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May 18th, 2015:

E-cigarettes alter lungs at cellular level

Since electronic cigarettes were introduced in 2004, the devices have become incredibly popular among smokers. As of 2013, there were 2.1 million users in the UK alone, despite there being no universally accepted studies on the safety of the tobacco replacement devices, or their efficacy in helping smokers to quit regular cigarettes.

In fact, new research shows that e-cigs — or more specifically, the flavourings that can be used in them — could have a dramatic impact on the human body. A report published by the American Thoracic Society, which focuses on pulmonary diseases and breathing disorders, has found they can actually alter lung function at the cellular level.

The findings were presented at the 2015 American Thoracic Society International Conference and include changes in cell viability, cell proliferation, and calcium signalling, though these effects were dependent on which flavour liquid was used in the trials.

The study uses cultures of human airway epithelial cells, which were exposed to various doses of 13 e-cigarette flavours for either 30 minutes or 24 hours. In the former, three flavours — Hot Cinnamon Candies, Banana Pudding (Southern Style), and Menthol Tobacco — saw a dose-dependent calcium response. At higher doses, they were actually toxic to the cells. In the 24-hour exposure test, the same flavours decreased cells’ ability to grow and replicate, depending on the dosage administered

“The effects of the various chemical components of e-cigarette vapor on lung tissue are largely unknown,” said the study’s lead author, Temperance Rowell of the University of North Carolina. “In our study using human lung epithelial cells, a number of cell viability and toxicity parameters pointed to five of 13 flavours tested showing overall adverse effects to cells in a dose-dependent manner.”

However, the toxic effects were not seen with either nicotine or the e-liquid vehicle, which consisted of the usual propylene glycol or vegetable glycerin. Longer term studies, including the “aerosolised product of e-liquid flavours on cultured primary human bronchial epithelial cells” are ongoing.

While it might seem a no-brainer to some that intentionally inhaling largely unregulated chemicals may have some negative health side-effects, there is comparatively little research into the long-term impact of either the “regular” nicotine delivery systems of e-cigs or the flavoured alternatives. Similarly, there is minimal oversight of the vapourisers or liquids — Rowell’s study used flavoured liquids from an American specialist retailer, though the ones UK consumers may purchase could come from a variety of different sources, all with different production standards, ingredients, and chemical compositions. However, a World Health Organisation report from 2013 concluded that “consumers should be strongly advised not to use any of these products, including electronic cigarettes”, and countries including Brazil, Uruguay, and Singapore have banned them.

Surgeon General Calls Out Atlanta Airport’s Smoking Lounges

The U.S. Surgeon General has called on the city of Atlanta to make Hartsfield-Jackson Atlanta International Airport completely smoke-free.

Currently, smoking is allowed in designated smoking lounges in each of the airport’s terminals.

A tweet, posted by Dr. Vivek Murthy, shows him standing in front of an airport smoking lounge sign. His face is stoic. His thumb points down. The tweet reads:”#MadMen ended, and this should, too. World’s busiest airport can be its healthiest. Make #ATL airport tobacco-free!”

Atlanta’s airport has at least one designated smoking lounge in each of its seven terminals. In the early 1990s, cigarette maker Philip Morris gave the city $250,000 to construct the rooms. The city is responsible for maintaining the lounges – including their ventilation systems.

But a CDC report found those systems do not eliminate second-hand-smoke exposure.

Georgia’s 10-year-old indoor smoking ban carries an exclusion for international airports.

An airport representative was unavailable for comment.

A spokeswoman for Mayor Reed says he’ll take the tweet under consideration.

Panel on Health Services – Tobacco control

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Progress of Tobacco Control Measures

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Tax increase goes up in smoke

The case for the mainland to do something about its smoking habit hardly needs restating. But we are prompted to do so by Beijing’s announcement of a derisory increase in the consumption tax on cigarettes which is highly likely to fail one of its justifications – to discourage smoking. The government has raised the wholesale tax on cigarettes from 5 per cent to 11 per cent. This may sound a lot, but it has had a featherweight impact on over-the-counter cigarette prices and sales, according to retailers in the capital. For example, a popular brand that used to cost 25 yuan (HK$32) a pack now costs 27 yuan. One retailer said his business had not suffered at all from the rise, indicating a zero deterrent effect.

The increase in the wholesale price is estimated to bring in an extra 20-billion-plus yuan in tax revenue this year compared with 2014, according to an informed source, although other experts put the figure much higher. In the absence of any significant deterrent effect on a dangerous habit that inflates national health-care costs, this is a socially questionable windfall for the state. There is an argument for socially “laundering” it by direct transfer to the national health budget. It would make even more sense, however, if the tax increase were also considerably larger. Since 2000, price inflation for cigarettes in the mainland has lagged rising incomes, and taxes account only for about 50 per cent of the retail price, compared with about 70 per cent in Hong Kong, up to 80 per cent in Europe and the World Health Organisation recommendation for China of at least 70 per cent.

The mainland has more than 300 million smokers. According to the WHO, about one million deaths a year can be attributed to tobacco use. In Hong Kong, a decade of regular tobacco-tax increases is credited with cutting the incidence of lung cancer after allowing for an ageing population.

That said, Beijing is to be commended for introducing, from next month, the nation’s toughest smoking bans yet since the first curbs on smoking in indoor venues in 2010. Weak enforcement has fostered defiance in eating places. Fines will now be 20 times higher at 200 yuan and the ban is being extended to schools, hospitals, and museums among other public places. A two-pronged approach of relentless enforcement of tougher penalties and higher tobacco taxes levied as contributions towards the future health-care costs would greatly enhance the deterrent effect.

Legislative Council Panel on Health Services – Progress of Tobacco Control Measures

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Phase II randomised controlled trial of an intervention to reduce time-to-consult with symptoms of lung cancer

Protocol for the CHEST Australia Trial: a phase II randomised controlled trial of an intervention to reduce time-to-consult with symptoms of lung cancer



Lung cancer is the most common cancer worldwide, with 1.3 million new cases diagnosed every year. It has one of the lowest survival outcomes of any cancer because over two-thirds of patients are diagnosed when curative treatment is not possible. International research has focused on screening and community interventions to promote earlier presentation to a healthcare provider to improve early lung cancer detection. This paper describes the protocol for a phase II, multisite, randomised controlled trial, for patients at increased risk of lung cancer in the primary care setting, to facilitate early presentation with symptoms of lung cancer.


The intervention is based on a previous Scottish CHEST Trial that comprised of a primary-care nurse consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to improve symptom appraisal and encourage help-seeking in patients at increased risk of lung cancer. We aim to recruit 550 patients from two Australian states: Western Australia and Victoria. Patients will be randomised to the Intervention (a health consultation involving a self-help manual, monthly prompts and spirometry) or Control (spirometry followed by usual care). Eligible participants are long-term smokers with at least 20 pack years, aged 55 and over, including ex-smokers if their cessation date was less than 15 years ago. The primary outcome is consultation rate for respiratory symptoms.

Ethics and dissemination

Ethical approval has been obtained from The University of Western Australia’s Human Research Ethics Committee (RA/4/1/6018) and The University of Melbourne Human Research Committee (1 441 433). A summary of the results will be disseminated to participants and we plan to publish the main trial outcomes in a single paper. Further publications are anticipated after further data analysis. Findings will be presented at national and international conferences from late 2016.

Trial registration number Australian New Zealand Clinical Trial Registry ACTRN 1261300039 3752.

More must be done to stub out the scourge of tobacco use in Europe

MEPs have a responsibility to reduce the EU’s 700,000 annual smoking-related deaths, argues Brian Hayes.

Cancer is one of the biggest causes of death in Europe and lung cancer accounts for a significant number of those deaths. I believe that one of our responsibilities as legislators is to tackle the largest cause of lung cancer – smoking.

Smoking is the single biggest preventable cause of cancer in Europe, causing 90 per cent of lung cancers. Every year, more Europeans die from smoking than from the combined total of car accidents, fires, drug overdoses, murders and suicides. Around 700,000 Europeans will die from smoking this year.

The passing of the EU tobacco products directive does not mark the end of the scourge of tobacco use in Europe. Quite frankly I believe we need to do more. Some member states are exceeding their obligations which I very much welcome. Ireland, my own country, despite strong objections from the tobacco industry was the first member state to pass legislation to introduce plain packaging.

Now other countries including the United Kingdom and France are following suit. Yet, the implementation of such measures could potentially be delayed as the tobacco industry intends on taking these governments to court.

Tobacco is a unique case. It is the only legal product that will kill half of its long-term users. That is why I fully support the introduction of standardised packaging in Ireland and would like to see a situation where every EU member state adopts the same position.

Australia was the first country to introduce such legislation and the evidence is clear. Dozens of studies have concluded that standardised packaging reduces the attractiveness of cigarettes, lowers the ability of packaging to mislead consumers into believing that some products are less harmful and increases the noticeability and impact of health warning messages.

Official statistics show that Australia’s smoking rate has been significantly reduced and is continuing to fall. It is now at its lowest levels since records began.

Another area where I believe we could work to discourage smoking is on the price of tobacco. In Ireland, we have increased taxation on cigarettes to approximately €10 per pack of 20 – one of the highest rates in Europe.

Repeated studies show that price is a deterring factor for smokers. In Ireland, the largest single annual decline in smoking rates was nine per cent between June 2009 and June 2010. The origins of this can be traced back to the preceding year’s budget in which a €0.50 excise duty was added to a pack of cigarettes.

Many people will disagree with my opinion and I respect that. However, we must face reality – cancer is one the biggest causes of death across the 28 member states with lung cancer accounting for a significant amount of those deaths. If we are serious about reducing our cancer rates we need to tackle the causes.

Arguments will be made that we are overregulating the tobacco industry but if we sit back and do nothing the 700,000 Europeans that die in 2015 from smoking could be a significantly higher figure in 10 years’ time.

About the author
Brian Hayes (EPP, IE) is a member of MEPs against cancer

ITIC: A Foundation Directly Sponsored by Transnational Tobacco Companies

The International Tax and Investment Center (ITIC) is a U.S.-based non-profit research and education organization headquartered in Washington, D.C. ITIC describes itself as an independent clearinghouse for best practices in taxation and investment policy that provides “its sponsors a seat at the policymaking table.”

ITIC’s main sponsors are large multinational corporations from the oil, alcohol and tobacco industries. ITIC’s sponsors include all of the leading transnational tobacco companies, and its Board of Directors includes representatives from BAT, PMI, JTI and Imperial Tobacco.

Internal tobacco industry documents made public through U.S.-based litigation settlements in 1998 disclose that ITIC has long played a role in facilitating the tobacco industry’s access to government officials. For example, a 1997 internal R.J. Reynolds memo describes ITIC’s role in assisting RJR and PMI in favourable tax reform in Russia.

ITIC provides advice to governments on tobacco tax issues. They hold workshops and meetings and provide technical advice through paid experts. They sponsor reports on illicit trade, producing illicit trade estimates with poorly defined methodology and often exaggerated rates of illicit trade. ITIC uses their workshops, contacts and research to push for tax systems and rates that benefit the industry over public health

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Tobacco industry misrepresenting illegal market to stop excise increase, expert says

An expert in tobacco control says claims that action is needed to curb illegal tobacco use in New South Wales are incorrect.

British American Tobacco Australia (BATA) said it commissioned research which found 14.5 per cent of tobacco consumed in Australia is illegal.

BATA is considering introducing make-your-owns, at $9 for a pack of 25 cigarettes, to curb the trend.

But Dr Becky Freeman from the University of Sydney said government surveys showed illegal tobacco use fell between 2007 and 2013, and has accused the tobacco industry of distorting figures.

“It’s clear that the use of illicit tobacco has actually decreased,” she said.

Dr Freeman said 3.6 per cent of smokers admitted to using illicit tobacco.

But British American Tobacco insists its figures are correct.

“Our particular figure, we stand by it,” British American Tobacco Australia’s Scott McIntyre said.

“That’s backed up by us going out there and going to all different locations across the country with ex-detectives doing undercover purchases.”

Dr Freeman accused the tobacco industry of distorting illegal tobacco use to offset the impact of the rises in excise.

“The primary motivation to say that there has been an increase in illicit tobacco use is to prevent the Government from further increasing taxes and that hurts the tobacco industry,” she said.

“This is completely an industry beat up. I find that the notion that legal cigarettes have passed some sort of safety standards completely laughable.

Dr Becky Freeman

“The Government should continue on with its taxation policy of increasing the price.”

The tobacco industry has warned that proceeds from illegal tobacco and cigarettes were being funnelled to criminal gangs and that profits should be going to government.

“The excise system is just not having the desired effect,” Mr McIntyre said. “It’s shocking people into changing their behaviour and looking for cheaper alternatives.

“We’re not encouraging people to take up the habit. “We’re just saying if you’re already a smoker and you’re smoking an illegal product, we would rather them smoke ours and that way at least the consumer knows that they’re smoking a product that has been through the right laws and standards and the Government is getting their fair share in tax.”

Mr McIntyre said consumers also have greater assurances over what substances are used in legal tobacco products. But Dr Freeman said that simply was not true.

“I find that the notion that legal cigarettes have passed some sort of safety standards completely laughable,” Dr Freeman said.

“The cigarettes that are sold legally in shops, we actually have no idea what’s in them either.

“The tobacco industry isn’t required to declare what’s in them.”