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s2smodern

Harry Shapiro Director DrugWise

Despite the best efforts of the powers-that-be to convince Americans that e-cigarettes are just as dangerous as smoking tobacco, a new study ( http://www.news-medical.net ) shows that among US smokers with respiratory conditions who continue to smoke, many are switching to e-cigarettes believing them to be less harmful.

Lead investigator Dr Gina Kruse from Harvard Medical School, Boston said, "Smokers with asthma, COPD, or cardiovascular disease probably use e-cigarettes for the same reasons as other adults: to quit cigarettes, reduce cigarette consumption, or reduce the harms from smoking. Smokers with these chronic diseases may feel an urgent need to quit or reduce combustible cigarette use and may be willing to try new products”.

Evidence obtained by The Guardian under the Freedom of Information Act, reveals that smokers in England wanting to quit face a postcode lottery as cash-strapped councils and doctors restrict access to services that can help them.The revelation has alarmed health experts and charities who claim that lives are being put at risk as a result of the fragmented provision. Public health grants have been slashed and local health funders have told GPs in some areas to stop prescribing nicotine replacement medications.

https://www.theguardian.com/society/2017/feb/19/smokers-who-want-to-quit-hit-by-postcode-lottery

The report made no mention of e-cigarettes as a viable alternative for those wanting a pathway to quitting. But of course the industry is forbidden to advertise its products in this way unless they are deemed medicinal products with all that implies for bringing a product to market. Time for a rethink on that one or at least health authorities and the medical colleges should be encouraging health professionals to discuss e-cigarettes with patients rather than leaving them in a fog of uncertainty.

Interesting article from Design Week magazine on how the design firm Wonderstuff have been working to rebrand Vapourlites to suggest that e- cigarettes can help quit smoking.

https://www.designweek.co.uk/issues/13-19-february-2017/vapourlites-reveals-new-packaging-show-ecigarettes-can-be-medicinal/

Given the strictures of the TPD, achieving this has to be 'nuanced' to say the least: they apparently went through 600 different packaging designs as the TPD kept changing the regulations. It all seems to come down to the 'clinical' look and feel of packaging, 'patient' information in the packet and possibly having one version for sale in pharmacies. Where there's a will...

The Punjab Government has prohibited the manufacture, storage, sale or distribution of gutkha, pan masala, processed/flavoured/scented chewing tobacco and any other food products containing tobacco or nicotine as ingredients, whether packaged or unpackaged or sold as one or separate products, throughout the state for a period of one year. Announcing this, an official spokesman said the decision had been taken in view of the orders of the Supreme Court, which observed that to circumvent the ban on the sale of gutkha, the manufacturers are selling pan masala (without tobacco) with flavoured chewing tobacco in separate sachets. Maybe the government's time would be better spent dealing with the heroin epidemic currently sweeping through the State, affecting an estimated quarter of a million of its people amid accusations of high level corruption.

Just read this chat transcript from what appears a US military sponsored site https://www.ucanquit2.org/AboutUs/Policy

1:05 PM

Angela:

Hello! How can I help you today?

1:07 PM

Guest:

My friend uses smokeless tobacco and smokes cigarettes. He's not prepared to be tobacco free at this time, but wants to reduce his risk. Which one should he quit if he's only prepared to quit one?

1:09 PM

Angela:

I cannot advise someone on that. Smokeless tobacco and cigarettes are both bad for you. It's not an apples-to-apples comparison.

1:10 PM

Guest:

But is one worse for you than the other? If he's eager to quit one shouldn't he quit the one that poses the most risks?

1:11 PM

Angela:

They both have risks - some of the same and some different. I cannot advise which one has the least amount of risk.

1:12 PM

Angela:

Perhaps your doctor (or his doctor) could advise on this.

1:12 PM

Angela:

Nicotine travels to the brain after being absorbed into the bloodstream. Within about 10–15 seconds, nicotine boosts the “reward center” of the brain, causing a pleasant, happy feeling. Adrenaline is released, which makes the heart rate and blood pressure increase and makes breathing rapid and shallow. Over time, these effects can damage your heart, arteries, and lungs, increasing the risk for heart attack, stroke, and chronic lung disease.

1:13 PM

Angela:

Besides being a factor in developing cancer, and lung and heart disease, cigarettes have other bad effects. The carbon monoxide absorbed by the body from one cigarette, stays in the blood for as long as 6 hours. This means the heart has to work harder to supply the body with enough oxygen.

1:13 PM

Angela:

Many individuals use smokeless tobacco despite its obvious drawbacks because they are hooked on nicotine, a highly addictive drug. As with cigarettes, smokeless tobacco products deliver substantial doses of nicotine along with powerful cancer-causing chemicals.

1:13 PM

Angela:

Because nicotine from smokeless tobacco is absorbed through the mouth, the drug takes longer to produce its rewarding effect in the brain than it does when it is absorbed through the lungs during cigarette smoking. The amount of nicotine obtained from smokeless tobacco is comparable to that of cigarettes, and once smokeless tobacco users become addicted they find it just as difficult as cigarette smokers do to quit

1:13 PM

Angela:

Cancer: --Chewing tobacco and snuff contain 28 cancer-causing agents. --Chewers are 50 times more likely than nonusers to get cancer of the cheek, gums, and inner surface of the lips. --Smokeless users are at greater risk for mouth cancer than are nonusers, and these cancers can form within 5 years of regular use. --Leathery white patches and red sores common in smokeless tobacco users' mouths can turn into cancer. --Tobacco juice can lead to cancer of the tongue, esophagus, larynx, stomach, pancreas, prostate, and the floor and roof of the mouth.

1:14 PM

Angela:

--Smokeless tobacco users have a higher risk of heart disease, high blood pressure, and heart attacks due to the high concentration of salt in smokeless tobacco. --Chewers are at greater risk for high cholesterol than people who don't use tobacco. -

1:14 PM

Guest:

Sound like you're saying they both equally risky and it doesn't matter which one he gives up first.

1:15 PM

Angela:

They both have horrible health risks. I cannot advise someone between the two. They're both very dangerous.

1:15 PM

Angela:

There are a couple of medications that a doctor can prescribe to help someone stop smoking.

1:16 PM

Angela:

There are also nicotine patches, nicotine gum, etc. that can help as well.

1:16 PM

Angela:

People who are trying to quit using smokeless tobacco may benefit from a transdermal nicotine patch during the first critical months after stopping use

1:16 PM

Guest:

So, wouldn't he cut his danger in half if he quit one? Are you advising he should just continue to use both until he's ready to quit both?

1:18 PM

Angela:

No, I'm not advising him to continue to use both. I'm advising him to speak with his doctor for medical advice. (He may have some health issues that could be exacerbated by one of those, for example.)

1:18 PM

Angela:

And I'm only saying that I cannot advise which one to stop.

1:19 PM

Angela:

My advice is to quit both. They are both very dangerous.

1:20 PM

Guest:

OK, you're saying they are so similar is risks that if he was only going to quit one, then he should seek a doctor's advice to determine which one to quit.

1:21 PM

Angela:

No. I did not say that about their risks. I said it is not an apples-to-apples comparison, and they both have their own health risks.

1:23 PM

Angela:

Your friend's family doctor should know his medical history and might be able to advise more specifically.

1:23 PM

Guest:

OK, got it. Different products, different risks. But given the research you surely must have access to, you cannot make a judgement on which product, all things being equal, is more risky to health than the other.

1:25 PM

Angela:

No. All things are not equal. They each have their own health risks - some same and some different.

1:26 PM

Guest:

But are the health risks of one greater than the other?

1:30 PM

Angela:

Please consult your doctor for medical advice. I've said - quite a few times - that I cannot advise between the two. They're both very dangerous.

1:34 PM

Guest:

OK, I will consult a doctor. And, I will do some research on my own. There have to be studies out there that, generally speaking, show which product poses a greater risk to health. But you're telling me smokeless tobacco and smoking cigarette are both "very dangerous." That statement makes them sound about equally risky.

1:35 PM

Angela:

I didn't say that.

1:35 PM

Angela:

Yes, it would be good to research this for yourself. Different sources say different things.

1:37 PM

Guest:

When you say "both very dangerous" I'm not sure what you mean by that. Could it be that both are so dangerous that difference between them don't matter?

1:40 PM

Angela:

I'm not a medical professional or someone who's researched tobacco products, so I cannot tell you which is riskier. As with many topics, you can find statistics and sources to prove whichever side you want. I cannot tell you which is less risky.

1:40 PM

Angela:

Smoking cigarettes and chewing tobacco are not apples-to-apples comparisons.

1:41 PM

Angela:

You should ask your family doctor for medical advice.

1:41 PM

Guest:

OK, it seems like you don't have the kind of information I'm looking for. Thanks for the help.

1:42 PM

Angela:

Thank you so much for stopping by. Best of luck to your friend in his journey.

1:42 PM

Guest:

Thank you.

A lot of hum on the wires this week about the FDA's kafka-esque proposal to require manufacturers to reduce NNN in smokeless tobacco products to no greater than 1 microgram per gram of tobacco – a standard for smokeless tobacco, not the tobacco used for smoking. Some products like snus can meet the standard, but the feeling is that most products will be forced out of the market.

As Clive Bates observes, “the approach FDA is taking goes against good practice on introducing regulation into a market. That is: start by setting standards at a levels that address outliers or that can be achieved by most manufacturers with improvements in their processes. Then, having learnt from that, tighten the standard over time. Unless, of course, the intent is to damage the regulated industry rather than improve it”.

And finally, the BBC gave coverage to an article in Nature from last May about the many published scientific studies which cannot be replicated http://www.bbc.co.uk/news/science-environment-39054778 . Those interviewed by the BBC thought the problems lay in the rush for cheap headlines, the need to make science 'sexy', pressure from funders for 'positive' results, publish or be damned and so on. Or in our world moral agendas posing as research. Nature interviewed over 1500 researchers, of which 52% thought there was a 'significant' crisis while 38% thought there was a 'slight crisis'. Isn't that like being a bit pregnant? So naturally, the magazine headlined its piece about a problem whose roots lay at least partly in sensationalism with the headline 'Survey sheds light on the ‘crisis’ rocking research' – although to be fair the word crisis is in quotation marks.

And finally, the BBC gave coverage to an article in Nature from last May about the many published scientific studies which cannot be replicated etc etc....