WHO FCTC suggestions and Finland

It seems my dear little corner of northern Europe has taken a head start with regulation suggested by the WHO FCTC. Reading through the points they give for consideration versus our national law since 15th of august 2016:

Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options: 
Our national health body suggested we should be banning ecigs alltogether, but EU is "forcing" us to allow them on the market. Ecigs were never banned, but all nicotine was classified as medication.

a. Banning the sale and distribution of ENDS/ENNDS to minors; 
In force
b. Banning the possession of ENDS/ENNDS by minors; 
In force for nicotine containing devices and liquids
c. Banning or restricting advertising, promotion and sponsorship of ENDS/ENNDS (see FCTC/COP/6/10 Rev.1); 
Complete ban of anything that might resemble any of these. Including product information on the internet, in face to face discussions with a store employee, and so on
d. Taxing ENDS/ENNDS at a level that makes the devices and e-liquids unaffordable to minors in order to deter its use in this age groupvii. In parallel, combustible tobacco products should be taxed at a higher level than ENDS/ENNDS to deter initiation and reduce regression to smoking; 
Draft legislation going to the parliament in september to add 30c/ml tax on liquids with or without nicotine, suggested to come into force 1.1.2017. However, the ministry of finance already budgeted the tax for next year. The tax would increase price of a 10ml bottle higher than a pack of cigarettes initially and level out to about the same in 2018. Possibly also adding things like 1500 euro tax on a 5 litre glycerine can if sold in a vape shop.
e. Banning or restricting the use of flavours that appeal to minors; 
Ban on characterizing flavors, as defined by the directive. Basically only cigarette flavour is allowed in liquids with or without nicotine.
f. Regulating places, density and channels of sales; and 
Channels restricted to physical stores only, places restricted somewhat. Health orgs suggest suppressing density of points of sale from 400 000 to 500, though this one is not in the legislation.
g. Taking measures to combat illicit trade in ENDS/ENNDS
No consideration given to black markets for some reason. Police has noted on snus that "sorry, but we have real work to do", presumably ecigs are not really different in that.

i. Testing heated and inhaled flavourants used in the e-liquids for safety, and banning or restricting the amount of those found to be of serious toxicological concern such as diacetyl, acetyl propionyl, cinnamaldehydes or benzaldehyde; 
Flavors banned.
ii. Requiring the use of ingredients that are not a risk to health and are, when allowed, of the highest purity; 
In force
iii. Regulating electrical and fire safety standards of ENDS/ENNDS devices; 
Not specific to ecigs, but exists
iv. Regulating the need for manufacturers to disclose product content to government; 
In force
v. Regulating appropriate labelling of devices and e-liquids;
In force. Though "appropriate" is highly debatable. 
vi. Requiring manufacturers to monitor and report adverse effects; and 
In force
vii. Providing for the removal of products that do not comply with regulations.
In force, with mandates offering the government officials power to do this simply at their own discretion. Includes trying to regulate cotton, wires, etc as ecigarette parts and flavorants and bases as nicotine free liquids.

b. Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options to minimize health risks to non-users: 
i. Prohibiting by law the use of ENDS/ENNDS in indoor spaces or at least where smoking is not permittedviii;
In force for both
ii. Requiring health warnings about potential health risks deriving from their use. Health warnings may additionally inform the public about the addictive nature of nicotine in ENDS; and 
In force, requires two languages
iii. Reducing the risk of accidental acute nicotine intoxication by a) requiring tamperevident/child resistant packaging for e-liquids and leak-proof containers for devices and e-liquids and 
In force
b) limiting the nicotine concentration and total nicotine amount in devices and e-liquids. 
In force. Though legislators forgot to add empty tanks to this and now are in the process of changing that.

a. Prohibiting implicit or explicit claims about the effectiveness of ENDS/ENNDS as smoking cessation aids unless a specialized governmental agency has approved them; 
In force. No approval possible under tobacco act.
b. Prohibiting implicit or explicit claims that ENDS/ENNDS are innocuous or that ENDS are not addictive; and 
In force
c. Prohibiting implicit or explicit claims about the comparative safety or addictiveness of ENDS/ENNDS with respect to any product unless these have been approved by a specialized governmental agency.
In force, no approval possible under tobacco act.

I wonder, is Finland a breeding ground for these things? They keep passing with very little to no objection.
Most absurd thing is, Finnish ASH actually considers this a "decent middle ground".

Part 14: Testing my addiction again and some thoughts on dependence scales

Earlier today, I released a questionnaire in Finnish that is based on the nicotine dependence syndrome scale (NDSS). It's something that seems much more appropriate to the wider audience I want to capture, even though it is designed to measure the dependence in smokers specifically. I did edit it somewhat to suit the need of measuring nicotine dependence between different products, because that sort of thing is rarely if ever done.

The reason for that are mainly these:

- It is widely assumed that nicotine products are equivalent in their "addictive" potential, which is of course absurd considering the huge differences in chemistry.

- Simply introducing a chemical to the system is not even remotely enough to induce addiction in any meaningful sense, so logically also the amount of that chemical in the system cannot be used to determine how addicted a person is or even if they are at all.

- The only widely used instrument is the fagerström test for nicotine dependence (FTND), which is notoriously bad when it comes to anything that is not smoking. It's simply utterly uninformative when it comes to a product that is not highly standardized and as such, extremely consistent in the effect it has when it comes to heaviness of use.

For instance, when I was a smoker my FTND score was "8 - high dependence". Now I don't actually smoke in any consistent capacity and it still indicates a score of one, because it assumes cigarettes are consumed regularly. Trying to modify it to fit vaping seems like a fool's errand, because there simply is no reasonable method to determine what amount is equivalent to a specific number of cigarettes.

NDSS however, goes into much more detail and leans much more on aspects like social issues, impulse control and so on, while leaving out the explicit reliance on heavy use. It also corresponds well with the diagnostic and statistic manual for mental illnesses, which has one of the most common descriptions of addiction.

My interest in doing this on a wider scale came from reading through a lot of different methods of measurement and applying some of them on myself, including comparing my scores from when I was a smoker and now as a vaper. While very subjective of course, what I realized that at least I have a very radical difference experience and that actual studies of dependence in vapers and other alternative nicotine users are unbelievably rare, despite all the claims of "switching one addiction for another".

So, I'll show you what I mean by radical difference :)

NDSS uses different scales for it's multi-dimensional analysis, which in the source material I used were condensed like this:

Drive and priority, meaning the time and necessity to engage in nicotine use

Stereotypy and continuity, meaning the consistency of nicotine use from day to day

Tolerance, which is self evident

And a total score, which can be used as a sort of dependence score

Here's what came up in my calculations, which are rather rough approximations, but should give an idea:

Drive/priority - vaping score a bit under half of smoking

Stereotypy/continuity - vaping 1/3 lower

Tolerance - vaping 1/3 lower

Total score - vaping slightly less than half of smoking

These results are also fairly consistent with smokers defined as nondependent, except in the stereotypy and continuity scores, because my consistency of vaping is much higher.

Obviously the fact is that this is in no way scientifically rigorous (to be blunt. it is rather unscientific really, sorry about that), just my subjective analysis of myself. But it did give me a bit more information to add to the hypothesis, that vapers are significantly less dependent than smokers.

This also highlights something more about the fagerström test, suppose it was modified to a vaping dependence scale, I would very likely score substantially higher simply due to the fact that I do vape a lot.. Despite both the NDSS and DSM indicating my addiction is low to nonexistent.

Now, the problem does somewhat remain with NDSS too, it's not fully compatible with vaping either.. But it does seem to be the best option we do have right now. There remains a distinct need to design a scale that properly works with alternative nicotine products.

But I am hopeful NDSS offers a useful starting point.

To be continued.. :D

E-liquid taxing scheme proposal doing the rounds in Finland

There are a few common constants in the way the Finnish government treats vaping products.

The primary one is that they release a legislation draft, and all the communication around the details in public are made with certainty. This is what we'll do and this is what will happen. No ambiguity whatsoever. Then various organizations and special interest groups make their statements, including whatever arguments and (occasionally, but mostly no) data they deem relevant to the issue.

More often than not, these statements include several points where the law could be stricter.

Committees hear out the statements, and then go on to change more or less nothing.

Makes you feel like the commenting process is just for show.

The other one is that most of the justifications so far have been disjointed to some degree. A lot of jumping to conclusions happens around issues where no substantial evidence exists, making assumptions about the impact of certain things without considering if such events are even plausible.

This time though, the tax law proposal manages to first make a rational assessment about the impact of a sin tax on e-liquids and instantly ignore it's implications completely:

"It can be assumed, that if e-liquids are not taxed, their consumption as a substitute for conventional cigarettes would decrease the consumption of products currently subject to tobacco tax" aka smoking, since all other forms are illegal.

And then they go on to claim this:

"The decrease om consumption of electronic cigarettes due to the implementation of the tax can be estimated to have a positive impact on public health. The positive impact is assumed to be associated with the prevention of uptake of electronic cigarettes, which would prevent the development of nicotine addiction"

No citations of any kind included. No consideration of the fact that the vast majority of vapers are current or former smokers. They also claim there's no tax on electronic cigarettes, which is blatantly false since VAT applies like everything else.

Like I said, disjointed. Very much so.

The Finnish goverment is proposing a tax of 30c per ml, or 3 euros per 10ml bottle. The proposal calculates that the cheapest liquids would double in price with the implementation of this tax. And they want to apply it to both nicotine liquids and nicotine free liquids, based on the idea that this way nobody needs to test if the liquids have nicotine in them or not. Though there's some more gaps in that logic, since every single liquid has to go through the notification process anyway with mandatory testing of the nicotine content and exposure and has to have nicotine volume marked on it..

They do note that the tax would likely increase overseas sales of nicotine free liquids, since they are not subject to distance sales restrictions like nicotine liquids are. I'd estimate that the future liquid market for knowledgeable vapers will develop something like this: People will order large amounts of nicotine free liquids overseas, since it's likely to be around 50-60% cheaper and non-tobacco flavored liquids are illegal here, possibly smuggle high strength nicotine and mix their own. The rest will buy home mixed liquids from other people in dedicated facebook groups.

Current smokers and very new vapers, as in the people who are not part of online communities though?

Screwed.

Basically people will either be ignoring the law or be hurt by it. It will cause unnecessary and arbitrary criminality and death.

Part 13: Thoughts on harm creation

Lately, I've been watching some very interesting lectures on the underlying factors that lead to and exasperate behaviours to such a degree, that they get defined as diseases or disorders under the umbrella of addiction.

Two basic premises came up that were suggested to lie at the core of pathological addictive behaviour:

Structural chages in the brain reward circuitry:

A process involving hypersensitization of the dopamine release process, that leads to overactivative reward pathways (and the physical tolerance-withdrawal cycle) and at the same time loss of activity in the regions that reguate things like impulse control. It has been suggested that the brain scans of these two regions is a reliable way of testing for the presence of addiction. This is kind of a potential objective measure which could be used, unfortunately it seems quite hard to implement on a larger scale, so the prevalence of subjective measures based on mostly frequency of use persist. But it does have some very interesting implications in comparing for instance different nicotine products and their effects on the functionality of the brain.

Chronic dysphoria:

Dysphoria refers to a sort of feeling of social unease, restlessness and is a source of fairly high stress. Others spell this out in with examples, like lack and dysfunctional social connections. It has been long established that functional social networks and relationships are a great resource for not only relapse prevention and helping people with problematic use, but protective against susceptibility for the development of problems in the first place. Dysphoria also seems to exasperate existing problems, due to an increased need to "self-medicate".

The concepts around dysphoria are a great interest to me, and I've touched on similar things in this blog in the past on some thoughts on "creating" addicts by conjuring a problem out of thin air in people that do not actually have addictive behaviour. What I got to thinking during the lectures is somewhat along the same lines of that, but involving the people that are actually addicted.

It seems clear, that if dysphoria is a driving factor in problematic use, then the de-normalization efforts of shame and stigma in reality are not just immoral. They are extremely counter-productive, possibly making the existing problems much worse. 

Potentially so much worse, that it's entirely possible the intentionally created social discomfort and anxiety is potentially acting as a cause of moving to more dangerous, even deadly behaviours AND making them worse.

A self-fulfilling profecy if you will, as low risk product use is generally opposed on the back of this effect happening caused by the product use itself.

A core rule of any policy and regulation measures is (or should be), that the action is weighed against inaction and trying to analyze which option is actually beneficial.

This, simply does not exist in the field of tobacco control. They seem to want any and all possible restrictions they can possibly think of, regardless of the consequences. And if the stick doesn't work, get a bigger stick with more pointy things on it.

it's a steep hill to climb, but I do hope we can get to a point, where people can be treated as human beings again.

As for THR-product use.. My hypothesis so far is that for instance vaping should likely have a fairly radical difference to smoking in the measures for both the addiction inventory questionnaires (excluding things like FTND, which is useless for vaping) but also in the decreases and increases of brain activity potentially associated with addiction.

I would love to see that study!

Maybe then we could see some of the intentional creation of dysphoria fade away and start being rational about nicotine use in a wider scale, not just the echo chambers of advocates.

Part 12: Conflicts of self-interest

Two days ago, I dropped a gofundme page (https://www.gofundme.com/deetwo7) on twitter, after a long time of thinking about doing it and two more weeks of not telling anybody about it. 

Asking for financial help, even when it became absolutely necessary, while doing something I'm perfectly willing to do for free felt weird. It still feels weird.

Advocacy is something that feels like you do because there's a passion and necessity, and getting paid for that is somehow antithetical to the whole idea. But that does get me thinking.. why is there so much assumed conflict of interest in this area?

Anti-tobacco crusaders and various other public health advocates that oppose nicotine use generally tend to be actually paid to do that. They generally work in healthcare or NGOs that drive health-related political agendas. 

And they often seem genuinely surprised people on the other side are not paid by anybody. So much that they might not even believe it, and resort to some form of financial incentive blame game.

Why doesn't the same standards apply to them?

Why do I have this idea in my head that getting something in return for hundreds of hours of work is somehow "wrong"? I'm honestly not entirely sure.

And if the financial angle fails, the final determination in their chain of logic seems to be "you're just addicted". And everybody "knows" you can't trust an addict.

But addiction can only be measured by asking the addict about their behaviour. No truly objective measure or test exists for the determination. There's no machine that can detect addiction, no kind of physical biomarkers that could be investigated.

So, if an addict cannot be trusted, can the tests be trusted?

Is "you're just addicted" even a meaningful argument anyway? Because even if they are, that certainly does not mean they are lying or wrong. It just means a very subjective set of criteria happens to match their behavioural patterns, without necessarily meaning problematic use.

Is addiction a conflict of interest, if it cannot even be meaningfully defined?

What I wonder is, how deep is the (for the lack of a better word) "brainwashing" of temperance movements, that even me as a fairly libertarian advocate have these notions coloring my perceptions of doing this work..

I'm quite certain that promotion of THR is helping reduce the burden of death and disease and I'd like to think I'm having some sort of impact, but still there's a feeling of embarrasment lurking at the back of my head when I'm asking for financial help.

Intellectually, it's quite strange and counter-intuitive. Really feels like being forced to play by the rules of zealots and having no say in what's actually rational. The kind of influential manipulation scheme the tobacco companies can only dream of.

Tobacco control really is an inherently dishonest field.

And as a more positive note, enormous thanks to everybody who has helped. Got a LOT of stress off my shoulders.

Part 11: Feeling ranty. Finnish Tobacco Act ratified today.

Today, one of the most stringent implementations of the tobacco products directive was ratified in Finland.

The one I've been blogging about, fighting over with health organizations, trying to correct misconceptions in the media and written official statements as a part of an editorial team of a vaping association based on various studies and also as myself personally, where I've been leaning more heavily on pragmatic sense of morality and various standards of legislative actions that are supposed to be in effect in the European Union and Finland as a part of it.

Namely the principle of proportionality, which states that two different products should not be regulated in the same way without substantial justification. 

And yet, that is exactly what Finland did today. Despite being offered vast amounts of argumentation and evidence showing they are substantially different. They simply refused to listen and referred to their unsubstantiated claims made without citations, that we and I already specifically answered to, and stated there is no need to make changes. Including issues that were simple flaws of grade school math or basic understanding of human behaviour.

Our constitutional committee didn't even comment on the issue of low risk products at all.

 

Our social and health affairs committee referred to the same unsubstantiated claims made without citations.

They basically insisted on justifying all the vaping restrictions based on the harms of smoking and proclaimed the violations of proportionality with pride.

But, at least they promised us that availability of nicotine liquids would not be interrupted and set a grace period so people can order them abroad during the mandatory 6 month notification period.

They just neglected to set the grace period AS 6 months... 

So now it's a static date and the tobacco act is almost two months late (because some MPs felt like we're falling behind in the "strictest tobacco act" game, they forced in an amendment to add an unenforceable ban on smoking (and vaping) in cars if a child under 15 is present that doesn't even have a penalty, but is supposed to "spark discussion at daycare centers").. 

As a consequence, at a minimum a 1,5 month gap is going to happen in january-february when there will be no legal way to get nicotine liquids other than physically importing them 10ml at a time, because apparently that's enough for a vaper for two weeks and is equivalent to 200 cigarettes.

Which means there will be people going back to smoking and also likely others becoming criminals because a law that was not based on logic or evidence was passed.

And after we do get nicotine liquids on the market, the only flavor allowed is tobacco. Because apparently kids learn how to smoke with liquids that taste good and then move on to cigarettes that don't?

That kind of causal pathway might be likely to happen to somebody somewhere at some point, but in trying this hard to prevent that they seem to be shifting the net effect to the side of more smoking, not less.

I'll just quote the first paragraph of the tobacco act here, which I think will illustrate this whole unmitigated disaster perfectly (my own translation):

"1§

Aim of the act

The aim of this act is to end the use of addictive tobacco products that contain substances toxic to humans and other nicotine containing products.

To achieve the aims mentioned in paragraph 1 this act enacts measures that prevent the initiation of tobacco products and formation of nicotine addiction as well as promote ending the use of tobacco and similar products and protect the public from exposure to their smoke."

I recently dropped a little soundbyte on twitter and I think it will fit perfectly here:

"Denial of the principles of harm reduction is the implicit acceptance of avoidable misery, disease and death"

I just...

I'm ashamed. I really don't feel proud to be finnish today.

Just a random aside from Warsaw

Well, warsaw is kind of amazing. So glad I got to be here :)

Plenty of things to disseminate, new ideas and a lot of new energy to go with them. Been talking to a lot of people and it has helped me further some of my thoughts about addiction from especially a sociological standpoint.. Especially the lovely and brilliant Amelia Howard. Her presentation and just discussing all kinds of issues got me back to thinking of the underlying mechanisms.. And I really do believe there's a legitimate cases to be made on multiple fronts, ranging from the neurochemistry to the social to simple pleasure and evolutionary psychology sort of serving as groundwork.

Whether or not I'm actually capable of connecting those things remains to be seen, but I think I'm going to try. I think we need a much more comprehensive model of dependence, addiction and where we can draw lines between continuous use and pathological behaviour.

I think vaping not only improves the quality of life for a lot of people, maybe even saves them, but the phenomenon importantly has the potential to open up new lines of thought and understanding how people work.

Part 10: Testing myself, addictiveness and mental state

First off, I'll start with being candid. Well, more so than normal I guess.
I have no disdain for smoking and even less for smokers. I don't really have a negative attitude towards cigarettes, despite strongly being an advocate of the alternatives (not just vaping).

I still smoke on occasion, maybe once a month or two, because I still like the distinct experience it offers. And a menthol cigarette every now and again opens up my olfactory senses like nothing else, while offering a much more intense psychoactive effect than my normal low concentration vaping liquids. Also going out on the balcony is somehow quite different with a cigarette than it is with my ecig, the latter kinda feels silly since I do it inside most of the time. The behavioural pattern is completely different for me, and I can fall into the smoking thing very much fluidly, it comes naturally to me. Vaping does too, I can easily switch back and forth if I want to do so.. somewhat similar to how some of my nurse friends switch between the sleeping rhythms of night, day and morning shifts.

During my "career" of vaper and in researching addiction I've learned to be much more analytical of my dependencies and related mental states. I'm always trying to build a big picture of whatever addiction is and trying to look at it from as many angles as I can, especially including my own perspective.
Now, last week it just happened that my nicotine reserves ran out. And it takes five working days to order abroad, so basically I had to wait a week to have nicotine liquids again.

First off I took a few days to see if any withdrawal progressed. Took around 8 hours or so for the lack of nicotine to be noticeable, my thoughts felt a bit less crisp and focused. Four days or so forward, the feeling was pretty stable. No major cravings or negative psychological impacts. But I did miss the effects of nicotine, as I value my mind over almost everything else. Bought some lozenges, mildest available.. But even those were physically awful, like a cheese grater in your throat and yet the effect of the nicotine was very underwhelming. I just couldn't handle a whole one.. Maybe next time I'll try patches instead :D

Over the weekend I decided to test out my tolerance for smoking again and sort of risk falling off the wagon (with menthol-black currant camels which actually taste rather good). So I bought a pack on friday morning and fell right back into the 1 per hour regularity I had 1.5 years ago. But something was decidedly different this time around, as I no longer have the second order preference of wanting to want to quit and associated congnitive dissonance.
I smoked intentionally, simply because I wanted to enjoy it.

Later that night I went out to drink, left my pack at home and never even thought about having a smoke at the bar.. I just had my zero nic liquid and dripper with me. Drinking is the one instance where the lack of nicotine is not meaningful, as while drunk my mental faculties are not exactly up to par anyway, so the same feeling of missing the effect doesn't come up.
Saturday and sunday I continued smoking, pack a day as before. Maybe a few less due to also having vaping devices around. Either way, according to the standard metrics (heavy smoking index for example), I was addicted to smoking during the weekend.
Monday I think I had half a lozenge, but felt quite fine. And on tuesday got the nicotine shipment, so business as usual vaping away and no lasting cravings of smoking or withdrawal.

Earlier in this series I noted how perception looks like it shapes the condition of "addiction" significantly and to me this little experiment only reinforces that notion. When I had no competing urges to both use nicotine and stop smoking, the difficulty simply was not there.

What the week taught me is that I'm mentally dependent on nicotine. It's not in any way problematic, but my thought processes work with a different sort of clarity with a small amount of nicotine in my blood stream. Whether or not that is some sort of withdrawal avoidance or the effect of nicotine, I'm not entirely sure (though studies suggest the latter, or maybe a bit of both)..

But I simply do not want to stop either way. If vaping was made impossible, it's more than likely I would go back to smoking.
I'll even rather take the risks than not use nicotine.

I'll choose my cognitive faculties every time.
I trust myself to be enough of a rational actor to make the informed choice myself.

And "addiction" continues it's journey towards absolute vacuousness.

Part 9: Preliminary thoughts on my ongoing vaping experience survey

I published a survey that looks tiny, but has proven to be quite fruitful. Even more than I thought too. A couple hundred answers in now and a big picture is already emerging and I'm finding it truly fascinating. English and Finnish versions of the survey here :)

I had my suspicions on the progression and reasons for the apparent efficiency of the vaping habit and experience, based on my own experience I have been outlining a bit in this blog already. This is a very illuminating exercise and is intended to build upon my existing knowledge from the literature and user reports, focusing on an aspect that is very often overlooked in scientific discussions:
The experience itself as a social phenomenon.

Addiction has a weird status in the current society, it's a sort of "I'll know it when I see it" kind of thing and all the current attempts at defining it fail to adequately make any distinction between the supposed pathological patterns and simply just continuous behaviour. The former is included, but not necessary for the determination, which makes the whole exercise rather pointless.

I think a more comprehensive understanding of the behaviour is necessary, before the concept of addiction can be solidly defined, in a sense of determining what it's not. And this is what I am attempting to establish and solidify. Deeper understanding and knowledge.
Even if only for myself, though obviously I'm hoping I can make an impact past that as well.

But, for now.. As I obviously did not participate in they survey myself, I'll just give my answers here:

1. I smoked for around 17 years, with the last decade being a bit over 20 cigarettes a day.

2. What I would miss the most is the enjoyment I get from the experience, the sense of community, all the little fiddling with juices, coils and so on.. And being a part of something far greater than just e-cig advocacy. The emergence of vaping is not just a new technology and consumer product, it's a social phenomenon that highlights a lot of the failings of conventional wisdom around nicotine and addiction. I don't think I'd honestly stop doing research even if I'd quit vaping.

3. What got me vaping was a desire to decrease the distress caused by smoking while knowing it was harmful to not only in terms of health, but economical issues as well. Money did play a big part in the choice.

4. I continue vaping because of it's many benefits which I outlined above. Flavors are a integral part of that and the huge variety is something that keeps the novelty alive, the experience fresh and enjoyable.

5. I would like to thank everybody who is taking part in this quest of mine and hopefully you too will have realizations of new things along the way while thinking about these things. I love the community and the sheer enthusiasm that exists within vapers.

To be continued :)

Part 8: Some thoughts on morality, disease and addiction

Getting back to more personal views on the issues, I've been thinking a lot about the classifications surrounding vaping and nicotine use. It basically all starts with morality.

To me, the question of morality is very simple. A moral act is something that increases wellfare and well-being or decreases harm. A rather straight-forward risk-benefit analysis. I realize this is a somewhat nihilistic position on the concept, but to me it seems to be the only definition that really matters in a pragmatic sense.

Most importantly, this does preclude statements of immoral behaviour simply on the basis of what is and suggests that the consequences are the primary consideration, whether or not the net benefit of an action or behaviour is positive or negative. In a sense, it seems to me that being moral is the result of evolutionary processes that has led to us as a species being extremely social, the existence of empathy and acting on that impulse.

This is exemplified in the principle of harm reduction. What we should do is determined by evaluation if an action is likely to cause more harm or reduce it.

Ascribing meaning beyond these simple terms is usually an addition of personal bias, subjective views and the dilution of objective consideration. What matters, is well-being and welfare and not what some people might consider offensive or "unwanted", absent any considerations into evidence of actual harms and often at the expense of well-being and welfare of other people. The problem with most claims of morality in different ideologies is that the concepts are too varied, so things need to be boiled down to the core to have a coherent definition, so discussions about the same thing are even possible.

The problem with the concept of disease in the context of my interests, is that it gets muddled with inconsistent notions of morality. There seems to be a concentrated effort to redefine nicotine use to be a chronic disease, instead of voluntary exposure and behaviour. 

It's a sort of dehumanizing practice, treating the symptom instead of the person kind of thing, that is rightfully frowned upon in medical practice.

Defining use as a disease that needs treatment completely takes out major factors, choice and preference, leaving behind the notion that it's all involuntary and forced upon the "victims" by things like advertising, flavor options, even exposure to the mere sight of nicotine use which are all orchestrated by amorphous and malicious entities like "big tobacco" and the like.

I don't know why this happens, but often it does seem that there's a necessity to bypass personal freedoms and rights, in order to promote their preferred brand of "morality" under the guise of protecting the people. Seems to me like an illusion of grandeur. The pretense of power to know what is correct behaviour to other people, while ignoring that they are in fact people.

Addiction is the other side of this coin. It's a concept that instantly invokes concepts of compulsory actions, involuntary behaviour and inevitably results in the injection of a moral duty because the people are "unable" to stop. 

The huge issue though is that there is no coherent definition of addiction, much less "nicotine addiction" and thus the ability to even pretend to measure it is largely invalid. It suffers from the exact same problem morality does, it means different things to different people and most of them cannot agree with each other what it is, what to do about it and even if anything should be done about it. Unfortunately, it's a very complex phenomena, so making a simplistic statement about it is likely not going to be correct or useful, without including things that are not problematic. The conventional wisdom seems to be far too broad and leads to statements like "half the population is addicted". If such a systemic issue exists, surely we can at least pretend defining the term so we can discuss it?

For now, I can only leave this consideration hanging with questions that everybody should be asking themselves:

"Is the continued use of nicotine by somebody any of my concern to begin with?"

"What evidence is there to support my views, do I have a right to impose my views on others and above all, what are the predicted impacts of doing so?"

Translation: Finnish TPD implementation draft was updated

The TPD implementing legislation is currently going rounds with expert statements in various committees in Finland at the moment, their thoughts on whether or not things need to be changed should be out soonish. But in the mean time, here's what's on the table right now as far as national additions to the directive are concerned, all of which are derived from existing cigarette regulation and the asserted "need to regulate them in exactly the same way" (which ofcourse fails spectacularly due to TPD itself):

- Only allowed flavor in liquids (nic and non-nic) is tobacco. Specifically the ban on "characterizing flavors" was extended to electronic cigarettes. This is based on the assertion that the measure would reduce appeal among youth, but still leave the products available for adults who choose to use them.
This has also led to opponents arguing that "but we are not criminalizing ecigs!".

- Ban on cross-border and distance sales to consumers, including domestic sales. Justification stated is that internet-based market cannot be adequately overseen, particularly when it comes to checking age.

- A shop employee must be present at all times at a sales event and must be able to keep an eye on the products at all times. Also only 18+ can sell any products under the tobacco legislation.

- Age limit 18 years for buying and possession of electronic cigarettes and nicotine liquids. Also illegal to give under-aged persons electronic cigarettes or nicotine liquids.

- Ban on usage anywhere smoking is prohibited (more or less anywhere indoors that's not a home and outdoor events if there are stationary bystanders), this includes vape shops. The law also includes provisions for housing companies to ban usage on balconies, without requiring evidence of harm to health of bystanders. The only exception is that vaping cannot be banned inside apartments.

- Import limit of 10ml nicotine liquids for products that do not have warning labels in finnish and swedish. This is a straight implementation of the restriction on cigarettes. They justify the amount by asserting that 200mg maximum content is equal to maximum nicotine yield of 200 cigarettes. This, of course, is a nonsensical and absurd calculation. The original restriction of 200 cigarettes is in place to control the prevalence of imported products so finnish and swedish warning labels stay atleast at a constant level.

- Sales require a permit. Oversight fee for each point of sale 500 euros per year. The permit is the same as for cigarette sales, but the fee is separate for each.

- Point of sale display ban on products. Customers can be shown a printed catalog if they request it, that includes a picture of the products and their prices (not known at this point if it can include anything else). The catalog must be hidden otherwise.

EDIT 22.03.: An amendment was just proposed, that would ban smoking in a private vehicle when a 15 year old or younger was present. It was reasonably well argued and does make sense, although unenforceable for the most part. But, the legislation draft includes a statement on electronic cigarette emissions, extending ANY ban enacted on smoking to apply to vaping as well. So, basically vaping in a car when a child is preset would also be banned, on the basis of the hazards of cigarette smoke without ever specifically mentioning vaping. Whether or not such a ban is a good idea is certainly a legitimate discussion, but it should definitely be done so on it's own merits.

Reverse quote mining, or just random thoughts.

A rather major issue in communicating matters of science is the sentiment "that is not only not right, it is not even wrong". To be specific, it's an issue of lacking falsifiability. What this means is that for any scientific hypothesis to be worthy of any consideration, it has to be presented in a way that can be tested and includes the possibility of being shown to be wrong.
Or to put it simply, a claim can only be shown to be right if there is a way to show it is not.

Usually this issue only happens in metaphysical matters, where falsifiability is not possible by definition, but unfortunately it seems to be creeping into discussions that seem scientific on the surface. Here though, an additional layer of masquerading as science usually blurs the fallacy, by leaving out rather important bits.
Consider the following:

"Electronic cigarettes may be a gateway to tobacco use"

What does gateway even mean? Is it defined in a way that can be tested and shown wrong?
Most of the time it really cannot. The vast majority of comments including a proposed gateway-effect only mentions it's existence, without any sort of justification why it might exist, what mechanisms it contains and what would be a reasonable test to see if such an effect even exists in the first place. The comment is more or less worthless, has no real substance to consider or be concerned about. It is a legitimate question, but only in the context of actually trying to define what it means and how it might happen.
(more on this here, it's a rather complicated subject)

Then, what about this:

"Electronic cigarettes have formaldehyde in them"

Formaldehyde is infamous for being an embalming agent and a carsinogen, so this evokes fear and doubt about the safety of vaping.. But is it even wrong? Sure, it's technically falsifiable.. But the existence of anything is meaningless without comparisons.
Human breath also has formaldehyde, but that doesn't exactly tell us anything relevant. Is the amount of the substance enough to be a part of any meaningful discussion? Is there an actual hypothesis hiding in that statement? Do we gain any real information from that statement?
So let me fix it:

"Electronic cigarettes have formaldehyde in them, but mostly in amounts that are unlikely to cause any concern to users and even less to bystanders"

And now we get something that has something relevant that can be tested, analyzed and shown to be wrong. And most importantly, can actually tell us something that IS useful information.

And a bit of analytical brilliance from my beloved country, Finland (though I don't think level of absurdity can be really fixed without abolishing the limit):

"The import limit of 10ml is based on the fact that it contains a maximum of 200mg of nicotine, which is the same amount of nicotine a person gets from 200 cigarettes when smoking them"

This is about as vacuous as one can get. Comparing the nicotine content of e-liquid to nicotine yield of cigarettes and pretending that this is somehow a reasonable calculation to base restrictions on.

"Electronic cigarettes are harmless"

No, they are not. No such thing exists. In pragmatic terms, they are practically mostly harmless as far as we know, but stating that absolutely is very much absurd as it's impossible. And this gets (rightly) used against us. So:

"Electronic cigarettes are not likely to have risks on any meaningful level, which makes them harmless enough to be reasonably safe"

Unfortunately the discourse is full of these kinds of things, on both sides sometimes even.
I really wish at least the pro-vaping side would start also being pro-science as a whole.

Don't play their game. We will lose that one.

Part 7: Thoughts on the logic of dissenting opinions

"It has toxic substances in it"

"We don't know what the long term effects are"

"There is already a decline, so they are not needed"

"They contain formaldehyde"

"They contain antifreeze"

"They are not 100% safe"

"They can cause harm"

"They exist to earn more money to the industry"

And so on. Sound familiar, right?
Obviously these comments are made about vaping, right?
This is the stuff that gets thrown at vaping advocates on a daily basis more or less, so it's obvious what they are talking about, right?

You'd be wrong. These come from the anti-vaccination crowd.
The undercurrent of anti-science that is going on right now is seeping into a lot of areas right now and it seems clear to me that the vehement opposition to electronic cigarettes is an unfortunate symptom of that sort of mindset. Although, it is not clear why certain people manage to endorse electronic cigarettes and still oppose vaccines, as these are essentially different manifestations of the same philosophy that is also the basis for the medical profession and promotion of health in general, harm reduction.

Harm reduction is thought of as a sort of ideology, but the practices and ideas embedded in it are not something novel or new. They have much further reach than that. The basis for promoting HR is quite simply the fact that risk-benefit analysis is an essential part of modern societies, since everything inherently has some level of risk. There is always a consideration of "is this likely to be a net benefit, or in other words are the rewards worth the risk" and a way to reduce those risks while retaining the benefits. This includes things like bicycle helmets, seat belts, condoms, needle exchanges and obviously I think also electronic cigarettes.

While the role of ecigs is very much under disagreement, the basic science is rather clear and sound. Smoke is something societies strive to get rid of by introducing better alternatives, across the board, just not in nicotine use. This is because the health effects of combustion are rather well known and switching to non-combustion options is likely to be a real net benefit, but somehow this doesn't seem to register with the anti-vaping crowd.

This leads me to wonder, why is that?
Well, it seems there's a train of thought behind it that is reminiscent of some arguments I mentioned in my last blog post. Specifically considering this issue, they could be formatted something like this (and PLEASE, do correct me if these are way off base):

1. Nicotine in cigarettes is highly addictive

2. Electronic cigarettes have nicotine

3. Therefore electronic cigarettes are highly addictive

and

1. Exposure to nicotine from cigarettes leads to smoking

2. Electronic cigarettes have nicotine

3. Therefore electronic cigarettes lead to smoking

and

1. Cigarettes are designed to make nicotine use as highly addictive as possible

2. Electronic cigarettes are designed and have nicotine

3. Therefore electronic cigarettes are designed to be as highly addictive as possible

Now, I'm not aware of anybody who would say these things outright.. But the first one is something very clearly implied in the discourse globally. The second one seems to be a basis for the insistence of gateways. The latter is implied in the accusations of tobacco industry involvement, in the sense that "we can't trust these things".

If you state them out loud though, do they make sense? Are the assumptions of equivocation required plausible?

Do the anti vaccination arguments make sense if you consider the science?

To me, these seem like very classic type 1 observational errors, or false positives. In this sort of case the two razors should likely be at the forefront of thinking:
"Among competing hypotheses, the one with the fewest assumptions should be selected"
"That which can be asserted without evidence, can be dismissed without evidence"

Ultimately, does rational opposition to electronic cigarettes even exist at all?

Part 6: The children, sort of.

The new tobacco law draft was presented to our national parliament yesterday, including some discussion with very outlandish claims and assumptions.

 - "It's not vapor, it consists of 10-300 nanometer size solid particles"

Which has to be, by far, one of the most absurd claims I have ever seen in the discourse. And the fact that it came from the vice chairperson of the social and health affairs committee that's going to handle the finalized details of the law just makes it so much worse. But.. she didn't stop there.

- "It's clear that the tobacco industry does not want electronic cigarettes under medical regulations, because they would not get on the market in any country"

Except, that's not.. really.. true.
It's well established that's clearly not the case, since BAT already has a product that is approved and it seems that would be the easiest way for tobacco companies to avoid the restrictive tobacco regulation. I'm starting to be seriously worried about the future of health policy here, because if this kind of person is on the committee, there's no way legislation is based on sound science or even factual information.

She drops "tobacco industry" into the discussion regularly and eventually goes on to claim that because it's a nicotine product, it's also a tobacco industry product and their aim is to produce lifetime addiction. The obvious implication, although not explicitly stated, is that electronic cigarettes are a bad thing by default and should be restricted simply because they are made by the "tobacco industry".

As a whole, the discourse is centered on children. Claims of "well, we are not criminalizing these products, only restricting the flavor options to tobacco so that they are not appealing to children, so adults can still choose to use them if they want to do so" go around.

The reasoning behind forcing electronic cigarettes under the identical regulation as regular cigarettes (although in reality, ecigs have much more stringent restrictions due to TPD) is nicotine, specifically gateways and a "new generation of nicotine addicts". So, I started digging on that gateway issue as presented here and it seems it's based on some very glantzian logic:

- A person starts with an electronic cigarettte, learning "how to smoke"
- (remember, only flavor would be tobacco. I can't reconcile how that is a logical way to reduce this "learning" that supposedly happens)
- When the person feels like they are not getting enough nicotine from vaping, they move on to conventional cigarettes

Which has to be a non sequitor on a level only things like discussions on deities achieve, namely cosmological and teleological arguments. The fact is, this discourse really does remind me of religions. Science and logic are used as a smokescreen to lend credibility to hollow arguments with no real substance. I think the resemblance is really striking:

- Because X causes Y, Z also causes Y
and
- Because Y is caused by X, Z also causes Y

Insert terms relevant to the discussion at hand. The assumption, although again technically unstated, is that electronic cigarettes and smoking cause the exact same level of dependence and addiction. And that because cigarettes are designed to cause maximum amounts of addiction (though not entirely sure if many of these people actually realize this), surely electronic cigarettes are as well.

Obviously these things start to break apart when actual science is considered, namely the fact that it's absolutely untenable to claim tobacco addiction and nicotine dependence are in any way the same thing and that smoking is somehow "better" as a method of nicotine delivery.
Cigarettes do deliver the dose more quickly and efficiently, being designed that way. But it is far less enjoyable in other respects in my opinion, making it's benefits noticeably inferior.
But the fact is that a vaper never needs to turn to smoking to get more nicotine, since they can just use a stronger liquid and enchance their existing behavior instead of taking on another.

The reality is that vaping or smoking is just not something you can reduce to simply being a nicotine delivery method, although many "health" officials seem to think that's somehow justified.
This is both why NRT exists and why it's not very effective.

Sometimes I'm really at a loss, how does one explain the major difference between these products to people who don't understand the mechanics, have any experience in the behavior and have already decided a stance based on nothing more than their personal prejudices.
Incidentally, she claimed that there's only one meta-analysis on the issue of smoking cessation with ecigs and that showed they are less effective than "real" smoking cessation methods.

In short, the discussion is not just reminiscent of religion.. It's more or less exactly the same problem, forcing personal fallacies and fantasies into public policy.

Part 5: Meet me, my road to becoming a vaper and more personal thoughts

An important part of writing this is my personal story, the “deconversion” from the conventional wisdom surrounding nicotine use and nicotine products. The attitudes surrounding this extraordinary spread of electronic cigarettes and vaping are very varied and often are based on simple prejudices: the fact that smoking cigarettes is highly addictive and destructive and vaping is superficially similar.

That kind of thinking is hindering progress into avenues that could be used to gain major advances in public health, due to resistance towards tobacco harm reduction ideas and products as well as the demonization of nicotine itself, which almost certainly plays a part in the fact that most people still try to quit smoking using the least effective method. Going the so called “cold turkey” way, without any kind of help has proven to be a hugely limiting factor in reducing smoking as most of those attempts inevitably fail when smokers relapse. Personally, I would suggest trying any and all help available, especially counceling and peer support.

Quitting smoking is one of the biggest positive health impacts a person can achieve, no matter how you do it. So, please don’t fear nicotine, smokeless products, vaping or whatever else is available to get there. Preventing relapse is a goal that possibly should be the major focus of efforts intended to reduce tobacco related mortality and disease.

As for me, I tried multiple kinds of nicotine replacement therapy, reducing consumption and hated all of it. The options just weren’t appealing enough for me, personally. I started smoking when I was 14, the last ten years or so of my 17 year smoker career I wanted to quit. Until I picked up an electronic cigarette I didn’t think I was going to quit at all, even though I wanted to be able to do so.

What made me finally connect the dots was a double blind smoking cessation trial I took part in the summer of 2014. It included some lozenges that were sweetened, quite tasty and the idea was that you have one while you are smoking and the pill had a simple compound in it that would bind to specific parts of smoke and render them inert. What really happened was it actually made smoking more enjoyable, when the act was associated with candy essentially, one that even masked the taste of smoke and ash.

That lit a lightbulb for me: This is more or less what electronic cigarettes do, without the actual smoke too!

So I picked one up and ordered some liquids with nicotine, which were deemed to be medicinal so I was forced to get them from abroad. I did have some previous experiences with nicotine free that failed, but add the throat hit and suddenly my smoking habit was more or less gone. Dropped off from over a pack a day to one in the mornings, eventually just deciding I don’t really need that habit either

It was incredibly easy. Thinking back on that, it’s becoming increasingly clear that there’s more to smoking cessation than getting nicotine. Dependence is a very complex function that involves a lot of sensory and motor actions and experiences, not just the rewarding effects of the drug itself. Clearly, for me it was the habit itself, inhalation and various social aspects that I needed to retain.

These simple realizations have started a chain-reaction for me, and since then I have learned incredible amounts about nicotine and dependence. Including a lot of myths, prejudices and counter-productive thinking. I think a lot of the credit should go to Carl V Phillips for these permanent changes in my brain, reading his work has been a huge eye-opener. Though I'm sure he'd be likely to disagree with a lot of my thoughts :) I'm a layman after all, not really qualified to analyze the science at a precise level.

It really does feel like a deconversion of sorts, going from “wait, if this is true these other things I used to believe don’t make much sense” to “If these things don’t make sense, there must be other explanations” and ultimately “Things are really not as simple as people think and things could be much better if perceptions were accurate”. A sort of continuum of thinking that is apparent in quite a lot of other areas of inquiry. Conventional wisdom and common sense are just not very useful when we need to think about specifics of complex phenomena.

Hence, why I’m writing this.

I truly, honestly believe that instead of pretending behaviour can be eliminated by prohibition, we would be better off not trying to bend to the morals of those trying to tell us things we should not do, but rather think of ways we can choose to do things that offer us benefits in a way that’s as safe and as enjoyable as we can make it, while also minimizing risks to human life and health without infringing on fundamental rights.

Harm reduction is an essential part of human evolution and success as a species.

We have done this with so many things already, why not nicotine?

Part 4: Personal thoughts on addiction and dependence

Continuing again on this topic, in the midst of translation projects. There's a lot to addiction and dependence, so I'm sure I won't run out of random thoughts to run out any time soon.

One argument (almost using scare quotes here) I keep constantly running into while working on the legislation in Finland and discourse surrounding it, is the assertion that vaping supposedly enables people to continue their addiction, or that "you're just switching one addiction for another". On their face, both claims are not just absurd based on the radical difference of health risks associated with each product, but I would assert that they are a result of very counter-productive thinking on the issue in combination with the claim that vaping would not help smokers to quit.

People seem to think that nicotine dependence and tobacco addiction are interchangeable phenomena, when in reality they are substantially different in terms of intensity. Cigarettes are designed to be as addictive as possible and are a result of highly sophisticated engineering and other scientific efforts, so there's no way a few components put together by mostly hobbyists could possibly achieve the same level of dependence. Even suggesting that undermines just how purposeful the cigarette really is.

So the reality is that when somebody switches to an electronic cigarette, they are not really continuing their addiction at all. Trading one addiction for another has slightly more merit, though even then they are barely even comparable.

The part that's counter-productive comes in when you consider the fact that most vapers tend to be the ones that are by far the most dependent, usually failing cessation attempts with various other forms of available products, nrt and such.

First, this obviously suggests that the effects nicotine, much slower speed of delivery or preventing the effects of nicotine alone is not enough to make them switch. Or to put it bluntly, the new product is not enjoyable enough, which appears to be one huge factor. The others being sensory experiences, social aspects and various other things nicotine alone cannot provide.

Second, addiction or dependence in itself cannot be considered a harm. It's just the pattern of behavior that results in harm if the product used is causing harm. However, that should not be a concern if the product is relatively safe and the person recognizes and accepts the risks, like say nicotine gum, snus or vaping.

Third, even IF we consider that the assertion would be true that vapers continue their dependence or switch one addiction to another, isn't that still a good thing? The fact that the new product might cause some harm, even if it's measurable and noticeable, is not exactly anything to be concerned about in comparison to the devastating effects smoking has. It's highly likely that past smoking has caused more harm than continued nicotine use will, especially if that use is preventing relapse.

Fourth, if it's the case that vaping could possibly cause the same level of addiction or dependence, wouldn't that suggest it's actually easy switching from smoking to vaping? I don't see a reason why ecigs could not help in cessation if that is true. The claim about not being effective at cessation usually comes in very close proximity to claims about continued or even increasing addiction, which seem to be quite mutually exclusive.

It does really seem to me that the discourse on vaping is riddled with insular one-liners about this and that problem that supposedly exists, asserted as facts.
Is nobody stopping to think about the big picture and actual health outcomes of real people?

Apparently the only thing that matters is personal sense of morality, that nicotine is some evil demon that possesses people and needs to be eradicated.
We've already had enough judgmental treatment, thanks. Sex, drugs, alcohol, nicotine, gambling, whatever else is next on the agenda.
Bullying, penalizing, patronizing and demonizing people just doesn't work.

Addiction is not a matter of morality, but a matter of helping them minimize risks in a way that does not infringe on their personal rights.

Translation: Bordering on libel, Finland ASH chairman pitches in on ecigs

This is something I felt I had to get out, again just a translation unaltered. The specific part about the PHE report will be also sent to the authors of the paper. This is not some random guy off the street, he's a prominent figure in the field of tobacco control. I feel like disparaging your colleagues in public in a language they cannot understand is just unacceptable behavior. Ofcourse they need to be regulated, that doesn't even need justification.. But blatant lying about the issue is only going to do more HARM.
Original here: http://www.suomenash.fi/fin/ajankohtaista/2016/02/miksi-sahkosavukkeita-on-saadeltava/


---------------------------

Why electronic cigarettes must be regulated?

Chairman of Suomen ASH ry, professor Pekka Puska speaks out on the regulation of electronic cigarettes.

Stopping the acquiring, trying and using nicotine containing electronic cigarettes has not been possible. The products are also tried by non-smokers and on the other hand seem to be appealing especially to youth who already use other tobacco products.

Youth interest in electronic cigarettes has been increasing significantly in the last few years: only five percent of 12-18 year olds do not know, what an electronic cigarette is. Half of the youth who have tried electronic cigarettes has used nicotine containing liquids in them. Most commonly electronic cigarettes are used by boys in polytechnic schools, seven percent is vaping daily, 13 percent occasionally.

Electronic cigarette liquid flavoring agents (like strawberry, chocolate and vanilla) and the appearance of the device are important factors in their attractiveness to youth.

Electronic cigarette can impede quitting smoking

Some electronic cigarette users experience help in smoking cessation, but there is no evidence of their effectiveness in quitting smoking on a population level. On the contrary: According to a recent American study electronic cigarettes undermines the users’ chances of getting rid of smoking. According to another study youth who try electronic cigarettes, are more sensitive to starting smoking regular tobacco.

Nicotine causes strong dependence and changes the structure and function of the brain permanently. If electronic cigarettes are marketed as smoking cessation aids, nicotine containing electronic cigarettes should be regulated under the medical legislation like other nicotine containing medical products. This way their marketing and use would have oversight.

Compared to nicotine replacement products, like nicotine gum or patch, electronic cigarettes have been studied relatively little. Information on the impact of electronic cigarettes on for example lung diseases and subsequent mortality can be obtained only after years, even decades.

The effects of inhaled flavoring is unknown

Electronic cigarette liquids form vapor from chemicals, such as glycerol and propylene glycol, which have been classified as safe for food- and hygiene products. However, there is no systematic, longitudinal study based information on how these substances affect when vaporized and inhaled. There are indications that the flavorings used in electronic cigarettes have harmful effects on health. Vapor from nicotine free electronic cigarettes also contains harmful substances, although less than cigarettes.

Electronic cigarette vs cigarette

Almost any product is safer than a cigarette, since cigarettes kill more than half of their users. Electronic cigarettes are broadly a form of smoking, which is forcefully advocated by the industry. However, electronic cigarettes are both harmful in many ways and suited to sustain a society favorable to smoking.

According to a report Public Health England (PHE) published less than a year ago, electronic cigarettes are 95 percent safer than regular cigarettes and an effective aid to quit smoking. However, this conclusion is based on only a single study, which is funded by electronic cigarette and cigarette companies.

Execution, results and the expertise of the authors of the report has been disputed by many prestigious parties, like medical journals Lancet and British Medical Journal, British Medical Association, the United States National Institutes of Health and the World health organization WHO. WHO has also recommended, that electronic cigarettes would not be used until their safety has been verified.

(sidebar)

-          Nicotine contained in electronic cigarette causes strong dependence

-          Electronic cigarettes are also marketed to children and youth, which can lead to a new generation of nicotine addicts

-          Nicotine dependence also often leads to mixed use of different tobacco products, also including cigarettes that is

-          Nicotine is a powerful poison and even a small amount can be fatal to a small child

-          Scientifically sound evidence of the efficacy and safety as a smoking cessation aid does not exist

-          Electronic cigarette flavorings can be dangerous to health when inhaled

More information:

Pekka Puska

Professor

Chairman, Suomen ASH ry

pekka.puska@thl.fi

Sources:

Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii. Tobacco Control 25.11.2015
E-cigarettes and smoking cessation in real-world and clinical settings: a systematic review and meta-analysis. The Lancet Respiratory Medicine. 14.1.2016
Nicotine as a Health Risk. Deutsches Krebsforschungszentrum 2.12.2015
UK report claiming e-cigs 95% safer than cigs based on one industry-linked report raises questions PHE’s scientific dredibility. University of California, 16.9.2015
Evidence about electronic cigarettes: a foundation built on rock or sand?The British Medical Journal, 15.9.2015
E-cigarettes: Public Health England's evidence-based confusion, The Lancet, 29.8.2015
E-cigarette industry funded experts who ruled vaping is safe: Official advice is based on research scientists in the pay of manufacturers. London Daily Mail, 28.8.2015
E-cigarettes: an evidence update A report commissioned by Public Health England. PHE 2015.
Sähkösavukkeet eivät ratkaise tupakointiongelmaa. Terveyden ja hyvinvoinnin laitos. 3.9.2015
Tupakkatuotteiden yhteiskäyttö yläkouluissa ja toisen asteen oppilaitoksissa 2000–2015. Tutkimuksesta tiiviisti 2/2016. Terveyden ja hyvinvoinnin laitos, Helsinki.
Sähkösavukkeiden terveyteen liittyvät vaikutukset ja teho tupakoinnin lopettamisessa. Tutkimuksesta tiiviisti 19, kesäkuu 2015. Terveyden ja hyvinvoinnin laitos.
Sähkösavuke-sivut. Terveyden ja hyvinvoinnin laitos
12 ways to reduce your cancer risk. IARC 2015.
16th World Conference on Tobacco or Health
Tupakka ja sairaudet. Duodecim 2014.
Nuorten terveystapatutkimus. Sosiaali- ja terveysministeriö 2015.
Nuuska ja sähkösavuke –esite. Suomen ASH.
Luonnos: Hallituksen esitys eduskunnalle tupakkalaiksi ja laeiksi eräiden siihen liittyvien lakien muuttamisesta. Sosiaali- ja terveysministeriö, 11.8.2015