Ashes to Ashes!

 

hny

“This time next year Rodney….”.

Yeah, we all do it, make resolutions which we immediately abandon. The big one is losing weight, followed by giving up smoking. Get a gym membership, join a slimming club, try an e-cig. No?

No! No, No! Not an e-cig! Not according to ASH Ireland who are “against vaping as a solution, saying that quitters should use patches or gum instead”. They went on a media blitz with this message on January the first, getting coverage in most national newspapers, radio stations and online publications. It was to be expected, this has been ASH’s position since e-cigs first turned up around 8 years ago and despite the lack of emerging evidence of harm and the emerging evidence of their usefulness as tools to reduce smoking prevalence. ASH has not budged. (They do on the other hand sing the praises of Plain Packs which they say are proven to reduce smoking despite the lack of empirical evidence. It seems projections are good enough if it’s a measure they like.)

Dr Patrick Doorley, Chairman of ASH Ireland said today;“The New Year is a good time for people to consider quitting smoking and I encourage them to do so. Many people quit for good at this time each year. For most people they will make a number of attempts before finally quitting – so I would encourage those who have tried before to try again. People can attempt to quit on their own, or call the National Quitline on: Callsave 1850 201 203.”

Not super encouraging for people thinking of quitting, it’s almost as if ASH aren’t that pushed if you do or don’t. Pat isn’t too bothered because he has put his faith in Plain Packs;

“In Ireland we have lost some time with the full roll out of the plain packaging legislation, however, the final legislative process will be completed in the New Year and it is vitally important that the Government then push ahead and get the plain packs on the shelves as a matter of urgency.”

 

Being the sceptical kind, I paid little attention to this apart from sighing and rolling my eyes when they turned up on the telly or radio. (I did this a lot, I do it a lot anyway but this week had me working overtime) However, by the next day, I did notice something, a slight change of tone, a small uncertainty in the condemnations. January the third, things got even stranger, ASH now were qualifying their initial warning and instead of “vaping doesn’t work” they were saying “there is some evidence but not enough…” Did someone somewhere have a word in their shell-like?

A week is a long time in politics and make no mistake, this is politics not health. On Jan the fifth  HIQA released the draft of their Health Technology Assessment on smoking cessation therapies. I’ll add a link at the end if you want to plough through it, it’s long, detailed and has lots of graphs and tables if that’s your thing.

I’ve gone through it and to be fair, it’s a pretty good if over cautious assessment of the current evidence on e-cigarettes. Heavy on the caution in regards to both their usefulness and the studies available. Stating that most were inconclusive at best and not supported by the real world evidence at worst. Here are some highlights pulled from the document;

if e-cigarette use in Ireland (26%) rose to the levels currently reported in England (45%), the number of prescriptions required could fall by nearly 40%

e-cigarettes and combination varenicline and NRT the most cost-effective strategies when individual therapies are compared to each other.

regulating vaping products as tobacco products may give the message that both are of similar risk

Any smoking cessation intervention must be made available in a way that promotes the autonomy of the individual by providing information on the risks and benefits associated with the particular intervention.

provision of inaccurate information on comparative risk is fundamentally unethical as it fails to allow consumers to make informed choices

Continuing increases in the uptake of e-cigarettes are likely to improve the cost-effectiveness of the overall mix of cessation interventions in Ireland, by increasing the number of successful quit attempts at an acceptable cost .

No quibbles with any of that. I noticed that a lot of the data on e-cigs,  smoking prevalence and smoker demographics is from UK or US sources because such data isn’t available for Ireland. Which raises the question, what the hell do the Tobacco Free Research Institute of Ireland do exactly?

However, it’s not all good. While mostly well done, the ideological bias shows through when they give credence to this kind of nonsense;

1.Although there is clear benefit to existing smokers from switching to e-cigarettes, there are concerns that if it becomes socially normalised, large numbers of people who have never smoked might take up smoking e-cigarettes

2.It is also possible that e-cigarettes will have a ‘gateway effect’ for non-smokers who take up e-cigarettes, and they may later migrate to tobacco cigarettes or marijuana.

3.Smokers who use e-cigarettes as a smoking cessation aid may in effect be swapping tobacco for another dependency,

1.No evidence this is happening so this is nothing more than a biased opinion which should have no part in a policy document.

2.Marijuana! OFFS! gateway theory is nonsense and needs to be buried with phrenology and Humourism. This is just reefer madness all over again.

3. Sounds reasonable until you realise tobacco dependence is a synonym for nicotine dependence so it’s not swapping anything, it’s replacing something with a harm reduction alternative. But “The tobacco control community are wary of accepting harm reducing products, such as e-cigarettes” and “If e-cigarettes make smoking socially acceptable, this could be seen as a retrograde step after decades of anti-smoking efforts”. 

Vaping is NOT smoking, how hard is it to understand?

There is a consultation process attached to this draft and if you want to add your voice, it’s available on the same page as the draft report linked below.

Anyway, the publication of this draft does give us a clue as to why ASH have had a full week of backpedalling on their New Years message.Here’s a free tip for the lads at ASH, it’s never a good idea to start with bold claims and then have to back down. It makes you look incompetent. If you’re explaining, you’re losing as they say.

I’m going to do what I do every year as far as resolutions go, I hope you take my advice and do the same. ASH might be better to not adopt this approach, I recommend they resolve to keep up with the literature and adjust position as the evidence indicates.It could save them further embarrassment!

nyr

 

Link to the draft report and the consultation paper

 

 

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