ASH Daily News for 2 October 2019



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UK

  • British man’s death from 2010 suggested to be linked to vaping
  • Vaping deaths: Are e-cigarettes safer than smoking tobacco? A complete guide to the facts

International

  • Australia: New study finds that warnings on individual cigarettes help smokers quit
  • USA: Virginia and New Jersey report first vaping-related fatalities, bringing the US death toll up to 17
  • India defends e-cigarette ban in court with criticism of Juul
  • Opinion: Juul and the damage done to e-cigarettes
  • Audio: What’s the deal with vaping?

UK

British man’s death from 2010 suggested to be linked to vaping

Terry Miller, 57, died in 2010 after developing lipoid pneumonia – a rare condition that occurs when fat particles (lipids) enter the lungs.

A post-mortem report said: “It was thought that he may have developed lipoid pneumonia from the inhalation of oil-blended concentrated nicotine from the device.” An inquest into the glass-factory worker’s death recorded an open verdict.

Terry’s widow, Glynis Miller, said that after they discovered a build-up of oil on her husband’s lungs the doctor told her he was “as certain as he could be” that it was caused by the e-cigarettes Mr Miller had been using to try and quit smoking. She is now calling for a new inquest after the first recorded an open verdict. She believes her husband’s vaping habit hastened his death – claiming he was better off smoking. Glynis also believed Public Heath England did not have enough evidence at the time to back up the claim about the risks of e-cigarettes.

NHS Professor John Newton said: “It [vaping] isn’t risk-free but it is far less harmful than smoking. It would be tragic if smokers who could quit with the help of an e-cigarette did not do so because of false fears about their safety.”

Source: The Mirror, 30 September 2019

See also
The Telegraph: Death of factory worker is first in Britain linked to vaping
Metro: Widow who fears vaping helped kill her husband calls for new inquest
Daily Mail: Factory worker, 57, is first Briton to die from lung disease ‘linked to vaping’
BMJ. Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. 2018

ASH Editorial Note: This is more detailed than usual because of the seriousness of the concerns. Terry Miller died in 2010 from serious lung disease which has been linked to vaping. To date there is one other known case of lung disease linked to vaping in the UK from over a year ago, reported in the BMJ. In the BMJ it said the source of the oil was vegetable glycerine, but glycerine is not an oil but an alcohol, so if there was lipid in the e-liquid then it was not from the glycerine itself. In neither case has the link to vaping been proven.

The situation in the US is very different. There has been an acute outbreak of serious lung disease linked to vaping mainly linked to vaping cannabis, with first reports in late June 2019. As of 27 September the total number of reported cases in the US was 805 with 13 deaths.

There are 3.6 million vapers in Britain, the majority of whom are using e-cigarettes to help them quit smoking, or prevent relapse back to smoking, and have been vaping for at least a year.

ASH only recommends vaping for smokers trying to quit or ex-smokers to prevent relapse. ASH advice to vapers is that:

  • Vaping isn’t completely risk-free but is far less harmful than smoking tobacco.
  • If you’ve switched to vaping and are finding it helpful to stop you smoking, and are not suffering any adverse effects, then carry on — don’t go back to smoking.
  • E-cigarettes on sale in the UK are regulated by the medicines regulator, the MHRA – when purchasing e-cigarettes you can check with the retailer whether their vaping products are notified/regulated products.
  • Vapers should only be buying from mainstream suppliers who are selling regulated products; using black market products may carry potentially lethal risks.
  • Anyone concerned about adverse effects from an e-cigarette they’re using should immediately report this to the MHRA, using the yellow card scheme.
  • If you’re experiencing serious adverse effects which you think are due to vaping, then stop vaping and get advice from your doctor.

Read Article

Vaping deaths: Are e-cigarettes safer than smoking tobacco? A complete guide to the facts

The Independent has produced an explainer in response to concerns over the level of harm e-cigarettes pose compared to smoking. Ann McNeill, professor of Tobacco Addiction at King’s College London, told The Independent: “Vaping isn’t risk free, but it’s much less risky than smoking, which kills nearly 100,000 people a year in the UK. If you are a smoker who is struggling to stop smoking, do try vaping and buy your products from a reputable source. And if you are a vaper, it is better to continue to vape than relapse to smoking.”

Professor John Newton, director for health improvement at PHE, said: “Vaping is not without risks. If you don’t smoke don’t vape. But if you smoke there is no situation where it would be better for your health to continue smoking rather than switching completely to vaping. The sooner you stop smoking completely the better.”

Public Health England (PHE) said most of the American cases of vaping related-illnesses were linked to people using “illicit vaping fluid” bought on the streets or containing THC products. A PHE spokesperson said: “Unlike the US, all e-cigarette products in the UK are tightly regulated for quality and safety by the Medicines and Healthcare products Regulatory Agency and they operate the Yellow Card Scheme, encouraging vapers to report any bad experiences.”

Deborah Arnott, the chief executive of Action on Smoking Health (ASH), told The Independent that vapers in the UK “should not be scared back to smoking by the news of vaping illness in the US. Nor should smokers stick to smoking rather than switch to vaping. It is essential, however, to only use legal vapes bought from reputable suppliers in the UK and not source illicit unregulated products over the internet.”

Source: The Independent, 1 October 2019

Read Article

International

Australia: Study finds that warnings on individual cigarettes help smokers quit

Research has suggested that printing novel warnings including a “minutes of life lost” counter on individual cigarettes would help smokers to quit. Research conducted at James Cook University, Queensland, surveyed more than 2,000 smokers and non-smokers about how effective current and novel approaches to encourage people to quit or not start smoking are.

This found that despite declines in smoking rates, current strategies including plain packaging on cigarette packets were rated as a low deterrent by current smokers. Most smokers had become desensitised to the warnings which were introduced in 2012 as part of Australia’s landmark plain-packaging legislation.

“It’s simply due to repetitive exposure,” lead researcher Aaron Drovandi told Guardian Australia. “If you look at a disgusting image it will have an effect, but after you see it many times it won’t have that same effect. The warnings on cigarette packages remained largely unchanged, things like the warning about emphysema or gangrene. They’re certainly graphic, but when you’re exposed to that graphic image over and over again it loses its impact.”

Instead novel warnings about how much cigarettes cost, the effect on family members or a “minutes of life lost” counter on individual cigarettes – which would show the minutes disappearing as the cigarette burned – were found to have the biggest effect. “The novelty of warnings on individual cigarettes were roughly twice as effective as on packaging, and we saw that repeated from a wide range of participants from different age groups and ethnicities,” Drovandi said.

Source: The Guardian, 2 October 2019

Tobacco Induced Diseases. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: a four-country study. May 2019

Read Article

USA: Virginia and New Jersey report first vaping-related fatalities, bringing the death toll up to 17

Virginia and New Jersey have each reported their first deaths linked to e-cigarette use, bringing the US total count up to 17. The death in Virginia occurred on 26 September at a hospital in Greensboro, North Carolina, while the New Jersey death occurred in August. Further details about the cases have not been released.

Source: Mail Online, 1 October 2019

Read Article

India defends e-cigarette ban in court with criticism of Juul

The impending introduction of Juul e-cigarettes in India was a factor in the government’s decision to ban the sale of vaping products last month, a top government lawyer said in court on Tuesday while defending the order.

Juul had aimed to start offering e-cigarettes in India in late 2019 and had hired several senior executives in recent months, Reuters has previously reported. “What was impending was a nationwide launch of Juul … it (the government) chose to act immediately,” additional solicitor general Aman Lekhi told the court in Kolkata. Lekhi was defending two challenges against the ban on the sale of vaping products that have been filed by e-cigarettes importer Plume Vapour and another company Woke Vapors. He told the judge the cases were a “proxy for Juul” but did not elaborate. He later told Reuters: “We feel they are a proxy for Juul, there’s a very real possibility”.

Plume Vapour’s counsel told the court that “relative harm” from e-cigarettes was less than from tobacco products and the government was scaring consumers by banning the product. Woke Vapors said in a statement it will continue to work towards an outcome whereby e-cigarettes are regulated, not prohibited. The government’s counsel Lekhi said e-cigarette’s novelty and attractiveness pose a public health danger.

The court on Tuesday did not put the ban order on hold, but as a temporary relief revoked the current requirement for sellers to submit their existing stock of e-cigarettes to authorities for disposal. The cases, a legal test of the government’s ban order, will next be heard on Thursday 14 November 2019.

Source: Reuters, 1 October 2019

Read Article

Opinion: Juul and the damage done to e-cigarettes

In an opinion piece for the Financial Times, John Gapper argues that the US is “in danger of lurching from an overly permissive approach […] to barring e-cigarettes.”

“The best public health outcome remains to persuade as many adult smokers as possible either to give up cigarettes, or limit their risk by switching to vaping nicotine from regulated suppliers. That means keeping e-cigarettes available for sale while trying to prevent young people from taking up vaping […] This strategy has worked quite well in European countries including the UK, despite the US crisis. Cigarette smoking is in long-term decline and while 3.6m British people now vape, only 6% of them never smoked. Meanwhile, only 1.6% of 11 to 18-year-olds vape more than once a week.”

“The danger is that the US compensates for past laxity and cracks down so heavily that it snuffs out proper uses for e-cigarettes; vaping companies face a deadline of next May to submit existing products for approval. Outlawing vaping would be easy, but the side effect would be heavier smoking.”

Source: Financial Times, 2 October 2019

Read Article

Audio: What’s the deal with vaping?

Earlier this summer, Amina Akhtar (host of the Aspen Institute podcast) had a conversation with internationally recognised anti-tobacco experts Deborah Arnott and Matthew Myers at the Aspen Ideas Health Conference to better understand what vaping is. A lot has happened since then, including several deaths and hundreds of cases of lung injury in the US associated with vaping the exact cause of which has yet to be determined. Deborah Arnott is the Chief Executive for Action on Smoking and Health in the United Kingdom, and Matthew Myers is the president of the Campaign for Tobacco-Free Kids in the United States.

Key takeaways include Matthew Myers stating how vaping companies in the United States are mirroring techniques that big tobacco has used for decades, and Deborah Arnott talking about the United Kingdom’s standards with regulations and banning advertising.

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