Annalizeing*

A few weeks ago Public Health England released their annual report on vaping in England. https://www.gov.uk/government/publications/vaping-in-england-evidence-update-february-2021/vaping-in-england-2021-evidence-update-summary

They release this report every year, (the clue is in the name), and since the first one, very little has changed. No evidence of a gateway, still about 95% safer, can still help people stop smoking, ect. The only thing of note is the shift from ‘yet no evidence of harm’ to ‘still no evidence of harm’.

Meanwhile in Ireland, our Health Service Executive released their annual report on vaping in Ireland, so I thought I would compare and contrast. Except the first part is a lie, the HSE did no such thing, they don’t do an annual report. Healthy Ireland do include some data in their Healthy Ireland report but it’s fairly generalised. The tobacco control people, do report and do research but the stuff they release is so out of date it’s irrelevant. Anyway let’s look at what the HSE and the tobacco control unit did report on.

First, the HSE as it’s the easiest to mock, sorry, analyze. Here’s the ‘report’ This is a focus group of teens and it’s from pre-2018 as Juul wasn’t yet available as mentioned in the report. Juul has come and gone in the meantime, so HSE might have to do another report. I expect to see that one around 2025. It’s not a report based on data or research btw, this is nothing more than a report of a conversation between teens and ‘facilitators’ for which the teens received a gift pack. I hope it matched the HSE chief executives’ reward. breaking news

It’s obvious they intend this not for research purposes but to use in the war on nicotine. The set of recommendations do not follow the information gathered in the interviews.

• Advertising banned: None had seen an e-cig advertisement outside of a vape shop or point of sale, so for this report social media posts by friends were counted as advertising. Some claimed to have seen an add for Juul but I suspect they saw one of the Truth Initiative’s anti-Juul adds from the description given.
• Restrictions on flavors: The ‘kids’ said flavors were not the reason they vaped ( or rather thought they were not the reason some kids vaped, no one admitted vaping themselves)
• The introduction of mandatory e-cigarette warning notices and posters on the addictiveness of nicotine at all retail outlets selling e-cigarettes: This isn’t even done for cigarettes!
• And of course an immediate age restriction; which begs the question why now and not when the TPD was being transposed? I guess they just forgot.

The HSE even claim with a straight face;

The HSE has a legal obligation to monitor e-cigarette market
developments, including any evidence that their use is a gateway to
nicotine addiction and tobacco consumption among young people
and non-smokers. Although there have been some Irish studies of
E-cigarette prevalence among young people in Ireland, detailed
information is limited in terms of access, knowledge, the context in
which e-cigarettes are used, and their association with tobacco and
other drugs.

And they give us this? A marketing tool to be used to form policy? Policies such as “the installation of e-cigarette detection for Irish school toilets”? For real! This is not just a waste of time with no useful information but an insult to anyone with an interest in reducing smoking.

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Another useless effort.

Let’s move on to the ‘serious’ research also from Feb this year and published with the title;

E-Cigarette-Only and Dual Use among Adolescents in Ireland: Emerging Behaviours with Different Risk Profiles

The study was carried out by the HSE’s Department of Public Health West and Planet Youth West. The HSE we know, Planet Youth West is a five-year pilot program, initiated and developed by the Western Region Drug and Alcohol Task Force.

Notice the theme here; teen use, no mention of adult smokers or vapers. I guess they don’t count. Anyway, as this is the serious one I’ll give it the serious attention it deserves.

It contains several things which I think are wrong so to keep this short, I’ll list the main issues and why I think they are wrong.

For established adult tobacco users with long standing nicotine addiction, the e-cigarette may be an effective harm reduction tool, a role which merits rigorous investigation for the benefits it could reap in this population. However, this argument is not relevant to adolescent users, who receive all the pernicious properties of nicotine without the proposed benefits of harm reduction.

If they just left it at that, I would think it was just a misspoken idea but they go on to throw further shade at PHE;

The public health message around e-cigarettes has been mixed—Public Health England promote a message that they are 95% safer than conventional cigarettes. This message is applicable to adult smokers with an established nicotine addiction, using them as a harm reduction tool. For most adolescents, e-cigarettes are not being used as an adjunct to quit a sustained smoking habit. Therefore, adolescents are being exposed to the harmful effects of e-cigarettes without the potential benefits of harm reduction. The public health message must be tailored accordingly. An unambiguous public health message on the harms of e-cigarette use among adolescents is required.

Here’s why I think this is wrong.

Never mind the blatant admission they would lie about the risk from vaping, I suppose as it’s a ‘good lie’ they think it’s acceptable.

Harm reduction does not depend on being harmed first, in fact, it works best when it avoids the harm completely but failing to do that it next works best by diverting from harm to reduced harm. This means the most benefit from reduced-harm products goes to the ones who never use the higher-harm product. In fact, an adult smoker with an established nicotine addiction is going to get less than 95% harm reduction depending on how long they have smoked. The harm of smoking is cumulative, the earlier you stop the less harm is accumulated. An adult smoker who quits has already had harm done.

On the other hand, never smoking and only vaping reduces the harm by about 95% right then. Never smoking or vaping at all reduces the harm to 100% obviously. Quitting smoking stops the harm from accumulating further and switching reduced the future harm by about 95%.

The flaw in tobacco control is the assumption that no one will ever use the harmful product or that so few will, that the harm from the reduced product being used will outweigh the original harmful product. The idea that things that reduce risk might provide a false sense of security and lead to reckless behaviour is one of those things that sound right as long as you don’t think about it.—it’s contrarian and clever and fits the “here’s something surprising we smart folks thought about” mould that appeals to, ahem, people who think of themselves as smart. This kind of argument has been used against every effort to persuade the public to adopt almost every advance in safety, including seat belts, helmets, and condoms. Even NRT was decried by public health at first. Most recently we have seen the WHO and our own medical experts, advising against masks using this logic, masks create ‘a false sense of security’ they said. But the numbers tell a different story: Even if safety improvements cause a few people to behave recklessly, the benefits overwhelm the ill effects.

To be fair the study itself isn’t completely useless, it does give us some insight into the use patterns of adolescent users. Its main failing is; if the gateway hypothesis is such a concern, why didn’t they include a question on whether the dual users smoked or vaped first? If they did I couldn’t find it. Which given the amount of concern and reference to an EU obligation to determine if a gateway was happening is a glaring omission. The authors themselves are aware of this but shrug it off with;

There are however limitations to this study, perhaps the most significant being that it is cross sectional. Therefore, it is not possible to establish a temporal relationship between exposure and outcome and not possible to infer causation

Ahh well, nothing that could be done then… except infer causation;

dual-use may represent a transition to tobacco product use, a process known as the gateway effect,
and longitudinal evidence for this effect is mounting.

It’s hilarious to see them decry the lack of data and then present data from 2018 as current. Might I respectfully suggest they get off their collective arses and do some actual research? I have said before that the level of research in Ireland is woefully underpowered. We check smoking rates approximately every 2 years and publish the results 2 years later. We complain about the fact that the UK doesn’t use the same metric as we do and therefore can’t be used for comparison. Because we use the US metrics even though we share very little in common with them in regulation or culture whereas we share the same tobacco regulations as the UK and a similar culture.

It’s also disconcerting to see the obsession with vaping when the data from this study shows smoking is still king for nicotine use, with 17% classed as current smoking.

Alcohol is the drug of choice for adolescents with 41% having consumed alcohol in the previous 30 days, that’s the same metric used for vaping. The only mention of alcohol is that it might reduce the ‘kids’ capacity to refuse to vape!!!

Even more concerning is the illegal drug use of Irish adolescents at 20%. Cocaine use is cited at 2.2% among adolescents. These are products illegal to purchase, have no advertising, no flavours, come in the plainest of packs, and have had a huge campaign informing of the dangers of consuming. Why if none of this works do they think it will work, this time, for vaping?

https://www.emcdda.europa.eu/publications/joint-publications/espad-report-2019_en

In this study, there was a statistically significant inverse association between value for conventional social norms and conventional cigarette and dual-use. Those with higher value for conventional social norms were less likely to be conventional cigarette or dualusers but were not less likely to be e-cigarette only users. The lack of association with e-cigarette use is concerning and supports the hypothesis that e-cigarette use is viewed as a more socially acceptable behaviour, one that, unlike conventional smoking, society does
not attach the same negative connotations to.

Well, that’s telling; it seems the concern is rebellious behaviour among the ‘good kids’ As the urban dictionary defines an epidemic; “A disease or behaviour that has started affecting middle-class white kids” No wonder we have headlines referring to the vaping epidemic and the Irish Medical News running an article this month last year on the ‘emerging epidemic ‘ Oh irony, you are a bitch.

*I’ll get me coat….