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Recently I posted a series of questions on Facebook for our Community, the Tahlequah City Council, and the Cherokee County Health Coalition to consider in regards to the proposed Vaping/E-cigarette ban ordinances that are being promoted around the State.  Below is my original commentary and questions in black with research and answers provided by Kaye Beach, an independent researcher and activist that has over the years shown herself to be a wonderful asset to the people of Oklahoma in helping keep everyone informed on many issues our State faces.

If you are interested you can find more on Kayes work Here.

Dr. Shannon Grimes, Chairman
Cherokee County Republican Party

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The discussion about prohibiting Vaping products continues in our community. I think we would all agree that there are a great many serious questions that need to be asked and addressed when we are looking to limit and control the behavior of others.

Carol Choate recently had these comments in a news interview with Channel 2 out of Tulsa:

“We’re kind of with e-cigarettes like we were 50 years ago with cigarettes. We had no idea what cigarettes could do to us, but we know now that they cause cancer.”

“What this ordinance is all about is Public Health. Its about changing environments. Its about keeping our social norms.”

Regarding Vaping what do these statements mean? What environmental change is sought? What social norm is going to be maintained?

Those are just a few question based just on that interview. I have a lot more questions and not just for Carol Chaote, the Cherokee County Community Health Coalition, our community officials, and other interested parties. I would love for all interested parties to stop and consider these questions and more as we move forward.

Where did the proposed ordinance prohibiting Vaping originate?

From the Cherokee County Community Health Coalition and they were prompted to push the ordinance by the promise of funding from the Oklahoma Tobacco Settlement Endowment Trust (TSET)

TSET uses funds from the tobacco Master Settlement Agreement to incentivize policies that the TSET and their partners determine is desirable for the community. 

Did the Cherokee County Community Health Coalition propose the Vaping ban ordinance at the request of entities outside our community?

The ordinance is financially incentivized by entities outside the community.

The direct impetuous for the ordinance is provided by the Oklahoma Tobacco Settlement Endowment Trust that is providing millions of dollars from the Master Settlement Agreement to communities for a variety of (sometimes) remotely related health initiatives under the Healthy Communities Incentive Grants program. 

In 2013, TSET is incentivizing cash strapped communities ‘tobacco control’ measures with $4.1 million dollars in grant money.  Banning e-cigarettes earns the highest level of grant rewards.

Communities of Excellence in Tobacco Control – A One-Year RFP (PDF), Nov. 20, 2013.”

 http://www.ok.gov/tset/Grants/Communities_of_Excellence_Tobacco_Control_1_year_RFP.html

 (In 2012, TSET’s ‘tobacco control’ incentive budget was $6.06 million)

Does the Cherokee County Community Health Coalition have a financial incentive to see this prohibitive ordinance in place?

Yes.  TSET Grant funding is conditional upon the grant applicant working to ban e-cigarettes on city property and elsewhere. 

Millions have been set aside by TSET specifically for funding tobacco coalition grantees’ activities to reduce tobacco use in communities for 2013 (TSET has redefined ‘tobacco’ to include vapor devices and products) http://www.ok.gov/tset/documents/TSET%20ProgramFact%20SheetFY12Final2%201.pdf

Grant applicants, like the Cherokee County Tobacco Coalition, led by Carol Choate, get 10% of the grant award. Carol Choate is the Cherokee County  “Communities of Excellence in Tobacco Control” grant Coordinator

This grant money is contingent upon the community achieving certain ‘community indicators’ established by TSET including the establishment of a city ordinance to prohibit the use of e-cigarettes and vapor devices/products on all city property both inside and out.

There are a total of nine Community Indicators (or goals)  These nine ‘community’ goals were chosen by TSET (and the Oklahoma Tobacco Research Center (OTRC) which is funded by TSET)

Grant Applicants must, at a minimum, develop work plans to achieve all five of TSET designated “Core Indicators” and one “Optional Indicator”   Three of the five “Core Indicators” require e-cigarettes or vapor devices/products prohibitions so any organization that applies for TSET’s grant must work to achieve vaping bans.

This year, “The TSET Board of Directors doubled grant funds available to communities as part of the Healthy Communities Incentive Grant.”  According to TSET.

In reference to Carol’s statement quoted above about the state of our cigarette knowledge 50 years ago, has our clinical sciences and testing improved in the last 50 years?

Indeed it has. And I would like to state, up front, that any person, entity or group claiming that there is no evidence that using e-cigarettes is much safer than smoking is either  ignorant, misinformed or (as much as I hate to use this term)  lying.

Do you think we can have a better idea about the risks quicker than in the case of cigarettes?

Science already provides enough evidence to conclude that vapor is much safer, by orders of magnitude, than smoking. 

For example: ‘Using the multi-criteria decision analysis method previously used by the Independent Scientific Committee on Drugs (ISCD) to rank the harms of drugs used in the UK, a working group of international nicotine experts convened by the ISCD considered the potential harms of a wide range of nicotine containing products based on sixteen parameters of harm to individuals and harm to others. Not only conventional cigarettes were judged to be by far the most harmful form of nicotine containing product, but e-cigarettes were ranked as similar in harm to nicotine patches [33]. By and large, nicotine per se does not cause much risk when separated from inhaling smoke.’ 

Multi-criteria Decision Analysis: A new approach to evaluating the harm caused by nicotine delivery products. http://www.drugscience.org.uk/external-resources/nicotine-mcda-briefing/

“E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by  FDA.”

Is there any evidence of big business hiding and lying about the effects of Vaping such as was done by the Tobacco Industry historically?

None that I am aware of although it is apparent that the anti-smoking industry advocates are unfairly conflating the e-cigarette business with Big Tobacco.  The truth is that this product was not developed or marketed by the tobacco industry until very recently, after it became clear that vaping is the wave of the future. 

Is there any evidence that Vaping is anywhere near as toxic as tobacco use?

If you mean the use of smoking tobacco, no.  Not all tobacco use is equal.  Smokeless tobacco products are well-established by science and historical statistical data to be 98% safer than smoking tobacco.   

Smoking cigarettes accounts for every one of the app. 440,000 deaths that the CDC attributes to tobacco each year.  The number of deaths from all other tobacco products combined is so small and difficult to track that the CDC doesn’t even bother. (Centers for Disease Control and Prevention, “Smoking & Tobacco Use: Tobacco-Related Mortality,” August 1, 2013. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm)

‘E-cigarette vapor, as inhaled by the users, is mainly water, propylene glycol and glycerin, with small amounts of nicotine and flavoring. There is no carbon monoxide, no tar and no products of combustion.

There is no side-stream smoke or vapor. None. Propylene glycol and glycerin are generally recognized as safe. Propylene glycol has been used as the propellant in asthma inhalers and is the main ingredient in theatrical fog’(Statement by Joel L. Nitzkin, MD, MPH, DPA Past Co-Chair, Tobacco Control Task Force American Association of Public Health Physicians Senior Fellow for Tobacco Policy, R Street Institute September 4, 2013 http://www.rstreet.org/wp-content/uploads/2013/09/Nitzkin-duluth-statement.pdf

Evidence to date indicates that e-cigarettes do not raise serious health concerns and is considered to be much safer than smoking tobacco by orders of magnitude.

Is there any compelling evidence or research showing harm to Vaping users beyond possible nicotine addiction realizing that not all even use the nicotine versions?
No. While e-cigarettes are relatively new and any long term effects cannot be established, we do know a great deal about the ingredients of e-liquid and their effects on the human body. 

Community ‘health leaders’ that refuse to provide truthful information about alternative nicotine sources and misguided prohibitions are a far greater threat to public health.   How many current smokers will be dissuaded from switching to a safer alternative for nicotine and continue to smoke?   This is nothing short of tragic because smoking is the single most harmful method of delivering nicotine and it is smoking cigarettes, in fact, that responsible for all of the some 440,000 deaths attributed to tobacco. 

Is there any evidence, compelling or otherwise, about risks to those around persons using Vaping product?

Evidence isn’t evidence unless it is compelling and there is no such evidence. 

There is much evidence, however, to show that, not only is vaping much safer that smoke, e-cigarettes have less toxins that FDA approved nicotine inhalers and no one is suggesting that this product be banned from public use.

Passive vaping, compared to cigarette environmental tobacco smoke: Total organic carbon in the test chamber after 5 hours of smoking or vaping, showed no detectable levels of acrolein, toluene, xylene and PAHs for the e-cigarettes, compared to high levels in the cigarette chamber. (Giorgio Romagna, Konstantinos Farsalinos, et al, 14th Annual Meeting of the Society for Research on Nicotine and Tobacco, 2012)

FDA approved nicotine inhalers have higher amounts of six carcinogens, including five to ten times the amount of three heavy metals compared to e-cigarettes. (Michael Siegel, “Anti-Smoking Researcher Misleads Public with Invalid Comparison of E-Cigs and Nicotine Inhaler: Correct Analysis Shows that Nicotine Inhalers Have Higher Amounts of Six Carcinogens,” Tobacco Analysis, July 25, 2013. http://www.tobaccoanalysis.blogspot.com/2013/07/anti-smoking-researcher-misleads-public.htm)

As Dr. Joel L. Nitzkin, speaking against a similar prohibition ordinance in Duluth, MN. Recently pointed out “If the nicotine and trace carcinogens in e-cigarette vapor presented any significant hazard to bystanders, those advocating for this legislation could have and should have included pharmaceutical nicotine inhalers in this ban. The fact that they have not done so strongly suggests a perception on their part that no such hazard exists”

 

“For all byproducts measured, electronic cigarettes produce very small exposures relative to tobacco cigarettes. The study indicates no apparent risk tohuman health from e-cigarette emissions based on the compounds analyzed.”

T.R. McAuley, et al, “Comparison of the effects of e-cigarette vapor and cigarette smoke on indoor air quality,”Inhalation Toxicology October 2012. http://www.ncbi.nlm.nih.gov/pubmed/23033998

 

There is simply  no threat to bystanders from exhaled e-cigarette vapor that justifies a ban.

 Are the fears about tobacco risks and dangers being applied to Vaping? Is that fair or honest given that the two products pretty much only share one factor, nicotine?

Yes to the first question and No to the second.  And it is the fears and risks of smoking, not tobacco, that is being fantastically misapplied to vapor.

If people actually stop using tobacco and thus stop paying the tobacco sin taxes do many of the non-profits and organizations that nominally seek cessation risk having lower funding?

46 states get a bundle of money from the tobacco Master Settlement Agreement. The Master Settlement Agreement was an agreement reached in 1998 between the tobacco industry and a number of states that had filed lawsuits against tobacco manufacturers for reimbursement for smoking-related health costs.  The amount that the states get from the Master Settlement Agreement (MSA) each year varies depending on inflation and the quantity of traditional tobacco products that are being shipped within the U.S. 

E-cigarettes and other smokeless tobacco products don’t count towards MSA funds. 

E-cigarette sales means less tobacco settlement money for the TSET

Master Settlement Agreement (MSA) Payment Distribution Through FY2013 “NOTE:As tobacco use declines nationally, MSA payments to all states will be reduced.”

http://www.ok.gov/tset/documents/MSAFinancial4_30.pdf


Is the desire to have cessation of Tobacco use with all its problems or nicotine in general?
Good question because the goalpost keeps moving. 

First the goal was ‘smokefree’ then ‘tobacco free” (although smokeless tobacco carries only about 2% of the risk that smoking tobacco does) and now it appears the war that began with smoking, is being extended to nicotine regardless of the deliver y system, unless of course, the delivery system happens to be a profitable pharmaceutical product.  It is important to remember that these government approved smoking cessation products fail 93% of smokers who use them as directed Link

Here are some key terms and definitions issued by TSET to guide tobacco coalitions;

DEFINITIONS:

The definitions of tobacco,tobacco-free, smoke-free and vape-free is consistent throughout this document:

  • Tobacco: Any product that contains or is derived from tobacco and is intended for human consumption excluding drugs or devices approved for cessation by the United States Food and Drug Administration. This includes e-cigarettes and vapor devices.
  • Tobacco-free:  Prohibits the use of any tobacco product by anyone, anywhere, at any time.
  • Smoke-free: Prohibits the use of combustible tobacco products.
  • Vape-free: Prohibits the use of e-cigarettes and vapor devices/products

 Does the Cherokee County Community Health Coalition really want to decrease Tobacco use and if so why try to prohibit a product that is very promising in actually helping attain that goal?

The Cherokee County Community Health Coalition will have to answer that question themselves because I am at a loss to explain the incongruence of their efforts.  You might try asking them some pointed questions about their stance, for instance, “How much safer than smoking does an alternative source of nicotine have to be before it is considered an acceptable alternative?”

Does the alternative need to be 20% safer than smoking?  50%?  If they say 100%, you are not dealing with a rational mind.  If I had a loved one who smoked and couldn’t or wouldn’t quit, an alternative that they found to be an acceptable substitute for smoking that was 20% safer would be enough for me to encourage them to switch.  E-cigarettes, which contain no tobacco, no tar, no carbon monoxide are 99% safer that smoking cigarettes

The truth is that the efforts of overzealous anti-tobacco organizations like the Cherokee County Community Health Coalition means that more smokers will continue this deadly habit. 

Is there any evidence that prohibiting Vaping would have any significant positive impact on public health?
Yes!  .As the American Association of Public Health Physicians (AAPHP) points out, “Almost all tobacco-attributable mortality in the USA is due to cigarette smoking.” Link   and there are no serious denies that that vapor is much safer than smoking.

 (AAPHP) states that it “favors a permissive approach to e-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years.”  Link

If there is no compelling evidence regarding public dangers of Vaping and there is no compelling evidence regarding significant positive public health benefits from a ban then is there any REASONABLE grounds for such a ban in our community?

There is not.  I trust the people of Tahlequah will guide their elected officials towards a rational stance on vapor product use

Kaye Beach, Independent Researcher  11/29/2013

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