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s2smodern

Harry Shapiro Director DrugWise

There has been some debate on the wires that the FDA Mission statement only seems to be concerned about reducing tobacco use by minors but not adults. The exact wording is “ FDA also has responsibility for regulating the manufacturing, marketing and distribution of tobacco products to protect the public health and to reduce tobacco use by minors”.

One posted comment came from Richard Cranfield from US Health Works who made the insightful point that the FDA (and probably most other US public health agencies) have no interest in harm reduction when it comes to minors, children or teenagers in relation to tobacco products. He says, “ I think what the public health agencies in the USA are doing is a protracted generational battle to remove tobacco as a vice kids will use to challenge authority. If it takes another several generations, they are fine with that as long as they can see even a little progress, perhaps measured in decades, not year to year. So the argument of harm reduction is meaningless in a scheme that has a multi-generational plan to harm eliminate. We think of harm reduction in an immediate, game changing sense. They think of it as a 'save the future', not a 'save us now' type of process. They are fully prepared to sacrifice the present for their vision of the future”. Which is very reminiscent of the UN slogan from the 1998 General Assembly Special Session on drugs “A drug free world we can do it”.

And of course, as another commentator posted, “add to that the racketeering conviction of the big-tobacco cigarette companies in the late 1990's -- you have a situation in which there is no way any of these tobacco control activists will consider any role for any non-pharmaceutical tobacco-related product in the context of any public health initiative. They (the tobacco control activists) justify this based on a firm belief that the only reason any tobacco-related company would ever introduce any low-risk product would be to recruit the next generation of teens to a life-long nicotine addiction, with eventual transition to cigarettes for a bigger and better nicotine hit.”

A new report has been published in the States from the Core Team on Tobacco Control (http://www.tobaccoreform.org)  entitled Ending cigarette use by adults in a generation is possible: the views of 120 leaders in tobacco control. The authors are listed but the respondents are not (although their names and contributions are available on request) and there is a disclaimer that the views expressed don't represent the views of the organisations these leaders work for. I am not sufficiently au fait with the tobacco control community to know where the named authors stand on e-cigarettes and other HNB technologies, but I (at least) was quite surprised to read as the third of three actions for “ immediate, accelerated implementation”,

“Establish a more rational tobacco, nicotine,and alternative products regulatory framework based on their relative risks, and that is adaptable to the increased speed of innovation in new technology development”

“Consumer use of alternative nicotine delivery systems has increased dramatically in the U.S. and globally, outpacing development of policy around them as a potential tool for tobacco control. These products, which now include electronic cigarettes, heat-not-burn tobacco products, snus, and vapor products, reduce user exposure to the toxins associated with combusted tobacco, while maintaining nicotine content close to levels in traditional cigarettes. These technological advances spotlight a neglected policy option to support addicted smokers in making substantially less-harmful choices for their health. Such harm-reduction approaches have gained a foothold in other areas of drug and addiction policy in the U.S., and in tobacco control in the United Kingdom and Sweden”.

“Stakeholders broadly supported development and regulation of all tobacco products, including alternative nicotine delivery systems”.

Interesting video lecture https://www.youtube.com/watch?v=xHbZmwzB-us broadcast from the Heartland Institute, a free market think tank based in Chicago. Brad Rodhu was the first of two speakers who gave the audience a basic primer on both the facts and myths about e-cigarettes. The slides that caught my attention were the frankly hopeless 'tips' from the National Cancer Institute for those wanting to quit smoking including 'call a friend', 'read a book', 'get out of the house' and my own favourite 'keep a daydream ready to go'. Oh yes, there was also 'reward yourself'. By doing what? 'Read a magazine', 'listen to music' – and maybe 'have a fag'?? He also pointed out that at a population level, studies have shown that NRT can only boast a 7% success rate which is deemed by health authorities 'a success'. He asks – what other medicinal product would be deemed a success at just 7%?

During the Q/A, he pointed out that when he gives this type of overview lecture, the doctors and scientists in the room do 'get it'. The trouble comes when you need government grants to do research not in tune with the tobacco control zeitgeist. Keep a daydream ready to go.

The other speaker was a former Republican politician, Pamela Gorman, now Executive Director of the Smoke Free Alternatives Trade Association (SFATA) who made a strong case for the free market tackling a public health problem which had defeated the government. And for anybody who needs to understand the insanity of the FDA Deeming Regulation, this should also be required viewing.

One interesting point came out of the Q/A; despite the virtues of HNB technologies, the majority of American states are addicted to tobacco sales to boost flagging budgets through the Tobacco Master Settlement Agreement signed in November 1998 whereby the four largest US tobacco companies agreed to pay 46 states in perpetuity to cover medical costs of smoking in exchange for an end to the constant round of law suits against Big Tobacco.

https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement

Over in the land of Fosters, the message to smokers is 'so long, its been good to know you' as the government adopts the quit or die message propagated by the WHO and US Surgeon General by not reconsidering the interim decision not to allow a variation in Australia's poison schedule that would have permitted nicotine e-liquids up to 36mg/ml (3.6%) to be made and sold in Australia. Click on the link for a typically forensic take down:

https://www.clivebates.com/documents/TGASubmission2.pdf

Want to bring an e-cigarette product to market? I suspect the process is a lot less tortuous in the UK: 

https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products?utm_content=bufferf9f3d

On the other hand, read the small print of your insurance policy as companies conveniently buy into the anti e-cig propaganda as yet another wheeze to avoid paying out.

http://www.mirror.co.uk/money/there-no-difference-between-vaping-10026369

Two takes on the rise of e-cigs – one benefiting vapers, the other, lawyers

https://journalistsresource.org/studies/society/public-health/ecigarettes-sales-increase-tobacco-cdc-research

https://www.vice.com/en_uk/article/lawyers-see-dollar-signs-in-exploding-vapes

And finally, the finer points of vaping etiquette from Debretts which has been telling Brits how to behave since 1769. Just in case you wondered, blowing vapour in somebody's face is an apparent no-no. Who knew?

http://www.express.co.uk/news/uk/780164/Vaping-e-cigarette-rules-politely-etuquette