InfoPages: Switching or Quitting?

[rolygate]

As this is the Switching thread I figure it's OK to discuss this here.

It has been asked why the new InfoPages section takes a conservative view on the quit-or-switch question. Here are some of the reasons:

-- The new section has reference material that will be updated from time to time - it is not a home for blog posts that stay as they are. This means that material will change, and wording will change. In some cases there may well be a better way to write something, and assistance is welcomed.

-- ECF - at least in its official capacity - has to take a conservative position on all topics because that is its job. ECF is safe but probably not in the front line when it comes to any given topic. We are talking about 'official' or staff-published material here.

That is in contrast to individual posts or contributions, because ECF is not officially responsible for those - people can say or post what they like, within reason. In some cases they will be way ahead of the curve. ECF in some ways is like a medical publication, it cannot publish staff work that is unproven or otherwise not recognised as factual unless that material is clearly labelled as speculative. Members can do this but they are not subject to the same constraints.

-- ECF does not allow vendors to make claims that electronic cigarettes can be used to quit smoking, as there is no proof of this that could withstand legal challenge. If we do not allow vendors to state this, then we cannot do it ourselves. There is a difference between what members can say, and what ECF can say - people can post what they like because it is just opinion and nothing more. If ECF published it then it would be a statement of position and open to challenge. There need to be at least two recognised, published clinical trials that report that e-cigarettes are successful for the purpose of quitting smoking (whichever meaning is chosen) as a verified result for a reasonable size sample, before this becomes a legally-valid position we could hold. In addition, the success rate would need to be better than the 2% success rate for NRTs which is frequently described as 'efficacious' in journals but would not stand up to a well-funded challenge.

-- ECF is a global site and we take a global view. It is true that currently, most visitors are from the US, but we don't intend to ignore the rest of the world. Eventually there will be an equal number, and possibly more, e-cigarette users elsewhere.

Luckily for US vapers the legal situation is now clear in the USA: e-cigarettes are a tobacco product. This means they have avoided the desperate situation of being classed as a pharmaceutical and thus banned. Everybody else everywhere in the world still has to fight that battle. Pharma and the establishment own the term 'quit smoking', and by using it you place yourself firmly in the pharmaceuticals department and liable to shutdown by the pharmaceutical licensing agencies. It wasn't so long ago that the same applied in the US - memories are short. We don't intend to place vendors appearing on ECF in that position, and we don't intend to make things difficult for people in countries that still face outright bans. And that's many if not most of them.

-- Vapers are split between those who feel they have given up smoking and those who believe they have found a better alternative. Until there is universal agreement on this topic it is probably best to take the conservative view, which is: that e-cigarettes are an alternative nicotine product and/or an alternative tobacco product and there is disagreement on whether exclusive use of an e-cig equates to quitting smoking or not.

-- There are powerful arguments on both sides. For example:-
For quitting:
- 'quit smoking' means cease smoking cigarettes but continue with other nicotine supply methods, because smoking just means to smoke a cigarette.

Against quitting:
- 'quit smoking' means quit everything totally because if you are still holding something that looks, feels and acts exactly like a cigarette - you are still smoking and you haven't quit.
- If you are using something that looks like smoking and that has nicotine in it and the nicotine is a tobacco product - you are still using tobacco and as it is inhaled you are still smoking and you haven't quit.
- If you try as hard as you can to get something that replicates smoking a cigarette as closely as possible, that has nicotine in it, and the nicotine is also a tobacco product - you are still smoking and you haven't quit.
- If the courts and the FDA say an e-cigarette is a tobacco product, and it certainly looks very much as if you are smoking it - you are still smoking and you haven't quit.
- If a restaurant owner and other customers complain about you smoking because they see you holding a cigarette and blowing out clouds of smoke - you are still smoking and you haven't quit, even if what you have is not exactly a cigarette.
- If you support tobacco harm reduction then you must also consider that you haven't quit, since harm reduction by definition only refers to use of a substance in a different form, it doesn't refer to quitting - as it wouldn't be needed then. If you use tobacco harm reduction you haven't quit.
- If you don't think tobacco harm reduction is relevant then say goodbye to all the work of messrs. Siegel, Phillips, Bergen, Rodu et al - they can't help you any more.

...Just a few of the (mainly one-sided) arguments here, to get the pot stirring well

-- The term 'quit smoking' is undefined in the wider medical context, in any case. Unlike the terms 'smoker' and 'non-smoker', which are never used in a medical context unless the precise meaning is unimportant, the term 'quit' in reality has no meaning because there are no definitions for it, or for any sub-classes of meaning. 'Smokers' or 'non-smokers' do not exist in precise medical discussion: when the actual meaning is needed they become never-smokers, ever-smokers and so on. This process has not taken place for the term 'quit' since harm reduction has been ignored as far as is possible. Does 'quit smoking' mean quit cigarettes, quit nicotine, quit all inhalation, quit tobacco, quit all, or quit what? There is no real definition so the term is meaningless.

Because it is meaningless it is not safe to use unless in an informal setting, because some will take it to mean one thing, some another. This is why the term 'non-smoker' had to be split and defined - by itself it means nothing. Unlike terms 'never smoker' or 'ever-smoker' it has no real meaning. To quit smoking has no meaning and if you asked ten e-cig users what it meant, you would certainly get more than one answer. Contrast this with a term like 'never-smoker' or 'ever-smoker' where there is only one possible answer, and you will see what the issue is.

-- ECF is the most visible face of e-cigs, and the target all the antis would like to squash. You can bet your bottom dollar that lawyers from every possible anti faction, agency and corporate have inspected us closely. What individuals can post here is very different from what staff can publish - please remember that. The people up against us have unlimited funds to spend any way they like - on politicians, on government agency officials, on lawyers. It's OK for you to say, "Stick your head above the parapet - go on!" - but it's not your head.


So broadly speaking, before we would endorse the use of the term 'quit smoking' in connection with e-cigarette use, it would require that the community in most countries had succeeded in their fight against corruption-induced e-cigarette bans; that the medical world had actually defined the term in some way; that the community had universally decided on whether use of an e-cig is an alternative you switch to or instead a quit-smoking device; that harm reduction had been abandoned; that several clinical trials had proved 'you can quit smoking with an e-cigarette', at least in some form; that we would somehow be indemnified against diverse civil suits for damages in connection with various types of claim, spurious or not; that we allowed vendors to make any such claims freely; and, most likely, that we had taken leave of our senses.

One or two of those may well eventually be the case - but it seems unlikely that all will transpire.


Edits
This is, however, a different matter from whether or not a rewrite may be necessary. It probably is, since we are only looking at Version 1 in what will probably be a long series. It's just that any rewrite will not include a statement like, "E-Cigarettes are used to quit smoking".

 

[Thulium]

Since people who switch to other nicotine products like smokeless tobacco or NRT are not considered "smokers", I think that any suggestion that e-cigarettes "are not for quitting smoking" is just as fallacious as saying that smokeless tobacco can't be used to help you quit smoking. I think it is a very serious mistake to contribute to the use of "smoking" in an ambiguous way and gives fuel to the prohibitionists whose primary tactic is using the terms "smoking" "nicotine" and "tobacco" interchangeably as if they all have the same health risks.

I understand that there is concern about refering to "quitting smoking" being considered a therapeutic claim, but the TRUTH is that it is only a therapeutic claim if it made by a vendor in reference to a specific product implying a specific therapeutic benefit. We don't worry about bubblegum or jellybeans being banned if someone claims you can use them to help quit smoking (which, by the way, you can), and it's still a real "quit" even if you are substituting one habit with another--that's exactly what the quitlines tell you to do: Take a walk (not a 100% safe alternative--you could be mugged), drink a cup of coffee or tea (not a 100% safe alternative--caffeine is addictive), do some breathing exercises (not a 100% safe alternative--cigarettes are not the only source of environmental smoke and pollution), etc.

The real distinction is whether or not you are quitting the recreational habit. There are some people who believe that "habits" and addictions are inherently "bad" and need to be broken in order to be truly free. I mostly disagree because I think that many habits can be quite healthy, or at least reasonable coping strategies, but I do not begrudge anyone who wishes to stop doing anything habitually that they don't "need" to do. Smoking is a recreational habit, and vaping is a very similar recreational habit--so it is understandable why someone might think that quitting one by switching to the other isn't "really quitting", but that would be like saying that someone who quits smoking by taking up knitting hasn't really quit because they're still doing something with their hands on a regular basis. While it is true that "switching to knitting" has never been evaluated by the FDA for its effectiveness as a therapeutic or medical intervention for smoking, but that has nothing to do with the fact that people can use still choose to quit smoking in this way.

Although Quitting Smoking certainly has specific public health effects, that does not mean that every product that can be used to help you quit smoking is therapeutic--it may be a very HEALTHY choice that may happen as part of a therapeutic treatment, but it is still an action of CHOICE, not therapeutic treatment. Just because many people use e-cigarettes to quit smoking does not mean the manufacturer is claiming that they are using them in a therapeutic manner. You are only using it in a therapeutic manner if you are using as part of an approved cessation plan--and there currently is no approved cessation plan that uses e-cigarettes, even though many people still make the very personal choice to quit smoking after they discover e-cigs.

Although e-cigs that make therapeutic claims may be regulable as a drug or medical device, that does not mean that non-vendors claiming that e-cigs can be used as part of an individual plan to continue or reduce smoking (dual use) OR as part of an individual plan to stop smoking completely should be construed as marketing with therapeutic claims.

 

[rolygate]

There are a lot of opinions on this but the safest place for ECF to be is in the Harm Reduction camp, until things change substantially. HR by definition means you haven't quit.

The individual can say what they like, they have the right to do so. Our job is to be conservative and that's what we are doing. It's also safer for us and others who may be affected by what we do.

Soon we'll have a magazine section and people can write articles about their point of view - so get yours ready

 

[renstyle]

I can see the logic in an ecig, being a "smoking alternative" will provide the same ends as "ecig to quit smoking", just using different language. That's how I looked at it myself when I quit smoking (I take the first opinion, smoking=burning).

 

[cigarbabe]

I don't see how you can make the distinction that by touting a HR platform it means that you have not quit smoking? I'm not sure I see vaping as "my alternative" to smoking, I gave up smoking albeit accidentally so of course in my opinion pv's can be used to stop smoking={burning+inhaling a tobacco concoction} but I certainly don't look at vaping as a habit forming addiction to nicotine which is less harmful than smoking although I'm sure it is! I think vaping is a whole different category unlike using a hookah or smoking cigars for lack of a better example.
Obviously I am missing something here.
I understand that you don't want to open yourself {ECF} to any frivolous lawsuits so you take a very conservative view on the whole but by allowing the "Antz" or others {who don't vape} or whom don't perhaps have a real understanding of what it consists of to determine what comprises a quit aren't you doing just that? Shouldn't ECF be helping to lead the way to determine what "not smoking" is or could be? I guess I'd would like to see ECF helping to lead the way even though it is not your mission statement I suppose.
C.B.

Yes I'm addressing issues all over the place I can see that.....

 

[rolygate]

Yes, this is a complex subject - perhaps the most complex of all and certainly the most likely to cause debate. Essentially we are taking this stance for safety, and not just for us.

Look at it this way: does the use of an alternative tobacco product like Snus qualify as Harm Reduction? Almost everyone would say yes. Have you quit if you use Snus? Well, that's the question, no doubt. Now ecigs: they seem a lot more like smoking than Snus. The nicotine is a tobacco product (sure, it doesn't have to be - but while it is, it is). So, is it HR? Have you quit?

These questions get different answers from everyone. There is no consensus and it is entirely wrong to act or speak as if there is one. Yes, we could 'take the lead', but it is not our function to go out on a limb and does not help certain sections of the community.

 

[Thulium]

Yes, this is a complex subject - perhaps the most complex of all and certainly the most likely to cause debate. Essentially we are taking this stance for safety, and not just for us.

Look at it this way: does the use of an alternative tobacco product like Snus qualify as Harm Reduction? Almost everyone would say yes. Have you quit if you use Snus? Well, that's the question, no doubt. Now ecigs: they seem a lot more like smoking than Snus. The nicotine is a tobacco product (sure, it doesn't have to be - but while it is, it is). So, is it HR? Have you quit?

These questions get different answers from everyone. There is no consensus and it is entirely wrong to act or speak as if there is one. Yes, we could 'take the lead', but it is not our function to go out on a limb and does not help certain sections of the community.

I'm not sure it needs to be so complicated. There is nicotine/tobacco use for recreational purposes and nicotine/tobacco use for therapeutic purposes. The difference is that therapeutic use is when electronic cigarettes are used as part of a plan with a specific health outcome (ie. quitting smoking and/or nicotine by a specified quit date), while recreational use is when e-cigs are used as a reduced harm recreational alternative as a temporary or permanent smoking replacement.

A quit smoking message board probably should only deal with issues related to using e-cigarettes as part of a plan to quit smoking, while ECF's focus is "all things electronic cigarettes" and we frequently discuss therapeutic AND recreational uses of e-cigarettes.

 

[Brad.]

A quit smoking message board probably should only deal with issues related to using e-cigarettes as part of a plan to quit smoking, while ECF's focus is "all things electronic cigarettes" and we frequently discuss therapeutic AND recreational uses of e-cigarettes.

This from someone that won't stop trolling qsmb trying to push your way "ecig" or no way. Trying to push nicotine on people trying to stop nicotine?

 

[renstyle]

Yes, this is a complex subject - perhaps the most complex of all and certainly the most likely to cause debate. Essentially we are taking this stance for safety, and not just for us.

Look at it this way: does the use of an alternative tobacco product like Snus qualify as Harm Reduction? Almost everyone would say yes. Have you quit if you use Snus? Well, that's the question, no doubt. Now ecigs: they seem a lot more like smoking than Snus. The nicotine is a tobacco product (sure, it doesn't have to be - but while it is, it is). So, is it HR? Have you quit?

These questions get different answers from everyone. There is no consensus and it is entirely wrong to act or speak as if there is one. Yes, we could 'take the lead', but it is not our function to go out on a limb and does not help certain sections of the community.

I understand where we are going with this. It is really just a matter of semantics. Since I'm in "group #1" where quitting smoking == quitting combustion, the rest of the nicotine debate is secondary.

I have always advocated for a split between smoking (combustion) and nicotine. It is my opinion that this could be the defining characteristic of ecigs, since no other quit-smoking or smoking alternative can give you most of the attributes of an actual analog cigarette without the killing smoke.

That way, everybody can have what they want (again IMHO):

- quit smoking analogs and continue to get your nicotine

- quit smoking analogs and use your ecig as a self-directed NRT-type device, dial down your nic until it is gone

- quit smoking analogs, go to zero nic, and continue using your ecig as your ritual "straw" to prevent relapse (I do this myself)

- quit smoking, use a zero nic ecig from the get-go, and use a patch or gum for your nic (I know others that have done just this)

In every single senario, the killing smoke stops. Nobody on this forum, or even at other quit-smoking sites disagree with this one point. That's where I would very much like to have focus placed, removing the combustion to allow individuals to make their own decision about how to proceed, knowing that the smoke will no longer be killing them slowly.

 

[renstyle]

This from someone that won't stop trolling qsmb trying to push your way "ecig" or no way. Trying to push nicotine on people trying to stop nicotine?

With respect, the ecig would need to be given a chance before it could be "pushed". We both know that has not been the case. This is not really the time or place to discuss or mention such matters specific to a different forum, so this shall be the last I will speak on the matter here.

 

[cigarbabe]

This from someone that won't stop trolling qsmb trying to push your way "ecig" or no way. Trying to push nicotine on people trying to stop nicotine?

Thanks for the clarification and my new signature Rolygate!

Speaking of trolling.....
C.B.