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October 31st, 2015:

The Resource Manual by ITIC is a tool for promoting vested interests rather than designed to help governments

The Bangkok-based Southeast Asia Tobacco Control Alliance (SEACTA) warns legislators and finance ministries against replying on this Manual which is being widely promoted by ITIC to ASEAN governments.

An academic review of the Manual’s section on tobacco taxation has revealed contradictions and inconsistencies when compared against international best practices and recommendations in the Framework Convention on Tobacco Control (FCTC) of the WHO – Article 6 guidelines on tobacco tax and price measures, which 180 governments worldwide have committed to implement.

Professor Hans Ross from the University of Cape Town, who reviewed the Manual said; “On the surface, the Manual and the WHO-FCTC Article 6 guidelines seem to be aligned on some issues. However, the main principles and views that the Manual promotes often contradict its analysis and recommendations.

It also runs contrary to international best practices on tobacco taxation outlined in the Article 6 guidelines of the WHO-FCTC.

Among the main faults of the Manual are the following;

The Manual fails to acknowledge the evidence and recommendations of the WHO-FCTC Article 6 guidelines on Price and Tax Measures to reduce the demand for tobacco that states Parties unanimously adopted in 2014.

The ITIC claims Indonesia has the lowest penetration of illicit tobacco products in another document, yet this Manual claims Indonesia is an example of a country with the highest taxes in terms of affordability, which according to the Manual, drives illicit trade in Indonesia.

The Manual warns against substantial tobacco tax increases, even if some countries in the ASEAN region and many others globally have successfully increased tax to reduce tobacco use while also boosting their tax revenues.

The affordability of cigarettes is driven not only by tobacco taxes, but also by the industry-set prices which the Manual conveniently does not address.

The Manual’s very strong opposition to tobacco tax earmarking sharply contrasts with the recommendations in WHO-FCTC Article 6 guidelines.

The Manual falsely claims that the tobacco industry’s system supposedly designed to deal with illicit trade is compliant with the WHO-FCTC Protocol to Eliminate Illicit Trade in Tobacco Products.

Professor Ross added; “Its estimates of illicit trade and the associated revenue losses are based on another ITIC report funded by the tobacco industry that has been discredited due to its methodological weakness, the use of unreliable data, biased conclusions, and abundance of mistakes and errors.”

“Given the vested interests of the transnational tobacco companies that fund ITIC and provided it with data, it is obvious that the manual cannot be trusted”, Ms. Sophapan Ratnachena, the Tobacco Program Manager of SEACTA.

She added; “ A tobacco tax roadmap developed in collaboration with the tobacco industry is a dangerous proposition for both tax revenue and public health. It is important that governments protect their public health policies, including tobacco taxation, from commercial and other vested interests of the tobacco industry.”

Ministry to regulate e-cigarettes

KUALA LUMPUR: THE Health Ministry will not allow the unregulated use of e-cigarettes, including vaping devices.

Despite the ministry’s failure to get the cabinet’s nod to ban vaping, a trend already picked up by about one million users, it is aggressively working to put in place stringent regulations to keep its use in check.

Health Minister Datuk Seri Dr S. Subramaniam told the New Straits Times that as he and the healthcare community were deeply concerned about the rapid increase in the number of people taking up vaping, he was looking into tangible action that could, among others, prevent hazardous contents from making their way into vaping liquids.

The ministry, he said, was also looking at applying the same set of rules regulating the use of tobacco products to e-cigarettes.

This would mean that the use and sale of vaping devices and accompanying items would be off limits to those under the age of 18.

Dr Subramaniam said the ministry was duty-bound to ensure the substances used in the liquid were not hazardous to users.

The ministry had registered its concerns of possible long-term consequences of inhaling vapours containing nicotine, formaldehyde and propylene glycol.

He also told the NST that in regulating vaping devices, including e-liquid that contains nicotine, the existing Poisons Act 1952 (Revised 1989) would likely come into play.

Under the act, nicotine is underlined under “category C poison”, meaning anything that contained the substance could only be sold and supplied as dispensed medicine or an ingredient in dispensed medicine by licensed practitioners.

Nicotine in tobacco is exempted from the act, as tobacco control is regulated under the Food Act 1983.

As the ministry moves to regulate e-cigarettes in ways similar to how the sale of tobacco products is governed, its promotion could also be restricted.

Under plans to regulate the use of e-cigarettes, the ministry is looking at keeping certain public areas off limits to vapers.

The NST learned that the ministry would convene a meeting on Monday to detail plans to regulate the use of vaping devices.

It is also understood that health experts with the ministry are studying possible cancer-causing agents in e-liquids, including propylene glycol.

If heated for a prolonged period at five volts or higher, propylene glycol could be converted into harmful substances such as formaldehyde.

The debate on the use of vaping devices gained momentum over the last few days as the ministry made it clear it would ban vaping.

It had announced on Wednesday that it was looking at laws to ban e-cigarettes and vaping devices.

Yesterday, many in the vaping community rejoiced when Rural and Regional Development Minister Datuk Seri Ismail Sabri Yaakob posted on his Facebook account that the cabinet had decided against banning e-cigarettes and vaping.

Dr Subramaniam, in a statement, said he had expressed “his deep concern about the steep increase in the number of people vaping in Malaysia and its possible long-term consequences”.

The cabinet, he said, fully recognised the adverse health effects of cigarette smoking and vaping, and the need for greater public health education on the harmful effects of vaping, as well as the need to stringently regulate it.

The ministry, he said, would immediately work on the two matters.

He said safeguarding public health and regulating vaping, as well as the advent of further evidence of the hazards of vaping, would be the deciding factors of whether it would be banned in the future.

More Malaysians have, in recent years, picked up vaping, some as a new habit while others, dependent on the device, to aid cessation of cigarette smoking.

The device, which atomises the e-liquid, is often doctored with additional additives, such as flavourings and colourings.

Those containing nicotine come with various levels of concentration.

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Vaping association to cooperate with government

KUALA LUMPUR: The country’s first “vaping” association is extending its cooperation to the government to regulate vaping.

Malaysia E-Vaporisers and Tobacco Alternative Association (Mevta) president Allan Foo said the government could come up with standards, rules and regulations.

In an industry that involves five different players, Foo suggested that the government gain insight from producers, exporters, importers, retailers and consumers, among others.

“On our (Mevta) part, we are willing to share and provide information. Since vaping has come into the picture, the tobacco industry has been affected.

“We are willing to talk to the government on whether vaping should be subjected to tax and its implementation,” Foo said, adding that government agencies, such as Standards and Industrial Research Institute of Malaysia (Sirim) were welcomed to participate.

Sirim, said Foo, could assist by testing the hardware, computer chips and the liquids used.

“Getting the right benchmark will give vaping proper regulation. We can also follow British standards as they are ahead of us in this.”

Although there are no official figures, Mevta estimates there are between 500,000 and 800,000 users in the country.

“We believe vapers make up for slightly more than 10 per cent of smokers, which is between four million and five million.

“That is 30 per cent of the total number of smokers. If the figure is accurate, the tobacco industry would have been hit badly and that is the last thing we want.”

Demand for hike in legal age for buying cigarettes and e-cigarettes

They say that the hike should not only be for tobacco products, but also for e-cigarettes. “The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and so unsafe to their long-term health”.

The tightened regulations, including raising the minimum legal age from 18, are created to protect children and adolescents from the “pernicious effects” of tobacco and nicotine.

Many youth said flavoring was a reason to use e-cigarettes, hookahs, cigars, smokeless tobacco, and snus pouches, the researchers reported in JAMA.

Health experts are particularly concerned that e-cigarettes are threatening to addict a new generation of smokers.

A new study of young people aged 12-17 years indicates that most teens who reported ever experimenting with tobacco said they started with a flavored tobacco product. Though e-cigarettes are considered as tool to help smokers quit their habit, a few researchers suggest it as a gateway to conventional cigarettes.

“There’s a lot we don’t know about e-cigarettes”, Claire McCarthy, MD, a primary care pediatrician at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School, told CBS News.

They are also less expensive than cigarettes because they are not subject to the same taxes, despite containing the same carcinogens, said King, who was not involved in the JAMA research letter. The AAP policy statement urges the U.S. Federal Food and Drug Administration to regulate e-cigarettes and other electronic nicotine delivery systems the same as other tobacco products. As little as half a teaspoon can kill an average-size toddler, according to the AAP. The AAP agency also recommends to expand smoke-free laws that already govern secondhand smoke to include e-cigarettes as well along with promotion of smoke-free homes and vehicles. The new policies also advocate promoting smoke-free homes and vehicles.

In three policy statements published Monday in the journal Pediatrics, the AAP offers its guidance on what should happen within public policy, regulation and family counseling for reducing exposure and dependence on tobacco.

Consumers and other interested parties can report a potential tobacco-related violation of the FD&C Act, including sale of tobacco products to minors, by using the FDA’s Potential Tobacco Product Violation Reporting Form.

The safety or danger of e-cigarettes is as cloudy as the vapor they produce

By Lois M. Collins , Deseret News National Edition

The small clouds are more noticeable than the people enveloped in the white smoke, visible on city streets and college campuses across America. They are caused by “vaping,” the use of liquid nicotine from one of various types of so-called electronic cigarettes.

The users — or “vapers” — include the roughly 13 percent of high school students who admitted using e-cigarettes last year, a threefold increase to close to 2 million adolescents, according to the 2014 National Youth Tobacco Survey. The Centers for Disease Control and Prevention said that’s the first survey to show more e-cigarette use than any tobacco product in that age group.

That trend has caught the attention of pediatricians and apparently the general public. The American Academy of Pediatrics this week called for a minimum age of 21 to buy products containing nicotine, including e-cigarettes. A recently released NPR-Truven Health Analytics Health Poll found 57 percent of American adults think e-cigarettes should be regulated like cigarettes by the Food and Drug Administration.

Health experts say parents should discourage use of vaping products because the safety or danger of e-cigarettes is as cloudy as the vapor they produce.

“We can’t say definitively it’s bad and you shouldn’t use them,” said Brittany Karzen, spokeswoman for the Utah Department of Health Tobacco Prevention Program, “but a lot of caution should be taken.”

A CDC spokesman is more blunt. Youths should not be using any form of tobacco or nicotine, regardless of how it’s delivered, Dr. Brian King, deputy director for research translation in the CDC’s Office on Smoking and Health, told the Deseret News. “There’s a lot we don’t know, but we know enough to know they should not be using any of these products.”


Nicotine is a chemical found in several plants, including tobacco. It stops insects from chewing tobacco crops and keeps tobacco users addicted. It can also be produced synthetically.

E-cigarettes, vape pens and related products deliver nicotine, flavorings and different chemicals by way of vapor instead of smoke. “Puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The resulting aerosol or vapor is then inhaled,” according to the National Institutes of Health.

E-cigarettes owe their increasing popularity to different factors, experts say, from popularity of an ever-growing list of flavored “e-liquid” or “e-juice” to marketing of the devices as a quit-smoking aid. The supposition is that they may be less dangerous because e-cigarettes deliver less nicotine and are not lit, so they don’t produce tar and other byproducts of burning tobacco that cause cancer.

On the other hand, nicotine is known to be both very addictive and a stimulant. It has been associated with heart disease, poisoning — sometimes of young children who get hold of a parent’s e-liquid and drink it — and possibly birth defects.

“Today, while (e-cigarettes) are not quite the same and we hope these aren’t as bad, we do know there are going to be some dangers associated because of the nicotine,” Karzen said.

A Chinese pharmacist named Hon Lik is generally credited with creating the modern e-cigarette in 2003 and most of the devices are imported from China. Vapers have lots of choices — including disposable or reusable, pre-loaded or load-your-own-juice and more. The price range reflects that variety, from a few dollars to significantly more.

Uncharted territory

Right now, e-cigarettes are not federally regulated, though most states have restricted youth access to them, barring use age 19. Seven states and at least 400 communities include e-cigarettes in clean air legislation governing public spaces. Because no electronic smoking devices have been approved for therapeutic use, the National Park Service won’t allow them. Vaping is also banned on U.S. airplanes and new rules won’t allow vaping devices in checked luggage, either, because of fire potential.

But there are dueling views on the devices’ health impact.

A recent World Health Organization report on possible and perceived hazards of e-cigarettes was sharply criticized by King’s College London professor Ann McNeill and her colleagues, who said the review used “alarmist language to describe findings and to present opinion as though it were evidence.” Their own research said e-cigarettes are 95 percent safer than traditional tobacco products because they don’t contain the tar found in regular cigarettes.

But users do face risks associated with nicotine and with no regulation on what can be put into the e-liquids. “You don’t know what’s going into your body when you inhale,” Karzen said, noting nicotine is the biggest concern in use by kids, because it’s bad for the developing brain. It’s also possible that vaping wires young minds for addiction.

What’s listed on the packaging and what’s actually in the e-cigarette often don’t match, Karzen added. “There are pretty large discrepancies” between percentages listed on packaging and what testing shows.

Several recent news stories have noted that e-cigarette users sometimes vape marijuana oils.

The ultrafine particles in vaping aerosol are worrisome, too, King said. Some e-liquids contain organic compounds and heavy metals.

It’s a common misconception that everyone’s inhaling water vapor. In some devices it’s true. But others contain no water vapor, Karzen said, and studies don’t agree if what’s inhaled is dangerous. She said it reminds her of what happened in the 1930s and ’40s, when popularity outpaced knowledge about safety or risks of cigarettes.

“It’s the wild, wild west in terms of manufacturers and distribution,” King said. “We don’t know long-term effects for adults. We do know some potentially harmful ingredients have been identified, including nicotine, which harms the brain and creates fetal toxicity.”

The FDA has said it will regulate electronic nicotine delivery devices, but not when or what rules will look like. The comment period got more than 135,000 before it closed over a year ago. But the agency is still involved in dozens of related studies and getting some of those results is expected to take a long time.

Meanwhile, Wells Fargo Securities predicted vaping will reach sales of $3.5 billion by the end of the year.

Quit aid or enabler?

Chandler Cutrer, 18, of Salt Lake City, is among those who both vape and smoke. He said he vapes for a lot of reasons, including the fact that it’s acceptable where smoking is not. Like many young vapers, he’s a “cloud chaser,” doing tricks with the smoke vapor he exhales. “It’s entertaining to watch and it takes a lot of skill to do it,” he said.

But he also believes vaping is healthier than smoking. “I could feel cigarettes hurting my lungs more; they have way more chemicals in them and they smelled awful.”

He said he now smokes only infrequently, which he credits to the e-cigarettes. He noted he tries to choose e-juice with the lowest level of nicotine possible and is fond of a flavor that reminds him of whipped cream and strawberries.

While vapers and e-cigarette proponents say the electronic devices are a stop-smoking tool, not everyone’s convinced. Karzen calls it the stuff of anecdotes, not research. “Using it as a cessation product without knowing the real risks may be a pretty dangerous thing to do.”

Anti-vaping groups are speaking up. CASA Columbia, a national nonprofit research and policy organization that focuses on substance abuse and addiction, just released a report that says “alternative non-combustible products that contain nicotine but not tobacco are not harmless, particularly to young people. Nicotine remains one of the most addictive and potent substances, regardless of whether it’s delivered through a combustible cigarette, electronic cigarette, vape pen, hookah pipe or cigar.”

King said that most who use e-cigarettes continue to use tobacco, too. “Just reducing the number doesn’t reduce health risks,” he said. “You have to quit completely.” He said the best tools for quitting have been tested for efficacy and FDA approved.

The U.S. Preventive Service Task Force said it can’t recommend e-cigarettes as a stop-smoking tool because current evidence is inadequate.

Gregory Conley, president of the American Vaping Association, questioned the task force’s decision. “The task force should have at least had the integrity to advise doctors that vapor products may be a positive intervention for hardcore smokers who have tried and failed to quit with products like the nicotine gum, patch and medications,” he said in a written statement.

“In the United Kingdom, Public Health England and over a dozen respected public health authorities have endorsed the use of vapor products by smokers looking to quit. Their rigorous assessment is based on a totality of the evidence, both from clinical trials and the real world. … Every time groups like the USPSTF dismiss the benefits of vapor products, there are smokers that take their advice seriously and continue to smoke.”

Tastes like candy

Of the middle and high school students who tried tobacco in the past month, about 70 percent used at least one flavored product, a recent CDC Morbidity and Mortality Weekly Report said. The products most-often tried were flavored e-cigarettes, flavored hookah and flavored cigars. Nearly one in five high school students said they used at least one flavored product in the past month.

In a written statement, Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, cited the report as evidence of “the urgent need for the FDA to issue its long-overdue final rule regulating all tobacco products, including electronic cigarettes and cigars, and to expand the current ban on candy- and fruit-flavored cigarettes to include all flavored tobacco products.”

There are many popular “e-juice” flavors, including bubble gum, vanilla, cotton candy and cherry, some reportedly aimed at kids, said King. While some of the flavors are considered safe to eat, “we don’t know the effects of inhaling flavorings and we don’t want to just assume it is safe.”

The Flavor and Extract Manufacturers Association of America in its safe-production manual warns workers about dangers of inhaling heated flavors, which the Center for Tobacco Control Research and Education cites as proof of health risk.

A special report by the Milwaukee Journal Sentinel noted a lack of standards for e-liquids or a requirement that manufacturers test them. Their own tests of various e-juice products documented the presence of chemicals “known to cause permanent and fatal lung disease” in some of the products, but which were not listed as ingredients. They also found varying levels of those chemicals and a dearth of certainty about how much is too much.

Health experts have a goal of a tobacco-free generation, which also means nicotine-free. Karzen said that rising popularity of e-cigarettes makes that goal harder to achieve.

Email:, Twitter: Loisco