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COSH urges the Government to take full account of public opinions Enact Enlargement of Pictorial Health Warnings Promptly

Hong Kong Council on Smoking and Health (“COSH”) urges the Government and Legislative Council to enact the enlargement of pictorial health warnings promptly in order to reduce the attractiveness of tobacco, motivate more smokers to quit and deter youth from trying the first cigarette. Mr Antonio KWONG, COSH Chairman remarked, “Results from survey conducted by COSH and two rounds of public consultations organized by the Legislative Council showed that majority of citizens and organizations supported the enlargement of pictorial health warnings to 85%. The Government and Legislative Council should take full account of public opinions and enact the proposed tobacco control measure as soon as possible.”

The Government briefed the legislative proposals to strengthen tobacco control on 18 May 2015, including enlarging the size of pictorial health warnings to at least 85% of the two largest surfaces of the packet, increasing the number of forms of health warning from six to twelve and adding the quitline 1833 183. The date of enactment is yet to be scheduled after more than one and a half years.

The Legislative Council collected views of the public and held special meetings on the enlargement of pictorial health warnings twice. Among the hundred submissions received in July 2015 regarding the increase in the size of pictorial health warnings, more than 80% supported. Besides, over 100 submissions were received for the special meeting of Legislative Council Panel on Health Services to be held tomorrow (17 January 2017), in which around 70% agreed the proposed measure.

The School of Public Health of The University of Hong Kong was commissioned by COSH to carry out the Tobacco Control Policy-related Survey 2016. It was found that public support on enhancing the pictorial health warnings was overwhelming, 79.5% of all respondents agreed to display more threatening messages about the health risks of smoking. About 72.5% of all respondents supported to increase the coverage of the health warnings to 85% while about half of the current smokers also supported. Majority of respondents opted for plain packaging* of cigarettes as well. In addition, COSH has collected over 26,500 signatures from citizens and organizations through street counters and online platform supporting the enlargement of pictorial health warnings since May 2015.

In recent years, many countries have successfully introduced more stringent measures to regulate tobacco packaging. Prof Judith MACKAY, Director of Asian Consultancy on Tobacco Control and Senior Policy Advisor of World Health Organization claimed, “Hong Kong ranked the 72nd in the world regarding the implementation of pictorial health warning and behind many developing countries like Laos, Myanmar and Sri Lanka. Hong Kong should enlarge and strengthen the pictorial warnings promptly in order to reduce the use of tobacco.” World Health Organization called for more countries to enlarge pictorial warnings covering more than 85% and implement plain packaging. “Get ready for plain packaging” was designated as the theme of World No Tobacco Day 2016.

Recently, some organizations opposed the proposed enlargement of warnings in the pretext that it would lead to a surge in cigarette smuggling activities. A recent study also claimed that illicit cigarettes composed for around 30% of cigarette consumption in Hong Kong. Prof LAM Tai-hing, Chair Professor of Community Medicine cum Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong said, “the public should express reservation on the results of this tobacco industry-funded study. The data collection methods and calculations of the study were unclear using dubious methods.” The tobacco industry and its allies always express strong opposition against tobacco control measures proposed by the Government under the pretext that it will lead to a surge in cigarette smuggling activities. As recommended by the World Health Organization, the most effective measure against smuggling is tight control and aggressive enforcement.

With the Government’s multi-pronged tobacco control policies over the years, the smoking prevalence in Hong Kong has gradually reduced from 23% in early 80s to 10.5% in 2015. In view of the tobacco epidemic in Hong Kong and the international tobacco control trend, we urge the Government and Legislative Councilors to take account of public opinions and implement the enlargement of pictorial health warnings as soon as possible to safeguard public health. The Government should also actively consider adopting plain packaging within 2 to 3 years and develop long-term and comprehensive tobacco control policies including regulating the emerging tobacco products and e-cigarettes, raising tobacco tax substantially, expanding no-smoking areas, increasing resources on education, publicity, smoking cessation services and enforcement to further reduce the smoking prevalence in Hong Kong and protect people from the harms of smoking and secondhand smoke.

*Remarks: Plain packaging standardizes and simplifies the packaging of tobacco products. The pictorial health warnings on the main sides of cigarette pack are expanded. All forms of tobacco branding should be labeled according to the government prescriptions and with simple and plain format. This means that trademarks, graphics and logos are not allowed on cigarette packs, except for the brand name that is displayed in a standard font size, colour and location on the package. The packaging should not contain other colours and should include only the content and consumer information, such as toxic constituents and health warnings required by law. The quitline number should also be displayed at a prominent position. Australia was the first country to introduce plain packaging in 2012. The measure was also implemented in the United Kingdom, France and Hungary in 2016 and will be implemented in Ireland in 2017.

Bigger graphic health warnings on Hong Kong cigarette packs needed, anti-smoking group says

Survey finds most in favour of move, which advocates say can protect public health and encourage more to quit habit

An anti-smoking body has pressed the government to speed up legislation on cigarette pack health warnings after a survey revealed almost 80 per cent of people desired sterner messages on smoking risks.

The Council on Smoking and Health made the call ahead of another public hearing held on Tuesday in the Legislative Council to collect views on whether to implement the law.

The legislation will expand the size of health warnings on cigarette packs from the current 50 per cent to 85 per cent of the packaging surface.

The proposal was first submitted by the government in May 2015, and the first hearing was held in July in the same year.

According to a survey commissioned by the council and done between February and September last year, 79.5 per cent of 2,058 respondents – comprising smokers, non-smokers and ex-smokers – want cigarette packs to show clearer and more graphic warnings.

Another 72.5 per cent of them also want to see the graphic warnings enlarged to cover 85 per cent of the packaging surface, a move also supported by almost half of the smokers in the survey.

“The implementation work has dragged on for one and a half years. This measure can protect public health and help more people quit smoking.

“We hope that Legco will not procrastinate on the legislation any further,” council chairman Antonio Kwong Cho-shing said.

He said that Australia recorded a drop of 2.2 percentage points in average smoking rate after introducing plain cigarette packaging in 2012.

Of this amount, 0.55 percentage points, or 108,000 fewer smokers, were due directly to the new measure which only allowed brand names to be displayed in a standard font size, colour and position on the packaging, thereby making them less conspicuous and seemingly less desirable.

Professor Judith Mackay, a veteran tobacco control advocate and senior policy advisor for the World Health Organisation, said a larger graphic warning would have an even bigger visual impact and induce more smokers to quit.

According to a Canadian Cancer Society survey which studied the effectiveness of health warnings on cigarette packs worldwide, Hong Kong ranked 72nd out of 205 places.

“We used to be among the top 12 jurisdictions [in cigarette pack warnings] … now we are lagging very far behind from the international experience,” Mackay said. She has been working on tobacco control advocacy in the city for more than 30 years.

The survey done by the Canadian group looked at various factors, including whether graphic warnings existed on the packaging design, the sizes of the images and when the warnings were introduced.

Mackay attributed the city’s poor ranking partly to outdated warnings, which were first introduced in 2007, and the lack of information on helpline numbers for those seeking to quit the habit.

She said in the long run the government should also further increase tobacco tax to make cigarettes less affordable.

Kwong from the Council on Smoking and Health said it submitted a letter to the financial secretary late last year to suggest increasing tobacco tax to 100 per cent.

Vaping: Government unmoved, key researcher clears the air re research

The Food and Health Department sticks to its old guns while key HKBU researcher Dr Chung Shan-shan looks to clear the air about previous media misstatements about her research results.

The Food and Health Department sticks to its old guns while key HKBU researcher Dr Chung Shan-shan looks to clear the air about previous media misstatements about her research results.

Dr Chung Shan-shan (鍾姍姍), Assistant Professor of the Baptist University’s Department of Biology, has been oft cited in Hong Kong for her research on vaping (aka e-cigarettes). Dr Chung was commissioned by the Council on Smoking and Health (COSH) between October 2015 and February 2016 to lead a studies on the potential harm brought about by vaping. She found in favour of stricter regulation, or perhaps a total ban of the product, but is keen to clear up misconceptions about the research in previous media reports. She takes issue with previous media reports that neglected to report on nuances she presented, leaving a misleading impression that has been repeated and magnified in the community.

“Neither COSH, which commissioned the research, nor we, claimed that the sample products were representative. But, like all other manufactured goods, product variability does exist. It is particularly so for vaping products as the history and experience in regulation and quality control are short when compared to many other electronic products,” Dr Chung explains. “One should understand that both PBDEs and PAHs [chemicals created from burning petroleum] are not by-products of e-liquids but rather the electronic appliances themselves. Even if the flavour is the same, different vaping products can use different flame retardants or different types of plastic resins, resulting in varying levels of emission of these by-products in the aerosols. So a thorough understanding of the health effects of vaping should not just focus on the compositions of the e-liquids but the whole e-cigarette product.”

While brief, the associate professor makes her stance clear: “Firstly, I haven’t gone through the entire the [new RCP] report, so it’s not something that I feel comfortable to comment with. Secondly, to more accurately interpret the arguments made, one needs to understand the backgrounds of the authors of this report as well. On the whole, it is a summary of available research findings at their time of writing,” she says. “I noted in our press conference that our findings on PBDEs [industrial toxic chemicals used as fire retardants] were likely the first of its kind. But so far, findings of our studies were announced only through a press conference. So I didn’t expect a literature review or a monograph that has to be based on proven scientific findings to cite from us.”

“Our findings are in a stage of being assessed by an international journal and are currently under review [i.e. unpublished]. So I believe that’s why [the RCP report] did not take into consideration our discovery,” she says.


A million times more harmful than outdoor air: Hong Kong study raises e-cigarette cancer alarm

Health council urges ban on the electronic devices after Baptist University study finds more risks

Electronic cigarettes were found to contain one million times more cancer-causing substances than outdoor air in a study by Baptist University.

Researchers also discovered a type of flame retardant that affected the reproductive system and could lead to cancer – the first such discovery in e-cigarettes.

The Hong Kong Council on Smoking and Health, which commissioned the study, called for a ban on e-cigarettes as soon as possible before they become more popular.

In analysing 13 types of e-cigarettes bought on the market, researchers found that the level of polycyclic aromatic hydrocarbons (PAHs) – a by-product of burning petroleum that is commonly detected in roadside air – ranged from 2.9 to 504.5 nanograms per millilitre.

The substance, which contains highly carcinogenic chemicals such as benzo(a)pryene, also carries various kinds of chemicals that promote growth of cancer cells.

“[Level of PAHs] in e-cigarettes is at least one million times more than roadside air in Hong Kong,” said Dr Chung Shan-shan, assistant professor in the university’s biology department.

Polybrominated diphenyl ethers(PBDEs), a flame retardant used extensively in furniture and electronic products, were detected in a range of 1.7 to 1,490ng/ml in the 13 brands of e-cigarettes.

That level was much higher than in two samples of conventional cigarettes used in the study, which ranged from 5.6 to 6.3ng/ml.

The chemical reduces the risk of burning in the plastic combustible component of e-cigarettes.

But PBDEs disrupt the thyroid hormone and cause toxicity of the reproductive development.

“Even though we don’t know the exact number of e-cigarettes one should take, not to mention that many of the carcinogenic effects are cumulative, I don’t think there is a safe margin,” said Chung, adding that the situation was worrying.

While the packaging of the tested e-cigarettes either claimed they contained zero nicotine or did not mention nicotine, they actually containted a level ranging from 3.5 to 28.5 ng/ml.

Adding to the concern, a University of Hong Kong study, commissioned by the council, found that 7.9 per cent of smokers aged 15 to 29 had used e-cigarettes, significantly higher than other age groups.

The study, done between April and October last year, interviewed 5,252 people. Some 68 per cent did not know what they were inhaling.

As 16 countries have fully banned the sales, advertising, import, distribution and manufacturing of e-cigarettes, the council’s chairman, Antonio Kwong Cho-shing, urged legislation to enforce a total ban as soon as possible.

The Food and Health Bureau earlier stated the possibility of legislation would be reviewed, it was not clear when the regulation would go into effect.
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Immediate ban of e-cigarettes urged

The Council on Smoking and Health (Cosh) on Monday called for an immediate ban on e-cigarettes, highlighting its danger through two separate studies.

In one study, it found at least two cancer causing chemicals in 13 of the e-cigarette brands available in the market. The test, carried out by the Baptist University, found harmful chemicals such as formaldehyde and PAHs – both known carcinogens – in these brands.

Dr Chung Shan-shan from the university’s biology department said these chemicals pose a high degree of risk to its users.

The second study found more young people make a major section of e-cigarette users. Cosh urged the government to enact a total ban on the device as soon as possible, before the situation gets worse.

Tobacco industry ‘should be sued by government’ over smokers’ health costs

Clear the Air says:
When can we expect this insipid SAR Government to stand up for its citizens’ rights and sue Big Tobacco in Hong Kong for the costs of health care caused by their wretched product ?

Don’t hold your breath.
It seems the Financial Secretary, aka the Almighty, prefers the Profits Tax income from the enhanced addictive drug peddling murderers instead.

Australian Council on Smoking and Health says new research showing smokers’ mortality rates is ‘a national catastrophe’

The Australian government should sue the tobacco industry after landmark research found Australian smokers have a three times greater chance of dying today than a lifelong non-smoker, the president of the Australian Council on Smoking and Health says.

Up to 1.8m of Australia’s 2.7m smokers are likely to die from their habit if they continue to smoke, losing an average of 10 years of life expectancy, the first Australian large-scale study on smoking and mortality, published in the international journal BMC Medicine, found.

The study findings highlighted the extreme hazards faced by the 13% of Australians who smoked, an author of the study and director of the University of Melbourne’s global burden of disease group, Professor Alan Lopez, said.

“Australia still has a smoking problem,” he said. “Saying Australians are getting fatter, and shifting the focus towards diet and obesity should not mean we forget about tobacco, which is still a major public health problem.”

The research was led by Sydney’s Sax Institute using data from their 45 and Up study. Researchers linked health information from 204,953 study participants aged 45 and over from NSW, with data from the register of births, deaths and marriages.

Previous research from the Sax Institute found pack-a-day smokers had a fourfold risk of dying early, while the risk of death for lighter smokers was more than doubled.

The president of the Australian Council on Smoking and Health, Mike Daube, said the study revealed smoking as a “national catastrophe” because even though Australia had among the lowest smoking rates in the word, its effects were widespread.

“That smoking will kill 7.5% of Australians means it deserves a massively increased focus, and we need to keep increasing taxes on tobacco, step up public health campaigns and limit the number of outlets that sell it,” Daube said.

“It is time for the Australian government to follow what the US did about 20 years ago and sue the tobacco industry for costs incurred because of smoking, and force them to make internal documents public.

“That would bring in tens of billions of dollars which would help the budget, and enable stronger action on smoking.”

Known as the Master Settlement Agreement, the 1998 court action involved 46 US states and several of the largest US tobacco companies. The tobacco industry was forced to pay the states more than US$200bn in compensation and make public previously secret documents.

The chief executive of the Public Health Association of Australia, Michael Moore, said the research confirmed smoking as Australia’s most preventable cause of death and disease, killing even more people than previously believed.

It meant politicians and policymakers must do “everything possible” to encourage smokers to quit, he said.

“We cannot stand by and see yet more generations of Australians dying, often painful deaths, because they smoked,” he said.

“Public health leaders campaign on smoking not because of any moral fervour, but because it kills people. Now we know that it kills even more than we had thought. That is cause for deep concern and a call for strengthened action.”

Raising Tobacco Tax Substantially to Lower Smoking Prevalence

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The economics of tobacco

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Hong Kong may move to ban e-cigarettes. Advocates claim it is the best alternative to reduce harm from smoking. Opponents claim the unknown makes it worth banning outright.

Alan*, a local academic, is a smoker. It was time to kick the habit when his family welcomed a newborn daughter. He hadn’t been able to stop in the past, but now had new incentive. Strong incentive. And a new option.

An alternative to conventional smoking cessation devices was presented to Alan in the form of a “vaping” device, aka the e-cigarette. Using a battery, an “e-liquid” is vapourised for the user to inhale producing a similar experience to smoking without any combustion involved. They can, but legally do not in Hong Kong, contain nicotine, the addictive substance in cigarettes. People can use them to control and reduce nicotine dosage and eventually give up nicotine altogether. Regular use of his e-cigarette enabled Alan to cut his smoking to one pack of cigarettes in three weeks, and then extended periods of zero smoking. He was on his way to reducing his nicotine dosage to zero.

Unfortunately for Alan, a recent crackdown by the government on e-liquids containing nicotine disrupted his use of e-cigarettes. He has reverted to smoking a pack of cigarettes per day.

Nipping it in the bud

His personal situation plays out against a broader campaign. On March 30th, the Hong Kong Council on Smoking and Health (COSH) held a press conference advocating a total ban on e-cigarette products.

E-cigarettes, without nicotine, are easily accessible in Hong Kong. COSH claims some products “target youngsters”, and “normalise smoking behaviour”, potentially creating a (supposedly new) “tobacco epidemic”. COSH Chairman Antonio Kwong says, “COSH has serious concern on the spread of e-cigarettes. To protect public health, we advocate the Government for a total ban on e-cigarette to prevent its prevalence among the youngsters and stop it from becoming the gateway to smoking.”

A total ban on e-cigarettes would entail the “prohibition of sales, advertising, promotion and sponsorship, distribution, importation and manufacturing” of the product.

Hours after the COSH press conference, Secretary for Food and Health Dr Ko Wing-man was quoted stating that the government was “inclined to agree” with the Council’s request citing possible health risks and the possibility that youngsters may pick up smoking [conventional] cigarettes after they begin smoking e-cigarettes. He added that detailed studies would be required before they could proceed with legislation.

Currently, under the Pharmacy and Poisons Ordinance, any e-cigarettes containing nicotine and marketed as nicotine replacement therapy must be registered before sale and possession, under threat of a maximum penalty of HK$100,000 and 2 year’s imprisonment. No nicotine containing e-cigarette product has ever been registered as pharmaceutical products in Hong Kong, creating a de facto ban.

Against the ban

Ray Story, founder and CEO of Tobacco Vapor Electronic Cigarette Association (TVECA), is an advocate for regulation, not banning it outright. Mr Story, an owner of several e-cigarette brands, successfully pushed for the legalisation and subsequent regulation of e-cigarettes in the United States and the EU. He was recently in Hong Kong to speak to the media on the matter after attending the Shenzhen International Electronic Cigarette Industry Expo where over 100,000 industry professionals gathered.

Mr Story claims that the focus is misplaced. He explains, “when you look at conventional tobacco and how it’s used, you create all different types of chemicals when you light a cigarette.” A conventional cigarette is known to have approximately 600 chemicals in it and produces up to 7,000 when burned, at least 69 of which are known carcinogens. “An e-cigarette has five ingredients. So by not having all those chemicals and tar through combustion, it is therefore less harmful than conventional tobacco,” claims Mr Story.

Instead, Mr Story believes banning e-cigarettes is unfair to current smokers. “To ban e-cigarettes, would only mean you will allow conventional cigarettes to continue,” he says. “Banning the product would therefore be extremely irresponsible.”

What lies within

The five main ingredients in an e-cigarette, are nicotine, water, propylene glycol, glycerin, and flavouring. There are e-liquid options on the market that contain no nicotine, which are currently on sale legally in Hong Kong.

Out of the five ingredients, water is obviously not a point of contention. Nicotine, on the other hand, is undeniably addictive. However, advocates suggest the e-cigarette is still a much less harmful alternative. Mr Story says, “Nicotine is not the problem in tobacco. It is the tar and the carcinogens and the chemicals that are the issue. E-cigarettes do not have these issues.”

Propylene glycol and glycerin, while found in many food items and cosmetic products, are often touted by opposers to cause health risks. At COSH’s press conference, Dr Daniel Ho Sai-yin, associate professor at University of Hong Kong, cited literature claiming the chemicals cause mouth and throat irritations, and, at high temperatures, form formaldehyde and acetaldehyde, known carcinogens.

Investigating papers referenced by Dr Ho muddles the argument. The conclusions found in the report in the New England Journal of Medicine, from University of Portland researchers, titled “Hidden formaldehyde in e-cigarette aerosols”, were criticised earlier this year due to methods failing to reflect realistic situations. The report described what happened when researchers used two different voltage settings on the vaping device: “At low voltage (3.3 V), we did not detect the formation of any formaldehyde-releasing agents (estimated limit of detection, approximately 0.1 μg per 10 puffs).” In other words, when they tested a tank system at a realistic voltage setting of 3.3V, no formaldehyde was detected. But at an unrealistically high temperature setting of 5.0V, formaldehyde concentrations five- to fifteen-fold that of cigarettes were measured. The experiment showed that when overheated, vaping devices yield unacceptable levels of formaldehyde.

Media reports, however, touted the more sensational conclusion, leading readers into believing that normal consumption of e-cigarette vapour can expose a user to cancer-causing chemicals more dangerous than conventional cigarettes. The vapour, if produced at such levels, would be so noxious and irritating to the airway that the user would be unable to inhale it anyway, according to Professor Peter Hajer, Director of the Health and Lifestyle Research Unit at the Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London.

For the ban

Nonetheless, COSH is adamant the time to ban it is now. Speaking to Harbour Times, COSH chairman Antonio Kwong said, “the e-cigarette is a new product that hasn’t been widespread in Hong Kong yet. If we need to wait for all the evidence to come out, say in 20-30 years, many people may have already picked it up by then and we’ll be asking ourselves why we didn’t ban it earlier. We feel we need to ban it to avoid this situation.”

The fact that e-cigarettes are less harmful than conventional tobacco products by “orders of magnitude”, as some claim, holds no water with COSH and, to them, doesn’t even bear examination. Kwong: “I can’t comment on [whether it is less harmful], we don’t have enough research to prove that. What we do know is, there are carcinogenic agents. A carcinogen is a carcinogen. What is a safe level?”

Glamour and gateway arguments

To COSH, health risks are only half the problem. “It took us a number of years to bring the smoking prevalence down from 23.3% in the 80s to the 10.7% today, and took major efforts to de-normalise this behaviour, so if this “re-normalises” tobacco use it could be very harmful, especially when we see its attracting a younger age group and non-smokers,” explains Kwong.

According to a survey conducted by COSH last year, while only 1.8% out of the 2,400 participants admitting to having used e-cigarettes before at least once, the study concluded that “young people were more likely to use e-cigarettes”. “The promotion of e-cigarettes remains unregulated. Nowadays, e-cigarettes come in all shapes and sizes and can be very attractive to curious young people,” explains Kwong.

Responding to these claims that e-cigarettes could become a “gateway” to smoking, or re-normalise the behaviour, Mr Story claimed, “to state that you use one product and that takes you to the next level to use another product is unfounded. Does it happen? Potentially. But is that the norm? There’s a lot more people that have gone from conventional tobacco to e-cigarettes, than the other way around. But I’m obviously not going to rule it out, because that would be ignorant on our part. The majority, however, goes from regular tobacco cigarettes, to e-cigarettes, and that has been the norm, and all the science backs it up as well.”

Official UK figures from a study on smoking behaviour by the UK’s Office for National Statistics conducted last year support Mr Story’s claim. The study found that about one in 10 current cigarette smokers surveyed and one in 20 of the former smokers said they were now using e-cigarettes. Over half of e-cigarette users surveyed said their main reason was to stop smoking. About one in five said it was because they thought they were less harmful than cigarettes.

Regulate not ban

“If there’s no regulation, we don’t know where they’re manufactured, what’s in them. All these issues need to be addressed, and can only be addressed once you have a conversation logically and responsibly,” explains Mr Story. “But if you don’t want to have that conversation, just ban it, pretend it’s not there, then you’re gonna have the same situation we’ve seen in other places, where the product will continue to sell, but without regulatory oversight.”

The regulations Mr Story proposes would go along the lines of: age verification for sales, advertising restrictions, nicotine content restriction, labeling, maximum capacity tanks, maximum nicotine strengths.

“The toxicity of any product is determined by its dosage. But if you regulate a product and allow them to only have 2 milliliters per cartridge, if you regulate the product and allow the bottle to only be 10 ml, just like we did in Europe, there’s no way it can hurt you,” claims Mr Story.

The right course of action

In 2009, when the authorities began cracking down on e-cigarettes by seizing shipments into the States, Mr Story took it upon himself to challenge the decision — and succeeded. American style.

“I sued them,” he says, with a dramatic pause. “I took them to court and put my foot down and said I want to talk, but if you won’t talk to me, I will take you to court and make you prove your position in court to where you’re right and I’m wrong and somehow, they couldn’t do it. Because to ban it because you don’t have any information, is ignorant. We try to build laws based on an abundance of information, not a lack of information.”

So will the TVECA replicate the process in Hong Kong? Mr Story says he truly hopes we won’t have to go there, but added “I will do what it takes.”

Kwong believes that what COSH is doing is the right course of action. “It’s actually quite like the total ban on smokeless tobacco by the HK Government in 1987.” The ban successfully kept the product off Hong Kong shelves up till today, and according to Kwong, Hong Kong has avoided the diseases related to smokeless tobacco.

“If you look at countries such as Sweden, Norway and Finland, or Pakistan and India, they have very serious problems related to smokeless tobacco, causing many cases of mouth cancers. Luckily we banned it and have no such issues. Therefore we hope the Government can do the same this time,” explains Kwong. Not known are the benefits Hong Kong missed out on from avoiding secondhand smoke had smokeless tobacco products been allowed for the past 28 years.

At the moment, Singapore and Thailand are among thirteen countries globally that have taken a similar stance on e-cigarettes, banning the industry altogether.

Alexander Basile, CEO and founder of e-cigarette developer Digirette, an American e-cigarette firm launching a Hong Kong office, urges the authorities to think about the 10.7% of Hong Kong people, “If you start looking at it from the public good and be open to the possibility that this technology can make a significant difference, then you’re going to be able to find the middle of the road. To ban it right now would literally be to condemn everybody in HK who would have transitioned to this, to death instead.”

The unapologetic Mr Basile feels that, if its young people who were going to smoke who are picking up vaping instead, then everyone should be happy about that. “We’re transitioning people through technology to a much better delivery system. Here with this technology, you actually have a chance to make a difference with people who are alive that you spend time with. If it’s going to make vaping cool, then so be it.”

To Mr Basile, and supporters of e-cigarettes alike, the bottom line is this, “It’s like driving on a freeway. If you’re smoking, you’re on the wrong side of the freeway and you’re driving against the traffic: you know that’s going to end badly. But vaping is equivalent to driving on the right side of the freeway. By no means is it harmless, but the likelihood of you dying from it is far less.”

*Name changed to protect anonymity.