Clive Bates from The E-Cigarette Summit U.S. 2018
My presentation from the E-cigarette Summit (US) 30 April 2018 – video (top) and PowerPoint slides (below).
Continue reading “The urge to ban: 10 questions to ask first”
Category: Nicotine
FDA wants to reduce nicotine in cigarettes – what could possibly go wrong (and right)?
On 28th July, FDA announced that it wants to hold a “public dialogue” about regulating to reduce nicotine levels in cigarettes to “non-addictive levels”. I’ve previously written about this idea in my critique of ‘tobacco endgame’ ideas, and I was pleased to present on the subject at SRNT 2017 conference. Generally, I’ve taken the view that the idea is crazy, unworkable, unethical and will never happen, and I have a hefty bet against it.
But now that FDA has announced it, everyone should ask: might any good come of it? That has prompted me to reconsider my previously entirely hostile approach. So here are some updated views in a report done in collaboration with Dr Carrie Wade, Director of Harm Reduction Policy at the R Street Institute, Washington DC.
- Counterfactual report: Reducing nicotine in cigarettes: Challenges and opportunities
- R Street Institute Policy paper 115 and PDF
The three minute version…
Is Australia falling behind on tobacco policy?
Updates: New Zealand moves / Media interviews
Update: two new submissions (available at Committee submissions page #336)
- Clive Bates, Colin Mendelsohn. Do vapour products reduce or increase smoking? 19 October 2017
- Clive Bates memo to accompany appearance before the Committee, 19 October 2017
Introduction
I’m visiting Australia next week and looking forward to some good discussions with people holding any and all points of view on vaping, nicotine and smoking. My aim is to share experience from the US and UK where we are seeing encouraging uptake of low-risk vaping alongside an unusually rapid decline in smoking. Historically, UK has always had substantially higher levels of smoking than Australia, but in 2016 that gap has finally closed. Both countries have comprehensive tobacco policies – albeit with some differences in the details and Australia generally the first to do new measures, like plain packaging. But there is one major difference. UK (and especially England) now encourages smokers to switch to low-risk alternatives like vaping, while Australia actively prevents it and actually criminalises people who try to protect their own health in this way.
Five talking points inspired by the Royal College of Physicians
The case I want to make is that Australia is missing an opportunity, and there is a human cost for that in terms of cancer, heart and lung disease and premature death. I’ve structured my talking points around five of the key findings of the excellent April 2016 Royal College of Physicians (London) report: see Nicotine without smoke: tobacco harm reduction and press release. It was, of course, the RCP that first put the dangers of smoking on the public agenda with its groundbreaking 1962 report, Smoking and Health. Continue reading “Is Australia falling behind on tobacco policy?”
English tobacco control plan embraces tobacco harm reduction – world first
The Department of Health (UK/England) today released its tobacco control plan for England: Towards a smoke-free generation: tobacco control plan for England (PDF)
The embrace of vaping and other low-risk alternatives to smoking runs through the text. This is probably the first significant government policy paper anywhere that recognises and pursues the opportunities of tobacco harm reduction, rather than defining these technologies as a threat to be suppressed. For that, the Department of Health and its allies deserve considerable credit. Continue reading “English tobacco control plan embraces tobacco harm reduction – world first”
American experts call for risk-based reform of FDA regulation of tobacco and nicotine
There have been two very encouraging initiatives in the United States in the last month, both captured in the form of letters to recently-appointed FDA Commissioner Scott Gottlieb.
Some of the most experienced US tobacco control experts are showing support for tobacco harm reduction and calling for a rethink of the approach to regulating low-risk nicotine products, such as vaping technologies. I see this as an emerging second front in US public health tobacco policy – one that is more pragmatic and focussed on tackling disease as effectively as possible than the established coalition. Continue reading “American experts call for risk-based reform of FDA regulation of tobacco and nicotine”
Hold the Mayo
Once again the Mayo Clinic indulges in unethical and misleading risk communications in the form of a new article on e-cigarettes, promoting fear and confusion and dissuading smokers from trying them.
Mayo clinic: Electronic cigarettes: Not a safe way to light up
Update: Mayo Clinic subsequently (probably in June 2016) amended and shortened this document – though much of the original remain and the criticisms below still apply.
Vaping and tobacco harm reduction in Ireland – consultation response in five quotes
On 5th January, Ireland’s Health Information and Quality Authority published a draft Health Technology Assessment on smoking cessation interventions with a press release. The assessment was positive about e-cigarettes.
Dr Máirín Ryan said: “This HTA found a high level of uncertainty surrounding both the clinical and cost-effectiveness of e-cigarettes. While the long-term effects of using e-cigarettes have not yet been established, data from Healthy Ireland reveals that 29% of smokers currently use e-cigarettes as an aid to quitting smoking. HIQA’s analysis shows that increased uptake of e-cigarettes as an aid to quitting would increase the number of people who successfully quit compared with the existing situation in Ireland and would be cost-effective, provided that the currently available evidence on their effectiveness is confirmed by further studies.”
In Ireland, that is very positive!
The report is out for public consultation until the 3rd February 2017. The consultation page allows for a free-form response. You can put in whatever information you think will assist the review team. Here is my response, framed around five quotes from the Royal College of Physicians:
Reshaping American tobacco policy: eight proposals for the Trump administration
Welcome to a new report written by me, Clive Bates, with David Sweanor of Ottawa University, and Eli Lehrer, President of the R Street Institute. The fully designed report is available at R Street with press notice.
Reshaping American Tobacco Policy
Eight federal strategies to fight smoking and ignite a public health revolution
The report is an unforgiving and but fair critique of the United States’ federal approach to tobacco policy, which we think is an unmitigated regulatory disaster. Whatever the stated intent, the effect is to protect the cigarette trade from competition, damage pro-health American businesses, mislead and harm consumers and add unnecessarily to healthcare costs. Federal agencies are preoccupied with negligible or imaginary risks at the expense of great opportunities to address the health risks to America’s 38 million smokers. Around nine million vapers are already taking action to protect their health, the federal bureaucracy is set to block their efforts.
So far smart, self-interested consumers, innovative producers and disruptive technologies have interacted in a lightly regulated free market to begin to tackle the huge burden of disease arising from smoking. That is about to change: the dominant reaction of the federal government is to choke these highly positive developments with huge regulatory burdens, opaque authorization procedures, impossible evidential tests and misinformation about risks.
American federal tobacco policy couldn’t be much worse, but it could be a lot better. The fundamental change required is to embrace and maximise the huge opportunity of vapor and other low-risk nicotine products, while keeping a sense of proportion about minor risks.
The eight proposals to reshape policy are listed below. The report provides a context, summarises the proposals and provides two pages on each. Continue reading “Reshaping American tobacco policy: eight proposals for the Trump administration”
To tax or not to tax? Response to EU on taxing vaping and other reduced risk products
European Commission consultation: the Commission is consulting on applying excise duties (i.e. tax) to vape products and other reduced risk alternatives to smoking – see here for consultation page with online form for interested parties to complete – please do add your response.
New Nicotine Alliance response: I have been working as an Associate Member of the New Nicotine Alliance to put together a briefing for this consultation. The NNA summarises the main points: EU Tax policy – harmful to health – our briefing.
There is no case on principled or practical grounds to apply excise duties to vaping products and other products that offer a much safer alternative to smoking. The value to health and wellbeing associated with switching from smoking to vaping will exceed any benefits arising from revenue collection.
Main briefing: The full briefing: Revision of the Tobacco Excise Directive: Implications for low-risk nicotine products (24 pages – PDF)
Summaries: the Executive summary and Conclusion of the briefing are reproduced below.
When you thought public health could go no lower – it just did
The news coverage:
British newspapers, the main domestic vector of the anti-scientific public health dogma and baseless fear-mongering, were yesterday filled with prominently positioned garbage articles about vaping:
- The Sun: VAPING BAD E-cigs are just as bad for your heart as smoking fags as they damage key blood vessels, say experts [note different printed cover above]
- The Mirror: E-cigarettes are as bad for you as SMOKING, a new study has claimed
- The Mail: E-cigarettes are ‘as bad for the heart as tobacco’: Nicotine vapour damages blood vessels and raises risk of disease
- The Telegraph: Vaping as bad for your heart as smoking cigarettes, study finds
- The Times: Vaping risk is similar to smoking
- Independent: Vaping is ‘as bad as smoking cigarettes’ for damaging key blood vessels
Not one single element of these headlines has any grounding in reality, and all are grossly misleading. The contributory negligence or cynicism of journalists in reporting vaping health stories is now commonplace. However, in this discussion, I would like to focus on the extraordinary negligence of the scientist behind these claims. Continue reading “When you thought public health could go no lower – it just did”