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s2smodern

Harry Shapiro Director DrugWise

Back in the day, I worked in the library of the Institute for the Study of Drug Dependence. The collection policy was literally everything in English on illegal/non-medical drug use. We ended up with one of the best English language drug libraries in the world. But there was a lot of dross – and the one category we soon dropped were animal studies. Researchers would inject a rodent with high levels of the psychoactive THC, watch it fall over and then declare that cannabis caused everything from cancer to Ebola. And we would be sent many similar studies, so reproducability wasn't the issue, it was just pointless with no relevance to real world situations and just a way of building up a publishing record.

And this same nonsense is being inflicted on the world of e-cigarettes. The American Heart Association are claiming that vaping causes severe strokes and poses a higher risk of severe strokes than smoking. This claim is based on a study where those mice exposed to e-cigarette aerosol for 10 days or 30 days had more severe strokes than those exposed to tobacco smoke. 


In a trenchant criticism of the AHA, Dr Michael Siegel writes, “To extrapolate from this single pre-clinical, animal study to population-based human health effects is ludicrous. There are many reasons why stroke-related findings from rodent studies do not translate well to humans”. He cites a paper from 20009 by Braeuninger and Kleinschnitz who say

"There are, of course, significant physiological, neuroanatomical and metabolic differences between humans and small rodents, which are the most widely used experimental animals in preclinical stroke research. For example, small rodents usually require higher drug doses on a mg/kg body weight basis for a similar effect than larger mammals. Thus, effective doses derived from preclinical stroke studies in small rodents cannot simply be transferred to the situation in humans, even if adjusted for body weight." https://etsmjournal.biomedcentral.com/articles/10.1186/2040-7378-1-8


Dr Siegel continues, “This blatant disregard for the truth, which I would term "public health malpractice," is not only unscientific but it is also damaging to public health...After all, if vaping poses a greater risk of stroke than smoking, then there is absolutely no reason to quit smoking using e-cigarettes. You'd be better off smoking. And if you already quit smoking by switching to e-cigarettes, then you'd be better off returning to smoking than continuing to vape. Why take a chance of increasing your risk of suffering a stroke? If the American Heart Association has any regard for scientific accuracy and professional responsibility in communication, it will offer an immediate retraction, correction, and apology for this action”

http://tobaccoanalysis.blogspot.co.uk/2017/02/american-heart-association-claims-that.html


The exact same story prompted two entirely different headlines. The global marketing agency Mintel produced a report looking at the e-cigarette business in the UK and on their own website, headlined the report E-cigarettes ignite the smoking cessation market with 340% growth year on year to 2013. It reported that “while sales of smoking cessation aids have slowed, the market for E-cigarettes in the UK is booming...from an estimated £44 million in 2012 to reach an estimated £193 million in 2013”.

http://www.mintel.com/press-centre/social-and-lifestyle/e-cigarettes-ignite-the-smoking-cessation-market

By contrast, the British Telecom news site headlined its story, Fewer people using e-cigarettes to quit smoking amid lack of official guidance, going on to say that “Meanwhile, use of non-prescription nicotine replacement therapy products remains stable at 15%, as does use of nicotine replacement gums or patches on prescription from health professionals at 14%.” The message is read the actual report rather than rely on word bites.

Mixed messages also come from Ireland. In partnership with the nation's pharmacies, the Irish Health and Safety Executive (HSE) is launching a Quit Initiative. Despite recent falls in smoking prevalence, around 18% of the population still smoke while smoking-related disease claim over 5000 lives annually. But when asked about vaping as a way of quitting, Carmel Collins of the Irish Pharmacy Union said, “The jury is still out”, and “not enough research has been done in this area”.

http://www.thejournal.ie/quit-smoking-4-3263215-Mar2017/

Yet Irish prisoners trying to quit smoking will soon have access to electronic cigarettes. In a recent court case, the barrister for a defendant complained to the judge that the man had been advised for health reasons to stop smoking, but e-cigarettes could not be sent in because of a “procurement problem”. A spokesperson for the Irish Prison Service told TheJournal.ie that these devices are not currently available at present, but their availability does form part of a new smoking policy that is being finalised. So does that mean that it is OK for inmates to vape until 'enough research has been done'??

http://www.thejournal.ie/irish-prison-e-cigarettes-3257518-Feb2017/

The Financial Times ran a special on regulation with contributions from regular commentators who offered some valuable oversights for the general reader not familiar with the issues.

Clive Bates, on how governments can overreach themselves in the thirst for regulation:

https://www.ft.com/content/8f75bac2-eded-11e6-930f-061b01e23655

Derek Yach on why he chose to leave the WHO to work with industry:

https://www.ft.com/content/5fbf2eb0-d990-11e6-944b-e7eb37a6aa8e

And David Sweanor, on not discouraging the switch to safer alternatives through over-restrictive regulation:

https://www.ft.com/content/490982dc-ec5b-11e6-930f-061b01e23655

You've probably heard the expression 'All the news that's fit to print'' Well, here is the letter to The Lancet from Professor Pierre Barsch and a host of international colleagues which the journal would not print. It was in response to an editorial published on 21st January entitled Tobacco elimination:an economic and public health imperative.

http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)30132-0.pdf

“We have read with great interest the editorial of your 21 January issue.

We are all supporters of one of the central objectives of the WHO Tobacco Control Framework Convention initiated in 2005: to protect present and future generations from the devastating effects of tobacco smoking and other forms of high-risk tobacco consumption. Partly as a result of this convention, we observe, in our developed countries, a slow decline of the smoking prevalence.

Nevertheless, in New Zealand, a high performing country in Tobacco Control, the Smoke Free 2025 goal is not on the way to be achieved.

In this country, where domestic sales of e-cigarette containing nicotine are currently banned, the authors highlight the potential contribution these electronic-containing-delivery devices could make to reach this difficult goal. We support their action to change the current regulation.

Among us are health professionals who strive to help people in smoking cessation. We have observed that even after using licensed medical products together with psychological support, we remain with 70-80% smokers still smoking.

We also see that we obtain a substantial improvement by encouraging smokers use improved nicotine delivery last generation e-cigarettes which offer greater potential for substitution with conventional cigarettes and therefore less harm, as promoted by recent reports from the Public Health England, the Royal College of Physicians, the Royal College of General Practitioners and the Victoria Centre for Addictions Research, among others.

Of course, nicotine dependence and some residual health risks may persist among e-cig users; so we believe our duty is also to encourage and support those “vapers” who express the wish to quit vaping and all nicotine use, without relapsing to smoking, to come back to breathing air only.
The development and appropriate regulation of safer alternative nicotine delivery products such as e-cigarettes could accelerate the ending of the global tobacco smoking epidemic.

E-cigarette could be a major contributor to the Tobacco End of Game at a moment when Heat not Burn tobacco products come on the market. E-cigarettes should be supported along with other Tobacco Control efforts outlined in the FCTC and integrated to it, instead of being demonized and opposed the Public Health community.”

And finally...in a dramatic reversal of his campaign pledge to 'Make America vape again' – Donald Trump has signed an executive order confining all vape industry CEOs to Guantanamo Bay and introducing the death penalty for vaping. He is now turning his attention to another pledge to 'Make America young again'. Professor Chuck Bonkers from the Centre for Research on Anything Profitable (CRAP) said, “We here at CRAP have irrefutable evidence that old people are responsible for 80% of all deaths. And given that all old people were once young, this is clear evidence of a gateway effect”. Among the more radical measures being considered to deal with the crisis are sky diving tests for 60 year olds, but over the Pacific Ocean in case any vulnerable young people are walking underneath.