Electronic Cigarette: Dual use of ecigarettes and cigarettes

The World

Dual Use Update…

The New Tobacco War
They may be safer, but could e-cigs renormalize smoking?
Nov 4, 2014
By Markian Hawryluk / The Bulletin / @markianhawryluk
The debate raging over electronic cigarettes largely comes down to the fate of people like Dylan Johnson, a 21-year-old from LaPine who started smoking when he was 14.
“I was pretty young,” he admits.
Dylan Johnson, 21, exhales vapor from his e-cigarette while sitting on the front porch of his home last month. Ryan Brennecke / The Bulletin
After seven years of smoking — all but three below the legal age to buy tobacco cigarettes — he had developed a pack-and-a-half-per-day habit.
Living in a house where most of his family smokes, without some sort of assistance Johnson might never be able to quit smoking. Only half of smokers do. He faced a lifelong risk of disease and disability, and could expect to cut 10 years off his life expectancy if he smoked past the age of 35.
But in January, Johnson decided on his own he needed to make a change and began to wean himself off smoking using e-cigarettes. Almost immediately, he was able to cut his cigarette use, stretching each pack of 20 cigarettes to last a full day, then two. He experimented with preloaded, disposable e-cigarettes, but they didn’t work well for him. He soon switched to using an atomizer with a refillable tank system, often called vaping. By September, he was down to just five cigarettes a day.
“I smoke about the same number of times each day but more towards the vaping side,” he said. “I don’t cough up any black tar or anything.”
He’s been ratcheting down the nicotine levels in his e-cigarettes as well, from a potent 24 mg/ml when he started vaping, down to about 6 mg/ml by September.
His ultimate goal is to stop smoking tobacco cigarettes, but he has no immediate plans to stop using e-cigarettes.
“I think I’ll still be vaping regularly but I want to be at a much lower level (of nicotine) than what I started,” he said.
Cases like his leave public health officials with a conundrum. On the one hand, e-cigarettes could significantly reduce the harm for smokers, taking away the tar and other carcinogens that cause myriad health problems, saving millions of lives and billions in health care costs. On the other hand, e-cigarettes carry the risk of addicting a new generation of nicotine users and potentially undoing much of what health officials have accomplished in stigmatizing smoking.
After eight years on the U.S. market, there is widespread agreement by both proponents and critics of e-cigarettes that regulation is needed. But how that regulation is put into place could ultimately determine whether these products become the best chance of moving to a tobacco-free society or whether the progress of five decades of tobacco control efforts will go up in smoke.
No standards, little data
E-cigarettes exploded onto the U.S. market in 2006. By 2014, there were 2.5 million e-cigarettes users nationwide. While initial products looked much like traditional cigarettes, a long cylindrical tube with a glowing tip, over the past year in particular the market has moved toward refillable tank systems that bear little resemblance to tobacco cigarettes.
While there are multiple different designs, most use the same basic concept: a battery-powered heating element that heats a nicotine-containing liquid until it turns into a vapor to be inhaled just like cigarette smoke.
Read more and see the photos.


The Indefatigable Frog, or Why this won’t stop us!
9/17/2014
By Lorien Jollye
So, ask youselves. Why am I angry? Why are many vapers angry?
We did what you want, just not how you wanted us to, or BECAUSE you wanted us to, and you still persist with the demonisation. Except, this time, you are lying about us personally.
Understand, this is NOT related to any one individual, this has happened for as long as I have been doing this and before, it is not new but has worsened. And what can we do?
Read More


Propaganda Propaganda – WHO Would Have Expected This?
September 1, 2014
The very same day that the World Health Organization launched its latest attack on electronic cigarettes one of the UK’s best-selling newspapers ran an article making exactly the same claims. If you were really suspicious you might suspect a major international PR agency was somehow involved. Of course that can’t be true…
The World Health Organization has now laid its cards on the table when it comes to electronic cigarettes; it doesn’t care if they’re healthier than actual cigarettes and wants them banned anyway. I’ve already discussed the stunningly inaccurate report they released on Wednesday, but it’s throwing up quite a few other things that are worth a closer look. Specifically, while the WHO doesn’t know anything about e-cigs they seem to be quite switched on when it comes to manipulating the media – and it’s coming pretty close to being propaganda.
The very same day as the WHO released their report, the Daily Telegraph ran a lifestyle piece on e-cigarettes by Rachael Lloyd. It had it all. Her amazement at finding something so enjoyable, her relief at hearing how much healthier than smoking it was and even her dazzled thoughts about how vaping was so cool and why wasn’t everyone doing it? Then it all began to go horribly wrong.
Ms Lloyd started to worry about how much she was spending on vaping. She was laying out ?30 a week on e-cigarettes and felt increasingly dependent. Finally she spoke to her chemist, who is of course your best possible source of up-to-date health advice.
The chemist, a Mr Patel, was shocked and told her to stop “smoking” e-cigs right away, before passing on some (highly inaccurate) scare stories about nicotine and formaldehyde. Lloyd then went to her doctor who told her she was “smoking” the equivalent of 40 cigarettes a day. The end result was that Lloyd decided to quit vaping, which she found difficult enough that she had to use nicotine patches.
So. What’s Rachael Lloyd? Is she an innocent victim who narrowly avoided a horrible death at the hands of e-cigs, or is she a luckless vaper who was given inaccurate advice by a pair of badly informed cretins?
Neither. She’s an employee of an international PR agency.
Reading the article, it’s easy to pick out the carefully crafted triggers. The ?30 a week she was spending on vaping? That’s a lot of Vype disposables. Allegedly she vaped for two years. Surely she’d have picked up an Intellicig starter kit or another decent carto-based system to save a few quid – she could easily have got the nicotine equivalent of 40 a day for less than a tenner a week. Except that wouldn’t have sent the right message about vaping being an expensive habit, would it?
And a trendy habit, of course. It’s a “hip, environmentally friendly” thing to do and “Why wasn’t everybody doing it?” Carefully worded to show how vaping is a tempting trap for the unwary, who’ll be sucked in by the glamour and instantly addicted. She actually wrote “I was a vape addict.” Uhuh. What’s the scientific evidence that vaping is actually addictive? That would be zero. However just to make sure everyone knows how alluring it is there was a picture of Lily Allen with a Vapestick in her hand. Because, you know, we all want to be like famous people.
“Mr Patel”’s health claims are just rubbish. There’s no evidence at all that nicotine causes circulation problems or heart disease, and to make an e-cig produce more formaldehyde than is naturally contained in your breath you have to deliberately abuse it. This is just scaremongering. The same goes for the claims that a doctor told her it was the equivalent of smoking 40 a day – it’s nonsense. Cleverly, Lloyd worked in the obligatory reference to children; when advised to stop vaping, she said, she felt like her sweets were being confiscated.
Finally there’s the struggle to quit vaping, which she could only manage with the help of WHO-approved (but almost completely useless) nicotine patches. The message here: Vaping is as addictive as smoking. Of course as any real vaper knows you just don’t crave it the same way as you do tobacco. If a smoker leaves home without their cigarettes they’ll stop at the first shop to buy a pack. When a vaper goes out without their e-cig they’ll just shrug and wait until they get back. Absolutely nothing about this story is believable.
Then again, Rachael Lloyd isn’t just a random person with a story to tell. She works for BLJ London, an “international strategic advisory consultancy” that specialises in “policy, legislative and market access campaigns”. The WHO’s jihad against e-cigarettes is focused firmly on changing policy, encouraging legislation and denying market access – just the sort of campaign BLJ discreetly carries out for its high-profile clients. And yes, “discreetly” is their description, not mine.
Of course I’m absolutely not suggesting anything here. I’m sure it’s just a coincidence that a WHO report and an article by an influencer-for-hire, both making exactly the same misleading and dishonest claims about vaping, were published on the same day. Makes you think though, doesn’t it?


The Inversion of Science, Justice and Common Sense
August 29, 2014
There has been something bouncing around in my mind for some time and I could not put my finger on it. I was vaguely ruminating, as one does, and something clicked. It is not a fully thought-through idea, but I’ll write this as I think.
I am sure that we are all aware that the WHO has recommended that ecigs should be banned in enclosed places (surprise, surprise). This propaganda suggestion is blatantly the work of the Big Pharma Companies which the WHO represents. And the reasoning is also blatant nonsense – literally. “We do not know what the long-term effects on ‘passive vapers’ will be, so make sure that there are no passive vapers so that no one will EVER know what the effects on passive vapers will be”. Re-work that sentence with a few clever words, and Bob’s yer uncle – vaping banned in pubs. But it was the evidence that the WHO produced which led me to think.
Here is a quote from the McTear Case (2005) [See Sidebar]. The Judge said:
(1.5) The pursuer can succeed in this case only if she proves all of the following:
(1) that cigarette smoking can cause lung cancer;
(2) that cigarette smoking caused Mr McTear’s lung cancer;
(3) that Mr McTear smoked cigarettes manufactured by ITL [Imperial Tobacco] for long enough and in sufficient quantity for his smoking of their products to have caused or materially contributed to the development of his lung cancer;
(4) that Mr McTear smoked cigarettes manufactured by ITL because ITL were in breach of a duty of care owed by them to him; and
(5) that such breach caused or materially contributed to Mr McTear’s lung cancer, either by making at least a material contribution to the exposure which caused his lung cancer or by materially increasing the risk of his contracting lung cancer.
Now then. Can you see the similarity between that and Science? The connections are the precision, the required ‘proofs’ and the ‘quantification’. There is nothing vague about it. [In the event, the Judge said that ‘the pursuer’ had failed on every point, and kicked the whole thing out. He complained strongly that ‘the pursuer’ (nominally, Mrs McTear, but actually ASH, acting for The Medical Profession’, especially the Royal College of Physicians) had brought no evidence that smoking causes lung cancer]
Now, let us consider Tobacco Control. What are TC’s stated objectives? The overall objective is “to make the smoking of tobacco history” (paraphrased). Suppose that objective was placed before a Judge. Would not that Judge lay out the required actions with some precision, one by one, and require TC to lay out its programme before him to achieve that objective? Who is the Judge in ‘The Case of Tobacco Eradication’? In the UK, it is Parliament. It really is, because Parliament exists to stop injusticesbeing perpetrated by the Executive.
But TC has never been required to lay out its FULL programme, and Parliament has never had the opportunity to examine that programme. Taking the smoking ban to start with, how did TC manage to wangle a ban for adults, especially in places which children rarely go, and almost never alone, and then, once that ban have been forced, move on the children? It seems to me to be similar to the idea of the Victorians ignoring vast numbers of infant mortalities and concentrating on deaths due to horse trampling. (In fact, they might have done just that, for all I know).
So let’s just consider the WHO recommendation about ecig use with the above in mind. We are thinking in terms of SCIENCE and JUSTICE. Let us imagine that the WHO has already laid its full programme for ‘the eradication of tobacco smoking ‘before The Court, and received approval. Now, it has approached The Court with an amendment to its programme to include ecigs. What will the WHO be require to show?
(1.5) The pursuer can succeed in this case only if she proves all of the following:
(1) that ecig smoking can cause lung cancer;
(2) that ecig smoking caused Mr McTear’s lung cancer;
(3) that Mr McTear smoked ecigs manufactured by XXX for long enough and in sufficient quantity for his smoking of their products to have caused or materially contributed to the development of his lung cancer;
(4) that Mr McTear smoked ecigs manufactured by XXX because XXX were in breach of a duty of care owed by them to him; and
(5) that such breach caused or materially contributed to Mr McTear’s lung cancer, either by making at least a material contribution to the exposure which caused his lung cancer or by materially increasing the risk of his contracting lung cancer.
When the WHO made its recommendation, did it produce any evidence of that nature? Absolutely not. Nothing at all remotely connected. Nothing. It said that ecigs produce SOME particulates from the gradual deterioration of the tiny heating element, and claimed, without specific evidence, that these particulates are as bad as tobacco smoke. The only other ‘evidence’ was, “We do not know [and do not want to know] what the long-term effects might be” (which I have already mentioned), which is not evidence of long-term harm.
Why have they not done lab experiments with hamsters? They did with tobacco (failed – perhaps that is why they have not). And it would be extremely simple, since hamsters have a short life-span. Just have 100 hamsters, genetically engineered to get lung cancer easily (how do they do that?) and let them run about in cages as they do, but ensure that they breath an atmosphere which is laced with ecig vapour. Also, have a similar control group which does not. Treat both groups equally in terms of warmth, food, water, etc. Wait for them to die. Do ‘post mortems’, looking for evidence of particulates of burnt tungsten, cyanide, etc, and record the events. The evidence would be:
1) More hamsters died in the affected group than in the control group,
AND
2) Those that died in the affected group had more burnt tungsten, cyanide, etc, in their lungs than the control group,
AND
3) It was the excess of burnt tungsten, cyanide, etc which caused their death.
Do you see how we are approaching something scientific and just? The just and scientific demands are:
1) That the exposed hamsters inhaled more ‘toxins’ than the control group.
2) That it was the toxins which caused the deaths of the hamsters in the exposed groups.
3) That more hamsters in the exposed group died than in the control group.
Even if all these requirements were present, there would still be uncertainties, but, at least, it would be reasonable evidence.
Clearly, the WHO Tobacco Control charlatans have over-reached themselves. They have resorted to easily debunked lies.
But will The Court, Parliament, fail in its duty to ensure that the SCIENCE and the JUSTICE are compatible with the WHO’s recommended ban? It completely failed with the smoking ban, and has completely failed with the proposed PP and smoking-in-cars ban, and we know why. It is because The Courts (being Parliamentary Committees), which examined these matters, were rigged.
If it is so bad in an ancient democracy (of sorts) like ours, think how bad it is in the EU and the UN. Bribery and Corruption cannot help but be rife. Let’s face it, if a person has the opportunity to raid the open treasure chest without the possibility of repercussions, who could resist the temptation?
—-
I haven’t even mentioned ‘Common Sense’.


Voices of Liberty with Dr. Ron Paul: FDA Funds Research of Electronic Cigarettes
July 8, 2014
Today we discuss federal funding for research into the use of electronic cigarettes.
E-cigarettes, as they’re called, are growing in popularity and have already become a booming business. Wells Fargo Securities estimates global sales of e-cigarettes to reach $2 billion this year.
Since they hit the market, however, concerns have been raised over their potential health risks and marketing of the devices to minors.
In an effort to gain more information about e-cigarettes before their use becomes even more popular, the U.S. Food and Drug Administration is spending $270 million on 48 different research projects.
Those projects range from examining Facebook posts to learn how users are altering the devices to extract more nicotine to a virtual convenience store for 13- to 17-year-olds measuring how displays and price promotions influence minors.
The intent behind these projects is to gather as much data as possible in order to develop future regulations on the marketing, sale and use of e-cigarettes.
On the surface, it seems the FDA is on the hunt for ways to regulate and most likely tax e-cigarettes like tobacco.
Is it at all a surprise that the federal government would go after this lucrative business?
These devices were designed so that smokers would use to help them quit, yet there are individuals who never smoked before picking these devices up and using them for their own purposes.
Shouldn’t people be able to use an e-cigarette if they want to, regardless of whether it’s for smoking cessation or simply for pleasure?


One-on-One with Mitch Zeller: A Special Warner Series on FDA Regulation of Tobacco Products
May 30, 2014
Posted by: Natalia Gromov
One-on-One with Mitch Zeller
Director of the U.S. Food and Drug Administration
Center for Tobacco Products
Watch


Dual Use
May 27, 2014
An examination of the issues surrounding dual-use of ecigarettes and cigarettes, and whether it can be regarded as a positive or negative for individual or public health
E-cigarette use is, by definition, dual-use: few smokers who try out or start to use an ecig quit smoking immediately they try one.
There would be very little ecig use at all without dual-use. Therefore – QED – dual-use cannot overall be a bad thing as it is almost exclusively the route to complete substitution (replacement of cigarettes by a nebuliser) and possible total cessation.
In the UK, because the number of smokers has been growing steadily since smoking prevalence reduction ceased in 2008, but has now finally started to fall due to smoking cessation caused by ecig use, it is abundantly clear that dual-use is the primary mechanism by which smoking prevalence is now reduced.
Perhaps it might be considered that extended dual-use is a negative outcome. In order that this has any validity, we then need to look at exactly what any negatives might be, and if any are found, then how long is ‘too long’.
The 3 dual-use outcomes
Use of ecigs (EV or electric/electronic vapouriser use, hereinafter) concurrent with smoking (dual-use) will lead to one of three possible outcomes:
1. Smoking cessation
2. Reduction in smoking
3. Failure and relapse to smoking
1. Smoking cessation
If EV use leads to permanent cessation of smoking, either by (a) permanent use of an EV or (b) by eventual total cessation, this is a clear benefit to individual and public health. In practical terms there is little difference between the two outcomes, because:
• Currently, EV use cannot be classed as more hazardous than coffee consumption, so that a transition to exclusive EV use has no quantifiable negative health impact at this time.
• If nicotine consumption is considered an issue (which in itself is debatable), then on average the quantity of nicotine consumed is less than that consumed when smoking.
• Additionally it decreases over time, as vapers routinely gradually reduce the nicotine strength used.
There is no harm caused by or risk elevation for harm caused by vaping, measurable at this time; and on the other hand quantifiable benefit occurs in the form of (a) removal of risk from smoking, (b) improvement of quality of life, as the vaper is happier (than if not smoking or vaping), and (c) supplementation of dietary nicotine has obvious benefits for many while having no negative clinical significance.
2. Reduction in smoking
A reduction in smoking must create a benefit, unless there is no difference in health outcomes between smoking 1 cigarette a day and smoking 40 cigarettes a day. There has been much argument about this issue, but logic dictates that the less smoked, the better. If the benefit is hard to quantify statistically then perhaps the issue lies more with the power of the statistics than with the basic issue: otherwise there would be no point in smoking less, and smokers might as well smoke 60 a day. This is clearly ridiculous.
NICE for example state that smoking less = harm reduction (see NICE PH45). We might quibble about the exact definition of ‘harm reduction’ here, or whether other methods might be more efficient; but the takeaway is that, officially, smoking less is beneficial to health. Doctors can tell patients, with official blessing, that smoking less is beneficial to health. In fact, doctors are officially instructed to tell patients this.
In dual use, any vaping at all must translate into less smoking. The more vaping the better and the less smoking the better. Added to this we already know that EV use is unique among smoking substitution products (including NRTs) because there is an unmotivated vaping-increase / smoking-decrease effect seen nowhere else: people unintentionally vape more and smoke less; and this can even lead to unintentional quitting. As long as the right products are selected – which is usually related to unhindered access plus expert mentoring – it seems as if vaping may be subconsciously preferred, at least by some smokers, and it increases at the expense of smoking. This effect is unintentional and is probably unique (and is certainly unrecognised in smoking cessation practice, never mind explained).
Therefore we need to factor in these two unique effects of vaping, unseen with any other cessation strategy:
• There is a tendency to vape more and smoke less, which appears to be unintentional even in inveterate smokers, and requires dual-use by definition.
• Vaping (and by definition, dual-use) can lead to unintentional smoking cessation.
A proportion of vapers will totally quit (quit smoking via vaping, then quit vaping), and the route to this is dual-use (by definition – since few smokers quit on Day 1 of vaping). In addition, as noted above, the transition can be involuntary: smokers vape more and then quit. Thus, dual-use leads to smoking cessation and may lead to total cessation.
3. Relapse to smoking
Some prospective vapers fail and relapse to smoking. This can occur at any point: it can happen in Week 1 or Week 12. The longer a person continues with vaping, the more successful it is likely to be: a graph could probably be drawn that shows relapse rates decreasing over time, with high rates at first, and low relapse rates after 6 months. This tends to mirror what normally happens with smoking cessation quit rates, although the mechanism may be different.
Potential negatives with dual use
It has been suggested that dual-use may lead to failure to quit:
a. Permanent failure to quit: continuation of smoking
b. Relapse to exclusive smoking and failure to ever quit
a. Continuation
If a smoker continues to dual-use and never transitions to either exclusive vaping or (relapse to) exclusive smoking, is this a negative in any way? And does this happen in significant numbers?
It is very likely that every ecig usage session replaces a cigarette smoked. A claim has been made that each cigarette reduces expected lifespan by 11 minutes, but a similar claim can hardly be made for ecig use, so there appears to be a benefit to extended use per se.
Currently we are not aware of large numbers of dual-users who have stayed as such for several years, and surveys do not currently appear to have the power to measure such figures. It is worth noting that transitioning to exclusive EV use can certainly take up to a year, particularly in the case of a smoker who has no intention of quitting. Indeed this is one of the features of the EV: it can cause smokers to quit who had no intention of ever doing so – but this may well take time. Extended dual-use is the pathway to eventual smoking cessation for smokers who have no intention of quitting. They may have originally intended to use an ecig in situations where they could not smoke; but, for smokers exposed to the correct product choice for the individual, the EV ‘grows on you’ and can lead to involuntary cessation.
We have to hope that eventually the dual-user encounters a mentor who will be able to assist them to locate a better solution, since extended dual-use is directly connected to poor product choice or usage; it represents a failure of the specific vaping solution chosen to work properly. This is one area where the large and dedicated EV user community have a role to play: online support is very effective via forums and social media.
Is a smoker who vapes more likely than an exclusive smoker to encounter an experienced vaping advisor? Quite possibly. A simple scenario for example is that a smoker may only be aware of the existence of first-generation products (mini ecigs or ‘cigalikes’) since they are the type widely advertised and available. These products are well-known to be inefficient, and ineffective in the long term, for most smokers. A smoker using one who encounters a more experienced vaper may well be offered the chance to try a far more efficient model and/or refill – and we know from the community that (a) this has occurred thousands of times, and (b) has led to thousands of smokers upgrading successfully to better products. This is far less likely to occur for a smoker since many vapers do not freely offer advice on vaping to smokers; but they may well do so if encountering a beginner-vaper using a mini.
b. Relapse to exclusive smoking and failure to ever quit
Relapse is certainly an expected outcome. A percentage of vapers will eventually fail and relapse to exclusive smoking. In fact this will be the majority, under normal conditions – since it requires good advice (mentoring) to achieve good success rates, as anyone familiar with traditional smoking cessation practice will know. Ecigs are not a magic bullet that somehow evades all norms and succeeds where everything else fails: it is simply the best answer so far, but no more than that. Smoking is addictive (very much so for some), and suggesting that the simple provision of an alternative will fix that is not being realistic – especially where the solution is complex and highly dependent on free consumer choice and good advice (or luck) in order for a successful outcome, as is the case with vaping. There are thousands of choices but only a few of them will work well for any given person.
Therefore in a climate where the least efficient and effective products are the norm (minis), where no mentoring is likely to be available, where true and realistic advertising is prohibited, where the facts are suppressed, and where spurious counter-arguments are given prominence, then it is obvious that most prospective vapers will fail and revert to smoking. This is inarguable.
The critical factor is always mentoring, that is to say good advice that is available on an ongoing basis. The first thing this advice will lead to is correct user technique, which is very different from smoking (as using an electronic nebuliser has little or no relationship to smoking). The second thing it will provide is a much improved route to product choice – which is everything, in vaping. Unfortunately, such advice can only be provided by family members, friends or work colleagues – so in an environment where there are few vapers, or where they are artificially restricted from vaping openly, mentoring will be limited in availability.
Over time this will change simply as EV use grows by natural progression: once the genie is out of the bottle it cannot be put back in, and use will grow. This means the availability of mentoring will grow. This means EV use will grow more. This means EV users will become more expert. This means EV use will grow more as there is a feedback loop that leads eventually to conversion of the maximum number of smokers (limited by other factors). It means the sight of vapers, opportunity for vaping, resistance to corrupt laws, and the number of potential mentors, will all grow.
In a climate where EV use grows significantly every year, products improve every year, access to better products improves every year, the quality of advice potentially offered by mentors improves every year: then the result is smoking prevalence shrinks every year, and vaping gradually replaces smoking. It then becomes clear that concerns about non-conversions of smokers leading to never-quitting are not valid. This is confirmed by the Swedish experience: male smoking will not exist soon (male smoking prevalence falls at 1% per year, has done so since 2003, and will be just 5% by 2016). If no one is smoking then all concerns are revealed as without substance (and almost certainly agenda-based).
Note that Snus is mostly used by men, so that the effects are easy to confirm since they are not seen in the female population, who are – uniquely – by far the greater smokers now. Sweden is the only country in the world where smoking has any realistic chance of being removed, at least for men, in the foreseeable future; and where the female population are the greater percentage of smokers (and a very much greater percentage). Smoking is a female pursuit in Sweden due to the free availability of a THR product that appeals mostly to men; perhaps we will even see female smoking reduced there by a ‘drag-down’ effect, as very few Swedish men will be smokers in the near future.
It is absolutely clear that, in Sweden, all the arguments why THR potentially may not work, or may potentially be a bad idea, are utterly worthless: when hardly anyone is smoking any longer and all the smoking-related mortality and morbidity figures have fallen through the floor, this is obvious. The same thing will be shown soon enough in countries where EVs are freely available without hindrance (if there is to be such a thing). Or, where the black market successfully evades the laws, implemented by commercial rivals and monopolists, designed to severely restrict EVs or limit their manufacture and distribution to the chosen few.
Hard statistics on dual-use
We therefore know that dual-use is a very good thing: it leads to reduction in smoking, smoking cessation, and total cessation. All these are a positive for the individual since (a) all have health benefits, and (b) they are voluntary and self-motivated positive choices, whichever is chosen.
What we do not currently know is the profile of dual-use over time: what is the percentage of smokers who remain permanent dual-users (if any); what is the average time point to failure and relapse to smoking; what is the average time point at which smoking cessation occurs. Until we have better statistics, some things will remain hard to evaluate fully – though we do know the end results.
We now have an overall picture: the latest UK stats tell us that, in early 2014 when measured, about one-third of vapers had quit smoking. This figure is higher than had been expected and is extremely encouraging.
Thus we can state with absolute accuracy that the new reductions in smoking prevalence that we can now expect every year, which has been static for so many years (since 2008 in fact), are due almost entirely to dual-use. This is an important concept to grasp, and is critical to correct evaluation of EV usage trajectories.
Dual-use is a very good thing. Indeed, it is probably the principal mechanism by which smoking (or even total) cessation occurs. Since smoking prevalence reduction stalled in 2008 and remained so until EV use entered the picture, we can also state factually that dual-use is therefore almost exclusively responsible for all current and future reductions in smoking.

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