Monthly Archives: March 2016

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When foot meets bullet

Category : rants , vaping

So a couple of days ago an article appeared. Some vaping advocates thought it was a great piece of work. A somewhat larger number were less impressed. I’m with the second group. It may have been meant well, but the author could have spent his time more profitably doing something else. Practically anything else, in fact.

This article was all about arguments the author thinks vapers shouldn’t use, because in his opinion they’re “misleading” or even “total bullshit”.

I suppose he’s entitled to his opinion, but that’s all it is – his opinion. Does the fact he holds this opinion make his article a useful contribution to the debate? No, I don’t think it does. I think publishing the article to a high-profile blog, then tweeting about it, was an act of mind-blowing stupidity.

I’m not going to spend a lot of time deconstructing the author’s claims, because Dick Puddlecote has already done a splendid job of that; I’ll just pick up on a few points where I find them relevant. What I want to do is talk in more general terms about who we need to be getting the message out to, and what sort of message that needs to be.

The public are the priority

In my opinion, the most important people vapers need to be influencing are the general public. If we can get them – at least a solid majority of them – on our side, we’ll be in a pretty strong position when it comes to fighting off hostile legislation. If we don’t successfully get our message out to the public we’re basically screwed. We’ll just be another small, irate and slightly weird special interest group that nobody cares about, and if we’re in that position we might as well give up. Persuading ordinary people that vaping is a real alternative to smoking, and that it’s safe, has to be our number one priority.

Yes, safe. Vaping is safe – at least, as much as anything is safe. Sure, there’s probably some residual risk. I have no doubt that vaping means you’re at slightly more risk of some obscure disease than if you breathed only the freshest alpine air. But really, how high is that risk likely to be? Not very.

Propylene glycol is safe to inhale unless you’re one of the unlucky few who’s sensitive to it, and even then it’s not exactly Zyklon-B. Cigarette smoke contains hundreds – or thousands – of times as much diacetyl as e-cig vapour, and smoking has never been linked to popcorn lung. No, really. It hasn’t. You can certainly argue that smokers might have died of popcorn lung, but who do we know who makes wild, speculative claims about hypothetical dangers of vaping? If you find yourself using bullshit ANTZ arguments in your blog post, do us all a favour; hit delete and have a serious word with yourself.

Safe enough is safe enough

By any sane standard vaping is safe. Serious people with white coats and letters after their name say it’s as safe as drinking coffee, and frankly you have to be a bit of a cock to think coffee is dangerous. Vaping is safe. The problem is, the public don’t believe that.

Unfortunately the public are, by and large, not scientifically minded. They don’t really understand that science is tentative. Creationists and anti-vaccine lunatics exploit that all the time, and ANTZ use exactly the same tactics. They take the systematic uncertainty that’s inherent in the scientific method and portray it as a genuine doubt, something that we should really worry about. Time after time the public fall for it, and most scientists have a very hard time countering the bullshit. They make reasoned, nuanced arguments that would carry the day in any scientific discussion, but huge chunks of the public ignore them and soak up the big, bold doubts spread by the loons.

When it comes to countering these big, bold doubts we have a choice. We can park ourselves on the moral high ground and make reasoned, nuanced arguments like the ones advocated in the article. Then we can spend the rest of our lives complaining that the public didn’t listen to us, because I can guarantee you, they won’t.

Our opponents like to scare people by implying that a global epidemic of vape cancer could be lurking a couple of decades down the road. And the article’s author just encourages them:

“We might be able to do so in 20 or 30 years, but right now we’re far from being able to honestly compare death rates.”

Awesome. Stan Glantz could have said that. We have enough ANTZ scaring people with purely hypothetical risks. Why make painful, pedantic statements that to the casual observer sound very like what the ANTZ are saying?

Instead of further muddying the waters by dumping in a bucket of vagueness we could stick with something big and bold of our own, like Agent Ania’s excellent cartoon:

Deaths

Except we can’t do that anymore, because the ANTZ have just been given an in-depth, superficially persuasive and oh so nuanced demonstration of how to attack it. And that’s what really annoys me about the article. Yes, if you want to descend into useless pedantry all the “misleading arguments” it complains about can be attacked. But they are all, in broad terms, true. E-liquid does contain four ingredients, compared to hundreds in a cigarette. All those ingredients are generally recognised as safe. Nobody has died from vaping. Smoking hasn’t been linked to popcorn lung. And so on.

Where was the problem?

If these arguments were as much of a liability as the article claims, rest assured the ANTZ would have attacked them long ago. They haven’t, because it would have backfired on them spectacularly. What tobacco controller wants to make a big fuss about the gravedigger cartoon when, in the end, they’re just going to have to admit that the number of deaths attributable to vaping is indeed zero? Who wants to be the clown yelling triumphantly, “Aha! You said there was 750 times as much diacetyl in cigarettes but really it’s only 240 times as much!”?

These arguments may not be pedant-proof, but they are effective. They are simple, easily grasped and carry a positive message. Unfortunately they’re now all compromised, because they can be dismissed with an airy, “Oh, even vaping advocates say that’s not true.” We have, essentially, just thrown away some reliable and effective weapons – in exchange for what? A warm glow of sanctimony?

The suggested arguments added to the article in an effort to temper its initial relentless negativity might be appropriate for a discussion with public health activists, but that’s a sideshow at best. The likes of ASH will use vaping when it suits them, and abandon us when it doesn’t. Where was their condemnation of Pembrokeshire’s decision to ban vaping on a beach? Yeah, I didn’t hear it either. Even when they do decide to take our side they’re of limited use. Politicians only listen to them when it’s convenient. ASH Wales spoke out against Drakeford’s plan to ban vaping in public places; Drakeford simply tuned them out and started quoting the California Department of Public Health instead. There’s no shortage of tobacco control rent-a-gobs, so legislators don’t need to pay attention to the ones who’re not on-message.

Talking to pressure groups can be somewhat useful as long as we don’t start thinking they’re our friends, but the first priority has to be winning over the public. If that means saying things ASH don’t like, so be it; the public are more important than ASH. If we want to preserve our freedom to vape we need to convince the ordinary man or woman in the street, and to do that we need to have clear, persuasive, hard-hitting points. That’s going to be pretty difficult if some on our own side insist on trashing them.

Apply the safety catch, place the weapon on the ground and stand back from the firing point. Because you’ve just put a bullet in our foot.


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Formaldehyde Strikes Again

With the “gateway effect” dead in the water formaldehyde has become the new cause du jour of the anti-vaping nuts. The latest assault has been launched through the letters page of a major US medical journal. Let’s look at the facts.

So the New England Journal of Medicine has joined in the latest crusade against electronic cigarettes. Yesterday they published a letter to the editor about a new study claiming that e-cigs produce more formaldehyde – a carcinogen – than actual burning tobacco-filled cigarettes do. I already blogged about this somewhere else, but there’s a lot more that needs to be said. Basically this study was carried out by researchers who were either utterly clueless or intent on pushing their own agenda at the cost of scientific integrity, and for reasons I’ll explain I strongly suspect it’s the latter.

What the study claims is that electronic cigarettes, when run at high voltages, generate enough formaldehyde to make them between five and fifteen times as much of a cancer risk as real cigarettes. One of the study authors, James Pankow, admitted that this claim could have done with some more context but “we just wanted to get it out.” The extra context of course is that formaldehyde isn’t the only carcinogen – or even one of the significant carcinogens – in cigarette smoke. In fact while it’s classed as a known carcinogen there’s (at most) vague knowledge on what cancers it’s actually associated with and how strongly. Complicating all of this is the fact that formaldehyde is ubiquitous. It’s everywhere; all living things produce it and it’s naturally present in every fruit, vegetable or piece of meat you eat. Every breath you exhale contains formaldehyde from your lungs, whether you vape or not. As context for the study this is all highly relevant, and the fact it was omitted doesn’t look encouraging.

Of course lots of other essential details were omitted too. The letter to the NEJMdidn’t mention what type of e-cig was used in the tests, just that it created huge amounts of formaldehyde at high voltages. Luckily a quick-thinking vaper emailed one of the responsible scientists and asked; much to their amazement they actually got a reply (this doesn’t happen much when dealing with anti-vaping loons):

“The results published in this letter come from samples vaped using a Sailebao CE4 cartomizer with a 2.1 ohm coil and an Innokin iTaste VV V3.0 battery.”

Hmm, okay. Is the Sailebao CE4 clearomiser (it’s not a cartomiser) a suitable device for testing high-power vaping? I would say not. CE4 clearos are usually supplied with starter kits that include an eGo battery, and these batteries output a fixed 3.7 volts. They’re entry level technology, and old entry level technology at that – three years old, at least. This also looks like a particularly cheap example, but the CE4 is a simple enough design. It’s also a top coil design; the heating element is at the top of the tank, just below the mouthpiece, and two long silica wicks hang down into the liquid. This means liquid transport to the coil depends on capillary action, which is not a fast process. If the coil is vaporising liquid too quickly it will outrun the wicks’ ability to keep it supplied and the liquid that remains won’t be evaporated; it will be burned, producing a foul-tasting phenomenon known as a dry hit. That, of course, is why nobody uses CE4s on a high-powered device. When Dr Konstantinos Farsalinos did his own research he tried using a CE4 at a power output of 9 watts, but had to replace it with a bottom-coil Evod because it was consistently dry-hitting. The power output of the 2.1 ohm CE4 used in the new study, when run at 5 volts, is 12 watts.

A CE4 works just fine on a lower voltage battery, of course, and it doesn’t produce any formaldehyde either – when Pankow and his associate David Peyton tested their equipment at 3.3 volts they found no formaldehyde at all. That’s only to be expected; the wicks can keep up at that sort of power output so no liquid would be burned. Unfortunately they either didn’t test at the iTaste VV’s full range of voltages or didn’t release the results; all they’ve revealed is the figures for 3.3V and 5V. It would be nice to know how much formaldehyde was created at 3.7V – i.e. what the clearo is supposed to be used at – but I can guess anyway: None. I suspect that if they’d produced a proper voltage/output curve, like they should have done, we’d see no formaldehyde at all until pretty close to maximum power, at which point the level would rise steeply.

But wait. Are we actually talking about formaldehyde at all? I’d naturally assumed that this, at least, was correct – that formaldehyde had been released in the vapour at high voltages. Then Dr Farsalinos intervened to point out that no, it wasn’t. What Pankow and Peyton were measuring was actually a class of chemicals called formaldehyde hemiacetals. These are a combination of formaldehyde and alcohols; they’re produced when propylene glycol breaks down at high temperatures to produce formaldehyde, which then reacts with more propylene glycol (an alcohol) to form the hemiacetals. Pankow and Peyton classed formaldehyde hemiacetals as “Formaldehyde Releasing Agents” and backed this up with a link to another paper, showing how FRAs can cause health risks.

Well, there’s a serious problem with this. The paper they linked to wasn’t talking about formaldehyde hemiacetals at all; it was discussing several completely different classes of chemicals. In fact there’s no evidence that formaldehyde hemiacetals even release formaldehyde, or that they pose any risk of cancer or any other health problems. To do what this study did, and assume they pose the same cancer risk as free formaldehyde, is utterly dishonest. In fact it’s actually possible that hemiacetals could have a protective effect against formaldehyde!

So this study was using equipment inappropriately, in a way that it never would be used in real life, then misrepresenting the results to make completely inaccurate claims about a danger that does not in fact exist. Why? What possesses scientists to do this? Well, let’s follow the money. The NEJM, like most journals, asks authors to fill out a conflict of interest form. Here it is.

If you look at the list of donors declared by each scientist there are two names at the top that are quite significant; these are Michael J Dowd and Patrick J Coughlin, who contributed “philanthropy to support research”. So who are Dowd and Coughlin? Philanthropists? Well, not exactly. They appear to work for this law firm, and have previously been involved in class action suits against tobacco companies. Lawyers don’t generally pay for research unless they have an ulterior motive, commonly involving another giant class action suit and another few million in fees. So does anyone believe that this pair funded their pet scientists out of a healthy spirit of open-minded inquiry? No, me neither.

This post was originally published on 22 January 2015


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california tobacco control

Lying It Up At The Hotel California

“Mommy, why does the state bear smell of burning fur?”

“That’s because his pants are on fire, son.”

The recent formaldehyde fiasco reminded us, if anyone needed it, that we can’t expect a lot in the way of integrity from the weird coalition of temperance zealots, tobacco companies, pharma manufacturers and crackpots who’re opposed to electronic cigarettes. The California Department of Public Health have just upped the ante spectacularly, though. Their latest “State health officer’s report”, released yesterday, is a breathtakingly dishonest document that manages to cram just about every myth, distortion, misrepresentation and outright lie about vaping into its 32 pages. I know a little about propaganda and this is one of the most egregious examples I’ve seen that wasn’t actually printed in Pyongyang – a place Sacramento increasingly acts like a suburb of.

This document, available as a PDF here, has an impressive title and uses serious-sounding terms like “Executive summary” to create an air of scientific rigour. The text itself, however, is far from scientific despite the references that pepper it. It’s heavily slanted and inflammatory, stuffed with loaded terms like “aggressive marketing” and “toxic vapor.” It presents facts out of context and misrepresents statistics – for example it employs the now-common trick of relabeling “calls to poison control centres” as “poisonings”. Worst of all, it lies. I don’t mean it makes errors; I mean it lies. The authors deliberately make claims that they know to be false.

You’d have to be suffering from truly Glantzian levels of insanity to mistake this for an objective, unbiased publication. Its full title is “State Health Officer’s Report on E-Cigarettes – A Community Health Threat.” The first chapter is headed “The Problem: E-Cigarettes“. And that sets the tone. There’s no attempt to balance risks and opportunities, no attempt to weigh up differing views on the potential for health gains or harms; just relentless, almost hysterical negativity from the first page to the last. However I’m not going to deconstruct the entire document right now. I have work to do and bills to pay, and as much as I’d love to I can’t spend all day blogging. I will go through some of the most blatant points, though, and perhaps go into more detail at the weekend. So, here are some of the “facts” California is offering you:

  •  “E-cigarettes do not emit water vapor, but a concoction of chemicals toxic to human cells in the form of an aerosol.” (p. 9) – Note the loaded language: “A concoction of chemicals”. They might as well have said “witches’ brew”. Is this accurate, though? Technically yes, it is; the chemicals in e-cig vapour are toxic to human cells at a sufficiently high dose. Guess what else is toxic to human cells at a sufficiently high dose?Fucking everything! As I’m sick of explaining, the dose makes the poison. Yes, the stuff in the vapour will damage cells if there’s enough of it. No, there’s not enough of it.
  • “Mainstream and secondhand e-cigarette aerosol has been found to contain at least ten chemicals that are on California’s Proposition 65 list of chemicals known to cause cancer, birth defects, or other reproductive harm.” (p.9) – They’re talking about the likes of nickel and cadmium here. Guess what else contains them? You got it; everything. They’re naturally occurring substances. You have trace amounts of them in your body. Some of them are essential to life. So again technically true, but deliberately misleading; none of these substances are present at toxic levels.
  • “There is no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes.” (p.10)- This is simply a lie.
  • “The aerosol also contains high concentrations of ultrafine particles that are inhaled and become trapped in the lungs.” (p.11) – This stinks of Glantz, a suspicion reinforced by the fact that it’s utter rubbish. It’s not technically inaccurate to refer to liquid droplets as particles – although it is a bit odd – but the reason it’s being done is obvious; it’s to confuse them with the solid particles found in cigarette smoke and exhaust fumes, which is what Glantz’s sources about the harms of ultrafine particles were actually talking about. Needless to say liquid droplets don’t get trapped in your lungs; they get absorbed.
  • “There has been a significant rise in the number of calls to poison control centers”(p.11) – Yes, we know. Calls. Not poisonings; calls. Now shut up about this; you’re getting boring.
  • “Many are concerned that e-cigarettes are a gateway to using traditional cigarettes.” (p.12) – Well so what? Many are concerned that gays are trying to steal your wedding. That’s not true either. There is conclusive evidence from both the UK and USA that vaping is not a gateway to smoking, and in any case we’re still waiting for the ANTZ to explain why it even might be.
  • “Younger adults and youth who are experimenting with these products may not realize that e-juice contains the highly addictive chemical nicotine” (p.16) – Only if they can’t read. It’s on the label.

There’s pages of this stuff, some of it backed up by references (Glantz features prominently, as do Tobacco Free Kids, so you can guess at the level of science we’re talking about) but much more is simply asserted. Even if you’re familiar with some of the previous horrors Glantz and others have come out with, this is bad. What’s worst is that it’s not a dry paper in some obscure academic journal that only doctors and the likes of us will ever read; this is being pushed on the public by the state of California. It’s presented as essential advice they need to protect their families from a menace that all the evidence says doesn’t actually exist. 

What the hell is going on here? Why on earth would a publicly funded health body in one of America’s most advanced states produce such a deliberately misleading piece of propaganda? The potential consequences are horrific. The percentage of Americans who know that vaping is safer than smoking has already fallen from 85% to 65% in just three years (a similar trend is going on in the UK) because of misleading claims by “health” advocates. The result of that is obvious. Smokers who were tempted to switch to vaping, but now believe that the risk is the same or higher, will stick with tobacco instead. Some of them will try to quit using approved methods, like patches and gum. That’s unfortunate, because of course the success rate of approved nicotine replacement therapies is dismal and while Varenicline (Champix or Chantix) is somewhat more effective it also has a few known side effects. Like, you know, inducing a suicidal psychosis or possibly (evidence on this is mixed) giving you a heart attack.

This is how safe FDA-approved cessation aids really are

FDA approved, so obviously safe

Keep that in mind next time someone advises you to use a “safe and effective” approved medication. Varenicline might be safer than smoking, but it’s been linked with a lot of deaths – while “unapproved” e-cigs haven’t. The fact that the FDA have approved something doesn’t mean it’s safe; it just means the FDA have hard numbers on how dangerous it is. Next time someone bleats “They’re not approved by the FDA” you can point out to them that actual tobacco cigarettes are. Does that mean cigarettes are safe? I think the FDA might not be too happy if you made that claim.

Still, this isn’t about how happy the FDA are. It’s about trying to work out why the state of California is so hell-bent on restricting e-cigarettes as severely as they can. I could go into the amount of pharmaceutical industry funding Senator Mark Leno receives but I suspect, this time round, it’s more to do with state funds than Leno’s own personal bank balance. My feeling is that we need to look at the 1998 Tobacco Master Settlement Agreement.

Most non-Americans probably aren’t familiar with the MSA, so here’s a quick summary. In November 1998, to end a string of court cases against them by people who apparently couldn’t read the health warning on a cigarette pack, the major US tobacco companies signed a deal with 46 of the 50 states. In exchange for a guarantee of not being sued again they agreed to pay huge sums of money to the states in perpetuity – the agreement was for at least $246 billion dollars over the first 25 years, but the amount each company actually pays is based on its market share and the number of cigarettes it sold compared to the year before. The money is shared between states based on their population, and because California is the most populous US state its share isn’t exactly small – $745 million in 2007. The state keeps about $400 million of this and distributes the rest among the county and city governments.

Now, $745 million a year is rather a lot of money, but it wasn’t enough for California or many of its local authorities. More precisely, it wasn’t coming in fast enough. They didn’t want rather a lot of money every year for the foreseeable future; they wanted shitloads of money now. So what the state, and many counties and cities did, was come up with a clever plan. They decided to sell investment bonds, then use the annual payments to pay out the bonds as they mature. That looked like a good deal to investors and the bonds sold like very popular things that people want to buy.

The annual MSA payments started on 15 April 2000. By 2007 the state of California had received close to $3 billion in payments, but it had sold $13.16 billion in bonds. That put the state $10 billion in the hole, but it didn’t matter; after all the tobacco money would keep coming in forever, and as nobody seriously believed those last stubborn 20% would ever stop smoking the revenue stream was safe. Sure, there was a clause in the agreement that said the tobacco companies could reduce their payments if their sales dropped, but how likely was that?

Then e-cigarettes came along.

Oops.

Already cigarette sales are down, and MSA payments are down with them. Until a couple of months ago many market analysts, including Bonnie Herzog at Wells Fargo, were predicting that vaping products would outsell real cigarettes within a decade. Right now they’re not so sure; the growth of vaping has slowed, and most people agree the reason for that is the recent flood of alarmist reporting. But if it picks up again, and the number of smokers falls to 10% or less over the next dozen years, then there won’t be enough money to pay bonds as they mature. Some other states that issued bonds could default on them, which is tough luck for the investors, but California guaranteed its bonds with the full backing of the state government.

Oops again.

Unless tobacco sales recover the state of California – as well as all but one of its cities and counties – is in trouble. The state’s already pretty much bankrupt, and if they have to dig into their existing budget to pay for maturing bonds some very tough decisions are going to be made. When the 38 million people of California find that their schools, public transport and emergency services are being stripped bare to pay for a government scheme that turned out not to be all that clever after all there’s going to be hell to pay.

How bad could it be? In 2013 Ohio allocated $31.5 million from reserve funds to make up for the shortfall in MSA payments needed to pay its bonds. But Ohio has less than a third of California’s population, so less than a third of its MSA revenue. California’s shortfall last year was probably in the region of $100 million, and that’s only going to get worse. The more cautious states assumed cigarette sales would fall slightly, but they decided that allowing for a 2% drop per year was all the safety they needed. In 2013, as vaping really started to take off, cigarette sales fell by 4.9%. Investment expert Alan Schankel says that if the fall reaches 6 or 7% per year it will trigger a rapid collapse of the whole tobacco bond racket. In June 2014 Herzog was predicting an average fall of 6.8% per year for the next ten years. That would almost completely destroy the tobacco bond market by the end of the decade.

A complete failure of tobacco bonds would cripple California’s economy, but it’s worth considering what the state’s population would want to cut first. Would it be their kids’ teacher? Or would it be the California Department of Public Health, which isn’t very popular right now anyway after covering up abuse in state nursing homes for more than a decade?

I think we can all guess who the people of California would rather see the back of, and what’s more I think the California Department of Public Health can, too. So what’s the solution? In fact there are two. One is to scare vapers back to smoking, so cigarette sales get back up into a nice safe zone where MSA payments will keep up with maturing bonds. The other is to bring e-cigs into the MSA – even though it’s an Agreement, and none of the independent e-cig manufacturers have agreed to that – or at least slap a tax on them that can then be ring-fenced to pay for the state’s bloated tobacco control industry. And, for anyone who believes in coincidence, guess what the odious Glantz hinted at yesterday?

UPDATE: 29 Jan 2015, 11:40am

Ron Chapman, the outgoing head of the California Department of Public Health, has just spoken to Fox News. He said, “I’m advising Californians, including those who currently use tobacco, to avoid using e-cigarettes“. In other words: “If you smoke, keep right on smoking. Please. We need you to, so we can keep on getting paid to tell you to stop.”

 

This post was originally published on 29 January 2015