More Tomfoolery

I mentioned in a previous post that a certain Canadian MD – none other than Matthew Stanbrook, by far the most ideological and idiotic anti-vaper “researcher” there is, who claims that “e-cigarettes are a gateway that must be shut” – has had an opinion piece published, alongside a certain study, which is now getting some media attention. Hardly surprising really. Most notably (so far) is his mention in a Medscape article.Stanbrook_Medscape

As you can see, he hasn’t shifted one iota in his ridiculous ideology in that e-cigs are in fact a really bad thing. He also proudly tweeted about a “qualitative” e-cig twitter study – the one where they trawled through twitter and found that folk use e-cigs and looked for very specific terms. You can tell what sort of chap he is can’t you? He’s a Canadian Simon Capewell, and we know how much Capewell loves loathes e-cigs.

Anyway, on with the editorial.

These findings add to mounting evidence associating use of e-cigarettes with tobacco use. A recent study involving US youth found that never-smokers in grades 11–12 who used e-cigarettes had sixfold higher odds of becoming cigarette smokers a year and a half later when they reached the legal age to purchase tobacco.

The referenced study is of course (one I’ve yet to read) another one from the same author as this lovely piece of work so you can pretty much guarantee that it’s going to be wildly incorrect to the point of absurd – I will of course do a full write up once I’ve had a chance to read it. But I do find it odd that Stanbrook makes no mention of any UK data on the supposed “gateway” theory. Nor does he even reference the MTF survey data which has shown, quite clearly that the use of lit tobacco products is at its lowest. But of course, that doesn’t fit with his idea that all e-cigarettes must be medicalised.

Although this study, like previous ones, found that e-cigarette users were more likely to be identified on a validated measure as being inherently susceptible to smoking, susceptibility did not explain the association.

Just like this study on “future use” and other studies that look at “susceptibility” explains absolutely nothing. It is, plain and simple conjecture – saying that “if your parents and/or friends smoke/vape – you will too” – which is basically bollocks. There’s a good chance you will at least try (note that Stanbrook – trying, i.e. experimentation does not equal use) either product, because we homo sapiens are curious creatures – also, there isn’t a “one size fits all” demographic that can explain why folk try things, though to be fair it is mostly within the younger age ranges – regardless of ethnic, economic and social backgrounds.

Instead, lack of susceptibility magnified it: e-cigarette users not inherently susceptible to smoking had nearly 10-fold higher odds of becoming smokers. These results are consistent with those of prior studies involving students in grades 9–10 and together leave little doubt that e-cigarette use can function as a gateway to tobacco smoking.

So by some bizarre logic, because an individual isn’t susceptible to smoking they are automatically more likely to start vaping. What studies are finding is increasing experimentation. As the study that this editorial accompanies, 10% of the total number of participants were either “daily”, “used once or twice”, or  “used once” respondents. In fact, out of the 238 that were “users” (to varying degrees) only five were daily users. The rest of them either didn’t answer or were those that were experimenting (“frequently” could indicate a social use type pattern).

The spread of e-cigarettes to youth is not merely an innocent consequence of adolescents’ natural inclination to experiment. It has been driven by aggressive marketing tactics by the industry — the same tactics that have long been used to promote tobacco to youth, including provocative ads and celebrity endorsements.

While it is possible that adverts have piqued the curiosity of some youth, it is highly unlikely that advertising alone is responsible for teens to experiment with stuff. The “innocent consequence” of the teens natural inclination to experiment is far and away the biggest driving factor in teens trying anything. It may be that they have friends that vape (or smoke), a parent or other family member that does. Celebrities endorse Mercedes-Benz motors, are they part of some Big Tobacco plot? What about David Beckham and his fragrance range? Advertising is the business of making products attractive to a set or subset of the population. I regularly see adverts for digital cameras (I do own one) but I’m not in the least bit tempted to get another one.

I’m not the only one who thinks like this, Dave Dorn had a few choice words on the subject too:

THAT is how advertising works. If you’re not interested in what’s being advertised, you tune out. Advertising does not make anyone buy stuff they’re not already considering. The best advertising alerts the consumer to the thing they want, where they want it, and when they want it.

–Dave Dorn

That’s advertising 101 folks. Not the ideological theories of a Canadian quack.

E-cigarettes may renormalize smoking-like behaviours for youth and encourage such behaviours by introducing a popular factor — electronic technology — into an activity that public health efforts had succeeded in making increasingly unpopular among youth.

There it is, the smug, self-absorbed jackanapes. “We’ve made smoking, and smokers unpopular among youth” I’ll bet you are really proud of that. But, the thing is, all this demonisation of smokers (and yes it is smokers you are demonising) and those that choose to use an e-cigarette, or snus as part of the ‘public health’ campaigns haven’t really paid off have they? Let’s face it, smoking prevalence is still high in most places – with one notable exception. Sweden, where snus is the most used tobacco product. Guess how low their smoking rates are? 12% That’s a marvellous public health win, thanks to tobacco harm reduction. Something that, quite frankly, doesn’t have any kind of appeal to Stanbrook.

There is no good reason for youth — or any nonsmokers — to be using e-cigarettes. Nothing good can come of providing vulnerable individuals with a more appealing way to become addicted to nicotine.

I guess Stanbrook has forgotten what enhances the (limited) reinforcing properties of nicotine. To be fair, there is no good reason for youth to take up vaping or smoking, but let’s face it, if they want to then I have zero problems with them doing either (though I would prefer they vape rather than smoke).

While we debate the question of whether e-cigarettes may enable harm reduction for smokers, we cannot ignore the simultaneous potential for harm creation, especially for youth.

While there is a small risk of harm from vaping, and rest assured it is small – almost non-existent in fact, here Stanbrook is almost correct (which in itself is a shock) in that vaping is a harm reduction tool (along with being a pleasurable alternative to smoking), what he wants is a medicinal e-cig which can be prescribed just like NRT. Dull, boring and completely unattractive.

Mitigating this will require expansion of existing public health anti-tobacco programs to explicitly encompass e-cigarettes, including more active participation on social media. The federal government must prohibit flavourings in these products, because they entice youth and many are inherently harmful. Advertising restrictions currently in place for tobacco products must be explicitly extended to e-cigarettes. At an individual level, we all have an important role to play in engaging our youth in a conversation about the harms of e-cigarettes, lest we lose the progress against tobacco that we have worked so hard for decades to achieve.

So, in a nutshell, in Canada Stanbrook wants e-cigarettes to be targeted with the same campaigns used against smokers, he wants ‘public health’ to be more active on social media (how well has that turned out in the past?). He wants a ban on flavours – because adults don’t like them apparently and they are “kid centric” (purlease!). He also wants e-cigarette advertising to be treated the same way as tobacco (shocker). Then, last but not least, he wants “one on one” time so he can nanny the youth of Canada.

Bravo Canada, you’ve got one heck of a zealot there and I’m so sorry you have to put up with that.

(Image Pressmaster/shutterstock.com)