AVCA response to ARFNZ

Link to original press release from ARFNZ is here. 

“There is no evidence for a public health claim for an unregulated approach to e-cigarettes and personal vaporizers. ARFNZ recommends that if there is support for e-cigarette use in New Zealand as a smoking cessation device, then these products should be classified as therapeutic devices and regulated through Therapeutic Goods Administration (TGA), Medsafe and PHARMAC.”

The call for “medicalisation” is in direct opposition to saying “there is no evidence for a public health claim”.  If what they mean is medicalisation is the only regulatory approach that they find suitable (which I presume they are, in fact, saying) then what they are really saying is that they want only products from companies that have the funds (thousands if not millions of dollars) to go through the regulatory process.  In other words, you are looking to completely annihilate the independent vape industry and hand out engraved invitations to tobacco and pharmaceutical companies while at the same time telling adults that they have no right to choose harm reduction to reduce risk of illness and death?  That sounds a ridiculous to us as it is for us to say to you you might as well tell adults that they don’t need seatbelts, condoms or helmets, and  to immediately stop the campaigns promoting vaccination and childhood dental hygiene too.   Sounds ridiculous doesn’t it?  That is because it IS ridiculous in both contexts.

“If not intended as part of a smoking cessation plan then e-cigarettes should have the same restricted sale and accessibility placed on them as conventional cigarettes e.g. prohibit sale and supply in public places, not sold to under 18 year olds and no point of sale advertising of e-cigarettes and e-liquids.”

Read as:  in reality, we consider e-cigarettes as a medical product and therefore, if not a medical product they must be tobacco products, ala TPD.  Except my atomiser does not contain any tobacco, nor does my mod, batteries or the e liquid I use.  Interestingly enough, the nicotine in my eliquid is the same pharma grade nicotine that is used in NRT and THAT isn’t considered a “tobacco product”.   

“The last thing we want to happen is for our young generation of New Zealanders to pick up e-cigarettes thinking they are not harmful and inadvertently becoming an entry to a smoking habit,” says Dr Stuart Jones, President of the Thoracic Society of New Zealand and Medical Director of ARFNZ.”

Dr. Jones might wish to read the studies done in the UK regarding “The Gateway Effect” – that is the now disproven theory that vaping leads to renormalisation of smoking and induces youth to smoke themselves.    He might also consider making himself familiar with science and policy in the UK where the smoking rates have decreased dramatically since the promotion of e-cigarettes as an option for THR and the availability of the same items in the US, where smoking rates have also shown the same level of dropoff of combustible smoking rates.  There’s a multitude of robust data already out there to peruse through that shows science-based facts around vaping.

“The position of the Thoracic Society is that these products are likely to be harmful to the lungs long-term. We cannot think of any other product which is manufactured to be inhaled, that has not been through stringent regulatory controls. This is vitally important and e-cigarettes should not be given a free ride. We have seen the damage caused by letting cigarettes escape regulation and New Zealand can ill afford to make the same mistake again,” says Dr Jones.”

“Likely to be harmful to the lungs..” is a (flawed) perception based on the concerted disregard for the fact that e-cigarettes have been around since 2005, became “mainstream” in 2007 and have ten (10) years of science that has shown they are an effective “Tobacco Harm Reduction” tool.  Tobacco Harm Reduction (THR) is what vaping is all about.  Life is inherently risky, and just as individuals choose to use helmets, seatbelts, and condoms, using e-cigarettes is about harm reduction.   

In terms of e-cigarettes being used as a smoking cessation aid, the evidence is weak at best. We have heard that e-cigarettes are likely to be less harmful than conventional cigarettes, but there are many alternatives already available to assist smokers to quit which have passed stringent regulatory processes. We urge real caution with respect to e-cigarettes. We recognise that for some individuals who struggle to give up using current smoking cessation aids, the use of e-cigarettes may be beneficial, but we need to make sure that we’re targeting that group,” says Dr Jones.

Public Health England and the Royal College of Physicians (your colleagues in the UK) have PROVEN that e-cigarettes are less harmful than combustible cigarettes.  However, the real point here, as far as I can see it, is that the “alternatives that are already available to assist smokers to quit” have failed, and failed miserably.  The advent of e-cigarettes was a consumer driven phenomena from consumers who wanted an alternative to combustibles because the aforementioned “alternative” failed and failed miserably.   

That failure, which is wholly owned by those who refuse to acknowledge “THR” and instead preach “quit or die”  is two fold – the first being the mantra of “quit or die” – which is at best patronising and at its worst stigmatising/denigrating has been a wholesale failure in this context.  The second being that said “alternatives” do not address the behavioural aspect of ritual that is ingrained in many smokers.  The issue is not black and white as you suggest nor is it something you fully appreciate until you have “been there done that” like those of us who vape have.

“Using unregulated e-cigarettes to reduce tobacco smoking in Aotearoa is akin to introducing stoats to control rabbits. This concept of becoming so widespread and of greater negative impact than originally thought is of concern here. Another current issue is unregulated ingredients – anything could go in them. If used as part of a smoking cessation plan, the Government should ensure that nicotine e-cigarettes and e-liquid (vaping products) are regulated with product safety standards,” says O’Dwyer.

Considering that the current “alternatives” are failing miserably, and the switchover rate that we have in our mentoring programs is +/- 97%, I fully disagree with this statement.  The vaping community are the ones you need to make an effort to engage with so you can understand the real world implications and realities of e-cigarettes in practice.

As far as regulation, you are aware that the current discussions on regulation includes product safety standards.  What you may not be aware of is the majority of the independent vape industry in NZ, whilst currently unregulated by government, is actually self regulating by choice, and the consumers of NZ applaud those that are part of the self regulation scheme as it shows their professionalism and respect for the vaping community.  Again, to know these things you would need to have engagement with the vaping community – as they are the benefactors of the technology and have no other vested interest in the process besides self determination and control of their health.

“Since the Government has voiced its stance, the ARFNZ urges that in addition to regulation, e-cigarettes be part of a proper smoking cessation programme by the Ministry of Health – a wraparound service involving health professionals at a primary and community care level.”

In the beginning of this you clearly stated that “In terms of e-cigarettes being used as a smoking cessation aid, the evidence is weak at best” and then you call for them to be part of a proper smoking cessation programme that involves health professionals?   The dichotomy of this statement is not lost on anyone who vapes.  It means/shows that you fail to realise that the majority of vapers in New Zealand have found this technology without the assistance of health professionals.  You are, in fact, discounting their achievement because it was done independent of you.  Reality is, it is an achievement and it is not necessary to “medicalise” the process for it to be “effective” as it already is in the community.   

In other words, what we would like to see is less conjecture from the medical community and public health and more objectivity, acceptance of evidence based science and engagement with the people who actually have utilised the technology to switch from combustibles.  

The ARFNZ also raises concern that there is significant conflict of interest on the Ministry of Health Electronic Cigarette Technical Expert Advisory Group with three industry representatives (including a buyer for Cosmic retail stores) giving advice on Electronic Cigarette Product Safety. This is like putting the fox in charge of the hen house.

Interestingly enough, that is exactly how the majority of vapers in New Zealand feel about the need for the medical profession and public health experts to medicalise their self determined choices in Tobacco Harm Reduction.  There is a conflict of interest in wanting people not to smoke and then criticising and denigrating the choices they do make if they don’t fit within a medicalised protocol – the same protocol of NRT that has failed most and led them to vaping.   Interesting indeed.  

ARFNZ voiced its position statement at a Ministry of Health meeting on 7 November 2017, discussing the update on proposed regulations for e-cigarettes and nicotine-delivery products.

You and your colleagues have the position statement from the vaping community that we, AVCA, present on their behalf.   If you wish to engage and have discourse, please feel free to contact any one of us via our website.

Nancy Sutthoff

Nancy comes from a diverse administrative background that includes surgical research administration, teaching (primary and tertiary level), executive administration and community property management. For over 15 years she has been very active in community advocacy with youth, lower income folk needing advocacy and now, vaping advocacy. She brings a wealth of scientific, medical and research administrative/management knowledge with her to her role as CEO/Director at AVCA.