On Monday 2nd Novemeber 2015, Dr Attila Danko, President of the NNA (AU), presented as a witness to the committee of the South Australian Senate Committee on Ecigarettes. The Hansard transcript of the committee hearing is now online, and can be viewed under "Hansard" here: http://www.parliament.sa.gov.au/Committees/Pages/Committees.aspx?CTId=3&CId=323
This is the Hansard transcript of the presentation by Dr. Danko:
The CHAIRPERSON: Thank you. If you're happy, state your name and title of your organisation, and then I think you have something you'd like to present to us. When you are presenting for the Hansard written record, if there's something on the screen that you'd like recorded, make sure that you describe it. Thank you.
Dr DANKO: My name is Dr Attila Danko. I am a general practitioner from the town of Ballarat in Victoria. I have been in clinical practice, seeing patients, for over a decade. I am also the president of the New Nicotine Alliance Australia, a group that represents consumers of reducedrisk nicotine products such as e-cigarettes. We have absolutely no funding from any e-cigarette, pharmaceutical, and especially not any tobacco company. I am also a vaper myself. I used electronic cigarettes to quit smoking. I was one of the most hardened smokers I have ever met. From the age of 11 I smoked but, by using advanced electronic cigarettes, I was able to give up when nothing else worked, and as long as I keep using them I will never return to smoking. I am also an advisor to Professor Ron Borland from the Cancer Council in Victoria on an upcoming Australian NHMRC-funded trial on e-cigarettes. I was also recently a plenary speaker at the world's foremost scientific and public health conference on safer nicotine products, the Global Forum on Nicotine 2015 in Warsaw earlier this year. I have met personally, and I am in ongoing contact with, the world's top scientists and doctors in this field. I continually keep up-to-date with all the research in this area. On returning from Warsaw I was invited by the New Nicotine Alliance United Kingdom to establish an Australian sister organisation, which is what we are, along with other vapers and other public health professionals, including two associate professors. I do not accept any payment for my work and I am passionate about the potential for this game-changing, disruptive technology to potentially make smoking obsolete. As a GP I have seen many patients who struggle time and again, relapsing into smoking, trying all the different methods, and I have seen some of these people give up by using electronic cigarettes when nothing else has worked. It is often easy for people in public health, who are not on the front line, to just look at populations as a whole and not consider the individual; I cannot do that, as a GP. I want to briefly go through some of the most important bits of evidence on this issue. Today I am going to cover issues around the effectiveness of e-cigarettes, their safety, issues around children, what appropriate proportionate legislation would be, and a bit about what is happening in the UK. Regarding the effectiveness of e-cigarettes, when we look at the Public Health England report, within their stop-smoking services they actually encourage the use of e-cigarettes in some of them, and when they look at the relative effectiveness of different quit aids that are used, it is on this bar graph. The very right-hand side of this graph shows the effectiveness of unlicensed nicotine-containing products, which obviously are e-cigarettes. So we have a higher success rate, when you are on an even playing field with all the other methods such as Champix, gums and patches. It is not only enough to have a method which is effective, it also has to be interesting and attractive to people to be able to give up, and e-cigarettes have now become England's most popular quitting aid by far. If you look at the green line, that is the rates of support used for quit attempts.
The CHAIRPERSON: Before you leave that slide can you just quickly say what the others are, the other measures?
Dr DANKO: Absolutely. The NRT OTC is nicotine replacement therapy over-thecounter; NRT Rx is prescribed nicotine replacement therapy; Champix is the drug Champix prescribed as a stop-smoking aid. I have to be honest in that I am not sure what 'Beh'l Support' is but it is obviously not very effective—
The CHAIRPERSON: Is it behavioural?
Dr DANKO: I think it is, yes. It probably is. If we look population data, we see that ecigarettes are certainly rising dramatically in the US. However, most interestingly, if we look at data on smoking rates we see quite a steep decline happening from 2012/13 onwards. In fact, looking at the angle of that graph, it's on track to go below Australia's smoking rates in a couple of years if these trends continue. Then we have various studies. There are plenty of studies showing how effective e-cigarettes are. I chose this one because it shows the effectiveness under the most optimal conditions. An optimal condition is when you have a lot of support for your choice to move away from cigarettes. The interesting thing about this is that it showed that vape shops act as de facto quitsmoking centres, at no cost to the government; in fact, they are revenue-positive because they increase jobs and give extra taxation money as well. In this study, they showed that it was a 12-month prospective trial of people who were smokers going to a vape shop for the first time. They showed that 40 per cent were complete quitters (on the graph, the green is 'quit'); not quite so many, but still a significant proportion who reduced to a large degree; and then a about a third who were failures. But you have to compare this with typical quit smoking methods, especially at 12 months. You have typically rates of 4 or 5 per cent with Champix, gums or patches, particularly at the 12-month mark, because people can often quit for six weeks or 12 weeks, but then something will happen, they will get stressed, they will be at a party and they pick up a cigarette again. So, relapse is a big problem. What you have with e-cigarettes is that you have a method that you can use to stop you relapsing. The safety of electronic cigarettes is an important issue. The first thing to say is that there are many studies and many pieces of evidence that have been put before you talking about the presence of toxins. I have just examined one, which is called nitrosamines, which is one of the major cancer-causing chemicals in cigarettes, but it is important to note that the does makes the poison, not the simple presence. We all breathe out formaldehyde in our breath, but it is at nonsignificant levels. Again, if you look at e-cigarettes, we have nanograms, vanishingly small levels of nitrosamines, prettymuch on par with the amount in nicotine gum. If you compare this with cigarettes, on the other hand, we have 1,000 to almost 2,000 times more nitrosamines. Based on this, you would have to vape 3 mls a day for an entire year to get the same amount of nitrosamines as you would get from one cigarette. There have been a lot of rat studies, but what is really important is studying these on humans. My colleague Prof. Riccardo Polosa did a study on asthmatic smokers and the effect on airway function and their symptoms after their switching to e-cigarettes from tobacco cigarettes, and they found that on the ACQ, which is the asthma control questionnaire, when they switched they had quite large improvements in their asthma control; so they weren't smoking but they were continuing to vape. In fact, there was even harm reversal in dual users if they significantly reduced.
The CHAIRPERSON: Did everyone in that trial use the same content of cigarette, as in juice, or did they use nicotine? Do you know what the details—
Dr DANKO: I do have the study, but I can't remember off-hand. I assume that it was probably similar or the same. This was backed up by clinical data. So, FEF 25 to 75 is a measure of airway function on spirometry, and they showed objective measurements of improvement on that and, in particular, on the methacholine challenge, which had a huge improvement. This measures the reactivity of airways (that is, the amount in which airways will tend to contract), and they had a large amount of harm reversal on these objective measurements. Then we come to the children, and if e-cigarettes truly were a plot by Big Tobacco to hook young kids onto lolly-flavoured vapour and then transition them to cigarettes, then I would be against them as much as anyone else, but we have to see whether these claims are backed up by evidence. We have discussions and presentations in the media that teenage use is stratospherically rising, but when you look at the figures they use in these media stories, they talk about 'ever use'. That means a teenager who has one puff of an e-cigarette at a party to try it out is counted in these numbers. These come from Clive Bates, one of the tobacco control people in the UK—well respected for quite a few decades—and when you drill down into this data and take a bit more of a sophisticated approach to analysing it, you see that most of these ever-users were not current users. So, the difference between the two graphs is quite dramatic. These are the adolescents who used them in the last 30 days and, not only that, but almost all of them were smokers, so using them for the same reason that adults use them: to give up smoking. One of the questions which is very rarely
Ms COOK: Sorry, just while you're explaining that one, just take a quick step back for us. You justmade the statement then that they're using them to give up smoking.Was that actually asked of the young people in that questionnaire: 'Why are you using both? Are you using it to give up?'
Dr DANKO: This study didn't examine that. It was just prevalence of use and use amongst smokers or non-smokers.
Ms COOK: So how can we assume they're using it to give up smoking?
Dr DANKO: We can't necessarily assume. They might just be using both, that's true. It is something that I suppose is the most common reason for using e-cigarettes.
Ms COOK: Even in young people?
Dr DANKO: I don't have the data on that. I suppose that's true; it is an assumption. But I figure that at least they're not using cigarettes when they are using the e-cigarettes. The other question about gateway is that it is very difficult to get addicted to nicotine if you are not even having nicotine. I looked a lot for surveys on the incidence of the use of nicotine amongst high school students who were experimenting with e-cigarettes. I only came across one study, which showed that 72 per cent of this group were using them without nicotine, which makes it very hard to consider that that could be a gateway.
Ms COOK: Sorry, so they're using it without added nicotine. They can't be 100 per cent sure that there isn't nicotine in the e-juice, though, can they?
Dr DANKO: I suppose not. There are some that are sold that say they are without nicotine.
Ms COOK: That's the sort of evidence that we've said, so that's why I just wanted to—
Dr DANKO: Sure. One of the most interesting pieces of data that I came across was youth daily smoking rates. A lot of studies will look at youth use in the last 30 days, but really, what is most important is whether or not kids are getting addicted, because once they get into a habit of using cigarettes every day, then they are likely to continue that for the rest of their lives, or a large part of their lives until they quit.What I got was data from Florida, and the reason I chose Florida was because that was the only group that had frequent or daily smoking data available, so I could compare it directly with Australia's daily smoking rates, because you've got to compare apples with apples. If we look at Florida in the blue and Australia's data in the orange, if we go back to 2004, we've got Australia with slightly higher daily youth smoking rates, down to 2007 when Australia has caught up and overtaken Florida in getting young people off daily smoking. In 2010, the trend pretty much continues, but then in 2013 we see that Australia is actually getting worse and Florida has taken quite a significant decline. So, the idea that the availability of e-cigarettes in a population is associated with higher smoking rates in teenagers has to be challenged and questioned. This is only one study. We need to do more studies. We do need to monitor it, but so far on this data, there is a suggestion that experimentation with e-cigarettes could indeed provide a protective effect against smoking. If you have as few as three or four tobacco cigarettes as a teenager, that can easily put you into addiction quite quickly. There are other added chemicals. Cigarettes are highly engineered to produce addiction by tobacco companies, with their pH levels, with other chemicals that are in them which reinforce addiction, such as acetaldehyde and carbon monoxide. These things are not present in e-cigarettes, and so even if teenagers are experimenting with the e-cigarette, with just nicotine alone, there is evidence that nicotine alone is far less addictive than cigarettes. At a party, if they're going to experiment with an e-cigarette instead, it may actually stop them from experimenting with a tobacco cigarette. Another study which came out recently showed that states that banned e-cigarettes in teenagers actually showed an increase in smoking rates compared to states without such bans.
The CHAIRPERSON: Where was this study done, please?
Dr DANKO: This was in the US. It looked at all the different states in the US and when they brought in bans. There was a lot of technical economic analysis, which I wouldn't pretend to understand, but it raises the question that needs to be researched.We can't just assume because of what we think might happen. We have to actually look and see what does happen in these populations. Then, of course, we come to the issue of flavours. People assume that all these flavours are there just to attract children. They can't see any conceivable reason why adults would want flavours and that they must be there just for children, but when you actually ask the children instead of just making a guess, you find out from this study that—this was a study on children and adults and the amount that flavours would influence their attractiveness to e-cigarettes. In the black section, the black filled-in dots are the children's responses. In the open ones are the adult responses. We see that actually children weren't much interested in them at all, so their rating for interest was quite low. If there was anything that they preferred, it was classic
tobacco and single malt Scotch.
The CHAIRPERSON: Did they try them?
Dr DANKO: No, they just asked. They just said, 'If we've got e-cigarettes with different—'
The CHAIRPERSON: So no pictures or anything?
Dr DANKO: I don't believe so. It was actually adults who were more interested in flavours like vanilla and menthol.
The CHAIRPERSON: Did the children even know what the e-cigarettes were? How old were they?
Dr DANKO: Teenagers. I don't have an age breakdown, but they were teenagers, so I am assuming 13 to 17.
Ms COOK: And where was it from?
Dr DANKO: I don't know exactly where that study was. I do have it.
The CHAIRPERSON: Is it London? Does it say something down in the corner there?
Dr DANKO: It does say about London there, yes. I suppose when children are experimenting with a smoking type of behaviour, they're often trying to mimic adult behaviour. They're not wanting to have a childish flavour. They're wanting to be all grown up and mature. That's where our assumptions about what flavours are about need to be questioned, need to be considered, because in terms of adult smokers using e-cigarettes, they're used to provide a separation from smoking, and also to help you to avoid relapse. If you consider that you have fine wine available and then someone offers you a homebrew of rot gut, how attractive is that going to be to you, compared to the fine wine you've been drinking? In a way, that's what works with the flavours. It produces a different type of pleasure to make sure that you don't return to cigarettes. It makes cigarettes taste disgusting by comparison, so it can actually be a public health good. Sorry, I cannot find that study, but I can certainly provide it to you later. In terms of appropriately regulating e-cigarettes, first of all, when a story was done on Channel 9 and they did a poll of over 6,000 people, 90 per cent took the commonsense approach that they have to be safer than cigarettes and that therefor, of course, they should be legal. My honest opinion is that they do not work if you are going to treat them as a medicine, that they are a recreational product that smokers switch to. It addresses a group of people who do not want to go to stop-smoking services. We have phenomena such as accidental quitters, people who try them and suddenly find, 'Hey, I don't want to smoke anymore.' If you treat it as a medicine you might have a completely safe, bland product that nobody wants to use, and therefore that makes it useless. Neither should be it be regulated as a tobacco product; there is no burning, the levels of harm are a magnitude lower than smoking, and there are also unintended consequences of regulation. The more regulation you put into place the more that only companies such as big tobacco companies can comply with those; so instead of having to compete on an even playing field with these disruptive, innovative small companies they can simply get the market to themselves by getting regulators to over-regulate for them. In the end we do have many thousands of Australians who have given up smoking by vaping when nothing else has worked. We appeal to this committee to please do not make it any harder for us, please do not force us back to smoking. This is just the Voke. I put this in to illustrate that when you do a medicine regulation, this is the only sort of product that is likely to succeed. This has gone through in the UK, but no other product, no other company, has had the resources to go through medicine-type regulation. Despite the claims by many that Big Tobacco is taking over all the minnows, the trends are actually going the other way. If you look at this they talk about the vapour market, which is increasing, but vapours, tanks and mods—which are the refillable, customisable devices—are actually increasing in their market share while the ones that look more like cigarettes, which are generally done by the big tobacco companies, are falling in their market share. We have to remember too, with that, that Kodak used to dominate photography for the last century; nobody ever thought they could have fallen. But small, disruptive, innovative companies, who are much faster at innovating, basically took over and Kodak is now defunct. I believe the same thing can happen with Big Tobacco unless regulators protect them. What is happening in the UK? The Nicoventures presentation did discuss a lot of this so I will just go over it briefly. You are getting headlines like this, 'British smokers urged to start vaping by health officials.' We are a long way away from that here. The mainstream document that their peak anti-smoking body produced, called 'Smoking Still Kills', 126 different organisations—including their College of Physicians, their cancer research council, pretty much everyone—signed and endorsed this, and it recommends increased use of e-cigarettes in the population. We would love to engage more with public health. We feel that they have not had the chance to talk to us and find out what it is all about, and they are often going on misinformation. In the United Kingdom vapers and public health work together. They have events such as a School of Vape, where, under government auspices, volunteer vapers help other smokers to quit smoking. We would love to do the same here in Australia. In conclusion, they are more effective than most aids and are more attractive to smokers. They are at least 95 per cent less toxic than cigarettes, and they lead to substantial improvements in health for smokers who switch. High levels of availability are associated, although it can't be proven, with causing a rapidly falling teenage smoking rate, and regulation must not protect the smoking tobacco industry and must allow smokers to switch. I just want to finally end with the voice of the most important people here, the ordinary people who struggle with smoking. It is a story from Judith, who is a 65 year old, who has been able to give up by using e-cigarettes.
The CHAIRPERSON: Just so you know, we did actually receive 142 or 147 submissions.
Ms COOK: We got one especially from Judith.
The CHAIRPERSON: Yes, we did get from her, so thank you for that. Thank you for your comprehensive overview of where you sit and why you think that e-cigarettes are important in the Quit Smoking area. I have a couple of things to ask you, but first of all, you mentioned that vape shops act as a de facto quit smoking tool. Can you perhaps expand more on that, such as, in view of regulation, for instance, how you think that works on point of sale? Do you think that e-cigarettes should be available for sale elsewhere or should we confine them to vape stores? What is your view?
Dr DANKO: I think that we should do everything to encourage them to be sold through vape stores primarily but, at the same time, we shouldn't take away the opportunities for other avenues to develop. This is a rapidly developing and changing industry, and its innovation is where its power lies. In the end, not everyone is going to visit a vape shop, so I think that there needs to be opportunities for tobacconists to be able to sell them too, but they must not be just confined to tobacconists. Probably the most important thing is that the biggest potential of them gets
unleashed if they are with people who are dedicated vapers themselves, who can help people through the difficulties of starting vaping, which often requires a bit of trial and error, a bit of trial of different juices, which one works for you, which flavour you hate, which flavour you like, which device works, which one doesn't work, issues with the maintenance of the devices. Vape shop owners provide these services for free.
The CHAIRPERSON: Therefore, if tobacconists were able to sell e-cigarettes, why would someone behind the counter say, 'Perhaps don't buy the cigarettes, have a go at this e-cigarette?' What would be the incentive in that?
Dr DANKO: Yes, that's correct. They certainly have mixed motivations; they may well make more profit on the cigarettes. There have been some public health organisations which have called to make it mandatory that tobacconists sell e-cigarettes as well so that smokers have the option. I basically think that when you have such a disruptive lifesaving technology, the more places it can be sold the better, as long as you have safeguards in place in terms of not selling to under 18 year olds.
The CHAIRPERSON: How would those safeguards look?
Dr DANKO: I think that the current laws in terms of alcohol are probably appropriate. We know that children will still access alcohol. We don't decide to ban it as a whole just because teenagers do. It is about regulating it proportionally to its risk. I would say that e-cigarettes are a little bit more risky than caffeine and energy drinks, but they are certainly a lot less risky than alcohol. So, I think regulating it in a similar way to alcohol is probably a fair compromise. Regulating it as a tobacco product where you can't see the devices and you can't try the devices would be counter-productive and would actually not help people to switch to this.
The CHAIRPERSON: You cited the Kodak company as an example of innovation and the dying out of one industry for the sake of another. You made the comment that unless regulators protect the tobacco company—what did you mean by that? I am a bit curious about what that means.
Dr DANKO: As an example, in the United Kingdom they have two methods for approvals or regulation. E-cigarettes can be sold as a general consumer product, just as available as cigarettes, or they can be sold as a medicine, such as through their equivalent of the TGA. So far, the only companies which have had the resources to go through those levels of regulation have been tobacco companies. So, what you are doing if you are putting up large regulatory hurdles is only the companies with large amounts of financial muscle will be able to go through them. If you ban all your competitors, then you end up as the only ones on the market.
Mr PICTON: Do you have a view on what advertising restrictions, if any, should be in place for these products?
Dr DANKO: Again, along with the idea of proportionate to risk, I would be looking at the guidelines we have for alcohol and also not selling to young kids and not promoting it as a product for people who have never smoked.
Mr PICTON: Because there is obviously a risk that people—particularly big tobacco companies who own an off-shoot of a vaping company—might use advertising as a way to promote all their products and smoking generally.
Dr DANKO: Yes, that's right. One interesting fact is that currently there is no Big Tobacco e-cigarette product on the market in Australia at all.
Mr PICTON: We did just hear from somebody who is interested in those.
The CHAIRPERSON: Would you recommend we keep it that way?
Dr DANKO: I think it's hard to make one rule for some and another rule for others, but what you've got to do is make sure that you don't make rules that have the unintended consequences of favouring Big Tobacco.
The CHAIRPERSON: I just was a bit curious about your view on this, because in Australia we have done very well with our campaign against people smoking. Our record in people quitting is excellent, so why wouldn't we here make sure we don't let Big Tobacco back in in any particular form in the marketplace?
Dr DANKO: I suppose I just don't know how you would do that as such. Big Tobacco is already in the marketplace with cigarettes; that's their main market. If, for example, they changed to become an e-cigarette company, then you can't treat them the same as that. I honestly don't think that their products will succeed on the market anyway, but to make artificial rules is just going to be unworkable. To prejudice against one particular company because of their name or history I just don't see as a workable option. But I do think that if you allow free competition, they will be out-competed anyway.
Mr PICTON: Just on flavours, which you talked about a bit in your presentation, we have obviously had some advice in terms that we should be cautious of flavours that appeal to children, but on the other hand we have had advice that we should be cautious about lots of the ingredients that are used in these flavours and their health impacts on the general population, particularly those that are normally used for ingestion rather than inhalation.
Dr DANKO: Correct.
Mr PICTON: Do you think there should be regulation around what flavours are used and information for the public on what they contain or do you think it should be the sort of free-for-all
that exists at the moment?
Dr DANKO: I certainly think that we need to do more studies into flavours. There are already quite a few studies on which flavours are more toxic than others, but you always have to look at the reference with cigarettes. When you are making something 95 per cent safer or 95.1 per cent safer, there is really very little in it compared to the advantage of being able to get people off cigarettes. There have been some chemicals which have been shown to be more toxic than others, such as diacetyl, and I certainly think that there are some components that should be banned. But always the temptation is to regulate, and there are risks in regulation as much as there are in not regulating.
Mr PICTON: Could I ask what flavour you use when you vape?
Dr DANKO: I use a sweetened tobacco type flavour, a bit of a caramely one.
Mr PICTON: Are you confident that you know the ingredients of that and what the potential effects of those flavours are?
Dr DANKO: Yes. There are some companies that do quite extensive testing and have toxicity results of their flavours on mice and cell studies and that sort of thing.
Mr PICTON: And so the company that you buy from has done that?
Dr DANKO: Yes.
Mr PICTON: What company is that?
Dr DANKO: It is Flavourart in Italy.
The CHAIRPERSON: When you are seeing your patients, if you like, helping them to quit smoking, do you suggest that they purchase nicotine for their e-cigarettes?
Dr DANKO: What I do is, I go through all the standard quit smoking things first, but if they fail at all of those things, then I think it would be negligent in my duty as a doctor to not inform
them that there is another option.
The CHAIRPERSON: What process would you go through? For instance, you go through all the usual quit smoking things: how many months might that be, or years? How long might you—
Dr DANKO: That depends; it's not fixed.
The CHAIRPERSON: And what would you say to them after that, when they got to that point that they thought they couldn't actually give up with all these other supports. What would you say to them as far as getting onto e-cigarettes goes? How would you point them in the right direction?
Dr DANKO: I would introduce the idea to them and see if it appealed to them, and I would send them to a brick and mortar vape shop, which is not too far from where I am. Then they would go from there, more or less.
The CHAIRPERSON: Would you recommend to them to purchase nicotine somehow?
Dr DANKO: Yes, because the evidence is that if they have nicotine in them, they are far more effective. Without nicotine, it's not much better than a placebo.
The CHAIRPERSON: Where would they get the nicotine from?
Dr DANKO: Usually the United States.
The CHAIRPERSON: An online order? Not through the vape shop itself?
Dr DANKO: No. I can provide a prescription for them as well, to make it legal, but to my mind it's a bit like making condoms prescription only. They are a great public health good and why should we make it harder to get this than cigarettes?
The CHAIRPERSON: Condoms aren't on the S7, though.
Dr DANKO: Correct, but they're similar in that some people don't like the type of behaviour that the use of condoms represents, but they feel that having condoms available encourages all sorts of depravity.
The CHAIRPERSON: Do you think that still exists, that view?
Dr DANKO: I think it's a very minority view, except when it comes to smokers.
The CHAIRPERSON: The other thing I was interested in was, have you had any interactions with the Cancer Council, the Asthma Foundation or any of those types of organisations? What would their view be of what you're doing with your patients?
Dr DANKO: We're a fairly new organisation. I only gave my talk in Warsaw in June this year, and it all came out of that. So far, we've had the opportunity to meet some politicians in Canberra to discuss this, and also had a few media reports, and we've been developing the support of our base and presenting submissions to various committees, such as this one. I do have an ongoing relationship with Professor Ron Borland from the Cancer Council Victoria. I am currently looking at more opportunities to engage with people in Cancer Council, in Quit and in other public health organisations, and I would welcome opportunities to engage in a completely civil, open way of trying to understand each other. I think so many problems happen in this area because we don't sit down and try to understand each other.
The CHAIRPERSON: You talked about the School of Vape. I have heard about the School of Rock but not the School of Vape; how does the School of Vape work? Tell me about the process, I am just curious.
Dr DANKO: They have a hall and they invite smokers, the official stop-smoking services invite smokers who have not been able to quit if they are interested in trying e-cigarettes, and they have volunteer vapers who are there and who can tell them how it works and give them a try. There is a bit of a learning process that is involved, and it is all within their stop-smoking services.
The CHAIRPERSON: Would you have e-cigarette providers set up with stands and stalls as well? Is it that type of thing, like a fair?
Dr DANKO: I haven't been there so I do not know, but I don't think so. I think it is free from any industry influence; I think it would just be the people themselves who have their range of devices to show people.
The CHAIRPERSON: Would you suggest that people could use e-cigarettes anywhere if they were regulated, if we viewed that they were fine to use? Given the stance that we have in, say, hotels and on buses and in the public arena for non-smoking, how would policing ecigarettes happen, do you think? Would you allow them in public spaces? Would you allow them in hotels?
Dr DANKO: There is no credible public-health argument for banning indoor vaping. The amount of toxicants that are emitted are below occupational levels of exposure—even though it looks bad, it looks like a big cloud. We are pretty much having the same sorts of emissions as, say, from a fog machine, which is certainly allowed in indoor use. It uses pretty much the same ingredients. However, there is a manners argument to be made, and I think that any venue or any organisation has the right to prohibit vaping on their premises—but it should be for the premises
to decide. So if a pub decides to go vape-friendly, that should be their right; if they decide to ban it that should be their right as well. What the public health organisations in the UK have come to— these are their standard, legitimate organisations that have been around for decades—is they have decided they should support the possibility of indoor vaping because it sends a clear public health message that these are safer than cigarettes. This is one of the biggest problems that advocates face with this, that the perceptions of the harm are actually out of step with the scientific reality.
The CHAIRPERSON: Thank you; I think that was very comprehensive. Is there anything you would like to say to the committee in closing? One thing I would ask is if we could have a copy of your presentation forwarded to us.
Dr DANKO: Yes, absolutely. I think I have actually emailed it to you already.
The CHAIRPERSON: Okay. I think there were a few requests that were made along the way as well, and that will be in the Hansard. Shannon will help you with those. Is there anything that you would like to say to us in closing?
Dr DANKO: Just that we should not act too quickly because the evidence is coming out all the time. When we were in Canberra there was certainly some significant support for the legalisation of nicotine, and the same exemption under schedule 7 that applies to cigarettes. The National Party has already come out publicly, saying they support the legalisation of e-cigarettes. If we overregulate too quickly from a state basis, it might be hard to rewind disproportionate and unnecessary regulations when the evidence gets stronger that they are actually a public health
The CHAIRPERSON: Thank you very much for that.