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

https://www.dropbox.com/s/yk1e0vmun2l0giv/UK%20Flavors%20Only%20Vaping%20Truth%20Survey.pdf?dl=0  

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

http://www.mdpi.com/1660-4601/10/12/7272/htm  

 

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   

http://www.ecigclick.co.uk/e-cig-research/flavoured-e-liquids-help-smokers-stop-using-tobacco/ discusses this also 

Vaping profiles and preferences.......Dawkins et al http://www.researchgate.net/publication/236102505_Vaping_profiles_and_preferences_An_online_survey_of_electronic_cigarette_users 

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 * 

 ECF Big Survey 2014  http://vaping.com/data/big-survey-2014-initial-findings-eliquid 

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 . 

  xxxxxxxxx  11th August 2018 Update  xxxxxxxxxxxxxxxxxxxx

Dr Farsalinos Flavour submission to the FDA request for comments 

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

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 

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

FOREST = http://www.forestonline.org/

NNA = http://nnalliance.org/

VIP = http://vapersinpower.co.uk/

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,

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

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  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

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/ 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110871/

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066317

http://notblowingsmoke.org/tag/e-cig/

http://www.ecigalternative.com/ecigarette-studies-research.htm 

http://www.discoverymedicine.com/Riccardo-Polosa/2015/09/what-to-advise-to-respiratory-patients-intending-to-use-electronic-cigarettes/

http://www.harmreductionjournal.com/content/10/1/19

http://www.jmedicalcasereports.com/content/5/1/585

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. 

Is this part of a concerted campaign highlighted here ?

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