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E-Cig Summit debate: Will medical regulation of e-cigarettes result in better quality and safer prod

Chair: And I’d now like to invite the panellists for the first Expert Panel this afternoon to come and join me on the stage. So that’s Robert, Clive, Deborah, Jean-Francois, Jacques and Jeremy. So if you want to take a seat up here at the front. Okay, now in this session I’m sure we’ll pick up where we left off at the end of the morning, but we’ve invited the panellists just to give a couple of minutes response to the main question involved at the top there, which is ‘Will medical regulation of e-cigarettes result in better quality and safer products.’ I just need to introduce Deborah Arnott on the far side of the panel, she did speak from the floor this morning, she’s the CEO of Action on Smoking and Health charity and she’ll be speaking after the break this afternoon. I think you’ve met everybody else on the panel this morning so I won’t introduce them again. So perhaps, I did this in some sort of weird alphabetical order when I was looking at it, so Clive I had you.

C Bates: Oh, that’s okay.

Chair: Okay.

C Bates: It will result in a smaller number of less interesting, better quality products with less appeal to smokers and therefore ultimately less uptake of the product category and therefore more smoking. So although the products themselves may be better measured in the way that the regulator thinks about these things, the public health outcome will be worse.

Chair: Thank you. And then I had Deborah.

D Arnott: Okay, well I’d like to go back to what Konstantinos said this morning, which is that there is a regulatory gap at the moment which means that we don’t really know what’s in the liquid. And we know from research done by the MHRA and others that some products do have liquid that contains carcinogens, which definitely do lead to death. Not today, not tomorrow but 10, 15 years down the line. So I think definitely the safety and the quality will be improved. And I think it needs to be improved. Actually we don’t know enough about how these products work and how to make them work better for smokers. And our research shows there’s something like 1.3 million users earlier in this year, spring this year of ecigarettes, but that’s compared to another 2.6 million people who’ve tried them and didn’t like them, smokers who, as a result are carrying on smoking. So I think regulation can ensure safer, better quality products, which is better for smokers and better for everyone.

Chair: Jacques?

J Le Houezec: Well I think you don’t need medicinal regulation for that; you can set up standards, industry standards that industry has to follow. And again, I would like to stress something I think Jean-Francois mentioned it this morning, you are living in a specific country where you can think about the so-called light touch regulation, which is not applicable in any other EU country. So that’s a very specific situation and if you lead Europe to this path there will be huge problems in many countries around, France, Germany, Spain, Italy. I mean the situation is totally different. We don’t have aspirin in the supermarket; we don’t have any drugs in the supermarket. We have the pharmacies that sell medicinal products and we have the tobacconist selling tobacco. Now we have e-cig shops that sells e-cigs and medicinal regulation is certainly not the way for good public health.

Chair: Okay. Thank you. I’m actually going to ask Jeremy to go next. And could you perhaps address the point about the wider European issues? Thank you.

J Mean: Well, it won’t surprise you to know that I think medicinal regulation for electronic cigarettes will result in a better set of products. But it will also operate in a market. Medicines regulation is a pre-approval process that produces a product but then the product operates in the market and products fail or thrive on the quality of the product. So it isn’t a case of taking the marketplace out of electronic cigarettes. It’s rather introducing a set of controls which assure the quality of the product. There is no reason that products should be less dynamic, less attractive, marketing in a different way, other than claiming that they can help you to cut down and to reduce the harms of smoking to smokers and those around them. This is an industry in its infancy. The vision is for high quality products that people can access anywhere. In terms of Europe in particular we’ve been talking to our colleagues in other member states and actually two thirds of member states already have a category of medicines which are for sale outside pharmacies. So it’s the majority of member states already have that. In the general agreement supported by the member states including the ones listed, France, Germany, Italy, Spain, there was a provision for a transitional period in which member states would not only transpose the legislation into the national legislation but allow for products to come onto the market. Now we see that period as crucial to us showing some leadership in how this can be done. We want to show how products can be marketing, put out there and lead the way for other member states. So there is an opportunity in the transposition of the legislation to make these products more widely available across Europe.

Chair: Thank you. And Jean Francois?

Prof. J Etter: I think it’s an illusion to think that unlicensed product will disappear if some products are unlicensed. What’s going to occur, as I said, is that the ciga-likes from the big tobacco companies are going to be licensed, but what about the other products? This regulation will do nothing and they won’t disappear, you cannot stop a tsunami just by brandishing the law. It’s a huge phenomenon that’s not going to be stopped by regulation. Do you think that judges and custom officers and policeman are going to bother going after honest citizens who do not create any trouble? It’s not cocaine or alcohol; it doesn’t cause criminality or divorce like alcohol. So, the unlicensed product will not disappear, they will be there and their quality will not be improved by medicines regulation, it will be improved only by competition on the market.

Chair: Okay. And last but not least Robert.

Prof. West: The honest answer is, I don’t know. I passionately don’t know. But I would say a couple of things in terms of the evidence and what I’m hoping to get out of this afternoon in terms of clarification. One is, does anyone here really believe that we have a problem right now in England with an unregulated market? Smoking prevalence is falling, quit rates are rising, electronic cigarette use is showing a huge increase. Are we seeing a problem? I think probably the answer is, ‘No.’ So therefore the reason for regulation is not to address a current problem, but to address a future potential problem or to maximise a future potential opportunity. The key bits of information that I think we can get some clarity one, one of them we can get some clarity on today and one we will need more evidence. One of them is the costs of manufacturers complying with GMP and getting a licence, because what I’m hearing is very different stories from two sides. And these are issues that can be addressed by information and I think that will be terribly important, because if the costs are, as I think Jeremy alludes to, then there is far less of an issue concerning small companies coming on the market. And the other is efficacy; we’ve got two rather poor randomised control trials at the moment. We may get more, but we do need more data. Anecdotal reports are great but believe me, I hear a lot of anecdotal reports from people with homeopathy, hypnotherapy, loads of things that people honestly, honestly believe helped them. And maybe they did for those individuals but in science that’s not how it works, we have to look at it in the round. So we do need more evidence on the extent to which these products, variance of them or in general, are genuinely better. Because if they’re not there is a huge opportunity cost, for example if people go to these products rather than using the stop smoking services.

Chair: Okay. Well thank you very much. And as expected we had quite a diverse range of opinions there from the panel. I’d now like to open it up to the floor, please, to pick up on any of the issues that you’ve heard or raise new ones in relation to these issues. So I saw a few people here and at the back there, so three people in that cluster and then at the back. We’ll try and address questions one by one and again I’d like to encourage as many people as possible to contribute. As well as the industry I’m particularly keen for Vapers and for the Public Health people in the audience to raise their hands as well. Konstantinos?

K Farsalinos: Hello, I’m Doctor Farsalinos, you saw my presentation today. I want to discuss with the MHRA representative here. I perfectly understand the incentives of the MHRA and the UK government that they want a better product, a more efficient product, better quality product. I don’t believe in any kind of conspiracy theories that you will hear concerning pharma industry also. However, my opinion is that the way that you are presenting the proposed regulations just shows that the MHRA or the UK government has not understood at all what the e-cigarette is. You are presenting the e-cigarette as a nicotine delivered device. Do you think that tobacco cigarette is a nicotine delivered device? No, it’s much more than that. And the addiction from the tobacco cigarette is much more than nicotine. The same exact thing happens with electronic cigarettes. You are discussing about the over the counter medications that are available in the UK, which is a special situation, but I will give you an example. The electronic cigarette consists of a battery, an atomiser and the liquid. There are more than 100 types of batteries, which are not only in shape or size the differences, they have now integrated circuits, electronic sequence, voltage regulated, voltage stabilisers and so on. There are more than 200 atomisers and there are more than 300 liquids. Multiply all of them now and try to find how many combinations of products you may have. You cannot perform any kind of medicinal regulation study with all these products, no-one will ever have the money to do that.

Chair: Okay. Thank you.

K Farsalinos: One is this. The second aspect that someone should understand –

Chair: Can you keep it short, please.

K Farsalinos: … with e-cigarettes, basically it’s not only the nicotine delivery. There is the motor simulation, there is the sensory stimulation, there is a (inaudible 04:48:52). I have never seen an internet forum discussing about what kind of colour of NRT parts and NRT is using. I have never seen an internet forum discussing about nicotine gums, about anything (inaudible 04:49:08). But you see, some phenomena but you have never seen before, no-one has ever seen before in this theme of tobacco (inaudible 04:49:18) that …

Chair: Okay. Thank you. I’m going to cut you off there because we do want to get as many people to raise –

K Farsalinos: One more question, I’m sorry. [Laughter]

Chair: Sorry? Be quick, please.

K Farsalinos: Concerning first, not for me, concerning the presence of toxic chemicals in the ecigarette. It is inevitable that such chemicals will be present in e-cigarette. And it is impossible for any kind of regulation to stop these chemicals from emitting. The reason is very simple, if you understand the way that the evaporation takes place, you will see that it is impossible to remove completely formaldehyde or (inaudible 04:50:01) or other toxic chemicals. We just have to find the way to make them emit as low levels as possible. Thank you. Chair: Thank you. Okay. Jeremy, do you want to answer that?

J Mean: Okay. Thank you for that. To begin with I absolutely agree that there are multiple factors in the efficacy of these products, how they work. Why a particular set of people find them much more attractive. I received the letters too of users who are evangelical about their use and how nothing else has worked and this has changed their life, and I have as many anecdotes as others will have. So I absolutely accept that it’s not simply nicotine delivery but it’s a multiple range of factors, including the look and the feel of the product. And regulation doesn’t need to impact on the look and the feel of the product. If people want a range of products, if they want ciga-likes as well as third generation ones, there’s nothing in regulation that will stop that. The market may. I suspect the market is likely to consolidate in any case, with or without regulation, so there is likely to be a market effect which will reduce the range and scale of products, with or without medicines regulation. And sorry, I’ve forgotten your final point.

K Farsalinos: (inaudible 04:51:24), there are so many different types of device, they don’t perform any (inaudible 04:51:40). There are so many it is impossible to do it.

J Mean: But this is why, for example, in a regulated framework what it allows us to do is to learn about the development of the product, in some cases than the market might be able to learn about the development of the product. For example, clear cartomisers so that you know when the product has run dry and when the risk of producing toxicants is going to be higher. That’s the sort of thing that one can learn and build into product regulation going forward so that new products coming forward can address that particular risk or a risk that we learn about associated with how products evolve can have standards set for them. But the important thing is that they can change and evolve, the regulation can follow the science. It isn’t about a set of standards that are fixed in time and can’t evolve with the product on the market.

Chair: Okay. Thank you very much. I don’t know whether anybody else wanted to add anything, otherwise we’ll go, we’ve had some more hands up at the back over on the right hand side there. Yes, thank you.

Dan Griffin: Yes, hello. Yes my name is Dan Griffin, I sit on a smoker’s panel of the UK (inaudible 04:53:07) tobacco control studies and I’m also a smoker and user of electronic cigarettes. I guess I’m a vaper. My question really follows on from the speaker there and also the speaker that raised the point about making his own e-cigarette liquid. And it is that in a scenario where I wanted to make my own liquid and so I built a shed in the back of my garden and I put some e-liquid together and made my own and decided that it was awesome and I wanted to sell it, what sort of regulation would I be … I mean I could if I go a bit Daily Mail on this, I could be facing some criminal charges way down the line for creating some drug and that’s why I worry about the extent of regulation. I mean what’s going to happen if I want to make my own stuff?

Chair: Okay. Do you want to reply and come in?

J Mean: Yes, certainly. I mean in regulatory terms I would be very alarmed if you had nicotine in your shed and you were making a product for sale. Nicotine, as we’ve seen, there aren’t horror stories in terms of its proper use. Most of the electronic cigarette industry has moved to the use of European Pharmacopeial grade pharmaceutical nicotine. But it is a dangerous substance, it has always been controlled as either a poison or a medicine.

Dan Griffin: Yeah, but I’m sorry, I’m talking about the … I mean this is already in existence, these e-liquids, that people do make their own stuff, so for those people, and I’m not just talking about myself and my shed. I’m talking about all the other people that buy the e-liquid and mix their own. I mean, surely, there’s a lot of people out there, are you talking about if you put your regulations in there that every single one of those people is going to be restricted from doing that, are you going to eliminate that product line?

J Mean: No because there will be licensed e-liquid available.

Chair: So you’ll licence a category of e-liquids if they conform to a certain standard? Is that right?

J Mean: Yes.

Speaker: So if I mix two of them …

A McNeil: Yes, sorry, Clive wants to come in and then anyone else.

C Bates: Unless you’ve got a very high-tech shed, I’m not sure we really do want you mixing stuff and then selling it. And I think, trying to pose this as you either regulate it as a medicine or you just have no regulation at all, that’s not right. I don’t think anybody is saying there should just be a complete free for all. I think it’s possible to do a lot of what’s needed to provide an adequate proportion that safeguards simply by having some standards for purity, for having some standards about the construction of devices and then really letting consumers decide what are the right products. The trouble comes, I think, is if you don’t do that and you go too far with regulation you force too many products off the market, there’s not the diversity, people can’t get the products that they want. There’s a natural reaction to that which is to say, ‘Well, I don’t want to buy your licensed stuff, I’ll get it from another supplier.’ An illicit supply chain of people in sheds, mixing stuff, doing what they think people want to buy, probably with not that much risk, but will grow up to meet those needs. It’s not totally obvious therefore that they net harm or the net risk that associated with a stronger standard of regulation causing a narrower product range would actually be safer overall once you take users and suppliers counter veiling illicit responses into account.

Chair: Okay. Thank you. Let’s take a couple of other questions there from the back and then there was one or two here at the front. Speaker: Thank you.

David Dorn: David Dorn from Vapour Trails.tv. I’ve been following this for the last … well, since the TPD came around, indeed since the consultation. The first thing that I would like to say in all of this, for every vaper, no matter what form regulation takes, there should be nothing about us without us and until we decide to do something about the TPD our voices had not been heard. And they should be. And there are many reasons why they should be. Not least of which is the fact that every smoker in the UK today is different. I don’t know how many brands of cigarette there are out there but there are many and there are many illicit ones as well. But each smoker has his choice of cigarettes or her choice. Each smoker decides how many of those cigarettes he is going to smoke per day and how many drags from each cigarette he’s going to take. Every vaper is also different. Those of you  vapers that are in the room now would you do me a favour please and hold up the device that you’re using at the moment. Those of you that aren’t aware, people that aren’t vapers, have a look. They are all different. They’ve all got different atomisers, they’ve all got different juices, they’ve all got different battery units, first generation, second generation and third generation. Thank you everybody. Everybody is completely different. You cannot regulate medicinally for all of us because there isn’t one product or even ten products that would satisfy even the small number of vapers that we have in this room. Similarly, Mr Mean, I remember on June 12 when you made your announcement, you said that nothing on the market currently was good enough to gain a marketing authorisation as a medicine. That means that all of the devices that we’ve just shown up, should medicinal regulation come to pass, would be taken off the market. That would mean that a very great proportion of the vaping public in the UK, in excess now of 1.3 million, would be looking round for an alternative. And has Clive has said, one of those is the black market. And as has just been said, it be e-juice mixed in somebody’s shed and I don’t really want his shaving stubble in what I’m going to be inhaling. [Laughter]

David Dorn: But that would be down to medicinal regulation, would it not? The bottom line on it is that really a regulatory body that’s dealing only in medicines has no idea what works for me. You don’t know how many cigarettes I smoked before I switched, before I substituted what I use for my smoking habit.

Chair: Thank you.

Speaker: One size won’t fit all. Medicinal regulation, I am afraid to tell you, will not work. [Applause]

Chair: Thank you very much. Okay. Well done Jeremy.

J Mean: Thank you for that question. [Laughter]

J Mean: In particular I wanted to come back on your first point about nothing about us without us. And in fact the MHRA has worked very hard to try to engage with the vaping community. I met with the forerunners of ECITA, the companies that made up ECITA, during the consultation, I’ve had regular contact with ECITA. They made a submission to the Expert Working Group so we have had continuing contact. And the point about whether UK government has had a heavy hand in this, the UK government hasn’t done what other member states have done, or other countries have done. They haven’t banned products, they haven’t taken them off the market, they haven’t restricted choice. But they do want a framework that will produce a diverse market. Just because they’re regulated, doesn’t mean there can’t be a marketplace for different types of products, for different types of people. Now whether that becomes commercially viable is not something that I can comment on. We regulate products, not marketplaces. But regulation need not kill a diverse marketplace.

Chair: Okay. Thank you very much. And if anybody else wants to leap in I’d like to take a few more questions. We’ve got about 15 minutes left of this session so do try and keep your comments short so we can get more in. I saw one more hand here, there’s certainly two people at the front if we can bring a mic to the front as well, please. So if we take one more from the back while we bring the mic up to the front, thank you. I can’t tell who put their hand up next so … Thank you.

Lorien Jollye: My name is Lorien, I’m from the Electronic Cigarette Consumer Association in the UK, so my name is Caerulea Sea on the forums and on Twitter. My question is generally to the panel, obviously it could be directly to Mr Mean but I think he’s probably answered enough. My concern is as we stand we’ve got about 1 million and a half users or thereabouts of all manner of devices which Dave has just covered perfectly. By 2016 when this is meant to be implemented that number is going to have grown massively. By 2016 there are going to be millions of people using the devices that are currently available and as Dave rightly pointed out, what happens at that moment in time.? Now I don’t want Mr Mean to have to address this because he’s coming from a different angle. I would like the rest of the panel to think about this from a human perspective and explain to me what I am going to be using or everybody else in this room is going to be using when our choices are actually taken away, potentially millions of us.

Chair: Okay, thank you. If there’s anybody else on the panel who wants to address that, anyone jumping at the gun to address that question. Yes, Robert, go on then. Robert and Clive, go on. And then we’ll have the mic here.

Prof. West: Well we can only speculate but I think that if I may say I think the MHRA and the government, shall we say, have played this rather well in the sense that in 2016 or 2017 if this regulation comes through and there are 3 or 5 million people using a wide variety of different products that don’t have a licence it’s going to be awfully hard to take those off the market. But in a sense, by then we will have the information that we need to know whether that would be a good or a bad thing. It may be, in fact I suspect that before then we will know whether this is the sort of thing that we would need to do. So I think that, as things stand at the moment, because I said at the beginning, we don’t have a problem, everything is going in the right direction. Smoking prevalence is coming down faster than it has for years, the quit rates are going up, e-cigarette usage is going up. Whether there is a connection, we don’t know, but as long as things are going in the right direction there’s not going to be a massive push to change it. However, things can change overnight so the important thing is to monitor it, to keep a very close eye on it, and then see what happens. But like you, I sort of imply I think, that it would be terrifically hard politically for a government to take a product off the market that was being used or product off the market that was being used by 3 or 4 or 5 million people.

Chair: Okay, thank you. And you, Clive.

C Bates: I agree with that. Let’s say there was a determined push towards medicines regulation, there’s several ways that could come undone and there’s probably one or two ways in which it could work. The ways in which it could come undone, it could be challenged in the courts, quite likely, there’s been lots of success in the courts challenging that approach to regulation. But I think Robert’s point is right. In the end if you’re a government and you’ve got 5 million or so people and a lot of whom are extremely forthright at putting their views across, many of you are, you simply don’t deal with that by saying, ‘Well we’ll just plough on regardless and take the political pain,’ you find some other way of doing it. So either what would happen there would be a new regulatory approach designed or something would be done to the MHRA or some interpretation would be made of the Medicines Act … [Laughter]

Chair: Would it be physical?

C Bates: No, it would be much more painful than merely physical. [Laughter]

C Bates: And a different approach would be taken, sense in the end will prevail. So if we get to 2017 there’s only like a handful of not particularly attractive products on the market and there’s huge … it’s not just the products by the way, it’s all the SMEs all round the country who are in the marketplace. All these governments want to be the champions of small business, especially outside London so they’re not going to just put up with something that just wipes out of that out and causes a big movement against them. So something would definitely be done. It’s not the right way to go about doing things, to say you’re going to do one thing and then go off and do another, as we’ll probably soon find out with energy taxes as the government does a U-turn on that because the public is in revolt over those. So I think, I doubt that this will all end in people having their vaping devices seized from them. But there’s a better way of doing it which is to get the regulation right and proportionate in the first place. And just a final point, Robert is absolutely right, it isn’t a problem. We’re in a situation at the moment where we should be saying, ‘What’s not to like? This is all going rather well.’ But nobody is dropping dead, nobody’s face is on fire, people are quitting, people like it, markets growing like mad, fantastic amount of innovation, huge creative destruction sorting out the crap from the good products, third generation already, we’ll be five generations I’m sure by the time we get there. The burden of proof is on those who want to intervene now with a heavy duty regulatory framework because they think something bad might happen in the future. And they don’t have the burden of proof for that, things are good at the moment.

Chair: Okay. Thank you, Clive. [Applause]

D Arnott: Can I just pick up on what Clive said and go back to something Jeremy said earlier. This is about getting the most effective products out there and they’re not out there at the moment. Okay the market is expanding dramatically, but as our research shows, for every one smoker who thinks this product is worth carrying on with, and most of them are dual users, there are two more who think, ‘Actually, I don’t like this.’ So the products at the moment are not good enough. We want regulation to inform and improve the quality of the product on the market.

Chair: And I think we mustn’t forget this is probably quite an informed (inaudible 05:08:12). Do you want to come in on this because I am keen to get more questions. I keep hearing this word, dual user. NICE has set up harm reduction here in the UK. How can you talk about dual users? They are doing harm reduction, they are following NICE guidance.

D Arnott: Yes, but the point –

Prof. Etter: But not (inaudible 05:08:11).

D Arnott: No, but can I answer that question because it is an important point. Dual use is good in that it can lead to quitting. It is not in and of itself an improvement to people’s health. That’s the point I am making.

Prof. Etter: Yes. We all agree on that and we all know –

Prof. West: No, we don’t actually agree on that.

Chair: Well we probably don’t agree. Okay.

D Arnott: And that was the decision that NICE made. No.

Prof. Etter: No no no.

Chair: Hang on. Please let the panel speak.

D Arnott: If you carry on smoking then you are not improving your health.

Chair: I sense from the floor here that there isn’t agreement that dual use is necessarily a bad thing. Presumably you’re saying if it comes down to one or two cigarettes that people are still smoking. Okay, go on then Clive. Enlighten us.

C Bates: Linda presented some of the data on this, okay, and it was people cutting down, basically. Now the trouble is, if you start from the model that smoking is a nicotine satisfying behaviour, in other words, you’re consuming a quantity of nicotine that you want. You cut down, you have the same kind of compensatory effects that you have when you smoke a light cigarette. You just smoke them differently, you work at them harder, you take more puffs, deeper puffs, you work them harder. So the reason people cut down is usually economics, they’re so damned expensive. But it doesn’t mean they get less nicotine from them. If they get less nicotine, they get the same amount of toxins. Now all of that changes when you introduce a new clean source of nicotine, because people are getting the nicotine they want but without the toxins in that case. So the figures that Linda put up were for people cutting down without a substitute source of nicotine -

D Arnott: No. Can I cut in because that is actually really, really dangerous. Because actually Pfizer did randomised controlled trials to try and get a licence for cutting down using nicotine as a substitute and could not prove the health benefit. But what they were able to prove, and that’s where cutting down is helpful, is that by cutting down you’re more likely to go on to quit and that was what they got a licence for. Not for the fact that cutting down, using nicotine which should help prevent compensation. But that in itself was a health benefit. Now it’s getting a bit precise –

Speaker: I agree. I was assuming you were –

D Arnott: But it’s important people realise that just by cutting down, even if you’re using ecigarettes, even if you’re using NRT, you’re not necessarily improving your health.

C Bates: But going on the data than Linda presented she didn’t have a substitute source of nicotine in it.

Speaker: No, they didn’t.

C Bates: And that’s the weakness in drawing conclusions about using e-cigarettes on that data, it’s a completely different thing. So if there’s other data, which I haven’t seen from Pfizer or whoever –

D Arnott: Well I’ll send you the RCTs and I’ll send you the NICE findings.

Chair: Okay. Let’s bring in some more people from the floor. Go on, go on, you haven’t spoken.

J Le Houezec: About the companies with NRT, people are not using e-cigarettes like NRT. Few people will use NRT together with cigarettes long enough to observe outcomes they do with e-cigarettes and there are very few data vapers outside laboratory settings with longitudinal data looking at whether they quit smoking. But we published recently a paper on addictive behaviours showing that dual users quit smoking in large numbers after one year and also ex-smokers relapse in amazingly small numbers after one year. So we need more follow up data. But the comparison with NRT I think is not very relevant.

Chair: Okay, thank you. Okay. Question.

Charlie Hamshaw-Thomas: Charlie Hamshaw-Thomas from E-Lites, one of the UK’s biggest e-cigarette companies. I’d like to ask a question about the fourth bullet up there in the third option. I’m also thinking of Anne’s comment this morning at the start of the day about us listening to both sides of the argument. There seems to be agreement in the room, shout if I’m wrong, that e-cigarettes have a public health benefit. There also seems to be agreement in the room that there’s a difference of opinion as to how they should be regulated. That uncertainty is not helping at the moment. It’s not helping the industry and obviously we’re the industry. It’s not helping the people who are selling e-cigarettes, whether that’s tobacco retailers or pharmacists. I would argue that it’s not helping the consumers either. And ergo, it’s not helping public health. So I’d like to ask this question of all six of the panel there, what chance we could all get into a smoke filled … oh sorry, oops, vaper filled room and try and agree something which is workable and achievable for these products. From what I’m hearing I think Robert might be best placed to be the referee or the chairman of that.

Chair: Okay. So is there a third way essentially? Anybody want to take a view on that? I mean we obviously we aren’t going to get a third way in five minutes but any quick top of the head thoughts?

R West: I’m not sure that it will happen but I think a starting point for it is to establish what you want it to look like and then see how you can achieve that. And actually I think there is far more agreement in this room and in fact out there on what we want it to look like than there is on how we should achieve it. Looking through the various points of regulation, about marketing, about quality, about safety, etc., etc., actually I think there is quite a lot of agreement. The key issue on regulation is that we’re not all convinced, or the community is not all convinced, that we can achieve that with either medicines regulation or with the existing product regulations that there are out there. However, as Clive says, it’s not beyond the wit of man to engineer something. That comes at a cost as Deborah has alluded to, but everything comes at a cost. So what you do is you work out the costs of the benefits and you see which one of these gives you the best kind of outcome. So I think there is reason to believe that if we can start with what we want to achieve, we can then get a better idea about how we go about achieving it.

Chair: Okay. Perhaps I won’t take other questions, because I know there were a couple of people who were desperately keen to come in from the floor, so … yeah.

Darren Burns: Hi, it’s Darren Burns from Safercigs. My question is to Ms Arnott. Earlier on you were told there were 1.3 million vapers in the UK currently and immediately you came back with, ‘Oh yes, but there’s 2.6 million people who have tried electronic cigarettes and gone straight back to smoking.’ Can you just let us know where you’re pulling these figures from and who are filling these surveys out for you. Because I’ve conducted an awful lot of research in my shop with my customers, real time people, and I’ve spoken in length to many of them. And I’ve asked them, I’ve even put some of them on staged programmes where they’ll start at a certain nicotine level and we’ll reduce them down over time. Because their ultimate aim is to not smoke anymore, but whilst they’re going through that process to use a healthier alternative, a better alternative, a substitute to tobacco smoking. You pull out these figures of 2.6 million, where are these figures coming from?

Chair: Okay. Thank you. Speaker: Do you have anything that you could show us on the screens that shows that you have actually conclusively done this research and these are real people? Because it’s very easy to sit behind a desk and say, ‘Right, but there’s 2.6 million people against that.’ Give us the figures, let’s see them.

Chair: Okay. If I could just remind people of what I said at the outset. Let’s try and be as constructive as possible in our questions. Deborah, can you –

D Arnott: No, I think that was a very constructive question. We do a survey of around 12,000 people a year with YouGov. We’ve been asking questions of smokers and non-smokers about e-cigarette use going back for a number of years now and the most recent figures were from this survey last May and that’s where it comes from. It’s an aggregation up from a survey but it’s a large sample and so we can calculate from that basis turning the proportion of smokers and nonsmokers to say they use the products. That’s where we’ve got the figures about the fact that our surveys certainly don’t show that large numbers of non-smokers are using these products, both amongst adults and amongst children and young people, and that’s where it comes from. Now the point is that people coming into your shop aren’t going to be the smokers who try them and then go away and don’t like them, because they aren’t going to come back.

Chair: Okay, thank you. Do you want to add …?

Speaker: Just very quick.

Clive Bates: I think to be fair to ASH this is actually a very good piece of work that they’re doing. It’s a very good survey and it provides very useful information and we should be glad that they’re doing it. The question is whether the numbers that come out like that represent success or failure. If you look at the number of people who try NRT for a while and then stop using it, probably very high as well. And so just because something isn’t a slam dunk solution that works for absolutely everybody first time, doesn’t mean it’s a failure. It means that actually there’s quite a large amount of success coded into those numbers, I think Deborah, to be honest.

D Arnott: Yes. And we do say that.

C Bates: I know so –

D Arnott: We’re not saying it’s a complete failure.

C Bates: No, I –

D Arnott: But on the other hand, I have to say that we’ve been attacked by the cigarette companies saying that millions of people are going to quit smoking with these products when the evidence isn’t there, that it’s actually that they are actually meeting the needs of all smokers at the moment. And that’s all I’m trying to point out. I’m not saying they are a complete failure, but they’re not a complete success either.

C Bates: But nothing meets the needs of all smokers, especially not NRT or varenicline or any of those other products. The question is, how much success is being generated in this marketplace and where’s it heading? You know, products are getting better all the time, the growth in the market represents an incredible interest in this. Robert’s survey showed that that people are opting into trying this because it looks like an interesting way forward that might meet some of their needs in a way that the other approaches don’t. It’s another weakness in the randomised control trial approach; people think this is more attractive then they’re more likely to have a try with it. Given time though, maybe those numbers will improve. I would say at the moment they represent quite an incredible success for a relatively new technology.

Chair: Okay. I’m being told I’m afraid that we can’t have any more questions and that it’s tea-time. So apologies for that. I know some people have their hands up at the back but maybe you’ll get a chance to ask them. Can I just thank again please all the panellists and in particular can I thank Jeremy Mean because I know he’s got to leave now and you’ve had quite a grilling. So thank you very much. [Applause]

Chair: Okay. A focus on the tobacco industry after the break. Thank you.

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