THE evidence that persuading cigarette smokers to switch to less harmful products saves lives has been around for a long time.

Cigarettes kill. We’ve known that since 1950 (here and here),  when it became clear that the greater the exposure to tobacco smoke, as measured by depth of inhalation, amount of tobacco smoked per day and number of years smoked, the greater the risk of disease and death from smoking tobacco.

Doll and colleagues concluded in 1994 that “about half of all regular cigarette smokers will eventually be killed by their habit”.

Doll and colleagues also found that if smokers stopped smoking tobacco, their risks of dying from a tobacco-related disease reduced dramatically, with the tobacco-related excess risks approaching zero after 20 years.

Cessation works.

So, too, does harm reduction, and the evidence for that has been around for a long time as well.

In its 1962 landmark Smoking and health report, the Royal College of Physicians of London suggested: “Since pipe and cigar smokers have a smaller risk than cigarette smokers of developing lung cancer, bronchitis and coronary heart disease, the possibility that cigarette smokers could be persuaded to change to these safer forms of smoking must be considered”.

In 1997, Wald and Watt published their Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases. Their research was confined to men and the three diseases were lung cancer, ischaemic heart disease and chronic obstructive lung disease, the major tobacco-related diseases causing death.

Among other things, they found that the men who gave up cigarettes and switched to pipes and cigars — “switchers” — enjoyed a 46% reduction in mortality from the three major diseases when compared with the men who continued smoking cigarettes. In practical terms, by the end of the research’s follow-up period, 35 deaths from the three major diseases had occurred in 522 switchers.

If the switchers had experienced the same mortality as the continuing cigarette smokers, they would have suffered 76 deaths. Thus 41 deaths from these diseases were prevented by switching to pipes and cigars, representing 8% of switchers.

The question then becomes, what role can e-cigarettes play in harm reduction for cigarette smokers?

About 3.2 million adults vape in Great Britain. This includes 1.7 million ex-smokers, 1.4 million current smokers and 100 000 never smokers. The Royal College of Physicians of London estimates that vaping carries about 5% of the health risk of continuing to smoke cigarettes.

Based on these numbers, it can be argued that the health benefit to cigarette smokers who switch is vastly greater than the possible harm to never smokers who take up vaping. For the 1.4 million continuing smokers who also vape, no significant health gain nor material health loss can be expected.

There are about 2.5 million smokers in Australia. If the prohibitions on vaping in Australia were lifted, and the same proportion of cigarette smokers switched to vaping as in the United Kingdom, then tens of thousands of Australian ex-cigarette smokers could live healthier lives and avoid premature death from diseases due to tobacco smoking.

In addition, there could be other community benefits associated with quitting smoking such as reduced hospital costs and reduced absenteeism from illnesses caused or exacerbated by smoking.

Distinguished British biostatistician Sir Austin Bradford Hill said in 1965: “All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time”.

Vaping is probably far less dangerous to health than smoking pipes or cigars. If vaping was as dangerous as pipes or cigars, then we could expect cigarette smokers who switch to vaping to enjoy a 46% reduction in mortality from the three major diseases investigated in the Wald Watt study.

Because of the substantial benefits of harm reduction that are likely to be gained for smokers if Australia takes a more permissive approach to vaping, we believe that Australia’s vaping laws should be reviewed.

In practical terms, we see no need for legal and regulatory controls on vaping to be any more permissive than those on tobacco smoking. The cost of vaping paraphernalia should not be subsidised through the Pharmaceutical Benefits Scheme. However, the tax rate on vaping paraphernalia should ensure that the nicotine dose equivalent cost of vaping is less than it is for cigarettes to give low-income – indeed all – smokers an incentive to make the switch.

Steve Woodward was a Wittenoom asbestos researcher before becoming Australia’s first full-time antitobacco lobbyist. Through the 1980s and 1990s, he led campaigns in all states and territories, and in the UK parliament.

Emeritus Professor Bruce Armstrong is an Australian epidemiologist and public health physician. He is recognised nationally and internationally for his research into the causes and control of cancer, particularly skin cancer.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.


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Australia's vaping laws should be relaxed








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56 thoughts on “Vaping: the argument for relaxing Australian laws

  1. Anonymous says:

    Vaping stopped a 40yr smoking habit after trying every other cessation products. Cheers Tracey

  2. Emeritus Professor Simon Chapman AO says:

    The Tobacco Harm Reduction Emperor’s New Clothes?

    The three-pronged claims made by ecigarette advocates for harm reduction are that these products are far safer than smoking, that they are an excellent way of quitting smoking and that there is negligible evidence of ecigs acting as training wheels for smoking uptake in youth.

    Each of these appear to be rapidly evolving into yet another case study in the emperor’s new clothes. The history of tobacco harm reduction claims is strewn with failures (filter tips, asbestos filters with Kent cigarettes, lights and milds, reduced carcinogen brands, earlier launches of heat not burn products). All were giant weapons of mass distraction from the task of preventing uptake and motivating quitting.

    The factoid that ecigs are “95% safer” than cigarettes (used by Woodward and Armstrong) derives from the guesstimates of 12 hand-picked panellists (the Nutt report https://www.ncbi.nlm.nih.gov/pubmed/24714502
    ). Public Heath England’s lead officer on smoking told an Australian House of Representatives Enquiry “There’s a lot of nonsense talked about-this 95 per cent figure. It’s getting beyond a joke really. We are very clear that this is just one of the figures that we have used, and there are plenty more. We say what really matters is that evidence underlying this figure came from the Nutt report.”

    However, the Nutt report stated “A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria.” Limitations don’t come more fundamental than that.

    Ecigarettes have been in widespread use in a handful of countries for about 10 years. Chronic diseases caused by smoking can take decades to manifest, and it may be that the health consequences of pulling vaping mixtures deep into the lungs some 200 or more times a day will be quite different (in both positive and negative ways) than those from smoking. The NASEM report’s conclusions strongly underline the vast range of concerns where we have little to no evidence about here. (see https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyOutcome.pdf)

    Effective in cessation?

    Cross sectional data of the sort cited by Woodward and Armstrong for Great Britain do not account for the tremendous amount of relapse that occurs with ecigarettes, as with all smoking cessation and that some who quit using ecigs would have quit regardless, using other methods. Robert West, the editor-in-chief of Addiction factored in estimates of relapse and substitution and estimated that some 22,000 additional smokers quit in 2014 in England because of ecigs. (https://onlinelibrary.wiley.com/doi/full/10.1111/add.13343) This is in a smoking population of over 6 million. Let’s be very generous and double that estimate and then multiply it 10 (for 10 years of widespread vaping). 440,000 is a far cry from 1.7m ex-smokers who vape today, and whose ex-smoking status is attributable to vaping, if that is the implication intended by citing that statistic.

    Longitudinal cohort data (12 months) are being published in the USA from the PATH (Population Assessment of Tobacco and Health) study of vapers. These data are of course far more powerful and important than cross-sectional data, which give no account to widespread relapse.

    In Coleman et al’s paper ) https://tobaccocontrol.bmj.com/content/early/2018/04/25/tobaccocontrol-2017-054174) looking at nearly 3000 ecig users found for every person vaping at the start of the study who benefited across 12 months by quitting smoking, there are 2.1 who either relapsed back to smoking to or took up smoking. (https://ses.library.usyd.edu.au/bitstream/2123/18240/3/Missing%20Elephant_in_room.pdf )The net impact of ecigarettes may well be to hold more people in smoking than it provides an exist ramp out of it. This would be increasing, not reducing harm.

    Most disturbingly, in this adult cohort nearly one in four of those who had never been established smokers took up smoking after first using ecigs. Concern about putative gateway effects of ecigs to smoking have been dominated by concerns about youth. These data showing transitions from ecigs to smoking in nearly a quarter of exclusive adult ecigs users with no histories of established smoking should widen this debate to consider adult gateway effects too.

    In another PATH paper, ecigarette users had the worst quit rates for all tobacco products at 12 months (5.6% — ie a 94% failure rate) compared to smokers using other quitting aids and especially those who quit unaided (12.5% quit). (https://academic.oup.com/aje/article/187/11/2397/5046037)

    Youth uptake booming

    The US National Youth Tobacco Survey has just reported that between 2017-2018, there has been a huge increase (78%) in current (past 30 days) ecig use among high school students (from 11.7% to 20,8%) and a 48% increase among middle school students (3.3% to 4.9%), Over the same period 2017-2018, overall use of any tobacco products increased by 38% in high school students and 29% in middle school students. Such increases have not been seen in the USA for many, many years. https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm

    The genie is well and truly out of the bottle in the USA, much to the delight of the vaping and tobacco industries. Australia has very sensibly taken a precautionary approach and not been swept along by the often commercially motivated hype. Australia’s peak health and medical authorities, health departments and NGOs are united in maintaining that approach. It should come as no surprise that all tobacco companies have petitioned governments to do the opposite.

  3. Anonymous says:

    Vaping will save lives! But Yes it needs to be regulated in some way but don’t make it impossible for smokers to take up vaping when the UK has the stats to prove it can help smokers quit and is far less harmful!

  4. Joy Joy says:

    I gave up smoking 120 days ago and removed nicotine from my vape 12 days ago. Vaping has saved my life and to me is an interim solution not a substitution.

  5. Charles Sammut says:

    From a 56 year old who had smoked tobacco for 35 years I have to say vaping has given me a new lease on life. My GP’s lack of knowledge about vaping is astounding considering the amount of data available from UK health departments.

    The current laws in Australia make it legally complicated for someone to give vaping a worthy alternative and our neighbours in New Zealand are leading the way when it comes to laws around nicotine.

    Vaping has been around for almost 15 years now and I would like to think with the advancements in medical technologies we would have picked up any long term adverse effects.

  6. Anonymous says:

    How about we do modelling based on people quitting, rather on things that are a bit less (or *maybe* a “lot less”, or maybe “we-don’t-know-how-much-less”) ? Which is what is happening in Australia, without a significant number of people using e-cigarettes…

  7. Anonymous says:

    I’ve been a smoker for 14years. Vaping has allowed me to quit the stinkies. I’ve tried champix, patches, inhalers, gum, and spray but none of these have allowed me to quit as I was still smoking while using these methods. Vaping has made me 8months cigarette free and is the only method that has worked.

  8. Sarah says:

    The European Respiratory Society taskforce on e-cigs has just published their report. The key paragraph from the abstract is below. This report reinforces the NASEM evidence review, the CSIRO review, the EUPHA review (just three from the last 12 months that I can reel off the top of my head) – all of which support Australia’s precautionary approach.

    With all respect to the authors, I think these evidence reviews (coupled with recent PATH data from the USA on the uptick of youth smoking) undo a few of the assumptions underlying their ‘back of the envelope’ calculations.

    The modelling that is going to be undertaken by ANU (funded by the Federal Government) – in the AUSTRALIAN context – will be more comprehensive and evidence-based. So, how about we wait for the results of that one…

    ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support that ECIGs are an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licensed stop-smoking treatments. So far, there is conflicting data that use of ECIGs results in a renormalization of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIGs use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Negative health effects cannot, based on the current knowledge, be ruled out.

  9. Johnson George says:

    Traders and advocates of e-cigarettes claim that e-cigarettes are up to 95% safer than tobacco products. i.e. “Jumping out of the 20th storey isn’t as bad as jumping out of the 30th storey” [Stan Glantz, a tobacco control expert at the University of California San Francisco].
    Edzard Ernst once said “In alternative medicine, [the] argument [‘absence of evidence is not evidence of absence’] is used to silence doubters and critics. As long as you cannot show that an unproven treatment definitely does not work, we are all supposed to give it “the benefit of doubt” because it might just work, because patients do like it, etc, etc……..

    The onus to demonstrate effectiveness of a treatment rests squarely on the shoulders of those who promote it by claiming that it is useful.

  10. Arthur Chesterfield-Evans, anti-tobacco campaigner. says:

    Vaping may help some people quit. But vaping should be considered on its own merit. If it had to prove that it was safe, it could not do so. So its proponents need it to be a quit aid, then get widespread use. Then its proponents can start marketing seriously, get tens of millions of people to start vaping who would never have taken up smoking, and bingo, we have a billion dollar industry and a worldwide habit. Zillions of dollars are made, and then there is a suggestion of long term harm from inhaling organic compounds that damage cell membranes. It is denied by the manufacturers of course. After a heated debate 20 years and 20-30,000 research papers it is decided that it is probably harmful. In the meantime, a needless epidemic has been deliberately created and a lot of money has been made. Far fetched? I do not think so. This is all about money. The possible quit benefit is the Trojan horse for a needless new product and potential epidemic. I am disappointed that the medical profession is so naive.

  11. Maurice Swanson says:

    How about we leave an in depth analysis of the evidence on e-cigarettes to Australia’s leading Health, Medical and Scientific organisations: the Therapeutic Goods Administration, the National Health and Medical Research Council and the CSIRO. Not to mention also the most comprehensive recent review of the evidence by the US National Academies of Sciences, Engineering and Medicine.

    All of these leading scientific organisations, when reviewing the published evidence on e-cigarettes, have supported Australia’s current precautionary approach.

  12. Randal Williams says:

    Long term nicotine is still associated with cardiovascular, respiratory and gastrointestinal disease and with pancreatic, lung and breast cancers. Vaping is probably safer than smoking cigarettes but let us not kid ourselves it is free of material risk. A well known Adelaide columnist writing in our Sunday newspaper in support of vaping asserted that “nicotine is harmless” and in response to this I have written a Letter to the Editor pointing out the above facts.

  13. Anonymous says:

    Smoking kills vaping saves life it’s black and white

  14. SLC says:

    I have successfully quit smoking for over a year through vaping.

    I was spending $300 dollars a fortnight and I caught every cold and flu going around.

    In the last year I have not caught any cold or flu even when everyone else in the house did and I can afford to get my car serviced.

  15. Anonymous says:

    If vaping is safer, why hasn’t Phillip Morris and other multi national companies that manufacture e-cigs submitted the evidence to the TGA to prove their claim? With their squillions of dollars there must be a reason they haven’t? Oh wait, maybe they already know the outcome…

  16. Dianne Gorman says:

    I smoked heavily every single day for 45 years, despite numerous attempts to quit. In 2013 I thought I’d see if this new-fangled vaping would help me at least cut down. For me, the switch to vaping was immediate, complete and painless (and totally surprising). That’s well over five years without even a single craving for a cigarette.

    Of course it would be better to inhale nothing but fresh air, but this is about harm reduction. I’m happy to have lost the disgusting morning cough and to return a lung function test in the normal range.

  17. Margaret Phipps says:

    I started vaping 4 1/2 years ago, havent smoked since. I smoked for 40yrs, tried everything there is to quit, only vaping worked.

  18. Charlie McCracken says:

    Randal Williams says “Long term nicotine is still associated with cardiovascular, respiratory and gastrointestinal disease and with pancreatic, lung and breast cancers.” Randal, please post here your evidence for such a miguided statement. Is nicotine really associated with all that, or is it smoking?

  19. Jonathan Hall says:

    A little over 12 months ago I was in intensive care from smoking…..at the age of 38! Since vaping I now have full lung capacity back again, my asthma is under control, no skin flare ups, mood swings and I can now enjoy a healthy lifestyle with my family and keep up with the children. I had tried all options available to give up smoking and vaping has been the only one that has worked long term.

  20. Anonymous says:

    Quit smoking after 24 years and have been off smokes for just over a year
    This was 100% due to the use of e cigarettes
    Our government by taking a approach similar to the UK could potentially save 1000s of people like myself
    If smokers can get the correct information advice whilst being supported by our government the flow on financial and health benefits would be tremendous
    I have tried every method of quitting and I truly believe that e cigarettes or vaping if you prefer are the most effective smoking cessation product and Iam so thankful I was introduced to them

  21. Anonymous says:

    Certain anti vaping campaigners on here are being disingenuous when they pretend that the vaping industry and tobacco industry are one in the same to scare the public yet support draconian measures which yield massive profits for the tobacco industry,the pharmaceutical industry profiting off the misery of smokers desperate to quit,with the peddling of quackery like patches,gums and sprays which have been proven to have low success rates and finally politicians who have never met an easy tax dollar they didn’t like.
    The anti vaping lobby really needs to be exposed for what is to the public.

  22. Emeritus Professor Simon Chapman AO says:

    The various anonymous contributions above are anecdotes, true for those individuals but of the lowest level of evidence when it comes to developing policy on “what works” . See https://theconversation.com/why-anecdotes-arent-strong-evidence-when-it-comes-to-quitting-smoking-82064

  23. Cancer Council, Quit Victoria, PHAA, ACOSH says:

    These speculative claims come at a time when US health authorities report a 38% increase in tobacco product use in high school students between 2017-18, in the same 12 months that saw a 78% increase in vaping.

    They ignore the risks of promoting nicotine addiction, respiratory disease and multiple other harms to a new generation of young Australians.

    The article also assumes that e-cigarettes are an effective cessation tool – a claim not supported by Australia’s independent Therapeutic Goods Administration (TGA), National Health and Medical Research Council (NHMRC) and the Commonwealth Scientific and Industrial Research Organisation (CSIRO).

    A recent European Respiratory Society Taskforce Report on e-cigarettes found there was no evidence to suggest that e-cigarettes were safer than tobacco in the long term and that they contained potentially toxic chemicals.

    Moreover, the trends in the US in high school students should ring alarm bells for public health policy-makers around the world – and also explains why the tobacco industry is investing heavily in the e-cigarettes market.

    E-cigarette advocates will no doubt point to other studies claiming benefit, will dispute the gateway argument and continue to publish opinion pieces that ignore the risks and naively overlook the aggressive promotion of e-cigarettes by commercial interests.

    Individuals have different perspectives. This is why we defer to the independent TGA for claims of therapeutic benefit and to the NHMRC to evaluate the evidence on a whole-of-population basis.

    The use of opinion pieces to promote e-cigarettes with no consideration of the net harms nor the unique circumstances in Australia shows precisely why the evidence must be independently reviewed in a rigorous, comprehensive framework.

    – Cancer Council Australia, Quit Victoria, Public Health Association of Australia, Australia Council on Smoking and Health

  24. Anonymous says:

    Vaping is a total winner for my 2 cents worth, I have a new hobbie too with it. Making my own ejuice. I haven’t had a lit thing in nearly 4 years and I had tried everything to quit apart from will power, I was not born with it sorry. Never going backwards again.

  25. Mark Edgar says:

    The health and monetary benefits of vaping are to me an incredible benefit. I smoked heavyweight tobocco for 25 years. And became a disenfranchised person because of the expense over that period of time.
    I beleive adults should be allowed to smoke, vape, drink, run, jog, talk. Etc. However. ??.
    There is a responsibility imposed (and expected) on doctors and health professionals to have the best outcomes of bad situations in the forefront.
    I beleive single women over 55 are the largest growth area in homelessness. Of that demographic many of the unfortunate statistics are smokers. They cannot afford not to vape instead of smoking if they have the affliction, psychological or in some circumstances medical dependance to the inhalation habit.
    To make up your minds in this poll there are only two things to really consider. There is a lot of money to be had for the tobacco giants if vaping becomes legislated away from the vapers themselves. And suffering will only increase if there is no alternative to smoking for those that have bocome conditioned to do so.

    Vaporising has been used by aromatherapists, asthma sufferers, and those trying for a better nights sleep etc. for years without any major requiremnts of new laws or radical restrictions. Why not allow smokers to have the right to decide if they will risk an alternative???
    I have been vaping for 5 years and am in better health for switching. No cough in the morning and better quality food in the fridge.

  26. Steve says:

    Vaping worldwide has been developed by smokers… we had to take matters into our own hands. Other traditional ‘quit smoking’ programmes have been failing us, not to mention there is also this perverted opinion amongst those who believe that we should suffer whilst gratefully profiting others doing so. Surprisingly academics and those in a position of trust concerning public health, have been demonising vaping instead of showing any support with those who use electronic cigarettes. I understand it must be humiliating to those with their ‘expertise’ in public health as such an achievement that has been developed by ex smokers with no government funding or corporate backing has been so successful, but to condemn us and victimise us with questionable claims and research is unacceptable and no way warranted by anybody in a position of trust.

  27. Otter says:

    If you are going to let people smoke – it defies all logic and basic human decency not to let them choose the safer alternative of vaping. How much safer is completely irrelevant – not even the most one-eyed of the anti vaping lobby are suggesting that vaping is worse than smoking, and it would have to be for banning vaping and continuing to allow smoking to make even a modicum of sense. The anti-vaping lobby need to stop obsessing about punishing tobacco companies (who have far less involvement with vaping than is made out) and spare a thought for the millions of Australian smokers who are being punished as collateral damage – they should be ashamed of themselves.

    I have been vaping for about 7 years and my health improved dramatically after the first 6 months from not being able to walk around the park easily I now cycle 200+ km per week with my kids and have saved (including my wife) over $130,000 in that time. That is 7 years of health, wealth and fun I know would not have enjoyed without vaping – I’ll take that 7 years thankyou very much whatever the future might hold. If we required every food additive, pharmaceutical product etc. to be tested for decades before being allowed we would still be banging rocks together.

    NRT has a success rate of only a few percent – so should we ban it? (After all, it does contain nicotine, which while not that much more harmful than caffeine is not completely without side effect). No – because even at a success rate barely distinguishable from random noise, it helps some people and that is a good thing and vaping should be seen in the same light.

    It is 2018 and is time for the anti-vaping lobby to develop some compassion towards smokers and learn some new tobacco company punishing tricks that don’t have negative outcomes for smokers and vapers.

  28. Cancer Council, Quit Victoria, PHAA, ACOSH says:

    These speculative claims come at a time when US health authorities report a 38% increase in tobacco product use in high school students between 2017-18, in the same 12 months that saw a 78% increase in vaping.

    They ignore the risks of promoting nicotine addiction, respiratory disease and multiple other harms to a new generation of young Australians.

    The article also assumes that e-cigarettes are an effective cessation tool – a claim not supported by Australia’s independent Therapeutic Goods Administration (TGA), National Health and Medical Research Council (NHMRC) and the Commonwealth Scientific and Industrial Research Organisation (CSIRO).

    A recent European Respiratory Society Taskforce Report on e-cigarettes found there was no evidence to suggest that e-cigarettes were safer than tobacco in the long term and that they contained potentially toxic chemicals.

    Moreover, the trends in the US in high school students should ring alarm bells for public health policy-makers around the world – and also explains why the tobacco industry is investing heavily in the e-cigarettes market.

    E-cigarette advocates will no doubt point to other studies claiming benefit, will dispute the gateway argument and continue to publish opinion pieces that ignore the risks and naively overlook the aggressive promotion of e-cigarettes by commercial interests.

    Individuals have different perspectives. This is why we defer to the independent TGA for claims of therapeutic benefit and to the NHMRC to evaluate the evidence on a whole-of-population basis.

    The use of opinion pieces to promote e-cigarettes with no consideration of the net harms nor the unique circumstances in Australia shows precisely why the evidence must be independently reviewed in a rigorous, comprehensive framework.

    – Cancer Council Australia, Quit Victoria, Public Health Association of Australia, Australia Council on Smoking and Health

  29. Wayne Kramer says:

    ‘Certain anti vaping campaigners’ are death to smokers and make excuses for their now failing anti-smoking policies. Their closed minds and need to manufacture fear that its evil tobacco companies that are pushing tobacco harm reduction on ‘the kids’ to hook them on nicotine is purely there to cover up their inability to even conceive that something other than a public health strategy can work to reduce smoker deaths.

    https://health.spectator.co.uk/smoking-rates-plummet-as-vaping-becomes-more-popular/

  30. Anonymous says:

    “The various anonymous contributions above are anecdotes, true for those individuals but of the lowest level of evidence when it comes to developing policy on “what works”

    Let’s follow this logically then because it applies tenfold to nicotine patches,gums,sprays and lozenges etc these have incredibly high failure rates, that is beyond debate.
    Indeed it has been proven these nicotine replacement devices have led often times to people resuming smoking and the latest trend of certain high profile pharmaceutical companies marketing flavoured nicotine devices begs the question why is the anti vaping lobby not also calling for these nicotine devices to be banned? the only purpose they are serving is making nicotine more widely available and that’s not even touching on the public health nightmare that is champix although committing suicide will of course result in an individual successfully ceasing to smoke.
    A few isolated anecdotal tales of people claiming to have quit smoking using patches etc simply isn’t backed up by the numbers.
    Unless there was some sort of financial advantage to having these products out there I see no logical reason for them to be on the market.
    Smokers in the perfect world of the anti vaping lobby should be left with the cold turkey quit or die model,maybe if they get a bit of Jesus that’ll help them quit.
    I’m guessing though Jesus doesn’t pay quite as well as pharmaceutical companies or react as favourably as politicians getting tax money.

  31. Joe Kosterich says:

    Despite plain packaging and the highest cigarettes prices in the world – smoking rates have not fallen in Australia since 2013. In countries where vaping is legal/supported quit rates are falling. Those are the facts. The ideological stance of public health in this country lacks any scientific basis. It is indeed sad that the best that it offers smokers is quit our way or die.

  32. Scott Brennan says:

    I am 42 years old started smoking at the age of 14. I have have tried many times to quite nothing worked till I found vaping.

  33. Alan Beard says:

    ‘The various anonymous contributions above are anecdotes’
    Why are they anonymous? Do you think that massive fines and jail threats could contribute!

    At what stage are tens,hundreds,thousands of anecdotes considered data?
    Casaa collected a few (11k +) http://www.casaa.org/testimonials/

    Regarding ‘what works’ isn’t it blatantly obvious from the UK where 3.2 million are Vapers, of which 1.7 million are sole users. All of the UK Health authorities state that this is the most popular method of effectively stopping smoking. Weasel words and arguments may well be advanced by some to deny this, but this is the reality as recorded by ONS (Office for National Statistics), ASH-UK, and Smoking Toolkit.

  34. Steve says:

    I will direct my response to the self proclaimed Simon Chapman in regard to anecdotal evidence and “what works”.
    Every person is different in “what works”. So your lame and harmful attempt to make one policy that fits all is doomed to fail, as that is never going to work for everyone. Secondly, why you believe that you should dictate to others on how to live their lives or in this case, how to cease smoking is quite frankly sickening and harmful to say the least. We live in a supposed free country, a lucky country, where our freedom to choose is a right. This should also include our right to choose whether or not we smoke, vape, use Swedish snus, alcohol or any other drug. If you want to live in a dictatorship, do us all a favour and go find the next boat to China.
    We do not need you meddling in our private and personal choices.

  35. Chris Baxter says:

    I smoked for 42 years and quit many, many times. But I always relapsed. Switched to vaping on first puff 6 years 4 months ago. I know I won’t relapse. I haven’t had a cold in the whole time. I completed a mountain marathon 11 months after switching. I’ve done 3 more since. In short: VAPING SAVES LIVES!

    In reply to Johnson George:
    1. The old “Jumping out of the 20th storey isn’t as bad as jumping out of the 30th storey. [Stan Glantz]” The correct comparison is that 50% would die from a fall of around 8 metres (25ft). 95% safer is a fall of 40 cms (16in). I’ll take those odds.
    2. “The onus to demonstrate effectiveness of a treatment …”. Smoking isn’t an illness – it’s a behaviour. Vaping isn’t a treatment – it’s a safer behaviour. (And it works!)

    To Randal Williams:
    “Long term nicotine is still associated with cardiovascular, respiratory and gastrointestinal disease and with pancreatic, lung and breast cancers.” Utter nonsense. Check out Sweden where millions have been using Snus for decades – with no discernible health costs.

    To Emeritus Professor Simon Chapman:
    Hi Simon. I had a poor marathon this year – 21 minutes off my best time when I was 60 (I’m 64 now, as you know). Shame really – training had gone very well and by the halfway mark I felt I was up for a PB. But my knee gave out and I could only hobble for the last 9 miles. There’s an anecdote for you – vaping wrecks knees!

  36. Emeritus Professor Simon Chapman AO says:

    To “Anonymous” who wants to suggest that the vaping and tobacco industries are not the same — suggest you read this report on the global ecig market https://www.businesswire.com/news/home/20180925005630/en/E-cigarette-Vaping—Global-Market-Size-Share

    “North America accounted for the largest share in the market in terms of revenue and is estimated to reach USD 20.49 billion by 2025. North America is home to prominent players, such as Altria Group, Inc. and Philip Morris International Inc., which command a significant share of the market.”

    ” Chapter 8 Competitive Landscape

    Altria Group Inc.
    British American Tobacco
    Imperial Brands
    International Vapor Group
    Japan Tobacco International
    NicQuid
    Philip Morris International Inc.
    R.J. Reynolds Vapor Company
    Shenzhen IVPS Technology Co. Ltd.
    Shenzhen KangerTech Technology Co. Ltd.
    6 out the 10 biggest players are tobacco companies

  37. Anonymous says:

    Vaping has helped me quit, unlike all other cessation methods I have tried in the past.
    Yes, the dury is still out on the possible negative effects of vaping but this is about harm reduction for many smokers and for me there was enough evidence out there to make my decision.
    Yes, anecdotal these individuals stories may be, but I have never seen so many positive comments on how vaping has help others quit smoking, nor have I ever seen such support for vaping advocacy groups surrounding vaping. Have you ever seen a nicorette gum or patches advocacy group? No, me either, Anecdotal perhaps, but the sheer numbers speaks volumes doesn’t it.

  38. Emeritus Professor Simon Chapman AO says:

    Dear Steve, actually you are not free to use 1000s of drugs that require a dr’s prescription (unless you have one). And no one is free to use drugs that have applied for TGA registration but been refused because they either don’t work or the risks of use are considered unacceptable. Every country in the world (including China where you would like me to go) has such a drug regulatory system, except chaotic nations with high corruption indexes where you can buy almost anything, with people suffering the consequences. Ecig manufacturers are of course at perfect liberty to submit their applications for approval to the TGA. The argument that they are not drugs is disingenuous. All vaping advocates extol their value in smoking cessation, which is a therapeutic claim. So either stop making those claims or get in line for regulatory approval if you want them available in chemists etc. Cancer cure quacks make grandiose claims about safety & efficacy and we all appreciate the quality of that information. Vaping advocates seem to believe they are above having to do what any other manufacture making therapeutic claims has to do.

  39. Maurice Swanson says:

    There is overwhelming evidence that the decline in smoking in Australia since the mid 1970s is the result of a comprehensive approach including prohibitions on the marketing and promotion of tobacco products, increases in the price of tobacco, expansion of smoke free workplaces and public places, TV led mass media public education campaigns and most recently the plain packaging of tobacco products.

    The tobacco companies challenged the legality of plain packaging in the High Court and the WTO but failed.

    “The panel made important findings for both the evidence base for plain packaging and the relevant legal standards. Its reasoning is extremely detailed, running to nearly 900 pages.

    “The panel thus rejected arguments by the complainants that Australia could have introduced
    other measures instead of implementing plain packaging, finding that alternative measures, such as increasing excise tax, raising the minimum legal purchasing age, and increasing the use of mass
    media campaigns were complements to rather than substitutes for the removal of branding on packs through plain packaging. ” (Zhou and Scollo Published Online: November 26, 2018 .doi:10.1001/jamainternmed.2018.6480)

    But what’s missing at the moment in Australia? Despite the Federal Government collecting more than $12 billion in tobacco excise this year, a hard-hitting TV led public education campaign has been missing since 2012, and there is no consistent approach to providing smokers with evidence-based cessation support.

  40. Steve Woodward says:

    I invite Simon Chapman to review what he says our paper says because it does not say what he says it does.

    For example, Chapman said “The factoid that e cigs are “95% safer” than cigarettes (used by Woodward and Armstrong)…”. But we did not. Our estimates of health benefits of vaping are based on e cigarettes being as dangerous as pipes and cigars. In the Wald Watt study we referred to, the mortality outcomes for lung cancer, heart disease and chronic obstructive airways disease were compared for continuing cigarette smokers, and cigarette smokers who switched to pipes and cigars – “switchers”. Switchers were found to have a 46% lower death rate from the three major disease groups when compared to continuing cigarette smokers.

    For anyone who missed the point, we said clearly in our third last paragraph “Vaping is probably far less dangerous to health than smoking pipes or cigars. If vaping was as dangerous as pipes or cigars, then we could expect cigarette smokers who switch to vaping to enjoy a 46% reduction in mortality from the three major diseases investigated in the Wald Watt study”. This 46% reduction in risk translates to tens of thousands of deaths averted from tobacco related diseases if Australian smokers took to vaping as UK smokers have.

    If the health risks of e cigarettes lie closer to the “95% safer than cigarettes” estimate of the Royal College of Physicians of London than to pipes and cigars, then the benefits to health for Australian cigarette smokers who switch to vaping would be tens of thousands more tobacco related deaths prevented.

    The dangers to health from e cigarette vapour lies somewhere on a continuum between cigarette smoke containing nicotine, and chewing gum, patches and sprays containing nicotine. Given the complex aerosol of some 4,000 chemicals including twenty or so proven human carcinogens in cigarette smoke, and pipe and cigar smoke, the health risks of e-cigarettes which emit a relatively simple vapour is likely to lie closer to nicotine chewing gum than pipes or cigars. There have been several published studies which examine the constituents of e cigarette vapour summarised in Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf

    This review addresses other contentious issues raised by Chapman, including:
    • Vaping by young people
    • Vaping by adults
    • The effects of vaping on cessation of tobacco smoking and reductions in consumption
    • Poisonings, fires and explosions
    • Health risks
    • Regulations, monitoring and research recommendations

    This expert review found no significant detriment associated with vaping.

    In the 1980s before it was disbanded as a cost cutting measure, the Australian Government Analytical Laboratories (AGAL) tested Australia’s cigarettes for tar, nicotine and carbon monoxide. It is too many decades since I worked as a laboratory scientist for me to do it competently today but with $12 billion collected yearly in federal tobacco excise tax, it seems the government could easily commission the measurement of the constituents of e cigarette vapour and publish comparisons with cigarette smoke from Australian cigarettes.

  41. Ross MacKenzie says:

    Simon Chapman has done an excellent job of highlighting the growing evidence for taking a cautionary approach to vaping policy, as well as exposing speculative claims made and questionable evidence cited by Woodward and Armstrong.

    It is particularly important to emphasize that the 95% safer figure formulated by Nutt et al has been widely dismissed. As Chapman notes, Nutt et al acknowledge “A limitation of this study is the lack of hard evidence for the harms of most products on most of the criteria.”

    A Lancet editorial “E-cigarettes: Public Health England’s evidence-based confusion” (29 August 2015) https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00042-2/fulltext?rss=yes underlines the lack of hard evidence for claims made, and the absence of formal criteria for the recruitment of the experts involved noting that “In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE [Public Health England] based the major conclusion and message of its report.”

    The Lancet editors also note the connections of some of the authors to industry; “The study led by Nutt was funded by Euroswiss Health and Lega Italiana Anti Fumo (LIAF). Riccardo Polosa, one of the authors of the Nutt paper, is the Chief Scientific Advisor to LIAF. In the paper, he reports serving as a consultant to Arbi Group Srl, an e-cigarette distributor. His research on e-cigarettes is currently supported by LIAF. Another author reports serving as a consultant to manufacturers of smoking cessation products. The editors of the journal added a note at the end of the paper warning readers about the ‘potential conflict of interest’ associated with this work.”

    Any argument for policy change with potentially significant implications that is based on such “extraordinarily flimsy” evidence carries little weight.

  42. Randal Williams says:

    I am surprised that a couple of respondents have denied adverse effects of chronic nicotine usage, as may occur with vaping. A simple PubMed search reveals numerous articles and reviews on this subject. Nicotine is highly addictive and chronic use is associated with numerous documented health problems as well as carcinogenicity . Vaping certainly is preferable to cigarette smoking, with all the other poisons in tobacco and those added by the cigarette companies, but denial of any adverse effects of pure nicotine does not help the debate.

  43. Wayne Kramer says:

    At the end of the day the sophistry of the the anti-harm reduction lobbyists in the form of health charities, health groups and government departments will (and is) costing lives of smokers.

  44. Donna says:

    Simon Chapman says “All vaping advocates extol their value in smoking cessation, which is a therapeutic claim.” and suggests by doing so, products should be approved by the TGA.

    Since when is it against any rules for any individual to do so? You and I both know that it’s only the sellers/manufacturers that are disallowed from making a therapeutic claim and yet you lump us all in as snake oil salesmen.

    If a consumer/Doctor/scientist/pollie is not profiting from doing so says… “Evidence suggests that vaping is successful in helping people stop smoking cigarettes” or “I tried everything and failed but I quit smoking by vaping”, what’s the problem?

    Also Simon, Maurice, Ross, Quit Vic, Cancer Council, PHAA & ACOSH; can you explain why you don’t spend your time trying to have tobacco cigarettes (you know the carcinogenic burning ones that we know kill people) put into Schedule 7 of the ‘dangerous poisons’ standard rather than spending all your time stopping the far safer products being included in it ie. vaping & snus?

    You know you can apply to the TGA for a scheduling change and it doesn’t cost a cent.

  45. Steve Woodward says:

    Emeritus Professor Simon Chapman AO is quick to dismiss the evidence of ex-smokers who have quit completely using e-cigarettes as being anecdotal, and of the “lowest level of evidence”. While his subsequent conduct left a lot to be desired, Dr William McBride’s 181 word Letter to Editor of the Lancet in 1961 might have been regarded as anecdotal. http://www.jameslindlibrary.org/mcbride-wg-1961/

    “Sir, Congenital abnormalities are present in approximately 1-5% of babies. In recent months I have observed that the incidence of multiple severe abnormalities in babies delivered of women who were given the drug thalidomide (’Distaval’) during pregnancy, as an antiemetic or as a sedative, to be almost 20%. These abnormalities are present in structures developed from mesenchyme-i.e., the bones and musculature of the gut. Bony development seems to be affected in a very striking manner, resulting in polydactyly, syndactyly, and failure of development of long bones (abnormally short femora and radii). Have any of your readers seen similar abnormalities in babies delivered of women who have taken this drug during pregnancy? W. G. McBride Hurstville, New South Wales”.

    Maurice Swanson, Cancer Council Australia, Cancer Council Victoria, Quit Victoria, Public Health Association of Australia and the Australian Council of Smoking and Health, are apparently prepared to “defer to the independent Therapeutic Goods Administration (TGA) for claims of therapeutic benefit and to the NHMRC to evaluate the evidence on a whole-of-population basis” without rigorously examining the evidence themselves.

    Are they aware that the USA has no cases of thalidomide among its children whose mothers were given thalidomide in the USA? One single health bureaucrat, Dr Frances Kelsey stood against approving it. Australia’s NHMRC was in existence in the late 1950s but it did not stop thalidomide from doing harm, neither did the TGA or its predecessors, and Australia has hundreds of thalidomide victims. The USA does have thalidomide victims but their mothers sourced thalidomide from Canada.

    Canaries in coal mines serve a valuable purpose.

  46. Chris Baxter says:

    Emeritus Professor Simon Chapman (point 36) provided a link to: https://www.businesswire.com/news/home/20180925005630/en/E-cigarette-Vaping—Global-Market-Size-Share

    I checked it out. Access to the full article is paywalled. Unfortunately I don’t have a spare £4,808 on me at the moment. (Yes £4808, AUD $8474). Apparently the article proves Simon’s argument that vaping is a just another conspiracy by ‘Big Tobacco’. Hmmm…

    Here’s my experience for free. In 6 years and 4 months of vaping I haven’t spent a penny (or a cent) on a product made by ‘Big Tobacco’.

    Nicotine: I use pharma grade nicotine made by one of the world’s leading phytoceutical companies. It is exactly the same nicotine they have been supplying for gums, patches etc. for several decades.

    Propylene glycol and glycerine: Pharma grade from pharmaceutical suppliers.

    Flavouring: From a long established Italian company originally suppling flavourings to the catering trade. Seeing the potential of vaping from the start their products are batch-numbered, laboratory tested and guaranteed diacetyl-free.

    Batteries: Funnily enough, not made by BT.

    Hardware: Same again (I’ve been using the same tank now for over 4 years – quality engineering – not BT!)

    Weekly cost – around £4, (AUD $7).

    Perhaps Simon could explain how I’m the victim of ‘Big Tobacco’?

  47. Emeritus Professor Simon Chapman AO says:

    Donna, the problem of course is that the evidence does NOT suggest “that vaping is successful in helping people stop smoking cigarettes”. The NASEM report concluded “Conclusion 17-1.Overall, there is limited evidence
    that e-cigarettes may be effective aids to promote smoking cessation.”Conclusion 17-3. There is insufficient evidence from randomized controlled trials about the effectiveness of e-cigarettes as cessation aids compared with no treatment or to Food and Drug Administration–approved smoking cessation treatments.” https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyOutcome.pdf. The American Preventive Health Services Task Force “that the current evidence is insufficient to recommend electronic nicotine delivery systems (ENDS) for tobacco cessation in adults”. Similar conclusions have been reached by several other reports and a good many reviews.

    Head to head, the English reports you prefer are minority views when all reviews are considered.

    I have no problem with anyone wanting to tell the world how they quit smoking. As I wrote earlier, that’s true for them. But for the reasons set out here https://theconversation.com/why-anecdotes-arent-strong-evidence-when-it-comes-to-quitting-smoking-82064, to move from individual accounts (even 1000s of them) to inferences that this is generalisable to a random selection of smokers attempting to stop, is to misunderstand what is meant by evidence.

    All the groups and individuals you have named have spent huge energy for decades in securing policies that most vaping advocates oppose, often pillory and show little understanding of their collective contribution to the huge falls in smoking that we have experienced in Australia. The last time male lung cancer rates per 100,000 were as low as they are today was in the early 1960s.

    Vapers commonly say that they switched because they were concerned about their health from smoking. I always find it highly amusing that these attacks on tobacco control and public health are attacks on the very agencies and individuals who put so much work into refining ways to get smokers to be concerned about their health and saved, globally, millions of lives. As a former chief epidemiologist at the American Cancer Society said “Even our most conservative estimate indicates that reductions in lung cancer, resulting from reductions in tobacco smoking over the last half century, account for about 40% of the decrease in overall male cancer death rates … during the period 1991 to 2003 … without reductions in smoking, there would have been virtually no reduction in overall cancer mortality in either men or women since the early 1990s. The payoff from past investments in tobacco control has only just begun.”

  48. Wayne Kramer says:

    “A long-term decline in smoking prevalence among US youth
    accelerated after 2013 when vaping became more widespread”

    https://athra.org.au/wp-content/uploads/2018/11/Levy-D.-Examining-the-relationship-of-vaping-to-smoking-initiation-among-US-youth-and-young-adults.-Tob-Control-2018.pdf

  49. Emeritus Professor Simon Chapman AO says:

    Wayne, the authors of the paper in Tobacco Control that ATHRA publicised did not include the data from 2017-2018 which I summarised in my first response above. This shows a dramatic acceleration in youth vaping and smoking in that 12 months. I doubt that ATHRA will be keen for its supporters to read this inconvenient information but I’m sure you will be. https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm

  50. Steve Woodward says:

    Emeritus Professor Simon Chapman AO again seems to have missed the point of our paper “Vaping: the argument for relaxing Australian laws”.

    Professor Armstrong and I do not argue that vaping is a proven treatment for smoking cessation. We argue if e-cigarette vapour is as harmful as pipe and cigar smoke, then by preventing current smokers from exercising the opportunity to vape as a replacement for their tobacco smoking, our public health authorities must understand there are unintended consequences, in terms of thousands of tobacco-related deaths not prevented from lung cancer, heart disease, chronic bronchitis and emphysema.

    Professor Chapman makes the point that “the last time (Australian) male lung cancer rates per 100,000 were as low as they are today was in the early 1960s”.

    The only comparable country of which I am aware that has a lower lung cancer death rate among its males is Sweden. The tobacco attributable mortality rate per 100,000 males aged 30+ years is 32% higher in Australia when compared with Sweden (201/152 per 100,000 persons) http://www.drugsandalcohol.ie/17205/1/WHO_tobacco_mortality.pdf .

    Most of this excess will be among disadvantaged Australians for whom the differential is far greater.

    Male lung cancer death rates are quoted because the lung cancer epidemic in males is ahead of the lung cancer epidemic in females, so it is instructive to only quote males to know where we are and probably where women’s rates will be going if preventive action is not taken.

    Sweden does allow e-cigarettes to be sold and used. Sweden does allow the sale of nicotine for use in these devices. Sweden bans advertising and promotion of e-cigarettes. There is not a massive epidemic of vaping by Swedish children, as there is, apparently, among US children.

    Sweden also allows the sale and use of snus – a smokeless tobacco product containing nicotine.

    The Snus Commission in Sweden reports : “In total and among men over the age of thirty, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate. Sweden clearly has the lowest tobacco related mortality rate within the EU in relation to its population size, despite daily tobacco consumption among men being at the same level as other countries in Europe. Sweden is also the only country in the EU where snus is permitted. There is a clear connection here – snus is a significantly less dangerous tobacco product than cigarettes: the difference in terms of health effects corresponds to hundreds of thousands of lives per year in Europe. Snus enables Sweden to have a uniquely low number of smokers, and it is difficult to ignore the connection between the low level of smokers and the uniquely low tobacco-related mortality rate. http://snuskommissionen.se/wp-content/uploads/2017/06/Snuskommissionen_rapport3_eng_PRINT.pdf

    Australian tobacco-harm reduction experts, Professor Coral Gartner and Professor Wayne Hall, called for Australia to lift the ban on snus and other low-nitrosamine smokeless tobacco products in the MJA ten years ago. https://www.mja.com.au/journal/2008/188/1/should-australia-lift-its-ban-low-nitrosamine-smokeless-tobacco-products .

    Professor Mike Daube, a previous correspondent on e-cigarettes with MJA Insight is credited with introducing the tobacco death clock to Australia. This clicked over each time a tobacco-related death occurred on average in Australia. Perhaps it is time we had a death clock to record when a tobacco-related death was not prevented by the adoption of proven harm-reduction tobacco policies?

    The massive harm caused by smoking tobacco can be dramatically reduced by using smokeless tobacco products – e-cigarettes and snus.

    Why should we follow the example of Sweden and the UK and not the USA on e-cigarettes? Let us examine another public health issue close to the heart of Emeritus Professor Simon Chapman AO – firearm related deaths.

    Wikipedia reports rates for recent years as UK 0.23 per 100,000 people, Sweden 1.47, Australia 1.04, and USA 11.96. https://en.wikipedia.org/wiki/List_of_countries_by_firearm-related_death_rate

    Emeritus Professor Simon Chapman AO is an accomplished musician and he will be familiar with Bob Dylan’s words : “Come mothers and fathers throughout the land, and don’t criticize what you can’t understand. Your sons and your daughters are beyond your command. Your old road is rapidly agin’. Please get out of the new one if you can’t lend your hand. For the times they are a-changin’.”

  51. Joe Kosterich says:

    Excellent piece and comment 50 further nails it Steve. What becomes apparent from the comments thread is that those with direct experience of vaping (either their own or patients they treat) are supportive of harm reduction and helping smokers. Those in ivory towers reading papers whilst sipping latte are opposed.

  52. Donna says:

    This is the rub isn’t it Simon….

    “Vapers commonly say that they switched because they were concerned about their health from smoking. I always find it highly amusing that these attacks on tobacco control and public health are attacks on the very agencies and individuals who put so much work into refining ways to get smokers to be concerned about their health and saved, globally, millions of lives.”

    My answer to that is….
    Vaping is the carrot, you and those in Tobacco Control always want to hit us with a stick. And today, the carrot is working far better than the stick but you and your ilk had nothing to do with it.

  53. BakerB says:

    Nailed it Donna. Question is like tobacco companies constantly attempting to undermine tobacco control policies should public health/tobacco control be attacked/criticised for constantly undermining tobacco harm reduction as tobacco companies are. Clearly not according to our heroes.

  54. Donna says:

    And Simon, You say in post 47 ….

    “Donna, the problem of course is that the evidence does NOT suggest “that vaping is successful in helping people stop smoking cigarettes”. The NASEM report concluded “Conclusion 17-1.Overall, there is limited evidence
    that e-cigarettes may be effective aids to promote smoking cessation.””

    How does “NOT suggest” gel with “limited evidence” in the affirmative by the very report you quote?

    I’m just a simple ex smoker now vaper but if I know my expressions, you are suggesting an oxymoron!

  55. Pete K says:

    Prof Chapman, is the bar that you require for impact on smoking reduction/cessation one of superiority to currently available methods or is non-inferiority sufficient?

    Quoting Prof Chapman above:
    NASEM report concluded “Conclusion 17-1.Overall, there is limited evidence
    that e-cigarettes may be effective aids to promote smoking cessation.”Conclusion 17-3. There is insufficient evidence from randomized controlled trials about the effectiveness of e-cigarettes as cessation aids compared with no treatment or to Food and Drug Administration–approved smoking cessation treatments.”

    Although the specific data needs to be examined, this very careful wording seems to suggest claims of superiority cannot be borne out yet, but non-inferiority for e-cigarettes may already be able to be established. This will however depend on exactly what “limited evidence” actually means i.e. limited evidence does not equal no evidence. Also, smoking reduction, even if not complete cessation, can still have benefit to overall morbidity and mortality.

    If e-cigarettes are at least not inferior to other smoking cessation or reduction methods (including no treatment), then why should they not be a choice (in a regulated framework) for those that wish to use them as a smoking cessation or reduction aid?

  56. Anonymous says:

    People who suffer from anxiety and depression are able to go to the doctor obtain a script for antidepressants or other form of opiate to help them cope with their feelings and emotions. Research finds that in approximately 35% of research, the placebo does better or is equal to the pharmaceutical drug being researched. Even when the patient is told that they are being given a placebo that could not possibly do anything for them – but that some people who take it will get the beneficial results – and many of them do.
    I was a smoker for 25 years, a packet a day. Logically I knew smoking was affecting me. I only caught one cold a year, but when I did it would turn into bronchitis. One year I had pleurisy. But that didn’t happen in the early years. I exercised and felt extremely healthy. A friend of mine smoked excessively. I visited her in hospital. She had a number of times lost consciousness through lack of oxygen in her blood. She couldn’t walk without dragging an oxygen contraption behind her, and then only very slowly having to stop every now and again, until over time even that became worse.
    On one of those visit, another smoker lost consciousness in the ward. I pushed the nurses button and gave CPR until someone arrived. A daughter of a father in the room asked me if I could help her father give up smoking. He coughed and hacked and had been hospitalised a number of times – he did not want to give up smoking he told me.
    My symptoms told me it was time to stop. I too didn’t want to stop. It had been part of my life for many years. For over 12 months I had cravings for a cigarette, but I wouldn’t give in. My life was worth more to me.
    Those vaping for 4 to 7 years is what they are feeling a temporary respite or a feeling better after 25 years – after all, I didn’t have any symptoms the first 20 years so why should they be any different. So is a temporary placebo that will come back to bite them at a later time?
    The people I speak about above are all dead now – they too argued the point that they should decide what to do for themselves. But this is about not being so selfish to pass on the habit to an upcoming generation – and they will find a way to use e-cigs once they are allowed to be sold.
    Remember the lies told about cigarettes. Each Tobacco company said; “We believe that smoking does not cause cancer.” And of course it did, but they couldn’t be prosecuted for the many lives lost to smoking although they knew it did cause cancer because of those two words; “I Believe”.
    So, should we treat it as an addiction and rehabilitate the addicted smoker or prescribe him/her with a script for self use. It is easy enough to check misuse for there are nicotine tests available to ascertain the need without compromising a new lucrative market for the drug dealer – if that isn’t going on already anyway?
    History tells us we should show caution and not succumb to AstroTurf reports or those that want to open the flood gates for themselves.

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