An apology from Professor John Ashton

It’s only fair that I should post the apology made on Twitter by Professor John Ashton just a few minutes ago.

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And here is why it just isn’t good enough:

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Whilst John Ashton has apologised for the choice of language he used on Saturday night, he makes no effort to explain, much less apologise for the prejudiced thinking that underlies his choice of words. Well he can’t really can he, a bigot is a bigot no matter how polite the actual words used may be.

Professor John Ashton CBE – The Meltdown

It’s not often that we get to see behind the mask of senior players in public health but we got to do just that last night and what we saw was not very pretty.

Hot on the heels of his rude exchange with Robert West on BBC World Service’s ‘Health Check’ programme, and then his disastrous ‘discussion’ (ill mannered rant) with Clive Bates on radio 2’s Jeremy Vine show, Prof Ashton took to Twitter in order to troll and abuse vapers. Some, very kindly, suggested he might like to put the bottle down rather than embarrass himself further, but I think the suggestion that he was drunk is probably too generous, and after all – in vino veritas. Naturally he has tried to cover his tracks this morning by deleting the worst of the tweets.

Fortunately I managed to screenshot a few, and they speak for themselves, so I don’t need to provide commentary, other than to ask whether this attitude is really desirable in the President of the Faculty of Public Health.

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Ok, he was baited in this next one but I think the President of the Faculty of Public Health calling a vaper a cunt on Twitter has to go down as my personal favourite..

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Update – Redheadfullofsteam has published an open letter of complaint to the Faculty of Public Health, you can read it here.

Update 2 – Vapemestoopid has published an excellent blog on this too, includes links to the radio interviews referred to above.

Dear Who

Dear WHO,

Wow what a day..I bet you’re really pleased with how it went eh? I mean, what fun to turn the release of your normally-oh-so-very-boring paperwork into a full scale attack on the health choices of such a large number of people. And didn’t they bite back – well you knew they would – vapers always do, right? Anything to get those clicks..

What you don’t realise is that our anger is real. I doubt there’s a single vaper in the twittersphere who won’t be able to get around any and all regulation which the governments you seek to influence try to throw at them. But you see, they don’t do it for themselves – they do it for those who will follow them. And for those who are currently vaping but don’t have the knowledge to get around your unethical dogma. And they see you for what you are – a seething mass of gravy train style corruption and a complete and utter disgrace.

Whether or not the government signatories to the FCTC take up your recommendations on ENDS as you call them is now almost immaterial. The damage you did today was immense, and will be far reaching. I’d love to quantify that in lives ruined and lost, but well, I’ll leave the junk epidemiology up to you. You seem to have a penchant for it.

I won’t ever forgive you for what you did today. I hope you’re proud.

RV

Idiotic Bandwagon Jumpers

Vitamin ecigs. Yes really. Apart from the fact that I can find no information about the absorption of vitamins via inhalation, if it’s even possible, why would you want to when there’s a perfectly well recognised method of consuming them – i.e. orally, or through just eating good food? What are the harms of inhaling say vitamin C (ascorbic acid) or peppermint oil? Of course the same could be said for the various components of ecig flavourings, but at least they serve a purpose – to make ecigs palatable to smokers – and work is underway to weed out the more harmful ingredients. Without flavourings it is likely that vapers would turn back to the more dangerous alternative, lit tobacco.

So if vitamin e-cigarettes are being targeted at smokers that would probably be sort of ok wouldn’t it? It’s still going to be a reduced harm option and the vitamins might be attractive to some even if they’re useless or carry harms of their own. But why stop at smokers eh? When there are all those other health loving people out there to attract.

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Smoking bans, public opinion, social norms and vaping etiquette.

We all remember the days before the smoking bans. I was a smoker and I remember all too well smoke filled pubs and clubs: my clothes and hair smelling, my eyes streaming, ash and burn marks on my clothing – and I thought nothing of it. This was normality. Now put yourself in the place of the non smoker who suffers the same, but with none of the benefits of nicotine use. A never smoker said to me recently that the widespread support for bans on smoking in enclosed spaces was, whether or not the science on the dangers of second hand smoke is correct, non smokers pushing back. They were saying that smokers had inflicted the by-products of their habit on them for too long, and now it was going to stop. And of course the non smokers were in the majority so the result was inevitable.

Seven years later we now find ourselves facing the same issues with vaping. Except that this is different, as there are no known adverse effects to bystanders from the vapour emitted from e-cigarettes, and for their users, the huge majority of whom are current or ex smokers, they are vastly safer than consuming lit tobacco. The ability to use e-cigarettes in enclosed spaces is one of the factors which make them attractive to smokers, many of whom will switch to them completely. It is also one of the factors which create distance between the habits of smoking and vaping, and that distance is important in preventing relapse to smoking.

But we live in a world now where the non smoking public, having won their battle for smoke free air in enclosed spaces, is protective of it. Furthermore, encouraged by the more zealous anti smoking organisations, they are pushing for more – in the US there are areas where in some circumstances it is illegal to smoke in your own home and here in the UK we are now seeing calls for bans in outdoor spaces such as parks and at beaches. It is not at all uncommon these days for non smokers to complain at the faintest whiff of cigarette smoke, for example in a tweet I saw recently a non smoker on a camp site was complaining at being able to smell cigarette smoke coming from another tent. In public opinion today there is no longer any need for there to be any notion of harm, simple distaste is apparently enough. Like it or not, the social norm has changed.

Against this background smokers across the developed world have turned in their millions to e-cigarettes. First brought to the market by a Chinese pharmacist in around 2004, the uptake of these products has been staggering, and the innovation which has followed has been too much for all but the most ardent of enthusiasts to keep up with. And too much it seems, for many in tobacco control too. Faced with a consumer lead revolution towards a product which is both attractive to smokers and orders of magnitude safer than combustible cigarettes, they are on the back foot.  Some in tobacco control nevertheless advocate bans and restrictions based on little more than theoretical risks of renormalisation of smoking, the rehabilitation of their sworn enemy the tobacco industry and unknown future risks to health which, even if they materialise are unlikely to affect anyone other than the consumers themselves, and to a much lesser degree than the only true comparator, smoking lit tobacco.

Smokers who switched to vaping understandably thought that they had found a situation which would be welcomed by all. They had found a way by which they could continue to use nicotine, a well understood drug with a harm risk profile similar to caffeine, but via a delivery system devoid of the 4,000 odd toxins contained in lit tobacco. They were dramatically reducing the harm done to themselves, and also that said to be being done to others. Because the vapour emitted by e-cigarettes disperses very quickly and is almost odourless this should have been a socially acceptable method by which to consume nicotine.

However, they reckoned without the effects of the social engineering undertaken by the tobacco control movement. So successful were the policies of denormalisation in turning smokers into social pariahs that there is little sympathy among some sectors of the public for those smokers who choose to vape. And they are still seen by many in the tobacco control movement as the hopelessly addicted victims of the tobacco industry, weak willed (or deluding themselves into believing they enjoy nicotine) and beyond realistic help. So in order to minimise the as yet unsubstantiated theoretical future risks, policy recommendations dictate that these people are simply sacrificed as collateral damage in the war against the tobacco industry. If vapers are not careful the public will support these policies, just as they did with the smoking bans, and for even less good reason.

Another non smoker described to me what he felt was the issue. He believes that many vapers are “liberated smokers” with memories of all of the persecution that went with being a smoker, and so are fundamentally opposed to any and all restrictions on vaping and want to flaunt their new found freedom at every opportunity. If this means blowing vast clouds of vapour in a pub restaurant next to other diners they will do it. But would anyone, let alone a non smoker, really want to eat their chicken supper sitting next to this?

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OK, that one is probably a little extreme. But if, as a restaurateur, you allow vaping, you are also allowing people to do that – unless you can think of some way to put restrictions on cloud size and density. Additionally, it is not practical to put a restriction on the number of vapers you have in at any one time, so even if they are all vaping ‘normally’, with a large number present things can still get pretty foggy as anyone who has been to a vape meet will know. We cannot expect the public to simply be happy to be told that the fog is benign, especially in light of the adverse propaganda spread through the media on what seems to be a daily basis. We also cannot expect proprietors and employers to fly in the face of the opinions of the non smoking, ‘clean air’ loving majority – but it should be their choice.

Vaping is relatively new and the etiquette is still developing. Most people I know are considerate and discreet when appropriate, but it only takes one obnoxious ‘its-legal-and-I’ll-do-what-i-like’ cloud blower to spoil the party for all of us in any given establishment. So we need to develop the etiquette ourselves, before public (and business) support results in further statutory bans of the sort now proposed in Wales, with Scotland watching intently. You can be sure that if bans are brought in the excuse will be “we don’t know what’s in them”, but the real reason will be “we just don’t like them”.

So vapers, what do you think? Is it better to be loud and proud, or is discretion sometimes the better part of valour?

Loom bands and gummy bears.

I have a confession to make. Yesterday I bought 3,000 loom bands on Ebay. Of course I told myself that no one would actually know that I don’t have loom band aged children but the fact is I don’t. I bought them having been told what to do with them by a passing 8 1/2 year old and found the action of weaving multi coloured elastic bands into multi coloured stretchy string somewhat calming and perhaps even habit forming.

If adults and children didn’t sometimes find the same things pleasurable, even if for differing reasons, it would be a surprise. We are all human afterall, with the same pleasure seeking tendancies. Of course loom bands aren’t consumed (normally), and present no problem in terms of an inherent risk of chemical addiction, and so probably don’t need marketing controls to keep them out of the hands of pleasure seeking adults. But is it ever right to deny either adults or children access to appropriate beneficial or pleasurable products just because the other group may also be attracted to it?

Since day one of my vaping journey I have used fruit and candy based flavours. I am not alone, recent surveys by Doctor Konstantinos Farsalinos and the Electronic Cigarette Forum both concluded that the majority of adult vapers prefer such flavours. Why wouldn’t we? Whilst as smokers or ex smokers we are used to the flavour of burning tobacco, it’s not something which can be accurately replicated in e-liquid, and is not necessarily desirable anyway. For many people sweet flavours create a distance between smoking and vaping and so can assist in preventing relapse. The availability of a variety flavours creates and maintains interest, and provides an advantage to the safer product over the much more dangerous alternative.

Some in Public Health either ignore or refuse to accept the fact that the e-cigarette industry, in marketing fruit or sweet flavoured liquid, are targetting the very large number of adult smokers who prefer those flavours and not children. Still smarting from their battles with the tobacco industry they incorrectly attribute that industy’s historical desire to hook new users to their product to the fledgling e-cigarette industry. They do so based on the premise that the tobacco industry is buying into the e-cigarette industry and cannot be trusted. They are partly right of course, many of the larger cigalike brands have been snapped up by the tobacco industry in their efforts to catch up. But those companies typically only sell two flavours – tobacco and menthol. The tobacco industry owned firms are only just now tentatively dipping their toes into the fruit or sweet flavoured liquid market.

It’s pretty much a given that kids will want to try anything, and yet we do not seem to have a problem with fruit and sweet flavoured alcoholic drinks such as vodka and schnapps. NRT itself is available in cherry, “freshfruit” and mint flavours, and available to buy online for anyone aged 16 and over. Oh and those 16 year olds can buy it for 12 year olds. Why is NRT marketed in these flavours? No one is suggesting that Johnson & Johnson are attempting to attract an army of nicotine dependent children to ensure the continued success of their product. The answer is simple. Both Johnson & Johnson and the e-cigarette industry recognise that there are millions of adult smokers to attract, and those adults like nice flavours.Ever seen tobacco flavoured NRT gum?

It is also entirely possible (or at least as possible as any of the anti e-cigarette scare theories) that the availability of flavoured e-cigarettes will prevent the transition from e-cigarettes to cigarettes by those experimenting with them. If it is true that smokers smoke for the nicotine but die from the tar, why would anyone in their right mind reject juicey peach in favour of burnt leaves and tar filled lungs?

Whilst there are some who will say that given the fact that nicotine has a risk of harm profile similar to caffeine there is no reason to restrict access to it at all, many people would not consider it desirable for children to become dependent on nicotine. Apart from the fact that there is some evidence that nicotine has an effect on the developing brain, they are not old enough to make a decision to take on what could become a life time dependency*. But the answer is not to restrict flavours to the extent that the product becomes unattractive to adult smokers. That would simply result in a black market which would be far more accessible to children than reputable vendors, and a considerable number of adult vapers would return to smoking. The answer is education and the appropriate and proportionate regulation of marketing.

So back to those loom bands – anyone want a multi-coloured stretchy ecig lanyard?

*There is some discussion on the risk of dependency attributed to nicotine containing products. Whilst cigarettes appear to be highly addictive, patches are said to present a very low risk for dependency. It is not known where on the scale other products lie. Read more on the subject here:

…and they call this science?

I have been distracted from my general vape waffle this morning by a link to a blog post by Stanton Glantz of UCSF (more about him on another day maybe). In his blog he is trumpeting a ‘study’ by ASHRAE, which apparently stands for the American Society for Heating Refrigeration and Air Conditioning Engineering. What does this have to do with vaping? Well apparently ASHRAE think themselves qualified to opine on the hazards of e-cigarettes in terms of indoor air quality.

It appears they base their study on a photograph which shows a consumer….wait for it…exhaling vapour, more properly called aerosol. It’s ground breaking stuff, I’m sure you’ll agree. They then go on to use the analysis from the 2013 Goniewicz study to determine what might be in the exhaled aerosol and exposures to a non user trapped in a room with a consumer. The difficulty with this is that the Goniewicz study used smoking machines to analyse the contents of emissions from 12 e-cigarettes. It does not take into account the respiratory absorption which would occur if there were a human on the end of it, rather than a machine. Additionally, the Goniewicz study does not take into account the ‘dry puff’ phenomena (a machine, unlike a human, cannot detect dry puffs and so will continue to vape when a human would stop and solve the problem).

Unperturbed by these issues with their base analysis ASHRAE then continued their study on the basis that the consumer in their theoretical situation would exhale 100% of what they inhaled, and that the hapless non vaper would inhale 100% of the compounds in the vapour in the indoor air that they breath.

Having deduced their totally unrealistic exposure levels they then compared them to the ‘No Specific Risk Levels’ (NRSL) for cancer, and to ‘Chronic Reference Exposure Level’ (CREL) guidelines for non cancer health effects. Unfortunately for them there are no CREL guidelines for nicotine or propylene glycol (maybe because no one has identified a hazard risk worthy of  producing a guideline?) so they used 1% of OSHA eight hour permissible exposure guideline instead. There is no explanation as to why they chose that figure. 

For indirect exposure (passive vaping) all elements other than propylene glycol and nicotine came in well under the levels identified as a risk. Nicotine and propylene glycol did fail their (apparently made up) standard and they go on to summarise that this represents a significant health risk. The study contains no information as to why the inhalation of nicotine at these levels may be a health risk, and refers only to a completely different study (with different exposure levels – Wieslander et al ) to support the contention that propylene glycol is harmful to health. This does not prevent our intrepid researchers concluding that “e-cigarettes emit harmful chemicals into the air and need to regulated in the same manner as tobacco smoking”. Nor does it deter Stanton Glantz from concluding that “It’s bad”. Way to go ‘Prof’…

Hobbies and Communities

As a smoker smoking was just something I did. I didn’t talk about it or compare brands with others, I never even looked at the details written on the packs. I was a Benson & Hedges Gold smoker (apart from a brief interlude on Marlboro Lights) and that was the be all and all. So as a new vaper I had no expectation of it being any different, it would once again just be something I did. But vaping was different. A cigarette is an infinitely less complicated thing to master than even a CE4 /Ego combination, which is pretty much entry level stuff in the vaping world. And so I found myself trawling YouTube and Google for instructions on such things as how to dismantle and clean it, how to replace the atomiser head and what it means when the battery light blinks several times in quick succession.

What I found was literally thousands of people from across the globe who were prepared to give up their time to help. Some had written tutorials, others made videos, and still more answered specific questions posted in umpteen forums. No question was to silly and there seemed no limit to the time and energy they would spend in ensuring that the question was answered and understood. When they weren’t answering daft newbie questions they were chatting among themselves, posting pictures of their own devices, entering competitions, teaching each other new tricks, writing reviews of new products, bickering or arranging vape meets..

..wait..what? Vape meets? What I had stumbled upon was a vast online community united by having discovered a way to give up tobacco and keen to pass on their wisdom. For the majority of them vaping had become not only a substitute for smoking but a hobby and a new sense of identity. There were some who would pay hundreds of pounds for the latest artisan created device, and others who would make their own. Some had small businesses selling vaping products but were primarily vapers themselves – the only way you could tell the business owners apart was from their identifying flashes on the forums. And they had vape meets.

My local one meets up roughly every 6 weeks and it was with some trepidation that I signed up for my first one. I knew no one and it’s a daunting prospect to walk into a room full of strangers who all know each other. I needn’t have worried. My only regret was that the group were so friendly that I simply didn’t get time to talk to everyone. The ice breaker was always the same – comparing devices or liquids. In August 2013 I went to my first Vapefest – an annual event which that year was held in Tamworth. If you can imagine going to a beer fest with a trade show tacked on, entirely populated by 1,000s of friends most of whom you haven’t met yet – that’s kind of what it was like. This was a world away from smoking.

They say that your chances of giving up smoking are far greater with the support of NHS Stop Smoking Services. Well vapers have their own support network – with knobs on!

In the Beginning…

…there was smoke. Lots of it, everywhere. I was a smoker for more decades than I care to remember, and I liked being a smoker. It gave me an identity, it was social, and as far as I recall, no one complained. You could smoke in bars and restaurants, on public transport and at work. Of course it made everything smell, and I had to suffer a few burns on clothing and even on my skin, but I rarely even thought about the downsides. And the harm to my health? Well that was something that happened to other people, not to me. Or at least if it did it wasn’t going to happen any time soon, and the next cigarette would hardly make a difference, would it?

In 2007 the UK government introduced smoking bans in enclosed public spaces. These were…annoying. Not because or the restrictions they placed on my smoking per se, but the vindictive nature of the bans irked me. An enclosed public space was pretty much defined as anything with more than two walls and a roof, which meant that smoking areas were open to the elements. Proprietors couldn’t make comfortable places for smokers even if they wanted to. The bans were followed by and facilitated the ‘denormalisation of smoking behaviour’, which of course translated into the denormalisation of smokers. Although I was largely ambivalent to the bans themselves (I could see how being shrouded in other peoples smoke might be annoying for non smokers), being turned into a social pariah to be pointed at with disgust was rather less welcome. But still I continued to smoke, enjoying the camaraderie that standing outside with other smokers created.

In 2013, on a whim, I bought an e-cigarette starter kit. It was what vaping enthusiasts would call an Ego / CE4 combination, also known as a generation 2 refillable tank / rechargeable battery system. I had absolutely no intention of giving up smoking, I just wanted it for those times when I couldn’t or didn’t want to go outside to smoke.  Once I had overcome my initial total confusion as to what went where and how, I took my first lung full of peach favoured vapour. And I liked it. Very much. In fact I liked it so much I over did it and gave myself a nicotine headache (which is very similar to an ice cream headache) but it passed after a few minutes of abstinence. I also noticed a bit of a dry mouth, but drinking extra water soon sorted that out. As I gazed at the crazy looking contraption in my hand I thought “this could work”. And it did. For a couple of weeks it got me through those times when I couldn’t smoke. Then something amazing happened. I no longer wanted to smoke at all – I preferred to vape.

I had unwittingly become a vaper.