A new paper on e-cigarettes published in the BMJ today by JF Etter and colleagues:
Electronic nicotine delivery systems: a research agenda -- Etter et al. -- Tobacco Control
The full PDF is available by subscription only. The paper is published in the tobacco Control section of the BMJ: Tobacco Control - BMJ Journals
The paper's authors are a who's-who of medical professionals interested in the e-cigarette: Jean-François Etter, Chris Bullen, Andreas D Flouris, Murray Laugesen, Thomas Eissenberg.
The abstract states, I think, that we don't know much about e-cigarettes and research is needed to establish the health impact, if any; and whether e-cigarettes can be used for smoking cessation. Regulation is needed but a hotchpotch of rules have or have not been applied, so far.
ECF view
The most significant aspect is that several well-known, widely dispersed researchers who have worked with or commented on e-cigarettes, are involved.
It would be hard to disagree with the opinions expressed in the abstract. Some sort of regulation is needed - but the argument will generally be over exactly what kind. The fact is that consumer product regulations and oversight, especially in the area of foods and products consumed, is in a chaotic state even in many countries where things should be better organized (such as the US and UK for example).
The Royal College of Physicians in the UK appealed for a tobacco products oversight board to be set up, and that seems a reasonable request.
The problem is threefold:
1. Buyers of consumer products do not want a medical licensing authority regulating their products because that is a ridiculous situation in the first place, and essentially means 99.9% of products will be removed from the market.[1]
2. Consumer products are spectacularly poorly regulated considering the funding available, the importance of the issues, and the potential effects on the public.[2]
3. There is a fundamental difference of opinion among users, medics and commentators about what an e-cigarette is for in the first place.[3]
[1] It's hard to see why products like low-alcohol beer or low-nicotine tobacco (or whatever) could be described as medicines or require licensing as pharmaceuticals; but this is the issue we face with e-cigarettes, which are simply a substitute for tobacco cigarettes.
[2] For example: the UK at least has a functional Trading Standards system that operates at hyper-local level, but describing it as 'comprehensive, efficient, well-managed' would be slightly optimistic. Its overall management, above all, is poor - local staff work efficiently considering the system is effectively headless (it has little importance at government level and needs a total restructure).
[3] The majority of e-cigarette users do not intend to quit smoking. They are looking for a better alternative, and have switched to a substitute that has no smoke and is therefore likely to have less health impact. It is up to researchers to decide exactly what the implications are - but it is not up to researchers to tell users what they are or are not doing. Some might want to quit, some might want to reduce the nicotine level, some might want to just keep on as they are - and the latter group appears to be the largest by far. Above all, e-cigarette users are not using some sort of medicinal product or participating in some kind of therapy - any more than someone who drinks low-alcohol beer is.
There may be a slight conflict of interest here in the work of some of the researchers, since (a) they are medics and thus regard everything as a medical process, and (b) some may be committed members of the Tobacco Control movement, which seems more associated with 'quit smoking' than alternative solutions. There are less hazardous smoking alternatives, and consumers above all do not want more 'control' that gives them less options.
Harm Reduction as a consumer-driven process needs more emphasis and less regulatory impediment. No one is saying that there should not be some form of analysis and quality control of consumed materials - but in the end the question is: who will be doing it? Consumers will not accept any form of pharmaceutical agency involved in the process because, firstly, it is not relevant; and, in addition, that system is so obviously corrupt, clearly working to the pharma industry's agenda. The current national consumer protection agencies may or may not be up to the task. Tobacco products oversight as a separate materials regulatory system may or may not be appropriate - depending on its implementation.
Electronic nicotine delivery systems: a research agenda -- Etter et al. -- Tobacco Control
The full PDF is available by subscription only. The paper is published in the tobacco Control section of the BMJ: Tobacco Control - BMJ Journals
The paper's authors are a who's-who of medical professionals interested in the e-cigarette: Jean-François Etter, Chris Bullen, Andreas D Flouris, Murray Laugesen, Thomas Eissenberg.
The abstract states, I think, that we don't know much about e-cigarettes and research is needed to establish the health impact, if any; and whether e-cigarettes can be used for smoking cessation. Regulation is needed but a hotchpotch of rules have or have not been applied, so far.
ECF view
The most significant aspect is that several well-known, widely dispersed researchers who have worked with or commented on e-cigarettes, are involved.
It would be hard to disagree with the opinions expressed in the abstract. Some sort of regulation is needed - but the argument will generally be over exactly what kind. The fact is that consumer product regulations and oversight, especially in the area of foods and products consumed, is in a chaotic state even in many countries where things should be better organized (such as the US and UK for example).
The Royal College of Physicians in the UK appealed for a tobacco products oversight board to be set up, and that seems a reasonable request.
The problem is threefold:
1. Buyers of consumer products do not want a medical licensing authority regulating their products because that is a ridiculous situation in the first place, and essentially means 99.9% of products will be removed from the market.[1]
2. Consumer products are spectacularly poorly regulated considering the funding available, the importance of the issues, and the potential effects on the public.[2]
3. There is a fundamental difference of opinion among users, medics and commentators about what an e-cigarette is for in the first place.[3]
[1] It's hard to see why products like low-alcohol beer or low-nicotine tobacco (or whatever) could be described as medicines or require licensing as pharmaceuticals; but this is the issue we face with e-cigarettes, which are simply a substitute for tobacco cigarettes.
[2] For example: the UK at least has a functional Trading Standards system that operates at hyper-local level, but describing it as 'comprehensive, efficient, well-managed' would be slightly optimistic. Its overall management, above all, is poor - local staff work efficiently considering the system is effectively headless (it has little importance at government level and needs a total restructure).
[3] The majority of e-cigarette users do not intend to quit smoking. They are looking for a better alternative, and have switched to a substitute that has no smoke and is therefore likely to have less health impact. It is up to researchers to decide exactly what the implications are - but it is not up to researchers to tell users what they are or are not doing. Some might want to quit, some might want to reduce the nicotine level, some might want to just keep on as they are - and the latter group appears to be the largest by far. Above all, e-cigarette users are not using some sort of medicinal product or participating in some kind of therapy - any more than someone who drinks low-alcohol beer is.
There may be a slight conflict of interest here in the work of some of the researchers, since (a) they are medics and thus regard everything as a medical process, and (b) some may be committed members of the Tobacco Control movement, which seems more associated with 'quit smoking' than alternative solutions. There are less hazardous smoking alternatives, and consumers above all do not want more 'control' that gives them less options.
Harm Reduction as a consumer-driven process needs more emphasis and less regulatory impediment. No one is saying that there should not be some form of analysis and quality control of consumed materials - but in the end the question is: who will be doing it? Consumers will not accept any form of pharmaceutical agency involved in the process because, firstly, it is not relevant; and, in addition, that system is so obviously corrupt, clearly working to the pharma industry's agenda. The current national consumer protection agencies may or may not be up to the task. Tobacco products oversight as a separate materials regulatory system may or may not be appropriate - depending on its implementation.
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