The level of Support Required for New #ecig Switchers and a few suggestions

None of what I shall be writing here is rocket science or even original content,apart from a wacky idea that I shall advance towards the end of this blog

After this quite encouraging but slightly misguided RCGP conference summary was published,it triggered an instant response from me in the comments section

Without rehashing the same comments, it ran along the lines that GP and most Stop Smoking Service(SSS) have neither the knowledge, or in particular the financial resources(+staff) to fully support new switchers, if they have chosen to use e-cigarettes in place of tobacco cigarettes. Please note, I do not expect, or am advocating for free kits to be provided by SSS, however if their budgets allow,this could well be very helpful(but piss off non-smoking taxpayers?) Hampshire and Bristol have just  introduced such schemes .

The vast majority of #ecigs users will have transitioned from tobacco cigarettes without any GP or SSS involvement whatsoever. There are a few notable exceptions, such as Louise Ross from Leicester SSS, who have been incredibly supportive since 2014 pioneering and campaigning for an e-cig friendly service(along with so much more).

How, many of the 1.5 million UK sole users have been 'supported' to date

1) Vaping Forums  eg AAEC , Planet of the Vapes , UK Vapers , E-Cigarette Forum are the 'Big Four' in the UK

Each of these have new user sections, the level of knowledge,guidance, general product and mental support awe inspiring, and certainly not to be dismissed or discounted.

2) Dedicated Facebook Groups :- way too numerous to make a meaningful list, but try this 

3) Twitter - very quickly can get support from #Vapefam, most folks very willing to help new users. try this site to get you started  as a suggestion(thousands of others also exist)

4) Bricks and Mortar Vape shops - again a vast amount of knowledge exists here

Items 1-4 have supported 'many', but I cannot and would not estimate how large a proportion of the 1.5 million sole users(out of 2.9million total users) were exposed to this knowledge and information

**Note, after writing my blog, this academic article appeared on twitter, which covers the above points in a similar, but more rigorous manner, covering 4192 former smokers.

Hare brained Suggestion Time to provide additional useful Support

 a) Social Media from Central Governmentt Sources/ Public Health England/NHS dealing with Smoking eg #Stoptober here 

 b) As above but local Government based + funded (eg pre-existing SSS.)

c) 'Sympathetic' University Departments

could

Operate a dedicated #Switch2Ecig  website+ Social Media sites with  both a) +b)+c) providing funds + personnel to establish and operate, BUT crucially involve the genuine experts :- VAPERS to help run this (try NNA and VIP, even IBVTA /ECITA for knowledgeable volunteers).

It only needs a handful of folks to operate,and potentially be a very cost effective scheme, especially as austerity measures continue to bite. Empowerment is a word frequently used...this would be a good opportunity to demonstrate just that!

** NOTE

E-Cigarettes are primarily a pleasurable consumer device, that have the added benefit of being a highly popular and effective aid to stopping smoking . Other aids are available, having varying effectiveness, the key to cessation success, is consumers having access to detailed accurate information, and making an informed choice of method. This blog was not intended to 'knock' SSS(many of which are under great financial pressure), rather to inform GP and interested others, of what *alternatives* currently exists for new switchers and how that could be enhanced.

As mentioned above,and as we are all aware  many local authority SSS have received massive reductions in their budgets  which politicians and NGO such as ASH and CR_UK are campaigning Central Government to address. However this is further complicated by many local authorities antipathy towards Vaping , without a wholehearted embrace of Vaping as a valid cessation method , ,they should be defunded or have their budgets slashed, as has been the case.

Why should Central Government bale out rogue councils who have decided that the advice and guidance from themselves via PHE,NCSCT, Stoptober(NHS) is ignored for ideological reasoning, to the detriment of their citizens. This commentary from LGE  (2016)is illuminating, giving a glimpse of the conflict and ignorance that exists(recently reinforced via this damning follow up survey) .

In economic terms the costs/quitter figures do not make for enthralling or edifying reading  this quotes £55,571 per quitter, although I have read estimates of £74,000 elsewhere...... naturally a price cannot be attached to a smokers life BUT surely a more radical commonsense  approach needs examining and implementing?

The solution is staring cash strapped councils in the face, what are they waiting for? All professional and responsible bodies apart from the BMA have made positive reports or commentary towards Vaping in England, surely the WHO negativity(heavily criticised) should hold zero credence!

Lengthy reply Removed by Moderator

One of lifes' little frustrations, is writing what you consider a courteous detailed reply to someone, only for the moderator to jump in and remove the commentary(their prerogative of course!)

This happened today Monday 21/8/17 in reply to  Prof Michael Eriksen in the Conversation here 

my reply was thus :-  .....

'Prof.Eriksen….Michael

Much to admire in your article referring to the recent announcement from the FDA, I wish to make a few points regarding a few of your comments

You stated ‘I can assure you that few smokers derive true pleasure from their addiction. My research team has found that most smokers regret that they ever started, and they desperately want to quit the habit.’

I have seen varying reports/surveys ranging from 40-90% that state smoker regret having started see for eg https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163128/ at 83%, http://www.gallup.com/poll/163763/smokers-quit-tried-multiple-times.aspx at 74%, https://www.chronicle.pitt.edu/story/switching-low-tar-cigarettes-halves-chance-quitting-smoking-pitt-study-finds at 43% and indeed your own https://www.ncbi.nlm.nih.gov/pubmed/28383508 at 71.5%

I make the observation that many of those surveys compiled data from smokers who had a clear determination and motivation to quit as they had accessed stop smoking services.

As an ex-smoker myself, it is not quite as cut and dried as you imply,I cannot provide counter-data, but believe a 'love-hate' affair is probably nearer the truth for many smokers,unrecorded by researchers.

Additionally the notion of smoking pleasure was dismissed, however these  items(many others are available) present a different picture.

https://nicotinepolicy.net/neil-mckeganey/6587-the-enjoyment-of-smoking and

https://www.youtube.com/watch?v=qP1GCLeVXn8

http://www.spiked-online.com/newsite/article/smokers-enjoy-cigarettes-deal-with-it/19161#.WZr1FiiGPtQ

http://news.bbc.co.uk/1/hi/uk_politics/3789591.stm  

I have no desire to labour the point further, but a substantial number of smokers derive pleasure from their smoking and have zero desire to quit.

However, even though now a non-smoker for well over four years, I read some of the claims from tobacco control with ever increasing scepticism. Truth and facts should not require embellishment, 'the end must not justify the means' in what has become an ever more acrimonious pro-anti nicotine 'debate', with the consumer as the casualty in this war.

********

The notion and appeal of Very Low Nicotine Content Cigarettes(VLNC) to Smokers having no desire to Quit is either very low or zero. These gentlemen put across the arguments against VLNC,far more succinctly than I could hope to achieve

Dr Siegel
http://tobaccoanalysis.blogspot.co.uk/2015/10/anti-tobacco-groups-publicly-lie-about.html

Prof. Kozlowski

https://theconversation.com/why-requiring-low-nicotine-cigarettes-is-still-ill-advised-66545

Clive Bates

https://www.clivebates.com/huge-fda-announcement-on-future-tobacco-and-nicotine-strategy/

Prof. West

http://www.rjwest.co.uk/blog.php  

Regarding the possible size of the black market you said ‘Of course, regulators would have to figure out how to prevent black market sales of high-nicotine cigarettes.’

I honestly believe that you,the FDA and all who are advancing VLNC have grossly underestimated the scale of this market, and the unintended consequence of empowering and emboldening the criminal element who would willingly supply and satisfy the demand. 1920’s-30’s alcohol prohibition was not a glorious chapter in US History, it will be repeated if this VLNC folly continues.

Nothing rude,maybe some items are contentious,but that is debate?

Challenges for Vendors and Desirability of Compulsory Membership of a Trade Association

Firstly,
I am not a vendor and so claim zero expertise or deep knowledge on the details of running a successful business, but as a consumer directly influenced by their current and future viability these thoughts are directed towards them.

I do not propose to rake over the sad history of how and why TPD2  evolved as it did, or bleat about how the MHRA is implementing such as this, despite Lord Prior stating

• “the promise of Italian light-style implementation”

But rather concentrate upon what was said in these tweets via ECF 

'It's obvious that without consistent, professional and unified industry representation vaping will face continual challenges.''

More to the point, how to convince this disparate industry that without a well-funded professional body the future is not good?''

The disturbing reality is that out of 2000 vendors,equipment manufacturers,juice makers....etc there exists only a tiny number who are involved or members of a trade association

see ECITA , IBVTA and yes even the infamous TVECA , also a newer entry UKVIA for current UK membership numbers *please note,no details of subscription costs are included in my blog*

whilst some of the big players are contained here,there are vast numbers who are not involved whatsoever. Again, I don't want to now start a long script extolling the virtues of belonging to a trade association other than saying 'strength in numbers, helps to protect your business', 'helps to guarantee the quality of the ''product'' and to avoid rogue traders'................. 

It is inexplicable that vendors have not joined up, and a false economy to save upon the membership fees, when the very future of their business is in the balance.

Maybe controversially, I shall advance a thought that all vendors should  belong to a trade association (of their choice ), on a compulsory basis. I am a libertarian by nature, but something along these lines has to be at least considered, before regulators decide that for you. 

Licensing(of e-cig outlets) appeared in recent Welsh and Scottish proposed legislation,inevitably this will be passed eventually.This is but one example of where a meaningful 'lobby' that a strong trade association could represent, may help favourably frame the debate with legislators.

The same circumstances exist in the US(and elsewhere), with the same unwanted outcome expected so fgs. Get yourselves organised NOW!  

Join one of the 3 UK based Associations asap or if you are from a European country without a Trade Association consider ECIV 

** I regularly listen to Dimitris  on here  bemoaning the lack of vendor involvement in the various state trade associations ** so the problem is far from unique to the UK 

*** Further updated 2021*** 

I am reliably informed from one of the Trade Associations that they now estimate that 75% of all businesses now belong to an Association(by volume), but still only 10% of business belong to a Trade Association,  with membership packages from £600 pa.(up to 4 shops) that seems a foolish economy. 

Action Required to Halt Plummeting Public Perception

Despite weighty reports from Public Health England, Royal College of Physicians, from Eire the Health Information and Quality Authority, from the US Truth Initiative and recently from Canada University of Victoria and News articles such as this in the Guardian  it is my contention that the battle for hearts and minds(of the general public) is losing ground quickly.

ASH UK estimated the following in 2016 here with the disturbing analysis of only 15% of the adult population believing that e-cigarettes are a lot less harmful than smoking

Other jurisdictions had similar dismal results Germany recorded 20.7% In the US ''According to the survey, 35 percent of adult smokers perceived e-cigarettes to be equally or more harmful than combustible cigarettes in 2015''. What will these figures be like in 2017? if comments sections in various media outlets are any guideline,there is little cause for optimism.

Without some immediate action from the likes of Public Health England,ASH UK,CRUK, this situation will be irreversible. 

Over the last 3 weeks we have witnessed the most concerted negative media campaign against e-cigarettes that I can recall over the last few years, whether it be reduced male potency(sperm),additional violence and burglaries,maladjusted children, philandering adults associated with e-cigarette use amongst the most bizarre claims.......endless baseless junk, BUT syndicated around the World, and as Brad Rodu recently indicated is only the tip of the iceberg of what is in the pipeline for the coming year. 

Undoubtedly Duncan Selbie, Kevin Fenton and Martin Dockrell at Public Health England are very well aware of all of these 'facts', but when are they going to counter it? 

I could waffle on about Public Health Campaigns,TV + Newspaper advertisments......... but if they wish to preserve their groundbreaking, immensely brave decision from 2015 status (to be supportive of e-cigarettes), vigorous action is required asap.