Royal College of Physicians- What You need to know about electronic cigarettes

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Spazmelda

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    That was interesting for sure. I still think that the medical professionals have some way to go however: the first comment from a Dr shows that he doesn't quite have a full understanding of things. Perhaps even the BMA might now have to reconsider their position too.

    Right, it's not quite there yet, but this is a huge shift in the right direction, IMO.
     

    Oliver

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      Doubt the BMA will moderate their position on the basis of the RCP statement - they never have before. The BMA just cannot countenance harm reduction, but other groups seem to be moving towards it. I think they realise that tobacco control spending cannot be justified given the lack of statistical significance in year-on-year smoking reduction.

      Interesting times.
       

      Tom Servo

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        A couple of important takeaways:

        The main benefit of e-cigarettes, therefore, is that they provide inhalable nicotine in a formulation that mimics the behavioural components of smoking but has relatively little risk. (...) Switching completely from tobacco to e-cigarettes achieves much the same in health terms as does quitting smoking and all nicotine use completely.

        This is very important, coming from this body.

        Much concern has been expressed that use of e-cigarettes in public, especially in places where tobacco smoking is prohibited, undermines the denormalisation of smoking achieved in recent years and hence promotes smoking. Concerns about renormalisation through use in places where smoking is prohibited assume that e-cigarettes and tobacco cigarettes look so similar that non-smokers, and particularly children, cannot tell the difference, which is unlikely. E-cigarettes – especially later generation products – clearly look different, and the odourless vapour that they produce is quite different from tobacco smoke.

        This part is pretty much obvious to anyone who's been around e-cigarettes, but it's nice to see it acknowledged. Whether it's tobacco or not should be instantly apparent to bystanders.

        Despite the controversies, it is clear that e-cigarettes are far less hazardous than is tobacco. With more than a million UK smokers using them to help to cut down or quit smoking, they are proving to be valuable harm reduction and cessation products and could make a substantial contribution to reducing the burden of death, disability and poverty currently caused by tobacco smoking. Health professionals should embrace this potential by encouraging smokers, particularly those disinclined to use licensed nicotine replacement therapies, to try them, and, when possible, to do so in conjunction with existing NHS smoking cessation and harm reduction support. E-cigarettes will save lives, and we should support their use.

        Let's hope physicians and policy makers here in the Colonies take heed.
         

        Bill Godshall

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          This is a very important new development, as some news articles may now acknowledge that different doctor's groups have different views of e-cigs.

          I was pleasantly surprised to see Linda Bauld coathored this statement with John Britton. While John Britton and the Royal College of Physicians have been advocating smokefree THR alternatives for more than a decade (i.e. snus), this is the first time I'm aware that Linda has endorsed e-cigs for smokers.
           

          sebt

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            Particular sensible bits from this report:


            The strength of e-cigarettes in health terms probably lies less in their ability to compete as pharmacological therapies than in their consumer acceptability, wide availability, non-medical image and price advantage over cigarettes.


            and


            In practice, new users of e-cigarettes are probably most likely to come from the same population of young people who currently experiment with tobacco.

            and


            Concerns about renormalisation through use in places where smoking is prohibited assume that e-cigarettes and tobacco cigarettes look so similar that non-smokers, and particularly children, cannot tell the difference, which is unlikely. E-cigarettes – especially later generation products – clearly look different, and the odourless vapour that they produce is quite different from tobacco smoke.


            We now have eminently-quotable opinions from a major UK medical institution, as ammunition against three very common fallacies: the "medical licensing or nothing" fallacy, the "gateway" fallacy, and the "renormalisation" fallacy.


            More worrying is the RCP's apparent acceptance (in the "UK Regulation" section), without questioning, of the regulatory attitude of the MHRA and the EU TPD. Perhaps it's too much to expect the RCP, at this stage, to take up arms against these regulations, especially in a short, non-technical "FAQ" document.


            Another passage that caught my eye as less positive than it could be is this one:


            There are concerns about sustained dual use in smokers who might otherwise have quit completely and also that continued use of e-cigarettes might make relapse to smoking more likely among those who have quit tobacco completely. Although it is too early to tell whether smokers who quit smoking with e-cigarettes are more likely to relapse than are those who use other methods, no evidence as yet shows that dual use results in reduced quit rates.


            Carl Phillips has a good analysis of this "quit cold-turkey or don't quit at all" meme. The counter-argument is, funnily enough, the same one that the RCP itself uses earlier on against the "gateway" fallacy: who can tell whether a minor who experiments with e-cigs WOULD, in the absence of e-cigs, have remained "pure", or WOULD be experimenting with tobacco instead? And, in parallel: who can tell, with regard to a "dual user", whether they WOULD have quit completely if they didn't use e-cigarettes?


            (This is modal logic, which is a course I remember enjoying for its psychoactive effect. A couple of hours thinking about possible-world theory is as good as a few drinks or unmentionables to put your mind into a strange state...:blink: )


            But generally the RCP's tone is calm, factual and open to new information. Makes a nice change!
             

            Bill Godshall

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              Sadly, the RCP and John Britton lobbied in support of MHRA regulation (i.e. ban) of e-cigs as medicines.

              Same with Deborah Arnott at ASH UK.

              They remind me of the those in the US (Legacy's David Abrams, NJOY, FIN, LOGIC) who espouse the benefits of e-cigs for smokers, while lobbying for or endorsing the FDA "deeming" regulation (that would similarly ban all, or virtually all, e-cigs).
               
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