by Martin McKee
Professor of European Public Health
London School of Hygiene and Tropical Medicine
Anyone walking through London’s King’s Cross station this week could be forgiven for thinking they had been transported mysteriously to somewhere else. Not, in this case, on the well trodden (albeit fictional) path by way of platform 9¾ on the Hogwart’s Express but rather to an earlier time, when cigarette advertisements were still legal. All along the stairways are pictures of what seemed to be cigarettes set against a soothing, healthy-looking blue background yet when you got up close you realised that they were actually Nicolites. The mistake is easily made. Indeed, the manufacturers take pride in the fact that their products are “designed to look and feel like real cigarettes”, which they certainly do.
As one branding expert said about an advertisement for E-lites, a competing brand, “everything about the ad and the way it’s targeted and it’s marketed to people does appear to be just like cigarettes”. With both products, the white barrel containing the battery looks just like the tobacco containing part of a cigarette, complete with a LED at the end that lights up when the user inhales. The nicotine container looks just like a filter tip. The marketing strategy is clearly working. Nicolites’ manufacturers advertise it as “the UK’s favourite electronic cigarette”, a claim seemingly borne out by independent sales data showing that their various brands account for six of the top selling brands of e-cigarettes sold in independent shops.
Yet e-cigarettes didn’t always look like the real thing. The early ones were quite different. Mechanical devices looking like something you might find under the bonnet of a car, with names that reflected their strange design, such as sonic screwdrivers, named after the instruments used by Dr Who. There was no risk that anyone would confuse them with a real cigarette. And just like Dr Who, these strange devices have attracted a remarkably dedicated group of supporters, as I discovered recently when I wrote a BMJ article on e-cigarettes. The article came about following the 2013 WHO European Regional Committee, where ministers from many of the smaller European countries were discussing the advertising blitz they were experiencing from the manufacturers of e-cigarettes (the ones looking like the real thing).
I did some homework and it rapidly became clear that the tactics used to market these so-called cig-a-likes were exactly the same as those used by the tobacco industry. These featured prominently highly sexualised advertisements and references to celebrity users, such as Katy Perry, Leonardo DiCaprio, Kate Moss and Lindsay Lohan. The e-cigarettes often contained flavours known to attract children, whether in cigarettes or alcopops, such as bubble gum. I heard from colleagues in several countries of new outlets springing up outside schools.
In my paper, I recognised that, just like any nicotine delivery device, e-cigarettes could play a role in helping people quit, although as most quitters succeed unaided, it is likely to be quite minimal, and anyway, the latest evidence from a New Zealand randomised controlled trial showed that they were no more effective than patches. But that wasn’t the point. The real issue was the way that these products, “designed to look and feel like real cigarettes” offered a means to get round advertising bans and to counteract one of the most effective measures against smoking, the campaign to denormalise it.
This had been so successful that those celebrities who did smoke would conceal it. Yet, as was already becoming clear, some were willing to be seen vaping, the term used to describe using e-cigarettes. And of course, e-cigarettes, if allowed to be used in public spaces, would undermine the remarkable success of smoking bans that have been policed by popular consent as bar staff would have to constantly check whether what someone was using was the real thing or an electronic copy.
I didn’t call for them to be banned. I simply called for them to be regulated just like other nicotine delivery devices and for advertising to be banned. In the light of what I have subsequently learned, I would add three more requirements. First, no company (including subsidiaries) should be able to manufacture both e-cigarettes and real ones. Second, they should not be designed to look like the real thing. And third, they should not be allowed to be used anywhere smoking is banned.
The response to my paper was remarkable. Within an hour of it being posted on the BMJ website I was the subject of dozens of messages on twitter. Most portrayed me as an idiot, but a significant minority believed I was evil (or both, calling me a “vile cretin”). I had absolutely no idea of the ability of those promoting e-cigarettes to mobilise so quickly and effectively!
So what had I done to upset them? Well, the main criticism was that the e-cigarettes I, and my colleagues at the WHO meeting were seeing advertised everywhere were not real e-cigarettes. Those attacking me sent dozens of pictures of the metallic contraptions they used, none of which looked anything like a cigarette. Indeed, the abiding impression is of what one might see if anyone ever created a museum of spark plugs. They also sent testimonies of how e-cigarettes had helped them cut down or quit smoking. Leaving aside the abusive tone of most of the messages, I was perfectly willing to accept what they said. They obviously did use these devices and I am sure that some of them found that they helped them to quit, even though I was equally sure that there were many more people who had quit without them.
When faced with such sustained criticism, it is important to reflect on whether you might be wrong. I put the term “e-cigarettes” into Google Images and, lo and behold, the vast majority of pictures were just like the ones I had seen advertised. There were a few of the mechanical devices, but only a very few. Then, some of my Twitter followers helpfully send me pictures of e-cigarettes being advertised in other countries. They also looked like the real thing. In some of the pictures, however, you did have to look hard as they were placed just beside the candy shelves, exactly where you would expect a kid to look.
The tide of abuse continued for several days. These things happen when you stand up for public health. But then something strange happened. Someone created a web page with a picture of me, subtly changed with reds, yellows and pseudo Cyrillic font, to look like a Soviet leader. They warned that I was “eliciting howls of rage from the vaping community, McKee is attempting to show vapers in the poorest possible light. Thuggish neanderthals who lack the wit, intelligence and willpower to abandon their filthy addiction to nicotine. Foul-mouthed fake smokers who will launch personal attacks upon a widely respected public health professional. It’s crude, but it can also be effective.” It was as if I had laid a trap into which they had fallen. If only I was so clever!
They accused me of a fundamental disdain for harm reduction, a strange argument as I chair the Global Health Advisory Committee of the Open Societies Foundations, the leading global funder of harm reduction in the drugs field. The attacks subsided for a while, but soon recovered, following the publication of a letter in the Daily Telegraph signed by the leading UK organisations working for tobacco control, including FPH, ASH, the RCP, Cancer Research UK and many others, as well as a large number of individuals, me included. The letter showed a clear consensus in favour of regulating e-cigarettes as a medicine and banning their advertising, the position I had advocated in the BMJ and which is supported by the UK government.
So what do I conclude from this experience? There is clearly a dedicated, highly vocal community using devices that look nothing like cigarettes. Many of them are, doubtless, deeply committed to harm reduction, but I argue that they miss the much bigger picture. However, given what we know about the tobacco industry, now that it has jumped on the e-cigarette bandwagon, it would be foolish to ignore the possibility that some of those responding with such speed and intensity to any challenge to e-cigarettes represent industry-manufactured Astroturf rather than spontaneously emerging grassroots.
Second, there are many small-scale manufacturers of these devices, some of whom almost certainly came into the business because they want to help people quit, although others probably saw the opportunity to turn a quick profit. But, with all due respect to these groups (even if it is not reciprocated), they are essentially irrelevant in the greater scheme of things. Big Tobacco once saw e-cigarettes as a trivial issue, given the work they had done to perfect the real thing as a product designed to attract kids. However, in the past year that has changed completely. It has spotted the new opportunities to circumvent advertising bans, via brand stretching and ambiguous imagery, and to renormalize actions that look for all the world like smoking.
Altria, the owner of Philip Morris USA, has just launched its first e-cigarette, MarkTen, using a subsidiary company. R.J. Reynolds has launched its new e-cigarette, Vuse. Lorillard acquired Blu Ecigs, one of the market leaders in the US and is expanding outlets rapidly. The small companies that initiated the manufacture of e-cigarettes will be swallowed up, as in every other field of commerce, and e-cigarettes will simply be a marketing extension of the real thing.
Unfortunately, some of the most vocal supporters of e-cigarettes seem oblivious to this development, with Clive Bates contending that “The normal controls on truth and fairness in advertising, supplemented by restrictions of the type applied to alcohol, should be sufficient to balance public health opportunities and fears that something might go wrong.” Those working in the alcohol field might consider this rather at odds with their experience.
Simon Chapman, perhaps the leading tobacco control advocate worldwide, has argued that “The indecent rush to facilitate the growth of ecigarettes may prove to be one of this century’s most myopic and catastrophic public health blunders.” He continues “I so hope I am wrong.” Sadly, I fear that he won’t be.
Better Health For All 
It is sensible to regulate e-cigarettes. Clearly they are currently underregulated in terms of the products themselves (the content of the vapour they produce) and the marketing (often inapporpriate). There is however a danger of suggesting that regulation as medicines is the way forward. Some will be used as aids to quitting but many, perhaps most will not. They are used a non medical drug for pleasure or recreation – and a medical model in this context is not appropriate. A strict medical regulatory framework is likely to lead to e-cigs being less avaialble than smoked tobacco: They would no longer be sold alongside the conspicuously more risky smoked tobacco products; users would not have the option of a safer product and there would indeed be a potentially huge harm reduction potential squandered.
The problem here is that policy makers appear to see only three options – no regulation at all (effectively what we have at present – bar basic EU product regulations), smoked tobacco regulations, or medical regulation. In fact none of these are apporpriate; this is a new product with different set of risks and using behaviours that requires a different bespoke regulatory framework. This new model would pragmatically review the risks and benefits of the product within the existing market and draw on elements of both tobacco regulation (for example marketing controls, some public use) and medical regulations (of the product itself).
There are risks that e-cigs will undermine some of the denormalisation of cigarette smoking that has been successfully achieved in the past decade. But if the strong trend of moving from smoking to vaping continues this risk needs to be seen in the wider context. The reality remains that smoking kills millions a year- and vaping is far, far safer. We need to keep our heads, avoid this issue becoming polarised, and find pragmatic ways forward – and not throw the baby out with the bath water – as the EU did with Snus product legislation previously.
Martin, please understand, you wont find the ecigs that dont look like cig-a-likes by typing into Google “electronic cigarettes” at least not on the top of the page, why? because many of them have names of their own, e-Vic, Innokin, GG, Evod, eGo, the list goes on and on…
We are not lobbyists for Big Tobacco, why would we be? we are people who have switched to ecigs as a step towards harm reduction, nothing more.
Big Tobacco invested in ecigs recently as they obviously realise that smoking tobacco is in decline, so to survive they need to diversify, they certainly have not paid me or anyone I know to fight for our right to harm reduction.
Well since you researched so deeply perhaps I should correct you somewhat. The ones like look like cigarettes were amongst the first designs released on general sale. Many users disliked their resemblance to real cigarettes which is where the market responded with devices that are more varied. Also individuals came up with home built devices which they could attach existing atomisers to since the battery part is just that a battery and some simple electronics to control them.
The ones that look like cigarettes are still around but have not advanced as quickly compared to other devices and still attract many new users who try them before they either stop because of dissatisfaction or find out about the more varied, more efficient devices and move to those.
As for the responses you have elicited from twitter and the like, you need to in fact, claim some of the credit for some of the harsher responses since you used language deliberately designed to elicit strong emotional responses. To claim shock after the event shows the false humility and concern you seem to be trying to foster.
The public health community is quite split on the topic of electronic cigarettes. Some indeed are hoping they are a help to cut smoking rates if allowed to mature properly and those who are not prepared to consider the ever growing evidence of their benefits. Selectively choosing evidence based on pre-conceived agendas does little to help public health.
An interesting and well argued article. But you don’t address the central point of electronic cigarettes: whatever they look like, there is absolutely no evidence that they are any more harmful than coffee. If this is true, then why the insistence in seeing these devices as an extension of the evils of tobacco? Surely they should be welcomed as a potentially revolutionary breakthrough in this area of public health, no matter their appearance or, for that matter, who manafactures them.
Thankfully the EU has just voted to allow ecigarettes to continue to be sold and so I’m not going back to the fags in 2016. That is the bigger picture for me and for future successful smoked tobacco quitters too.
The author’s reasoning is fundamentally flawed. He sees an equivalence between smoking and vaping: you move your arm in a similar way; e-cigs are the same colour and similarly tubular. Well, on this silly analysis we should also seriously reconsider pen-sucking, if the pen happens to be white. Why doesn’t he mention the fact that 1000s fewer injurious particles and toxins are part of the vaping experience? That seems more interesting to me.
Martin, hadn’t I warned you this summer, in Venice, that the minute you post something even mildly criticising eCig, the trollers are at you and the vast majority are agressive and violent? As you say, too quick not to suspect astroturfing. I would have thought this kind of lobbying would have failed, because of the form, not of the content. Today, EP voted against regulating eCig as medicinal products – who won?
Real people won.
People who have switched from the deadly form of nicotine intake to one that all research so far shows is close to harmless.
Democracy won today, real people had to chance to talk to their representatives in the EU and their representatives did their job and represented those people.
People can argue all they want about the theoretical “gateway effect” and the renormalisation of smoking until the cows come home and there’s no evidence of either but in the meantime real people are turning from smoking tobacco by the day.
Am I a lobbyist? Possibly, I’ve been politicised by the TPD and E-cigs and I’m no ready to vote on who supported harm reduction and who still maintains the quit or die.
So yes I fought for my rights, I stood up for myself and my family and all the millions who have avoided or cut down on smoking since they took up vaping.
I will fight for my right to continue to avoid harm no matter what someone who isn’t in my situation and who isn’t using my lungs thinks I should or shouldn’t do!
Catherine – we responded to this blog having seen it posted on twitter by the faculty of public health. It is an area of drug regulation policy Transform have been interested in and written about for some years. I hope you don’t view our contribution as trolling, agressive or violent – it most certain is not astroturfing. Its important to remember that Blogs are discussion forums and this is a new, developing and unresolved area of policy that demands discussion and critical engagement given what is at stake.
who won? everyone did. If you start regulating ecigs to medicines only large companies can afford to meet the manufacturing requirements, you may as well hand over the industry to big tobacco or their subsidiaries. BT did not start the ecig industry, and it should not be handed over to them on a platter. Let the industry and smaller operators continue to exist, let the products keep developing, and let ecigs evolve and it’s likely tobacco cigarettes will naturally get phased out by the consumers themselves.
Vaping is not the same as smoking, it’s not even the same to a smoker, it addresses the habit and addiction, but successful vapers aren’t using devices that look like cigarettes (cigalikes) because they’re just not terribly effective. They use the devices that martin mckee above described as older style, he got it wrong. These more cumbersome devices are the newer generation of ecigs, they don’t look particularly stylish, but they are more effective for the user, and vapers don’t care, they use what works, not what looks more sophisticated because believe it or not, smokers are more interested in what will keep get them off smokes and keep them alive, not how they look.
People who don’t understand vaping, or ecigs and how they work and are truly used are trying to make decisions on them, on behalf of the smokers who can benefit from them, based on fear and ignorance without truly understanding the devices and the users at all.
violent? come on get back to reality, the disparagement shown to vapers by many in the field of public health gets you a heated response. Astroturfing? Total lack of awareness of the 1.5 million uk vapers and 7 million in Europe, many of whom use social media to communicate.
Very interesting article, the title might be “The Empire Strikes Back” and certainly the appearance of e-cigarets should be regulated to avoid misleading messages among consumers of tobacco products, who are in a different stage of change related to quitting, and especially to prevent new tobacco addicts.
[…] So what should we make of e-cigarettes? […]
Funny, isn’t it Catherine, how people get ‘aggressive and violent’ when you try to regulate out of existence something potentially saving their lives.
So users enjoying themselves with something that looks like a cigarette but isn’t is bad for their health? Big tobacco companies making a profit doing something that isn’t selling tobacco is bad for people’s health? I disagree. It seems to me that the “Public health” lobby are really the new puritans with no regard for freedom whatsoever, unless of course it is the freedom to do things they want to do.
Martin, may I first say that I am truly sorry that you have been personally insulted in the past weeks. Satire, rebuttal, and satirical rebuttal are fair tactics, but outright abuse is regrettable. However, I do hope that you may reflect further upon your comments and accusations of “astroturf”; you have grossly misjudged the strength of feeling that exists in the e-cig community and it would appear that you do not fully grasp the truly awesome power of social media, especially when it is deployed by a close community with extraordinarily strong convictions.
As the lone female blogger, utterly unconnected with any interests other than those I have for my own continued personal wellbeing, responsible for the blog post (not web page, to be pedantic) to which you again refer I feel rather uniquely placed to tell you that what you have experienced is not some tin foil hat industry conspiracy ranged against you, but the gut reactions of people for whom this issue is deeply personal.
There have been many occasions in the past, Martin, when I have agreed with and deeply respected your views on public health issues, particularly with respect to your thinking on the impact of socio-economic factors. But this time, I am compelled to disagree with your ideas in the strongest terms possible. Like many others, I have made an informed choice. And like many others, I certainly did not invite opinions upon it. Although your points with respect to the entry of Big Tobacco into the e-cig arena has some validity, I cannot but help feeling that the issues are becoming confused here.
Please, respect our decisions as individuals. Feel free to attack the interests of big corporations, and given sufficient time you may very well find vocal support from the very community upon which you have again cast aspersions here today (I myself have on more than one occasion blogged almost hysterically against BAT for example), but please have the good grace to accept that members of the e-cig community have made their own choices.
Why the need for medical licensing? if these products are 90% safer than cigarettes surely we should be encouraging their use not calling for bans? By all means do what ecig manufacturers want and ban sales to minors but the rest of your argument is nonsense. I would go further and say damaging, dangerous nonsense. It’s almost as if you’d rather people carried on smoking cigarettes and dying of lung cancer – anything but admit that the market has found a way to reduce traditional smoking to a tiny rump of users.
Mercifully the amendment allowing free access to e-cigarettes has been accepted – at least future generations will have the choice whether to kill themselves or not! You seem to think this outcome was due to the tobacco lobby; not so. I and many like me have written impassioned letters to MPs MEPs and anyone who would listen begging them not to allow this life-saver to be handed over to Big Tobacco or, worse, the Pharmaceuticals whose approved NRT products fail 90% of the time and whose anti-smoking drugs kill.
Millions of us have switched to e-cigs, which are covered by all the necessary regs BTW, in order to get away from tobacco – we are the grass roots who stood up to be counted. It is precisely because of ill-informed comments such as the “astro-turf” one that you were flamed.
Do you seriously believe that people are better off smoking tobacco cigarettes? They are still freely available!
I think it’s disgusting that you could even suggest that it’s “astroturfing” browse one of the many ecig forums and you will clearly see that news articles are regularly posted, leading a large group of vapers to read and in most cases comment.
If you automatically view united opinion from consumers as “astroturfing” then when will you will never view important opinions seriously.
It’s of my opinion that you are “astroturfing” for the pharmaceutical market, but that would be a very narrow minded way of thinking, wouldn’t it?
Do more research, you think you have, but you haven’t.
Type “ego ecig” into google.
Visit ukvapers.org – read, digest and understand.
If the entire world started vaping and tobacco was removed from sale, it would be hugely beneficial.
Either way, the EU has voted and vapers have got their way.
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
Martin McKee clearly thinks he’s made a winning point following my aside on on alcohol advertising. Two points in response…
(1) The point about e-cigs, and a rather important difference to alcohol, is that they don’t do material harm to the user or to anyone else. My argument, which he seems determined to misunderstand however simply I state it, is that it is *good* for public health to advertise e-cigarettes because this will drive more smokers to try them, understand them and keep using them instead of smoking. I was illustrating this point by suggesting that there are other ways to control advertising, such as those used for alcohol, than pre-approval by a pharmaceutical industry body – the approach required for medicines.
(2) A lesser point, as I am not defending or attacking alcohol advertising, but has he not noticed the fall in alcohol consumption over time, especially among young people? This example might help: http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2011/rpt-chapter-2.html#tab-Trends-in-alcohol-consumption-over-time He has just asserted that alcohol advertising is regulated inappropriately, as though that is common knowledge and universally accepted.
What he needs to do is think more carefully about the trade offs between the (negligible) harms e-cigarette advertising restrictions prevent if any, and the (significant) benefits e-cigarette advertising would offer given this is a new ‘insurgent’ industry in competition with cigarettes.
Finally, I had hoped he might approach this issue with just a touch more humility after a thoughtful but brutal reprimand from Gerry Stimson, David Dorn and Rick Lines: http://www.bmj.com/content/347/bmj.f5780/rr/665237 – it seems not. It’s a shame he can’t share in the success of e-cigarettes and get behind them. Sadly, for many in professional public health e-cigarettes are a case of the wrong-kind-of-success.
Finally, for anyone interested in this issue, I recommend reading the full response I made to McKee, not just his chosen excerpt, here: http://www.bmj.com/content/347/bmj.f5780/rr/664328
Clive: this is the sort of response we’d expect from you given your long term alliance with the tobacco industry. Come clean first so we know where you are coming from.
Hmmm, a surprising accusation. I ran ASH-UK from 1997 to 2003 and was a senior civil servant in an unrelated field from 2003 to end 2012. I am now setting up a business and I have no competing interests. So what is the basis for this assertion? I assume you know that it’s not okay to use the internet to smear people just because they see the world differently to you.
You want to know where I’m coming from. Well, I’ve taken a consistent rigorous approach to ‘harm reduction’ based on supporting low risk alternatives to smoking (>90% lower) and encouraging smokers to switch to NRT with extended harm reduction indications, smokeless tobacco and more recently to e-cigarettes. I happen to think that is the most promising strategy to reduce the billion deaths forecast from smoking in the 21st Century and to make major inroads into smoking-related health inequalities. If you want to see why it is possible to support a tobacco product in the name of public health, you can take a look at this letter from some of Europe’s top academic experts arguing for lifting the unscientific, unethical and lethal ban on oral tobacco (snus).
http://www.clivebates.com/?p=1561
Are they all in an ‘alliance with the tobacco industry’ too? Do you support lifting the ban, or do you have better arguments than these? If you do, you should make them – that’s how we get to the right thing to do.
Unlike most in public health, I make my case openly to the extent I can on my web site and will take comments and criticisms from anyone, including you if you are willing to attempt a cogent argument rather than name-calling. If I’m wrong I promise I’ll change my mind. You can criticise my views here: http://www.clivebates.com
[…] So what should we make of e-cigarettes? […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
Yes, numerically the largest number of e-cigs made are the first and second generation look-a-like e-cigs, these are the ones that are most suitable for mass production. They tend to be expensive for the contents and not very efficacious (say 3 for efficacy where a patch IMO is a 1).
The next generation is the eGo style which is the simple battery with a clear plastic top/atomiser on it, these are now appearing more and more in the papers as the headline picture.(efficacy 5 -6)
The fourth generation of e-cigs is the mechanical battery tube with a carto/tank on top of it. The mod (battery tube) may or may not have a method of varying the voltage. (efficacy 6-7)
We are currently mostly using (experienced long-term vapers) fifth generation e-cigs. The mods are variable wattage or voltage or capable of either. The atomisers are stainless steel and pyrex, often hand made on CNC milling machines by experts, with fully rebuildable coils and wicks inside (genesis style atomisers).
The sixth generation of atomisers are coming out now in limited quantities, from experimenters who do their own design work in a back garden shed, before milling up the prototypes in their garage. There is one website/forum in the UK devoted to these hardy individualists (the Vapepit). If you think you have been abused, you should read what they call each other sometimes (me included).
There is no excuse for abuse in a public forum.
I am a hotelier, nearly 60, and certainly do not deliberately set out to offend anyone who has not already been rude to or about me, and even then I would prefer to do it in private. Calling vapers “astroturf” is certainly not the wisest of moves, we are not a monolithic organisation, indeed, one of the moderators of a forum referred to his job as “cat-herding.” Also the young among us (ie the mid 20s) do tend to be easily inflamed.
This comment can be read in full on my blog at http://schoolofdolphins.wordpress.com
[…] read at https://betterhealthforall.org/2013/10/08/so-what-should-we-make-of-e-cigarettes […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
Again I ask professor McKee to engage with the e-cig community. This is not the first time he has been invited to do so. Please, engage. Learn. Disclaimer: prejudices to be left with door staff. Come on Martin, you are better than this.
Unfortunately martin you will not learn a great deal about this by a quick google search on ecigs. As above if you engaged with and truly understood the vaping community you would see long term smokers who previously have not been able to quit, many have tried NRT with no long term success, but who have managed to greatly reduce or discontinue smoking tobacco cigs by using and ecig.
with the arrival of ecigs (not the cigalikes), smokers who thought they were destined to smoke until it killed them are getting off the tobacco smokes with greater ease. Not only do ecigs address the nicotine addiction but also the highly ingrained habit component that goes with long term use and this is what users find different about them. I suspect ecigs have the potential to save billions of lives and may even bring about the demise of tobacco cigs, they should not be feared, they need to be understood as do the motives of those who use them.
Imagine being a long term smoker, discovering ecigs and getting of the smokes and starting to feel the positive effects, then to have to face the threat of having it taken away again. That is why people respond angrily or passionately about this, because smokers are finding a way out with ecigs and do not want to be condemned to a death sentence by those who want to restrict ecigs.
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
The European parliament disagrees with you mate. As do I, ecigs save lives. Would you rather have people smoking and dying of cancer.
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
@Professor Mc Kee,
I’m a vaper, a user of one of those things that looks like a spark plug – properly known as a Personal Vapouriser. I agree with your comments regarding Cig a likes, personally I think they should be removed from sale on supermarket and petrol station counters and put in the cabinet with real cigarettes. As for the near instant and sometimes abusive responses to your earlier posts? I’m a member of the Planet Of The Vapes Forum, Members use RSS feeds and search tools to look for articles on E-cigarettes so if we can do it others can too. I’d suggest you visit our Forum, chat with some of the members – You’ll find a vibrant community every member of which would stand and denounce the selling of E-Cigs to minors, and virtually none who would care to support advertising of E-cigs. Mostly we just want to be left alone to vape in peace and stay off the Stinkies (real cigs) So please feel free to have a look around chat and learn what real E-cig users think…
[…] equally sure that there were many more people who had quit without them. Read the full article here. lol, "homework". He typed in "electronic cigarettes" into google images, and […]
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
[…] by Martin McKee Professor of European Public Health London School of Hygiene and Tropical Medicine Anyone walking through London’s King’s Cross station this week could be forgiven for thinking they… […]
MArtin, the information you are basing your article on is flawed for two reasons.
1. confirmation bias didn’t just creep in, it kicked down the door and planted its arse on your sofa and then told you to put the kettle on. You skills in using google for example are massivly flawed. Google is a search engine… it returns what it feels is the best response based on a complex system of genetic algorithems…and those change slowly in repose to users searches and prefernce… but the e-cig indiutry is galloping ahead perhaps 5 times faster than the search engine can cope with these demands to alter is returns.
Plus Google have decided to put a filter or ‘dampener’ on pages which state that the e-cig can stop smoking… that was done manually… and the person tasked with that clearly did not understand the distinction beween an addiction as a disease and the behavior of those with an addiction….smoking is a behavior… nicotine dependence is a disease…. so stating e-cigs stop smoking is clearly true, look at the sales for proof of that. They do not however address nicotine addiction, only the individual with help perhaps from their doctor and support from their family and ppers can do that.
But randomly typing electronic cigarettes into goodle will just give you images of what are called 808D model ecigs… and pretty poor ones too.
Thats like typing the phrase ‘cars’ into google and then stating that none of those images resemple the cars you see on the road…and they won’t either…try it now and see! If you want images of the car on the street you’ll need to filter yourself…
Next what on earth is your problem with a product that is used by millions that has to date no recorded health issues? Yes I know you don’t like them becasue they look like cigarettes and the images of sexy ladies in the posters confims that they are clearly as bad as cigarettes to you…. have you stopped to think that you might be totally wrong there and that observation in the field (the real world) tells us all that you are wrong there… simply put…they are safe… hundreds of millions of sales coupled with a hundre million users all perfectly healthy (except fpor the damage inflicted by smoking tobacco prior to purchase) says so. You simply can’t argue with the observation of no heath issues…despite wheter they look like cigarettes.
And even if they look exactly like cigarettes to my mind thats even better… becasue you will realise the folks atterated most to these picture will be ‘smokers’ the very folks the ads are aimed at, not children, or non smokers or anything like that…they are aimed squartely at smokers… the advertisers don’t waste money on non smokers or children becasue those segments of the population won’t buy their products. If they worked that out…why can’t you?
Now if the decline in smoking continues (and rem,eber the tobacco companies are taking an absolute hammering from e-cigs, so are the pharmacurticals) then this trend will not only continue but will speed up. By the time the UK government are legislating for the medicinal product thing… well at this rate 40% of smokers will be vapers… and that bill will be crushed in aheatbeat becasue politiicans are a lot of things…but politically suicidal is not one of them.
The tobacco companies won’t win in launching their own products either…becasue in all of your research like them you overlooked a very important piece of information…. and that is this…
1. E-cigarettes cost 10% the price of tobacco (average)
2. The e-cig is not where the supplier makes their money, they are too cheap to supply serious profit
3. the e-liquid is a consumable and a repeat purchase…this is where the money is…
4. almost all e-cigs can be refilled with e-liquid bought in bottles from any other manufacturer…
Vapers realise this within a few weeks of buying their e-cig…you went out of your way to reseach the matter and missed it… Which tells me a lot more about your skills in research then the efficacy of the information in your article.
I believe all of your statements are evidence-based aren’t they? All I read here reassures me: there is science, evidence, peer-reviewed research and obviously, all vapors are doctors.
Seriously, I have not read, not even once, from any public health supporter, that eCig should be banned – they say, like a lot of you do, that they should be regulated. What is the best format, this, is the point discussed by Member States and the European Parliament (EP)- as, despite what you may all think here, what happened yesterday is just one step in the legislative process, Governments (including yours) voted in June that e-cigarettes should be regulated as medicinal products, the EP, didn’t; they shall now enter in “negotiation” and I bet this will be tough.
Us, public health community, like politicians, should be held accountable for what we said and decided at a certain time and which, at a later stage, appeared to be harmful and dangerous; that is why supporting caution and some sort of regulation is nothing less than us fulfilling our duties.
Recommend this reading (among many others):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3432052/
Since you are here, may I ask: how do you plan on getting rid of your nicotine addiction? It is one thing to stop smoking, another one to keep getting nicotine into one’s body.
Jessamine: Simon Chapman has been working on and an expert in tobacco control for 40 years, how long have you been an expert in this field may I ask?
Finally, I am stunned that none of you speak about the fact that eCig “re-normalise” smoking in the eyes of the outside world and attract young people into a habit that is very addictive.
You like playing Russian roulette? I don’t. If you were to do some un-biaised, unsponsored research, you would find out that most people stop smoking (to save their life, like you say) unassisted.
“Since you are here, may I ask: how do you plan on getting rid of your nicotine addiction? It is one thing to stop smoking, another one to keep getting nicotine into one’s body.”
why is it necessary to get rid of the nicotine addiction for smokers to benefit from the harm reduction effects of vaping compared to smoking tobacco? This is part of the problem, a narrow minded one size fits all result. smoking is the only addiction where harm reduction appears to be intolerable to some. There are far more dangerous substances in tobacco cigarettes than nicotine, you know that, but it’s still not enough for smokers to be free of the most serious harm.
“Jessamine: Simon Chapman has been working on and an expert in tobacco control for 40 years, how long have you been an expert in this field may I ask?”
But he does not have 40 years experience in the ecig/vaporiser field, therein lies the difference. He also regularly spreads misinformation about ecigs because he has never bothered to learn about them or the people who use them. His misinformation is based on cigarettes and ecigs amounting to the same thing instead of looking at this new device with an open mind and an eagerness to understand it.
“Finally, I am stunned that none of you speak about the fact that eCig “re-normalise” smoking in the eyes of the outside world and attract young people into a habit that is very addictive.”
Young people will always experiment with things we would prefer they didn’t, cigarettes, alcohol, prescription drugs, illegal drugs. If you understood the devices, you would know that cigalikes are not user friendly and very quickly end up in the bin, and proper personal vaperisers which actually work are far too unsexy to be attractive to youngsters. It would make more sense to address the cigalikes as a separate issue, but the “experts” don’t even know the difference so what hope is there?
“If you were to do some un-biaised, unsponsored research, you would find out that most people stop smoking (to save their life, like you say) unassisted.}
one approach does not work for everyone. up until now the smokers who have been able to quit are likely to be the least addicted/habituated to it. Does it seem logical that there are still so many smokers around in spite of the fact they have become socially ostracized, are paying high taxes for smokes, have been bombarded with health messages about it? Is it possible to consider that the smokers left behind are the smokers who need ecigs the most, the badly addicted with years of habitual behaviour to overcome, the ones who haven’t been able to quit unassisted or with current NRT. Maybe this is what you are overlooking when you interpret results from people who have quit, rather than from people who have been unable to quit in spite of the difficulties it comes with these days.
I doubt if any of this will change your mind, but then you aren’t personally affected by it so why would it bother you when it’s not your life and health at stake here.
Catherine The MHRA confirmed that all existing products on the market would not qualify for a Marketing Authroisation under medicinal regulations.
Removing all of the existing products that the estimated 1.3 million UK citizens have been using, and which have successfully lead many of them away from much more harmful tobacco cigarettes of which I am one. This is a de facto ban no matter how you look at it. It would also mean that the costs of receiving a Marketing Authorisation would put most of the existing producers and vendors out of business and leave the market to the larger corporations such as Big Tobacco, as they could quite easily afford those costs. Those are undeniable facts. Why else would BAT already be producing a product (that looks like a cigarette) that would qualify for a MA? This is where many of the public health and anti-tobacco lobbyists arguments fall down. Also NRT products are legally available to children as young as 12 in the UK and there are reports of them being handed out to school children without parental consent on the NHS.. So again this doesn’t really support the protecting the children argument either. Again I’m not making this up, these are facts.
The Electronic Cigarette industry already self regulates in the UK and would welcome tighter regulation on age restrictions and product safety, but medicinal classification was literally taking a sledgehammer to crack a nut. The reality is it would have made a product that even skeptics have agreed are much less harmful than tobacco cigarettes less available, no matter how ‘light/right touch’ it would have been. It would have stifled innovation too. for example how far as NRT come in the last 30 years under medicinal regulation? Not very. Even ASH and CRUK called for less restrictions in licensing NRT back in 2008 for this very reason.
Not all public health officials share your or Martin views that this was the right approach. Also several European Courts have ruled that Medicinal Classification for Electronic Cigarettes has no legal basis as by definition and function they are not medicinal products. Another fact that seems to be constantly overlooked. Now with the EU Parliaments ruling that they are not Medicinal products it looks unlikely they will be regulated as such in the UK no matter how tough “negotiations” will be.
I can understand you would be dismayed at aggressive and violent attitudes you may have experienced, but I doubt that this was from the majority of any correspondence you have received from ‘vapers’. Unless you deem simply disagreeing with you as aggressive & violent? Many of us vapers feel that many politicians and health care professionals have behaved in a provocative and dismissive manner too, and many of them have failed to actually engage with the very people they are either there to represent or serve. Ignorant and aggressive behaviour is not exclusive to either side of this debate.
You state that most smokers quit unassisted, but it can just as easily be said that most smokers do not quit at all and maintain their nicotine addiction via tobacco smoke. Surely it will be a better option for them to maintain their addiction via a much less harmful alternative? RCP, ASH and the MHRA recently encouraged continued and prolonged use of patches, gums, inhalers etc based on research by Prof Hajek as a better alternative to continued smoking. So based on that denying prolonged use of electronic cigarettes would appear contradictory.
Then we come to the ‘renormalisation’ argument and this one entirely comes down to how you perceive it. Is it renormalising smoking? Or normalising vaping? Are smokers sub-normal Or law abiding tax paying citizens who are fed up of being stigmatised by catchwords such as ‘denormalise’ that basically victimises and discriminates them?
So far there is no evidence that non-smokers or children are attracted to Electronic Cigarettes nor that they are a gateway to smoking. Even the CDC’s report in the USA which tried to claim that non-smoking children were using ecigs actually proved the contrary, as nearly 80% of those who had tried an electronic cigarette were already smokers. This evidence actually helped to show they were a gateway away from tobacco not to it.
We are not astroturfers, we are a community who have organised & educated themselves via social media such as forums, Facebook, Youtube & Twitter who feel that they are fighting for not only a lifestyle choice, but many for their lives. I can understand how those in politics and public health can easily dismiss us as such, but doing so is a weakness rather than a strength. It’s a tactic that may have worked in the past but it negates rather than encourages open and honest debate. Many of us in the community feel that some politicians and health officials are just paid for mouth pieces of the Pharmaceutical Industry who will say anything to protect their interests. We are probably as right about that as those who dismiss us as astroturfers.
Neither side is faultless, neither side is 100% correct, which is why now it is necessary for both sides to put aside the rhetoric and the disdain for one another and engage with each other in open and honest debate and not just dismiss one another offhandedly. Only then will will ever discover the true and full potential of what Prof John Britton described as being “a massive potential public health prize”
Catherine, there have been many responses to your comment, as one of the few people to support the author in this comments section, I would like to hear how you respond to these.
You have asked me to reply, so here I go, but this is going to be my last message as I do not wish to repeat myself, and I believe I have already said what I think, and the challenges I get are still to convince me and change my mind.
1/ I respect all of you, your choices, the reasons for your choices even if I disagree with them. I did not get the same respect for my views, in the past, from a lot of people “vaping” who chose to insult and aggress to express their disagreement.
2/Speed of reaction from vapers to any comment put out in the air (on FB, twitter or blogs): I had understood that there were mechanisms to monitor the comments (RSS feeds for instance) but still find it “odd” to put it mildly that this IMMEDIATELY triggers many many responses: surely most vapers are not only vapers, have other occupation (or even, a job) and therefore have no or very little time to immediatley react – so how come they do? Please understand our suspicion.
3/I will never engage with people whose arguments are based on “” you don’t understand, you don’t suffer ” or “you are not one of us” – emotions and personalised arguments. First, you haven’t a clue of what I may be (or not) suffering from, 2/you don’t need to have a cancer or AIDS, or whatever else, to have an opinion on how to react to it, to do some unbiaised research, especially when you work in public heatlh, or do you?
4/Kids experiment all kinds of things: this is so true that I find it irresponsible to put on the market yet another (potential) dangerous device/product that they might be tempted to try, without any good safeguards and regulations that will, at least, attempt to protect them.
5/Vape of Groth: Nicotine addiction: my deep apologies, I did not understand you were happy with it and did not want to get rid of it – weird to me, but, hey, your choice. I am very aware of the battle between 2 schools, one that says that nicotine is not addictive versus the other one that says the opposite. You tell me yourself: if you try, or if you were to try, to stop vaping, will you suffer and your body be in need of nicotine?
6/I agree that waiting for evidence can be a long process – that is why I am in favour of regulating, one way or the other, maybe not as medicinal products, but regulate until we know more. Remember what I said in my other posts on the subject.
7/Flavourarturk: “Ah! the EU just did and came out in favour of common sense and public health ” you are incorrect – see my previous message on this subject, this was just a first step, the “EU” did not come out on anything, as it is only the European Parliament that has reached an agreement (not even a vote) and is now negotiating with Member States and your “battle” if far from being won, from this point of view.
8/I note that nobody commented on my comparison with the Russian roulette.
Conclusion: you have not convinced me, although I entered this conversation with an open mind, ready to change my views, and receptive to your arguments, despite having been attacked in the past, for expressing just a bit of caution on over-promoting eCig – and just that. I am glad that one of you noted that I am the only one, supporting Martin’s view, who engaged with you via this forum. But that is it for me.
Catherine: I merely mention Simon Chapmans’ name, factually describe his behaviour and you challenge my qualifications to speak at all? I am fairly sure you don’t need his experience fighting BigT to call people pathetic on TV though LOL I think you would do well to re-read my comment as you will find it is not offensive to Tobacco Control in the slightest. I had no issue with Simon Chapman personally (and had thanked him online for some of his actions in the past) untiol he decided to call my community name on TV.
“/I agree that waiting for evidence can be a long process – that is why I am in favour of regulating, one way or the other, maybe not as medicinal products, but regulate until we know more. ”
catherine, you are still talking as if an ecig is one single device. There are many variations of PVs (ecigs) because of interchangeable parts, but more importantly the ejuice is also not a singular product, it consists of 4 basic ingredients which are all flexible in their quantities.
e.g.
nicotine – this can be adjusted up or down by the user to suit their personal need
PG & VG – this comes in various ratios, from PG free to VG free and ratios in between.
flavouring – optional
so if for example, it was found that an ingredient used in high concentrations was a health risk, then all vapers would have to do is use lower concentrations or in the case of PG, VG, flavour, they could even use none at all. The option is already available to use more or less of any of the ingredients, because vaping is that flexible.
The limited research already done clearly comes out in favour of ecigs, and when you compare 4 ingredients with no combustion or tar in ecigs, to the 1000s of chemicals in cigarette smoke where tobacco is burned and inhaled, it is illogical to restrict their use in favour of cigarette use. Vaping and smoking are not the same thing, and health officials should not be scared of someone exhaling water vapour just because they associate it with smoking.
you may find the link below helpful as it really gets to the heart of many of the issues discussed here:
Click to access 1477-7517-10-19.pdf
Creating a law to medicalise a product where that product cannot attain licencing because it cannot meet the criteria is a ban..Moreover everyone proposing this nonsense knows that full well. This would hand the entire e-cig business to perhaps four multi-conglomerates worldwide that would do for smoking cessation what gum and patches done… nothing at all!
ecigs cannot demonstrate they function to address nicotine dependence… for a very good reason…the e-liquid contains nicotine. Last time I looked an alcoholic could not address their addiction by treating it with whiskey!
Its not a smoking cessation or nicotine dependence product…its a complete alternative to smoking. The powers arrayed against the e-cig industry have had half a decade to demonstrate any dangers and even with their vast sums of money, huge resources, laboratories and staff on call….almost every one of them worth Phds in everything from chemistry and physics to biology and bioinformatics none have yet pointed to a danger that is in any way a public health issue. Its a lot more interesting the resources they use in this battle are their legal departments and political lobbyists!
But it will be lost…and they are making a terrible enemy too.
This insistent nonsense on medicinal treatment is a little like insisting car manufacturers demonstrate the flight and avionics capacity of the family car before its given the green light to be sold… since cars cannot meet that criteria all of them would be banned.
E-liquid and ecigs never pretended to be a medicine… the branding , style and consumer base alone is absolute evidence of that. When was the last time you seen a forum with 60k folks discussing their favourite nicotine gum?
E-cigs are marketed as an alternative to smoking…they are bought as such. Nobody buying my e-liquid is buying it to treat a disease or ailment…they are buying it based on flavour and experience…even price is secondary to them.
Smoking is legal, not a medical product but it is dangerous…vaping is not dangerous. When you can demonstrate a danger above the danger posed by a slice of toast get back to me. Toast produces acroleins by the way, Clearly bread should be removed from the shelves…or at least be forced to be CHIP compliant what with all those toast delivery systems being sold by high street stores and all!
The sudden decline in sales of tobacco and increase in vaping is self evidence…if it were not there would be no debate on this issue whatsoever since e-cigs would not have any efficacy… and would be treated by the tobacco industry and pharmaceutical industry in exactly the same way homoeopathic remedies are treated… with total indifference since they pose no threat…because they don’t work at decreasing tobacco sales. E-cigs are certainly guilty of hammering tobacco sales…I think with 2 million vapers in the UK now we can both agree on that!
E-liquid is regulated anyway… just take a look at any random bottle of e-liquid sold by any UK vendor…on top of all the warnings and text that covers over 70% of the bottle they are also CHIP and CLP compliant. They are regulated by over 15 EU directives and also UK law. Thats plenty already with the regulation of a product that carries less public health risk than a loaf of bread thank you very much!
Either way, as a manufacturer if worse comes to worse I’ll simply make a total mockery of the law by basing my business outside the UK and selling the products direct to the consumers…removing tax, jobs and income from the UK state.
UK citizens would still be 100% entitled to legally purchase my products too…except now absolutely no regulation whatsoever would be applied and I’d be joined by every vendor and manufacturer I can think of…
With (by the time there is any legislation) over 4 million vapers in the UK about 200 million bottles of e-liquid imported to the uk every year just to satisfy a base demand.A loss of revenue to the exchequer in the billions…
How’d you like them medicinal bananas?
Lastly yes rather ironically I do have a doctorate, not in biology though.
Very lastly … I personally DO NOT plan on addressing my nicotine addiction… but that’s okay, its my choice and has nothing to do with anyone else. I also have a slice of toast in the morning…not that its any of your business and I generally wash it down with a cup of coffee…again none of your business… But I’d be pretty sure you’d like to make my business your puritan goal… as a puritan I’m sure you are horrified at the thought that someone somewhere might actually be happy.
Vaping does not re-normalise smoking… I usually laugh when I see smokers heading outside and on several occasions have waved to them from inside a building vaping away. It tells them they can swap to vaping at any time.
Either way smokers are bloody normal… and I think its pretty rich of you to treat an entire section of the population with the same derision the rest of us treated homosexuals, minority religions or races or those with any other disease in the past…that tells me a lot to be honest …
Your paper I have already read…and to be honest we know nicotine is not carcinogenic… and a Chinese team rehashing a 2009 study demonstrating that direct infusion of nicotine into a human cell is pretty paltry when raw eliquid has been tested for cytotoxicity earlier this year in human trials and cultures and again demonstrated no such issues.
I seriously…seriously would not attempt to bring this argument into the domain of science Catherine.
I seriously don’t give a damn who worked in any tobacco field doing anything… demonstrate e-cigarettes are dangerous or stfu! is my only argument.Its a valid argument too…because I really could not care less about any ideals of normalisation of tobacco smoking when we-cigs have lowered tobacco smoking so much that even tobacco companies are buying e-cig companies.
Hi Martin, the reason you get such emotional responses is that a) enthusiast vapers are very passionate about harm reduction and have been politicised and organised by the fight against ecigs globally and b) we are so very frustrated with the inaccuracies and what sometimes looks like shameless propaganda from those in the public health field.
The anti-tobacco public health people seem almost shell-shocked from their long and vicious battle with big tobacco, so much so that the public whose health they supposedly desire to defend (i.e. the target group of those vulnerable to exploitation by big tobacco) become paid lobbyists for big tobacco. People like Simon Chapman call those who use ecigs and support and chum eachother on forums ‘pathetic’ on Australian television. Doctors on US TV claim that ecigs can release a vapour ‘thousands of degrees’ in temperature, a scientific impossibility. Politicians harp on about fruit and sweet flavourings as if only children like those. Etc etc. Those who we thought would be happy for us and for our vaping culture have turned out to by and large by vicious enemies.
Maybe if you engaged with the vaping community on places like twitter, reddit, ecf etc you would find out what we know; big tobacco owned ecig companies do not care about the vaping community and they do want their ecig experience to taste and feel like a less effective version of smoking. They are in favour of less flavours as it makes inventory easier to manage. They are against online sales as they have the money to get into retail space. They are for medical regulation as only they can afford it and they can use regulatory capture to take over the entire industry. They are not friends with the vaping community and as Jason from Blu ecigs (owned by Lorrialard) has said online they think non cigarette looking vaporisers look like ‘dildos’ and publically disparriage them, as their competition.
We are NOT with big tobacco, we are AGAINST them!!! (in the majority of cases…although sometimes when we feel abandoned completely by public health, medicine and politicians that stance can temporarily soften). We want basically the same things as you, do away with ineffective cigalikes, get big tobacco out of the vapouriser space. I disgagree with banning public vaping unless a health risk can be demonstrated.
So engage please, so you can stop making rediculous errors like claiming that mods came before cigalikes!!! Thank you 🙂
When you see folks like Catherine chase the rabbit down that hole you also notice soon after that their number s begin to fall…because its apparent eventually to all but the psychotic that its a losing fight… many of these weirdos eventually realise that they can’t apply their nonsense in the real world…because its based on stuff that demonstrably is not true.
Arguments about public health are gone now not due to studies…but due to millions upon millions of vapers none of whom have presented themselves to A&E…
they have actually now all resolved to the tiny shed of trying to demonstrate minute and tiny risks… some so innocuous that any random product on the shelf in Tesco is many times more toxic and used to make the family meal.
When it get s to that level…and someone point out that a slice of toast produces the acroleins not produced in e-liquid but pretended to be found in quantities many times less toxic then the game is up….
She may as well be standing there pointing out the dangers of any random object… Pencils are dangerous and toxic because of X…or rubber tassels on my shoes are dangerous because of Y.
Thats the level they have now got too…and all the while they are arguing these paltry little arguments that are not even real…the vaping community doubles, triples or quadruples in 12 months. That’s the reality of the matter… one they haven’t worked out yet.
Lets see her persuade her local MP to lose 25% of his/her votes… because the UK general election comes BEFORE any legislation…(MAY 2015) and I doubt any candidate will be stating their objection to e-cigs at the doors with 25% of the population smokers and likely 30% of those using e-cigs by then.
Politicians are not stupid… the backlash would ruin them… We win, and she doesn’t even lose since tobacco will take a hammering it will not survive this decade…she just hasn’t worked that out yet.
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
Not sure its really a bad thing if tobacco companies stop selling tobacco… how would this be a bad thing?
There’s a reason why the clinical data on e-cigs don’t yet support the tens of thousands of individual testimonies given by people who claim to have quit tobacco smoking completely with electronic cigarettes.
Please see this infographic about why that is: http://i.imgur.com/V95HQGU.jpg
Please read this post about the 19,000 individual testimonies collected from successful ex-smokers who quit using ecigs : http://www.bmj.com/content/347/bmj.f5780/rr/664916
I’m happy that there is to be a clinical study using eGo batteries, although they arent variable voltage. We still need to push for a clinical trial on VV eGo batteries (or even mods like an eVic). Then e-cig opponents wont have a leg to stand on :
eGo battery clinical trial : http://clinicaltrials.gov/ct2/show/NCT01925781?term=electronic+cigarette&rank=15
Y’know this is just an opinion (although I’m sort of basing it on accepted saturation levels for e-cigs) but don’t vapers now outnumber the ANTZ folks and any other opposition group.
I think what I’m trying to say here is that pushing by these folks will always resolve to organisation by vapers and given the numbers of vapers and the fear of large groups by politicians…well…we win.
“I simply called for them to be regulated just like other nicotine delivery devices and for advertising to be banned.”
So, in the interests of public health you, as a self-appointed guardian, propose that a product that has already potentially saved millions of lives, including my own, should be regulated like other NRTs but that it should not be allowed to advertise when other NRTs are allowed to advertise. That statement alone is enough to convey the impression that you are merely spouting dogma without having a real understanding of smoking or vaping.
Fortunately common sense has prevailed and your proposals for ecigs have been binned, rightly so. Your proposals would have made it easier to buy tobacco cigarettes than the safer option (accepted by the medical profession)
of electronic cigarettes, how would that be safeguarding public health and protecting our children?
It isn’t your proposed regulations, or ineffective campaigns by the NHS with a leaflet and a plastic toy to play with that effects change, it is us, the people of the European Community who have changed perceptions over the past five years to prove that vaping electronic cigarettes is saving, and will continue to save, millions of lives.
Vaping is not smoking, when you can get that through to your grey matter you might start to understand what vaping and smoking are about.
You might think you know what smoking is, but you certainly don’t know what it’s like, and that is why we (the people) will succeed where you and the Labour Party and the NHS and the MHRA and ASH and the WHO have all failed us dismally.
One lone voice on a blog with not even a ‘first like’ is trying to tell millions of vapers who have successfully made the transition away from deathsticks that he knows best; maybe we should take a vote on it? Ah! the EU just did and came out in favour of common sense and public health.
Ecigs are steadily consigning tobacco to the history books, something that neither you nor any of the ‘official’ bodies have been able to do effectively. In the past five years I have helped thousands of smokers to make the change to ecigs and have lost count long ago of the number of messages of thanks I have received. What have you done today to make you feel proud?
My Dad used to say “If you want owt doin proper, do it thiself!”,
we are doing it ourselves and we are making a damn good job of it!!
Dear Sir as my professor used to tell me don’t just read from the first source, after reading your article it appears you have broken the cardinal rule. I would advise you to read some of your more learned on this matter before trying to ‘jump’ on the bandwagon .
There are many reasons for the passionate responses your BMJ OP received. I suspect that they are less likely to be the result of you “standing up for public health” than they are to have been a reaction to your ill informed petty authoritarianism and your attempts to spin the facts to suit your agenda. The Soviet analogies are entirely appropriate in that you, perhaps inadvertently, present yourself as a somewhat illiberal disingenuous man who is more interested in opposing industries that you don’t like than in anyone’s well being. This post does nothing to convince me that my interpretation of your motives is incorrect.
Catherine:
You and many other anti nicotine activists frequently cite these articles that study various (usually unrealistic) concentrations of nicotine’s effect in a totally unnatural environment of cell receptor studies. If you are a scientist you would know how many new compounds are found to have cellular and receptor effects that then go on to fail to work in the real world.
Increasingly it is being understood that smoking causes damage primarily through the products of combustion, secondarily through certain nitrosamines and other compounds, and that nicotine has little if any role. We know now from the epidemiology of the Swedish experience of snus that regular chronic and repeated clean nicotine consumption does not change life expectancy to any significant extent. We are coming to understand that particulate products of combustion of any type cause the same increase in mortality whether they come from tobacco or other burnt materials such as in urban pollution.
It could be argued that regular chronic and repeated consumption of soft drink is far more dangerous than consumption of nicotine. There is more evidence of alcohol as a tumorigenesis promoter than nicotine; oh, but that’s MY little pleasure, don’t you dare ban that, I bet you ANTZ will say. Oh and the epidemiology says that there is a J curve effect….oops; you can’t have it both ways, cite only cell studies for nicotine and only epidemiology for alcohol.
You’re banning urges are based on predjudice, about historic battles with Big Tobacco, and not hard science about the relative risk of various things we ingest.
You cannot be serious about anyone in public health not wanting to ban e-cigs, you’re hero Simon Chapman first got snus banned in Australia and more recently e-cigs. Who knows how many people have died because the option to switch was not available?
Any reason why you won’t publish my polite and restrained reply to Professor McKee? You can email me if you want.
It’s now live – we are a small charity, so moderating this blog is one of many roles.
Thanks Liz…!
As a vaper myself, and pro ecigs, I did not approve of the way that Martin Mckee was attacked. I respect that he is even considering the issue and it is short sighted of some vapers to think that they will change peoples minds by getting insulting and aggressive the way they did with Mr Mckee. That said I understand their frustration. It has been a battle to save ecigs, so defenses have been put up and aggression shown its ugly head. We are just folks.
As far as I am concerned, I welcome his questioning the subject and appreciate his consideration. It is better than being ignored isnt it?
I actually agree with Mr mckee about large tobacco companies that are setting up as ecig suppliers and I think he has a point when he says this might be detrimental. Most of us vapers know and love the ecig industry that first started up, the small companies that have helped us stop being slaves to buying packs of fags. But that is unlikely going to be the ecig industry of the future.
He is right that the majority of ecigs being advertised in towns and cities are those coming from big big players, the cigalikes that the old school vapers like to mock. It is a pity because the fact is that these ecigs are watered down versions of ecigs, that really do not work very effectively. The old school ecigs may not be pretty, but lets face it, they give a good throat hit, satisfy the cravings and stop you needing to smoke. We all know that most cigalikes dont do that.
Big tobacco could so easily kill the ecig industry themselves, by producing ineffective cigalikes, that will have people poo pooing ecigs and back on tobacco in no time.
I do not actually know how to combat that, it is like the old school ecig industry is threatened from every side, governmental, pharmaceutical and tobacco companies all closing in and waiting to take us down.
Best we dont make enemies of everyone who takes a look at what is going on.
My biggest gripe with med regs is the stifling of innovation. The industry right now is moving at a lightning pace, i’m not talking about the crappy cigalikes which you seem fixated about but the proper lightsaber mods, i’m on my 3rd in a year each one noticeably more advanced than the last. the cost and time of med regs would mean they would take years to get to the market, if ever. We’d be stuck with rubbish plastic pharma products which no-one would bother with.
I’m sure you’re through with stats and test results, we’re constantly 3 moves ahead of you on that, we move through the forums exchanging ideas, recipes, mod tips, product reviews on PVs and atomisers etc if an ecig is on sale in a supermarket its already way out of date. By the time any official public health data on quit rates or efficacy is done to your satisfaction with a product we’ll be 3 or 4 of generations down the line, so of course we’re going to yell out of frustration because its not based on stuff we’ll actually be using.
we’re generally not interested in Big Tobacco ecigs, they want to herd us into a few disposable products that give repeat sales at a high price, like cigarettes funnily enough. med regs would of given them this mandate. not surprised the cigalikes sell more, the cartridges are tiny and battery life is very poor so you need more of them, but in terms of usage no i don’t think they are more popular at all
I’ll second what people say here about the look-alikes or cig-alikes that people see advertised.
They have to advertise because unlike what long term users buy, they are useless.
By constraining themselves to look like cigarettes they are intentionally crippling their effectiveness.
They are overpriced pieces of junk.
Tiny batteries that are often one use and non-rechargeable, those batteries have an hour or two of charge in them.
Non-refillable cartridges that contain less than a few hours worth of liquid (not that it matters because the battery will die before the liquid runs out.)
Proper PVs or Mods or even the humble 2nd generation Ego style have decent sized batteries that are rechargeable and use a standardised attachment system to allow any of 100s of different tanks and atomisers to be attached according to preference.
That’s because the stuff that long term E-cig users buy and use has been refined over the past few years at an incredible pace.
A new revision comes out for each design about once a year as well as new designs every couple of months.
Each version is improved over the previous.
E-cigs are getting better and better by the month.
The junk that can be bought in any UK supermarket or garage is just a stepping stone to a better world, on most forums we consider look-alikes as an introduction to vaping and when the new users are disappointed with the effectiveness of their supermarket bought E-cig generally they come to the forums and ask for advice then they enter the real world of vaping and invariably they stay there.
Once you’ve found yourself a decent mod with good battery life and an atomiser you like along with the flavours that you love there’s very little chance of ever returning to the world of expensive, stinking, burning tobacco, morning coughs and early death.
Decent E-cigs are a gateway away from tobacco not towards because E-cigs are far superior to tobacco cigarettes.
Med regs would have thrown us all into this hell of no choice but to use ineffective, dull and useless products (exactly like current NRT) with no chance of escaping any time soon.
The reason NRT is ineffective at best is because Tobacco is better at providing an experience the users enjoy rather than a medicated hell.
I for one am so glad I avoided being dragged into that perpetual misery by the EU this week.
The future is bright and because I no longer smoke tobacco, hopefully my future is long and healthy.
What a lot of posturing Martin! Is there anything intrinsically wrong with people being in business for the purpose of making money? I suppose for a Marxist the answer would be yes. I’m glad that tobacco firms have seen that the future is e-cigs – so much so that they are investing wads of cash. Perhaps they have taken the trouble to examine the research, which, despite what you keep repeating, is abundant. If charities, foundations, whatever accept funding from certain companies then they are beholden to them and will dance to whatever tune the piper plays. Really sick of your astroturf references now – you are well aware of who has had the dedication to pursue this TPD and to force the amendment, despite the best efforts of those who would have stifled the e-cig in its cradle. For once, the people who really care have won. Live with it.
If a new product were launched today to treat HIV whose adverse effects were largely unresearched, whose cost-effectiveness was completely unknown and whose long term impact on smokers and quitting were also unknown- the need to regulate it as a medicine would be a no-brainer.
So what is different about a nicotine delivery vehicle-especially when nicotine is known to be addictive ? An argument for regulation is not an argument for a ban. Regulation of quality, delivery etc could be positive for smokers and protect them from false or dangerous claims.
But the MHRA have confirmed on a number of occasions a medical legislation is a complete ban on everything until a marketing authorisation is granted (no ecig has been granted one yet after 2 years of trying and a couple of million pounds spent.)
Forgive us if we have zero faith in the MHRA or medical regulation process.
Medical regulations are ridiculous considering ecigs aren’t medicine as proven in courts round Europe and by the EU at the plenary vote earlier this week, they would possibly be tolerated if it didn’t mean the utter destruction of the ecig industry and the end of ecigs.
We’ve seen what the MHRA would like as an ecig, BAT are applying for an MA for their voke ecig and it’s not something any self respecting smoker would ever want to seen using.
I wouldn’t use a medical ecig and I doubt many others would either.
Possibly that’s exactly what the MHRA want.
Why should we regulate as medication a product that is not treating anything? Will regulation make nicotine less addictive? And why are we talking about addiction from e-cigarettes when users are smokers (that means, already addicted)?
E-cigarettes are substitutes for a very bad habit. And they are by far less harmful, based on current knowledge (yes, it is not enough, but common sense should work when data are insufficient). Habits cannot be regulated. The pleasure and satisfaction users receive is what keeps them off cigarettes. It is unprecedented to have a medication with such properties. Moreover, such regulation would provide no information about safety. For example, to define safety you need to examine their use for at least 10 years. This is impossible to happen, unless they are available to the market and we do post-marketing monitoring of use.
Regulation is needed and is very easy to implement as long as there is will to do it. Certificates that pharma-grade ingredients are used, specific standards in manufacturing process (which can be done cost-effectively and without the need for medicinal regulation), specific regulation for advertising and marketing, specific labeling refering to ingredients and target group of users, realistic testing on liquid and vapor and, of course, a ban to sales in minors (especially to non-smokers). These are more than enough to ensure proper quality. Medicinal regulation will kill variability and innovation, which are the main reasons for the success of e-cigarettes as smoking substitutes.
“If a new product were launched today to treat HIV ”
but ecigs do not treat any medical condition, they are a smoking substitute not a treatment.
“Regulation of quality, delivery etc could be positive for smokers and protect them from false or dangerous claims.”
unfortunately the anti tobacco lobby are often the ones making false and dangerous claims about ecigs, not based on anything apart from fear and ignorance simply because they “look like smoking”, and they twist or ignore the research done to date to suit their anti smoking agenda which is being applied to vaping by default. This is where sense and logic need to prevail.
Sceptics are concerned, and that would be understandable if ecigs truly were similar to regular cigarettes. But honestly, if all the fear and panic was tempered, I think it would become apparent in a matter of years that ecigs are able to offer a massive harm reduction potential to smokers and the research to date supports that.
This is not smoking reinvented as some people fear. vaping is a similar, yet quite different practice to smoking
I second the comments already left in reply re ecigs not being medicines. Ecigs are no more medicines than energy drinks or vodka mixers are, both of them deliver a drug; caffeine and alcohol. Both come in candy and fruit flavours and both are recommended only to be consumed by adults.
I think this point is VERY important to make. Vapers are not against regulation! Vapers are against regulation driven by vested interest from pharma and tobacco companies. Vapers are also against regulation controlled by public health academics who do not understand how vaping works, what is in the liquids and how the equipment is made and why people do it. Vapers frequently express concerns about wanting various elements of the industry to be regulated (i.e. specific flavours which may contain diacetyl) but we never hear these concerns repeated by public health officials.
Public health officials who are concerned about this issue should engage with the vaping community in a friendly and inquiring fashion. The only reason the vaping community has been antagonistic to certain members of the public health industry is because this has not happened and certain members have tried to speak in an authoritative manner on this subject while being woefully uninformed, as the author of this article is.
[…] Prof Martin McKee of the London School of Hygiene and Tropical Medicine says tobacco firms have simply extended their advertising techniques to e-cigarettes. […]
Our page points out a few things we don’t like about e-cigs. Ppl are reading our message completely wrong and hating on us, that’s fine. Give us a visit, pro or con e-cigs we want to know your thoughts1
http://switchoffecigarettes.wordpress.com/
No people aren’t reading your message wrong and just “hatin on you”.
That page is an anti-cig page, it doesn’t take into account that the alternative to E-cigs is one of the biggest killers in the developed world, it just recycles cherry picked studies that aren’t balanced (yes ok we are all a little guilty of that) but the studies on that site have either been debunked as junk science or mis-represented/interpreted.
If that site actually balanced E-cigs fairly against their “nemesis” or alternative then suddenly you are comparing something that might have theoretical harm and some point in the future against something that kills millions every year worldwide.
If you were saying Life jackets should be banned on ships because they haven’t been tested for chafing I would say exactly the same thing.
Stop comparing E-cigs to Patches, Gums and other NRT (they have little in common) and start looking at the big picture.
When someone is using an E-cig they aren’t inhaling a toxic cloud of hot gasses from tobacco, they aren’t damaging others around them, they aren’t littering with cellophane wrappers, fag packets and old butts.
In fact they are minding their own business doing their “thing” and being persecuted as badly as smokers for it.
So it’s not “hating” it’s more likely people are sick and bloody tired of interfering people getting in their face all the time and telling them what to do for someone elses puritanical beliefs using argument buzzwords like renormalisation and gateway and the old classic… Think of the children!
If people just got on with their own lives and left others to do the same the world would be a much more peaceful place.
Now after that little rant of mine I still think the number one argument that all the antis keep missing/ignoring all the time is.
Compare E-cigs with tobacco smoking then come back when you actually have a basis to argue from.
[…] You might find this helpful …. comments are particularly insightful ……………… So what should we make of e-cigarettes? | Better Health For All […]
I haven’t read through all 80 preceding comments, but I appreciated Professor McKee’s comprehensive explanation of his view point, as always. Just wanted to point out one small possible error, however.
Martin says: “the latest evidence from a New Zealand randomised controlled trial showed that they were no more effective than patches”, but is is reported in the paper that the study “had insufficient statistical power to conclude superiority of nicotine e-cigarettes to patches”.
Hence, while I think it would be right to say that the study didn’t show that e-cigarettes were more effective than patches, I think it is wrong to say that the study showed that e-cigarettes were not more effective than patches (that is, absence of evidence of superiority isn’t evidence of absence of superiority).