Another day another prohibitionist move against e-cigarettes – this time in Hong Kong. I would like someone, just one person somewhere in the world (but if possible someone at WHO), to explain why it is good policy to ban a product that nobody disputes is many times lower risk than cigarettes while cigarettes remain freely available. How can it be ethical to say to a smoker: “you know those cigarettes? They’re gonna kill you” and then say “sorry we’re going to ban these alternatives that will cause you a fraction the harm, if any“.  Really?  So it is with heavy hearts, Gerry Stimson and I write to the Hong Kong Legislative Council Panel on Health Services to argue against the Department of Health’s irresponsible proposal to ban sale of e-cigarettes.  There’s a hearing coming up on 6 July 2015.  Here’s the relevant documents:
Legislative Council: Panel of Health Services. Relevant papers for Legislative Council Panel on Health Services, special session 6th July 2015
- Agenda
- Progress of Tobacco Control Measures – the final proposal would ban e-cigarettes
- Updated background brief
- Paper with supplementary information requested by members at the meeting on 18 May 2015 – contains a supportive letter from WHO, but this conspicuously avoids endorsing the e-cigarette ban.
Submission from Clive Bates and Professor Gerry Stimson, in which we argue the case against prohibiting sale of e-cigarettes
- Panel on Health Services hearing 6 July 2015 – written submission –
- Chinese translation (please download and view with Adobe Acrobat Reader rather than a browser PDF viewer plugin)
All submissions for the meeting (there are a lot) are accessible via the Legislative Council’s list of published submissions.
Tobacco control. A local prohibitionist non-governmental organisation, the Hong King Council on Smoking & Health (COSH) has been feeding the government a highly misleading reading of the evidence through its e-cigarette position statement and has been campaigning to have e-cigarettes banned – why it thinks this is good for health rather than protective of cigarette sales is anyone’s guess.  A more realistic view of the evidence is presented in my Briefing for Policymakers.
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Hi Clive,
Your work is much appreciated.
Hope you manage to have some influence with the Hong Kong legislators.
Greeting from Wales (where things are not any way as bad but could be better),
Kurtis
http://www.sciencedirect.com/science/article/pii/S0306460315002312
n=45,128
“E-cigarette use was associated with smoking intention in never, experimental and former smokers in Hong Kong Chinese adolescents. In current smokers, e-cigarette use was associated with nicotine addiction but not quit intention and attempts. Prospective studies with detailed measurements on e-cigarette use are warranted for further studies.”
It is a common error, often perpetrated by unscrupulous commentators, to misrepresent studies like this. The reason that e-cigarette users are likely to have smoking intentions is because of something called ‘shared liability’ – they have common characteristics that incline them to both smoking and vaping – similar behaviours in some obvious respects, though the latter very much less harmful. What it is not the case is that the smoking intention is caused by e-cigarette use. It is an unambiguous Good Thing that people who are inclined to smoke take up vaping instead or as well – as this reduces their health risk and may establish a pathway out of smoking when needed or wanted.
Of course e-cig use is associated with nicotine addiction – that’s because they are overwhelmingly smokers.! If they weren’t then we’d be arguing about an imaginary gateway effect.
Finally, whether they have intention to quit is of little relevance, unless they had intention to quit and lost it somehow because of e-cig use. They may be quitting by stealth or unintentionally if they start to make greater use of e-cigs and lower use of cigarettes. Even as continuing smokers, their are benefits to transferring some consumption to e-cigarettes and no harms. Also, we know from other studies that e-cig use is a reasonable predictor of future quitting behaviour. Smokers’ familiarity with e-cigs from an early age is unambiguously beneficial because it will allow for quitting at some point before the mid-30s – and we know little lasting harm is done to smokers who stop smoking before age 35.
By the way, you probably aren’t as anonymous as you think. I recommend weekend reading from the National Centre for Smoking Cessation & Training: E-cigarette Briefing. It’s purpose is to assist NHS staff in understanding e-cigarette issues that relate to their setting without having to resort to distorted extremist interpretations that likely originate in California.
In two recent talks I have provided to clinicians, no-one but I was aware of these guidelines, which IS disappointing. I encouraged all to refer patients, refractive to multiple quit attempts and who wish to gain support via ENDS: to refer to local NHS Smoking Cessation Services. This is what do, as previously explained. Is that “extreme” practice??? Seems very ethical and reasonable to me . . . The Brief itself does need updating, being May 2014, would you not agree? For a really much more balanced view, one of my favourite papers from last year was Gartner et al’s “Duelling Letters” review of the Dr Chan goings on . . . very good.Did you ever read my email? Probably not . . . N.B. Please can you clarify “misrepresent”: I cut and pasted the exact words! :)
The original authors expressed their conclusion in the way they did, and you reproduced it here, in an attempt to problematise e-cigarettes – that is what you have been doing, inappropriately, for some time. There was no other reason to present it, without the kind of explanation I gave, other than to imply these products were damaging. The formulation is misleading because the underlying findings suggest benefit when interpreted with a reality-based understanding.
The duelling letter paper was very poor, not least because the analysis should always refer to the 3rd letter: The importance of dispassionate presentation and interpretation of evidence, which basically shows how stupid many of the things said in the Glantz et al letter were.
I read some of your email, but it was a tiresome catalogue of misunderstanding and misrepresentation – similar to that pouring from extremists in California. It’s not my job to provide remedial training to NHS staff in these issues and I don’t have the time or inclination to spend any time explaining things to you. However, it is your job to ensure you are giving smokers evidence-based advice, if you say anything to them at all.
Anonymous has a point there. Vaping is a SUBSTITUTE for smoking. People vape for the pleasure, just like they smoked. I can quite see that Tobacco Control do not want a world where people are vaping rather than quitting smoking. or a world where people ENJOY a smoking substitute.
I find it all very sinister. Tobacco Control should have been involved in making smoking safer but they failed to do any such thing. In fact the nocebos on the packets should make smokers sicker, quicker than ever before. Tobacco Control’s “quit or die” attitude has been extremely profitable for their bed-partner, Big Pharma. It makes perfect sense to me, that they want to kill off vaping as quickly as possible. Even in China, where the sickness and death toll from smoking is far less than in the West.
You are too young to remember what a relaxed place the world was before Tobacco Control/Public Health arrived on the scene. Things were less anal then. Tobacco Control have only recently arrived in China, sadly, but soon their venom will spread across the land. And Chinese smoking habits, will be ruined by guilt, shame and persecution, not to mention negative nocebos on all the new packaging that is bound to come, and it will ruin their economy, health and happiness as quickly as what has happened in the West.
Last thought – Tobacco is big in China, The Chinese Government need to protect their income. E cigarettes are not tobacco, despite the unfortunate name! How much better to do it than to heed the now completely bonkers Tobacco Control activists (COSH) who can feed off the funding and promote themselves in a nice, brand new country and also protect China’s most profitable industry.
I presume you see what an addled egg Tobacco Control has developed into.I don’t know how you’ve got the time, energy or will to try and get some sense into such a corrupt group. May strength and illumination be fully yours. You must be a saint.
Absolutely – when the tobacco control people realise that smokers increasingly see vaping as an improvement, not a sacrifice or ‘quitting’, we will have finally reached the foothills of comprehension. Then they may even realise that this is what underpins its great public health potential.
Vaping is not only a substitute for smoking , I have seen quite a few references online to people who have used it as a quitting device and then stopped vaping.It is just about perfect for doing that and not enough gets published about this aspect.Unfortunately these people seem to disappear off the radar and never appear in any statistics so we are unable to “claim” them even though we know they exist.
@Tom -I, was a smoker for 50 years, determined NEVER to stop, no matter how much persecution I endured. I haven’t smoked a single cigarette since 2011, because I find vaping preferable in experience to smoking. If vaping, for me, has replaced the wonderful cigarette which was my companion in grief and joy, then, for me, it has been miraculous. I feel privileged to have become a vapour, for my pleasure in it is deeper than simply rolling my own little fag and having a smoke. Vaping technology is exciting, the community is supportive, the products – vapourisers – are interesting. It is a complete hobby to many of us. We are an inspired bunch.
So, the question is – have I quit smoking? I think this question applies to the many like me. I get hundreds of letters from vapers who have watched me on YouTube to say they “quit smoking” because of me, by vaping (Which I promote). They check back again, a year, or two later, to tell me they are still off the fags. And tell me what device they are now using.
And some, that they have now “given up” (note loss) vaping too, exactly in the way you describe. They cut down to zero nicotine, vaped less and then stopped. So they “quit” completely. They DO exist. I think they must be the unseen many.
At this point though, how does Public Health find them? They are not smokers nor vapers, so they just fall back into the sea of people who aren’t any of those things either.
If we could find them, I think Tobacco Control/Public health would be astonished at how effective vapourisers are to those who simply want to quit smoking (and vaping) all together.