Thoughts from the Dungeon Dimension

Thoughts from the Dungeon Dimension

What follows here is purely my opinion on what seems to be a subject that is becoming the flash point for a lot of debate, argument and bickering. I’ll try to be as coherent as possible.

Most of you know that the All Party Parliamentary Group on ecigs met last week and a lot of good things came from that, there is already a very good write-up on the meeting from James Dunworth over on the Ashtray Blog, after all he was there. I wasn’t. Most of the information that came from the APPG I know through either that blog, the VTTV show The Haze Hour the following day, twitter (of course), plus the following two blog posts. Sarah Jakes, guest posted on Lorien Jollye’s blog to clarify her personal stance followed by a second posting by Lorien herself.

Both of those posts were in direct response to some shenanigans on twitter, and frankly those posts needn’t have been written. That is mostly because I know the personal opinions of both Sarah & Lorien, I have the luxury of having access to a group not widely shared. I actually feel privileged to have access, even though I don’t post there very often. In this group several things happen, pre-release information is often shared and discussed, opinions are sought and most, if not all of the information contained in that group doesn’t get shared until it is necessary. I take on board everything that is posted in that group.

I have also, on rare occasions emailed Lorien directly posing questions and seeking clarification, though I do occasionally have to remind her to respond, but when she does her answers are insightful and very informative; and because it is private correspondence none of it will be shared. Thanks to this group, and the email correspondence with Lorien (and I thank her profusely for taking the time to answer my, what must seem to her, stupid questions) I have come to trust her opinions and judgement. I don’t always agree with them, but I take them on board for consideration before drawing my own conclusions.

Imagine my surprise when Lorien, and by extension the New Nicotine Alliance came under fire on twitter because of one comment that was taken out of context. The comment was:

Lorien of the New Nicotine Alliance believes that if the NHS supply e-cigs it would reassure smokers that e-cigs are safer than tobacco cigarettes.

Now of course, this has only come up at all because of the media frenzy surrounding the release of the PHE Report where the media, with its usual incompetence latched onto a comment made in the press conference and made that the headline instead of the actual point of the report. I myself, when I saw the preview headlines my immediate reaction to them was negative. “eCigs available on the NHS? WTF?” The blog I wrote on the day of the release was not entirely positive about it. I hated the thought that vaping could be viewed as a medicinal aid, or even licensed as a medicine; which we know that in their current state, they never can or will be.

I did post comments on both of the blogs by Lorien and Sarah, but because they are comments on the content of those posts, along with some of my thoughts I’ve since decided to flesh those out a bit more here. After all, this is one of the reasons I have this blog.

Whilst I agree with the principles behind the idea of offering free or low-cost ecigs via the NHS (or GP’s / Pharmacies) in order to reach those that may choose not to switch for a variety of socioeconomic or societal reasons (such as the ‘luxuries’ reasoning), the concern I have personally is how this would reflect on the consumer market.

Thanks to the complex nature of our country and the people who live here, there is no one-size-fits-all solution to anything and that includes vaping. At the moment, we have some Stop Smoking Services offering support on the use of vapourisers as a smoking cessation aid. All well and good, if stopping smoking is the goal. This is where my opinions diverge somewhat from most in the vaping community. I do not see vapourisers as a means to stop smoking. Yes, many have chosen to vape to stop smoking and that is absolutely fine. Others choose to use vapourisers instead of smoking, again that’s absolutely fine. In both cases, the user has stopped smoking. It is an individual choice. For some benighted reason, some people just cannot grasp this simple idea.

But. Let’s look at this from a SCA point of view. There are likely to be many, in varying circumstances that want to stop smoking by using a vapouriser, and here is where it gets a little complicated. You have folk that are, shall we say, “better off” as in, life in general is difficult but manageable. You have the “well off” folks where life is ‘relatively easy’, and you have those folks that struggle. It’s a simplistic view of a complex socio-economic picture. As I’ve learned, many in the “well off” category; the upper-mid and upper classes if you will, generally don’t smoke. There’s a lot of reasons for this, some of those may be the simple fact that most “professionals” don’t smoke themselves, so it can be viewed as a kind of “reverse peer pressure”. As you move down the “class ladder” smoking becomes more prevalent, again for a variety of reasons and Sarah touched on those in her post.

For many people smoking could be one of their only luxuries, and it’s a social thing which people share – it could be that it means a lot more to people in those groups than it does to those with more alternatives. If so then the lost enjoyment cost of giving up smoking could outweigh the perceived benefits, or at least be much more finely balanced than in other groups.

I’ve always considered myself to be at the lowest end of the “middle class” where life is ‘relatively’ easy if managed carefully. Sure I’ve made mistakes, who hasn’t? The point is, I viewed smoking as an enjoyable societal activity, despite the fact that society as a whole shunned it. Did I consider it a luxury? To an extent maybe I did. But Sarah raises a valid point. Slight tangent here, I play a lot of games of varying genres and in games like Civilization and Colonization, tobacco (when it is mentioned) is classified as a luxury item. Does that same thinking apply to those in the “lower socio-economic” groups? Possibly, and a point of view I’d not really considered until now.

So if ecigs are to be made widely available to any and all who want them, there does need to be a cost-effective strategy for that group. It’s fine and dandy for the likes of me who can afford things, but there are several groups where access to ecigs aren’t exactly clear or cost-effective. Both Lorien and Sarah agree on this point.

If they chose to, they could go to their Dr, get a (probably crappy) e-cig and suddenly you have proof of concept. They get the chance to say ‘Oh wow this is utter pants but tell you what, I bet the ones they sell at the garage are better than this! Have you seen all the different flavours? Sod it, I’ll try one!’

— Lorien

 

What we are talking about is enabling the NHS to offer people a device which could start them on the road to switching to vaping – people who would not otherwise try, perhaps because they don’t want to risk spending their cigarette money on a product which will not replace them, or perhaps because they are not confident about the relative safety of ecigs. In either case the NHS can offer confidence and support for those who lack it and perhaps for some a cost-effective financial (for the state) solution for those who won’t take the initial risk.

— Sarah

So, as I said in the first part of my comment, I agree with this; in principle. But.

Let us assume for a minute that a device is available via the NHS; let’s for the sake of argument call it the “medi-cig” and it’s available via referral from your GP, or over the counter at your Pharmacy, or via a Stop Smoking Service. It isn’t free, it’s provided to these services by a local vape-store at cost, the only cost to the individual is possibly a small, perfectly balanced fee or in some extreme cases it is free. It is a 2nd generation device with limited functionality, so no variable wattage or voltage; a CE5 with a simple standardised battery for example.

These are then given to certain groups of people as an aid to stopping smoking or as an alternative to smoking, either way the end result is the same. This “medi-cig” helps a lot of people stop smoking, which is great for those that choose it. But. As I mentioned in one of the comments, I have more of a “smoker mentality” than most. I loathed NRT simply because of one word – “therapy”. Because of that one word, it put me in the mindset of “something is wrong which needs medicinal treatment”. Whereas this isn’t strictly the case at all. It is more a way of altering a ritualistic habit. Calling it a “therapy” implies that smoking is a disease or sickness that requires intervention. It isn’t.

Putting a ‘medi-cig’ out there could feasibly give that same impression (especially if it is actually called a medi-cig), and by extension the consumer products could also be viewed by the rest of the never-smoking population as the same thing. But we know that there will never be a medically licensed e-cig this was soundly put to bed although it could remain an option but is (as Clive Bates says) an entirely unattractive option at the moment but could come in later once the dust settles from the implementation of the TPD, and hopefully with a bit more flexibility.

Seeing a device handed out via the NHS at a cost to the user is a reasonable course to my mind, it allows those not willing or able to take advantage of another option.

it’s a tantalising opportunity, but care must be taken not to allow the consumer products be viewed as an extension of a “medically approved / provided” product.

Finally, my sincere thanks to both Lorien & Sarah for posting, though I still believe it wasn’t entirely necessary (as such). Hopefully, this matter can be put to bed once and for all. I don’t want to see a medically regulated device (which is impossible anyway), but I would like to see vapourisers available in the widest possible way, and if providing them at cost via SSS or the NHS is going to happen, it simply widens the scope of availability.

Three different blog post authors, one subject with three differing views leading to similar conclusions.

Update

I mentioned I left a comment on both posts. Sarah has taken the time to respond to mine, I’ve included the full response below:

I think the consumer market and vapers ourselves are by now so well established that I would be amazed if the existence of a med-ecig made any difference at all to public perception of ecigs in general. To my mind it would be far more likely that the public would think ‘hey look, that beardy tattooed rabble were right – and now even the NHS is jumping on the bandwagon’.
The idea that a late coming medicinal version of something taints the whole category just seems unrealistic to me – it’s not as if people stopped buying chewing gum or sweets when nicorette gum and lozenges hit the market.
My personal view is that a med-ecig will never exist (unless the MHRA drop the bar by a substantial amount) and so this whole discussion is moot. The fact that they haven’t yet done so tells me that they don’t understand ecigs (no surprises there) and given that they will be the competent authority for TPD regulated ecigs that is by far the more worrying aspect we need to overcome.
NHS prescription of ecigs is a side show – it might work for some people, it might not but as far as I can see trying doesn’t have a downside.

Like Sarah, I don’t believe a med-ecig will ever exist, but we do differ in our opinions on public perception; that’s absolutely fine I’m not going to hold that against her at all. It’s a simple case of agree to disagree on that point, which frankly is a minor sub-point of the entire discussion and is barely relevant. But we do both agree, the option to provide ecigs via a medically approved route such as the NHS doesn’t have any major drawbacks and may even help. But as Sarah succinctly points out:

There are more important things to concentrate on.

Cannot refute that at all.