In June this year the great and the good of tobacco control had a little get together to discuss progress on their Tobacco Free Ireland project. Sensibly they decided to cover the whole island of Ireland in this venture. Speakers from the republic, N.I. and the UK made presentations. If you have the time and patience you can listen to them here. All the accompanying slides are included. My compliments to the organisers for doing this, I wish all these things were so well published.
It’s almost like being there. Not!
Now what got me thinking was that during the whole shebang the only mention of harm reduction as a policy tool was an aside from Jenn Ruddick of ASH UK. She found it really interesting that when speaking in the UK she encouraged people to adopt e-cigarettes as a means of stopping smoking but it was going the other direction here. “I find that really interesting”, she said. Hmmm, only interesting, not bloody infuriating or a cause for concern?
As an example of this situation, I’m going to examine Prof Luke Clancys presentation because he was the one who mentioned e-cigs slightly more than in passing. It should be noted that all the Irish speakers were negative towards vaping and kept adding ending nicotine addiction as part of their tobacco-free Ireland goal. I won’t give the time of day to Gerald Hastings hyperbolic ramblings as they are all about marketing and should have been kept for the Towards a Marxist Utopia symposium. The rest stuck to cigarettes and tobacco in its strict meaning.
Luke’s waffling can be heard here but to be honest, you might want some strong drink to accompany it.
Now for those of you who don’t know, Professor Luke Clancy is head of the Tobacco Free Research Institute of Ireland. As the slightly too long title says its primary purpose is research. Luke describes it as “gathering evidence to inform policy which wouldn’t otherwise happen”. Right here, it becomes problematic because I always thought evidence directed policy. What Luke is saying is policy directs evidence. He admits the reason for his institute is to provide evidence for policy interventions already decided by politicians. Arse over elbow. It gives some idea of what Luke sees as science and the purpose of science.
He mentions the simsmoke model which analyses the effectiveness of different aspects of tobacco control policy. It’s an analytical tool from the U.S. and unsurprisingly has no attribution for harm reduction and only analyses prohibitory policies. Tax, public use bans, advertising bans, graphic warnings and youth access. No mention of product substitution. It looks like the model measures the effect of policy not on health outcomes but rather on the effect on the tobacco industry. Luke even admits the health benefit was minuscule and mortality actually rose in spite of comprehensive tobacco legislation. (ironic as he told us earlier that he had produced evidence that the smoking ban improved mortality and morbidity levels)
We need more and better policies
That’s a bullet point on one of his slides. My heart jumped! Is Luke going to embrace harm reduction as one of these better policies? I listened with bated breath.
Price needs to be constantly increased. Plain Packaging must be brought in asap and evaluated as to it’s effectiveness. Smoke-free legislation needs to be extended to outdoor spaces and “we need research to show harms but we know it can’t be good seeing people smoke, what if all we can show is, it’s not nice and we don’t like it? ” Well then shut up and leave people alone. If you can’t provide evidence of actual harm, you have no business interfering.
Ahh here it comes, Luke tells us he has been doing some work on e-cigarettes. This is where he joins the RCP and encourages their use as part of the tools against the harms of smoking. He mentions that one of the reasons lower socioeconomic groups use e-cigs is because they are cheaper, Luke thinks that’s one of the problems. WTF! Not looking good.
Now, he’s back on plain packs again and HIV? Actually, the problem is his level of waffle, Luke gets distracted and can’t seem to construct a linear argument or think in a straight line. Still, public speaking is hard, who am I to criticise as I’d probably be just as bad.
Then again, No. I bloody would not be. From HIV patients knowledge of e-cigs Luke claims smokers don’t like e-cigarettes, and adds “this may be a good thing”. So who is buying them? According to Luke, it’s the children. The complete lack of logic is bad enough but the sheer number of non-sequiturs is even worse. This isn’t a presentation on the current research on e-cigs or progress on a tobacco-free world. This is the public health version of “have you stopped beating your wife” It’s a carefully selected set of assertions designed to create the illusion of a problem. Luke asserts adults are not ‘smoking ‘ e-cigarettes to stop smoking, “we know that’s not true“, he says. A straight up falsehood, lie or just plain stupidity? (See two can play this game)
He then announces that the new battleground for second-hand smoke is outdoor spaces. He is going to check if people with asthma or COPD are affected when they go into these smoke-free spaces? It’s not going to be easy to measure, he tells us. He hopes to produce guidelines, cardiovascular guidelines, pregnancy guidelines, HIV guidelines. I have no idea what he’s talking about at this stage, there’s not even a slide to frame this rambling. Yeah he’s lost the train of thought again, or does he suffer from Alzheimer’s? 😉
Then he says e-cigs may be as effective as NRT but it’s not proven, they may be as safe as NRT but they are not because they contain particles and other drugs!!! He’s surprised anyone could recommend e-cigs in pregnancy as they contain nicotine. (Unlike the recommended NRT?)
They may be a tool for harm reduction, he admits ,then he claims the existence of a report that says NRT may reduce exposure to secondhand smoke “but there’s no proof of this”, e-cigs are not around long enough or some such bull spit. Honestly, this is just a mess as presentations go. I’m embarrassed for him.
“E=cigs may be less addictive than cigarettes but we know they are addictive”. Which is interesting since there is no study or research on this but Luke ‘knows’.
He then references the Glantz study (and I use the term cautiously) which showed teens to be 6 times more likely to smoke if vaping. We know this study was pure junk but professor Luke is blinded by it. I wonder if Luke has any scientific qualifications at all? He mixes up Glantz’s study and the mice one from Denise Kendal from last year. (Denise Kendal is most famous for originating the gateway hypothesis that stated soft drugs like marijuana could lead to a conveyor belt or escalator for harder drugs like heroin and cocaine. She is now claiming nicotine is a gateway to heroin)
Luke then rabbits on about how vaping is not reducing exposure to secondhand smoke and undermines the smoking ban. He keeps saying ‘smoking e-cigarettes’ so I guess he is too stupid to realise that vaping is NOT smoking. That or is he lying? I don’t know. (this is a fun game)
“Nicotine addiction is not that important but it does change the brain and there is no doubt it is a gateway to other drugs!” Followed with “I’m not suggesting any of these things are proven” That’s exactly what he is not just suggesting but stating! Or is “there is no doubt” a statement that there is doubt?
What most worries Luke, is the involvement of tobacco companies because? I dunno, tobacco companies are evil and so on, no real reason other than it’s a stick to beat vaping with.
Tobacco companies will get around the price tool by selling e-cigs “and people will temporarily use e-cigs until” they get rich or cigs fall in price? I dunno either but it’s worrying Luke. I’m more worried about the state of Lukes mental health tbh.
At this stage, he shows his real concerns, the threat to the FCTC. But first he has a go at PHE and the RCP who Luke feels are falling into disrepute by adopting a harm reduction approach based on the available evidence. In case anyone forgot Luke thinks evidence should support policy not inform it so he’s bound to have difficulty with evidence informing policy. That’s no excuse for a My Johnny approach, though. It should occur to Luke that it’s him and his antz crew that have fallen into disrepute. They’re the laughing stock of public health. So much so that they are now recognised as political campaigners rather than health professionals. Luke himself is a member of the College of Physicians yet he asks “who are they talking for and does anyone really believe, (long pause) that this industry is going to change the world.” That pause was not because he ran out of breath, it was deliberate to infer that no one should believe the RCP report on e-cigarettes. Pretty despicable behaviour and I hope the RCP takes scissors to his membership card for that.
Then the meat of his concern, the loss of funding for tobacco control as e-cigs become the most successful method for smoking cessation, That this should happen without any cost to the taxpayer (and consequently no money for Luke) is anathema to the professor.
Poor Luke admits that “reliable people have told the government that e-cigarettes are the answer”, which of course makes him and his kind the unreliable people. Right? Doesn’t stop him fighting the tide though. He admits he intends to take steps against this happening which for someone trying to achieve a tobacco-free island is an astonishing level of self-defeating activism. Yet he fails to see this. (Or does he? I have no proof but…)
So as he approaches the end, Luke rates Ministers of Health on their tobacco control efforts. Starting with Charles Haughey, who gets 2 stars and up to James Rielly, who gets 5 stars. As does Micheal Martin. It’s interesting that funding TFRII was one of the things both did. Mary Harney who banned smoky coal and did more for public health than most while in the dep. of environment gets 2 stars. She removed TFRII funding. In fairness, if Micheal Martin didn’t get 5 stars after bringing in the smoking ban I would have questioned Luke’s sanity. James Rielly seemingly deserves his stars based on his plain packs initiative and getting an award for the TPD.
He goes on to waffle about plain packs and some fluff about Australia and how they sought “evidence of all that was good about plain packs”. Shouldn’t they also look at what was bad or am I missing something about gathering evidence?
His last slide lists the purpose of the tobacco-free research institute of Ireland ;
Provides the evidence base for intervention. That’s called salting the mine. It only produces evidence that suits and as we have seen from Luke’s presentation ignores or disparages everything that doesn’t fit the predetermined agenda.
Challenges the Tobacco Industry. What does that even mean? It’s up to governments to fight the tobacco industry not academics from D.I.T.
Promotes interest in tobacco control among academia. Huh! With research of the kind TFRII do? Maybe as an example of bad research or a source of easy money for fossils who should have retired long ago?
No mention of harm reduction in any of the presentations and as to the presentation of Professor Luke Clancy, I may have adopted a slightly mocking tone but make no mistake, this man is not a fool. He is a clever, dangerous, ideologue, who instead of doing actual research and then following where that leads, only produces research that supports his ideology. His presentation for all its dithering is a carefully crafted piece of rhetoric. It implies, assets and downright states things he knows to be false, using the trick of posing accusations as questions. That my tax pays for this kind of crusading is disgusting. That Luke is a boring speaker is intolerable. That the whole presentation was a not so plain pack of lies might be the least worst part. That this will be used to justify policy is downright criminal.