A Day at the Summit

What a year it has been, the opening words of the E-Cigarette Summit 2016 Chair, Professor Ann McNeill. Could almost call that a throwback to the Summit of last year, but then the debate surrounding e-cigarettes hasn’t waned but intensified. This year, the Summit came hot on the heels of the FCTC Conference Of Parties (Seventh Session), which did get coverage (as did Brexit and Trump albeit briefly).

As with last year, I had the privilege of attending as a representative of Vapers in Power (says so on my badge), though I maintain that “Advocate” should be “Troublemaker in Chief”.

I had planned to take plenty of notes to write a detailed account of the event, but ended up tweeting slides and comments instead. Unlike last year I had a better understanding of what to expect, and how busy it would be, but it was still a whirlwind of information. Most of which I’d heard, or seen before. At least until the speaker from the BMA took to the stage.

I do have to say kudos to the BMA for attending and speaking at an event dedicated to e-cigarettes, given their overall position and their bitter disappointment of the rejected proposals in the Public Health (Wales) Bill, given that many consumer attendees and some within public health circles strongly disagree with them. The BMA speaker, Ram Moorthy gave a slick performance and was careful to say “The BMA position” or the “BMA stance” which would tend to suggest that he doesn’t wholly agree with them.

He did provide an overview of how the BMA reaches policy positions which I found informative. Instead of the usual top-down proposal by a board or management type, policy requests originate from the members. Should there be numerous requests for restrictions on e-cigarettes (as a prime example) those requests are then amalgamated into a single request, with substantially more weight, before being debated – and in most cases adopted.

The BMA continues to stand by the statement of “cessation only” for e-cigarettes, ending with total abstinence of nicotine. Moorthy seemed completely unrepentant about the BMA position on e-cigarettes and the “concerns” that ecig use may make smoking seem socially acceptable.

Therein lies one of the key problems surrounding this – many in public health want to see smoking eradicated, and that any product that “looks like” or mimics smoking is treated in exactly the same way. It would seem the BMA fall squarely into that arena.

The first highlight from that session wasn’t any of the talks, but a firm rebuke from Ian Gray of CIEH towards Moorthy (and the BMA in general) for their policies in forcing vapers outside to smoking areas. Whether you agree with that or not isn’t the point – the fact is, the BMA are recommending that vapers are to share smoking shelters, which as we all know the reasons why smokers are forced outside (which I disagree with by the way) – and that is to “protect” non-smokers. Their policies to force vapers to do the same tacitly puts vaping in the same risk area as smoking, when they are anything but.

Sadly for the BMA, any substantial policy changes must wait for the Annual Meeting, in the meantime their members (GPs and on-the-ground doctors) are giving wrong, or misleading advice about vaping. Moorthy mentioned that the existing policies have flexibility – which of course depends entirely on the motion(s) put forward at their Annual Meetings. The BMA want clear evidence.

Later sessions followed on from Peter Hajek’s presentation – specifically all about communicating results of studies and the risks/benefits of e-cigarettes – complete with science updates from Farsalinos (who, as expected ran over time!), Lynne Dawkins (all about self-titration), Ricardo Polosa (all about harm reversal), Marcus Munafo (analysing effects) and Linda Bauld (new and ongoing studies).

There had to be some coverage of the TPD in the UK – and generally across the EU – and coverage of the FCTC debacle.

Alette Addison covered what is supposed to have happened by now – as in, all EU Member States were to have a TPD transposition by May 2016 with a transitional period of 1 year up to May 2017. Of course, we know that a number of MS have yet to transpose the TPD into national law – the result of that ? Letters sent by the Commission, with the possibility of (substantial) fines for incorrect transposition – there’s always the possibility that MS may just refuse to pay those.

As for the FCTC debacle, a full report including decisions made is said to be made available “soon” – knowing how quickly the FCTC moves (speed of a striking sloth) that’ll probably show up next year. A lot of the wording in relation to e-cigarettes – specifically “prohibit” – is only in the context of “Parties are invited to prohibit or regulate” – which leaves the decision up to the signatory country. We know that some fully intend to prohibit of course. Parties are also invited to monitor the situation and report on scientific, regulatory and market developments. Again, leaving it entirely up to the signatory country to decide to do this or not. If a Party prohibits e-cigarettes, then they aren’t likely to report on any developments – other than the bleeding obvious illicit trade that would arise from prohibition.

No further research is currently being commissioned by the FCTC and no working party or guidelines were proposed. Meaning that things stand pretty much where they were at the end of COP6. Signatory countries doing it for themselves.

Beryl Keeley from the MHRA spoke on the purpose of the TPD – or specifically the intended purpose – which as we know will have substantially different effects than intended. The MHRA have been receiving product notifications – and those have been increasing – interestingly, the MHRA will be relying on the declaration of conformity submitted, there aren’t any current plans to cross-check. Beryl mentioned the Yellow Card scheme and that they’ve already received a few reports about e-cigarettes through that system which are in the “information gathering” phase.

Unlike last year where only Psinger was the “bad guy”, the Mayo Clinic and Neal Benowitz provided much needed counterweight to the conference. Although Mayo weren’t there as an outright “bad guy”, they were there to provide a sort of “rules of engagement” for academics when dealing with the tobacco industry, so were definitely more cautionary then bad-guy. Benowitz however, spoke in terms of addiction.

More specifically he spoke on the risks involved with nicotine and cardiovascular events, these events aren’t necessarily related to the use of e-cigarettes, but also snus. A study in Sweden suggested that continued Snus use after a Myocardial Infarction actually increases mortality.

His conclusion:

Though he is a supporter of reduced nicotine combustibles – which I’ve covered before as being a rather daft concept, and it seems indications from clinical trials support it being daft:

• Smokers do not like Reduced Nicotine Cigarettes
• Smokers of RNC seek alternative sources of nicotine, particularly in high reward value situations

Both the Mayo Clinic and Benowitz, while not overly positive as the other speakers, they did provide much needed counter-balance. Concerns over nicotine, while in some cases are over-exaggerated (it really isn’t as addictive as claimed and it is not carcinogenic), are warranted. Take the precautionary principle at face value there. Sit back, and watch rather than intervene.

I still maintain that the Summit needs more contrary opinion – though I highly doubt that any of the outspoken opponents of e-cigarettes would actually accept an invitation to speak – to provide a broader range of opinions and thus inform both sides of the debate.

Nevertheless, it was still a worthwhile experience for me, not least for the chance of meeting up with people I regularly talk to, but also a chance to catch up on developments I may otherwise miss.