Leading UK electronic cigarette health professionals and experts gathered in London on Thursday along with Government, NHS and Stop Smoking services officials for the 2014 E Cigarette Summit. They were joined by e cigarette experts from around the world and e cig manufactures and enthusiasts to discuss the future of electronic cigarette legislation.
First we are going to look at what we believe are the most important quotes to come out of the summit. We will follow this by summarising the event and then if you’re still interested we will finish with detailed analysis and notes.
Electronic Cigarette Summit – Important Quotes
I very conservatively estimate that, electronic cigarette use has already saved the lives of at least 10,000 people in the UK alone. – Professor West
Not one of the many hundred studies to date has shown any serious adverse risks or effects. – Professor Hajek
The health risks of ecigarettes are far, far smaller, including second hand inhalation exposure. – Public Health England
When we introduced electronic cigarettes to the range of products we use in our centres the success rate of our clients quitting smoking increased by 20% - Louise Ross of Stop Smoking Service NHS
The risk reduction in e cigarette use v smoking tobacco is at least 95% and maybe as high as 99%. - Dr Farsalinos Konstantinos
Perfectly good and effective e cigarette products could be taken off the market because of too much regulation. – Industry Expert Clive Bates
The electronic cigarette gateway to smoking theory has been completely discredited. – Professor Bauld
When you compare e cigarettes to burning tobacco, the dangerous chemicals are just not there and the ones that remain are much, much safer. – Dr Farsalinos Konstantinos
When I say ecigarettes are 95% safer than smoking tobacco, I am not making a medical claim, I am simply telling the truth. – Professor Hajek
Electronic cigarettes should not be banned simply because they look like tobacco cigarettes. – Public Health England
The Tobacco Products Directive is full of rubbish a ludicrous piece of legislation that should not even include electronic cigarettes as they do not contain tobacco. – Industry Expert Clive Bates
E Cigarette Summit Summary
Electronic cigarettes at least 95% safer than smoking tobacco? Yes, that’s the most important fact to come out of the e-cig summit. Unlike even as recently as 12 months ago the general consensus now amongst scientists, professors and health professionals is that electronic cigarettes are as much as 99% safer than burning tobacco. Even Government health representatives have started using the 95% figure as change their guidance on electronic cigarettes to NHS stop smoking services and centres.
Maybe just as important is the fact that the overwhelming consensus now is against a ban on electronic cigarettes. Health professionals including those in the Government seem to have accepted that the evidence to date proves that a ban would cost tens of thousands of lives. Threats remain from the big tobacco companies and EU legislation, however the health experts, scientists, professors and government officials at the summit came from across the globe and they are all reaching the same conclusion and changing their guidance accordingly – electronic cigarettes are at least 95% safer, they are saving lives, they should not be banned, they are the future for a safer, admittedly nicotine dependant proportion of people around the world.
Detailed Electronic Cigarette Information from the Summit
Professor West: Smoking and smoking cessation trends associated with electronic cigarette use
Ecigarettes have now surpassed NRT as the most successful tool for stopping smoking. But, around a year ago the growth in sales of ecigs slowed. It became apparent that this was due to unfounded health concerns raised and promoted by public health bodies, which were then miss-reported and exaggerated by both big tobacco and the news media organisations .
Professor West was open about his concern that ecigarettes might undermine quitting smoking, however, he made it clear that cessation was actually increasing and is higher now than at any point since the late 1970’s, also that the overall use of nicotine is falling. We can’t say for sure that this is down to the popularity of e-cigarettes, but it is obvious that e-cigarettes are not negatively affecting the stop smoking rate.
Using an over optimistic value of ecigarettes adding 0.5% to the smoking cessation rate, professor West very conservatively estimates that ecigarettes have saved at least 10,000 lives in the UK alone since there recent uptake.
NHS Stop Smoking Services perspective: Louise Ross
An article written by Louise featured heavy criticism of electronic cigarette effectiveness and safety. This article was in turn heavily criticised, which lead Louise to further research ecigarettes, following this her position has completely turned around. She has now increased the quit smoking rates in her centres by 20% by integrating electronic cigarettes in to her treatments.
MHRA: Electronic cigarette medical licensing; Paul Marshall
Mr Marshall explained how the MHRA medical application process works. And it appears to be more workable than the EU TPD.
Mr Marshall was asked two questions:
Is it true as suggested by a UK minister that some NRT products including nicotine gum are not as safe as electronic cigarettes?
Is it correct that the very same large pharmaceutical companies that manufacture NRT products supply the majority of MHRA’s funding?
Mr Marshall declined to answer either question, however we already know that even if the answer to the first question in not yes, it certainly is to the second question.
Ethical and legal responsibilities for Public Health Organisations in evidence and harm reduction: Professor David Sweanor
David states that we all have an ethical duty and responsibility to tell the truth, implying that many public health organisations have not been telling the truth about the risks associated with using ecigarettes. He disagreed with the theory that public health organisations could ethically mislead the smoking public or distort the truth for public health safety.
He went on to explain that some people have a miss-guided ideology with associates electronic cigarettes with smoking, this not rational as the position they take is based on emotion rather than evidence and facts. There are counter productive vested interests everywhere. The anti-tobacco organisations are too simplistic in their approach to e cigarettes, they should have a better strategy and accept that electronic cigarettes are doing more to stop smoking than they could ever possibly achieve.
The problem is that the status quo is being protected by the fear of change. It’s always been the same, when you look back manufactured foods, vaccinations and at one time even bicycles were originally opposed through fear of change. We should embrace social media to hold to account and vigorously oppose the misinterpretation of scientific studies on electronic cigarettes.
Major Points from the Panel Discussion
Professor West: It is possible that the recent cap in growth of e cigarettes is a consequence of the false belief that electronic cigarettes are just as dangerous as cigarettes.
This must be reversed, people should be aware and educated that e cigs are a much safer alternative to burning tobacco. These comments were reiterated by others speakers. Unfortunately, the latest advertising guidelines do not allow you to quote health experts comments like these or state ecigarettes are safer than tobacco cigarettes, so it will be difficult to get the safer message across.
Professor Sweanor: Smokers should be able to make an informed decision by having the correct information available. We need to use social media to blow away all the nonsense and false claims.
Dr Farsalinos: If ten smokers quit and ten adolescents start using e cigarettes that is gain for public health.
Professor West: Explained that many dual users of ecigarettes and tobacco go on to stop using tobacco.
Professor Hajek: Never before in history have sales of a reduced risk product led to an increase in sales of a higher risk product.
Cochrane review on electronic cigarette efficacy, harm reduction and smoking cessation: Professor Hayek
Last year Deborah Arnott claimed that using e cigs alongside smoking to reduce the number of cigarettes smoked had no impact on health. These claims were vigorously disputed by several health experts and she did not repeat the claim at this year’s summit.
The review found no serious adverse event related to electronic cigarette use in any form.
The major problem with a lot of ecig studies is that they use models which are by now almost obsolete, they are much less effective than the ecigarettes that are now available. This means that studies vary in quality and the results are often incorrect.
Schizophrenic patients were discussed with the belief that it is impossible for this group of people to stop nicotine use, however e cigarettes are helpful.
Professor Riccardo Polosa
The professor argued that today’s electronic cigarettes are much more effective than earlier devices and much more helpful in suppressing cravings to smoke.
He went on to explain that many people including professionals and scientists used nicotine to stimulate the brain and help them work. It can also prevent memory decrement and help working memory.
52% of smokers with high blood pressure experienced lower hypertension after switching to ecigarettes.
Preliminary results on chamber study of electronic cigarette second hand inhalation risk: Professor Roy Harris & Gordon McFiggins
This was both a controversial and complex presentation which brought challenges over the figures used in some key points. The main issue is that while larger particles are greatly reduced in e cig vapour there is an increase in smaller particles. The argument really is if this is even an issue.
Dr Farsalinos and Professor Polosa were both of the opinion that there is no evidence to suggest exposure to smaller particle is a risk and there is no real cause for concern.
Evaluating the safety of ecigarettes: Dr Farsalinos
- metals in electronic cigarettes are well below maximum pharmacological intake
- no one is ever going to die from inhalation of second hand vapour
- the most dangerous carcinogens that exist in tobacco smoke are not present in ecigarette vapour
- there is a health risk reduction of around 95% and this could be as high as 99%.
Based on his study and forecasts for the US 324,000 lives would be saved over 20 years if just 2% of smokers switched to e-cigarettes. The figure increases to 2,000,000 with a switch rate of 5%. Just imagine the number of lives that would be saved worldwide if everyone switched to ecigarettes.
Believes that the big tobacco companies who have entered the e cigarette market are deliberately trying to persuade legislators to highly regulate electronic cigarettes. This would effectively give them a monopoly as they are the only companies that could afford to comply with such legislation and smaller e cig companies including most of today’s well-known brands would be wiped out.
Department of Health: Tobacco Products Directive (TPD) implementation: Allette Edison
The Government is lukewarm on electronic cigarettes. I don’t believe they want to stifle them (however they will be very limited by the directive). The Government would also like to find a place for ecigarettes in NRT.
The directive will have massive consequences that are only now being realised. For example social media advertising will be prohibited under the directives ban on cross border sales.
The UK Government has no power to modify the directive in any way, although they will be consulted on some choices still to be made. She believes the directive is legal, however agrees with the current legal challenge to the directive, there are a lot of questions still to be answered here.
Public Health England: The use of electronic cigarettes in enclosed public spaces – a consensus built on evidence: Martin Dockrell
- Public Health England seems to have become very positive about c-cigarettes. Some important points from the presentation:
- Scale of risk is very likely to far far smaller including second hand exposure.
- Making e cig users use their devices outside could increase the exposure of children to e cigarettes.
- The growing body of positive e cigarette evidence must be taken in to account
Permitting or prohibiting ecigarettes – developing a logical policy: Gary Cheeseman
Mr Cheeseman educates councils throughout the UK on electronic cigarettes.
Here are some examples of questions they have been asked along with the reply:
Are ecigarettes safe? They are safer than smoking tobacco.
Do ecigs lead children to smoke? There is no evidence that this is the case.
Product user behavior and diversity – diversity of products, patterns of use and the different companies that make up the electronic cigarette market: Professor Etter
Big tobacco companies are spending vast sums of money on ecigarette development, a single company in the US has already invested over 2 billion dollars on research and development. Again the fact that the aim of the big tobacco companies was to seek disproportionate legislation in order to wipe out the smaller companies that currently dominate the market was discussed.
Unholy Trinity: Regulation, big tobacco and public health – a logical way forward: Clive Bates
A few of the most important points:
Continued intervention can be credited for the he current success of e cigarettes. Over regulation would stop this.
The big tobacco companies must competition in the ecigarette market to keep them innovative and honest, unfortunately the TPD directive will also stop this.
Both over regulation and banning advertising of e cigarettes will favour tobacco cigarettes. The results will be:
- reduced appeal
- far less innovation
- fewer new ecigarette users
The WHO report was very, very poor, and the TPD directive is an awful piece of legislation. This is just the type of legislation that leads to perfectly effective products being banned from sale. At the moment we have a good e cigarette market with innovation and competition.
Action on Smoking and Health: Deborah Arnott: The UK’s position in a global context - Feedback from Octobers FCTC WHO meeting.
Deborah made it clear that unlike the self-appointed, unelected public health organisations, our own elected UK government has no input or say in WHO policy on electronic cigarettes.
We all now know that there was in addition to the official WHO report, an unofficial who report. With the latter unofficial report being much more negative about ecigarettes and this was the report that received the most attention. The official WHO report was much more balanced in its approach stating that electronic cigarettes showed promise while also posing a threat. Unfortunately the overall conclusion of the WHO FCTC was very negative calling for a complete ecig ban or at least heavy regulation.
Alan Depauw: The European voice
Word of mouth information heavily influences electronic cigarette users. There is an influence in the type of e cigarette used and the success in stopping smoking. It appears that chances of quitting successfully are increased with the use of more advanced devices.
91% of users of more advanced devices fear the regulations in the EU TPD will ban the products they use. Many of the millions who use electronic cigarettes appear to be prepared to form a black market for the devices if the directive comes in to force.
UK trade organisations were strongly encouraged to challenge the directive. The UK is in a unique position in Europe as they can challenge the directive before it becomes legislation.
Are children starting to use ecigarettes?: Professor Linda Bauld
Reports and studies have clearly shown that the use of e-cigarettes amongst children is confined only to children who already use tobacco. 2% identified is the highest study rate of children who have used ecigarettes but have never used tobacco. Professor Bauld’s study group have identified almost negligible interest in electronic cigarettes or the intention to use them from the children in the study group. The interesting point from the Bauld study is that children see ecigarettes as a way for adults and often their parents to stop smoking which they know is dangerous. There is very little awareness of ecigarette marketing amongst children as brand marketing has been target at current adult smokers.
British Standards Institute: Ensuring product safety for public and consumer confidence by developing standards: Dr Scot Steadman
Dr Steadman’s presentation on the British Standards Institute was very impressive. As there are no BSI standards for e cigarettes at present, it’s up to the industry to make the standards and have them approved before the Government or MHRA does it for us.
BSI standards are voluntary but they can help to deliver legislation. ECITA are now working with BSI to create draft e cigarette British standards, hopefully they will be available for comment by the end of 2014.