November 13, 2013

Titans of the ECigarette Debate Clash: ECigarette Summit Review

by: James Dunworth
Speakers at the ECigarette Summit.
Speakers at the ECigarette Summit.

The e-cigarette summit was a huge success yesterday – congratulations to e-cigarette-forum for organising the summit. I was blown away by the success of it!

I’ve put together this summary for people who are interested but couldn’t attend. In particular, I think it’s important for e-cigarette advocates to understand the debate where it stands. Obviously, you can’t cover everything in a single post, so I’ve focussed on the e-cigarette debate as it stands today rather than the science discussed.

Hope for the Future

In private conversations with activists (some from as far away as Canada and the US) there was a lot of hope for the future. David Sweanor, who we interviewed before here, is hopeful of good policy being  made here, policy which could influence what happens in the US and Canada, while a UK activist talked of progress being made with UK MPs.

The Main Debate

There was agreement on both sides that electronic cigarettes are almost certainly vastly better than tobacco cigarettes. The differences arise on whether e-cigarettes should be regulated as a medicine or not.

As was pointed out in the conference, this is an important debate, because the  Medicines and Healthcare products Regulatory Agency (MHRA) has said that not one current device would be legal under medicinal regulation.

This means that 1.3 million users of electronic cigarettes would have to give up their electronic cigarettes when medicinal regulation comes in. We do not yet know what the alternative will be, but it’s likely to be mass manufactured cigarette lookalikes produced by the major tobacco companies. 

The Pro-Medicinal Regulation Argument

1. Effectiveness of ECigarettes

Deborah Arnott from Action on Smoking and Health (ASH), argued that e-cigarettes are good, but not yet good enough. Although 1.3 million have successfully switched to e-cigarettes, 2.4 million have tried e-cigarettes but not yet switched.

(Clive Bates, former director of ASH, who we interviewed here) replied that 1.2 million was an incredible success, especially when compared to NRT, and that success does not have to be 100% – different solutions suit different people. Continued innovation, he believes, would lead to more success in the future.)

Deborah and Jeremy Mean from the MHRA both argued that regulation was the answer to this, and Jeremy Mean believed regulation would lead to greater innovation. (Strange for the representative of a Conservative party to favour regulation over competition!)

2. E-Cigarettes not safe enough. 

Although e-cigarettes are almost certainly safer than tobacco cigarettes, regulation would ensure e-cigarettes were even safer. Deborah pointed that if there are problems with e-cigarettes, we won’t about know about them for 15 years or more.

3. Regulation will convince users of their safety. 

More important, Deboarh argued, is that many users are not convinced that e-cigarettes were better than tobacco cigarettes, with many mistakenly blaming nicotine for the cause of smoking diseases. Regulation would reassure users that e-cigarettes were safe.

Linda Bauld agreed, pointing out that many smokers mistakenly blame nicotine for smoking related diseases.

4. Could then be recommended under National Institute for Health and Care Excellence (NICE) guidelines. 

Currently NICE guidelines can only recommend smoking alternatives that have been licensed, although informally the advice is that if you have switched to ecigs, you should continue using them instead of going back to cigarettes.

5. Can’t trust companies

Deborah argued that companies are profit making machines, with no motive other than to maximise profits. Therefore, the responsibility for safety and efficacy should be handed to the MHRA.

6. Consolidation will happen anyway

Mr Mean and Deborah Arnott appeared to accept smaller companies will be wiped out, but argued that consolidation would take place even if there wasn’t regulation.

7. Need to limit ecigarettes to existing smokers

Deborah was also worried about the potential of e-cigarettes to renormalise smoking (although she did point out that their current research shows that this is not yet a problem) and to act as a gateway to smoking.

In response, it was pointed out (I think by Daz from Vapor Trails among others) that you are not going to stop children/people from using drugs like nicotine, and if they do it is better for them to use e-cigarettes than smoking. One speaker even argued that we should not have age restrictions on e-cigarettes (as NRT aids are available to children anyway.) Clive Bates argued that the amount of lives saves would more than than justify a few new nicotine users.

8. Need Restrictions on Marketing

Deborah Arnott also argued for restrictions on e-cigarettes which would ensure that the adverts target only smokers and are information based.

Clive Bates disagreed, arguing we need effective, fun and sexy advertising that will reach more smokers.

The Anti-Medicinal Regulation Argument1. Any gain in safety would be offset by the smokers reverting to cigarettes. 

As Clive Bates pointed, a huge improvement in the safety of electronic cigarettes would only see safety improving from something like 99% to 99.9%. This is not worth damaging the industry and making ecigarettes less attractive. (I’ve summarised all Clive’s arguments against regulation below this piece.)

However, the loss of innovation, competition and existing devices that meet different needs could see many vapers returning to cigarettes, and fewer smokers switching to e-cigarettes.

2. Free Market and Competition Best Way To Ensure Improvements

Several of the speakers argued that the best way to ensure continuing improvement and innovation is to allow competition. That’s because:

3. Regulation would Stifle Innovation

In contrast, Clive Bates, regulation would freeze development where it is now. Innovative companies would be wiped out, and companies currently regulated by the MHRA have shown an inability to innovate, to produce exciting products or to create the internet buzz that exists around e-cigarettes.

Many companies would be wiped out, and the cost and beauracracy of applying for medicinal regulation (one application can be ten thousand pages long) would discourage companies from applying for licenses for new products.

3. Cost of Regulation

Katherine Devlin (who we interviewed here) of ECITA said that ECITA’s case studies showed that the cost of applying for regulation could be as much as the whole value of the e-cigarette industry.

Mr Mean apologised and said that he did not yet have enough information to provide estimates of costs.

5. Regulators Don’t Understand E-Cigarettes

Dr Konstantinos (interviewed here and here) argues that “The MHRA do not understand the e-cigarette,” seeing it simply as a nicotine delivery device (a medicine) when it is far more than that for most vapers.

Perhaps Mr Mean made this point for him when he said that vapers don’t need the next new flavour, they just need a device which will delivery a droplet of nicotine to the lungs (although scientists like Murray Laugesen believe e-cigarette users probably absorb nicotine in their upper airways passages rather than in their lungs).

6. Regulations Can Not Cover All Devices

David Dorn from Vaper Trails TV made this point very well by asking all vapers to hold up their e-cigarettes – a huge range were displayed.

As David pointed out, these different devices satisfy the needs of different users. We already know that cigarette users as well as e-cigarette users use their devices in very different ways. Given the cost and bureaucracy involved in medical regulation (and the fact that all 1,300,000 vapers would see their current devices confiscated) how can regulation meet all vapers needs?

7. Regulation is Probably Illegal

The EU’s legal committee has already ruled that a medicinal ban would be illegal, and in countries where medicinal regulation has been introduced the courts have ruled against it.

8. The Black Market and DIY

“You can not stop a tsunami with a law,” Dr Etter argued, before pointing out that the e-cigarette revolution would take place without, or possibly despite, the MHRA.

Dr Etter wasn’t the only one who believed that medical regulation would lead to a thriving black market in the devices and liquids which would be banned under the MHRA, with a likely decrease in quality and nicotine produced in sheds (actually, Clive Bate thought it wouldn’t be that dangerous.)

Mr Mean argued that because there was not a black market for medicines such as aspirin, there would not be a black market in ecigarettes/ejuice. I think this again shows he fundamentally misunderstands the e-cigarette market.

9. You can’t trust the MHRA

Just as Deborah argued we can’t trust private companies, one retailer argued we can’t trust the MHRA.

90% of the MHRA’s funding comes from pharmaceutical companies, and, as we have pointed out in the past, some MHRA employees continue to receive funding from pharmaceutical companies. A House of Common’s report in the past has highlighted undue influence from the pharmaceutical companies.

Pharmaceutical companies, of course, manufacture competing nicotine cessation aids, and stand to benefit from a weakened e-cigarette industry.

10. Concern is coming from a very small number of public health professionals 

Clive Bates argued that the e-cigarette had been very disruptive to those who make their living from public health, and that most opposition was coming from them.

These people, he believed, were “clutching at hypothetical straws.”

Clive Bates: The Price of Regulation

Clive summarised the cost of regulation as follows:

  • Increased cost
  • Reduced Appeal
  • Decrease in Variety
  • Decrease in Innovation
  • Fewer, duller innovations
  • Decrease in personalisation
  • Boring branding and marketing
  • Trusted brands and firms destroyed
  • Oligopoly and reduced competition
  • Black market and DIY

The Art of the Possible and a Possible Compromise

As Lib Dem EU MEP Rebecca Taylor pointed out, we have to compromise and work with the art of the possible.

With broad agreement among all speakers that e-cigarettes are an incredible opportunity for public health, I wonder if our speakers could get together and work on two tier approach to licensing.

One tier would allow licensing of some devices, which would reassure users buying them that they are safe.

Another tier would allow existing smaller companies to continue to innovate and allow devices which meet a wider variety of needs without the regulation that would effectively ban them.

A Huge Debt of Gratitude

Dr Polosa (interviewed here and here) pointed out to me that in addition to carrying out a lot of unpaid work, many scientists are risking their careers when they support e-cigarettes.

That’s because their research does not support the established tobacco control view, an establishment which controls research funding.

I am personally hugely grateful that these scientists have prioritised our health over their careers!

Once again, thanks also to e-cigarette-forum for funding and organising a fantastic conference!

Update: I’ve just noticed that Chris Snowden has also blogged on the e-cigarette summit – it’s a good read from a totally different angle, so check it out here. If you know of any other good posts, please leave a link in the comments.

Update 2 – Slides Now Available: E-Cigarette Forum has now posted the slides used by the speakers the event here.

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