It’s good the European Parliament avoided regulating e-cigs as medicines, but for me the excitement is qualified. They did this because thousands of vapers filled their inboxes and spoke truth to power, not because it was the right thing to do (though it was that as well). If they were doing the right thing – really doing it, not just trying to look good or keep angry citizens at a safe distance, they would have lifted also the ban on snus. So I wrote to MEPs to make some points about snus – hardly for the first time – and we wrote to the FT (Safer than cigarettes, but still banned, 7 Oct) to underline the point.To: Group Chairs and Co-ChairsCC: Members7 October 2013Dear Chairs and Co-chairsWhy is snus banned? Can anyone voting on this directive answer this question?There is certainly no scientific case for banning snus:
- The decision to ban snus in 1992 is a 21 year error. It was not justified at the time, but it certainly is not justified now given what we have since seen in Sweden and Norway.
- It has led to the lowest rate of smoking in the EU, by far… 13% in Sweden compared to 28% EU average (Eurobarometer 2012). Norway has smoking rates almost as low and both countries stand out in Europe.
- Sweden has also had one of the 2nd greatest falls in smoking prevalence in the last decade, despite starting from a lower base (OECD 2013)
- Smoking related disease is much lower in Sweden – for example lung cancer mortality is about half its neighbour Denmark (WHO/IARC data)
- The idea that it would be a gateway has proved completely false. It is a gateway out of smoking – diverting young people away from cigarettes and helping older people quit.
- Snus is popular as alternative to smoking for people who wish to continue using nictine
- Snus is popular as smoking cessation aid – it gives another way out of smoking
- Member States like UK and Ireland score high on tobacco policy activity, but Sweden scores high on smoking and health outcomes [see here]
But the heart of this issue is ethical. There is simply no justification for using the force of law to deny even a single European citizen access to this much safer product when cigarettes are freely available throughout the European Union. Nor is there any justification for protecting cigarettes from competition from much less dangerous tobacco products. In this case, public health will be best served if Europe’s politicians lift their prohibition, stand aside and let the internal market work as intended.Experts think the ban is wrong. This view is shared by numerous experts in nicotine science and public health. Despite being carefully argued and evidence based, their views have been ignored in favour of political expediency.
We expect many MEPs to make speeches and statements declaring their determination to do everything possible to reduce smoking on October 8th. But do they really mean that? Sadly, it will not be possible to vote to lift the ban on snus – there is no amendment that allows for that. However, it is possible to create flexibility for a government to allow snus to be sold where use has been traditional. This is exactly the problem now confronting Denmark, which will be required to force loose snus users back to smoking or the black market if it has to enforce the letter of the Tobacco Products Directive.
Any government should be able to permit the use of snus where it is not a novel product: to secure this modest gain for public health please vote for amendments 131 and 134 on 8 October.
Disclosure: no competing interests.
The thing that strikes me about the snus ban is the hypocrisy of it – if snus was a new product, it would be able to get on the market with almost no problem at all. Surely this is discriminatory?
Tom – that’s right…. And legally relevant. When ban was tested in court in 2004, the court found only basis for banning it was that it was novel.
The whole thing is a real life slippery slope experiment.
Example 1: in France, they instaured a smoking ban in 2008, I think, and they justified it with studies on second-hand smoke. In 2013, they extended the smoking ban to e-cigs without any attempt at justification. The government just said it was more convenient.
Example 2: snus. No second-hand smoke or second-hand anything, no notable consequence on health, the only justification put forward is its addictiveness, which is of no consequence as long as the product is available. Once again, the justification is nonexistent.
In both cases, health authorities act as if they had a mandate to regulate anything they want in any way they want as long as it’s loosely health-related.
But the mandate they were more or less implicitely given only allowed them to regulate in order to prevent diseases. How did they manage to stray that far away from the original mandate?
ASH England in the same 2011 briefing
“They reveal that the proportion of adults who smoke in the European Union ranges from 14% in Sweden to 45% in Greece”
“The EU adopted a directive in 1992 prohibiting the sale of tobacco for “oral use not intended to be smoked or chewed,” which included the Swedish snus but not, for example, chewing tobacco or nasal snuff.”
“Lifting the ban on snus is also currently being considered during the revision of the Tobacco Products Directive. Despite a very strong tobacco industry lobby to lift the ban it is very unlikely that this measure will change as there is no demand for snus in other Member States.”
Sigh
It is just lore of the same, public health officials looking harmfully in the wrong direction. You are very right to point out that there will be no lifting of the ban on snus because there is no snus community which politicians fear letting down. It is obvious from this that purpose of public health politics cannot be population level health gains. More so it seems that the public health movement and anti smoking lobby has appointed itself as global protector from the tobacco industry, and it is that that motivates not a desire to improve public health. Oddly the consequence of this is to reinforce the grip of smoked tobacco on people who require nicotine. Neither snus nor e cigs are big income streams for the tobacco industry, but tobacco industry involvement has been used a justification for trying to keep both products from the public at large. The reality of the situation is that in terms of reducing ill health attributable to nicotine addiction it is irrelevant who sells these products. If these products are freely available and in the process the tobacco industry becomes more ethical as it products are less deadly,so what?
Mark, snus and ecigs might be as profitable as cigarettes. Most of the price of tobacco is duty. The tobacco industry is actually selling cigarettes for, at a guess, £2 a pack. This includes manufacture and packaging. Eliquid nicotine comes from tobacco grown by the tobacco industry. Around the same amount is consumed by smokers and vapours. Same with snus. I used to buy it online. It is cheap because there is no UK duty on oral tobacco, but the same amount of nicotine, and therefore tobacco, is ultimately consumed.
Jonathan,
I must admit that my claim that snus and e cigs were less profitable for the tobacco industry was mostly just a supposition, based on the fact that devices liquids are not predominantly their domain. However I don’t think that alters the main argument, that ultimately who profits from snus and e cigs is very much a secondary concern to ensuring there availability. However the tobacco control movement’s assumption that anything the tobacco industry does is a priori evil often has negative health consequences for those they purport to protect.
SNUS does not have broad based support precisely because it is limited in in the geography of its current use. Ironically, precisely because SNUS is a tobacco product — from a fairly complaint tobacco industry — it has not been sold widely and so there are not too many xScandinavian’s to “flood the inboxes.”
The interesting thing to me about yesterday is that the democracy of grass roots politics seems — to me at any rate — to have exacted more meaningful concessions than corporate lobbying.
On a separate note, I still find it astonishing that product will be sold that is nearly 4x the strength of the pharmaceutical product, but that’s perhaps just me pharma-clouded mentality.
I think the solution in the Quickmist is 14mg/ml.It is also accepted that NRT can be used concurrently if necessary.
“Intellicig has worked with a leading laboratory in the UK to determine the levels of nicotine delivered from the Intellicig to the user. These trials are essential as a method of ensuring the consumer is not put at risk from excessive nicotine levels”
Intellicig,seeking an MA and owned by BAT, are still selling 45mg/ml ecigs
Under amendment 170 you will have no control over the amount of nicotine actually delivered — rather a fairly high concentration in you permitted liquid and the (currently supported) theory that available devices don’t deliver that nicotine very well…. coupled with a further assumption that these devices will continue to work poorly.
What could go wrong?
Many of the more advanced devices currently in use do work very well – and nothing has gone wrong – yet.
As stated in the medicinal assessment for the NRT Inhalator,smokers are very adept at self-titrating
Intellicig have presumably achieved ‘safety’ with 45mg/ml juice.
We don’t know yet where the nicotine is absorbed – the Inhalator assessment says only that the major fraction is absorbed through the mouth.We don’t know whether nicotine absorption for ecigs is similar or different.
The establishment bodies like UKCTCS have had 5 years to make a positive contribution to our knowledge but have done nothing.We must rely on what we know and apply commonsense
Well, things have gone wrong (e.g. that poor toddler in Israel) but nothing that is more dangerous than lots of household products (I am sure we could find toddlers drinking household cleaners and the like).
I think the current product is clearly absorbed through the mouth — that’s why your PK curve looks so much like SNUS. If someone can reach the deep lung, then 45 mg/ml is going to create problems.
I am not sure why you say Intellicig in particular has achieved “safety” – I assume you are generally saying you think it has decent quality control and is not littering UK w bodies.
I think safe packaging/parental care is a different point to the efficiency of nicotine delivery.
I don’t have knowledge of the effect of 4.5% nicotine vapour in the deep lung – Intellicig do not make their research public.
They have been working on satisfying the standards set for medicinal products in the UK since 2009 and are the most advanced business in the respect (AFAIK).
We don’t know how close they are but have disclosed receipt of their Manufacturing licence.
I believe the risk/reward ratio is in favour of ecigs for those who can’t/won’t quit
I don’t disagree — but I will also tell you that you see the addictiveness of nicotine manifest in the explosion of bottle sales for ego pipes — when people go to the ego pipe the basically suck the whole day on the thing. The equivalent of cartridges sold in bottles is astronomical (in terms of what is being sold in bottles and how that is growing).
Not sure what an ego pipe is – but all ecigs I’ve seen work on juice being fed to the wick and vaporised.There are various feeding methods – most rely on silica or SS mesh sitting in a tank of 2-4ml.
Bottle sales have been around since I started in 2009 and are the only thing used by vapers once they progress from ‘cigalikes’.
You will appreciate that we’ve had anti-freeze,contaminants,heavy metals,nitrosamines,acrolein,formaldehyde etc thrown at us over the years.Most have proved unfounded scare stories.You may be right but we are now wary of those crying ‘wolf’.
Much the same was thrown at snus – as a member of the public I see the population wide benefit to public health in Sweden and wonder why the scare stories appeared
About that poor toddler in Israel. I have carefully read what I could find about this tragic accident. Nowhere is a statement that it really was e-liquid. All they said that it was like the nicotine liquid used in e-cig. Could have really been some bug killer as it is still used on some small farms.
Maybe I’m slightly paranoid by now, but I have the nagging suspicion, that this is another case of the fanatics abusing a real tragedy to create more of their malicious desinformation.
Speaking of buccal delivery of nicotine from e-digs, here is a product suggesting to condition the buccal cavity: http://www.prnewswire.com/news-releases/fuisz-announces-a-new-lozenge-product-to-enhance-e-cigarette-tobacco-satisfaction-as-well-as-thc-delivery-from-medical-marijuana-186000012.html
Who cares who profits in ‘genuine’ health products such as SNUS or e cigarettes! Should we really criticise BT?
If it was such a genuine issue, we’d have to object to some pretty big German car manufactures that played a huge part in the third Reich’s war machine during the 30’s and 40’s that could be credited with many a loss of life. The same companies today make some of the most prestigious, safest and reliable vehicles in the world.
That said, I do object to BT trying to ‘corner’ the market at the expense of the smaller enterprises.