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History Repeats Itself – But Is Anyone Now Listening

1962, 70% of adult men and 43% of women in the UK smoked. It was normal, it was socially accepted. Non smokers were the minority.

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Then in 1962, The Royal College of Physicians published a key report – Smoking and Health. It highlighted the link between smoking and lung cancer amongst other diseases. It made a strong and overwhelming scientific case for the harm caused by smoking. It called on the Government to implement a raft of Public Health measures to reduce cigarette smoking and on doctors to advise patients on illnesses caused and exacerbated by smoking, and eventually to help patients stop smoking.

The RCP's first ever press release, designed to inform and advise the public, resulted in a media storm with actively hostile reactions, as the majority of those in Government, the media and society in general were all themselves smokers who didn't want to hear of, nor listen to the report and ultimately, the cold hard truth – the scientific facts. Nevertheless, the reports findings were proven right and it marked the enduring role of the RCP in public health, both by advising Government and via its own publications and activities; it spawned the Tobacco Control movement and five decades of action on tobacco control.

By 1965 cigarette advertising on UK TV was banned. In 1971 health warnings appeared on cigarette packets. Further restrictions followed, resulting in today's UK smoke free legislation where smoking in enclosed places is banned.

The Royal College of Physicians (RCP) 1962 report was instrumental in changing people's thoughts and behavior with regards to smoking. It brought the harm associated with tobacco smoking into the public domain. The Royal College of Physicians is one of the most respected medical organizations in the world. Founded in 1518 it is dedicated to improve the practice of medicine through accreditation and education of It's 31,000 members. It's public health role has evolved, but in 1962 it stated:

"there can be no doubt of our responsibility for protecting future generations from developing the dependence on cigarette smoking that is so widespread today."

That statement was based on the scientific evidence from more than 200 epidemiological and biological studies, and concluded that smoking is a cause of lung cancer, bronchitis and probably contributes to coronary heart disease. So in order to curb the rising consumption of tobacco, it recommended tougher laws on cigarette sales, advertising and smoking in public places. The Royal College of Physicians went on to establish Action on Smoking and Health (ASH) in 1971 as a 'ginger group' to put pressure on the government and educate the public about the dangers of smoking.

However, despite 50 years of public health measures to try to discourage tobacco use, a large proportion of the public still choose to smoke tobacco. Fifty years later smoking rates within the UK were still hovering around the 20% mark representing over 10 million adults. Conventional public health measures of using a "stick" of bans and high tobacco taxes to coerce smokers to quit, have stopped working. The "quit or die" public health message for smokers has now been replaced. Harm reduction is the important new 2016 RCP message to smokers – switch to e-cigs.

2016 "GIVE E-CIGS TO SMOKERS"

The ground-breaking 200-page report from the RCP, released on the 28th of April 2016, seeks to dispel the doubts and inaccurate e-cig media stories that have taken place over the past 2 years. Following on the heels of the recent Public Health England report it provides the facts and dispels many of the false fears associated with e-cigs. The perception of the relative harm of vaping versus smoking, for both existing smokers and non smokers has been confusing and future e-cig users may have potentially been discouraged by false media reporting. The scientific truth of the relative harm of vaping versus smoking is crucial and smokers and non smokers both deserve to hear the facts, as was the case back in 1962.

The benefits of vaping need to be understood. The relative risks of using e-cigs also need to be understood.

Whilst the 2.6 million current UK vapers are fully aware of the benefits of vaping, despite being classified as anecdotal evidence, the overwhelming message the report conveys is, that if you smoke, but can't quit you really should be using e-cigs.

The report also identified the following:

* Quitting is difficult.

* People smoke for the nicotine.

* The harm from smoking is caused by the smoke, not the nicotine.

* Provide the nicotine, without the smoke and most of the harm is prevented.

* Before e-cigs smokers only option was NRT.

* NRT are a medicine and less popular and effective than e-cigs.

* NRT is more effective when used with medical support.

* E-cigs are a consumer product and enjoyable.

* E-cigs are proving more effective than NRT.

* E-cigs compete with tobacco cigarettes as a substitute and competitor.

* The hazard to health from long term inhalation from e-cigs is unlikely to exceed 5% of the harm from smoking tobacco.

E-cigs are not currently made to medicine standards so may be more hazardous than NRT.

The fears of e-cigs renormalizing smoking or becoming a gateway to smoking in younger people or being used just for temporary abstinence have not been shown to be occurring.

E-cigs are being used exclusively as a safer alternative to smoking by confirmed smokers looking to reduce the harm to themselves or others or to quit smoking completely.

Regulation is necessary, but should not inhibit the development and use of e-cigs as harm reduction products.

Any regulatory approach should be balanced in supporting product safety and enable and encourage smokers to use e-cigs instead of tobacco.

The tobacco industry is involved in the e-cigarette market and can be expected to exploit these products to market tobacco cigarettes.

In the interests of Public Health it is important to promote the use of e-cigs as widely as possible as a substitute for smoking.

With the upcoming Tobacco Products Directive becoming law on May 20th 2016 it certainly looks like the 2016 RCP report may struggle to replicate the 1962 report's influence. Back then it just had to convince the UK Government, but today the EU, insofar as e-cigs are concerned rules the roost. Looking at the RCP report key messages, it is clear that promotion of e-cigs as an alternative to tobacco must be the overriding strategy:

Will the EU listen? Has the UK Government any influence?

The UK has seen 2.6 million smokers switch to new e-cigs kits. A massive public health gain at zero cost to the tax payer. The innovative and market led e-cig industry has thrived by being unencumbered by the regulatory meddling designed for the tobacco industry. All that however will change on May 20th 2016 when the Tobacco Products Directive and the clauses affecting e-cigs become EU law. The only product competing head on with tobacco cigarettes will then be placed in leg irons and forced to hope that the Public Health regime will actively support and promote e-cigs.

So in order to follow the RCP recommendations, logically the use of e-cigs should be encouraged wherever and whenever possible Rewarding good behavior (switching to e-cigs) is crucial to the increase in uptake of vaping and the benefits for Public Health as opposed to penalizing bad behavior (smoking) with taxes and bans etc.

It is therefore worrying that despite all the overwhelming evidence that supports the use of ecig from both Public Health England and now the Royal College of Physicians that over in the EU they blatantly ignore the scientific evidence. Not content with placing e-cigs within a Tobacco Products Directive, we have the European Commissioner for Health Vytenis Andriukaitisa recently answer the question "how to regulate e-cigs?" with "I personally believe that electronic cigarettes must be regulated as strong as possible because from my point of view it is a danger for public health."

Added to which and I've alluded to this in previous blogs, the taxation of e-cigs via EU legislation is also high on the agenda next year and illustrates another worrying facet of e-cigs having been included within the Tobacco Products Directive. All member states are duty bound to comply with the WHO FCTC that is written within the Lisbon Treaty and requires all member states to impose excise tax on ALL tobacco products at a rate of 57% of the retail price. By definition in EU law e-cigs will be classified as tobacco products from May 20th 2016 and a draft legislative proposal is being prepared for 2017. More information here: https://euobserver.com/science/132510

Include the fact that the advertising of e-cigs within the TPD is also severely restricted, with online sales and cross border sales also banned in most EU countries and you start to pose the questions: How will the 2016 RCP report recommendations be acted upon and supported? How will e-cigs be actively promoted? The RCP may have influence with the UK Government, but the reality is that insofar as e-cigs are concerned the UK Govt have already passed the baton over to the EU. However the scientific facts regarding vaping are clear:

"If you're a smoker, it's a no-brainer to switch"

Professor John Britton Royal College of Physicians

The 1962 RCP Smoking and Health report was a watershed in tobacco control and reducing the harm from smoking. The UK Govt then listened and took action. The world then followed. The 2016 RCP report Nicotine without Smoke is also groundbreaking. It tells smokers to ditch smoking and use the 95% safer e-cigs. As the report stated " This is an opportunity that should be managed and taken" I fear however, that the opportunity may well depend on how the UK votes in the EU referendum. Given that today the European Court of Justice has ruled that the TPD is lawful and necessary the RCP's attempts today to save lives is falling on deaf ears. The EU simply isn't listening and the UK Government within the EU are sadly powerless to affect lasting change.

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