Should e-cigarettes be regulated?

Should e-cigarettes be regulated?

We had some forewarning of this dropping in the Medical Journal of Australia and frankly I wasn’t at all surprised by the authors of the opinion piece. Rest assured it is an opinion piece there is zero new evidence being bought forward. You could almost call it a review, if you are feeling incredibly generous. But I’m long past feeling generous to the three authors. We all know who they are. The three biggest dunderheaded buffoons that claim to be “experts” in the field.

Martin Mckee (hereinafter referred to as Bobblegom), Mike Daube (hereinafter referred to simply as Duffer) and Simon Chapman (hereinafter referred to as Simple).

Contrary to the claims made by Simple, this article in the MJA isn’t actually “new research” it’s a gathering of half-witted cretins with nothing better to do than to opine that they should be the ones in charge and that everyone and his dog should listen to them. So what do these three fearless - well somewhat fearless, remember that they complained behind a paywall about a waitress in Cornwall - “researchers” have to say?

As reported in this issue of the MJA, Australia, with the world’s lowest rates of smoking among adults and adolescents, is seeing nascent, modest growth in e-cigarette use, despite having some of the strongest restrictions on their marketing and sales. Manufacturers, now including all major tobacco corporations, have spent large sums publicising their brands, using tactics that have promoted cigarettes so successfully, but boosted by the added reach of the internet. They are ahead of the regulatory curve, adopting imagery, messages and tactics prohibited in cigarette promotions, such as the sponsorship of youth events.

What this boils down to is this simple comment - smoking in Australia is the lowest in the world (not really, just look at Sweden) and shock horror, we’re seeing growth in e-cigarette use (run for the hills!). To the best of my knowledge, and I’m sure a passing Aussie will confirm or deny this, ‘Big Tobacco’ doesn’t really have a foothold in Australia, the predominant aspect of the vapour market down under is none other than - wait for it - small businesses. Well smoke me a kipper lads. The three amigos are scared of entrepreneurs.

They have spiced their products with a bewildering array of flavourings that in many countries would be illegal in cigarettes, and have garnered vocal support from those who see any restriction on the use of e-cigarettes by governments as a threat to individual freedom. Some aspects of these developments are, however, surprising.

Spiced? Where on earth did these three cretins come from? While it is true that in the majority of nations that subscribe to the inept FCTC, flavoured tobacco is a wrong ‘un. There is a slight here that I just want to re-quote:

Some aspects of these developments are, however, surprising.

Remembering of course that two of the commentators are from Down Under, the land of Skippy the Bush Kangaroo - the fact that the general population are trying to point out that restrictions on a potentially beneficial product is a threat to individual freedom - I mean, what is so surprising about that? Oh right. The Nanny State, I forgot.

The first is that, despite intensive marketing, the use of e-cigarettes in some countries now seems to be plateauing, suggesting that their much vaunted appeal for smokers and the talk of mass migration to e-cigarettes has been exaggerated.

No you complete and total cretins, the appeal isn’t waning at all. It is, put simply the likes of you three amigos and your cohorts spreading utter bullshit. By creating confusion by saying things like “these products need to be regulated” Quit lying, start reading, and maybe do some of your own actual research for a change?

The second is the naive embrace of the e-cigarette and tobacco industries by some in tobacco control. Public Health England extensively promoted a message that e-cigarettes were “95% safer” than combustible cigarettes, a claim based not on empirical evidence but upon a single reference to a meeting that was attended by researchers who were mostly known supporters of e-cigarettes, and partially funded by an organisation with links to the tobacco industry.

Cretins. Utter imbeciles. Public Health England reviewed 198 different studies and in the opinion of the authors of the review they state - quite categorically I might add - that, with a margin for error, vapour products were at least 95% safer. Then of course the Royal College of Phsyicians - a reference that is conspicuous by its absence in this opinion piece - add that vapour products were likely to be 99% safer with little to no short-term harms.

But of course, this statement no doubt came from Bobblegom who thinks (in his infinite wisdom *cough*) that e-cigarettes are a tobacco industry plot - then proceeds to lie about it. This one statement, in an opinion piece, lays bare the contempt that Bobblegom - and by extension Simple and Duffer - have for a product that has the potential for a massive public health benefit.

This is despite hundreds of articles documenting the malfeasance of the tobacco industry, as recognised in the World Health Organization Framework Convention on Tobacco Control, which explicitly advises against engagement with the industry. Some of those investigating e-cigarettes are even receiving funding from tobacco manufacturers, now seeking to represent themselves as “part of the solution” while continuing their concerted opposition to measures effective in tobacco control.

Relying on history now? Jesus wept these guys are desperate. Look, I get it the tobacco industry fucked up. I mean royally fucked up. But thanks to the interventions from the likes of Bobblegom, Duffer and Simple along with the WHO, the tobacco industry employs actual scientists to do research instead of opinionated old farts with nothing better to do with their time. Them “seeking to represent themselves as part of the solution” should actually be embraced - in fact I’d go as far as commending them for their continued opposition to the meddling puritans in tobacco control.

In Australia, anyone considering importing or supplying e-cigarettes as a cessation aid must submit an application to the Therapeutic Goods Administration (TGA) with evidence of their safety and efficacy. The TGA then considers the evidence before determining whether the product may be sold, and, if so, under what conditions. The TGA website notes that “no assessment of electronic cigarettes has been undertaken and, therefore, the quality and safety of electronic cigarettes is not known”

Similar to the UK, there hasn’t been anyone bothering to “submit an application” to the TGA for one plain and simple reason:

Vapour products are not a cessation aid.

I really cannot make it any clearer - the beneficial side-effect of using these products (for many) is that they no longer smoke. They are not, never have been, nor will they ever be a cessation product. Submit them to the respective agency and they’ll become dull, boring and uninteresting products that no-one will use.

Further, nicotine is, appropriately, classified as a poison except when formulated in low doses in some smoking cessation products (or when supplied in tobacco, an historical anomaly common to all countries). Recent research has identified the role of nicotine in promoting angiogenesis and thus the spread of tumours, and the risks it poses to adolescent brain development. Further, there have been several reports about the use of e-cigarette liquids in suicide attempts.

I’ve read the poison schedule - makes for a very dull read indeed - and nicotine in NRT is fine and dandy. Regulated of course, but it’s fine - not classed as a poison. It’s not even really considered a poison in cigarettes. Yet liquid nicotine, the kind that you or I would use in an e-liquid is a deadly poison. That’s some kind of special backwater thinking right there.

These and other concerns about safety were reviewed in detail by Pisinger and Døssing in an article that, remarkably, was not cited in the Public Health England review of the evidence about e-cigarettes, despite being published in a leading international journal.

Well no it wouldn’t be would it? The “review” conducted by Pisinger et al suffers from the same biases and flaws as the Glantz “e-cigarettes don’t help smokers quit” meta-analaysis. That’s the thing with meta-analsysis - compounding flaw upon flaw. Different methodologies, different scenarios, heck even differences in measurements all get mashed together. They are, frankly pointless. That’s the main reason it wasn’t in the PHE review you dunderheads.

The authors concluded that there was no such thing as a standard e-cigarette, so that studies on one brand could not be extrapolated to others. They reported that many studies have found evidence that the inhaled products contained harmful substances, some of which do not occur in tobacco smoke, while the levels of substances common to both were found to vary wildly, and in some cases were higher than in tobacco smoke.

Well no, there is no such thing as a “standard e-cigarette” ‘cos then they’d be boring.

For a product promoted by some as a game-changer in quitting smoking, it has been remarkably difficult to obtain evidence that e-cigarettes are any more effective than unassisted cessation or conventional nicotine replacement therapy.

It’s not difficult at all to gather evidence. The trouble with you three troublemakers is you are asking the wrong bloody questions.

A Cochrane review reported the evidence as being of “low/very low quality”, and a recent meta-analysis concluded that they, in fact, reduced the probability of quitting.

Yes, the Cochrane review reported the evidence as being of “low quality” - not very low, stop trying to make things sound worse than they are because that’s what is known as lying. Plus the meta-analysis that you so clearly favour has been thoroughly ripped to shreds here and here. Hardly a shining example is it?

In these circumstances, it seems prudent to adopt the precautionary principle and to carefully monitor emerging evidence on their safety and cessation efficacy, the uptake of vaping and smoking by young people, and any further relevant developments.

In other words - keep ’em off the market until we can be bothered to look at them. The precautionary principle doesn’t apply here.

E-cigarettes have at least two distinct roles. The first is as products that may assist in smoking cessation, with possible but as yet unproven benefits that surpass those of existing methods. Second, they are a means for the tobacco industry to circumvent restrictions on promoting both their image and their tobacco products. This dual role implies the need for parallel regulatory tracks.

Again so much wrong. Yes they may help cessation but that is not their primary purpose. In case you three dunderheads didn’t notice, the tobacco industry owns less than 1% of the total market share - how on earth are they actually benefitting from the vapour market? In case you didn’t know, they aren’t. They are losing out. The more that switch to vaping the more their profits falter.

The first involves the application of existing provisions for the authorisation, marketing (eg, claims regarding effectiveness as quitting aids) and sales of therapeutic goods. The second involves applying existing controls on all promotions that may encourage smoking, including exposure of children and young people to advertising and other forms of promotion and to any other use of smoking or tobacco-related imagery.

Medicinal regulation - how well has that worked out in the UK or US? The answer is, it hasn’t. At all. Only one manufacturer has received an MA from the MHRA - British American Tobacco - those are the companies that have the most resources to even consider going down that route. Bans on advertising will have the opposite effect to what is intended, but of course these three don’t want folk taking up vaping - it’s in their game plan y’see. Without vaping they can carry on playing dragon slayer against the tobacco industry.

This twin-track approach offers a means for evaluating and maximising any potential benefits while minimising risks of harm. In the meantime, Australian governments and health authorities should not be distracted from existing approaches to reducing smoking, which are bringing such encouraging results.

In other words, something like the Tobacco Products Directive then? A regulatory scheme so far behind the curve it may as well be on the floor.

By the way, Simple has written an article about this op-ed. It’s full of rubbish as you’d expect. I’ll probably cover that in my next post.

But as expected, absolutely no new evidence, no new research - just old, broken down, repeated opinions.


It seems that someone isn’t entirely impressed with how I approached this particular post. Dear readers, the scream test.

No doubt that Simple has completely forgotten some of his more colourful descriptions of vapers which is covered beautifully in a post from Lorien. You could assume that his reference to his three year old grandson as being the grandson calls him Simple too. But I would never assume that. Oh no. *snork*