Monday, 7 December 2015

E-Cigs on Prescription?

Four excellent blogs already exist here,here,here,here covering this recent revelation from the Department for Health and Public Health Minister Jane Ellison

I shall hopefully not regurgitate similar thoughts and interpretations in my take of events and analysis

It was announced in the landmark Public Health England(PHE) report in August amidst much discussion that the MHRA would be encouraged to apply far less stringent requirements to obtaining a marketing authorisation towards e-cigarettes.

It is my contention that PHE clearly recognised that for widespread acceptance of e-cigarettes from sceptics, it required at least one 'medicinal' e-cigarette. Pressure was clearly applied to the MHRA to relax its traditional demanding requirements in favour of a very light touch.

Whilst the approval of the e-Voke seems perverse in so many ways(BT product, outdated technology from 2009-2010,SHITTY product) it at least destroyed the myth that MHRA would never authorise an e-cigarette as a medicine.

However,would the MHRA approve an application from a manufacturer of an open-tank system?

Should the e-Voke or indeed any other 'medicinal' e-cig be allowed on prescription?  NO!

The NHS has far too many demands on its budget, and could alienate non-smoking taxpayers, further increasing the antipathy towards e-cigarettes. Possibly there is a case for those who qualify for free prescriptions,but even this is contentious.

The only possible good news from this announcement, is that it could encourage some previously sceptical(due to safety issues) smokers to attempt to try e-cigarettes for the first time,however their experience could very well be tarnished by this Shitty product.

Monday, 16 November 2015

Is Tobacco Flavour really the most popular?

Yet again this entry was provoked by a twitter conversation(if you are not on there you should try it!) and was a request for flavours,used specifically by UK Vapers from Lorien J . This,as is usual on twitter produced a flood of information exceedingly quickly. However,some glaring differences quickly emerged, that shall be what I highlight,and examine the possible causes and implications.

ASH Data http://www.ash.org.uk/files/documents/ASH_891.pdf  (See page 7 of the pdf)
This implies in this survey of 605, that tobacco flavours are clearly the most popular in sole(n=239) and dual-users(n= 366).However,this data would not agree either with perception of the market,or more definitively with studies, but it is acknowledged in the document that less than 5% use e-cigarettes without flavouring 


Vaping Truth surveys via Kevin Crowley


This  data was accrued from a combination of Twitter,Forums and Facebook , yielding 983 results from the UK(out of a far larger World-wide Survey of 7300)

Here it states that only 5.3% solely use a tobacco flavour,with approximately 85% using a variety of different flavours on a regular basis  Anomoly 1


Impact of Flavour Variability .....etc via Konstantinos Farsalinos et al



 

To an untrained eye,this data appears misleading at first glance,but clearly shows that tobacco flavours are used by 1984 people out of a total of 12,909 who responded (15.4%)  Anomoly 2



This data at initiation shows a marked difference, to single out tobacco flavours 3118 users out of a total of  8607(36%),this figure appears more consistent with ASH data   





A better alternative link is here http://roar.uel.ac.uk/1875/1/2013_Dawkins_e-cig_survey.pdf  

Sadly this led to a wild goose chase,with nothing of value discovered on flavours * 






Tobacco Flavours = 22.3%   Anomoly3   


Nicotine and Flavour Preferences Survey http://www.factualvaper.com/nic-flavor-survey-final-results  

This survey of 1943 participants(and highly recommended as a resource) once again clearly demonstrates the lack of consumer desire in tobacco flavours  Anomoly4 



I could continue in this vein,but minimum research(simply from the afor-mentioned tweets via Twitter) allowed me to get to this point.A far more detailed approach is required to fully myth-bust, but this at least confirms a few doubts and suspicions.


Does it Matter? 

As we are all aware, flavours are a very important factor to the success of e-cigarette users in Relapse Prevention,Initiation, ASH acknowledge this with the afor quoted <5% using unflavoured liquids. This information is important to regulators. In the last survey cited, 94% stated that flavours were either very important or important to the user

However,some regulators such as Finland wish to ban all flavourings in e-cigarettes,this is only a hunch but do they mistakenly perceive that unflavoured e-cigarette juice has a tobacco tasting flavour? 

Why do the anomolies exist, is it statistical error? :- I agree that some of the data collected here to demonstrate this point was not UK specific, but I did not cherry pick the results, they were simply the first to be located. There may be a selection bias from where the anomolous data was collected(typically enthusiasts),so is the ASH survey representative of the general population with a sample size of 605?

ASH should undertake another far larger,more detailed and probing study forthwith(ask NNA or ECF etc for assistance in study question design). ASH appears broadly supportive of e-cigs,consequently, enhanced data would most certainly be advantageous to all concerned, especially as they(ASH) are referred to as a credible information source .










Friday, 13 November 2015

Stakeholders

As is usual,this was prompted by a twitter/facebook exchange or commentary. In this case it was a reference to the #ecigsummit held on 12th November 2015 and slides shown by a spokesperson from the UK Department of Health
https://www.dropbox.com/sh/s2850wok7k5t31w/AABZvpB8SAunFvrrGfUxgEeAa/1540%20Rosanna%20Oconnor.pptx?dl=0  see slides 4-5-6 the last slide makes reference to a Symposium attendance by vapers,but what policies were pre-agreed in uninvited meetings beforehand?

Stakeholders http://dictionary.reference.com/browse/stakeholder were listed on the slide,perplexingly, but all too commonly the most important key stakeholders were omitted :-CONSUMERS

Whenever any e-cig or smoking consultation takes place,the list of stakeholders is bewilderingly long,by and large part- government sponsored charities,or those with tenuous (or otherwise) links to the pharma industry.

Does this consultation with stakeholders, that excludes consumers arrive at balanced, workable policy decisions? DECIDEDLY NOT 

EU: TPD2

The only opportunity that arose for consumer participation in this shoddy process, was via the notorious ENVI committee meetings headed via rapporteur Linda McAvan.She allowed a 2 minute presentation from https://nicotinepolicy.net/who-is-who/consumers/424-interessengemeinschaft-e-dampfen-e-v  but insisted that this be conducted in English. This was a cruel and bizarre ruling to impose onto native German speakers, despite the usual bank of EU interpreters available.

The ENVI Committee also only allowed a total of 10 minutes participation from the Scientific experts, Konstantinos Farsalinos and Jean Francois Etter gave the only verbal independent scientific evidence, that the ENVI committee and by extension the EU ever heard regarding e-cigarettes - a travesty, remarked upon at the time by JF Etter!

Welsh Government and HSCC 

Consultation on the evidence- free legislation was supposedly encouraged,but submissions from consumers subsequently ignored by both . The most worrying aspect was the lack of participation by consumers in the 'call for evidence' made during the HSCC, the BMA by contrast appeared at 2 such meetings, as commented upon here in this letter.  https://docs.google.com/document/d/1o7XwdaZSrTytoDaGoVx3LF8TiUI81BwEhVKwh6r4t18/edit?usp=sharing

MHRA and PHE Consultation 

Consumers participated, but once again seemingly ignored

Summary 

Consumers are either totally ignored or not classed as a 'stakeholder', Organisations seemingly think that paying lip service will pacify the consumer,but use the echo-chamber of responses from like minded(smaller govt or NGO) groups as opposed to the people directly involved!

 A recommended extract I will link here comes from James Dunworth' Ashtray Blog  referring to Public Health Director Jim McManus http://www.ecigarettedirect.co.uk/ashtray-blog/2015/11/e-cig-summit-round-up-the-vape-debate-continues.html that demonstrates the thinking and action that is possible

Interestingly Jim evolved his position from this point post 2013 #ecigsummit  http://www.theguardian.com/local-government-network/2013/nov/19/debate-needed-safety-e-cigarettes-public-health to his very pragmatic position now


So ignoring the key stakeholders needs to change quickly! If no change...............?

 'You cannot legislate against a typhoon - a law will not stop it'  JF Etter


Acronyms used

TPD2 = Tobacco Products Directive http://ec.europa.eu/health/tobacco/products/revision/index_en.htm

ENVI = Environment,Public Health and Food Safety Committee http://www.europarl.europa.eu/committees/en/envi/home.html

MHRA = https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency

PHE = https://www.gov.uk/government/organisations/public-health-england

HSCC (Wales) = http://senedd.assembly.wales/mgCommitteeDetails.aspx?ID=227

Wednesday, 11 November 2015

Smoking-Vaping :-A Journey of Perception

I really don't wish to bore the pants off people, with yet another lengthy testimonial extolling the virtues of vaping, as I have written about such on many occasions. What I do wish to attempt here is to show the evolution of my perception of smoking.

As a smoker

I  thoroughly enjoyed smoking over a 45 year period,however due to a variety of stressful jobs I can truthfully state that that the vast majority of my 40/day went by mindlessly, as many burned away in the ashtray thus unmemorably. The most memorable were first and last in the day,following meals, or at some beauty spot of choice - hardly rocket science or anything unusual here! 

My perception of harms to myself from smoking were not well developed, but I realised that in periods of relative inactivity I could quickly lose breathing capacity. My early career was in coal mining,where lots of physical activity was required,I was relatively fit throughout this period. However,by my late 30's, with more responsible management roles,this resulted in increased physical inactivity,gaining weight, and becoming breathless with the simplest of tasks.

A change of career certainly helped this lack of fitness and breathlessness,to such an extent I was able to pursue some of the sporting pastimes that I had previously shunned.To aid this, a daily 2 mile run with the occasional 6 miler thrown in enhanced my fitness.Why am I giving you this potted version of Beard life? ...... Because my fitness improved,lost weight and importantly my breathing  was excellent,  throughout this period I was a smoker.

Fast forward a few years now, to my late 50's my sporting days over(stupidly!), weight piling on, and retired ,so in general less active in day to day life. My health gradually deteriorated,,but still smoking throughout this period. What I found the most troublesome or annoying was the smokers cough caused by phlegm and catarhh which increasingly disturbed my sleep 

The sleep disturbance, along with the progressively worse smokers cough, were the catalyst in deciding to be far more receptive to quitting smoking,which I had half-heartedly attempted many times previously 

Whatever the reasons, I personally had little peer pressure to quit(except my daughter who gifted me an Allen Carr book!),had neither seen or failed to take much notice of any stop smoking messages. In general, very uninformed outside of my personal experiences and I should add,up until this point, only a passing interest in politics,which was about to be rudely awoken.

As a Vaper 

Following a relatively seamless transition away from smoking(many thanks to AAEC forum advice here), I started to read some of the threads on AAEC, and another forum UKV, and was horrified to discover my 'healthier' option under threat. 

Via VTTV, I watched open-mouthed the performance of Linda McAvan and the ENVI committee farce, whilst listening to evidence from Konstantinos Farsalinos on the matter of TPD2.This was within weeks of starting to Vape in Febuary 2013, This travesty fuelled my interest in the Science and Politics surrounding Vaping,Nicotine, and Smoking,continued unabated to this day. 

Again,without wishing to bore anyone foolish enough to have read this far,I will highlight one notable event that unduly influenced my early thinking.I mentioned VTTV earlier, Andy Sutton,one of the presenters mentioned a twitterbomb to be sent on twitter to Linda McAvan,as I knew nothing of either, I dutifully signed up to Twitter. Quickly on Twitter I discovered a whole host of organisations and people opposed to Vaping - one stand-out person was Martin McKee and a guy who followed him (the name irrelevant + I cannot remember the name anyway)who I shall refer to as X.

X and I regularly swapped tweets,him with links and me with feeble words in response - I used him and others as twitter mentors, one thing really stood out after a few weeks. He eventually made sympathetic noises towards vaping but warned me of the dangers of aligning with smokers in our battle for truth,commonsense and acceptance.

To my nieve,uneducated mind I could see a lot of sense in that advice, expecting a more welcoming response from Anti-Smoking organisations and Government....BUT of course that was and remains NOT the case. Some Vapers carelessly,unthinkingly villify smokers with their comments in the media - this again is totally counter-productive to either group of people. My perception has slowly but surely evolved after reading such as :- 

http://www.ecigarette-politics.com/ along with many other sites eg http://www.clivebates.com/ a vast array of other sites are also read ,but this is not intended as a library entry!

 However,two great sources I heartily recommend:-

 http://memberdata.s3.amazonaws.com/jo/joejackson/files/3765647615810.pdf from Joe Jackson that is eminently readable.

http://vapers.org.uk/wp-content/uploads/2014/12/Big-Drugs-War-on-Nicotine.pdf from Wanda Hamilton charting the incestuous relationship between Big Pharma and WHO


Continuing,my journey was a growing realisation that much of the anti-vaper/vapor messages from certain Public Health bodies seemed to mirror exactly those given to smoking and has increasingly made me sceptical of either or indeed any Public Health pronouncements in general. The messages spouted to smokers such as enormous # of reported deaths attributable to smoking,second hand smoke.......etc are no longer believable. This propaganda clearly has been orchestrated to apply ever more draconian regulation, rather similar to what Vapers are now seeing around the world.The latest nonsense in the US to ban both Smoking and Vaping in social housing is a eg of this slippery slope.

 https://www.youtube.com/watch?v=KzPnnDDCIjo the 'anointed' ones seem to expect their stone tablets will be unquestiongly accepted

**** PHE and a few others are very notable exceptions****

So, this brings me up to date(although missing out much detail), a reasonably well educated sceptic, with much empathy as a former smoker towards smokers.

  For improved effectiveness, an anti-nanny-state coalition of interested parties would appear the obvious avenue to pursue, both in the UK and across the EU. To successfully mobilise any of the individual  interest groups is problematic,so maybe a different approach is now called for to raise sufficient numbers to be an effective force?

***updated***

Twitter spats between Forest and NNA are totally unproductive for both organisations

recent manifesto announcement by VIP summarises my present day stance

https://vapersinpower.wordpress.com/2015/11/19/manifesto-update-outdoor-smoking-bans/


References  to Acronyms inadvertently used

 VTTV = http://www.vapourtrails.tv/?page_id=41

AAEC = http://allaboute-cigarettes.proboards.com/

UKV = http://ukvapers.org/

PHE =  https://www.gov.uk/government/organisations/public-health-england

WHO = http://www.who.int/en/

ENVI https://en.wikipedia.org/wiki/European_Parliament_Committee_on_the_Environment,_Public_Health_and_Food_Safety 



Monday, 9 November 2015

Lest we forget EFVI (European Free Vaping Initiative)

This appears to be a timely reminder to all who participated,or wish to find out about the Efvi,approaching it's anniversary on November 25th

Efvi was part of a European Citizens Initiative(ECI) http://ec.europa.eu/citizens-initiative/public/basic-facts that roughly condensed,states that if citizens gain 1 million signatures to a proposal, the European Commission must examine and give valid reasoning for acceptance or rejection,but that it was not obliged to adopt the measure.

I don't wish to write up all of the background to the establishment of the Efvi, or be overly detailed in charting its progress, but rather highlight certain key stages that were memorable to myself

Summer 2013 Establishment of Efvi committee under chairmanship of the instigator Krisztian Pifko, whose task was to prepare the proposed ECI for acceptance

November 25th 2013 ECI Accepted and the 1 year collection timescale(to collect 1 million signatures) begins. However,due to administrative problems in the EU electronic data collection  this start date was delayed until

January 8th 2014 Actual start date

Feb 27th Vapour Trails TV http://www.vapourtrails.tv/ featured this via a very passionate, persuasive Dave Dorn(Hifistud), and the campaign in the UK that had been flagging, started to gain traction.

Early March Efvi-UK (along with other National Efvi eg Efvi -Fr,De,Dk,Es) was initiated to support the Efvi, this involved starting a Fb page,twitter account etc

Early April  Slim Ukv  via  http://ukvapers.org/ Literally hatched an excellent idea:- the Dodobox  which comprised a small cute collection box, supplied to various retail outlets with a purpose made signature sheet. Subsequently a crowdfunding appeal quickly raised ~£2300, and boxes with signature sheets distributed via Regional Co-Ordinators to willing participants.

Early May With collection boxes in place, many hundreds of  signatures were collected(and inputted by unsung volunteers) on a daily basis.The scheme  was so successful that the concept  was offered to other countries, many accepted UK collection boxes with a local language signature collection sheet, or produced their own versions of the box.

June-early July Despite great early success,three events happened that ultimately had a large influence on the success or otherwise of the Efvi signature collection in the UK.

1)  VapefestUK 2014 Organisers refused Efvi-UK a presence at the event, this caused a schism throughout Vaping circles in the UK

2)  A protracted  damaging debate commenced on UKV regarding the legality of the collection scheme introduced via the Dodobox

3) Slim Ukv - the main driving force and instigator of the Dodobox was unable to continue due to his work commitments overseas

From this time onwards,despite continued efforts from all who remained, the number of signatures collected on a daily basis dwindled.


November 25th 2014  The final total  collected from the UK was ~39,000 out of the required minimum total of 54,200(the threshold target that 7 EU countries needed to achieve as part of the 1 million total)

In my opinion this was a fantastic effort from those who were directly involved, and was by far the most successful effort at attempting to mobilise the latent numbers of ~3.8 million UK vapers.Trying to organise anything in the Vaping World has been likened to 'cat-herding' and this albeit briefly bucked that trend.

However,it must be acknowledged that it was of course a FAILURE, it did demonstrate a proof of concept in the Dodobox method of gathering support. Large retailers such as Liberty Flights and Totally Wicked were able to gather thousands of signatures(for an all too brief period) and some bricks and mortar retailers collected up to 400 from a single store.

Summary A great effort made by very enthusiastic amateurs,that was ultimately a failure.Hindsight shows, that no ECI out of all 52 submitted to the EU has achieved any change in policy,sadly a farcical reminder of non- transparency in action!

But was it worth the effort?  YES  

updated 

As a footnote and not wishing to open an argument, some critics were of the opinion that Advocates of the Efvi were obsessed with this, at the expense of all other available actions, such as meeting and letter writing to MP. I can state with certainty,in the case of this author,that was most certainly not the case. Many positives,as highlighted in the commentary below resulted from this ECI, probably the greatest was finding many new like-minded European friends and colleagues.

Another positive,and as a direct result of the Efvi collaboration,was the establishing of  the Daily News service from  http://vapers.org.uk/ which has an ever growing following around the World not just the UK,



Friday, 6 November 2015

Dear Representative Read This

Dear representative

Please read my short letter to you, I am a 62 years old male in your constituency who had smoked at the rate of upwards of 40/day over a 45 year period. My efforts to successfully give up smoking took over a 10 year period and involved all of the traditional methods such as patches,gums,sprays , prescription medicine(champix),hypnotherapy,Allen Carr book - all of these failed in a matter of days or weeks

Smoking is an expensive and not particularly healthy pastime and is obviously strongly dependence forming,so after trying and failing with all of the above methods I had resigned myself incapable of giving up or 'gave up on giving up'

I really do not want to appear or sound like a salesperson in what I wish to say next ,so please don't instantly dismiss it as commercial hype.

Purely by chance on a pedelec forum (electric bicycle) a fellow forum member charted his progression from smoking to using e-cigarettes over a 1 month period,explaining the process+pitfalls, and was generally very informative.I decided to do some detailed research into the various products and ordered a reasonable quality starter kit.

This was nearly 3 years ago,and I can truthfully state that I have never used a traditional cigarette since that date, the product evolution over that 3 year period has been quite remarkable, to such an extent I have no desire whatsoever to return to smoking, as I now have a more enjoyable product that is immeasurably safer and many health benefits have resulted . Please read for a moment http://alanbeard.blogspot.com.es/2015/11/relapse-prevention.html for another major plus.

Powys has no dedicated shops to purchase the more modern equipment, but you should be aware that these exist and bear absolutely no relationship in terms of appearance to a traditional cigarette, and 66% of all e-cigarettes bear no resemblence.

The main reason and point of my letter to you is to discuss the provisions of the Public Health Wales Bill.This will directly impact myself and other users of e-cigarettes, if the proposed ban on the usage of e-cigarettes in indoor spaces continues unabated.

I have given written evidence to both the Welsh Government and WHSCC consultations, and consider myself quite well informed on the subject (please read other blog entries of mine on here to confirm that statement)

So I am asking if you will please express my concerns that an evidence free approach by the Welsh Government on this matter will have a negative impact on the health of existing and future e-cigarette users (present smokers).

ASH estimates 130,000 total Welsh e-cig users of which ~56,000 are solely using e-cigarettes.It would be a Public Health disaster if a substantial number of these returned to smoking, due to the negative message from the proposals. As you will be aware widespread opposition,not only from the general public exists http://www.yourassembly.org/use-e-cigarettes-public-places-banned/, but also from many organisations such as ASH.CRUK,CEH,Tenovus,PHE,RCP,RSPH,Fresh,...etc who similarly agree that the proposals are unjustified.

Yours

G.A.Beard



Mark Drakefords written 'evidence' to the Welsh HSCC published 5th November

This:- http://www.senedd.assembly.wales/documents/s45375/HSC4-29-15%20ptn%203%20additional%20information%20from%20the%20Minister%20for%20Health%20and%20Social%20Services.pdf was published on Thursday 5th November in the HSCC minutes,sent from Mark Drakeford to the WHSCC as supporting evidence following his recent appearance in front of the committee.

Itemising the 4 provided links to evidence :-


1)  http://static.www.bmj.com/content/351/bmj.h4863

This features Simon Capewell and Martin McKee, both highly conflicted anti e-cig opponents,who in this dire attack on the landmark Public Health England report offer no valid scientific argument to the study conclusions.They have no expertise in this area of study,and simply providing rabble rousing commentary and innuendo.This is much to the detriment of the population,hence they could be characterised as renegades of pragmatic Public Health .

 The comments section to their baseless attack are far more illuminating,especially this one from PHE study author Ann McNeil http://static.www.bmj.com/content/351/bmj.h4863/rr

 This is further reinforced via expert commentary on SMC  http://www.sciencemediacentre.org/expert-reaction-to-article-questioning-the-evidence-on-the-safety-and-efficacy-underpinning-phes-recommendation-of-e-cigarettes-as-an-aid-to-quitting-smoking/


2)  CEH report (a grandiose title:- centre for environmental health)

 http://www.ceh.org/wp-content/uploads/CEH-2015-report_A-Smoking-Gun_-Cancer-Causing-Chemicals-in-E-Cigarettes.pdf

This sounds like a reputable organisation - WRONG it is a group of ambulance chasing lawyers who sue companies for breaches of the bizarre California Prop 65  https://en.wikipedia.org/wiki/California_Proposition_65_(1986)

:-they intimate in the pdf that they have commissioned testing of e-cig liquids, and found problematic levels of toxic substances  BUT failed to fully disclose the findings and testing methods.

3)  CDPH claims

 http://www.cdph.ca.gov/programs/tobacco/Documents/Media/State%20Health-e-cig%20report.pdf The author resigned from his position of Director(under a wave of scandal) prior to publication of this scaremongering nonsense, that has received universal condemnation.

 http://www.prnewswire.com/news-releases/a-response-to-the-cdphs-anti-e-cig-campaign-from-florida-based-electronic-cigarette-company-totally-wicked-300023216.html  many links here to further commentary

Dr Michael Siegel gives his analysis of the CDPH report http://tobaccoanalysis.blogspot.co.uk/2015_01_01_archive.html

Jacob Sullum on the same subject https://reason.com/blog/2015/01/30/california-declares-e-cigarettes-a-commu#.9rhunp:mJPy

Tom Pruen deconstructs the nonsense and gives further links   http://www.ecita.org.uk/ecita-blog/california-%E2%80%93-font-world-class-propaganda

4) Mark  Drakeford eludes to this

https://aspire2025.files.wordpress.com/2015/05/2014-aspire2025-anual-report-high-res.pdf in his reference to

''A Preliminary Investigation of the Consequences of Tobacco Company Involvement in the E-cigarette Industry by Richard Edwards, Nethran Pathmanathan, Janet Hoek, Marisa De Andrade and George Thomson from the universities of Otago and Edinburgh to the Population Health Congress in Hobart in September.''

Without wishing to be overly dismissive, this features some well known extreme prohibitionists,who are hardly neutral or without conflict of interest ( negative approach due to perception of marketing plots! ) eg this person http://www.otago.ac.nz/marketing/research/research-areas/otago079928.html a well known opponent of e-cigs.

Summary .....none of this is evidence of anything of substance whatsoever, other than Mr Drakefords increasingly desperate attempts to justify his illogical and highly unpopular so called 'modest' proposals towards e-cigarettes. Implausible,thoroughly debunked, cherry-picked historical information adds precisely nothing towards the evidence in front of the WHSCC.

Just as a footnote Mr Drakeford quotes the WHO on many occasions in discussions - this letter from 53 of the worlds foremost experts should be assimilated asap by the HSCC  http://nicotinepolicy.net/n-s-p/2003-glantz-letter-to-who-the-importance-of-dispassionate-presentation-and-interpretation-of-evidence

Thursday, 5 November 2015

Relapse Prevention

An interesting twitter exchange provoked this entry.

There appears some resistance in UK Government circles,and other influential sources,to acknowledge the concept of long-term e-cigarette use as a method to maintain  tobacco smoking cessation.

This appears totally contradictory when NRT is available for long-term use as approved via NICE guidelines to prevent relapse


It is totally inconsistent that NRT can be approved for Relapse Prevention,but the same logic cannot be applied to long term use of e-cigarettes. What is the desired  Public Health outcome from any method ....  maintaining Smoking Cessation!

This is not simply a lifestyle choice,but one of actively preventing the all too easy relapse back into smoking,that remains a possibility,especially in an overly restrictive regulatory regime.

For anyone who has used e-cigarettes for any length of time in a relatively(to date) free market,this is probably highly unlikely,but requires no further elaboration at this stage.

So is our government attempting to limit the recommended usage of all e-cigarettes,or just the ones purchased as consumer products? 

Will the MHRA approved nicotine inhaler- the VOKE be also subject to restrictive long-term usage recommendations,or indeed any other 'medicinal e-cig'(if such a product was ever was allowed to appear)?     Of course NOT!

** there are of course exceptions

Should consumer-products have artificial term usage restrictions placed upon them without justification?

Does relapse prevention depend on 'approved -products'. It most certainly should not !

Just as an aside,I wonder if all of the methods of smoking cessation could be compared,with follow up surveys monitoring 12 month users(minimum),over a period of time(3 years). I would wager that Vaping would have the greatest success rate of relapse prevention,this is supposition of course.I wonder when millions of £$ are squandered on largely pointless research projects(eg monitoring social media),why such a survey is not attempted. Some agencies of course do not wish for such information,preferring to attempt to keep the genie in the bottle.

 NICE needs to update its advice post haste,and that Government Officials need to take a far stronger positive lead,rather along the lines of Public Health England.Harm from long-term use has not been demonstrated,advice(+/-) could be amended accordingly over the coming years.The failure to adopt a more pro active approach at this stage will result in more harm than good.Doubts instilled into a generally misinformed public regarding e-cigarettes,are not well served by sensationalist and inconsistent media coverage.

Whilst caution can be expected from our regulators,they must consider the consequences of inaction or indeterminate delay.Assessing when long-term data exists,sufficient to recommend e-cigarettes as a valuable relapse prevention tool is the crux of the matter here.....Does this exist already?

Generally,the golden opportunity offered by e-cigs to solve the smoking epidemic around the World could be squandered,overly cautious bureaucrats and regulators,lacking in foresight or the will to ignore largely moralistic non-scientific arguments,(and blatant propaganda from certain organisations)must take note.

As is usually the case,existing long term vapers may well be self-sufficient (worryingly,maybe via the black market),when grossly inappropriate and disproportionate regulations are introduced from May 2016(TPD).However,existing smokers need some unequivocal positive encouragement to switch to e-cigarettes from the government,with the message effectively conveyed to the public by advertisment campaigns,not just a web-page entry.

The issue of long-term use must also be resolved by Governments,it is perfectly clear that the vast majority of existing long term users have zero wish to desist from using their relapse prevention device!

As a final take from this,please try to instil in any who are prepared to listen,the concept that Relapse Prevention is what we are participating in .......not just simply enjoying ourselves,since the discovery of what is a more pleasurable,safer way of using nicotine :-)



******************************************************************************


Updated (And  arguably should be a different blog entirely) - read on at your peril! PLEASE just take the main point from ABOVE^^^^^^^^^^^^^



I shall not name the author of this commentary, but it certainly introduces yet another element, overlooked by myself into this debate:- WHO.

I believe (possibly incorrectly) that this is advice and not obligatory for Governments to adopt.Certainly the advice is a polar opposite of what the majority of ~50 million Worldwide consumers probably desire, the largest fear I would suggest from all users is relapse back to smoking. 

However,WHO seemingly accept the medicinal use of nicotine as a public health option,but not for relapse prevention (not recreational)use. This is clearly a problematic subject, that needs far more open transparent debate from a secretive unaccountable organisation. 

Prof Michael Russell outlined  the obstacles placed in the way of nicotine replacement as far back as 1991. Has much changed since then?

Surveys undertaken have repeatedly indicated that at least 50% of the population(and rather surprisingly doctors also), have a totally incorrect perception of the harm and dependence potential of nicotine, when not associated with combustible tobacco. Calls for national debate remain unheeded from many sources regarding the harm and benefit

 As Etter and Eissenberg established ,the dependence levels of electronic cigarettes were on a par with nicotine gum ie 'not very' so why is this a concern?

This reinforces the paradox regarding long-term usage of NRT and e-cigarettes,to this author, this has neither a scientific or rational basis. 

 Professor Jason Hughes (Leicester Uni Dept of Sociology) argues that that restrictions will be applied due to social pressure rather than healthcare issues .

 Complete Nicotine Cessation appears to be the misguided, and unachievable objective of WHO.

This is totally counter-intuative and at odds to achieving Smokefree targets in an acceptable timeframe,without attractive viable alternatives readily available.

Attempting to remove or restrict the use of a popular and effective smoking alternative, that plays a similar role as NRT in relapse prevention is narrow sighted and foolhardy. 

A very recent article encapsulates many of the moral arguments regarding nicotine use, in its case for banning smoking, in this authors opinion there is absolutely no requirement for such drastic action.

This would in all probability be doomed to failure, causing much angst in the process,with a thriving black market and a dissatisfied group of smokers.

Smoking could be eradicated without coercion,whilst maintaining choice, IF all influential bodies concerned adopted a more positive approach towards e-cigarettes.

Many schemes to assist switchover could be advanced,however this is a radical departure from the 'norm' with a few notable exceptions eg 

 Leicester Stop Smoking Services  Manager :-Louise Ross  Pioneer of introducing e-cig friendly services 

 Public Health Consultant :-Lisa McNally - To vape 

Hertfordshire Public Health Director :- Jim McManus -How etc Which is a remarkable  and hopefully seminal account of his transition from sceptic to advocate, this should be compulsory reading for all engaged in Public Health. 


However,my update has now strayed somewhat.......RELAPSE PREVENTION is the message here!


And, far more scholarly papers exist that expand upon this concept









Another powerful well made call for WHO to adapt its very limited approach towards Nicotine  is made,outlining a far more visionary approach 


However resistance remains  
 

I am unaware of the gentleman concerned,but how prevalent is this attitude and approach? 

Neuberger appears in this excellent, blog with his conflating  'E-Cigarettes A Wolf in Sheeps Clothing', singularly failing to recognise that the tobacco and independents(of tobacco) are two distinct entities. 



At the recent e-cigarette summit Professor Peter Hajek  outlined THE PROBLEM

  producing the following telling graphic.







A completely unrelated graph ........ what is its point?  its one of the many areas where zero proportionality is applied to by opponents, seemingly for mischievous purpose.


courtesy of @Jake2001








Sunday, 2 August 2015

Blatant Mistruths and Spin

This guy
 (487 twitter followers) is one of the worst examples of a supposed educated man with a constant gripe against e-cigs . I have read his posts previously, ultimately deciding to unfollow him as he simply puts out propaganda on an epic scale, and as is usual, refuses to engage.

Two recent posts were highlighted by others and curiosity got the better of me

If the 2 links are not clear for you I will highlight what they lead to here http://www.atsjournals.org/doi/abs/10.1164/rccm.201505-0898ED?journalCode=ajrccm#.Vb1P2W5Vikp

and http://www.atsjournals.org/doi/abs/10.1164/rccm.201505-0915ED?journalCode=ajrccm#.Vb1QCG5Vikp

Both of these 'extracts' demonstrate what is  produced  ad nauseum from supposedly learned but misguided people. Just a cursory glance very quickly confirms that these are not in any way balanced, scientific pieces of work rather a hysterical,scaremongering piece of  opinionated garbage, more akin to the gutter press. Scepticism is acceptable but blatant agenda driven drivel is certainly not,I wonder how many of the commentators are expert in the field of smoking cessation? Or indeed any field that could add anything much of use to the ongoing 'debate', that every man and his dog has decided to pass an opinion on, usually with negligible knowledge.

An excellent article by Lindsay Fox summarises ''How to Write a Bullshit Anti-Vaping Article'' http://ecigarettereviewed.com/how-to-write-a-bullshit-anti-vaping-article this undoubtedly could be extended to include the blatantly biased studies and attendant hyped up press releases that are unquestioningly published around the World by the syndicated press.

Stanbrook has the gall to say ''Don't be fooled by #ecigarette 'proponents' spin ''   Hah!

How can this guy just blatantly ignore independent surveys conducted Worldwide that UNIVERSALLY state that the number of non-smoking teens regularly using e-cigs is of the order of <2% and substantially less in many .

 Professor Linda Bauld confirms here http://vaping.com/ecigsummit2014/linda-bauld

 ASH UK statistics http://www.ash.org.uk/files/documents/ASH_891.pdf

Cancer Research UK http://www.cancerresearchuk.org/about-us/cancer-news/press-release/2015-06-12-research-shows-most-children-do-not-regularly-use-e-cigarettes

ONS (Office for National Statistics) http://www.theguardian.com/news/datablog/2014/nov/25/e-cigarettes-not-gateway-traditional-smoking-great-britain?CMP=share_btn_tw

Many similar links could be provided for the individual States in the US demonstrating negligible numbers of non-smoking youth taking up e-cigarettes on a regular basis.

This article from Brad Rodu highlights part of the deception that seems rife when discussing numbers http://rodutobaccotruth.blogspot.co.uk/2014/04/nejm-fails-to-correct-data-on-childrens.html

The other article Stanbrook highlighted was calling for for more data - I'm surprised he didn't call for clinical trials! Oh wait .......US seems to put impossible hurdles there!! see esp P2 http://www.forbes.com/sites/sallysatel/2015/07/30/double-standard-for-e-cigarettes-v-medical-marijuana/

Once again an outbreak of hysteria, there is more than enough existing data for any reasonable person or medic to conclude that some unknowns still exist, but that e-cigarettes are undoubtedly a  substantially safer option than the alternative. For a good list of current studies see http://blog.rursus.de/studienliste/

For further confirmation of how pragmatic Health Professionals feel, I encourage the reader to examine M.O.V.E. http://moveorganization.org/move/ and try to encourage further involvement with their own acquaintances or indeed anyone else to extend into more countries and numbers

Finally I will leave the last words to Kevin ......... Who has tirelessly worked to produce both a Consumers Survey https://vapinglinks.wordpress.com/2015/06/22/the-vaping-truth-survey-is-now-live/   and a Health Pro Survey here https://vapinglinks.wordpress.com/2015/05/28/health-care-professionals-and-e-cigarettes-survey/

Read this excellent blog from him describing the early results of the Health Pro Survey https://vapinglinks.wordpress.com/2015/07/31/medical-professionals-say-what-about-e-cigarettes/

To conclude, thankfully there are many in the medical profession who are far more open minded than the likes of Stanbrook who appears to have set himself on a mission to become a wannabe 'Stan'(from UCLA)

****** Updated following horrific propaganda and spin at #ATS2016 Wednesday 18th May

this poster was the prelude to a series of manic tweets that featured a co-author of Stanbrook in his latest so called research with an  abstract of the ATS presentation here  
 


I suggest a look through Sean Spence (co-author) tweets on this date are called for look here  Again the point I made above are these the acts of dispassionate rational scientists/medics? I really doubt it!

The agenda is perfectly clear to my mind 



Sunday, 12 July 2015

An unashamed plug for Daily News in vapers.org.uk

Firstly I must state a conflict of interest, I along with a number of others (12 currently) voluntarily find news articles ,research papers and blogs of interest ,these are then assembled,curated and published by the mysterious editor.

The idea originated in October 2014 with the first Daily News published in November, this is put out on the website http://vapers.org.uk/, Facebook https://www.facebook.com/vapers.org.uk and Twitter https://twitter.com/vapersorguk

Obviously I am slightly biased, but the content and presentation would lead me to suggest this is the leading daily resource, especially for busy people who cannot spend all day trawling through a multitude of Facebook posts. Twitter used to be a very good resource especially when it had the 'Discovery' feature,but sadly this has now been removed.

If you have never tried the Daily News give it a go and register your appreciation with twitter and Facebook likes (500 just achieved btw) , the other alternative is to receive your Daily News by e-mail

to find the above,simply click http://vapers.org.uk/category/latest-news/ to find the subscription information on the right hand side of the page

If you do have interesting blogs or news articles not covered that you feel would be of general interest contact vapers.org.uk through any of the above avenues mentioned earlier .

Happy Reading

Wednesday, 8 July 2015

Evolving Nicotine Usage and Consequences

I must state from the outset that my conversion from ciggies began in February 2013 on a nicotine level of 24 mg/ml and  continues at the same strength to this day. All advice given in those early days from any respected source (forums) stressed that at least 18mg/ml or higher was required for a successful transition

Expert advice from Professor  Bernd Mayer expresses this in great detail here http://www.bernd-mayer.com/how-to-switch-from-tobacco-to-electronic-cigarettes/  another interesting blog covers aspects here by Norbert Zillatron https://nzillatron.wordpress.com/2014/11/01/dimishing-dependency/ 

There does however seem to have been a massive change in nicotine strength usage and patterns over the last 12 months which can be attributed to a number of factors 

These results have been obtained by kind permission from Kevin Crowley whose excellent ongoing survey I highly recommend everyone to take part (note current info relates to ~2700 persons) in https://vapinglinks.wordpress.com/2015/06/22/the-vaping-truth-survey-is-now-live/


The above shows a vast amount of information but the most remarkable is the massive change in user nicotine strengths.

Liquid manufacturers and vendors statistics confirm this is happening(sales data) , its not as a result of  panic over impending draconian and illogical regulation this is a consumer led evolution .

Or is it ? read Paul Barnes excellent blog http://fdm.ukvaping.com/2015/07/what-are-we-fighting-for/ are vendors and manufacturers driving the, or reacting to, consumer demand? 

( I am sounding like this guy now https://www.youtube.com/watch?v=SvfTa_B3hGA so will promptly shut up)!

So maybe its the rapid evolution of the products that researchers such as Ann McNeil have noticed and done preliminary studies http://www.kcl.ac.uk/ioppn/news/records/2015/April/New-e-cigarette-research-on-type-and-frequency-of-use.aspx  BUT this omits that devices have  further evolved,  to be far more efficient at delivering satisfying results via reduced nicotine concentration liquids,This highlights the problem for researchers, struggling to produce current real world data in a rapidly evolving market.

The next two results show this dramatic shift in the users choices of devices 



So what are the consequences ?

1) Probable increased usage of e-liquid in the latest high-end devices(high wattage possibly temperature controlled) with 'sub-ohm' tanks, using a low nicotine concentration content, as users self titrate, probably to the identical total of daily nicotine used(guesstimate). This in itself should not be especially harmful but just may increase the possibility.

2) Advice to new switchers is a very important and  a problematic area, should folks give advice as in the opening paragraph ie relatively simple devices that require high nicotine concentrations, but becoming  increasingly unavailable and will be regulated via the TPD to 20mg/ml (barely enough to satisfy new switchers)

Alternative advice could be to suggest the latest high powered devices and tanks but this avenue has many potential pitfalls.

3) Kevin's survey (below) shows 25% of consumers who either currently or could mix their own liquids this has increased enormously over the last few years as the numbers of experienced users has multiplied. 

May 2016 in the EU will see the TPD introduced with mixing supplies under direct threat regarding  bottle size restrictions and usable strengths. Obviously the survey throws up many other unintended consequences the most disturbing for regulators should be the first two on the list especially 'Will go to the black market'.


4)Regulators,advisers and their researchers appear ill informed in many aspects eg market share http://alanbeard.blogspot.co.uk/2015/06/e-cigarette-market-myths.html current,factual 
 information is required to aid their comprehension of smoking harm reduction. However, opportunities can be totally overlooked,due to misinformation,poor advice and possibly hostile external influence. For an eloquent plea to her own legislators read http://www.scoop.co.nz/stories/GE1507/S00032/is-nz-ready-for-consumer-driven-quit-smoking-programmes.htm this summary from Professor Glover  

Sunday, 5 July 2015

Breaking Out #1

These are just a few rambly thoughts put down more for me to refer to,but may provoke others to add and refine in a far more eloquent manner

Vaping advocacy involves getting across truthful messages,education and information about campaigns, but we have had very limited success so far in this. This is not a criticism,simply a statement of fact,that the 'message' is only heard by relatively tiny numbers of devotees inotherwords 'preaching to the converted'

Without me ranting about Vaping  Facebook groups and Forums that have little interest in such matters(some rare exceptions)  it brings me to other options that need exploration

Following a series of twitter exchanges with friends it led me to thinking about something we all have probably considered, maybe tried,maybe failed. As a forerunner to me trying and obviously succeeding with my conversion to e-cigs I used to spend long hours on a pedelec(electric bike) forum

Lo and behold I stumbled across this month old thread (at that time) http://www.pedelecs.co.uk/forum/threads/electronic-cigarettes.13501/ as a heavy smoker @40/day over a 45 year period I was inspired by the thought process and experiences charted by the author and inspiration for the blog @neptune  and swiftly joined a forum (http://allaboute-cigarettes.proboards.com/ and received some great buying advice - needless to say it worked! Can I add that the pedelec forum thread is the longest running most popular thread on an Electric Bike Forum.

this was started in pedelecs in an 'off-topic' chat section , Similarly but with less success I started something similar in another pastime http://www.motorhomefun.co.uk/portal/

*updated* @balbecdaze (Liam) put forward this as another eg
http://www.mumsnet.com/Talk/am_i_being_unreasonable/1912752-AIBU-to-STILL-feel-positively-evangelical-about-electronic-cigarettes-thread-2

We all have pastimes !! that we may belong to on forums - have they got an off-topic section?

Another very obvious way is to write factual replies in newspaper articles and journals,avoiding angry ranting if at all possible - they are great free opportunities to further our messages

These are very simplistic ways of trying to spread the message 'outside of the box' ....we need very many more ......to be continued


Saturday, 4 July 2015

Apathetic, Broke or Ignorance

There has been a number of calls for collections of money in recent times to assist various campaigns, an ill-fated e-cigssavelives campaign in 2013 , 2 crowdfunders for Dr Farsalinos in 2013 and 2014, Dodo-Boxes for the Efvi campaign 2014 and NOW donations to a political party that has pledged to use the money to help to gain signatures in Wales https://ldwales.nationbuilder.com/ecigs_donate

One thing that has always struck me throughout each of these campaigns is the relative difficulty in getting the required totals achieved

Consumers

Apathy   - how many know about these campaigns who just ignore them? 'seen it all before' , 'nowt to do with me' , 'why should I bother' , 'its scaremongering', 'not going to happen'. Forums and Facebook pages abound with chat about new devices,swaps,coil builds etc  but getting involvement in advocacy/petitions/collections is so bloody difficult. Some actively make this difficult (5th columnists - luckily few of those, but they do exist!) by hi-jacking and poisoning the purpose of the thread. I simply ask these people a question is it all about YOU?  maybe it should be about giving smokers the same opportunity that we have enjoyed. YOU may be able to manage in the future,but what about the millions of smokers who will not have ready access to products or even forums?

Broke - Undoubtedly times have been hard in recent years, but even a modest token donation of £1 boosts the totals and indicates both moral and financial support. A single  10ml bottle of bought liquid £3-£6! - could that money have been donated if you thought about it?

Ignorance- Many excellent resources exist , there is no excuse to be in the dark!
eg
 http://nicotinepolicy.net/
http://gfn.net.co/2014
http://www.ecigarette-politics.com/
http://www.clivebates.com/
http://vapers.org.uk/
http://www.vapourtrails.tv
http://www.ecigarette-research.org/research/index.php
this represents a tiny amount of excellent quality resources
join http://nnalliance.org/ as a supporter(free)

Another feature that is perplexing to me and really the purpose of this blog

Vendors 

Firstly, let me state categorically this is not directed at all vendors but, and a very big BUT at way too many 

WHY

1) No donations from you towards fundraising ?
2) Why not informing customers properly about important campaigns with newsletters,mailshots,Fb + Twitter entries?
3) Why not actively campaigning as above- Is anything on your website about ANY campaign ?
4) Why is activism in general ignored by you ?

graphic courtesy of @VaEHp  who points out what you already know, its the will to do it that's sadly lacking!

I have heard many moans from the dedicated consumer activists about this irresponsible, incomprehensible lack of feckin interest from vendors who seemingly don't care a jot, why should they be left to fight OUR battle alone?

Now is the time to MAN up not just STOCK up - because that will be a distant memory unless you get involved NOW

just as a reminder ,even though you shouldn't need it read Dave Kitson's excellent blog http://wp.thehappyvaper.com/?p=874

btw an important update from Totally Wicked - downloadable support forms for vendors + consumers http://article20legalchallenge.com/support-the-legal-challenge/

Tuesday, 30 June 2015

Why isn't Totally Wicked receiving more support?

Firstly, let me state I don't happen to use Totally Wicked products so have no conflict of interests

The TPD especially Article 20 has dire consequences for users, vendors,manufacturers of what is undoubtedly the most popular method worldwide of Tobacco Harm Reduction ie the bloody things work for a vast number of people and THIS is THREATENED

Without a definitive and  long winded history of  opposition towards the TPD, two campaigns have received modest support from the general public

EFVI  http://www.efvi.eu/  which although now complete received 185,000 signatures (the totals continue after the expiry date) . From an estimated 10 million users across the EU this was disappointing.

Totally Wicked http://article20legalchallenge.com/challenge/




These figures imply that  many of our European neighbours have either ignored this or considered it a UK only initiative with zero relevance to them . 

Surely,in the absence of anything else to challenge the TPD WE all should be  actively supporting the actions of Totally Wicked . 33,437 signatures of support (taking 5 secs) is mediocre at best . Let them walk into the courtroom with a minimum of 100,000 signatures of support to strengthen their argument . 

Who else is mounting a  very costly legal challenge from any direction?now is the time to put  commercial expoitation fears and any past bad feelings (whether justified or not) towards TW aside.

Fatilistic or 'bury the head in the sand' approaches are not required - get supporting! 


 ps..  If you are still dubious, please read this excellent blog http://fdm.ukvaping.com/2015/04/why-we-should-support/ that is very persuasive 

Where Half truths misinform



This is my starting point, the above comes from the Explanatory Memorandum justifying the Welsh Government proposed Bill to ban the use of e-cigarettes from all enclosed spaces  http://www.assembly.wales/laid%20documents/pri-ld10224-em/pri-ld10224-em-e.pdf  , I will highlight the 3 linked sources contained 



199:- http://ecigintelligence.com/

The last of the 3 links provided in the justification could be described as literally misleading (199)

The factors mentioned in the document ie over- saturation and age of sale restriction may well have played a part in the dramatic reduction of the e-cigarette market but ignores the role of a relentless negative campaign towards e-cigs that exists in Spain mirrored in the media.

One particularly high profile lipoid pneumonia scare story attracted enormous press attention, and even though the offending doctor was successfully challenged in court that was not deemed newsworthy. Two excellent blogs explain this in far more detail http://www.e-volutas.com/2014/01/expediente-l-la-falsa-neumonia-lipoidea.html , http://vaporyciencia.com/sobre-el-glicerol-y-la-pretendida-neumonia-lipoidea/

The afor mentioned ecigintelligence eludes to this here http://ecigintelligence.com/a-tale-of-two-tank-markets-success-in-u-s-woes-in-spain/

Propaganda is clearly rife in Spain, the observation that 'repeat a lie often enough until it becomes the truth' seems very appropriate here, and by implication the Welsh Government who cherry picked its 'evidence' to justify its proposals

The real scale of the reduction in e-cigarette use in Spain is a 90% reduction in retailers and 80% of consumers since early 2014, this is an unfolding tragedy of monumental proportion.

Yet the WHO on advice from local tobacco controllers estimate an 8% reduction in smoking rates from 29-21% in the upcoming 10 years http://apps.who.int/iris/bitstream/10665/156262/1/9789241564922_eng.pdf?ua=1, without THR products this seems an overly optimistic estimate.

Once again I encourage readers to visit here  http://jester-midnightmusings.blogspot.co.uk/2015/06/hscc-issues-call-for-evidence.html,which is an excellent explanatory blog from Simon Thurlow for actions that Vendors and Consumers should read and act upon.