New Head of RCGP provokes an angry Twitterstorm

This was the title of a Times Article  that appeared on Christmas Eve

''Put vaping under medical control, says GPs’ leader '' 

Dick Puddlecote immediately covered this in his own inimitable style here 

There's A New Idiot In Town  

I for one expected that would be the last we heard about this from the new head of the RCGP(Royal College of General Practitioners)  and here  .

But no, thanks to interventions from the likes of Lord Hunt (also President of RSPH) and presumably behind the scenes anger from RCGP members. 

A mini retraction was issued by the lady 

If one looks at her original quotations in the Times 

and 

Irrespective of whether one word was a mis-quote, taken out of context,the nature and tone of the quotations are perfectly clear to any reader,and what prompted my blog..Helen has badly misjudged here, and a speedy retraction and clarification is most definitely required. Whether through Chris Smyth the Times journalist, or via her own RCGP blog to confirm the agreed policy,either avenue needs pursuing asap.

The recent RCGP policy position was announced less than one month ago,and was commented upon in a previous blog which noted that every single respected Public Health body was e-cig supportive,with the exception of the BMA and a few noisy renegades.

''To vape or not to vape? The RCGP position on e-cigarettes'' 

The timing of this article in the Christmas- New Year  peak resolution period to Stop Smoking is particularly unfortunate,specialists in this field of study will be dismayed at the apparent naivety displayed.I could fling further mud at Helen, regarding her recent forays into the mass media.However that would be counter- productive,but I strongly suggest that she takes the wise and honourable step of a full retraction to clear this particular sorry mess up.

To conclude this,I leave this short but very cutting comment.

PS***

 My commentary assumed naivety and inexperience from Helen, and thus was of a charitable nature.However,there was a clear similarity in her commentary with that of the Public Health renegade element I mentioned earlier.If Helen has fallen under their influence, I suggest a rapid rethink is called for, as they are becoming increasingly isolated,so back the righteous and winning horse,....'You decide' !  

As another update this confusion at the RCGP resulted in this video from BBC South on the 4th January  the in video commentary was annoying, the accompanying general public comments truly mind-numbing in their ignorance and lack of empathy. 

**** noticed 26/7/17
Further updated , the RCGP website has removed any reference to the policy position from November that was 'reasonable' and any search on the website => fault page,..... thus leaving the commentary from Helen as the ONLY resource from RCGP covering the topic of Vaping. Does this adequately cover the complexity of the topic :- 'You Decide' 

'Moments' on Twitter :- An Aid to Info Gathering?

If like me you don't always spot what Twitter and Facebook 'updates' have actually done,please read on.

Once again a twitter conversation piqued my interest with a feature that has been on the twitter dashboard for months Moments wtf are they ? I had occasionally glanced through at the feature and decided(incorrectly) that there was nothing there of use.

Many thanks to Moments (read link)guru Norbert Zillatron  for his subtle guidance to allow me to scratch at the surface of what is actually possible with this feature. Within 24 hours I was producing this as an example of a quick 3 hour collection of anything I could locate on Battery Safety 

 The virtue of  any Moment that you produce, is that it updates itself in real-time when you add or edit it, entries can be moved up/down or removed at any time..

Ho hum I hear some of you saying .

What else is possible to build upon that , Neil Robinson suggested curated research links were possible :- accessible to anyone eg using a # like

#MomentsResearch or whatever, but endless possibilities are possible see here for my effort so far

There exists much knowledge out there on Social Media, google search,google scholar....etc etc Bill Godshall gives a comprehensive weekly update regularly published by Chris Price , there are Daily updates from Nicotine Science and Policy can we have too much information. Most of us bookmark pages and generally store away information on an individual basis on our devices.

What I see here is the germ of an idea that could result in a 'twitter persons library' and I advocate that we all embrace this notion of creating 'Moments'

****
 SEE  #CollectionOfVapingMoments - This is a very powerful feature that has the germs of an idea to create a central library accessible to anyone! At the moment about 10-12 moments exist in that collection #

IMPORTANTLY anyone can add their own Moment here on a topic that may be of General  Vaping Interest. We all have strengths+ weaknesses along with many varied interests, as long as the content is Vape related eg from DIY mixing up to high-powered research anything is fair game for inclusion.

The Library creation feature seems well-worthwhile pursuing, and may be a useful addition for any of the major Vaping Forums, where they could readily take away the useful links that are contained within. Maybe they could encourage their members to add their own Moments to the #CollectionOfVapingMoments? <<< Please examine the current content 

I hope this is a Sir Francis Drake moment of returning home with tobacco or potatoes from the New World rather than a blind-alley of fruitless effort. So some feedback would be more than welcomed

***
This was heavily modified on 16th December and may be updated again in the future

Two years ago a Fb group examined the feasibility of establishing a Library,some good thoughts but not actions were the fruitless result of that. Could the more computer literate readers examine the possibility of transferring all of these Moments elsewhere to a website that would allow a search function (or is that an impossibility?) Or examine other avenues to utilise these Moments??

Antipathy of BMA towards Vaping

Vaping proponents and advocates of Tobacco Harm Reduction, in general, have been baffled and confused by the curious inability of the BMA(British Medical Association) to change its policy towards e-cigarettes. As an example of this, simply type search e-cigarettes onto their website a plethora of negativity results.

Following the Royal College of GP latest announcement, to align with the policy positions of most Public Health organisations in the UK, the BMA is now an outlier, along with a few influential rogue malcontents. ** note this announcement was revoked and replaced Jan 2017 by RCGP(no reason given)

It is unconscionable for them to maintain this position, especially as they seem to be the 'go-to' organisation for commentary on e-cigs in the media.Their media influence has undoubtedly influenced the attitude of non-smokers, and smokers alike, contributing to the dismal public perception of 15%  believing it much safer than smoking.

 Some absolutely shocking media interviews could be cited as examples here eg Banfield (Wales), Rae(N.E.) but I shall spare readers further grief.

Various conspiracy theories exist for this increasingly implausible policy position, maybe some have a part to play in the antipathy of the BMA,but it is this author's contention that the paucity of education(in Nicotine and THR) whilst training has played a huge part in their flawed policy.

Recent examples of this misperception exist a,b,c,d,e within Dr's and Health professionals, I maintain it could well be due to flawed, possibly biased but certainly incomplete Education(but we need a large UK study of this phenomenon to confirm this ).

A perfect example of what educators need to foster is demonstrated here, stimulate intellectual curiosity, and challenge the perceptions!

So Why is this important?

The BMA  policy has to be voted upon(via members proposals) by a membership who have anything up to 50% misperception of the harms of nicotine and the value of Tobacco Harm Reduction

The(possible) self-perpetuating spiral of ignorance reflected in its policy needs addressing AND SOON! Inaction literally does kill!

Naturally, this will not be unique to the UK, all Doctors Medical Associations around the World will probably demonstrate the same antipathy for similar ill-founded reasoning.

Time to #ReThinkNicotine ! and maybe they take some advice

Waffle about Press Coverage

As we are all too aware, the accuracy and narrative across the various media outlets varies enormously in general terms, but more specifically related to Vaping.

I cannot recall many other divisive or polarised topics in my lifetime,  that emulate this,with the possible exception of climate change(I am an agnostic with insufficient knowledge to voice a considered opinion), maybe Industrial relations(UK) in the 70's-80's qualify here also.

However, my attempts at memory recall, and unintended conflict of viewpoints in my above examples are not the purpose of this entry, more to highlight a few of the events over the last 24 hours,mostly of a minor nature but they need raising nonetheless,

Guardian article discussing poverty came up with

in the middle of an article on poverty and deprivation in South Wales. 'dens of iniquity' and 'opium dens' are what were conjured up in my mind by the authors' use of den. Whether intentional or mistakenly it gave off a subliminal message that there was something seedy about a vape shop. 

A local Newspaper then came up with this irresponsible trash with quotations from poorly informed councillors. 

The resulting comments are a model of what should happen at any level of media  mis-reporting. Challenging garbage is crucial, but once again can we help to gain control of the narrative here - give your local press some stories that they may consider covering especially as they are always short of news. 

Two hugely contrasting stories highlight 'cool' or stylish  

This from GQ was one of the first positive pieces regarding a stylish product, usually most are dismissed as 'douch-bags' 'silly' etc etc ,this dross  typically un-amusing when referring to the topic . To me it matters nought what others may think what my product looks like, BUT it may well matter to a smoker who is considering giving Vaping a whirl. So GQ need a bit of a shout out from us maybe 

So nothing heavyweight or profound here(nothing unusual there!) 

***updated with more recent examples 

from  this Guardian article  

and 

from this one 

Researchers(and others!) Pet Hobby horses to Advance Smoking Cessation

 One observation that I have discovered over the last 4+ years(since stopping smoking), is the  illogical advancement of one cessation method over another ......I am excluding e-cigarettes and smokeless tobacco products from this debate (for now)

My early-teen smoking experiences were with Capstan Full Strength, Players Navy Cut or woe betide  me Woodbine, these were all unfiltered cigarettes and all very high nicotine (and tar) products. After trying a few filtered products, I found I preferred to use them, not for any notional tar -reduction but the fact that I didn't get a mouthful of fine tobacco, if I was careless placing between my lips.

 For 40+ years I happily puffed away in blissful ignorance of the so called science surrounding the filter apart from the very brief experience of  using Silk Cut which I found worse than useless, and either covered up the filter perforation holes or removed it entirely.

I make no apologies for giving you a potted version of the Beard smoking history, especially when the latest hobbyhorse from some quarters is the Very Low Nicotine Cigarette(VLNC) advanced by such groups  as Aspire 2025 , Tobacco Free Kids , Truth Initiative (formerly the Legacy Foundatiom) , Centre for Tobacco Control and Research at UCSF  

The reasoning behind VLNC is eviscerated by Dr M Siegel here 

Why do certain researchers and institutions come down in favour of one method,when as anyone who has gone through the experience of stopping smoking, can give a very detailed account of what worked for them, imagine a smokers version of 'The Wisdom of Crowds'!A cocktail of varied methods is the solution, humans tend to be like that -we respond differently to stimuli,some are more appealing and effective than others.

Clearly no coercion or nagging should be involved in smoking cessation, smokers have a very strong and well deserved reputation of 'digging their heels in'

From this authors point of view, simply give smokers  detailed,truthful, factual advice(if requested by them!). Also as wide an assortment of attractive smoking alternatives as possible, plus the traditional NRT and medications readily available, and simply allow freedom of choice.

Why should that be such a difficult concept? It is beyond my comprehension how and why puritanical approaches exist in a supposedly sophisticated 21st Century, tolerance,empathy and understanding appears in short supply whenever nicotine is the subject.

ps this excellent article further highlights the folly of VLNC  via Prof Lynn Kozlowski here 

Further updated with the announcement from the FDA critiqued by Clive Bates here  and from previously here

The very concept of VLNC is totally flawed,

1) Existing smokers have largely ignored VLNC forerunners(lights) in the past,what will make that change?  the market should not have government intervention when the harmful constituents in smoking are the smoke and tar, not the nicotine.

2) 'None of the pleasure for all of the harms' is the answer from any existing or ex-smoker who universally think this approach doomed to failure.

3) Maybe greatly increased harm to existing smokers due to compensatory additional smoking to obtain desired nicotine levels.

4) Black market would most definitely thrive if VLNC forcibly introduced

*** Jacob Sullum advances these arguments far more coherently   ***

5) Adolescent access to the 'scourge' of nicotine would not be addressed by this - they are resourceful!

6) There is a wealth of knowledge from 'laypersons' ie existing or former smokers that could and should be consulted (not lip-service) by researchers if they are wanting practical solutions that would have the chance of success.

7) I strongly suspect that VLNC has zero support from genuine smoking cessation 'experts', in my opinion it has been well- funded 'research' to support a pre-determined policy position(anti-nicotine) from the likes of the FDA (NIH) and WHO, with no genuine smoking cessation intentions. ie PURE IDEOLOGY

8) Watching two GFN video which are complementary towards VLNC  are here by Donny and by Hufford  present a somewhat compelling case, if taken in association. They present a solution that may be workable, but at what cost to freedom of choice towards existing smokers, this confuses this author greatly, as it's a moral minefield.

9) Apologies to any reader getting this far, this blog was written months ago,and updated at least 3 times, so it may well appear very disjointed with a mish-mash of thoughts and facts tossed in at random

10) Highlighting the possibility of the above point #8, If VLNC was to be a success, I believe they could be introduced with a huge financial incentive(ie very much cheaper than traditional cigs), a refund of the costs of using (if cessation demonstrated at say 12 months), but most decidedly no coercion involved towards smokers, choice remains the key in this 'debate'.

 Finally,talking of hobby-horses and ideology I really cannot forget the retired Sydney pensioner who eschews and denigrates anything other than 'cold-turkey',despite its abysmal success rate. He as per usual uses deception to advance his theory 'unassisted cessation remained the preferred and most successful method among smokers' - It is the most used method, but most definitely the least successful method, despite desperate attempts by colleagues to demonstrate otherwise who merely observed in their telephone survey of 1097 that 'cold-turkey' was most used. 

*** Further updated September 2017 

from these VCBH Conference submissions  see #16 

Rightful Anger and Bewilderment at Lack of Support towards A Billion Lives Screenings

This is a painful post to contemplate writing anything much positive about the recent UK fiasco regarding A Billion Lives screening applications. Two only, out of many applications have been successful :- Glasgow and Swansea, this is a hugely disappointing result so far and needs sorting out quickly

Simon Clark from Forest wrote this damning indictment  which is a very powerful summary, however a few points are inaccurate and in need of correction.

he states 1)...'Vapers have also risen to the challenge in Wales with a screening in Swansea on November 23 almost certain to reach its target thanks to Vapers In Power (Wales) and some local vape stores.' 

The 2 nominated persons associated with the screening and leading driving forces were Simon Thurlow(NNA trustee) and Rhydian Mann(NNA Associate and VIP member). VIP were also heavily involved to make this a success. 

another here 

 2) 'With a few noted exceptions I'm astounded the UK's leading vaping advocates have shown so little interest in organising their own screening or promoting someone else's. (The occasional tweet doesn't count. Getting out of bed takes more effort.)' 

This appears to be a direct 'dig' at the NNA, I will not spend too long on dismissing this ridiculous slur, ALL of the NNA consumer Trustees  + many of the Associates have actively campaigned and participated in organising screenings -  eg see David Dorn,Andy Morrison,Dave Kitson in action at the NEC in front of hundreds of Vapers at a recent event.(sadly no link)

3) ''I've lost count of the number of UK-based bodies that advocate vaping, some of them funded by the e-cigarette industry. Where is their 'Jeff Stier'? Where is their planning committee?'' 

I replied to Simon on his blog regarding this ambiguous statement which is open to many interpretations. To clarify, no consumer organisation receives any funding from the e-cigarette industry 

However, all of the above 3 points are relative nit-picking on my part :- the undeniable fact is that screening numbers have been hugely disappointing. 

Apathy and calls to make the screening available for free on the internet have abounded,but I personally think that local organisers maybe grossly underestimated what was required of them(this is not meant as criticism,just an observation). Following disappointing stories I along with others have assembled a guide to help future screening organisation see  here, but it is clearly obvious that 'we' are novices at organising and marshalling the necessary interest due to inexperience in such matters, we are not PR experts!). Another walkthrough guide is here  (but this doesn't give the nuts n bolts of how to do it successfully)

Enough of this reflection and negativity, hopefully anyone contemplating organising a screening will give the matter some serious thought before blindly blundering in on a tidal wave of enthusiasm and give the matter due diligence 

This documentary is a game changer, WE all have to up our game to give it the necessary attention to make it the success it deserves 

Defending the Indefensible

'New EU rules on nicotine strength not a problem for most vapers'  see

This is the headline from the latest press release from ASH, this author believes that this is not only disengenuous but that it is a political statement that attempts to mitigate the dogs breakfast that is TPD2, but more worryingly could be construed as an attempt to influence Vapers choice in the forthcoming EU Referendum #Brexit! 

ASH was formed in the early 1970's by the Royal College of Physicians, and amongst its many aims and roles it was designed to influence policy making in the UK and further afield jurisdictions. To this end it has enjoyed much success, and is widely held as a credible source of information BUT :- the long-term policy and aims seem to send very confused messages to observers and consumers alike. 
It is outside of the scope and inclination here to dissect the year on year position changes on THR policy since 2008 and, but suffice to say there have been many. Whilst small policy change can be expected as new research emerges, large fluctuations are undesirable. Alternative nicotine products require embracing, wherever they are sourced, with minimal regulatory control, do ASH consistently state this as an aim or objective? also read from 2008 
ASH directly influenced the UK Govt throughout 2011-12 to push the EU for an update of the TPD wrt SNUS and e-cigs. This was announced by Commissioner Borg in December 2012, with a draconian 2-4 mg/ml nicotine content maximum (e-cigs) and medicinal products only, with a continued SNUS ban. This was ASH policy! for confirmation read Lord Callanan's comments here  via Dick Puddlecote. 
Fast forward now to the present day, ASH are apologists for ridiculous arbitrary 20mg/ml nicotine restrictions, 10ml refill bottles and 2ml tanks, all based on errant nicotine poisoning  LD50 data.(disputed by leading scientists eg Mayer and Farsalinos)

20mg/ml nicotine limit will effect 9% of 2.8 million current users =252,000 (ASH data )
this of course ignores any future switchers or the needs for dual users possibly requiring a higher level. How can ASH trivialise these numbers? even if only one person reverts to tobacco cigarette smoking it would represent failure!

It has been suggested (erroneously via ASH) that to mitigate this, an NRT patch could be used in addition to using the max permitted e-liquid (18mg/ml for practical purposes by manufacturers!) this is nonsense :- costly, skin-rashes can result, folks don't want a treatment,- they are not ill!.....etc, and flies in the face of original limits imposed by EU (an admission it was bollocks in the first place!)  

ASH via Deborah Arnott took part and were signatories of the recent comprehensive RCP report, that pointedly made reference to the unintended consequences of the TPD, this press release seems to have ignored that message.

Finally, ASH bemoans the increasing amount of misperception in the general public with regards to THR products, I contend that its mixed messaging (whether intended or otherwise) has somewhat contributed to that and that consistency is required.

The present press release contains 'weaselly -meally mouthed wibble'( Lord Hunt ) and should be dismissed with the contempt it richly deserves .....think again ASH this is unacceptable bollocks, rewatch this ! 

*** thanks to @BV_dodderer for some of the sources here!