Tobacco Harm Reduction UK

[rolygate]

I'd like to invite criticism of my article on the ECCA website, please:

Tobacco Harm Reduction

It would be nice if it can stand up to fact-checking, apart from the opinions on numbers at the end, which are purely speculative but are probably obviously so.

The numbers / facts stated have all been seen in research papers somewhere, but just now I don't remember where, for those that have no attribution. Some assistance with location of the original references would be appreciated (and new ones as well - thanks).

 

[Demarko]

You forgot a (c) here:

(a) they are still inhaling nicotine, and (b) still using a tobacco product, and (b)

Still reading, looks good so far! Though I hate to think of myself as "still smoking". And how do you address people who don't use any nicotine? What about people who never smoked, but only started with an ecig?

 

[zereoue20]

I also wouldn't call ecigs a "tobacco product", where exactly is this tobacco they speak of?

Edit: just saying as nic is found in other plants as well. That would be like saying sugar was a sugar cane product, when in actuality it comes from any number of plants, etc.

 

[rolygate]

@Demarko
Thanks. Fixed the (c) typo.

Smoking or not smoking: this is a source of debate within the community but there are reasons I took this point of view in the article. The article is on a UK consumer group's website, and there they still have the big battle with the medical regulator to come, that has already been won in the US with the defeat of the FDA. That is all still to play out in the UK, where the pharma agency will attack in court probably in early 2013 (they are getting their ducks in a row just now).

The argument there will be the same as it was in the US: e-cigs are a drug because (a) they treat cigarette addiction by getting you off it, and also (b) they are a drug because they have a significant pharmacological effect.

So the UK trade and community will have the same battle with their regulator that took place with the FDA. In order to win that, every little bit helps. For example if vendors market their products to quit smoking, and if everyone says they have quit smoking if they use an e-cig, then those are weapons for the opposition. But if no vendors market them as quitting tools, but instead market them as alternative tobacco products; and if everyone says they have switched to an alternative tobacco product - then that takes away one of the opposition's weapons. Snus and coffee are not drugs, but NRTs are. You need to be clearly seen as a tobacco product not a drug, to win this fight (and not a consumer product since by definition that means you have quit smoking).
[the last sentence of the preceding paragraph has been edited to clarify an important point]

This is a global war, where battles will take place in every country, so you have to look at the local conditions each time. Here we are talking about the UK issues, so those have to take priority. Because we got a big win in the US it's easy to forget that everywhere else they still have to win their freedom. That battle may well be harder, because the opposition now has experience of what is needed to win. The FDA took a bad beatdown that probably came as a massive shock to the pharma industry as they assumed they were going to win. They'd probably committed at least $10m to the fight so a defeat must have been painful.

That experience will give them additional tools to win elsewhere, especially as the defence will never be as strong as it was in the US, since no one has the money and people that the US vendors had to mount their legal defence. It's like trying to win the same battle, with an army ten times smaller, against the same enemy who now has much more experience. A tough challenge.

So you'll perhaps forgive the UK community if they find whatever weapons they can.

 

[rolygate]

Thanks Zereoue20.

In the US we can debate if e-cigs are a tobacco product or not, in the UK they don't really have that luxury, for the reasons given above. Hope you understand.

 

[Eddie.Willers]

Interesting notes, Roly, on cotinine testing and how eating just small amounts of eggplant/aubergine can give an indication of that person being a 'smoker', or being exposed to 'second hand smoke'. I wonder if we will see health insurance companies deny coverage based on such a specious test?

 

[KevNewEngland]

Rolygate,
I appreciate all the effort you (as well as several others here) put into harm reduction and e-cig promotion. That is an excellent read. It sums up all the corruption nicely. Thanks!

 

[rolygate]

@Eddie.W
The tobacco test is normally a urine cotinine test, and smokers show much higher values than non-smokers - so there is a minimum level that qualifies the person as a smoker. To get to that level any other way would probably require something like eating ten eggplants doused with ketchup, so it would be hard to argue against a positive test result indicating you are a smoker. E-cigarette users also show up as smokers of course because they get a similar amount of nicotine, although a blood test for three indicators does show some interesting results that don't align exactly with a smoker's results.

http://www.e-cigarette-forum.com/fo...3-blood-test-lab-results-nicotine-levels.html

The blood nicotine level for this user is fairly low, e-cig users have scored up to 40ng/ml apparently. But the cotinine level puts him squarely in the smoker bracket as it means he recently consumed plenty of nicotine, even though it is at the lower end of the smoker's values. I think the half-life of cotinine is about 15 hours, so you would probably have to avoid vaping for 2 days to pass as a non-smoker, and even then the values would probably be a little elevated over those normally seen. You might have to say you eat eggplant with ketchup for breakfast.

@KevNE
Yep. It's going to be a long war. We will win in the end but there are two possible outcomes: things more or less go our way after five or six years of hard battles; or we get buried, and it takes forty or fifty years before it becomes acceptable to save life as against take the money. People are so gullible they will believe anything a politician or a man in a white coat tell them.

 

[Vap0rJay]

@Eddie.W
The tobacco test is normally a urine cotinine test, and smokers show much higher values than non-smokers - so there is a minimum level that qualifies the person as a smoker. To get to that level any other way would probably require something like eating ten eggplants doused with ketchup, so it would be hard to argue against a positive test result indicating you are a smoker. E-cigarette users also show up as smokers of course because they get a similar amount of nicotine, although a blood test for three indicators does show some interesting results that don't align exactly with a smoker's results.

http://www.e-cigarette-forum.com/fo...3-blood-test-lab-results-nicotine-levels.html

The blood nicotine level for this user is fairly low, e-cig users have scored up to 40ng/ml apparently. But the cotinine level puts him squarely in the smoker bracket as it means he recently consumed plenty of nicotine, even though it is at the lower end of the smoker's values. I think the half-life of cotinine is about 15 hours, so you would probably have to avoid vaping for 2 days to pass as a non-smoker, and even then the values would probably be a little elevated over those normally seen. You might have to say you eat eggplant with ketchup for breakfast.

@KevNE
Yep. It's going to be a long war. We will win in the end but there are two possible outcomes: things more or less go our way after five or six years of hard battles; or we get buried, and it takes forty or fifty years before it becomes acceptable to save life as against take the money. People are so gullible they will believe anything a politician or a man in a white coat tell them.

Synthetic - first time, every time. What nicotine? *shrugs*

My body, my business.

 

[Demarko]

So you'll perhaps forgive the UK community if they find whatever weapons they can.

My major concern, and I keep fearing this will end up coming up again, is that we'll end up with, "The UK considers it smoking, so it must be!" when the indoor use bans start coming up again here. They already do that with the fact that they can't be used on planes. "The airlines consider them unsafe!" When, in reality, it was one guys oppinion that it's the same as smoking.

And then the health insurance companies will start charging people who vape higher premiums because they "smoke."

 

[rolygate]

........... And how do you address people who don't use any nicotine? What about people who never smoked, but only started with an ecig?

Sorry, I omitted to address those points.

Well - none of this is my personal view, or at least it's not supposed to be -- the article is supposed to address the issues current in the UK. We have to assume the antis will wage war on anyone who puffs on anything, whether it has nicotine in it or not. How they justify that is their problem, but as far as I can see facts don't come into it, so why bother getting involved in the argument unless you have to...

As regards people starting with an e-cig instead of a tobacco cigarette - personally I think that is a good outcome, if someone was going to smoke anyway. Ask yourself: if your children grow up then start to smoke, for whatever reason, would you prefer they smoke cigarettes or e-cigarettes? To me that seems a no-brainer. However, the best result is they don't do anything of the sort, of course.

As my old Mum said to me: "Don't have any vices when you're young. You'll need every single one of them when you get old." Although I didn't fully understand at the time, she was right of course.

The trouble is, people starting with an e-cig is a very touchy subject right now. Although, logically, it is preferable to starting with tobacco, it still counts as a black mark against us in the antis' book. They call this 'initiation' or 'gateway' behaviour - that is, doing something that leads to smoking (and in addition they see e-cig use as being as bad as smoking tobacco).

It counts as a weapon against us if it can be shown that non-smokers take up smoking with an e-cig. There are a ton of arguments on this subject, it could occupy a thread of 100 pages, and it is not mentioned in the article we are discussing. Another time...

 

[Vap0rJay]

Sorry, I omitted to address those points.

Well - none of this is my personal view, or at least it's not supposed to be -- the article is supposed to address the issues current in the UK. We have to assume the antis will wage war on anyone who puffs on anything, whether it has nicotine in it or not. How they justify that is their problem, but as far as I can see facts don't come into it, so why bother getting involved in the argument unless you have to...

As regards people starting with an e-cig instead of a tobacco cigarette - personally I think that is a good outcome, if someone was going to smoke anyway. Ask yourself: if your children grow up then start to smoke, for whatever reason, would you prefer they smoke cigarettes or e-cigarettes? To me that seems a no-brainer. However, the best result is they don't do anything of the sort, of course.

As my old Mum said to me: "Don't have any vices when you're young. You'll need every single one of them when you get old." Although I didn't fully understand at the time, she was right of course.

The trouble is, people starting with an e-cig is a very touchy subject right now. Although, logically, it is preferable to starting with tobacco, it still counts as a black mark against us in the antis' book. They call this 'initiation' or 'gateway' behaviour - that is, doing something that leads to smoking (and in addition they see e-cig use as being as bad as smoking tobacco).

It counts as a weapon against us if it can be shown that non-smokers take up smoking with an e-cig. There are a ton of arguments on this subject, it could occupy a thread of 100 pages, and it is not mentioned in the article we are discussing. Another time...

Blowing bubbles (yes childhood bubbles) then is 'initiation' or 'gateway' behaviour because it establishes "hand to mouth."

 

[rolygate]

My major concern, and I keep fearing this will end up coming up again, is that we'll end up with, "The UK considers it smoking, so it must be!" when the indoor use bans start coming up again here. They already do that with the fact that they can't be used on planes. "The airlines consider them unsafe!" When, in reality, it was one guys oppinion that it's the same as smoking.

And then the health insurance companies will start charging people who vape higher premiums because they "smoke."

The legal definition of smoking is being in possession of combustible materials that are currently ignited. There is no way to include e-cigs within that definition. An e-cig user is smoking about as much as a Snus user is.

An insurance company is free to change their definition to 'any tobacco user' instead of 'smoker', although there would be no actuarial impetus to make this change - a Harm Reduction product user does not have the same risk as a smoker. A Snus user has the same risk as a non-smoker (but not a never-smoker), so in effect such a change would be the same as asking the question, "Are you an ex-smoker?". An ex-smoker has a risk of 0.3 (the same as a Snus user) compared to 100 (smoker), so in insurance terms it may not be worth the problems caused by lost business. It's true that a never-smoker has a risk of 0.001 on that scale but they would want to weigh up all the factors, it is unlikely to be a straightforward choice for them.

 

[rothenbj]

However haven't the insurance companies actually done that anyway? By testing for continine rather than CO they do not test for smokers, they're testing for nicotine. I posed that question to the author of an article months back and got a response from a testing agency in South Africa. I wrote back directly to the SA agency and never got a response (just checked to see if I still had the emails but must have cleaned up emails since then, but I did find an email I sent to S Glantz that he didn't respond to either).

It behooves the insurance industry to rate all nicotine users as smokers since it puts more premiums at a higher rate thus improving their bottom line.

 

[rolygate]

But apparently people lie when completing their insurance applications, when there is no nicotine test. What a surprise.

Also, this seems to affect the percentage of the population who are reported as smokers or non-smokers - the number of smokers may be higher, if occasional smokers are included, since these people usually report themselves as non-smokers.

Britain’s secret smokers. | LifestyleReviews

wwwDOTeasierDOTcom/91574-non-smoking-brits-occasional-cigarette.html
[please replace DOT with a dot in order to make this link work]

 

[rothenbj]

" To qualify as a non-smoker and to receive cheaper life insurance premiums, someone has to have been nicotine-free for 12 months.”"

That statement indicates the lie. We on this forum are still smokers in the eye of the insurance industry and nothing short of abstinence of nicotine will make us anything else. Therein is the crime and the boon to the insurance companies. For an average of an estimated 10 years less in premiums they are charging 46% more in premiums to smokers and anyone who uses any form of nicotine. Seems like a fair trade-off, for the company.

 

[Demarko]

On the patch? Still a smoker!

 

[emus]

I seem to recall someone on the gum claiming to be a non-smoker except when occasionally falls off the wagon.

 

[rolygate]

To be honest, I think many people would regard someone using nicotine gum or patches as still being a smoker. The definition is perhaps a bit elastic, but...

And anyway 98% of them will be smokers again fairly soon so it's just a temporary diversion.

 

[rothenbj]

I ran some interesting numbers based on this US Insurance site and they make that 46% less premium for non-smokers look tiny-

Return of Premium Term Life Insurance Calculator

I ran the numbers as if the only variable was year of birth and whether you used nicotine or not. You are basically classified as a non-smoker if you haven't had any nicotine for over a year and you pay non-smoker rates. The rest of us are rated smokers and pay a massive premium. So much for costing non-smokers on their life insurance costs. Based on some work I did yesterday, we're also picking up all the epidemiology based ex-smoker cost and probably some of the never smoker costs. You have to understand that based on epidemiology, there are more deaths in smoking related diseases within the ex-smoker class than the smoker class, basically in the lung cancer area.

What can't be calculated from these tables is the number of years do death difference for smokers compared to never smokers or ex-smokers for that matter. Ex-smokers may die some number of months later, on average, than current smokers. That would be fine, except the harm reduction nicotine users are being lumped with the active smokers moving the delta age of death numbers closer.

Anyway, on a $500k policy, I found that nicotine users pay the following percentages MORE than non-smokers or ex-smokers that quit for more than a year for term insurance-

Age__Premium rate increase

60___Won't insure with traditional term ins
50___185.65%
40___175.85%
30___141.57%
20___114.63%

A twenty year old is paying over twice as much for a 20 year term policy although most smoking related deaths occur after 65. A 30 year old almost 1.5 times as much and a 40 year old 1,75 times as much with their chances of dying of "smoking related diseases" not really being a factor in those twenty years the policy is in effect.

The only potentially cost effective insurance may be for a 50 year old and there again that policy is finished at 70. At 60 you might as well forget it. The cost of "high risk" policies is insane.

I hate getting older. I had an amazing memory when I was younger. I met an actuary sometime in the last month or so and at this moment I can't recall who it was (I meet a lot of new people each week). I hope I can figure out who it was because I'd like to get his perspective on this. There has to be some logic to these numbers but as a layman, I don't see it.