Life in Public Health - Murray Laugesen QSO
memoir from the frontlines of global disease eradication,
children's health, and ending smoking.
by Helen Clark. 344 pp. 70 illustrations. Published
Add $6 by courier within NZ. Send total cost to Health
New Zealand PO Box 79283 Avonhead Christchurch 8446.
Or to HealthNZ 02 0100 072 3644 000
from any leading bookseller.
Natalie Walker, Varsha Parag,
Marjolein Verbiest, George Laking, Murray Laugesen,
Christopher Bullen. Nicotine patches used in combination
with e-cigarettes (with and without nicotine) for smoking
cessation: a pragmatic randomised trial. The Lancet
Smoking prevalence 15+ years
All ages 13.1%
Least disadvantaged 23.2%
- Statistics NZ
Lung cancer rates for
new cases fall in overall population
All, Maori, Non-Maori
2015 29.9, 83.5, 25.1
2016 28.9, 80.1, 24.4
2017 27.7, 81.5, 22.6
Total new cases were 2250 in 2015 falling to 2226
Ministry of Health 22 May 2019. Data subject
to change for 2017.
23 April 2019
Majority of Professionals in NZ
support cig alternatives
(These are not known to cause lung cancer).
A majority of healthcare professionals in New Zealand
view Electronic Nicotine Delivery Systems (ENDS), such
as e-cigarettes and heated tobacco products, as a viable
alternative to cigarettes if they are legalised and
regulated appropriately, according to new research conducted
by Frost & Sullivan.
Over 500 adults in New Zealand (including current,
former and non-smokers), as well as 60 healthcare professionals
(including GPs, medical specialists (such as psychiatrists,
surgeons and radiologists), nurses, pharmacists, and
allied healthcare professionals) were interviewed as
part of an opinion research study to gauge the level
of understanding and attitudes towards alternatives
New Zealand has moved to reduce smoking rates in recent
decades, and currently boasts one of the lowest smoking
rates in the developed world. However, almost 600,000
New Zealanders continue to smoke, with particularly
high smoking rates among population groups such as Maori
and the most economically-disadvantaged New Zealanders.
While the Government has set a target of achieving
a Smokefree New Zealand by 2025, with a smoking rate
of 5% or less nationwide, achieving this goal is likely
to be challenging. Smoking is therefore likely to continue
to be a significant health and economic challenge for
Managing Director of Frost & Sullivan ANZ, Mark
Dougan noted: Smoking is still a key area of concern
amongst healthcare professionals, with 90% believing
that the government still needs to do more to address
smoking. Our research shows that there is broad acceptance
that ENDS are significantly less harmful than cigarettes,
and widespread agreement amongst healthcare professionals
that ENDS should be legalised as long as they are appropriately
Healthcare professionals are largely supportive of
the use of ENDS, with 65% agreeing that they would prefer
smokers who are unable or unwilling to quit to switch
to these instead of smoking cigarettes, with 33% unsure
and only 2% opposed.
In general, healthcare professionals believe
that tobacco harm reduction products such as ENDS can
aid in reducing the harm from smoking, Mr Dougan
Our survey indicates that 60% of smokers overall
and 64% of Maori smokers would like to quit, but are
facing challenges in doing so, with current smokers
who have tried to quit reporting, on average, over six
unsuccessful attempts to do so, he added.
However, about 40% of smokers do not wish to
quit or are not sure. In this case, switching to tobacco
harm reduction products is a better option in the long
term than continuing to smoke cigarettes, he said.
The survey also showed that healthcare professionals
believe that greater promotion and raising awareness
of the role of ENDS to both healthcare professionals
and smokers and their families is necessary.
For more information or to download the report, please
This research was commissioned by Philip Morris International,
however the analysis contained in this research reflects
the views of Frost & Sullivan analysts without any
bias or influence from any third party.
© Scoop Media
7 March 2019
PM wants concession on price
of Heat Not Burn
PM is selling its combustibles
and its non-combustibles for the same excise. (over
80 cents per cigarette). This may be fixed up during
the select Committee process later this year, but meantime
this serious anomaly persists. It is especially so because
the Wellington court has ruled that Heat Not Burn is
entitled to be sold, and does not contain tobacco, ie
it is a non-combustible, and is therefore of no harm,
unlike the Marlboro cigarette.
11 January 2019
PMI to stop selling cigarettes
in the UK by 2030.
With new research from Public Health England suggesting
that parts of the UK could be smokefree by as early
as 2024, PMI's director of corporate affairs in the
UK Mark MacGregor has stated that 2030 "seems a
realistic time to pull cigarettes from sale."
Source: the Daily Star.
11 Jan 2029.
and smokeless tobacco products to be regulated
Jenny Salesa Associate Minister of Health
announced today that vaping and smokeless tobacco products
are to be regulated.
Smoke-free Environments Act will be amendedin 2019 to
give smokers more confidence in the quality of vaping
and smokeless tobacco products, while also protecting
children and young people from the risks associated
of these products will be limited in bars restaurants
and workplaces. Advertising will also be restricted.
the methadone of smoking so let's support patients to
patients for smoking, making them feel like "losers",
is bullying within general practice." - Report
of RNZCGP conference 2018- reported by Fiona Thomas.
Smoking NZ welcomes Snus to NZ
Penny Truman and Dr George Laking have both recommended
snus as used in Sweden for use in NZ, as being much
safer than smoking.
says E-cigarettes and Smokeless are legal to sell
a result of recent judicial decision.
Smoking NZ appoints new chair
George Laking of Auckland DHB has now replaced Professor
Marewa Glover as chair of ESNZ.
to consider risk-proportionate regulation for vaping
and heated tobacco products
the court case below, it was found that nearly all tobacco
products could be sold lawfully under the Smoke-free
Environments Act. This means that largely the same regulatory
controls apply to smoked tobacco products, heated tobacco
products and vaping products made from tobacco. The
Ministry plans to consider how best to apply risk-proportionate
regulation to all tobacco and vaping produccts.
not part of Section 29. Philip Morris win over Ministry
the Wellington District Court on 12 March the Ministry's
claim that S. 29 of the Smoke-free Environments Act
included HEETS (the nicotine containing sticks in the
Heat Not Burn device) was dismissed. This was not the
original design of the 1990 Act, said Judge Patrick
plain packaging comes into force across NZ today
today tobacco companies will no longer be able to sell
cigarettes in branded packaging. Instead they will sell
them in olive green brown packets
which retain the graphic health warnings already prominent
on current branded packets. The brand is given in small
letters on the front of the pack. Deadline for selling
the old style is June 6.
helps people quit smoking
recent survey of vapers found the majority started smoking
e-cigarettes to help them quit smoking. More than 200
people from across New Zealand took part in the online
survey in 2016, led by Dr Penny Truman from Massey Universitys
School of Health Sciences.
The results, published in the International
Journal of Environmental Research and Public Healthyesterday,
are of interest internationally because at the time
of the survey vaping products containing nicotine were
not able to be sold legally in New Zealand. Dr Truman
says this study confirms accessing nicotine for vaping
was the main problem people had with vaping.
We found the main reason for
trying vaping was to stop or reduce smoking. Most study
participants said they had completely switched from
smoking to vaping. Some newer vapers still smoked, but
they were still cutting down on cigarettes and some
only smoked occasionally, Dr Truman says.
Health England publishes independent expert e-cigarettes
vaping poses only a small fraction of the risks of smoking
and switching completely from smoking to vaping conveys
substantial health benefits
......e-cigarettes could be contributing to at least
20,000 successful new quits per year and possibly many
.....e-cigarette use is associated with improved quit
success rates over the last year and an accelerated
drop in smoking rates across the country
.....many thousands of smokers incorrectly believe that
vaping is as harmful as smoking; around 40% of smokers
have not even tried an e-cigarette
.....there is much public misunderstanding about nicotine
(less than 10% of adults understand that most of the
harms to health from smoking are not caused by nicotine)
.....the use of e-cigarettes in the UK has plateaued
over the last few years at just under 3 million
....the evidence does not support the concern that e-cigarettes
are a route into smoking among young people (youth smoking
rates in the UK continue to decline, regular use is
rare and is almost entirely confined to those who have
Ann McNeill et al.
statements on tobacco required by law in the USA
from Nov 27, the media will be required to print on
behalf of the tobacco companies, a series of corrective
statements, as a result of a court case against US tobacco
companies, chaired by Judge Gladys Kessler:
More people die every year from smoking than from murder,
AIDS, suicide, drugs, car crashes and alcohol combined.
Smoking also causes reduced fertility, low birth weight
in newborns, and cancer of the cervix.
Smoking is highly addictive. Nicotine is the addictive
drug in tobacco.
Various companies (US companies) intentionally designed
cigarettes to make them more addictive.
When you smoke, the nicotine actually changes the brain
- that's why quitting is so hard.
All cigarettes cause cancer, lung disease, heart attacks
and premature death. .. There is no safe cigarrette.
Secondhand smoke causes lung cancer and coronary heart
disease in adults who do not smoke
Children exposed to secondhand smoke are at an increased
risk for sudden infant death syndrome (SIDS), acute
ear problems, severe asthma, and reduced lung function.
There is no safe level of exposure to secondhand smoke.
Harold Farber, American Thoracic Society.
of Government in New Zealand
dominant parties are now Labour, Greens and NZ First,
rather than National. The emphasis on harm reduction
and legalisation of e-cigarettes in 2018 is not expected
Ministry of Health position statement - E-cigarettes
2011, the Government set a goal for Smokefree 2025.
The goal aims to reduce smoking prevalence to minimal
The Ministry of Health believes e-cigarettes have the
potential to make a contribution to the Smokefree 2025
goal and could disrupt the significant inequities that
The potential of e-cigarettes to help improve public
health depends on the extent to which they can act as
a route out of smoking for New Zealand's 550,000 daily
smokers, without providing a route into smoking for
children and non-smokers.
Recent decisions taken by Government have increased
the focus on harm reduction with an aim to support smokers
to switch to significantly less harmful products like
The Ministry of Health encourages smokers who want to
use e-cigarettes to quit smoking to seek the support
of local stop smoking services. Local stop smoking services
provide smokers with the best chance of quitting successfully
and should support smokers who want to quit with the
help of e-cigarettes.
Expert opinion is that e-cigarettes are significantly
less harmful than smoking tobacco but not completely
harmless. A range of toxicants have been found in e-cigarette
vapour including some cancer causing agents but, in
general, at levels much lower than found in cigarette
smoke or at levels that are unlikely to cause harm.
Smokers switching to e-cigarettes are highly likely
to reduce their health risks and for those around them.
When used as intended, e-cigarettes pose no risk of
nicotine poisoning to users, but e-liquids should be
in child resistant packaging. E-cigarettes release negligible
levels of nicotine and other toxicants into ambient
air with no identified health risks to bystanders.
Currently there are no mandatory product safety requirements
specifically for e-cigarettes in New Zealand, however
generic product safety standards apply.
The Ministry of Health will continue to monitor the
uptake of e-cigarettes, their health impact at individual
and population levels, including long term effects and
their effectiveness for smoking cessation as products,
evidence and technologies develop.
The Ministry of Health will also continue to meet its
obligations under Article 5.3 of the WHO Framework Convention
on Tobacco Control to protect public health policy from
commercial and other vested interests of the tobacco
behaviour: Electronic cigarettes
Lynne Dawkins and Hayden McRobbie.
on smoking from Eurobarometer 2014 show that of 7.5
million surveyed, 35% of smokers quit.and 32% reduced
their smoking. BPS recommends use of e-cigarettes.
and Alcohol Nurses of Australasia
cigarettes for Tobacco Harm Reduction
2017 Position Statement No 3. Darren Smyth President
are not risk free but evidence suggests they are around
95% safer than smoking.
Use. All patients should be encouraged to stop smoking
and offered bes practice treatments to assist quitting.
Consider E-cigarettes for smokers who are unable to
quit with conventional therapies.
13, 2017 New York
heads up Foundation for a Smoke-free World
is Dr Derek Yach, a renowned anti-smoking crusader.
Foundation has secured funding of approximately US$80
million annually over the next 12 years, beginning in
2018 from Philip Morris International. PMI does not
interfere with the workings of Smoke-free World. (www.smoke-freeworld.org
) Initial activities are expected to be focused in four
areas of need:
1) Support research into harm reduction and build research
capacity through academic centers of excellence
2) Collaboratively build consensus around which interventions
can best reduce harm and deaths from smoking and increase
3) Measure and report on global progress towards smoking
4) Identify alternative crops and livelihoods for tobacco
farmers as the global demand for tobacco declines
Derek Yach, studied under Dr Michael Russell, the father
of addiction science, at the Institute of Psychiatry
in London. At WHO he was a cabinet director and led
the development of the Framework Convenrtion on Tobacco
Control. He has since been a professor of global health
at Yale University. He holds the degrees of MBChB and
it comes to the Foundation for a Smoke-Free World, there
are a number of clear conflicts of interest involved
with a tobacco company funding a purported health foundation,
particularly if it promotes sale of tobacco and other
products found in that companys brand portfolio.
WHO will not partner with the Foundation. Governments
should not partner with the Foundation and the public
health community should follow this lead."
Foundation is a health foundation with by-laws in place
to prevent the sale of tobacco such as Marlboro.
June 2017 NZ Med J;130 (1456)
consumption down 41%, cigarette prices up 230%: lessons
from 1985-1988: Life expectancy rises 3.6 years for
Murray Laugesen and Randolph C.
Zealand men are living much longer due to giving up
tobacco smoking in the 19851995 period. Diet had
an improving effect. In 1988, men were living 3.6 years
more than 10 years before, and women 2.8 years more.
That is equal to three months gain in life per person
over these 10 years. Most of the effect has benefited
men. Tobacco consumption per adult fell by 41% in these
10 years. To do that, the price of cigarettes went up
230%, and we started eating more vegetables and fruit
and a variety of polyunsaturated fats.
Aim. We compared
changes in tobacco consumption and diet in relation
to changes in life expectancy in 19881998 in 22
OECD (Organisation for Economic Cooperation and Development)
1985 and 1995 using regression analysis we estimated
differences in tobacco consumption per adult and the
differences in the sum of atherogenic and thrombogenic
indices against life expectancy. Each index was derived
from the various fats per gram of food from standard
texts, and from the annual measurements of fat in the
food balance sheets of each country.
19851995, New Zealand showed the largest decrease
in tobacco consumption per adult (41%) and the greatest
decrease (except for Switzerland) in the sum of atherogenic
and thrombogenic indices (17%) as a measure of diet.
New Zealand ranked first for life expectancy increases
from 19881998 for men (3.6 years), women (2.8
years) and for both sexes combined. Regression analyses
revealed that increases in life expectancy across the
OECD for males, but not females, were strongly associated
with decreases in tobacco consumption, with a weaker
effect of diet improvement.
results suggest that reduced tobacco consumption in
19851995 likely contributed to New Zealands
gains in life expectancy from 19881998.
2 June 2017 NZ Med J 130 (1456) Reduced tobacco consumption,
improved diet and life expectancy for 1988-1998: analysis
of New Zealand and OECD data. The 3.6 years will be
included in an erratum submitted to the NZMJ.
End Smoking NZ Submission
Inquiry into the Use of Electronic Cigarettes and Personal
Vaporisers in Australia
Who are we?
End Smoking NZ is an independent unfunded charitable
trust. Our members collaborate to conduct research and
provide up-to-date information to inform public health
policy and practice about reducing tobacco smoking in
New Zealand (NZ).
End Smoking as an organization has
no tobacco industry links, nor any commercial interest
in electronic cigarettes (e-cigarettes), or in nicotine
End Smoking NZ wasformed in 2006 to
raise awareness of, and lobby for, the acceptance of
a harm reduction approach to reducing smoking-related
morbidity and mortality. At that time we advocated for
a law change to enable NZ smokers access to Snus.
Switching from smoking tobacco to Snus
has regrettably remained an option for Swedish and Norwegian
smokers only. Enviably, smoking prevalence in Sweden
has dropped to 5% - the rate of New Zealand's 2025 aspiration
The lowered incidence of smoking-related
disease and life years saved in Sweden and Norway is
a buoy marking a lowered risk route all countries could
have followed. Instead, we in NZ and Australia have
let thousands of people continue smoking instead. Tens
of thousands of New Zealanders and Australians have
suffered longer and died earlier than they needed to.
The Swedish experience stands as a warning not to make
the same mistake again!
Our experience with electronic cigarettes
Almost 10 years ago we began to investigate the potential
of e-cigarettes. Over the intervening years our members
have continued to conduct and support a range of studies
on e-cigarettes and vaping. On balance the evidence
has led us to become more convinced that e-cigarettes
present the first real threat to smoked tobacco.
E-cigarettes don't just have potential
as a smoking cessation tool, they can deliver the Endgame.
Basic general points about electronic
vaporisers and vaping
1. E-cigarettes are not tobacco products.
2. Whilst nicotine is extracted from tobacco, or can
be synthesised, we do not consider nicotine liquid produced
for the purpose of vaping to fit the definition of a
3. Electronic vaporisers are not solely,
nor necessarily, a smoking cessation device.
4. Electronic vaporisers were created
to be a safer alternative nicotine delivery device compared
to smoking tobacco products.
5. The use of nicotine replacement
products is well established as a safe practice.
6. Vaping nicotine is estimated to
be at least 95% safer than smoking tobacco. The estimated
risk is as low as many of the established nicotine replacement
7. Millions of smokers worldwide have
found that vaping, with and without nicotine, has enabled
them to achieve sustained abstinence from smoking tobacco.
E-cigarettes are very clearly showing their potential
to significantly reduce smoking rates. A significant
proportion of these people go on to stop vaping as well.
Many others enjoy vaping and have no intention to quit
in the near future.
8. Vaping nicotine hasn't resulted
in sustained abstinence from smoking for all smokers
who have tried it. The devices have and continue to
vary greatly. Government restrictions are critical to
supporting or undermining switching from smoking to
9. Other alternative nicotine delivery
products are in development, or are on the market overseas.
No one cessation product or alternative nicotine delivery
product will help every smoker either switch off or
abstain from smoking tobacco. A range of products are
required. We should not limit smokers to just one type
of e-cigarette or just one type of greatly harm-reduced
alternative to smoking product.
Tobacco control has irrevocably changed
with the introduction of greatly harm-reduced alternatives
to smoking tobacco, particularly the electronic nicotine
vaporisers. Smokers now have more alternatives to smoking
The huge difference between the alternative
nicotine delivery devices is that vaping nicotine can
(if allowed) provide an equal or better experience than
smoking tobacco. This is evidenced by the millions of
smokers who have already switched to vaping around the
world. Research shows clearly that the huge majority
of that use is for smoking replacement or for cessation.
Very few never-smokers use e-cigarettes.1
" Vaping, even with nicotine,
is likely to be less addictive than smoking tobacco.
There are good scientific reasons from
animal studies to suspect that e-cigarettes should be
less addictive than smoking , and some strong indications
from cessation trials and observational studies that
e-cigarettes will prove less addictive than smoking.
Smokers now have an option. They can
receive all of the benefits that they enjoyed from smoking
tobacco from a significantly less harmful and probably
less addictive behaviour.
New Zealand's position on e-cigarettes
Following public consultation, the
NZ Government has opted to amend the Smoke-Free Environments
Act to permit and regulate the import, marketing and
sale of nicotine for vaping.
The NZ Ministry of Health is also establishing
an e cigarette product safety Technical Expert Advisory
Group. They are also progressing consultation on what
regulatory or other framework to use to determine a
NZ position on emerging tobacco and nicotine delivery
Why Australia should support Australian
smokers to switch to vaping nicotine
Tobacco control policies have contributed
to reducing smoking rates in Australia. But, unacceptable
disparities in smoking prevalence by ethnicity remain.
Australian Indigenous and Torres Strait Islanders have
much higher rates of smoking than non-Indigenous Australians.
Some sub-groups, such as mental health consumers also
have disproportionately high smoking rates.
We believe that nicotine liquid for
vaping and vaporisers should be legal to import for
sale and distribution in Australia.
Further, it would be unethical to delay
access to legal nicotine for vaping and instead wait
until the market provides pharmaceutically approved
nicotine containing e-cigarettes or other alternative
products. Vaporisers are already being used in Australia
by people who are trying to improve and protect their
health. The Australian society should help, not hinder,
Australia and New Zealand have enjoyed
a history of alignment on our tobacco control programmes.
Since the 1980's, Australia and New Zealand have emulated
each other's policies resulting in both our countries
being seen to be world leaders in tobacco control.
Of relevance to your deliberations,
there are various trade and investment agreements between
Australia and New Zealand, such as the Australia New
Zealand Closer Economic Relations Trade Agreement (1983)
(CER) and The Trans-Tasman Mutual Recognition Arrangement
which established mutual recognition to labelling and
product standards, including those for tobacco products.
Divergence on how Australia and New
Zealand regulate e-cigarettes needs to be considered
in light of the 2013 New Zealand-Australia CER Investment
Protocol and the great amount of work that has been
done towards New Zealand and Australia's commitment
to creating a seamless trans-Tasman business environment,
known as the Single Economic Market (SEM).
The appropriate regulatory framework
for E-cigarettes and personal vaporisers in Australia
An appropriate regulatory framework
for nicotine vaping products must:
1. Recognise that vaping e-cigarettes is significantly
less harmful than smoking tobacco.
2. Ensure it is easier, or at least
as easy, to find and buy vaping products as it is to
buy tobacco for smoking.
3. Avoid imposing any additional or
specific tax over and above GST on vaping products.
The initial setup cost for vaping has to be able to
be recouped within a short time frame, or people will
4. Protect the opportunity for Australian
and foreign vaping product manufacturers and suppliers
who are independent of combustible tobacco product companies
to operate in Australia. Policies should not favour
established tobacco industry giants. E-cigarettes represent
a major threat to the tobacco industry.
5. The primary aim of any regulation
should be to enable current smokers to switch to vaping
and to have vaping products widely and readily accessible
for ex-smokers facing relapse to smoking.
1. Vaping products should be able to be sold wherever
tobacco products are sold and in additional retail outlets
that currently do not sell and have no desire to sell
tobacco products, such as dedicated vaping product retailers
2. Advertising of vaping products should
not be restricted to the same extent as combustible
tobacco products. Applying the same type and level of
bans on advertising of tobacco products to vaping products
sends the misleading message that vaping is as dangerous
as smoking tobacco and this will put some people off
vaping. The primary purpose of controls on advertising
of vaping products should be to avoid the promotion
of tobacco products.
3. It is important that independent
vape shops be allowed to have a shop-front and/or on-line
presence, so people know where to get which products
and at what price. Vendors also need to provide information
to assist smokers to distinguish between different types
of products to ensure that they purchase a vaping kit
most likely to speed and assure their complete transition
from smoking to vaping.
4. E-cigarettes do not burn tobacco
and do not create smoke. There is no evidence of harm
to bystanders from exposure to e-cigarette vapour and
any risks to their health, if identified, are likely
to be extremely low. Bans on smoking should not wholly
be applied to vaping. Banning vaping wherever smoking
is currently banned contains several risks for vapers.
Bans on where people can smoke are extensive in Australia.
Despite this, Australia's smoking prevalence has stalled.
People who smoke are experiencing sometimes extreme
social exclusion, marginalisation and discrimination.
If vaping is similarly treated this sends a message
that vaping is as dangerous as smoking and that vapers
are no different from smokers (e.g. they're still recalcitrant
addicts). In this scenario, vapers are also forced to
retire to the same limited and increasingly close number
of areas that smokers have to go to. As ex-smokers,
this puts vapers at risk of relapse to smoking.Anything
that inhibits switching to vaping is counterproductive.
The ability to vape inside some places, where it is
allowed by the organisation or venue offers a valuable
advantage of vaping over smoking tobacco.The main argument
for banning vaping anywhere that has any claim to a
scientifically based theory, though not proven, is that
viewing adults vaping might influence a child to initiate
smoking. Firstly, vaping is not smoking. Research with
NZ children has shown that they can distinguish between
smoking and vaping. They also really want their loved
ones to stop smoking and they, despite their young age,
could see the sense in vaping over smoking.
5. Organisations should be able to
set their own policies about vaping. This will enable
compassionate employers to allow vapers to vape inside.
Hospitals should be allowed to develop policies that
provide for vaping as an alternative to tobacco smoking
for patients who are unable to, or who are prohibited
to, go outside and off the grounds to smoke and potentially
for those patients who are not allowed to smoke prior
to surgery. Banning vaping in these institutions may
disproportionately affect more disadvantaged smokers,
such as those with mental health or drug and alcohol
6. Vaping products should not be required
to display graphic health warnings. Vapour is not smoke.
The established dangers of tobacco smoking cannot just
be extrapolated over to vaping. It has not been established
that vaping, even with nicotine is addictive.
Our members who are party to this submission
Chair - Associate Professor Marewa
Glover, School of Public Health, Massey University
Dr Penny Truman, School of Public Health, Massey University
Dr Murray Laugesen, Adjunct Professor Dept. Psychology
University of Canterbury, Christchurch.
Dr George Laking, Medical Oncologist, Auckland
Professor Randolph Grace, University of Canterbury,Christchurch.
Greg Town, Medical Editor, Auckland.
risk factor for Sudden unexpected death in infancy
Smoking and bed-sharing
were now leading risk factors, and mothers doing both
at once increased their risk by a factor of 30. The
seasonal distribution seen in the 1980s has disappeared.
Total rate was 0.76 per 1000 births. Mitchell
E. et al. NZ Med J 2 June 2017;130.
June 2017 NZ Med J 130 (1456)
low nicotine content cigarettes would need to be $15
Fraser, Anette Kira.
cigarettes do not taste as good as the real thing, and
would have to be much cheaper, according to smokers
tested for this study.
publications of Dr Murray Laugesen
Murray Laugesen backs Government move
years of research in Christchurch I fully endorse the
government's move to legalise e-cigarettes", he
of End Smoking NZ backs the Government move
for vaping is a very supportive move by Government,
says Dr Glover, chair of End Smoking NZ. Delays may
be created meantime with difficulties of importing.
Morris says it "welcomes E-cigarette reforms as
a big step towards a Smokefree 2025."
says all smokers will need a range of smokefree alternatives,
including e-cigarettes and heated tobacco products,
and says small and local businesses should be encouraged.
of Nicotine e-cigarettes to be legalised in NZ - Associate
sale of nicotine e-cigarettes will be legalised in New
Zealand, the Government has confirmed - and the Associate
Health Minister Nicky Wagner even encourages reporters
to try vaping.
A law change will be needed and is likely to be completed
next year, although the Government says it will do so
sooner if possible.
Today's announcement is a big win for the e-cigarette
industry - its products won't be in plain packaging,
nor will the hefty taxes on normal tobacco be applied.
Associate Health Minister Nicky Wagner said the change
came despite the fact scientific evidence of the safety
of e-cigarettes was still developing.
And despite stressing the "low risk" approach
taken because of that lack of certainty, Wagner encouraged
reporters at Parliament to try vaping.
"I have [tried vaping]. But I'm not very good
at it but I don't smoke either. I suggest anyone who
smokes here has a go at vaping, too. "Around the
world we can't get clear research about this. But what
we're thinking is they are about 95 per cent less harmful
She said the Government had considered applying the
same tobacco excise duties on vaping products but had
decided not to.
"I think that's an important thing so when a smoker
goes into the dairy he or she will see cigarettes at
a very high price and e-cigarettes much cheaper."
Wagner was not concerned that some big tobacco firms
were behind many e-cigarette products: "I think
the important thing is we want the health outcomes.
Whoever sells them...I don't think is really important."
The new rules for all e-cigarettes, whether they contain
nicotine or not, include restricting sales to people
18 years and over, banning vaping in indoor areas where
smoking is prohibited, and restrictions on advertising.
The Government had already announced its intention
to legalise e-cigarette sales, and today's decision
comes after consultation.
Nicotine patches and gum can be bought now, but nicotine
e-cigarette liquid must be bought from overseas.
Users "vape" on an e-cigarette, inhaling
its nicotine-containing vapour, in the way that smokers
inhale the smoke of a tobacco cigarette, which contains
nicotine plus many cancer-causing chemicals.
In England, e-cigarettes are the leading form of quit-smoking
aid, used by 35 per cent of smokers trying to quit.
However, some researchers argue that e-cigarettes risk
providing a "gateway" into smoking for youth.
New Zealand's Ministry of Health has been monitoring
evidence on the role of e-cigarettes for smoking cessation.
Maori Party co-leader Marama Fox this month said the
Government should seriously consider subsidising vaping
as a tool to help quit smoking.
Today, Wagner said if an e-cigarette got approved as
a stop-smoking medicine under the Medicines Act the
Government may consider subsidising it.
About 546,000 Kiwis smoke daily, 15 per cent of the
adult population. Every day on average, at least 13
people die from a smoking-related disease - about 5000
Half of smokers die from a smoking-related illness
and on average their deaths will be 14 years earlier
than if they didn't smoke.
- Nicholas Jones, NZ Herald
site: E-cigarettes to be regulated as consumer products
: The Government is planning to change the
law regulating e-cigarettes. These changes need to go
through Parliament before they can take effect. This
will likely happen from the middle of 2018 at the earliest.
The proposed changes are to:
" legalise the sale and supply of nicotine e-cigarettes
and e-liquid as consumer products
" regulate nicotine and non-nicotine e-cigarettes
and e-liquid as follows:
" prohibit sale, and supply in a public place,
to under 18 year olds
" restrict sale via vending machines to R18 settings
" allow all retailers to display e-cigarettes and
e-liquid at point-of-sale
" allow R18 retail settings to display e-cigarettes
and e-liquid in-store (including window display), promote
products on the outside of the store, and offer discounts,
free samples, loyalty awards etc.
" prohibit broader advertising, e.g. billboards,
radio, TV, Internet (the rules above will apply to retailers'
" prohibit vaping in workplaces and other areas
where smoking is not allowed under the Smoke-free Environments
Act 1990 (SFEA)
" set requirements for product safety (e.g. nicotine
concentration, child-resistant closures etc.)
" In addition to these changes, a regulatory framework
will be developed to provide a pathway for emerging
tobacco and nicotine-delivery products to be regulated
as consumer products in future.
Cabinet paper: Improving the regulatory framework for
e-cigarettes and emerging tobacco and nicotine-delivery
products (Word, 129 KB)
" Regulatory impact statement - Regulation of
e-cigarettes and emerging tobacco and nicotine-delivery
Electronic cigarettes (or e-cigarettes) are electrical
devices that heat a solution (or e-liquid), which produces
a vapour that the user inhales or 'vapes'. The ingredients
of the liquid may vary, but currently most e-liquids
contain propylene glycol and flavouring agents. Some
e-liquids contain nicotine.
E-cigarettes come in a range of styles, from devices
that look similar to traditional cigarettes (first generation
or cig-a-like) to refillable-cartridge 'tank' systems
(second generation) to highly advanced appliances with
larger batteries that allow the power to be adjusted
to meet an individual's specific vapour requirements
Second and third generation e-cigarettes generally deliver
more nicotine than first generation e cigarettes.
Risks with using e-cigarettes
There is evidence that e-cigarettes pose fewer health
risks to smokers who switch completely from tobacco
smoking to e-cigarette use. Tobacco smoking, even at
a reduced level, remains harmful.
Short-term use of e-cigarettes has been associated with
mild adverse effects such as headaches, dry mouth or
throat, and throat
mouth irritation. The health risks associated with the
long-term use of e-cigarettes are unknown. It is only
known that the risks of smoking are likely to be much
Some e-liquids contain nicotine. For smokers, the nicotine
in e-cigarettes poses little danger, however, in excessive
amounts it can be lethal, especially for children. Nicotine
products should be kept out of reach of others, particularly
Use of e-cigarettes for stopping smoking
There is a good rationale for people to use e-cigarettes
to help them stop smoking as e cigarettes can provide
nicotine, which is what people desire from smoking.
Research into the effectiveness of e-cigarettes in smoking
cessation is growing, but the findings from these studies
are somewhat mixed and the quality of the evidence is
low overall. This is an active area of research and
more findings will become available over the next few
years. At this stage, the Ministry of Health does not
have enough evidence to recommend e-cigarettes confidently
as a smoking-cessation tool. Smokers should use approved
smoking-cessation medicines, such as NRT, to support
them to stop smoking and seek behavioural support from
consumption down again by 5% in 2016
2016 cigarette and tobacco consumption per capita decreased
by a further five percent below the changes noted in
2015. The average smoker smoked 704 cigarettes per year
(per adult in the population) in 2015 and 668 in 2016.
Millions of cigarettes sold were 2358 in 2015 and 2304
in 2016. The greatest decrease was in roll-your-owns,
from 547 tonnes in 2015 to 512 tonnes in 2016.
data were collected by Dr Murray Laugesen from the manufacturers
returns to the Ministry of Health for calendar year
14.2% of adults smoked in 2015-16, it means that the
average smoker smoked over 4700 cigarettes per year
or 13.2 cigarettes per day. Any increased use of e-cigarettes
may have occurred in 2017 rather than last year.
28 February 2017
Daily users compared
to less frequent users find vape as or more satisfying
and less dangerous than cigarettes, and are likelier
to use non-cig-alike vaping products
This report by Prof Lynn Koslowski et al on 105
adults in Preventive Medicine Reports
highlights what many vapers already know:
o Daily users of e-cigarettes found them at least
as satisfying as cigarettes.
o Satisfaction from e-cigarettes was more likely in
more frequent users.
o All daily users reported them as less dangerous than
o Perceived danger from e-cigarettes was higher in less
o Daily users of e-cigarettes were more likely to be
17 February 2017
Heets illegal for Heat
not Burn but does this apply to Nicotine Lactate?
to the NZ Herald on Feb 2, quoting the Ministry of Health
our view, Heets products are prohibited for sale in
New Zealand under the Smoke-free Environments Act.''
The ministry has now clarified its position and
says that while the battery-powered holder is legal,
the tobacco sticks, called Heets, are not, because the
tobacco in them is burnt rather than heated.
1) This is illogical, because on this definition,
HEETS and HnB are both illegal because the device heats
up the air in it, and HEETs are only the mechanism for
extracting that vapour.
2) But the legality of Heat not Burn is
a matter of major importance, as 1 million Japanese
have switched off mainstream smoking, nearly 6% of smokers
having now switched.
This is of major public
3) HEETS in Nicotine Lactate cigarettes are legal,
because HEETS are heated to 100 deg C, and no tobacco
is burnt in that device.
15 February 2017
New Shadow Minister for
Hon Annette King Labour Spokesperson on Health
has replied on this topic today and says
"Yes, I am in favour of legislation of e-cigarettes,
and have been saying so since last year."
8 February 2017
New Minister for Tobacco
Hon Nicky Wagner is the
new appointment to this task. We send her our best wishes.
8 February 2017
Study of inhaled toxins
finds E-cigarettes are much safer than smoking
This challenges the "we just don't know"
school with what we can know if we look: that the toxic
exposures from inhaling e-cigarette aerosol are much
lower than for cigarette smoke. We don't have to wait
20 years for a cohort study to know enough to be confident
these products are very much less risky.
The effects of shifting completely to e-cigarettes
are marked but the effects of half switching (dual smoking)
Shahab L, Goniewicz ML, Blount BC, Brown J, McNeill
A, Alwis KU, et al. Nicotine, Carcinogen, and Toxin
Exposure in Long-Term E-Cigarette and Nicotine Replacement
Therapy Users. Ann Intern Med. 2017 Feb 7;24:442-8.
For New Zealand, this information is confirmed
by Laugesen M. Nicotine and toxicant yield ratings of
electronic cigarette brands in New Zealand. NZ Med J,
27 Mar 2015.
21 Jan 2017
an economic and public health imperative
- Murray Laugesen
Among the comments in a recent editorial in the
Lancet was this:
comment in Lancet Public Health on the New Zealand
experience, points to the importance of political champions,
a government committed to dramatically reducing tobacco
use, and a tireless and fearless non-government sector.
Only with these types of leadership can real progress
These comments came from Profs Robert Beaglehole
and Ruth Bonita, who pointed out that the most recent
surveys show that 14% of adults smoke daily, but 36%
of Maori and 23% of Pacific people also smoke daily,
and this needs attention.
Their solutions include this: "Electronic
nicotine-delivery devices and low nicotine cigarettes
may have a role to play in achieving the 2025 goal by
encouraging cessation." This is the first time
that New Zealand experts of conservative and radical
positions in tobacco control have voiced support for
e-cigarettes, and is almost 10 years since I conducted
the first research on them. All sides should take note.
We hope that the government will soon agree to
making such devices legal to be sold.
Recent moves to ban heat not burn cigarettes were
a local enforcement issue, and should not influence
approval of the nicotine lactate cigarette in the next
12 months when it has passed its final tests in Christchurch
The price of combustible cigarettes has escalated
at a steady 10% per year since 2011, and in addition
to the 5% per annum decline since 2011, we will soon
know from 2016 data whether the decline is continuing.
Meantime, we need less harmful products such as e-cigarettes
and nicotine lactate to ease smokers off combustible
(1). Beaglehole R and Bonita R. Eliminating the
scourge of tobacco for a fairer and healthier world:
New Zealand leads the way. Lancet www.com/public
health v.2 January 2017.e-13.13.
13 Jan 2017
Heat not burn cigarettes
banned by Section 29(2) of the SFE Environments Act
: law fails to distinguish types of tobacco sold
See WWW.MOH.GOVT.NZ and use Heat not Burn to find
the topic, which was posted just before Christmas.
Ministry of Health in response to the manufacturers,
Philip Morris, has notified them that s.29(2) bans Heat
not Burn cigarettes, as it contains tobacco. However
the tobacco is not combusted. Thus Ministry of Health
has failed to make a distinction between tobacco-ignited
cigarettes and tobacco heat-not- burn cigarettes. The
former cause 5000 deaths a year, and the latter do not
cause cigarette deaths as far as is known. The only
solution to put HnB cigarettes on the market here is
to amend s.29(2).
In Japan HnB cigarettes have replaced 4.9% of
the combustibles sold in the past 6 months.
4 Jan 2017
Price changes 31
Dec 2016 to 1 Jan 2017
||2016 to 31 Dec
||2017 from 1 Jan
|Port Royal 30g
|Port Royal 50g
2 Jan 2017
Ill say it again:
E-cigarettes are still far safer than smoking
Linda Bauld. The Guardian.
Since I last wrote about e-cigarettes
one year ago, headlines about the dangers of these devices
have continued to appear and show no sign of abating.
The result is clear. More people believe today, compared
with a year ago, that e-cigarettes are as harmful as
smoking. In fact these incorrect perceptions have risen
year on year, from fewer than one in ten adults in Great
Britain in 2013 to one in four this past summer. Surveys
of smokers show similar patterns, with an increasing
proportion believing that e-cigarettes are more or equally
harmful than tobacco.
Why can't scientists agree on e-cigarettes?
Yet we know that these harm perceptions are wrong. There
is now very strong evidence, from a range of studies,
that vaping - inhaling nicotine without the combustion
involved in smoking - is far less risky than smoking
cigarettes. Just a few months ago this body of evidence
was brought together by the Royal College of Physicians
who published an authoritative report analysing dozens
of studies and concluded that the hazard to health arising
from long term vapour inhalation from e-cigarettes is
unlikely to exceed 5% of the harm from smoking tobacco.
The RCP, and since then other UK doctors organisations
such as the Royal College of General Practitioners,
have made clear that it is important to promote the
use of e-cigarettes, along with other non-tobacco nicotine
products (like Nicotine Replacement Therapy such as
gum or inhalators) to smokers who are trying to quit.
The work of these organisations is underpinned by a
consensus statement endorsed by many of the main health
charities and public health bodies in the UK. They agree
that vaping is safer than smoking, and while these products
are not risk free and should not be promoted to children
or never smokers, they have a legitimate and positive
role to play in tobacco control.
But this consensus is not shared around
the world. The regular stream of media scare stories
driving harm perceptions often originates in other countries
where there is no such view about relative risks. Some
media headlines are driven by poor science but others
originate from reports by credible organisations who
focus on the absolute risk of any e-cigarette use without
comparing it to smoking (which is uniquely deadly and
kills one in two regular users). 2016 saw at least two
major reports of this kind.
In September the World Health Organisation
published a report that set out a series of steps on
e-cigarette regulation for countries signed up to the
Framework Convention on Tobacco Control, a global public
health treaty. These options were primarily about banning
or severely restricting the sale, distribution and marketing
of e-cigarettes. The WHO report was comprehensively
critiqued by the UK Centre for Tobacco and Alcohol Studies,
but its findings mean that e-cigarettes will continue
to be unavailable to millions of smokers in many countries
who have banned these devices or are considering doing
Does a tobacco-free world need to be nicotine free?
December 2016 saw the publication of a review authored
by the US Surgeon General, which focused on e-cigarette
use in young people. This described e-cigarette use
as a public health concern, arguing that e-cigarettes
are now the most commonly used tobacco product amongst
US youth and that nicotine use in any form is unsafe
for young people and also pregnant women. While some
of the science in the report is accurate, the conclusions
endorsing heavy regulation of e-cigarettes were not.
The report did not compare the risks of smoking and
vaping, failed to make clear that e-cigarettes are not
tobacco products, and drew conclusions about nicotine
that would also apply to Nicotine Replacement Therapy
- which is safe and licensed for use in pregnancy and
by young smokers. It also endorsed policies which could
deter current smokers from switching to e-cigarettes.
American scientists have critiqued data from the USA
that provided the basis for the Surgeon Generals
report, but it is likely that this publication will
contribute to public perceptions that e-cigarettes are
These two reports largely ignore the
fact that there are already measures in place in many
countries (including all of the EU) to protect the public
from any risks from e-cigarettes. These include policies
like age of sale, limits on advertising and child- and
tamper-proof packaging - all important to protect children
while still allowing sales to adult smokers and ex-smokers.
Concerns about exploding batteries and nicotine poisoning
can also be dealt with by following simple safety rules,
such as those set out by the Royal Society for the Prevention
I believe that e-cigarettes have huge
potential to save lives by providing an alternative
to smoking. Yet this can only be realised if we address
negative harm perceptions and communicate honestly with
the public. Ongoing research can help with this, and
2016 has seen the start of important studies, many commissioned
by Cancer Research UK, which will tell us more in the
future. We also need to keep our eye on new technology,
such as heat not burn tobacco products, which are emerging
and about which we know little. Only time will tell
whether the UKs positive approach towards e-cigarettes
strikes the right balance between risks and benefits.
For now, however, we must do all we can to encourage
smokers to try to stop at New Year or any other time.
For those trying with e-cigarettes, this is a positive
choice that should be supported.
Linda Bauld is Professor of Health
Policy at the University of Stirling, Deputy Director
of the UK Centre for Tobacco and Alcohol Studies and
holds the CRUK/BUPA Chair in Behavioural Research for
Cancer Prevention at Cancer Research UK. She is a former
scientific adviser on tobacco control to the UK government
and chaired the NICE guidance group on tobacco harm
NZ Health Survey July
2015- June 2016
Total population: current 16.3% daily 14.2%. (2%
drop since 2011-12)
Maori population current 38.6%, daily 35.5%.
(2% drop since 2011-12)
Pacific population current 25.5%, daily 22.8%
(virtually no change).
Tobacco prices as from
1 Jan 2017
Customs Dept reports that duty on cigarettes and
tobacco will rise to $738.13 per 1000 cigarettes of
0.7g or roll-your-owns of 0.7g. This is a rise of 10.4%
on the 2016 prices.
Tobacco manufacturers and importers are expected
to raise their prices by the same amount. The average
2016 price was $22.83 for 20 cigarettes.
Fixing Medical Prices
- How Physicians are paid
Miriam J Laugesen Associate Professor Dept
of Health Policy and Management, Columbia Mailman School
of Public Health, New York NY.
Harvard University Press.
In Dec 2016 issue of Scientific American.
Sir David Hay 1927-2016
A pioneer of tobacco control in New Zealand, Sir
David Hay, had been ill for some weeks and died 3 December.
His funeral was held on Thursday 1pm at St Andrew's
College chapel on Papanui Rd in Christchurch. As in
the case of Helen Kelly, the well-known trade unionists,
Sir David died of lung cancer, even though his last
cigarette was in his teens.
Qualified as a physician in the 1950s he was the first
person to ensure tobacco advertising on television was
banned in November 1962, and a member of the Advisory
Committee on Smoking and Health which gave its advice
to government in May 1985. In 1991 he told the incoming
National government their law to ban tobacco sponsorship
of sport was wrong. He was the first medical director
of the Heart Foundation and held this post for nearly
two decades. In 2005 he published his life story "Heart
Sounds" through Steele Roberts, Wellington.
26 Oct 2016
COMMENTARY ON WHO REPORT
ON ELECTRONIC NICOTINE DELIVERY SYSTEMS AND ELECTRONIC
NON-NICOTINE DELIVERY SYSTEMS
John Britton University of Nottingham, Ilze Bogdanovica
University of Nottingham, Ann McNeill Kings College
London, Linda Bauld University of Stirling, from the
UK Centre for Tobacco and Alcohol Studies
Document available online at: http://ukctas.net/news/commentary-on-WHO-report-on-ENDS&ENNDS.html
Positioning ENDS as a threat rather than opportunity.
Overall, the WHO report does not correctly position
ENDS primarily as an alternative to smoking and instead
focusses excessively on risks of ENDS use without adequately
recognising the deep reductions in health risks when
a smoker switches to ENDS. The FCTC itself recognises
harm reduction as a key strategy in tobacco
control. But with minor exceptions, the WHO report discusses
ENDS as a threat, whereas in fact they represent a major
opportunity for public health.
Failure to quantify risk. The WHO paper provides
a poor assessment of ENDS risks. In terms of toxicology,
the discussion is naïve and places excessive emphasis
on negligible risks arising from very low exposures.
In toxicology, the presence of a potentially harmful
agent does not necessarily establish a material risk.
This is because the level of exposure matters and the
dose makes the poison.
Inadequate comparisons with smoking. The WHO
paper does not systematically make meaningful comparisons
with exposures arising from inhaling tobacco smoke or
refer to other useful comparators such as occupational
exposure limits. However, data from around the world
shows that almost all ENDS users are smokers, ex-smokers
or would-be smokers. The most relevant comparison for
health policy purposes is with smoking.
Misrepresenting second hand ENDS vapour risks.
The section on risks of second-hand exposure to ENDS
aerosol provides no evidence that such exposures pose
any material risks to bystanders. The claim that ENDS
have the potential to lead to adverse health effects
in bystanders does not reflect the science behind the
cited source unless potential is taken to
mean any exposure, no matter how trivial. Again, the
issue is not the presence of particular chemicals, but
the magnitude of exposure.
Discounting the evidence that ENDS do help smokers
quit. The WHO paper does not properly assess the
role that ENDS play in quitting smoking and uncritically
repeats a number of methodological errors found in the
literature. Taking the totality of evidence including
controlled trials, observational studies, changes in
population smoking and ENDS use, the experience of nicotine
replacement therapy, and widely reported user experience,
there is confidence that ENDS are helping many smokers
to quit smoking and not having negative effects like
renormalising smoking, reducing quit rates or creating
ENDS marketing can be anti-smoking advertising.
The vast majority of ENDS marketing is truthful promotion
of a low-risk alternative to smoking and targeted at
adult smokers. The evidence cited by WHO has been misrepresented
and does not make the case for any systematic malpractice
by ENDS vendors. However, the WHO paper overlooks that
most fundamental point, which is that ENDS marketing
is promoting an alternative to smoking and may therefore
be promoting desirable changes in smoking behaviour.
It may also reach people who do not engage with conventional
Flavours are essential to the appeal of ENDS
as alternative to smoking. The section on product
characteristics attempts to demonstrate a problem
with flavours appealing to teenagers. In fact, flavours
are integral to the appeal of ENDS to adults as an alternative
to smoking. The citations are selective and findings
misinterpreted and do not support this claim. Several
citations simply reflect opinions or speculation, while
important studies have been overlooked. These do not
show that any interest amongst teenagers in ENDS flavours
is resulting in regular use of ENDS in this age group.
Mischaracterisation of the ENDS market and role of
tobacco transnationals. The WHO paper misinterprets
the ENDS market, makes misleading and unreferenced statements
about the role of transnational tobacco companies in
the market and is not grounded in an understanding of
how competitive markets function. WHOs report
fails to acknowledge the threat of disruptive technology
such as ENDS to the commercial viability of the traditional
cigarette business. Ironically, the only references
given to published papers point out how regulations,
such as those favoured by WHO, actually help the cigarette
trade. WHO should be aware of the danger that its policy
proposals may provide the traditional tobacco industry
with a twin advantage: (1) slowing down the disruption
of the cigarette market by ENDS; (2) shaping the ENDS
market to suit the ENDS business model favoured by the
Unjustified support for ENDS prohibition. In
the discussion of policy options, the opening paragraph
for each policy set implicitly endorses ENDS prohibition.
It does this by stating that Parties that have
not banned the importation, sale, and distribution of
ENDS/ENNDS may consider the following options.
Prohibition is one regulatory option among many that
ought to be discussed on its own merits, not taken as
a default. The merits of prohibition are exceedingly
poor given the pervasive availability of cigarettes
in all jurisdictions. WHO should not be endorsing prohibitions,
explicitly or implicitly. It is unethical to deny smokers
much lower risk options than cigarettes, and there is
no scientific support for ENDS prohibition as a public
health intervention. The WHOs framing suggests
that a prohibition is something for Parties to progress
towards and should not be undone once done. In fact,
it is a policy that should be reversed.
Policy proposals made with no supporting policy analysis.
Numerous policies are proposed without any supporting
evidence for their effectiveness or cost-effectiveness.
Any policy proposal should be subject to evidence-based
justification, options appraisal and analysis of trade-offs
or distributional effects, and impact assessment. Policies
should be tested for proportionality and possible unintended
consequences. The WHO has not applied any policy-making
disciplines to its menu of proposed policy options.
No assessment of unintended consequences. There
is no recognition of the likelihood of unintended
consequences arising from the policies proposed
in the WHO paper. However, it is very likely that some
of the proposed policies would have the effect of increasing
smoking. The Royal College of Physicians explains this
in its 2016 Nicotine without Smoke2 report as follows:
"A risk-averse, precautionary approach to e-cigarette
regulation can be proposed as a means of minimising
the risk of avoidable harm, e.g. exposure to toxins
in e-cigarette vapour, renormalisation, gateway progression
to smoking, or other real or potential risks. However,
if this approach also makes e-cigarettes less easily
accessible, less palatable or acceptable, more expensive,
less consumer friendly or pharmacologically less effective,
or inhibits innovation and development of new and improved
products, then it causes harm by perpetuating smoking.
Getting this balance right is difficult." (Section
12.10 page 187)
Almost every policy listed in the WHOs paper
could easily have the effect of protecting the incumbent
cigarette trade, promoting smoking rather than vaping,
and lead to increases in non-communicable diseases.
It is very likely that widespread uptake of WHOs
policy proposal would reduce harm reduction
and therefore increase harm.
Transparency and quality. The WHO report has
been made available without the four supporting papers
upon which it is supposed to be based. These papers
are still undergoing revision during peer review. This
is poor scientific practice and does not provide a reliable
basis for policy advice.
COMMENTARY ON WHO REPORT ON ELECTRONIC NICOTINE
DELIVERY SYSTEMS AND ELECTRONIC NON-NICOTINE DELIVERY
The Seventh Conference of the Parties (COP-7) of the
Framework Convention on Tobacco Control (FCTC), to be
held in Delhi between the 7th and 12th of November 2016,
will discuss and formulate future policy on the role
of Electronic Nicotine Delivery Systems (ENDS; also
known as electronic cigarettes or e-cigarettes) and
Electronic Non-Nicotine Delivery Systems (ENNDS) in
tobacco control. In preparation for this discussion,
and in response to a request made by the COP at its
6th session (COP-6) in Moscow in 2014, the World Health
Organisation (WHO) has prepared a report providing updates
on evidence of the health impacts of ENDS/ENNDS; on
their potential role in smoking cessation and tobacco
control; and on policy options to achieve objectives
set at COP-6.
In our view, the WHO report succeeds in identifying
a range of areas of uncertainty over the potential benefits
and risks of ENDS to effective tobacco control policy.
However, by doing so from a position of emphasis on
the risks and disadvantages of these products which
disregards their potential to reduce consumption of
smoked tobacco, the report fails to deliver the equipoise
required for dispassionate formulation of public health
policy. The report also contains factual errors and
misinterpretations of evidence available in the public
domain; and refers at its outset to four reports, including
two systematic reviews, commissioned by the WHO but
as yet unpublished and hence unavailable for scrutiny.
Oct 6, 2016.
Philip Morris calls for
light regulation of e-cigarettesRob Stock
cigarette giant Philip Morris has appealed to the Government
to go light when regulating its "heat not burn"
Ministry of Health is receiving submissions on how to
regulate e-cigarettes, which deliver nicotine-laden
vapour, providing a safer alternative to smoking.
Philip Morris is keen the Government does not overlook
its heat-not-burn cigarettes, which heat tobacco plugs
to deliver their nicotine hit without the smoke which
causes about 95 per cent of smoking-related disease.
submissions have not been made public yet, but Philip
Morris said: "Electronic cigarettes do not burn
tobacco and do not generate smoke."
companies are seeking viable new business models as
their traditional products go into terminal decline.
They have invested heavily in both e-cigarettes and
heat not burn devices, and want countries like New Zealand
not to regulate them in the same way as conventional
companies are trying to transform themselves into nicotine,
not tobacco companies
envision a smoke-free world in where a broad range of
safer alternatives to cigarettes fully satisfies the
continuing demand for tobacco and nicotine products,"
Philip Morris said.
are keen that e-cigarettes should be at least as available
as cigarettes are, but we suggest that they should be
regulated differently from cigarettes in order to encourage
smokers to switch to them."
e-cigarettes like cigarettes would "run contrary
to the science and public health purpose of tobacco
company said e-cigarettes should not be covered by the
ban on cigarette advertising and sale.
and in-store displays were important in promoting e-cigarettes,
plain packaging laws should also not be applied to e-cigarette
Morris also did not want graphic health warnings on
e-cigarette supplies which would "relegate these
less harmful products to packaging that is effectively
equivalent to cigarettes". This
would make it difficult to differentiate the products
Morris also called for little or no excise tax to be
levied on e-liquids and heat not burn tobacco plugs
claiming it would discourage smokers from switching
from conventional cigarettes.
also said vaping, as the use of e-cigarettes is known,
should be permitted in some areas where smoking is banned,
though the company agreed their use should be banned
from places like schools.
regulations should also be flexible as nicotine-delivery
technology was developing fast, and innovation should
not be stifled. "Technological
innovation is transforming the tobacco industry,"
ministry plans to report its recommendations to the
Government in the next few weeks.f
26 September 2016
Christchurch group completes
another study on nicotine lactate
Christchurch Clinical Studies Trust Ltd today
announces the completion of a clinical study on an innovative
alternative to cigarettes.The product prototype, designated"P3L"
(Platform 3, Lactate) by the technology owner Philip
Morris International, mixes nicotine with lactic acid
to produce an inhalable nicotine salt aerosol with faster
absorption rates than traditional nicotine replacement
therapies. The device is the product of technology developed
by Professor Jed Rose, co-inventor of the nicotine patch,
and his colleagues at Duke University. Previously tested
in Christchurch by Dr Chris Wynne and Dr Murray Laugesen,
New Zealand's leading public health specialist, the
study validated the belief that P3L can provide smokers
with a suitable alternative to smoking.
The study investigated nicotine absorption after a single
use of the product by 16 adult smokers in comparison
to the Nicorette® inhalator. Approximating the rapid
nicotine absorption rates and levels of cigarettes is
an important element of providing smokers with a satisfactory
alternative to smoking. With P3L, nicotine absorption
reached peak levels six times faster than with the inhalator,
suggesting easier absorption and a significantly higher
potential for acceptance by smokers. The study also
assessed a range of subjective effects, as well as safety
and tolerability. Compared
with use of the inhalator,the study participants found
the product a more satisfactory alternative and reported
less intention to smoke cigarettes; no relevant side
effects were reported.
study investigator Dr Chris Wynne, Medical Director
at St Georges Cancer Care Centre, Christchurch, commented
on the results:
"In addition to quitting, which remains the safest
way to reduce the harm from smoking, a tobacco harm
reduction strategy envisions the development of products
with the potential to reduce individual risk compared
to smoking. A critical element for acceptance by smokers
is nicotine delivery similar to cigarettes as well as
the rewarding of subjective effects, and this novel
nicotine-containing product has proven to perform better
than existing nicotine delivery systems in both areas."
Given the promising results of this first clinical study,
Christchurch Clinical Studies Trust Ltd will conduct
further studies to assess in a larger population the
potential for smokers to substitute cigarettes with
4 August 2016
New Zealand to make nicotine
Scoop NZ release from End
End Smoking NZ applauds the Government (August 2) on
its decision to make nicotine for vaping (using electronic
cigarettes) legally available in New Zealand. The Government
has agreed in principle that nicotine for e-cigarettes
should be legally available for sale with appropriate
controls. Currently it can only be imported for personal
use creating often insurmountable barriers preventing
smokers from switching to vaping.
The Associate Minister of Health, Peseta Sam
Lotu-Iiga has made the right decision. Said End
Smokings Chairperson Associate Professor Marewa
Glover. He has listened with compassion to smokers
and vapers. We are so relieved that our pragmatic nature
as a country has triumphed over the negative misinformation
and unfounded fears that have dominated the debate for
Long-time advocate of nicotine e-cigarettes and founding
Board member, Dr Murray Laugesen started work on e-cigarettes
in 2007. Im absolutely delighted,
he said. This will be a turning point that will
have a significant impact on reducing the death and
disease caused by smoking. It also gives us a real shot
at achieving Smokefree 2025. He said.
This announcement by the Minister gives health
professionals a clear message that smokers who choose
to use vaping to help them quit can be supported to
do so. Said Board member Dr George Laking.
The Ministry of Health is calling for submissions on
how to legislate electronic cigarette products and what
regulations or controls need to be in place.
Vaping nicotine has been estimated to be 95%
safer than smoking tobacco, thus End Smoking doesnt
believe we need overly restrictive or costly regulation
and controls of e-cigarette products.
However, some concerns such as restricting sales to
minors will be wise to prevent retailers who currently
sell tobacco to minors pushing e-cigarette products
on to kids. Dr Glover said.
Some public health researchers and advocates in New
Zealand and around the world have concerns that vaping
will re-normalise smoking, be a gateway to smoking,
and establish nicotine addiction among new users. However,
there is no evidence that this is occurring in countries
where vaping is established.
Whilst there is still some way to go before nicotine
for vaping will be legally available in New Zealand,
End Smoking says the first steps are positive.
8 July 2016
Cigarette smoking prevalence
down 10% in USA
Cigarette smokers declined from 16.8% to
15.1% in 2014-5, with the greatest decline among young
For e-cigarette smokers, the greatest increase
was among former (ex-) smokers, from 2.0 million to
2.5 million, and increase of 26%, with 66% using them
A survey of teenage smoking showed that from 2011
to 2014, regular cigarette smoking had fallen from 4.0%
to 1.3%, and exclusive e-cigarette use had risen from
0.3% to 2.7%.
The inescapable fact is that e-cigarettes, used
by, among others, 2.5 million former smokers, are not
impeding the dramatic, welcome decline in cigarette
1 July 2016
Tobacco consumption in
NZ 5% down per year since 2010, and 5% down in 2015
According to 2015 statistics, tobacco consumption
per adult (including factory-made and roll-your-own
at 0.7 g tobacco per cigarette) declined 5% in 2015.
Consumption declined from 749 cigarettes per adult in
2014 to an all time low of 712 cigarettes per adult
in 2015. This amounts to a 65% decrease since 1990.
The data, from Health NZ, will be found under www.moh.govt.nz/ourwork/
assuming cigarette smoking prevalence declined to 14.86%
in 2015, this means that of 541,000 smokers,
average smoker in 2015 smoked 4791 cigarettes per year,
or 13.13 cigarettes per day. 30% of tobacco smoked was
sold as RYOs.
27 June 2016
New Study Finds Electronic
Cigarettes Helped 5 Million Quit Smoking
by Lindsey Stroud
The journal Addiction published a study in late June,
finding the use of electronic cigarettes and vaporized
nicotine products (VNPs) have helped 15 million smokers
quit smoking tobacco cigarettes and/or cut back, in
the European Union (E.U.). Using data from the 2014
Eurobarometer survey, which recorded responses of 27,460
participants, the study concluded that 48.5 million
E.U. citizens had tried e-cigarettes and 7.5 million
were currently vapers. Of the group reporting regular
e-cigarette usage, 35 percent reported that e-cigarettes
helped them quit smoking, while 32 percent said they
were smoking less thanks to e-cigarettes. (2.6
and 2.4 million respectively)
This research comes on the heels of a study published
by the British Medical Journal earlier in June, that
measured the effectiveness and safety of electronic
cigarettes at 24 months using data from respondents
that used e-cigarettes and VNPs to quit smoking and
those that remained on traditional tobacco cigarettes.
The study concluded that 61 percent of respondents had
remained abstinent from tobacco and that
only 23.1 percent of tobacco users reported abstinence.
The study by Addiction is only the latest bit of research
concerning the health implications of electronic cigarettes
and VNPs. After U.S. Food and Drug Administration (FDA)
announced in May to regulate electronic cigarettes as
tobacco products, more studies have been finding greater
evidence that e-cigarettes and VNPs may actually save
more lives than endanger, and help ease the health burdens
that are associated with tobacco. Addiction. 2016 Jun
24. doi: 10.1111/add.13506. [Epub ahead of print]
18 June 2016
The Ministry of Health's refusal to consider making
the sale of e-cigarettes here legal borders on the indefensible.
On the evidence so far banning "vaping"
actually punishes those most likely to be well on track
to giving up smoking altogether.....
New Zealander Dr Murray Laugesen, supports e-cigarettes
as a prime and remarkably low-risk weapon against the
killer habit. It's time the ministry listened.
Butting out. Editorial. The Listener www.listener.co.nz
2 May 2016
Australian Health Organisations
wrong to go against e-cigarettes
to Dr Colin Mendelsohn an influential tobacco treatment
specialist from Sydney, the precautionary position taken
by Australian health organisations and governments is
not supported by the available evidence and overseas
experience. The growing evidence for safety and effectiveness
of e-cigarettes significantly outweighs any potential
risks to public health.
A rational, evidence-based approach
would be to make e-cigarettes available in Australia
as consumer products and to encourage their use while
minimising uptake by people who would not otherwise
have used nicotine products. Ongoing monitoring and
appropriate proportionate regulation would help minimise
E-cigarettes represent a massive opportunity
for Australian smokers and have the potential for large-scale
improvements in individual and public health, and social
inequality. We cannot afford not to embrace them.
28 April 2016
WIDELY AS SUBSTITUTE FOR SMOKING SAYS NEW RCP REPORT
A new report released today from the Royal College
of Physicians, London, Nicotine without smoke:
tobacco harm reduction concludes that e-cigarettes
are likely to be beneficial to UK public health. Smokers
can therefore be reassured and encouraged to use them,
and the public can be reassured that e-cigarettes are
much safer than smoking.
Tobacco smoking is addictive and lethal. Half of all
lifelong smokers die early, losing an average of about
3 months of life expectancy for every year smoked after
the age of 35, some 10 years of life in total. Although
smoking prevalence in the UK has reduced to 18%, 8.7
million people still smoke. Harm reduction provides
an additional strategy to protect this group of smokers
from disability and early death.
Since e-cigarettes became available in the UK in 2007,
their use has been surrounded by medical and public
controversy. This new 200-page report examines the science,
public policy, regulation and ethics surrounding e-cigarettes
and other non-tobacco sources of nicotine, and addresses
these controversies and misunderstandings with conclusions
based on the latest available evidence:
- E-cigarettes are not a gateway to smoking
in the UK, use of e-cigarettes is limited almost
entirely to those who are already using, or have used,
- E-cigarettes do not result in normalisation of
smoking there is no evidence that either
nicotine replacement therapy (NRT) or e-cigarette use
has resulted in renormalisation of smoking. None of
these products has to date attracted significant use
among adult never-smokers, or demonstrated evidence
of significant gateway progression into smoking among
- E-cigarettes and quitting smoking - among smokers,
e-cigarette use is likely to lead to quit attempts that
would not otherwise have happened, and in a proportion
of these to successful cessation. In this way, e-cigarettes
can act as a gateway from smoking
- E-cigarettes and long-term harm - the possibility
of some harm from long-term e-cigarette use cannot be
dismissed due to inhalation of the ingredients other
than nicotine, but is likely to be very small, and substantially
smaller than that arising from tobacco smoking.
With appropriate product standards to minimise exposure
to the other ingredients, it should be possible to reduce
risks of physical health still further. Although it
is not possible to estimate the long-term health risks
associated with e-cigarettes precisely, the available
data suggest that they are unlikely to exceed 5% of
those associated with smoked tobacco products, and may
well be substantially lower than this figure.
The report acknowledges the need for proportionate
regulation, but suggests that regulation should not
be allowed significantly to inhibit the development
and use of harm-reduction products by smokers. A regulatory
strategy should take a balanced approach in seeking
to ensure product safety, enable and encourage smokers
to use the product instead of tobacco, and detect and
prevent effects that counter the overall goals of tobacco
Professor John Britton, chair of the RCPs Tobacco
Advisory Group, said:
The growing use of electronic cigarettes as a
substitute for tobacco smoking has been a topic of great
controversy, with much speculation over their potential
risks and benefits. This report lays to rest almost
all of the concerns over these products, and concludes
that, with sensible regulation, electronic cigarettes
have the potential to make a major contribution towards
preventing the premature death, disease and social inequalities
in health that smoking currently causes in the UK. Smokers
should be reassured that these products can help them
quit all tobacco use forever.
RCP president Professor Jane Dacre said:
Since the RCPs first report on tobacco,
Smoking and health, in 1962, we have argued consistently
for more and better policies and services to prevent
people from taking up smoking, and help existing smokers
to quit. This new report builds on that work and concludes
that, for all the potential risks involved, harm reduction
has huge potential to prevent death and disability from
tobacco use, and to hasten our progress to a tobacco-free
society. With careful management and proportionate regulation,
harm reduction provides an opportunity to improve the
lives of millions of people. It is an opportunity that,
with care, we should take.
Smoking is the biggest avoidable cause of death and
disability, and social inequality in health, in the
Most of the harm to society and to individuals caused
by smoking in the near-term future will occur in people
who are smoking today.
Vigorous pursuit of conventional tobacco control policies
encourages more smokers to quit smoking.
Quitting smoking is very difficult and most adults who
smoke today will continue to smoke for many years.
People smoke because they are addicted to nicotine,
but are harmed by other constituents of tobacco smoke.
Provision of the nicotine that smokers are addicted
to without the harmful components of tobacco smoke can
prevent most of the harm from smoking.
Until recently, nicotine products have been marketed
as medicines to help people to quit.
NRT is most effective in helping people to stop smoking
when used together with health professional input and
support, but much less so when used on its own.
E-cigarettes are marketed as consumer products and are
proving much more popular than NRT as a substitute and
competitor for tobacco cigarettes.
E-cigarettes appear to be effective when used by smokers
as an aid to quitting smoking.
E-cigarettes are not currently made to medicines standards
and are probably more hazardous than NRT.
However, the hazard to health arising from long-term
vapour inhalation from the e-cigarettes available today
is unlikely to exceed 5% of the harm from smoking tobacco.
"...the hazard to health arising from long-term
vapour inhalation from the e-cigarettes available today
is unlikely to exceed 5% of the harm from smoking tobacco"
Technological developments and improved production
standards could reduce the long-term hazard of e-cigarettes.
There are concerns that e-cigarettes will increase tobacco
smoking by renormalising the act of smoking, acting
as a gateway to smoking in young people, and being used
for temporary, not permanent, abstinence from smoking.
To date, there is no evidence that any of these processes
is occurring to any significant degree in the UK.
Rather, the available evidence to date indicates that
e-cigarettes are being used almost exclusively as safer
alternatives to smoked tobacco, by confirmed smokers
who are trying to reduce harm to themselves or others
from smoking, or to quit smoking completely.
There is a need for regulation to reduce direct and
indirect adverse effects of e-cigarette use, but this
regulation should not be allowed significantly to inhibit
the development and use of harm-reduction products by
A regulatory strategy should, therefore, take a balanced
approach in seeking to ensure product safety, enable
and encourage smokers to use the product instead of
tobacco, and detect and prevent effects that counter
the overall goals of tobacco control policy.
The tobacco industry has become involved in the e-cigarette
market and can be expected to try to exploit these products
to market tobacco cigarettes, and to undermine wider
tobacco control work.
However, in the interests of public health it is important
to promote the use of e-cigarettes, NRT and other non-tobacco
nicotine products as widely as possible as a substitute
for smoking in the UK.
21 April 2016
New study finds exhaled
e-cigarette vapour particles disappear within seconds
A new study being presented today at the 4th Workplace
and Indoor Aerosols conference in Barcelona shows, for
the first time, that exhaled e-cigarette particles are
liquid droplets that evaporate within seconds.
The research - a collaboration between Kaunas University
of Technology in Lithuania, EMPA Swiss Federal Laboratories
for Materials Science and Technology, ETH Zurich the
Swiss Federal Institute of Technology and Fontem Ventures
- is the first detailed study of its kind conducted
to investigate particles in exhaled e-cigarette vapour.
Speaking from the conference today, Professor Dainius
Martuzevicius, Vice Dean for Research at the Faculty
of Chemical Technology, Kaunas University of Technology
and leading expert on indoor air quality, said: "There
is little data available on the properties of exhaled
e-cigarette 'particles' in the scientific literature
and as a result there is a growing discussion amongst
the public health community as to whether the 'particles'
exhaled following use of vaping products have potential
implications for indoor air quality."
12 April 2006
Are E-Cigarettes a Healthy
Way to Quit Smoking?
Electronic cigarettes have an unparalleled potential
to reduce the public-health impact of smoking, by allowing
smokers to replace the habit and nicotine of smoking
without the toxic effects of combustion.
Dr. Rose is a professor of psychiatry and behavioral
sciences and director of the Duke Center for Smoking
Cessation at Duke University. He can be reached at firstname.lastname@example.org.
City Council to discuss banning smoking and also e-cigarettes
to the Committee: what is the harm of developing dependence
on a low cost non-fatal device?
committee of the Wellington City Council is about to
ban use of e-cigarettes on its properties. The debate
is on 13 April.
to Dr Joe Nitzkin, former chair of tobacco control for
the College of Public Health Medicine in the USA:
bottom lines are these:
restrictions and increasing taxes on cigarettes and
smoking will reduce tobacco-related addiction, illness
these same restrictions and taxes on e-cigs will have
the opposite effect. It will discourage smokers who
would otherwise switch to keepsmoking.
Vaping is not smoking and should not be defined as such.
exceed $1 per cigarette
from 1 January 2016 the following prices have been charged,
representing a 10.3% in excise and inflation as well
as similar increases in ex-factory price.
Royal $78 for 50 g. ($1.09 per cigarette of 0.7 g).
Mall $21.60 for 20 cigarettes.($1.08 per cigarette).
NHS to give out e-Voke
E-voke has been licensed by Medicines and Healthcare
Regulatory Agency for medicinal use. The aim
is to have these gadgets available for prescription
by GPs in 2016.
E-vokes are not an e-cig. They rely on producing
a powder, like an inhaler.
Vype e-cigarettes have been licensed but will not be
available for some time.
products are produced by BAT.
C. Wheeler. Express. 7 December
and ASH UK 8 December.
1 December 2015
to rise 10.3%
on 1 Jan 2016
According to NZ Customs Service the
new rates will be $668.51 per 1000 cigarettes as from
1 January. Smoking tobacco will cost $666.83 per kg
of tobacco content. This amounts to an increase of 10.3%
in tobacco price since 1 January 2015. This means a
cigarette costing $20 in 2015 could cost $22.06 in 2016,
assuming tobacco companies also raise their price by
the same percentage.
Is the jury still out on e-cigarettes?
Monday, November 30, 2015
Short of a pill that will magically take addiction
away, are e-cigarettes the best smoking cessation device
since the humble patch? Or are they just another dangerous
addiction,?a gateway device for children or, worse,
a sneaky attempt by Big Tobacco to renormalise smoking?
In the May 2012 Viewpoints, Matters of Substance compared
the arguments and decided the jury was still probably
out on e-cigarettes. A recent report by Public Health
England, however, has become the first authoritative
declaration that e-cigarettes are safer than cigarettes
and by a significant margin.
In this edition, we take a look at the English report
and at one of its detractors. Is the jury still out,
and should we bother waiting?
Public Health England
In August 2015, Public Health England (PHE) published
its commissioned report E-cigarettes: an evidence update,
which summarised the findings from two extensive literature
The reports conclusions were almost startling.
It said the evidence suggests using e-cigarettes is
95 percent safer than smoking and that e-cigarettes
have the potential to make a significant contribution
to the endgame for tobacco. Its policy recommendations
included making e-cigarettes much more prominent in
smoking cessation initiatives and streamlining convoluted
processes for them to be licensed as quit-smoking aids.
Among the reports findings was that e-cigarette
use by people who had never smoked was extremely low,
at around 0.2 percent. Regular use (at least once weekly)
by young people is also very rare at just 2 percent,
and while there is some youthful experimentation, only
0.3 percent of young people who used e-cigarettes had
never smoked tobacco before. It said the most important
reason people use e-cigarettes is to reduce smoking-
related harms and that, while curiosity plays a role
in why some people experiment with them, most of these
experiments did not lead to regular use.
It concluded from this that e-cigarettes are not
undermining, and may even be contributing to, the long-term
decline in cigarette smoking.
The report made much of a September 2014 Cochrane Review,
Electronic cigarettes for smoking cessation and reduction,
featuring New Zealanders Hayden McRobbie and Chris Bullen
amongst its authors. The reviews meta-analysis
of 600 records found that e-cigarettes can help
smokers unable to stop smoking ... to reduce their cigarette
consumption when compared with placebo e-cigarettes
and nicotine patches.
The PHE report also found e-cigarettes do not replicate
the problems of second-?hand smoke. They release negligible
levels of nicotine into ambient air with no identified
health risks to bystanders. No concerns were found
around the labelling of nicotine cartridges or e-liquids,
and when they were poorly labelled, they mostly contained
less nicotine than declared. While acknowledging nicotine
is a poison, the report found no evidence of nicotine
poisoning to users. The risks of poisoning to others
(such as children) or of evices causing fires were found
to be on a par with other household electrical goods
The reports authors discount recent news headlines
reporting high levels of formaldehyde found in e-cigarettes
as misinterpretations of research findings. They found
no indication electronic cigarette users are exposed
to dangerous levels of aldehydes and said this could
only happen when e-liquid was heated to levels
unpalatable to users. Instead, they assert that
most of the chemicals causing smoking-related diseases
are absent in e-cigarettes and that those that are present
pose limited danger.
PHEs findings have been supported by a number
of high-profile medical experts, including UKs
Chief Medical Officer Dame Sally Davies. A September
2015 British Journal of General Practice editorial concluded
that, for every million smokers who switched from tobacco
to e-cigarettes, more than 6,000 premature deaths would
be prevented in the UK every year. If all 9 million
smokers took up e-cigarettes instead, 54,000 lives could
Critique of PHE
The PHE research will probably be music to the ears
of the millions of smokers around the world who have
turned to e-cigarettes but who may still have niggling
doubts that their new drug delivery device is really
all that better for their health.
But in one of the greatest parade-raining articles
so far this century, Martin McKee and Simon Capewell,
writing in the British Medical Journal, are scornful
of the research and suggest its foundation is built
First, they say a recent cohort study shows most smokers
who switch to e-cigarettes (80 percent) are still also
smoking cigarettes at 12 months (dual use) and that
reduced smoking may not reduce overall risk of death.
Next, they attack the Cochrane report, on which the
PHE report relies heavily, by pointing out that it included
only two randomised controlled trials and that, by its
own admission, its evidence had limitations and was
of low or very low quality.
The claim that e-cigarettes are 95 percent safer gets
a particular hiding. McKee and Capewell cite a recent
systematic review in Preventative Medicine that found
serious methodological problems in many of the studies
it reviewed and so many conflicts of interest that
no firm conclusions can be drawn about the safety of
e-cigarettes but that they can hardly be
considered harmless. They also point out the 95
percent figure does not come from a review of the evidence
but from a single meeting of 12 people convened to synthesise
their opinions on the harms associated with different
products containing nicotine. They point out two of
those present had received tobacco industry funding
in the past and that some other attendees were known
McKee and Capewell also dispute the reports finding
that e-cigarettes are not helping to renormalise smoking.
They say a July 2015 survey by the Health and Social
Care Information Centre showed more than 20 percent
of 1115-year-olds had used e-cigarettes, and 73
percent of these were non-smokers. An American study,
published after the PHE report, they say, concluded
that those who had ever used e-cigarettes at baseline
compared with non-users were more likely to report initiation
of combustible tobacco use over the next year.
The McKee and Capewell rebuttal, which points out a
number of further perceived problems and inconsistencies,
does not claim to prove e-cigarettes are as harmful
as smoking tobacco. Rather,?its contention is that the
PHE report isnt sufficiently evidence based to
underpin changes in public health policy. And therein
lies the rub.
The precautionary principle: for
Many of those opposing e-cigarettes rely pretty heavily
on the precautionary principle. Its a bit like
insisting that policy must be evidence based but goes
a small step further.
The precautionary principle states that, if an action
or policy has a suspected risk of causing harm and there
is no scientific consensus that the action or policy
is not harmful, the burden of proof that it is not harmful
falls on those taking an action. In other words, it
doesnt matter that common sense suggests breathing
in vapour containing a handful of chemicals is better
than breathing in smoke containing hundreds. Until there
is enough evidence to provide scientific consensus that
e-cigarettes are safe, we cannot endorse them. This
is the view taken by the World Health Organization and
by our own Ministry of Health, which currently refuses
to recommend any?use of e-cigarettes.
That sort of scientific consensus is probably a long
way off. There is little available research on the long-term
effects of e-cigarettes because they just havent
been around long enough.
The precautionary principle: against
Massey University Associate Professor Marewa Glover,
who also chairs End Smoking NZ, is less a fan of
the precautionary principle when it comes to public
health policy. She points out the precautionary principle
was used first in the environmental risk arena and that
there arent any real grounds for transferring
it to public health.
Disease and illness are well established areas,
and we have well established practices determining risks
to health so we dont need to rely so heavily on
such a guilty until proven innocent approach,
In a randomised controlled trial, where the particular
new drug being investigated is clearly working and alleviating
harm for the intervention group receiving it, a point
is reached where it becomes unethical to continue withholding
that drug from the control group. Glover thinks the
situation is very similar with e-cigarettes.
E-cigarettes are clearly working in terms of
helping people stop smoking far more than anything
weve seen so far. We may not have had many randomised
controlled trials yet, but the evidence is definitely
mounting, so why make it difficult for people who want
to use them?
She also points out theres an uncanny exchange
between falls in smoking rates and rising e-cigarette
use in the US and the UK that strongly suggests e-cigarettes
help people quit.
And then theres the anecdotal stories from
millions of people who say their health has improved
or that e-cigarettes have saved their lives.?The precautionary
principle is being used by people who fear another industry-driven
epidemic. But an epidemic of what? Whats the disease?
Is the jury still out in terms of the safety of e-cigarettes?
Not at all, Glover says.
But the jury is absolutely in on how dangerous
smoking is, and theres ample evidence of its harm.
With e-cigarettes, there is no evidence of acute or
longitudinal harm whatsoever, even though researchers
are looking for it.
You can buy e-cigarette devices in New Zealand, but
nicotine must be ordered in from overseas because it
is not licensed here for non-medicinal sale. The case
is similar in most jurisdictions, and its a major
impediment, especially if youre not well off.
Nevertheless, e-cigarette use is growing just about
everywhere, suggesting a lot of smokers arent
bothering to wait for the jury. The day is probably
coming when stances soften and e-cigarettes become more
officially sanctioned perhaps not because theres
been a rush of irrefutable evidence but because our
government and Ministry of Health suddenly find themselves
woefully behind the times. Theres little doubt
e-cigarettes are here to stay.
cigarette mortality applies to NZ
that smoking kills half of current
but e-cigarettes do not, it can be
that if NZ has 0.6 million smokers
at present, a total switch of those smokers
e-cigarettes would have the eventual effect of saving
of those smokers (300,000) from predictable
due to smoking. If however,
to E-cigarettes, smoking deaths
decrease by 150,000 over the
consumption, NZ 2014
the years 2010-2014 the average drop
in consumption was 6.3% across New Zealand,
the fall was 23%. For 2013-4 the fall was 3.8%.
was the sum of changes in factory-made and
cigarettes. In March 2013 the Census
that a total of 15.1% of adults smoked daily.
2014 a total of 1% of smokers consumed e-cigarettes
nicotine cigarettes reduces nicotine exposure
this 6-week study 780 smokers (unwilling to quit smoking)
of reduced nicotine cigarettes versus standard cigarettes,
reduced their nicotine exposure, and dependence on nicotine,
and number of cigarettes smoked, as well as craving
during abstinence from smoking. Compensation was minimal.
E. et al. Randomised trial of reduced-nicotine standards
for cigarettes. N. Engl J Med 2015 Oct 1;313:
this study argues that reduced nicotine in the cigarette
means reduced addiction, and increased effect from increased
19 August 2015
out e-cigarettes free in England, doctors told
should be able to prescribe
says Public Health England,
it tried to debunk the myth that 'vaping'
as bad for health as inhaling tobacco
If all of England's eight million
switched to e-cigarettes overnight,
75,000 lives a year would be saved,
say. Not only are e-cigarettes 20
less dangerous than tobacco, they
also among the most effective quitting
Lay, The Times London.
17 July 2015
know a thing or two about nicotine!
the USA, in 2014, 16.7% of adults smoked.
the USA, 6.3 million smokers used e-cigarettes, and
22% used them daily.
nearly 2 million ex-smokers 63% use e-cigarettes daily,
and obtained their nicotine only from e-cigarettes.
nicotine e-cigarettes is illegal in NZ, but smoking
cigarettes which gives more nicotine is legal!)
B. 30 million US adults have used e-cigarettes, unpublicised
CDC data reveals. Tobacco Truth. 14 July 2015.
(based on the 2014 National Health Interview Survey,
released June 29).
1 Jan 2015
Excise and price up again
Excise up 10% and price of 20 cigarettes reaches
$20, and for 30g RYOs, reaches $30.50. Excise will increase
again on 1 Jan 2016.
2 Jan 2014
Murray Laugesen. Nicotine and Health – American Council on Science and
Health, New York.
special interest to smoking cessation experts and policy
This world-first publication
(71 pages, 137
1 How nicotine affects your
2 How smokeless affects your
3 Electronic cigarettes.
To view the free copy see http://acsh.org/2014/01/effects-nicotine-human-health/
more details please see