Beyond Vape Fear

Richard Roope, of the RCGP, has recently released a report on e-cigarettes.

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Essentially, the Royal College of General Practitioners, the official channel for General Practice of Medicine in the UK, has given their informed recommendations to health professionals regarding smoking cessation and the use of e-cigarette.

The recommendations:

1. GPs provide advice on the relative risks of smoking and e-cigarette use, and provide effective referral routes into stop smoking services.

2. GPs engage actively with smokers who want to quit with the help of e-cigarettes.

3. Where a patient wants to quit smoking, and has not succeeded with other options, GPs should recommend and support the use of ENDS.

BEGIN DIGRESSION.

[GENEVA – Electronic nicotine delivery systems (ENDS), of which electronic cigarettes are the most common prototype, are devices that do not burn or use tobacco leaves but instead vaporise a solution the user then inhales. The main constituents of the solution, in addition to nicotine when nicotine is present, are propylene glycol, with or without glycerol and flavouring agents. ENDS solutions and emissions contain other chemicals, some of them considered to be toxicants.The World Health Organization (WHO) submitted a report on Electronic nicotine delivery systems to the sixth session of Conference of the Parties to the WHO Framework Convention on Tobacco Control (COP 6), which occured in Moscow, Russian Federation, from 13 to 18 October 2014.]

END DIGRESSION.

4. GPs recognise ENDS offer a wide reaching, low-cost intervention to reduce smoking (especially deprived groups in society and those with poor mental health, both having elevated rates of smoking).

5. All GPs encourage smokers who want to use e-cigarettes as an aid to quit smoking to seek the support of local stop smoking services.

Harm-reduction has come out on top. Vape Fear has lost this one.

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I have written my fair share about e-cigarettes in Canada, the United States, and Great Britain.

For example:

* ‘Why Aren’t we Regulating E-Cigarettes?,’ Regina Leader-Post [May 16, 2016]

* ‘Let’s Get Proactive with E-cigarettes,’ Saskatoon Star Phoenix [April 24, 2015].

* ‘Lot of Smoke and Mirrors with Vape Policy,’ Saskatoon Star Phoenix [November 28, 2014]

Often, I have suggested a measured response. My sense is, a little bit of regulation can go a long way. Minor rules can make a major difference. Don’t go overboard, but the waters are rough. Vaping should play by the rules, basically.

With my last op-ed back in May, people in Canada weren’t impressed with my approach. Folks were not interested in a middle-ground perspective. Here’s a list of the harshest responses to my articles on vaping. I’m basically the Red Skull mixed with Lex Luthor for suggesting some thoughtful rules might be in order.

1. “Please take the check that you earned from writing this trash and take an ethics course. Or a journalism degree.”

(Uh, I didn’t get paid. Woulda been nice.)

2. “It’s pretty obvious you don’t quite understand how the system works here in Canada…”

(Does anybody. There are no regulations? Ha.)

3. “You help tobacco companies profit from murder.”

(Jeez, really?! C’mon it’s my birthday.)

4. “…governments are making decisions based on MONEY, NOT PUBLIC HEALTH.”

(No comment.)

5. “What tobacco lobbyist wrote this trash?”

(I’m no tobacco lobbyist, but I sure do think they’re funny in the movies. Aaron Eckhart, anyone?)

Anyway, read the piece and decide for yourself. And share. http://leaderpost.com/opinion/columnists/why-arent-we-regulating-e-cigs

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Vape Fear – Updated

November 25, 2016 – CBC NEWS

Vaping, e-cigarettes to be regulated by Health Canada

The federal government plans to regulate e-cigarettes to make vaping products less accessible to young people.

“The proposed act amends the Tobacco Act to regulate vaping products as a separate class of products,” Health Canada said in a statement on Tuesday November, 22.

The aim is to protect young people and non-users from nicotine addiction while allowing adults access to e-cigarettes.

“We know that there is some evidence to suggest that the use of vaping products can be used as a harm-reduction tool for people who are current smokers,” Health Minister Jane Philpott told reporters in the Commons.

“But at same time, they have [been] shown to be an enticement for young people to take up smoking and become addicted to nicotine.”

The government aims to regulate the manufacture, sale, labelling and promotion of e-cigarettes and vaping products.

A key part of the legislation introduced in the Senate is to regulate health claims, such as that a vaping product will help smokers quit.

The legislation would cover vaping products with and without nicotine.

Other measures in the proposed legislation include:

  • A ban on the sale and promotion of all vaping products to those under age 18.
  • Prohibiting the promotion of flavours that appeal to youth, such as candy flavours.
  • Creating regulatory authority to display health warnings on vaping devices.

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Here’s my original article.

In Martin Scorsese’s 1991 remake of Cape Fear, Robert De Niro plays sociopathic Max Cady, who has recently been released from prison. Years earlier, his attorney, Sam Bowden portrayed by Nick Nolte, deliberately withheld evidence during a criminal trial which would have seen Cady acquitted.

This of course enraged Cady and fueled a desire for revenge. As punishment, he stalked and brutalized the Bowden family. Yet, being a true believer, he also felt that by carrying out his terrible deeds he was helping Bowden achieve a type of moral and spiritual redemption. In short, he felt his actions were serving Bowden’s interests.

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In 2016, consumers, politicians, and health officials are going through Vape Fear. Due to lack of evidence, we are being tested by a product in the marketplace with a potential to improve health outcomes and cause other, if unknown, health problems.

It’s a dual-purpose product, in that it has recreational and medical applications. And in the public arena, opponents and supporters of e-cigarette regulations have contested the best approach to it.

Supporters of stiff regulation declare that children and young people need to be shielded from products that imitate smoking and might encourage nicotine addiction. (Think Mrs. Lovejoy in the Simpsons.) They favour regulation that might guarantee product safety and quality. These individuals also usually advocate on behalf of a precautionary approach – at least until there is sufficient evidence that e-cigarettes don’t undermine recent successes at controlling tobacco.

Opponents of stiff regulation, by contrast, argue that vaping is significantly less harmful than conventional cigarettes and beneficial in helping smokers to quit. They want minimal restrictions on availability and often absolute freedom for advertising, promotion and the use of e-cigarettes in public. (Think Charlton Heston and guns being pried from his cold dead hands.) Restrictions, this camp argues, might put off smokers from swapping to safer alternatives and limit the opportunity of curbing tobacco consumption. Here harm reduction trumps all other suits.

Now, against this messy backdrop, governments have taken action.

New EU regulations in May imposed standardised quality control on liquids and vaporisers across the union. They also required disclosure of ingredients in vaping liquids and child-proofing and tamper-proofing for liquid packaging.  And the NHS has backed e-cigarettes as a quitting aid.

In March, the Scottish government’s Health Bill banned under-18s from both buying the devices and limiting their advertising, which followed Health Scotland’s position paper in March 2015 that “NHS Boards must balance the benefits of e-cigarettes use to smokers with any potential concerns about impact on non-smokers.”

Meanwhile, the U.S. government has also taken broad steps to crack down for the first time on e-cigarettes, which have been growing in popularity among teens and is projected to be a 4 billion dollar industry this year.

The Food and Drug Administration’s move in May brought regulation of e-cigarettes in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This had been highly anticipated after the FDA issued a proposed rule two years ago on how to supervise the e-cigarette industry.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell stated during the announcement of the new rules. She asserted too that health officials still don’t have the scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and avoid the known ills of tobacco.

In all of this, though, a Vape Fear persisted.

Similarly, heart experts recently found that vaping damages key blood vessels in the heart in a similar way to normal cigarettes, and it’s “far more dangerous than people realize.” University College London heart expert Professor Robert West noted, “It would certainly be fair to say the study shows electronic cigarettes are not without any risk.”

Researchers at the European Society of Cardiology Congress in Rome thus decided to call the NHS decision to support e-cigarettes “premature.”

Added to all this is the idea of vaping garage labs, a part of e-cigarette mythology that’s difficult to shake. While no one has been publicly exposed for mixing juice in an actual garage, many in the industry have confessed privately that some set-ups that are only marginally better. It was and remains the nascent industry’s dirty little secret.

In my home country of Canada, Vape Fear is certainly present. According to the CBC’s celebrity doctor Brian Goldman, “my sense is that key thought leaders in Canada are alarmist about e-cigarettes.” They “ignore evidence,” “cling to the notion that nicotine addiction, as opposed to combusted tobacco products, is the paramount health problem,” and “overestimate concerns that e-cigarettes act as a gateway to regular tobacco use.”

For Goldman, it’s well past time that his colleagues “look up the facts” and stop “dissing a smoke cessation tool with a lot of potential.” It can serve the interests of public health. Jesse Kline for the National Post has likewise told Canadians, “Don’t believe the fear campaign — e-cigarettes can save millions of lives.”

In Cape Fear, Sam Bowden’s teenage daughter – played by Juliette Lewis – was tormented and assaulted by De Niro’s Max Cady, but she manages to survive. She tells the audience that her holiday in North Carolina had been so peaceful beforehand, “when the only thing to fear on those enchanted summer nights was that the magic would end and real life would come crashing in.”

With vaping, we know this won’t occur until all multitudinous studies have been completed. And regulators and health authorities reach consensus.

Until that point, the regulation and use of e-cigarettes in Canada, the United States, and Scotland will continue to spark serious challenges and health concerns.

Without reliable data and hard evidence, and in a state of affairs where no one has a claim to the unassailable truth, regulations that curtail access and promotion to young people appears to be the surest policy in overcoming Vape Fear.

Crackdown? Regulating E-Cigarettes

In the Regina Leader-Post today I write about Canadian e-cigarette rules. Both the U.S. and E.U. have moved ahead with new rules. Should Canada?

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Why Aren’t We Regulating E-Cigarettes?

Recently, the regulation and use of e-cigarettes in Canada, the U.S. and European Union has raised serious challenges for consumers, politicians, and health officials. Now, the U.S. and the EU have moved forward with new policies and Canada is being left in the dust.

In the U.K., an estimated 2.6 million people use e-cigs, prompting more calls for regulation. And this week, new regulations go into effect.

These include rules that limit the size of refill containers and the potency. All packaging must be “child proof.” Manufacturers will be asked to submit to government scrutiny. Finally, if three EU member states express a willingness to ban e-cigs, it will be possible to start a process banning them across the whole of the union.

Last week, the U.S. government also took broad steps to crack down for the first time on e-cigarettes, which have been growing in popularity among teens and are projected to be a $4-billion industry this year.

The Food and Drug Administration’s move brought regulation of e-cigarettes in line with existing rules for cigarettes, smokeless tobacco and roll-your-own tobacco. This action had been anticipated after the FDA issued a proposed rule two years ago on how to supervise the e-cigarette industry.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical,” U.S. Secretary of Health and Human Services Sylvia Burwell said. She suggested that health officials still don’t have scientific evidence showing e-cigarettes can help smokers quit, as the industry asserts, and thus avoid the known ills of tobacco.

In Canada, considering that both the Harper Conservatives and Trudeau Liberals have dithered on crafting any meaningful policy, perhaps it would be easiest simply to follow the lead of the EU or U.S.

First, e-cigarettes have not been proven as a legitimate and conclusive aid in quitting smoking. Anecdotally, many believe they are a useful harm-reduction tool. Many former smokers praise the devices, while many physicians and public health experts also support their use. Yet, there is anything but scientific or medical consensus on the e-cig.

Second, the flavoured liquid that substitutes for nicotine lacks proper regulatory standards, so the safety is problematic. Business owners either can craft the liquid themselves or purchase it from anywhere they wish. This raises questions of security. It’s basically a “wild west” market. Without appropriate controls over the liquid mixing process or the supply and distribution chain, consumer protection is weakened. It is unthinkable that a pharmacy down the block could operate in an unregulated, unstandardized environment.

Also, a recent report in the U.S. found that e-cigs have “sickened rising numbers of young children,” and in most cases this involved swallowing liquid nicotine. In Lethbridge, an e-cig exploded in the face of young Ty Greer. It “lit his face on fire,” knocked out teeth and seared the back of his throat. The young man will bear the scars of this accident forever.

Do such examples mean we ought to crack down hard and regulate this market out of existence? No. Does this mean we should think proactively? Yes.

Alberta, Saskatchewan and Newfoundland and Labrador are the only provinces that have not banned sale of electronic cigarettes to minors, according to the Non-Smokers Rights Association.

Les Hagen of the group Action on Smoking and Health said what happened in Lethbridge is another reason why e-cigarettes must be regulated federally and provincially. By contrast, Jesse Kline of the National Post has told us, “Don’t believe the fear campaign — e-cigarettes can save millions of lives.”

It is time for federal leadership. We need rules that meet the needs of consumer protection and business owners, and balance health concerns for children with harm reduction for adults. According to federal Health Minister Jane Philpott, “Health Canada is actively reviewing health and safety data and scientific studies on vaping products, including e-cigarettes.” She noted a report will be issued reasonably soon.

It will be a tricky task, especially with the marijuana file looming large.

Lucas Richert teaches the history of pharmaceutical and recreational drugs at the University of Saskatchewan.

Devising an Endgame in the War on Tobacco

In recent months, some tobacco and health experts around the country have begun to devise radical proposals to hinder Big Tobacco and crush the business in a final, coordinated attack.

Luckies

The National Post’s Tom Blackwell, in particular, has offered illuminating coverage of the debates within the anti-smoking community, where moderates are pitted against prohibitionists. The first endgame summit will be held this upcoming fall at Queen’s University.

The full article by Blackwell is here: http://news.nationalpost.com/news/canada/the-tobacco-endgame-radical-proposals-aimed-at-winning-faltering-war-on-smoking

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It begins like this:

In the faltering war against cigarettes, the latest battle cries are eye openers: prohibit smoking for anyone born after the year 2000; require a licence to buy cigarettes; nationalize the tobacco industry.

Or just make selling cigarettes illegal.

All have been proposed as part of the “tobacco endgame,” a radical — and controversial — new approach to the smoking scourge that a select group of Canadian public-health experts will discuss later this year.

Endgame proponents note that a stubborn 20 per cent of the population continues to smoke — tens of thousands of them dying annually as a result — and argue the numbers are unlikely to decrease much under current anti-smoking policies.

So, they say, it’s time for innovative, out-of-the-box ideas that might just stamp out Western society’s biggest-single source of disease.

“We’ve got to do something,” says Rob Schwartz, executive director of the Ontario Tobacco Research Unit. “I’m an academic, not an advocate, but when I have the data in my hands, I feel a moral responsibility to make it known.”

Canada’s first tobacco-endgame “summit” is planned for Queen’s University in Kingston, Ont., this fall. It will be headed by Dr. Elizabeth Eisenhauer, the oncology department chairwoman, with about 100 invitation-only public-health and policy experts brainstorming a blueprint for dramatic action.

SMOKE AND MIRRORS – MORE ON VAPING

Last year I had opinion-editorials published in the Saskatoon Star Phoenix and elsewhere. Both focused on “vaping,” Oxford English Dictionary’s word of 2014.

My take was this: we need to think more clearly about e-cigarettes in Saskatoon – as well as the wider world. The government needs to get proactive. We, as consumers, should also think about them more critically. Essentially, we need to cut through all the smoke and mirrors.

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Now, Saskatoon’s city council is voting (that is, tonight folks) on “a vaping ban” in the city.

As reported by the local paper, “If city council approves a proposed change to the local smoking bylaw, use of electronic cigarettes — also known as vaping — will be banned anywhere in Saskatoon that regular cigarettes are. The change, which will be considered at Monday’s council meeting, would expand the city’s Smoking Control Bylaw to include vaping as of Jan. 1, 2016. It would make vaping prohibited in public buildings, bus shelters, schools, businesses and other places cigarettes are currently not allowed.”

So, big changes are afoot here. And these changes could influence the smoking of traditional cigarettes at the local and provincial level. Indeed, many supporters of e-cigs make the case that the new technology deters relapses.

The Star Phoenix also quotes a local “vaping” business owner, Jim Wollf, who said he understands the argument that vaping puts unnatural chemicals into a person’s body, but argued it should be looked at as a harm-reduction strategy.

This is exactly the problem that my opinion-editorials have tackled. Here’s a taster:

“In September 2014, federal Health Minister Rona Ambrose called for more research on e-cigarettes from the Commons standing committee on health. Last month, the committee released its initial report, which called for an end to the legal grey zone that surrounds the technology in Canada and the implementation of a new set of rules that balances the benefits and risks of “vaping.”

Premier Brad Wall and the Saskatchewan government would be wise to take the committee’s advice and do the same. In their brief history, e-cigarettes have proven to be divisive products. They have raised serious challenges for consumers, politicians and health officials. It is time, however, to cut through the fog and for the provincial government to get proactive.”