read the statements here from Profs. Britton, Phillips, Rodu and West, and decide for yourself; there are dozens more in the same vein from many other professors of public health, clinical research, and law, and from other independent expert public health advocates such as Clive Bates.
"Opposition to THR is an entirely dishonest enterprise."
- Phillips, Rodu
On June 5th 2013 the UK health service clinical guidance organisation, NICE, published ground-breaking advice to the medical profession . It included the important advice for doctors that tobacco harm reduction is supported; that nicotine is relatively harmless and is not associated with cancer ; and that doctors may unofficially recommend ecigarettes if that seems the best option.
Nicotine, after all, is simply a normal dietary ingredient that everyone consumes and everyone tests positive for; that about a quarter of the population appear to need supplementation of (hardly an abnormal situation with dietary components); and that is probably not dependence-creating unless supplied in tobacco smoke (there is no proper evidence either way although the weight of anecdotal evidence is that, independent of supply within tobacco smoke, it cannot create dependence). The fact there is no published clinical trial of nicotine dependence in humans despite the huge interest in this issue indicates that it is not 'addictive': trials with unwanted results are not published.
There is no published clinical trial of the administration of nicotine to never-smokers to determine any potential for dependence.
Then, in October 2013, the nicotine toxicity myth was finally demolished; a new LD50 of up to 20 times the current figure will need to be established . This applies to absorbed nicotine only, since ingestion of very large amounts of nicotine by adults is known to be survivable without harm (due to the vomit reflex induced, which expels most of it.)
"Nicotine has about the same implication for health as coffee and fries."
- CV Phillips
"E-cigarettes are probably about as safe as drinking coffee."
- R West
We need to stop believing the propaganda published on behalf of industries who benefit substantially from smoking, and above all we need to stop them from influencing the political processes blocking THR.
It is time to stop protecting smoking; it is time to stop protecting industries that benefit from the disease caused by smoking; it is time to stop listening to front groups funded by those industries; it is time for radical change in smoking cessation practice.
It is a simple question of lives versus profits, and it is time for a change.
 Prof. J Britton, Chair, Tobacco Advisory Group of the Royal College of Physicians, Professor of Public Health, University of Nottingham: see quote above in green.
 The 20% Prevalence Rule: see menu item at right.
 OECD figures presented by Clive Bates: see Links page.
 NICE harm reduction Guidance: see menu item at right.
 Prof. CV Phillips, the authority on the science base for THR: see quote above in green.
 Prof. R West, Director of Tobacco Studies, Department of Epidemiology and Public Health, University College London: see quote above in green.
 The incidence of oropharyngeal cancers [mouth cancer] from modern oral tobaccos is so low it cannot be reliably identified, and smoking is by far the greater risk for such cancers (Prof Rodu, the authority on the oral pathology of tobacco consumption - private communication).
 Prof Mayer of Graz demonstrated that nicotine is far less toxic than previously claimed, and that a median fatal dose is between 500 - 1,000mg. The ridiculous overestimation of nicotine's toxicity, with a clearly far too low LD50 of 60mg claimed, has been obvious for a long time to those who work with it on a daily basis.