Electronic Cigarette Consumer Association UK

Tobacco Harm Reduction in the UK - Part 2

The Snus scandal

The first example of these highly effective consumer products, proven to be far more effective than pharmaceuticals, is called Snus. It is a Swedish smokeless tobacco product that has been popular there for more than 25 years. It is made by a special manufacturing process that removes virtually all of the carcinogens [1]. Tobacco is processed in this way, then packaged in small pouches that resemble micro teabags, which are placed in the mouth between the upper lip and gum. It is nothing like the old chewing tobacco as it is in a pouch. There is no spitting since hardly any extra saliva is generated.

A Snus pouch is used instead of a cigarette. It is termed 'smokeless tobacco' - a much safer way of obtaining nicotine and/or other tobacco ingredients because it has no smoke. The diseases caused by cigarettes are caused by the smoke.

And a Snus user has the same risk of oral cancer as a non-smoker. We now have two and a half decades of research on Snus that prove they are far less hazardous than cigarettes [2,3,4,5]. The smoking-related mortality rate for Swedish males was reduced by 40%.

A Snus user has:
-- A risk that is not statistically significant
-- The same risk as a non-smoker - that is, the same as an ex-smoker who has totally quit [6]
-- A risk of 0.3 on the scale 0.001 to 100, where a smoker has a risk of 100

As a result, Sweden has the lowest rate of smoking death in the developed world and the lowest rate of male cancer deaths in Europe, due to Snus usage by men there. The female rates are about the same, as Snus is not popular with Swedish women, who prefer to smoke [7]. We now know that Snus is proven the most successful way to reduce smoking deaths [8], is virtually harmless, is acceptable to smokers, and is probably the most successful harm reduction product in terms of the proven saving of life that has ever been used for any purpose. In addition, because the figures apply to men but not women, and because Snus are primarily used by men not women, we also know that the dramatic lowering of disease and death rates is due entirely to Snus and no other factor.

Unfortunately, Snus is banned throughout most of Europe.

Why? The sales of quit-smoking pharmaceuticals are particularly poor in Sweden, since people are sensible enough to use something that works. The pharma industry has exerted a huge amount of pressure to ensure that sales do not suffer elsewhere. Sweden quite rightly refuses to ban Snus because nobody can show they cause harm. After all, two and a half decades of research show that they are safe, and that they save large numbers of lives - which, clearly, pharmaceutical NRTs don't.

If Snus were widely available, we can see that the smoking death rate would be substantially reduced, because that is the experience in Sweden. They reduced their smoking-related death rate by 40%. Unfortunately, the pharma industry has a great deal of money available to make officials see things their way.

EU corruption?
Whether it is corruption or just incompetence within the EU administration, their attitude is one of the most worrying factors, because of the potential to negatively influence the administrations in EU countries.

There are about 650,000 deaths from tobacco-related disease in Europe each year according to the EU [9], and if Snus were to be widely promoted that figure would drop by up to 40%. That is the result in Sweden and there is no reason to assume it would be substantially different elsewhere. Instead, various lies about Snus are circulated [10,11], countries are advised to ban them, and the smoking death rate continues unabated.

With this demonstrable lack of any real interest in reducing the death rate, and hundreds of thousands of needless deaths being ignored, the prospects do not look good for e-cigarettes. If electronic cigarettes and Snus were strongly promoted in Europe instead of pharma products, the smoking death rate would reduce dramatically.

So we can clearly see that reducing the death rate has little real importance to the EU administration, it is all hollow words masking the true goal: keep that pharma money coming in.

Electronic cigarettes

Now we come to e-cigarettes. A fairly recent invention, they have only been used in the UK since early 2006. From a thousand or so users in 2007, growth has taken place at 500% per year plus, and now around 300,000 people use an e-cig. At Q2 2011 we think that about 3% of UK smokers have converted to an e-cigarette.

Why this explosive growth? Simple: the e-cigarette is the most acceptable harm reduction product that has ever been invented. Consumers love it [12]. It supplies the nicotine they need in their daily lives without any smoke or other toxins. It is smoking without the poisons, and it is expected that the potential for harm will be on a par with that of Snus. And when compared to Snus, smokers far prefer the e-cig, because it feels as if they are still smoking.

By 2013 it is expected that over 1 million smokers in the UK will have switched to an e-cigarette [13], which is more than 6% of smokers. At this rate, sooner or later 25% of smokers will switch to this better alternative. Anecdotal reports suggest that about 75% of smokers who are mentored in their conversion to e-cigarette use will succeed.

The effect on the pharma industry

Naturally, the pharma industry is extremely worried - they anticipate the collapse of quit-smoking drug sales. These drugs are a billion-dollar global market that will be substantially reduced if e-cigarettes and Snus are allowed.

Cynics have also suggested that since the chemotherapy and other drugs used to treat patients with smoking-related diseases are also a billion-dollar a year buiness, and since this is at risk of a 50% reduction if people don't get ill in the same numbers, this should also be factored into the equation.

The fact is that the pharmaceutical industry will be hurt very, very badly by full availability of either Snus or electronic cigarettes. People won't need their quit-smoking drugs, and they won't get ill so they won't need treatment drugs. The prospect of both Snus and e-cigarettes being widely available must be terrifying for pharma.

They have allocated millions of dollars to stopping e-cigarettes. They have bought government officials, they have suborned government departments, they have paid for propaganda and misinformation campaigns, they have 'heavily influenced' EU officials, and they have 'heavily influenced' the W.H.O. smoking health department - which is now known for its junk science approach, as a consequence. In fact because of the ridiculous misinformation promulgated by the WHO in this area, the entire reputation of the WHO has suffered and they have become a joke in the eyes of some medical professionals.

The pharmaceutical industry has considerable influence over the Department of Health. It is even said that the MHRA, the agency within the DoH responsible for medical licensing, acts more to protect the industry than it does to protect the public [15]. Pharma money has a huge amount of influence at the DoH and it is probably time to examine whether that influence has stepped over the line that separates benign influence from corruption: the MHRA are doing everything thing in their power to stop e-cigarettes being freely available and unrestricted in the UK. This will inevitably result in widespread loss of life since 99.9% of products will be removed from the market, and only pharma products will be legally available for smokers who want to stop or switch.

Any reasonable person would assume that if there is a choice between e-cigarettes (with no harm caused after millions of user-years, and no evidence whatsoever that any harm may be caused) and quit-smoking drugs like Chantix / varenicline (hundreds killed and tens of thousands of lives ruined in the same timescale that e-cigarettes have been available [14,14a]), that government health departments would automatically go for the consumer harm reduction options as a priority. After all, the result would be a proven 40% reduction in the death rate as a minimum, and massive savings on drug and treatment costs. But nothing could be further than the truth: those same health departments are doing their best to eliminate e-cigarettes.

One wonders why - it certainly has nothing to do with public health or reducing costs, as it is immediately obvious to anybody where substantial improvements could be made.

Attempts to ban e-cigarettes
In 2010 the MHRA attempted to ban e-cigarettes in the UK by forcing them to become licensed pharmaceuticals. This would have meant that 99.9% of products would have been removed from the market, and anything remaining would have had to have its price raised dramatically to pay for the licensing costs [16].

This attempt to enforce new and completely unjustified and unnecessary draconian regulations on a harmless consumer product was blocked by the RPC, a more senior government advisory group that has the power to prevent unnecessary or impractical new regulations. Since the proposed regulations were neither needed nor realistic this is not surprising, although it has to be said that there was a large element of luck involved in this, since if the proposals had been brought in under the previous government they would have succeeded. 

Further government regulation has been shown to be unnecessary at present - e-cigarettes are well-regulated already by Trading Standards authorities [20]. No evidence of any possible harm caused is available, and there is a mountain of medical experts who will testify that in fact this is the opposite of the case; and the costs (both financial and human) involved with extra regulation are indefensible.

The MHRA have stated their intention to go to court (scheduled for Q1 2013) and attempt to show through a legal action that e-cigarettes should be licensed as pharmaceuticals. They are obviously dedicated to shutting electronic cigarettes down and will take any steps they can to accomplish this, even when they have been told by government not to do so.

We need to ask why consumer products that will save thousands of lives should be prevented from being sold. Simple: there is no answer.

The only possible beneficiary is the pharma industry, who hope to have their commercial competitors removed by an extremely sympathetic government agency. The cost will be paid in human life: fabulously effective, popular, life-saving reduced-harm tobacco products removed to make way for all but useless, expensive drug company products that are widely promoted and sold but proven no use to anyone except a minuscule number of patients. Presumably there must be substantial benefits of some kind for someone.

At what point can we suggest that a government agency that is supposed to protect the public from an industry has in fact been suborned by that industry? At what point does an attempt by a government authority to promote the products of one industry over another and eliminate their competitors, resulting in increased loss of life as those products don't work very well, become a criminal act?

Procurement corruption
It is widely recognised that the most likely department of any business or government to be affected by corruption is the procurement division. This is because corporations who wish to sell their products to the firm or government will try to exert pressure in one way or another. Such pressure can include financial inducements to individual staff, or promises of other benefits such as jobs within the industry later, or even jobs such as board positions that are paid but require little or no work. These tactics are standard within many industries and many countries. The implications for government purchases or regulatory processes are grave, since independent decisions cannot be made under these circumstances.

Although certain countries are well-known for this type of dealing and no business can be transacted there without 'additional arrangements' being made, in fact no country is immune from it - certain departments of government in many countries must comply with additional rules of procedure because of the likelihood (or certainty) that their processes would otherwise be corrupted. For example, due to the very large sums of money involved, the armaments procurement departments of some governments have to comply with such extra rules - among which are that no staff may transfer between the government department and the industry, thus preventing the type of pressure that includes job offers.

We have recently seen very clearly in the UK phone hacking scandal how a revolving door staff policy between certain press organisations, police staff and senior political staff has resulted in corruption at the highest level, with serious crimes being overlooked due to the involvement of parties working for all three sides being closely connected.

Staff transfer between organisations who in effect are opposing parties, with one side working for the interests of the country and the other working to increase profit, leads directly to corruption. There is no argument about this and the effects are both obvious and devastating. It is one of the features of the form of intra-government corruption known as 'Regulatory Capture', whereby a government agency set up to regulate an industry eventually becomes owned by that industry. Regulatory capture is clearly a factor in UK health regulatory processes because there is so much obvious bias toward the interests of the pharmaceutical industry and against the interests of public health.

The revolving door staff policy between certain elements within the Department of Health and the pharmaceutical industry needs to be stopped. We are not talking simply about monetary gain by individuals here, but thousands of deaths that may be caused as a result. The pharmaceutical industry has just as much money as the armaments industry, perhaps more, and the same rules and procedures that are applied to relationships with the arms industry need to be applied to the pharma industry. Because of its veneer of respectability, it seems that nobody has looked at how corruption may potentially cost even more lives than the arms industry's products are responsible for the loss of. And the lives lost will be here in the UK, not in some remote foreign location.

THe EU ban on Snus, which is enthusiastically enforced in the UK, kills between 10,000 and 40,000 UK citizens a year (10% to 40% of smoking-related deaths) by denying them access to safer tobacco products. A similar ban on e-cigarettes will eventually kill even more. Even the arms industry would be jealous of figures like this - especially when achieved perfectly legally, and with hardly a whisper of complaint.

The Tobacco Control movement

One of the most worrying factors regarding the free availability of e-cigarettes is the powerful Tobacco Control movement and how it will naturally act to protect its interests.

For example, see this PDF of the 12th SRNT meeting at Bath, UK, in September 2010 [17]. The contents of this brochure clearly indicate that Tobacco Control itself is now a large industry, and we can well imagine that there are thousands of academics employed all over the world in this field.

Now imagine a scenario where the demand for their services is reduced by 90%. This would be the practical result of the widespread uptake of freely available and well-promoted alternative tobacco products such as e-cigarettes and Snus. If the death rate dropped to half its current level (as indicated by the Swedish experience) and continued to drop like a stone, where would that leave the Tobacco Control movement? Answer: unemployed.

This explains why part of the resistance to safer tobacco products comes from the Tobacco Control movement. Reducing the death rate is unfortunately not the only item on their agenda - they need their jobs, like anybody else. Taking a course of action that ultimately leaves you unemployed is a severe test of moral fibre for anyone, and it seems as if these academics fail the test just as surely as anyone else would.

You can't blame them, because if saving lives causes them to lose their jobs, they will fight to keep their jobs just the same as everybody else. Of course, it involves a large measure of self-delusion, but that is a natural defence mechanism. It's just another brick in the wall built around e-cigarettes. With luck, they hope, e-cigs will be ignored and it will be back to business as usual.

It worked with Snus, after all.

The plain fact is that the tobacco control movement is one of the most important factors keeping the smoking death rate up.

Tobacco Harm Reduction

One proven successful way to save smokers' lives is the successful tobacco harm reduction process validated by the 25 years of data from Sweden. Quitting with pharmaceuticals nearly always fails. Quitting unassisted fails except in unusual circumstances. Only Snus is proven by multiple research projects carried out over decades to actually save a realistic number of lives.

The phenomenal growth rate in e-cigarette use shows they will probably work even better, assuming they are safer than cigarettes. So, how safe are they? Let's look at the ingredients:

1) The carrier liquid is propylene glycol, BP. This is widely used for disco fog machines and asthma inhalers, and also in lung transplant patients' nebulisers. There is 70 years of research on it that proves it is absolutely safe (not just acceptably safe or GRAS). It can be injected in large quantities with zero effect as it is essentially inert in the human body.

2) A small amount of glycerine, BP is often used as it creates even more vapour than PG and reduces the drying-out effect PG has on the throat. Vegetable glycerine has been inhaled in one form or another without harm.

The two above materials are both used in disco fog machines and theatrical mist devices. Due to very strict employee health regulations, these materials are known to be safe and are licensed as such for long-term high-volume inhalation by employees in the entertainment industry. These regulations cannot be subverted, unlike other regulatory processes in the UK, so we know that these materials are safe for high-volume long-term inhalation.

3) Pure nicotine. This is not only considered harmless in low consumer doses, in fact it is increasingly seen as a beneficial material [18]. Smoking-associated diseases are not caused by the nicotine, they are caused by the smoke. Nicotine is harmless in small amounts because it is part of the natural diet. In larger amounts it is not likely to be harmful unless you are a foetus or have pre-existing heart disease.

4) Distilled water. Not normally considered harmful.

5) Food flavourings. Most are obviously harmless, although some will be found unacceptable for inhalation. More research is needed on this topic. However, we should consider whether food flavourings are likely to kill thousands of people - this does not seem credible.

And that completes the list. Compare this to the 5,300 chemicals found in cigarette smoke in the latest research, and which apparently is not a complete list.

You should carefully note that we know a great deal more about what is in e-cigarettes than we do about tobacco cigarettes. Any medical professional who states otherwise is an outright liar.

There are over 50 research trials on e-cigarettes, their ingredients, and their effects - any medical professional would know how to find all this information in the literature. A very long list of professors of medicine, expert doctors and physician's associations has endorsed e-cigarettes - and any medical professional who goes against the overwhelming evidence from and opinions of senior colleagues is unwise; and a liar if they claim this body of evidence does not exist.

It is also worth noting that electronic cigarettes do not need to be safe in order to save lives - they just need to be safer than cigarettes. Since all the medical experts who have examined the evidence say they are likely to have less than 1% of the risk (and some say thousands of times less risky), we can assume the right criteria are met.

Of course, this does not mean that they will ever be rightfully accepted for what they are, and rightfully promoted as a much safer alternative to cigarettes - just look at Snus. Proven safe, proven to save a phenomenal number of lives, proven vastly more effective than pharmaceuticals, and with two and a half decades of research to prove those facts - Snus are still banned.

This shows that the saving of life is seemingly of little importance. The maintenance of pharma income appears to be the #1 item on the agenda, with the maintenance of jobs in related areas apparently coming in at #2, Europe-wide, no matter the cost in human life.

E-cigarette research

The medical experts who have carried out all the extensive research trials on e-cigarettes say they are less than 1% as harmful as cigarettes - as seems obvious when looking at the materials list above. There are numerous professors and heads of public health schools in hospitals, plus doctors' organisations such as the AAPHP and public health groups such as ACSH, who have endorsed electronic cigarettes.

The only thing lacking is time-proven data that shows the factual nature of the reduced harm claims. Of course, even when eventually there are twenty five years of research that prove e-cigarettes are essentially harmless, that does not mean the lies and misinformation will stop - just look at Snus. Proven harmless, proven orders of magnitude more effective than pharmaceuticals, the lies and bans still remain.

Ask yourself why.

And please also ask yourself if the obviously incompetent and possibly corrupt should be in charge of this area of health provision in the UK, as they so clearly are.

Current practice vs a better approach

The Pharma Approach
The success rate for medically-managed smoking cessation in the UK is less than 10%, whatever the methodology used, when measured at a suitable time interval later (20 months). In some cases it will be only 2%. Placebos are almost as successful.

90% to 98% of patients will fail to quit, and will return to smoking.

Some people will try multiple times to quit, and will fail repeatedly. They go into a quit - fail - smoke - quit - fail - smoke cycle that may occur several times before they give up trying. Some smokers are reported to do this ten times or more, they are so desperate to quit but unable to do so.

If a pharma-based approach is used, up to 98% of the subjects will fail and therefore risk death. According to some sources, who say that one in two smokers will die as a result of smoking, this means that 49% of people who try to quit using pharma products may die. That is, 49 out of every 100 who try to quit smoking using official methods or programs may die.

The Harm Reduction approach
Reports suggest that 75% of smokers who attempt to switch to an e-cigarette are successful, when mentored carefully. This figure may drop to around 30% when unmentored.

If a dual-product approach is used, based on e-cigarettes and Snus, and with organised mentoring, it has been suggested that the success rate will exceed 80%. This is because some need other ingredients in the tobacco, which we call WTAs or whole tobacco alkaloids. It is not the case that people are only dependent on nicotine.

We believe that if an e-cigarette and Snus-based consumer harm reduction choice is made, and correct mentoring is given, about 80% of subjects might succeed, and at least 99% of that 80% will survive.

Comparison of the two approaches
If smokers use pharma products to try and quit, up to 49 in 100 will die as a result of returning to smoking (half of the 98 who may return to smoking). It doesn't matter what methods or programmes are used, the death rate cannot be less than 45 per hundred if we assume a worst-case scenario in which half of smokers die early. Note: this figure ignores those killed by Chantix.

If smokers choose a safer alternative tobacco product to switch to, and are fully mentored, up to 10 in 100 may die as a result of returning to smoking (half of the 20 who may return to smoking). Of course, this is a best-case figure that assumes the subjects are properly mentored and there is freely-available access to the best products for the individual concerned.

If anybody actually wanted to save lives, they would obviously promote the consumer choice route of Harm Reduction instead of the medical process, since it will clearly save many more lives. It is true we have compared a worst-case with a best-case scenario, but we offer no apologies for this - it is done to clarify the issue. As far as we can see, there is no possible way that use of alternative tobacco products could have the same high failure rate and therefore the same death rate as the use of pharmaceuticals. The proof is clearly shown by the Swedish experience.

Up to five times more people will die as a result of the current Department of Health policies compared with a properly-organised mentored and supported program based on inexpensive, easily-available consumer products instead of pharmaceuticals. And this is just within official programmes - if e-cigarettes were promoted strongly to the wider public, the smoking death rate would fall through the floor. The result would be even more lives saved than is the case in Sweden, which has the lowest smoking-related death rate in the developed world. The UK would have a tiny fraction of its current smoking-related death rate and be the most advanced country in the world for stopping preventable diseases.

Also, of course, costs would drop to less than 50% of the current level for the NHS quit smoking service, for two reasons:
1. The cost of consumer products is less than half the cost of the pharmaceuticals currently used.
2. Since we are talking about consumer products, which would become widely available and popular, widescale unmanaged purchase would contribute to a further drop in the death rate (as is the case in Sweden).

Corruption - or just incompetence?

It is up to you whether you wish to view the current situation as incompetence, or corruption, or a combination of the two. Whichever it may be, it is obvious to all that the Department of Health has some serious problems within its ranks.

Mitigating factors
We should consider this, in order to present a balanced view. The question of time and its various influences is always paramount in issues involving medical practice, because treatments change over time, and because the medical establishment takes time to embrace new and better methods.

It is probably true to say that there was not sufficient data five or six years ago to establish beyond doubt that the use of Snus was the best and the only practical choice for reducing smoking-related mortality. To ignore that data now would in effect be a criminal act, since we know Snus use to be as safe as quitting, and since preventing the sale and use of Snus will directly lead to loss of life.

It is also true that two years ago we did not have sufficient research and expert medical opinion on the safety of e-cigarettes, and the evidence of their tremendous popularity was not appreciated, so that it would not have been possible to reliably state that e-cigarettes appear to represent the best-ever route to reduce smoking mortality. To ignore these facts now would indicate stupidity.

To ignore or denigrate these two groups of facts now, especially taken together, indicates more than just stupidity. It indicates a knowing refusal to take the best, most efficient, safest, quickest and cheapest action to reduce smoking mortality. It indicates a willingness to allow many people to die without access to the best products to avoid harm to health. It indicates a decision to ignore the advice of experts and choose to allow people to die while preventing them either from knowing about the existence of safer products or having free access to them.

Why this situation exists is not known, but money and jobs seem like good places to start looking. 

As usual - just follow the money.

Many thanks are offered to those who have suggested edits, changes and additional references for this article, which will continue to be edited as further improvements are suggested.

Notes

[1] Snus contains the same amount of carcinogens as NRT nicotine skin patches and e-cigarettes: a minuscule amount, which is locked in to the nicotine and cannot be removed except possibly by expensive further processing - which is unnecessary, since we have two and a half decades of research that show Snus users don't get any form of cancer more often than non-smokers; and because skin patches are licensed as safe. E-cigarettes therefore have the same cancer risk, i.e. essentially none, which is why Dr Laugesen said, "It is impossible for e-cigarettes to cause lung cancer".

[2] Systematic review of the relation between smokeless tobacco and cancer in Europe and North America
http://www.biomedcentral.com/1741-7015/7/36

A meta-analysis of 61 reports that shows Snus are much safer than smoking.

[3] Summary of the epidemiological evidence relating Snus to health
http://www.ncbi.nlm.nih.gov/pubmed/21163315

[4] Effect of smokeless tobacco (Snus) on smoking and public health in Sweden
http://tobaccocontrol.bmj.com/content/12/4/349.full

"Sweden’s oral cancer rate has fallen during the last 20 years as Snus use sharply increased."
Conclusions: Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.

[5] Oral use of Swedish Snus and risk for cancer of the mouth, lung, and pancreas
http://www.ncbi.nlm.nih.gov/pubmed/17498797

[6] Assessment of Swedish Snus for tobacco harm reduction: an epidemiological modelling study
http://www.ncbi.nlm.nih.gov/pubmed/17498798

Snus users in Sweden have the same risk as non-smokers. That is to say, the same risk as smokers who have totally quit, but not as low as never-smokers.

[7] Should the European Union lift the ban on Snus?
http://www.ncbi.nlm.nih.gov/pubmed/12930202

"Sweden was the only country in Europe to reach the World Health Organization's goal of less than 20% daily smoking prevalence among adults by year 2000."
"19% per cent of adult men and 1% of women are daily Snus users and the trend is increasing [2003]."

[8] Role of Snus in initiation and cessation of tobacco smoking in Sweden
http://tobaccocontrol.bmj.com/content/15/3/210.abstract

Snus is shown to work better than NRTs for quitting*. Snus users are less likely to become smokers than non-Snus users.
Conclusion: Use of Snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking.
* Assuming that we equate 'quitting' with 'getting off smoking one way or another'. In terms of the number of lives saved, quitting is essentially the same as changing to a proven safer harm reduction alternative such as Snus. The stats apparently tell us that if either 100 people quit or changed to Snus, the resulting lives saved would be the same; but if 10,000 people were involved then a (small) difference would probably be seen.

[9] http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/Documents/tobacco_fr_en.pdf

[10] You might as well smoke: the misleading and harmful public message about smokeless tobacco
http://www.biomedcentral.com/1471-2458/5/31

".....consumers and policy makers have little chance of learning that ST is much less dangerous than smoking....."

[11] Some practical points on harm reduction
http://tobaccocontrol.bmj.com/content/12/4/372.full?sid=e5226a5e-ec70-40e5-bdf7-044cb7af3e75

"The evidence from Sweden is persuasive that a certain type of smokeless tobacco is much safer than cigarettes for individuals and probably safer for society."
"Note that a dramatic increase in Snus use in Sweden did not lead to increased smoking*. The major “gateway” to adult cigarette smoking is a cigarette itself."
* It did of course reduce it, which is why Sweden has the lowest rate of smoking in Europe.

[12] A commentary on the choice of quitting with pharmaceuticals or instead using a reduced-risk alternative, from the perspective of an average person. Assuming that e-cigarette use entails reduced risk, this is a compelling argument.
http://www.youtube.com/watch?v=dFQm2G4mz3w

[13] E-cigarette use has grown by about 500% per year in the UK from 2006 - 2011, and at a much higher rate than this in the US [ http://www.eccauk.org/index.php/uk-sitrep.html ]. Snus uptake has never been shown to rival this growth rate.

[14] Chantix issues:
http://whyquit.com/pr/061411.html

[14a] Chantix and heart attacks
http://tobaccoanalysis.blogspot.com/2011/07/meta-analysis-chantix-causes-one-heart.html

It is estimated that 62,500 heart attacks were caused by Chantix (Champix) in the US in 2010, or 1 for every 30 patients, or 1 for every 3 patients who were assisted in quitting smoking for a time. However there were considerably less suicides or murders caused by it, which is good news.

[15] MHRA issues
http://scientific-misconduct.blogspot.com/2006/07/mhra-why-is-government-not-acting.html

There are a number of accusations of incompetence and corruption at the MHRA, and although the volume does not equal that available for the FDA, the same basic questions seem to be being asked.

[16] It is impossible to find any agreement on the cost of licensing a pharmaceutical product in the UK but it appears that the minimum would be several hundred thousand pounds. For example, the cost of licensing the herbal medicines recently forced to become pharmaceuticals was £750,000 each and took four years, according to a company that has obtained some licenses. The actual licence fee is £28,000 for the MA (Market Authorisation) but the costs of research, documentation and legal fees, over the several years that the process takes, comes to a great deal more, even for the simplest product with pre-existing research or history.

If it takes four years and costs £0.75m for a herbal product known to have been used safely for thirty years, and it has already taken more than two years for the only UK e-cigarette firm to have applied for a license, with no result as yet, we can well imagine that costs are not insignificant. Of course, in the event that product licensing is required, a product cannot be sold until it has a license (it is not permitted to continue to sell the product until it receives or is refused a license). This means that, in the case of electronic cigarettes, virtually all vendors will go out of business, and is why medical licensing is effectively a ban.

[17] Brochure of a tobacco control convention in Bath, UK.
https://secure2.symphonyem.co.uk/CMS/UserDocuments/899/Cathy%20Book1-121%20.pdf

[18] The positive effects that smoking has for some conditions is probably due to nicotine:

Effects of nicotinic stimulation on cognitive performance
http://www.ncbi.nlm.nih.gov/pubmed/15018837

http://en.wikipedia.org/wiki/Health_benefits_of_smoking

http://www.forces.org/evidence/evid/therap.htm

http://health.howstuffworks.com/wellness/drugs-alcohol/nicotine-health-benefits1.htm

[19] There are several hundred e-cigarette models now, and thousands of refill liquid formulations (one retailer alone offers 7,000 possible combinations of base material, nicotine strength and flavourings). If one or two models of e-cig achieve a license, along with one or two refill fomulas, that means that the other many thousands of products are banned. The reason that e-cigs work is that a huge range of products are available to fit all user profiles. Only 8% of experienced users still employ a 1st-generation device - unsurprising when we are now using 4th-generation products that outperform the crude cigarette-clone devices by many times.

We know full well that the models that will achieve a license will not be the most effective or efficient - they will be the small cigarette clone, first-generation models that experienced users avoid, and the refills will be limited to one or two flavours since all variations will need a separate license. We also now know that the current time and cost for achieving a license is around three years and £750,000 per product.

It is therefore obvious that pharmaceutical licensing would mean that almost all of the currently-available thousands of products would need to be removed from the market; that only the least-efficient products would remain; that free availability of a wide range of products to suit all user profiles would cease; that almost all vendors would shut down or move offshore; and that a huge black market would ensue.

Pharma licensing is equivalent to a ban and would be a disaster. In any case it is not relevant to a consumer product since it is the equivalent of licensing coffee percolators and ground coffee. In fact if the MHRA succeed in licensing e-cigarettes, there is no legal reason why they could not then licence coffee percolators and coffee, or cocktail shakers and brandy, or briar pipes and tobacco - all are devices designed to "supply a drug with a significant pharmacological effect", in their definition of the legitimacy of such an approach.

[20] It is widely believed, and often stated in the official propaganda, that e-cigarettes are unregulated. Nothing could be further from the truth: Trading Standards officials visit, inspect, take away and analyse products sold by vendors just as they do for any other product type - and possibly more zealously. This applies to both high street shops and internet vendors based in the UK. The trade association ECITA works closely with Trading Standards to ensure a high degree of compliance with all regulations (see www.ecita.org.uk).