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Thread: The Lancet, top medical journal, cautiously recommends e-cigarette liberalisation

  1. #1
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    The Lancet, top medical journal, cautiously recommends e-cigarette liberalisation

    http://download.thelancet.com/flatco...3613615342.pdf

    The Lancet is regarded as the second most influential medical journal in the world just behind the New England Journal of Medicine, and it contains the latest NZ study (already posted) and the commentary linked here is fairly positive! This is really good news, and hopefully it puts a stop to the EU madness.

    An extract from it: (sorry about the formatting)

    " If traditional cigarette sales decline as e cigarette
    sales increase, it would suggest that e cigarettes are
    normalising non smoking and that it is in the interest of
    public health to promote and support their development
    rather than try to restrict it. The European Union and
    UK are currently proposing to regulate e cigarettes as
    medicinal devices, while leaving cigarettes available on
    general sale.
    If this regulation goes ahead, tobacco
    cigarettes will retain their market monopoly and we
    will never learn whether e
    cigarettes would replace
    traditional cigarettes if allowed to continue evolving and
    competing with smoked tobacco on even terms.


    There hardly exists a commentary that would not
    recommend more research, and this one is no exception.
    More data are needed on the efficacy of e cigarettes
    in smoking cessation and in harm reduction (when
    used under different conditions and compared with
    different comparators); on their long term safety, both
    in comparison with cigarettes (whereby e cigarettes
    can be expected to be orders of magnitude safer) and
    in absolute terms (whereby some health risks might yet emerge); and most importantly, on the effect that increasing e
    cigarette sales are having on sales of tobacco
    cigarettes. In terms of practical implications of the results
    of the study by Bullen and colleagues, stop smoking
    services which distribute nicotine replacement therapy
    with minimum support now have a cheaper alternative
    to consider, and health professionals will now hopefully
    feel easier about recommending e cigarettes to smokers,
    or at least condoning their use."

  2. #2
    T7x
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    I'll vape to that.
    Thanks for sharing.
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    Do you know de way 👺

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    Excellent post VoG. Thanks.

    Finally, people are finally understanding that medical regulation of ecigs is very bad.
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    I start to see a cautiously optimistic light at the end of the tunnel

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    Just read Carl Phillips' response. I beg to differ.

    A less impressive, but still positive result in such a major journal as the Lancet is more influential to policy makers and medical organisations that drive such policy than masses of social media and anecdotal reports. Carl is technically right, but like it or not, what the Lancet says is going to have far more influence.

    Until now, most mainstream organisations like the WHO, the AMA and others have been dead set against vaping. I see this as the first crack in the wall. The turning point perhaps. They draw the right conclusions, that heavy handed regulation and medicalisation of e-cigs simply protects tobacco from competition.

    As an example, take this paper's abstract. A lot more positive, but the methodology is qualitative and thus not seen as "hard science" It is in a small journal, so can be easily ignored or dismissed.

    "Addict Sci Clin Pract. 2013 Mar 5;8(1):5. doi: 10.1186/1940-0640-8-5.
    Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach.
    Barbeau AM, Burda J, Siegel M.
    Source

    Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118, USA. abarbeau@bu.edu
    Abstract
    BACKGROUND:

    Nicotine is widely recognized as an addictive psychoactive drug. Since most smokers are bio-behaviorally addicted, quitting can be very difficult and is often accompanied by withdrawal symptoms. Research indicates that nicotine replacement therapy (NRT) can double quit rates. However, the success rate for quitting remains low. E-cigarettes (electronic cigarettes) are battery-powered nicotine delivery devices used to inhale doses of vaporized nicotine from a handheld device similar in shape to a cigarette without the harmful chemicals present in tobacco products. Anecdotal evidence strongly suggests that e-cigarettes may be effective in helping smokers quit and preventing relapse, but there have been few published qualitative studies, especially among successful e-cigarette users, to support this evidence.
    METHODS:

    Qualitative design using focus groups (N = 11); 9 men and 2 women. Focus groups were conducted by posing open-ended questions relating to the use of e-cigarettes, comparison of effectiveness between NRTs and e-cigarettes, barriers to quitting, and reasons for choosing e-cigarettes over other methods.
    RESULTS:

    Five themes emerged that describe users' perceptions of why e-cigarettes are efficacious in quitting smoking: 1) bio-behavioral feedback, 2) social benefits, 3) hobby elements, 4) personal identity, and 5) distinction between smoking cessation and nicotine cessation. Additionally, subjects reported their experiences with NRTs compared with e-cigarettes, citing negative side effects of NRTs and their ineffectiveness at preventing relapse.
    CONCLUSION:

    These findings suggest tobacco control practitioners must pay increased attention to the importance of the behavioral and social components of smoking addiction. By addressing these components in addition to nicotine dependence, e-cigarettes appear to help some tobacco smokers transition to a less harmful replacement tool, thereby maintaining cigarette abstinence."

    The Lancet cannot be ignored or dismissed.

  6. #6
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    The funny thing is I know that it works, because it worked for me, and it was surprisingly easy to transition and that what makes it so frustrating. I will have been tobacco free for 2 years next month.

    When i read this article i didn't find the extent of the effectiveness of ecigs over trad nrt enough to warrant anybody jumping for joy, but recently the articles coming out from the UK saying that ecigs were the biggest cessation method currently a bit more encouraging.

    At the moment what the ANTZ are nailing us on is the dual-use question, this leads to some questions.

    Is a significant drop in tobacco use while vaping a good thing, or is smoking 2 cigarettes a day compared to 20 still incurring the same bad health effects.

    Is the dual-use snapshot just that, a snapshot, part of a process whereby the user eventually exclusively vapes (this for me would be an interesting study is it would take different people more or less time to be exclusively vaping (if at all) )

    When talking about this i always have to include the fact that if people want to smoke, they can and I really don't care or judge them any more harshly or otherwise now that I vape. I only pity them for the sole reason of how much they are paying for their cigarettes and how they are being right royally exploited by the government (Rudd is a perfect example of an exploiter, and thats coming from a labour voter).

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    Quote Originally Posted by tugboatofdeath View Post
    The funny thing is I know that it works, because it worked for me, and it was surprisingly easy to transition and that what makes it so frustrating. I will have been tobacco free for 2 years next month.

    When i read this article i didn't find the extent of the effectiveness of ecigs over trad nrt enough to warrant anybody jumping for joy, but recently the articles coming out from the UK saying that ecigs were the biggest cessation method currently a bit more encouraging.

    At the moment what the ANTZ are nailing us on is the dual-use question, this leads to some questions.

    Is a significant drop in tobacco use while vaping a good thing, or is smoking 2 cigarettes a day compared to 20 still incurring the same bad health effects.

    Is the dual-use snapshot just that, a snapshot, part of a process whereby the user eventually exclusively vapes (this for me would be an interesting study is it would take different people more or less time to be exclusively vaping (if at all) )

    When talking about this i always have to include the fact that if people want to smoke, they can and I really don't care or judge them any more harshly or otherwise now that I vape. I only pity them for the sole reason of how much they are paying for their cigarettes and how they are being right royally exploited by the government (Rudd is a perfect example of an exploiter, and thats coming from a labour voter).

    As I said earlier, I'm not ready to concede that Dual Use is not a myth. I know Simon Chpman is doing the dance right now over the clinical results, but I still believe that a nicotine consumer will either use tobacco cigarettes and lie about quitting, or they will actually become exclusive vapers. I don't believe there really is an in between. Not yet anyway. The main thing to take from the recent clinical trial was one very important piece of information : that ecigs show potential to administer nicotine with reduced risk to help smokers to quit.

    This was my response to Carl Phillips post ;

    We need to keep in mind that both clinical trials for e-cigs that have come out in 2013 were done using cigalike batteries – the 3.3V, 180mah prefilled cigarette-lookalike devices. The first clinical trial used the Catergoria ecig, and the more recent was PGM’s Elusion ecig.

    As Rory Morrison noted;

    “one issue to be clear on is that the results of the study only really applies to the brand that was tested (which was a fairly low-performance and basic e-cigarette model). E-cigarettes take many different forms and improvements in technology are rapid. If a higher performance ‘second generation’ device that provided better nicotine delivery or better consumer experience were used, results could be different. Hopefully following this study, others will design research looking at this.”

    E-cigarettes versus Nicotine patches tobaccounpacked

    The results from both these studies are far less than great, and most of us ecig enthusiasts expected it to go this way.

    If you read the vape forums, you’ll learn that these first generation ecigs, such as the one that the four Big Tobacco companies are trying to flog (BAT’s Vype, RJR’s Vuse, Lorrilard’s BlueCig, Phillip Morris’ MarkTen), and of course PGM’s Elusion ecig used in this clinical trial, are used as introductory models. A lot of vapers report to have made only a single purchase, and then quickly moved onto 2nd Generation devices such as the eGo model.

    When a clinical study has been conducted using 2nd Generation ecigs, for example the eGo battery with refillable tank systems, and 18mg/ml nicotine liquid bottles, I’ll take these studies more seriously.

    We need to start a movement to have 2nd Generation ecig product clinically tested. Enough of this bullshitting around with the cigalikes.
    I am very confident about the 2nd generation ecig products. You wont need to talk to people or read their blogs. At the end of a 13 week trial, I am confident that even in this non-real world setting, the majority of those given the 2nd generation electronic cigarettes would have quit smoking completely. 2nd generation ecigs will simply be the end of tobacco smoking. The Big tobacco companies know this, and it’s why they arent selling them.
    Last edited by mavinry4; 10-09-13 at 02:17 AM.

  8. #8
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    A less impressive, but still positive result in such a major journal as the Lancet is more influential to policy makers and medical organisations that drive such policy than masses of social media and anecdotal reports. Carl is technically right, but like it or not, what the Lancet says is going to have far more influence.
    I think that you are missing Carl's point. His point being that the margin favoring ecigs in this study is small enough to be a rounding error. Meaning that if the same study was conducted with different participants using the same methods it could easily come out the other way favoring patches as being the more effective.

    The danger of putting too much emphasis on studies like these is if more studies come out (and they will) and they don't favor ecigs then where will we be then? We can't well turn around then and say these studies don't matter.

    The most important factor in this study was the positive comments regarding ecigs as you pointed out. But this wasn't dictated by the science - it was dictated (fortunately for us) by the politics of the authors who interpreted the science in a favorable light - favorable to us.

    The same study can (and will) be interpreted differently.

    I don't mean to be negative VOP. It was a good result for us. But I disagree that the science dictates public policy. It is rather the politics of the policy makers and health professionals that dictates the science.

    And basically that is Phillips point. This kind of science is so easily manipulated that it is a dangerous game to put all our eggs into its basket.
    Last edited by pgscott; 10-09-13 at 02:33 AM.
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  9. #9
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    Dual-use is not a good enough excuse to destroy the ecig market through medicalisation. Its just used as a convenient reason to invalidate vaping because imho it is threatening to tobacco control industry employees because its not one of their initiatives and it might actually be much more successful.

    I understand what you are saying about non-cigalikes, but at the moment they are the introductory end of the market and you never know if a lot of people might just stick with them which is a bit of a shame and i hope it changes, ffs how hard is it to purchase a ego twist + evod/protank/vivi and get some juice.

    I am guessing (and may be wrong) that currently the *majority* of people using ecigs would be using cigalikes.
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  10. #10
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    Quote Originally Posted by tugboatofdeath View Post
    Dual-use is not a good enough excuse to destroy the ecig market through medicalisation. Its just used as a convenient reason to invalidate vaping because imho it is threatening to tobacco control industry employees because its not one of their initiatives and it might actually be much more successful.

    I understand what you are saying about non-cigalikes, but at the moment they are the introductory end of the market and you never know if a lot of people might just stick with them which is a bit of a shame and i hope it changes, ffs how hard is it to purchase a ego twist + evod/protank/vivi and get some juice.

    I am guessing (and may be wrong) that currently the *majority* of people using ecigs would be using cigalikes.

    I'm sure there are customers, but I've read so many times about people who purchased the elusion ecig, and threw it out after only a week or so. I honestly expected this result.

    Maybe the elusion ecig would have worked if they used higher nicotine levels, such as that used in the NJOY and Vype ecigs (35mg/mL and 45mg/mL). The higher concentration of nicotine is required because the voltage is so low. The elusion ecig does come with a portable charger which takes care of the charge time.

    But in the end, I think the cigalikes are only going to work on people who dont care about price. Prefilled cartos are very expensive, but more importantly, unless you have system like the one BluCig is developing where the portable charger has a GPS alert system letting you know where you can purchase new refills nearby, cigalikes are not going to sell.

    A person who is willing to stockpile prefilled cartos is someone who would learn about and quickly switch over to ejuice bottles, in which case, they'd start using eGos and clearomizers.
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