This video might shed some light on the problem. Deborah Arnott............
Mrs Arnott is the CE of ASH UK, and a member of the NICE Programme Development Group on tobacco harm reduction. This is the UK's health service advisory group on policy and methods.
The NICE THR group is notable for not having any stakeholders in Harm Reduction (an appellation, when correctly applied, that refers to consumer choice) as members; an anomalous situation since there are more than half a million current consumers exercising that choice in the smoking area in the UK, a number that will grow to more than five million. It appears that only medical interventions are considered as viable harm reduction choices (if such a thing makes sense).
There is an interesting point that needs to be made here: the NICE committee has numerous supporters of NRTs but not one single expert on e-cigarettes - but appears to be promoting them equally, according to a presentation point shown later (NICE appears to suggest that NRTs and e-cigarettes may be equally useful). Would it be considered good policy to promote heart surgery without a committee member who is an expert on it? A strange situation.
Notes on the presentation
Moving through the presentation: Skoal Bandits are not a form of Snus, which is a product that comes from Sweden. Only products that come from Sweden can legitimately be called Snus. Calling all other types of oral tobacco 'Snus' is a propaganda tactic. Snus has no elevation of risk for any disease; due, probably, to its special manufacturing process that removes most carcinogens. This almost certainly does not apply to products made elsewhere. To suggest that the risks of Snus use and other oral tobacco use are the same is an outright lie if it comes from a person knowledgeable in this field. We therefore assume this is some sort of mistake.
It is rather unfortunate, though, how many mistakes are made by medics talking about 'Tobacco Harm Reduction'. Prof Phillips is not quite so charitable about such 'mistakes' - see
Anti THR Lies.
Arnott makes a good point that nicotine is considered carcinogenic by many.
It is strongly implied here that nicotine does little or no harm. If nicotine use grows within the population, but nicotine does no harm, then increased use has no implications. There is a dichotomy here - tobacco control industry staffers seem rather confused about this and perhaps need to make their minds up. Either nicotine is low-risk or it isn't. Either NRTs do no harm or they have risk. The same applies equally to ecigs, another clean nicotine delivery system.
Arnott is being disingenuous if she says, as she seems to be doing, that there is some form of compromise on THR in the UK (involving nicotine-containing products). Indeed, the UK has some of the most stringent laws in the world: Snus is the only proven solution to smoking morbidity and mortality, which has a proven (not a demonstrated, or evidence-for) reduction of smoking by 45%, and is banned. Until e-cigarettes became available this was the only proven solution to reduce smoking-related deaths. Snus is banned in order to protect pharma income. A 'compromise' that allows pharma products to be sold is nothing more than a commercial arrangement between the regulators and an industry that profits from the arrangement. It is a cosy arrangement that maintains the smoking-related mortality at current rates instead of reducing them by 45%, and maintains pharma income at current rates. Reducing the death rate is not a consideration in UK policy and there is certainly no 'compromise'. It is very hard not to describe such statements as lies.
The only 'regulated products that meet smokers' needs' are now, at long last, on the market: e-cigarettes. They are strictly regulated by government to ensure no toxins or contaminants are present. We are not sure what the purpose of additional regulations might be, perhaps the 'dose' is the sort of thing being considered here? Unfortunately once you start regulating the dosage supplied by things like coffee, the product is no longer attractive to consumers, and a huge unnecessary and unwarranted expense is introduced. Regulated ecigs will not 'meet smokers' needs' and so are pointless. Regulation removes choice. Choice is the mechanism that drives e-cigarettes' popularity. Regulation, by definition, will create a black market for products that work and/or are attractive to consumers. People also seem to have forgotten that anyone doing the regulating either works for or will eventually work for pharma, whose agenda is to remove ecigs from the market or regulate them out of existence. Or perhaps this is recognised, but being carefully hidden?
What possible relevance does a pharmaceutical industry agency such as the MHRA have to consumer products such as coffee, beer, cigarettes, decaff coffee, low-alcohol beer or e-cigarettes? A reasonable (and sane) person would say: none whatsoever.
Harm Reduction has not been supported by the BMA, they are absolutely dead set against it; they promote pharma's agenda, which is to destroy any form of consumer harm reduction that isn't sold by pharma. What the BMA support is Harm Management, the medical supervision of pharma products for smoking cessation. This might be loosely described as 'harm reduction' but is a world away from real Harm Reduction: the consumer-driven free choice of an unrestricted range of products that are safer than the original. It doesn't matter how much or how little safer they are: the market decides their popularity. It doesn't work if you regulate it. The Swedish experience clearly shows that 'unregulated' THR choices reduce the death rate in parallel with the numbers who switch. One assumes this is a satisfactory objective? If 20% of smokers switch and 20% less smokers die, is this not the designed goal? Perhaps there is some other agenda here, and reducing the death rate is not the prime consideration.
The DoH Tobacco Plan of 2011 which purportedly seeks to "develop new approaches to encourage tobacco users who cannot quit to switch to safer sources of nicotine" is nothing of the sort. It is purely a commercial arrangement with the pharmaceutical industry to promote their products. The result is that smoking prevalence has increased in Scotland, and in England declines at 0.4% per year or less. The NHS's treatment programme contributes a pathetic 0.01% or thereabouts annually to this reduction. It is the very definition of a useless and corrupted system. Snus availability reduces smoking by 45%. The DoH's approach reduces it by about 2% a decade. Which do you think works? The cosy arrangement with friends, that must provide considerable benefits to somebody somewhere - but not to the smokers, as there is no significant reduction in smoking; or the Swedish solution that knocked 45% off the smoking figures? The first thing that anyone sensible would do is remove the stranglehold pharma has on the DoH, in order to do something concrete about the smoking mortality rate.
May 2013 is a key date because it represents the time when the MHRA intends to increase pharma's control on UK smoker's health (or lack of it) by enforcing new laws that remove any alternatives. Like the Snus ban, a new ban on e-cigarettes is intended.
The NICE public health guidance on tobacco harm reduction apparently includes the four points itemised below. I may have got this wrong as it is complete gibberish, and professionally speaking, incompetence and/or lies if mentioned as having any relation to THR.
- People who smoke can stop smoking altogether
- Cut down prior to quitting
- Smoke less
- Abstain from smoking temporarily
I must have got this wrong since there is no possible connection to any form of THR in this advice. On the next page of the presentation NICE does mention, though, the use of NRTs and e-cigarettes, for temporary or long- term use.
This area is confusing as the previous page should not be present in any debate on THR, and needs to be removed. There also needs to be a clear disassociation between consumer products and medical processes. The consumer version -unrestricted choice of alternative products - is called Harm Reduction. The medical version is called Harm Management or possibly harm reduction in a generic sense. It is not, nor can ever be, Harm Reduction: this is the unhindered consumer choice of freely-available consumer products.
An interesting point was brought up: the use of NRTs by pregnant women is not supported by NICE but is supported by the MHRA, since clean nicotine is likely to be less harmful to the foetus than smoking.
In 2010, the MHRA licensed NRT for long-term use since 'there are no circumstances in which it is safer to smoke than use NRT'. How very true; the same applies to ecigs of course. We could paraphrase it in fact, to get: 'There are no circumstances in which it is safer to smoke than use any kind of e-cigarette'.
Incidentally, the Snus data was used to obtain this license extension, as it is the only high-volume long-term data resource on consumption of nicotine without smoke. It also helps that Snus does not elevate risk for any disease, clearly demonstrated by the giant-scale meta-analyses of Snus studies by PN Lee, and Lee and Hamlin. However we don't need to look at the results from the hundreds of clinical studies over many decades which show there is no statistically-relevant risk: you can simply look at the facts. Sweden has the lowest smoking mortality of any developed country by a wide margin, and the lowest rates of anything related to smoking disease or death in the EU (the lowest rate of male lung cancer, oral cancer, etc.). Only 11% smoke in Sweden, as 45% of potential smokers switched to Snus. This is the effect of consumer Harm Reduction. It has zero relevance to or connection with any form of regulated system. One reason we know this is because it works. Not to put too fine a point on it, but the DoH SSS is the very definion of a useless, expensive, incompetent and corrupt system: a £200m annual flushing of taxpayer's money down the toilet.
The MHRA is described as having a public health remit. I believe it would be more honest to put it this way: the MHRA has a public health remit as long as this does not conflict with pharma industry profitability. They appear to model themselves on the FDA, who are well-known for their admissions that their client is the pharmaceutical industry and not the public. No one who has public health as their core value would consider regulating e-cigarettes any further ( the UK is the only country in the world where ecigs are comprehensively and effectively regulated). The only purpose would be to regulate them out of existence.
To state that 'there was clear support for regulation' is a lie by obfuscation, omission and misdirection: the people who supported it were the pharmaceutical industry and their partners in government and the medical industry. The consumers are totally against it, as they would be if you asked about regulating coffee. It's a pointless, expensive irrelevancy that only benefits a commercial rival and their partners.
There may be 'concerns' about e-cigarettes, if not 'pitfalls', which is why they are regulated, like all consumer products for consumption. If a product receives more attention from the regulators (Trading Standards) than any other (ask them), and if the products are regularly inspected, tested, and comprehensively analysed for toxins or contaminants - precisely what additional aspect needs regulating? The colours?
A marginal product? Hmm - it's been used by millions worldwide for seven years, and has been intensively developed in the crucible of the market, where a large and critical community push the progress day by day. No other process could possibly have generated the huge changes that have been made to the early, obsolete models. It's 'under-marketed' because no one can invest while threats of regulation are present. Suggesting that ecigs are 'under-marketed' sounds like an appeal to giant marketers like pharma to become involved. We don't need the pathological liars in the tobacco and pharma industries, thanks all the same. And while we're on this subject, you may like to note that pharma corporations are officially the world's biggest fraudsters and criminal corruptors. They are certainly no better than their tobacco equivalents. Since they kill by control and regulation instead of by hiding the truth like the tobacco industry, some feel they are much worse.
Let's keep well clear of all these liars, fraudsters and corruptors, please. E-cigarettes are controlled by a small and fragmented cottage industry that turns over only about $500m a year. It has snowballed due to widespread acceptance by smokers, and the small-scale nature of the business that means that any consumer can phone the CEO of a vendor and ask any question they like. Try that with a drug cartel based in Geneva or Medellin. It seems to have worked quite well so far. What it needs is assistance not termination; and a recognition of the basic honesty of the system, which is entirely consumer-driven.
'Concerns about safety and efficacy'. Not this again. Please, not again... Safety is currently well-regulated, since nothing with toxins and contaminants can be sold. We know exactly what is in them: ask your local Trading Standards office, they have done enough GC-MS and LC tests on the products. Efficacy? Since when did you worry about the 'efficacy' of coffee? The market decides which products survive and which don't; how well a consumer product works is critical to its survival. In an area like smoking, 'how well it works' might be determined by multiple factors, in any case. It might be how efficiently it raises the blood plasma nicotine level to the same level as a cigarette; or it might be the pretty, shiny appearance. It doesn't matter, so long as people don't smoke.
And by the way, if you want to bring science into it, don't bother trying to support the use of or sale of the tiny obsolete models of yesteryear - multiple clinical trials have demonstrated they don't work. They deliver zero or little nicotine to the blood of new users. If you want something that is 'efficacious' then you are talking about an eGo with a clearomiser head, or an APV with a tank or an RTA. Somehow I don't think these models, that actually work, are what pharma has in mind. Show me an ecig that raises blood plasma nic to 25ng/ml (about half what some smokers test at) for new users and I'll bet it doesn't look like a mini.
The statement that, "There are real concerns about safety and efficacy" is an outright lie or the most tremendous ignorance, assuming we are talking about people who have some knowledge on the subject. There are no such concerns among the regulators who regularly test them (ask them), or among the users who buy them and upgrade if a model does not suit them. Same as any other consumer product. This is blatant propaganda, seeking an increased role for pharmaceutical regulators; a pointless, expensive and life-threatening role. Please keep the world's biggest criminal fraudsters and corruptors out of our industry.
Chinese sofas may be an issue but since ecigs are tested rigorously by UK regulators, we have to assume there is no similar issue. Or are the government and local authority staff negligent? If so, please say so, so we can resolve the issue.
The BMA are concerned about ecigs because their partners have told them to lobby to have ecigs banned. Contrast the position of the RCP and the BMA; ask yourself which group receives more pharma funding. And when discussing the BMA's proclamations, please remember we are talking about an organisation named by ECCA as the British Medical Association of Incompetent Fools and Liars, as a result of the outright lies and incredible incompetence they have published (see
the ECCA UK website); also an ECF comment on their
incompetence. Their propaganda on ecigs can be regarded as directly from pharma HQ. Anyone who takes such rubbish seriously needs to have their medical license revoked, they can't be competent to practice. Current medical opinion is that e-cigarettes are safer than smoking, and even the MHRA has been forced to admit this; if you know exactly what is in them and it is all GRAS / acceptably safe, and licensed for pharmaceutical inhalation / injection / topical use, and numerous professors of medicine have stated they are acceptably safe, then it is not just disingenuous to state there is no agreement on this, again it is a lie. The BMA's comment on 'efficacy and safety' is what might be expected from incompetents and liars, seeming to reinforce ECCA's view.
The EU Health Committee is recognised as one of the most harmful agencies existing in the world of health regulations. Smoking kills 700,000 a year in the EU according to their stats. 45% of smokers disappear if unrestricted access to Snus is allowed. Snus does not elevate risk for any disease: the health outcomes of smokers who switch to Snus or who totally quit are the same, so the death rate falls in parallel with the conversion to Snus. The EU therefore kills hundreds of thousands by reason of the Snus ban. The only people who benefit are pharma; the status quo is preserved, and the hugely profitable treatments for sick smokers are protected: the multi-billion market for chemotherapy drugs, COPD drugs, cardiac drugs, vascular drugs, and associated treatments. The EU protects pharma and kills large numbers of its citizens.
The EU is best described as the most corrupt and murderous agency in the world, if success can be judged by the number of people it kills. At a minimum this would be 10% of the smokers who die through no knowledge of or access to low-risk alternatives: 70,000 a year. The EU kills at least 70,000 a year due to its Snus ban.
Every e-cigarette ban (i.e. medicalisation) that has
ever been challenged at law has been overturned. In the USA, Germany and Holland, the courts' outright rejection of such bans, and maintenance of their rejection through each level of appeal court right to the top, has been the biggest consumer win for decades. There are no legally-valid arguments for restricting e-cigarettes; the only possible winner is pharma, and this is who such bans are designed to assist.
Blucigs was the firm bought by Lorillard.
No regulatory environment is needed to 'encourage innovation and investment' - it's worked quite well without any of that. Indeed, the only effect pharma influence will have on ecigs is to kill them off. Arnott demonstrates this herself, with the stories of previous alternative products rejected by pharma and bought up by tobacco.
It is all very well to recommend 'keeping up the pressure' on smoking to 'make it less attractive and less affordable to the consumer', but it's one of those attractive soundbites that is garbage in practice. This kind of naivety is the core currency of tobacco control - ignoring the rather obvious fact that if you take away what people want, you create a black market that fills the hole. Already a significant percentage of UK tobacco sales are black market. Do we want to increase this figure? Apparently so. One-fifth of the population will continue to smoke as they have every right to do so. If you don't want them to, then the only other option that works is to offer them something better.
Arnott ends by suggesting that the best way to reduce smoking is to offer an alternative. Unfortunately, offering a viable alternative is at complete variance with many of the other points she makes, which would guarantee there is no viable alternative.
An interesting presentation, clearly given either from the perspective of someone funded by pharma or extremely confused. Business as usual, then.