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s2smodern

Harry Shapiro Director DrugWise

OK, so let's start with some good news for a change.

In Canada, the University of Victoria’s Centre for Addictions Research of British Columbia (CARBC) in a report called “ Clearing the Air” have concluded that fears of vaping being a gateway to tobacco smoking are unfounded.

Researchers comprehensively surveyed the rapidly increasing academic literature on e-cigarettes and found evidence that vaping is replacing—rather than encouraging—the smoking of tobacco cigarettes among young people. The CARBC researchers identified 1,622 articles on the topic, of which 170 were relevant to their review. Evidence shows that tobacco use by youth has been declining while use of vapour devices has been increasing.

They also found strong evidence that the vapour from e-cigarettes is less toxic than tobacco cigarette smoke and encouraging evidence that vapour devices could be at least as effective as other nicotine replacements as aids to help tobacco smokers quit.

“The public has been misled about the risks of e-cigarettes,” concluded Tim Stockwell, CARBC director and co-principal investigator. “Many people think they are as dangerous as smoking tobacco but the evidence shows this is completely false.”

The report was taken up by Andre Pickard writing in the Toronto Globe and Mail.

“Dr. Stockwell is not just blowing smoke” Pickard wrote. “He and fellow CARBC researchers have just produced one of the most comprehensive reviews of the research to date and it shows unequivocally that vaping is replacing, not promoting, smoking”

“The most encouraging aspect of the report is that it seems to debunk the notion that e-cigarettes will entice young people, get them hooked on nicotine and then see them embrace smoking”

“In fact, the evidence points to precisely the opposite trend. Between 2003 and 2013, teen e-cigarette use rose from 1.5 per cent to 16 per cent; during that same period, teen smoking rates fell to 9.3 per cent from 15.8 per cent”.

And over in the UK, the New Nicotine Alliance consumer group, chaired by Professor Gerry Stimson, helped convince the High Court in London that a challenge to the ban on snus in the UK should be referred to the European Court of Justice (ECJ). As Gerry explains,

“Swedish Match (SM) initiated the challenge to the ban on the sale of snus in the UK. The case was brought against the government who opposed the application for Judicial Review on the grounds that it was out of time – they argued that the case should have been brought in 2014 when the Tobacco Products Directive was passed. SM argued that it could not bring a challenge against the law until the EU Directive had been passed into UK law, and the judge agreed. Because the UK law is based on EU law (the TPD), the case now has to be referred to the ECJ.

“The next stage is that the lawyers agree the ‘reference’ to ECJ – which should take about a month, and then the case passes to ECJ, which will likely take about 18 months. So we get a further opportunity to advance our case when it goes to Europe. We are still in Europe in this timescale. If the EU decides in our favour and against the ban then the ruling applies across the EU. It’s a big IF - as the ECJ has not been sympathetic to challenges to the TPD”.

“But I think that even getting this far is a triumph for a new, small consumer advocacy group, NNA was only founded in 2015, is a small group of volunteers and has few financial resources. We are pleased that this shows the potential for consumer advocacy groups to make a noise and make a change”.

So now for the inevitable not so good news.

According to an article in the Journal of the American Association of Nurse Practitioners, nurses discourage patients who smoke from trying to quit using e-cigarettes. "Currently, it is neither advisable for practitioners to recommend e-cigarettes for smoking cessation, nor is it recommended to commend patients for making the switch to e-cigarette use over traditional cigarette smoking."

In his blog Michael Siegal wonders whether we “have completely lost our mind?” 

“I just cannot understand how a nurse could possibly be advised not to commend a patient who successfully quit smoking. It is an amazing accomplishment and the patient deserves the highest commendation for such an achievement. To withhold such a commendation simply because you don't happen to like the methods the patient used is, frankly, sick. It suggests that the health of the patient doesn't matter. What matters is that the patient quits the way this particular nurse thinks is best. It is like a spit in the face to the estimated two million Americans who have successfully quit smoking using electronic cigarettes”

Some gloomy news too from Germany; a robust survey which included perceptions of relative risk between smoking and vaping revealed that over 60% of those surveyed thought e-cigarettes were as or more dangerous than cigarettes. Roughly equivalent figures for the US and UK, according to surveys conducted there would be around 40% and 25% respectively, although the UK trend is for increasing antipathy towards e-cigarettes.

You might expect that an august medical publication like The Lancet would acknowledge the role of e-cigarettes in the global drive to wean smokers away from cigarettes. Well, no. In its editorial concerning the latest WHO report, http://www.who.int/tobacco/publications/economics/nci-monograph-series-21/en/ it endorsed the recommendations about economic sanctions as the route to go and that was it. END of;

There was an intriguing article in The Guardian which asked the question why do bad ideas refuse to die?. This long article led off with the continued existence of flat-earthers and delved into the murky world of conspiracy theory – the American covered up alien arrival in 1947, the moon landing never happened and so on. Science is not immune from this plague of 'zombie ideas'.

The principle behind the peer review process should in theory make it “impossible to publish clownish, evidence-free hypotheses” But as reported in Scientific American magazine in 2011, “false positives and exaggerated results in peer-reviewed scientific studies have reached epidemic proportions in recent years,” Healthcare research seems the most problematic because of conflict of interest funding.

The author notes “Nearly every academic inquirer I talked to while researching this subject says that the interface of research with publishing is seriously flawed. Partly because the incentives are all wrong – a “publish or perish” culture rewards academics for quantity of published research over quality. And partly because of the issue of “publication bias”: the studies that get published are the ones that have yielded hoped-for results. Studies that fail to show what they hoped for end up languishing in desk drawers”

This is certainly true in the world of illegal drug research. Try getting funding from the US National Institute for Drug Abuse for research that demonstrates anything other than the negative effects of drug use. I recall an article in The Lancet back in 1983 which clearly showed that you had more chance of getting a paper published showing the negative effects of cocaine on the foetus than one showing a null effect even if the latter had a more robust methodology.

And so I'm sure we are seeing the start of the growth of zombie ideas surrounding e-cigarettes and similar products resulting from a toxic mix of bureaucratic and scientific ideology and vested interests. I just wonder how long it will take for those propagating 'clownish' zombie ideas in this arena to find they have come back to haunt them.

And a quick final thought. According to a survey by Halo, an e-cigarette company out of the top 300 largest cities in America, Massachusetts has the highest number of vaping restrictions — 116 to be exact. Boston has 1.52 vape shops per 100,000 residents, earning it a spot in the top 10 for cities with the fewest vape shops. Guess which state just legalised cannabis? Go figure.