Smoking: it’s the end of the word as we know it. Report from the e-Cigarette summit.

Photo credit Sarah Jackson (@DrSarahEJackson)

In this post Georgia Mannion-Krase (@GeorgiaMKrase) updates us on events at the E-Cigarette (EC) Summit held at the Royal Society on the 14th November 2019. The conference brings together leading experts in different aspects of EC research such as smoking cessation, youth uptake, harm reduction, marginalised groups and policy and was attended by academics, policy makers and industry.

Most of the speakers were researchers themselves, so it will surprise no one that there were a lot of findings to present, but it may surprise you to hear there was a lot of agreement among them. The climate around e-cigarettes and vaping changes day to day, and as such a lot of presenters had to adapt. Cliff Douglas (American Cancer Society Center for Tobacco Control) started his talk with “What the hell is happening in the US?” and the resounding answer from the data presented was “nothing rooted in evidence!”

In her opening remarks Professor Ann McNeill (King’s College London and the UK Centre for Tobacco and Alcohol Studies) said something exciting in this field was that everyone had an opinion…but she’s tired of opinions which aren’t based in fact! Aren’t we all?

Frequently asked questions on vaping are listed below. The answers to these questions have been taken from the presentations at the summit of world leading experts in e-cigarettes.

Does vaping lead to smoking cigarettes?

Short answer: No.

Dr Sarah Jackson (UCL) dispelled rumours that vaping undermine smokers’ desire to quit, and that vaping renormalises smoking in public places. She showed that duel use (smoking and vaping in combination) may actually indicate an intention to quit smoking.

Is vaping bad for you? Is it killing people?

Short answer: Yes, but the data so far show it’s nothing in comparison to smoking tobacco.

Professor Konstantinos Farsalinos (University of Patras) says use of ECs causes arterial stiffness…but so does caffeine. He says we need long-term health data on vapers. We agree!

Professor John Britton (University of Nottingham) says yes of course the effects of vaping will be lung cancer, COPD and cardiovascular events, but this is going to be less than 5% of what is caused by smoking tobacco. The deaths in the US are related to THC vaping which includes vitamin E acetate (which is not found in any EU regulated products) and have mostly been traced back to an illicit company called Dank Vapes. He claims the number of vaping deaths pales in comparison to smoking-related deaths.

Would a ban work?

Short answer: No.

Ethan Nadelmann (Drug Policy Alliance) claimed an attempt to ban tobacco/ECs would create a 21st century drug war, that bans don’t work and people need to be educated in harm reduction.

Professor Tikki Pangestu (University of Singapore) discussed harm reduction in Asia and advocated a move towards the British model of vaping regulation over an outright ban. As the evidence shows ECs are less dangerous than tobacco cigarettes, to remove access to a less harmful product is discriminatory, verging on a human rights violation.

Clive Bates (The Counterfactual) claimed bans are the “regulator’s fallacy”, that  they don’t work and are actually an abdication of responsibility.

Have America got this wrong?

Short answer: Boy oh boy, have they.

Professor Martin Jarvis (UCL) -to put it bluntly- absolutely roasted the FDA and their “gateway to cigarettes” argument, using the same dataset (NYTS). Of the huge numbers claimed by the FDA, only 8% of the high schoolers who have tried ECs didn’t already smoke, and this drops to 1% when remove those who don’t use ECs on a regular basis. The gateway to smoking, and the youth ‘epidemic’ doesn’t exist.

Cliff Douglas claimed that banning EC flavours could inadvertently increase tobacco smoking among young Americans by making vaping less appealing.

Liam Humberstone (Totally Wicked and The Independent British Vape Trade Association) showed that tobacco, and coffee/vanilla flavours accounted for less than a fifth of all vape flavours sold. This is interesting because tobacco flavour, which accounts for around 10% of all vape liquid sold, is the one they are considering allowing in the flavour ban. The implications for this could be huge.

Does seeing people vape encourage children to smoke?

Short answer: No.

Professor Peter Hajek (QMUL) stated that this could only be possible if the promotion of ECs leads to new nicotine addiction and a move to tobacco cigarettes, which is unlikely given the extremely low rates of smoke-naive vapers. He said “exposure to vaping doesn’t lead to smoking, it’s doesn’t even lead to vaping!”

Clive Bates showed 20.8% of UK youth are reported as using ECs but if you take out the ones who were already smoking cigarettes and the ones who don’t use e-cigarettes regularly, it’s actually 0.6%.

Dr Graham Moore (Cardiff University) showed that young people in the UK don’t generally approve of vaping unless it is being used to quit tobacco. ECs do not appear to be renormalising smoking, vaping is seen as something adults do to stop smoking.

 

Can vaping stop people smoking?

Short answer: yes!

Dr Caitlin Notley (University of East Anglia) spoke about the trajectory of relapse to smoking.. Interestingly in some cases they found people who have switched from smoking to vaping inadvertently reduced their nicotine intake to the point of quitting without meaning to.

Dr Jacques Le Houzec gave an impassioned presentation on the role of vaping shops in smoking cessation. He said “If we get rid of smoking it will be because if vaping and vape shops.”

Professor Peter Hajek gave a comprehensive rundown of current evidence for the use of ECs in cessation. He claims ECs should be used among the battery of  s available in Stop Smoking Services (SSS), supported by the findings of the TEC study.

 

What about marginalised communities?

Short answer: They have different needs which shouldn’t be overlooked.

Deborah Robson (King’s College London) stated that 15% of the general population in the UK smoke but this figure hides a huge disparity. 50% of people with a mental health condition smoke. 88% of people being treated for a substance use disorder smoke. She said this could be partly due to the reputation of cigarettes to help cope with stress, which is completely unfounded. She discussed EC-friendly environments being created in NHS settings, which was optimistic and ended “We cannot afford to leave these people behind again.” Here here.

Professor Jasjit Ahluwalia (Brown University) presented on an RCT looking at ECs used in substitution (essentially American for “cessation”) in . There were really interesting and significant results, but as it is not yet published, I can only tell you to keep an eye out for it.  Prof McNeill ended the session by saying it’s great to finally see studies focussed on people of colour. – Agreed!

What are we getting right in UK regulations, and what needs to change?

Short answer: Research.

Deborah Arnott (Action on Smoking & Health) says the UK needs tighter controls on packaging, underage sales, enforcement and advertising (as EC companies currently use social media to advertise – which is illegal but they seem to be getting away with it). “Our politicians are reading about events in the US, and they might begin to ask WHY our regulations are so different. We need to push the evidence side, but the vaping industry also needs to clean up its act.”

Professor Linda Bauld (University of Edinburgh) made the point that a lot of the high-quality research being discussed was funded by Cancer Research UK, which should be noted for its impact, and that research is the cornerstone of the harm reduction approach taken in British policy. She also said we need to be better at communicating research to the public.

Can we trust research funded by tobacco?

Short answer: Probably not.

Professor Jean Francois Etter (University of Geneva) gave a thorough breakdown of an investigation into the legitimacy of The Foundation for a Smoke-Free World (created by Philip Morris International – a Swiss-domiciled multinational cigarette and tobacco manufacturing company best known for brands Marlboro, Benson & Hedges and L&M). To cut a very thorough presentation short, the lack of transparency and experience on their board makes it difficult to trust their processes or outputs.

 

How do we stop poor quality research affecting our regulations?

Short answer: Transparency and clarity.

Professor Robert West (UCL) says the solution to poor EC studies and wild claims is open science and research ontologies. An ontology is a resource which defines and categorises terminology pertaining to a specific topic. This webinar gives more info on the EC ontology produced in partnership with researchers at London Southbank University.

 

Do the Press have any responsibilities here?

Short answer: Yes.

Louise Ross (National Centre for Smoking Cessation and Training) spoke about the importance of understanding the lives of people using SSS, for example some identify quitting smoking as a form of class betrayal, and that ECs are a middle-ground where they are still engaging in the act of smoking something, but it’s less harmful than tobacco. She said “I want to see less awfulness – cherry picking science, making stuff up, and printing it in the papers to be consumed by people who know no better than to believe what they read in the tabloids.”

Professor John Britton (University of Nottingham) called on the UK media to stop sensationalist headlines which cause people to return to smoking tobacco. “It is important for our media colleagues to remember that these sorts of headlines have direct consequences for health.”

Both speakers got a huge round of applause suggesting to this delegate that researchers see the press as possible partners in leading the world in safe EC regulation.

What do researchers need now?

Short answer: Data.
Both Professor Konstantinos Farsalino and Professor Peter Hajek say we need long-term health data on vapers. We at King’s are working on it! If you’re an EC researcher we need to know which data you want. Find out more here.

Which speaker broke the law on stage?

Short answer: That would be telling.*

*The law wasn’t broken, but you would be forgiven for thinking vaping indoors in a public place would be treated the same as smoking. As it stands it’s down to the property owner to set their own policy, so with The Royal Society’s policy being ‘no use of cigarettes or vapes on site’ at the very least it was a policy violation. But that doesn’t sound as exciting, does it?

Further information on the e-cigarette summit is available through the links below:

https://www.e-cigarette-summit.com/resources/ 

https://www.ecigarettedirect.co.uk/ashtray-blog/2019/11/e-cig-summit-2019.html 

The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.

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  1. Vaping Digest December 2nd – vapers.org.uk

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