Tonights guest is…

Ladies and gentlemen, it’s time to give you a break from my ponderings and let someone who knows what they are talking about have a say.

This week was a good one for vaping news. The smoking toolkit showed 18000 extra smokers quit by switching to e-cigs (yeah, it sounds low but it’s a conservative estimate based on complex math and stuff and it’s still over and above what would have quit if vaping had not figured).  An update to the Cochrane review showed e-cigs can help people quit lit tobacco and showed no evidence of harm short to medium term. Irish Health reported the story here E-cigarettes do help smokers quit  All good! I have however heard some commentators when speaking about this review say the quality of the studies are low which seems to imply that the Cochrane review itself should be taken with the proverbial quantity of salt. So to explain this issue I got someone far better able to do so than me. Sarah Jakes,  @Twigolet on twitter if you want to follow her. Sarah is a trustee of the UK charity New Nicotine Alliance (UK). She knows her stuff!


Over to Sarah;

Cochrane reviews are one of the most highly regarded review systems in the academic world, but sometimes they can leave you feeling a little, well, flat. Let’s face it, ‘E-cigarettes may help smokers quit but the quality of the evidence is low’ is not exactly the advocacy message of the century.

To understand why this finding is kinda better than it seems you have to first understand the purpose of a review. As anyone following the vaping debate knows, practically every day brings new studies and the conclusions of those studies are sometimes problematic. This could be down to the methodology used, or it could be due to bias. It would be an impossible task for decision makers who need a question answered to wade through literally decades of conflicting studies in order to come to the correct conclusion about what the evidence currently says. That is where reviews come in. Reviews will start with a question, find all of the research that addresses the question, assess not only the quality of the research itself but also, and importantly for our purposes, how well it answers the question and how much confidence the reviewers have that the resulting effect size will not change once more research is undertaken. The primary question asked in the latest Cochrane Review was – do e-cigarettes help people who smoke achieve long term abstinence from smoking?. The conclusion was a muted ‘yes’, with confidence in the accuracy of the estimates of the size of the effect being graded from low to very low. What this means is that the reviewers believe that with more research the effect size will change. In theory it could change in either direction. Both Cochrane Reviews on e-cigarettes found only two relevant randomised control trials and both were undertaken using now obsolete cigalike type devices.

Of course the effect size is going to change! Saying otherwise would be like testing a model T Ford for fuel efficiency and then assuming that result will apply to all cars forever more. There was absolutely nothing wrong with the two RCTs themselves, but they don’t tell us much about the effect that modern devices would have. At the time the review was written Cochrane had come across a further 15 ongoing RCTs which they say appear to be eligible for inclusion in future reviews. I wouldn’t mind betting there are more in the pipeline than that, although many could be excluded for various reasons. Let’s hope that the new studies incorporate factors missed so far such as improved nicotine delivery from modern tank systems, and study designs which take into account real world use patterns. Of course RCTs will never fully quantify the efficacy of e-cigarettes in real world use, but they’ll come close enough for those who need such answers, and the rest of us really don’t care.

So there you have it, next time you hear someone try to dismiss the Cochrane review by claiming its low quality you will know they are engaging in wibble. Take what they say and apply salt generously.

Who speaks for the vaper?*

Yesterday Simon Clark tweeted that he was going to be speaking on BBC Radio Oxford about vaping bans. He had been contacted by the BBC for comment. Simon is against bans and I trust him to make a good case against this one. I did react to his tweet with a sense of despair as once again a media outlet has contacted Forest about vaping. “Forest’s mission is to protect the interests of adults who choose to smoke or consume tobacco”. Rightly so but vapers don’t consume tobacco. It behoves the media to not colligate the two.

I meant no offence to Simon or Forest for that matter, they serve their cause well enough but rather I was wondering if the BBC had deliberately sought to bundle vaping with smoking or was it just laziness on their part. While Simon would defend both with equal vigor, the fact that it is Simon defending vapers rights is itself part of the problem.


Simon blogged about our exchange and shared his thought on it here; You’re welcome


“in my experience the vaping community has still to get its act together, media wise”

Harsh but possibly fair. I’m sure Simon knows how hard it is for part-time volunteers to break into the circle of contacts media have as ‘go to’ voices. Never mind the commitment required to maintain such status. Vapers advocates are not paid for doing so, they fund their own efforts and have to maintain jobs as well.

Also, what does he mean by “vaping advocates”? The tobacco control industry is full of them – ASH, Public Health England, Cancer Research, and so on.

This is what got me thinking! What do I mean?

I do some advocacy myself, this blog, some tweets and positive support of the The New Nicotine Alliance (UK) . It’s not much and not nearly enough but right now it’s all I as a consumer can do.

From the NNA’s about us; “We wish to see a mature public and organisational understanding of the potential of safer nicotine products for reducing cigarette smoking, including their safety and efficacy, and hence contribute to the reduction in cigarette smoking.” See the difference between this mission statement and Forests one?   Now I’m not criticising the NNA, its mission is different from Forests for a good reason. It is there to promote harm reduction. But that begs the question in the title of this piece. Who speaks for the vaper?

when it comes to defending vaping in ‘public’ places – including pubs, clubs, beaches, parks and other spaces, indoors and out – I don’t think anyone has Forest’s track record, and we have the cuttings, broadcasts and parliamentary submissions to prove it.

True but it’s more by default than anything else.If you are the one contacted for comment then you will have the track record.

We’re also the only consumer body that has consistently fought for choice on tobacco and emerging products such as e-cigarettes.

That, I think, gives us a certain credibility.

This is an exaggeration at best. Yes, you are the only one fighting for choice on tobacco products but that’s your job Simon, you certainly are not the only one fighting for choice on e-cigs, Snus or other emerging products. The NNA defends vigorously the rights of consumers of other nicotine delivery products. It engages with policy-makers and regulatory bodies, and comments on legislative and policy issues. It fully supports the right of smokers and others to make their own choices based on evidence.

The NNA is completely independent of commercial interests in relevant industries (e-cigarettes, tobacco, pharmaceutical companies, etc). It operates on a not-for-profit basis and is free from commercial bias. Our policies and public statements are evidence-based,

That, I think gives them some considerable credibility.  What you have Simon, is Profile!


But thanks and I hope you play a blinder on the wireless, we need all the help we can get. I’m just not sure being always represented by Forest is as helpful as you think it is.

*Yeah but at this stage, everyone has bowdlerized this iconic title so.. my turn.




The Long Game.

The WHO released the documents for the Convention of the Parties number 7. The COP is a little get together of all 180 signatories to the framework convention on tobacco control. They get together every two years and discuss tobacco control stuff. With 180 countries it must be like herding cats.

They are hyper paranoid about the tobacco industry finding out what they discuss, so they ban anyone and everyone who might be connected to the tobacco industry from attending. Last time they closed the doors, shut down wifi and kicked out all journalists from observing. This time, their paranoia has grown to the point where they are considering banning government representatives from the 180 countries from attending! It’s like they have something to hide!


Anyway, last time was the first time they looked at the issue of electronic cigarettes. Of course, they had to invent a scary acronym for what the rest of us just call E-Cigs and they adopted ENDS. Electronic.Nicotine.Delivery.Systems. Sounds broad enough and I’m sure they thought it would cover everything they felt needed to be covered.

Well, they sat and talked, listened to some sage counsel and still made a hames of it as far as e-cigs (or ends) are concerned. They wanted public use bans, advertising bans, bans on flavors and all sorts of tobacco control measures applied to what is not a tobacco product. I’m not sure what drove this, fear of tobacco industry taking over the market, fear of health risks or fear of nicotine becoming a hazard free consumer choice. Found this clue in the previous COP6 review.

Article 5.2(b) of the Convention commits Parties not only to preventing and reducing tobacco consumption and exposure to tobacco smoke but also to preventing and reducing nicotine addiction independently from its source. Therefore, while medicinal use of nicotine is a public health option under the treaty, recreational use is not.

Yeah, they don’t like it!

Snail Run Near The Finish Line

Anyway that was 2 years ago and science has moved on, the RSP report came out as did PHE’s review, the next COP, COP7 should reflect this advance. As they let us have a look at the report, I thought I give it a review to see what had changed.

Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS)

Well, that’s new! Electronic non-nicotine delivery systems? I guess ENDS wasn’t broad enough.  Now they have captured everything from e-cigs to the internet to voice mail, pretty comprehensive I’d call that.

This report builds on the last one without moving from the initial position of bans, bans and more bans, Oh, they added taxes this time. It’s spread over 33 points and I’m going to cover the main ones so this is going to be a long read. Sorry.

1 to 4. Introduction and explanation of terms. Fair enough!


If the great majority of tobacco smokers who are unable or unwilling to quit would switch without delay to using an alternative source of nicotine with lower health risks, and eventually stop using it, this would represent a significant contemporary public health achievement. This would only be the case if the recruitment of minors and non-smokers into the nicotine-dependent population is no higher than it is for smoking, and eventually decreases to zero

This is just factually wrong. It would be a significant public health achievement whether or not it eventually decreased to zero. To say otherwise is ideology and diminishes the huge impact smoking has on health in favor of implicating nicotine.

6;  Mentions heat not burn. I wonder if they will need another acronym next time?

7 to 11; Is about toxicants and contains this;

long-term use is expected to increase the risk of chronic obstructive pulmonary disease, lung cancer, and possibly cardiovascular disease as well as some other diseases also associated with smoking

Increase from what? the level caused by smoking? from zero which does not exist? There is no evidence at all that this is expected to happen. None. Nil. Zero. In fact, the expectation is ENDS would reduce the risk by 95%  Why isn’t this in this report? The only mention of the PHE report oddly enough is The magnitude of these risks is likely to be smaller than from tobacco smoke which is an understatement of the 95% less harmful estimate.

12;  Nothing more than an argument, that as we can find no evidence of harm there may be no method to find, it must exist. Or some weird logic they only understand.

13 14 and 15; Second-hand exposure, it’s not just air, therefore…ban it!

16 and 17; Claims no evidence they help smokers quit. I’m not sure this is relevant one way or another, e-cigs are not being marketed as cessation therapy in the main. One e-cig has been granted a licence as a cessation product but hasn’t come to market yet.


18 19 and 20; The Gateway! Given we hear so much about this it’s surprising it only gets 3 small paragraphs. No evidence they say but strong indications.Of course for this exercise they include nicotine use as the other side of the gate rather than smoking. Might that be because youth smoking rates are falling like a lead balloon in markets where e-cigs are available?

21; Advertizing and marketing. No real meat here, mostly speculation.

22; The big bad wolf! Tobacco industry involvement and the threat to the precious FCTC. What’s interesting is they recognise that both the TPD and the FDA regulations are a boon to the tobacco industry, they seem to view this as inevitable and best to just treat the whole thing as a tobacco plot in the first place. Siege mentality at work.

23 to 32; Regulatory options. “Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options:” because banning is the prefered option but some pesky vapers fought that and so we must respond with as strict a regime as possible.

a. Banning the sale and distribution of ENDS/ENNDS to minors;

b. Banning the possession of ENDS/ENNDS by minors;

c. Banning or restricting advertising, promotion and sponsorship of ENDS/ENNDS (see FCTC/COP/6/10 Rev.1);

d. Taxing ENDS/ENNDS at a level that makes the devices and e-liquids unaffordable to minors in order to deter its use in this age group. In parallel, combustible tobacco products should be taxed at a higher level than ENDS/ENNDS to deter initiation and reduce regression to smoking;

e. Banning or restricting the use of flavours that appeal to minors;

f. Regulating places, density and channels of sales; and

g. Taking measures to combat illicit trade in ENDS/ENNDS

Banning possession? That’s not even done for cigarettes or alcohol! Taxing ends/ennds and raising tobacco taxes to maintain the gap! A gap they say exists the other way earlier in this report! Banning flavors that appeal to minors. Which flavors exactly and what about the effect this has on uptake by adults? Channels of sale? I suppose they mean restricting to licenced tobacco vendors. Banning cross border and internet sales, you know the kind of stuff that gives the market to their sworn enemy the tobacco industry.

i. Testing heated and inhaled flavourants used in the e-liquids for safety, and banning or restricting the amount of those found to be of serious toxicological concern such as diacetyl, acetyl propionyl, cinnamaldehydes or benzaldehyde;

ii. Requiring the use of ingredients that are not a risk to health and are, when allowed, of the highest purity;

iii. Regulating electrical and fire safety standards of ENDS/ENNDS devices;

iv. Regulating the need for manufacturers to disclose product content to government; v. Regulating appropriate labelling of devices and e-liquids;

vi. Requiring manufacturers to monitor and report adverse effects; and

vii. Providing for the removal of products that do not comply with regulations.

This is all obvious stuff, the devil will be in the detail. No ii is interesting as they clearly state all ingredients pose a risk to health earlier in the report so I’m guessing they meant to say “Ban them”

i. Prohibiting by law the use of ENDS/ENNDS in indoor spaces or at least where smoking is not permitted;

ii. Requiring health warnings about potential health risks deriving from their use. Health warnings may additionally inform the public about the addictive nature of nicotine in ENDS; and

iii. Reducing the risk of accidental acute nicotine intoxication by a) requiring tamperevident/child resistant packaging for e-liquids and leak-proof containers for devices and e-liquids and b) limiting the nicotine concentration and total nicotine amount in devices and e-liquids.

More bans. The first one has no justification under any definition of public health. Though I have seen Ruth Malone try to shoehorn annoyance as a public health issue. The last, iii, is already standard industry practise and law in the EU and the US.

a. Prohibiting implicit or explicit claims about the effectiveness of ENDS/ENNDS as smoking cessation aids unless a specialized governmental agency has approved them;

b. Prohibiting implicit or explicit claims that ENDS/ENNDS are innocuous or that ENDS are not addictive; and

c. Prohibiting implicit or explicit claims about the comparative safety or addictiveness of ENDS/ENNDS with respect to any product unless these have been approved by a specialized governmental agency.

I have a real problem with C. E-cigs are prohibited from comparative risk claims unless a gov agency has approved them. What does this mean? That e cigs can not  quote the RCP report, that unless you apply for permission to quote PHE you can be prosecuted for telling the truth? TBH it sounds like guff stuck in to cover all bases.

a. Raising awareness about potential industry interference with Parties’ tobacco control policies;

b. Establishing measures to limit interactions with the industry and to ensure transparency in those interactions that do take place;

c. Rejecting partnerships with the industry;

d. Taking measures to prevent conflicts of interest for government officials and employees;

e. Requiring that information provided by the industry be transparent and accurate; f. Banning activities described as “socially responsible” by the industry, including but not limited to activities described as “corporate social responsibility”;

g. Refusing to give preferential treatment to industry; and

h. Treating State-owned industry in the same way as any other industry.

The real objective; public health and specifically tobacco related public health is our ball. No one else can play.

All of the above serving suggestions come with the preamble “Parties that have not banned the importation, sale, and distribution of ENDS/ENNDS may consider the following options;” Just in case they didn’t make it clear enough that banning them outright is the prefered option.

This is not going to be over soon, the WHO are playing a long game, slowly maneuvering the vaping industry under its remit by forcing regulation that hands the emerging industry to big tobacco, shifting goal posts to nicotine cessation and capturing nicotine as a medicinal produce. That last goal may be the end game they are playing for. Much more than the stated goal of “combating the tobacco epidemic”

Well, it got me thinking and not happy thoughts about unicorns!





Boys keep swinging!


I usually witter on about harm reduction but today I have sex on my mind. What brought that on you may ask? Oddly enough it was an article in Alive, an Irish catholic monthly magazine. It’s a free thing left in the porches of churches and in fairness, it isn’t that bad. It’s well laid out, legible and the writing is articulate enough to get its point across.

However the point it’s making is usually, how to phrase this?  Mental conservative catholicism that harkens back to the mythical 50’s. A time when the church ruled, women knew their place and all was well with the world. Of course, the reality was nothing like this apart from the church ruling us with an iron fist.

This tweet brought an article to my attention;

Men no longer know how to man up

Thanks Alan, you got me thinking!

The full thing is available online here;

Men no longer know how to man up Show yourself a man – part 1

Now I’m not opposed to anyone wondering about men and their role in society, it’s a common enough topic. From crisis in masculinity articles in broadsheets, to how to be a real man in click bait tabloids, everyone is having a go. So why shouldn’t Fr Brian McKevitt OP join in the fun, or me for that matter!! I’m only surmising Fr Brian is the author of the piece as it under the heading Editor’s Jottings and Fr Brian is the editor. If it’s someone else I apologise but you should have put your name to it.

This crisis receives little attention from politicians, scholars, the media or the Church,

Well as I’ve pointed out this issue receives a lot of attention from scholars and the media,I’m not sure politicians would help matters and the fact that Alive has the issue in its editorial section gives lie to the last claim. In fact here’s Cardinal Raymond Leo Burke speaking about it.

“Man-crisis” and what to do about it

But the family today is under attack as never before in history, due principally to the failure of men to be men, to man up to their responsibilities.

Oh ,so it’s men’s fault we don’t man up to our responsibilities. Better fix that. I wonder what these are so I can ‘man up’? It’s not specified in the article but there is some less than specific stuff about serious responsibilities for all the members, especially parents, to defend and foster love. To care and support the family. I suppose this is where we men are failing. Or is it? Exactly what is so different about men now from 100 years ago that causes a crisis in manning up? Damned if I can see it. Men have always been a mixture of good and bad, they range from misogynistic bullies to caring nurturing individuals who sacrifice for their families. Pretty much the same as women come to think of it, the difference is now a woman who gets stuck with the former example doesn’t have to put up with it. Good. The duds no longer can count on the support of society to remain duds, the crisis seems to be that the ones who never manned up are now cast adrift. About time.

But wait! It’s not men’s fault at all, it a plot!

It is engineered by the State and by many other agencies promoting an irrational individualistic ideology.

Huh? The state is engineering the destruction of the family and causing a crisis in masculinity which is being ignored? Is this for real? How is the state achieving this failure of men to be men, to man up to their responsibilities? Perhaps he means by facilitating women not to have to suffer what they must, to be able to pursue careers, to remain single if they choose, to marry whom they love.  Equality be damned, it’s all an evil plot to destroy the family. Unlike when women had to retire from work on marriage, couldn’t have a bank account in their own name, and ended up in Magdalen laundries. And why? What’s in it for them?

Would you ever cop on, man up and grow up!


Where’s the harm?

I’ve mentioned harm reduction before in the context of tobacco control. I’ve been wondering why it’s so low on the agenda and why when it’s mentioned at all, it seems to be only in relation to harm to public health. The reduction of harm to the user is assumed to cause harm to society in general. We have arguments against reduced risk products on the grounds that they will increase use and thereby increase the harm. It’s a position based on the notion that the harm of a product or activity is the best protection for society.

This begs two questions;

1. If the harm is reduced to the user, isn’t the harm also reduced to society?

It seems not; “to reduce the harm from drug use to the lowest level possible by … developing the skills of less dangerous drug use” can be perceived as condoning rather than condemning outright drug use. Indeed, a person might argue that the end result of condoning drug use might be an increase in drug use and ultimately drug related problems. There is also the suspicion that many of the fears associated with drug use are dispelled by harm reduction information strategies and these may have the unintended consequence of encouraging use among non-users.  This from a response to Clements, I., Cohen, J. & Kay, J., (1996) Taking Drugs Seriously 3, A Manual of Harm Minimising Education on Drugs. Healthwise Helpline Limited, Liverpool.

2. If this assumption is correct then why not increase the harm of products and activities to discourage anyone for engaging in them? End needle exchange and methadone substitution. Regulate inherently dangerous activities and products to increase the risk to  a risk of instant death! Where death isn’t possible, impose fines and/or prison sentences for the miscreants foolish enough not to abandon their wicked ways. Punish those who do obey but enable other to indulge.

 This got me thinking, where’s the harm?

If we accept that the harm of engaging in an activity is due to the nature of that activity, a risk intrinsic to whatever it is you do, then anything beyond that is an artificial and imposed harm. Standing outside in the rain to have a smoke, being subject to income disparity by taxation, facing prosecution for using cannabis, being ripped off or risking death by overdose or contamination for using drugs, catching infections  from dirty needles, prosecution or assault for involvement in the sex industry. All of these harms are imposed by society to protect the rest of society who don’t do any of these things from the risks inherent in doing the thing. You can see how illogical this is! If they are not doing it then they are at no risk and need no protection. The most obvious and easiest harms to remove are the ones imposed by the state. Decriminalisation is not just a sensible policy but the first and easiest step in reducing the harm from drug use. Once that is done we can then get on with product testing, education and health interventions.

The same for the sex industry, criminalising either the provider or the client is imposing harm where none existed. It doesn’t address the actual risks or harms and only adds to the misery of those suffering them.

It was the advent of  the AIDS crisis in the early 90’s which forced the Irish government to acknowledge a role for harm reduction in the area of treatment. IV drug users were identified as a “high-risk category” and so there was the discrete introduction of methadone maintenance, needle exchange schemes, all harm reduction measures designed to curb the transmission of the virus. All designed to reduce harm to the non-user while maintaining the state imposed harms to the actual user. Abstinence being the only officially approved harm reduction for users.

This kind of harm reduction is based on the assumption that others need protection from not just the harms of drugs but from the users of drugs. It imposes a stigmatisation and social exclusion which are harms in themselves.

This isn’t an alien concept, harm reduction is already being used to regulate all sorts of things. Promotion of condoms, use of crash helmets, safety belts or the provision of lifebuoys near rivers. It’s the basis for regulating the alcohol industry. The total failure of prohibition in the U.S. clearly demonstrated the value of reducing harm while accepting that abstinence will never be achieved .User’s face no social stigma for drinking, they don’t worry if their beer is safe to drink and they accept the limitations on use, by and large, because they recognise that it reduces harm.

Opposition to harm reduction is a moral position, not a pragmatic or evidence based position. Actually, strike that. It’s an immoral position based on prejudice! The fact that the first tentative adoption of harm reduction was a self-serving action only highlights this. If drug policy was genuinely based on morality then the desire would be first to help the user reduce the harm to him or herself. If morality is based on force, correction or prohibition then it’s immoral because it violates the first principle of a moral action. Do no harm.

If this short rant had piqued your interest in the concept of harm reduction, here are two more opinions. The first link is a must read. One of the best arguments for a far more liberal harm reduction approach which genuinely seeks to help the user.

If harm reduction is reduced to a list of WHO-prescribed interventions, avoiding the imperative for decriminalization, then harm reduction becomes part of the problem. It becomes a mechanism whereby autonomy is wrested from drug-using members of the community and placed in the hands of prescriptive, paternalistic medical structures.

The Harm Reduction Movement Needs to Rediscover Its Soul

This second one questions the Nordic Model of regulating the sex industry; (may be NSFW!)

“If you care about gender equality or poverty or migration or public health, then sex worker rights matter to you,”

The laws that sex workers really want



Have you stopped beating your wife?

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!

Workshop: A Tobacco Free Island

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.

Lukes presentation

The slides

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.


Public health matters….But!

This week Public Health England published their guidance on the “Use of e-cigarettes in public places and workplaces” A useful addition to the literature on vaping or another example of government interference in people’s lives? Go have a read of it;

Use of e-cigarettes in public places and workplaces Advice to inform evidence-based policy making

OK at first glance it seems quite good and then I read it again and I thought ‘this is brilliant, exactly what we needed’ However as the day wore on I started to feel a bit uneasy and I couldn’t put my finger on exactly what caused this unease. That got me thinking! (roll credits).

The guidance is boiled down to five points for quick scanning, obviously business are busy people who can’t be wasting their time reading long involved arguments which is why this policy guide is needed in the first place. For them, it’s far easier to just include e-cigs in all smoking bans.

1. Make clear the distinction between vaping and smoking

Well duh!, The fact that you need to state this is because, you, public health, spent the last 4 years confusing the two. OK now you have seen the light, that’s good.

2. Ensure policies are informed by the evidence on health risks to bystanders

The thing is, there is no evidence of health risk to users let alone bystanders. There is, however, a lot of junk science being peddled by the media and most of it coming from factions in public health.

3. Identify and manage risks of uptake by children and young people

So far there’s none so no need for any additional policies then! Still, I suppose some mention is necessary or the ‘think of the children’ brigade will be after you.

5. Support compliance with smokefree law and policies

Support compliance? Smokefree laws are enforced by the law, the only way to support compliance is to ban smoking and report transgressions. Are you suggesting smokers be encouraged to vape in places they can’t smoke? I’m all for that. I get the feeling that’s not what is intended here. Yep, that uneasy feeling is starting.

When e-cigs first came on the market they looked like cigarettes, they were marketed as cigarette replacements and they really didn’t work well as such. They did show potential and users started adjusting them. Within a few years the products on the market looked nothing like cigarettes, were being used to replace smoking rather than cigarettes (there is a difference!) and ‘e-cigs’ began to ‘work’. Vaping started to replace smoking permanently for millions of people.

So here we are, vapers see e-cigs as a new thing, they see themselves as former smokers, they don’t feel they deserve any of the stigma or restrictions smoking suffers. This set of guidelines goes a long way towards that but within limits. Limits based not on vaping but on smoking and the stigmatisation of smoking. Isn’t it only a matter of time before those limits are tightened until we get to a point where vaping is the new smoking and  restricted to designated areas? In fact this is built in to the guidelines, “Managers should indicate accurately where vaping is permitted or prohibited,“, ” Where a designated outdoor smoking area has been provided in a public place or workplace, vapers should be allowed to vape elsewhere“, “Approaches might include allowing vaping in a designated adults-only indoor area” and most telling of all ” Where a decision is taken to allow vaping in an enclosed place, policies could consider some simple etiquette guidelines for vapers, such as minimising the production of visible vapour“. The assumption being prohibition as the default and if not followed then vapour should be minimised.

Don’t get me wrong these guidelines are not just welcome but enthusiastically welcomed, without them, we are stuck with ad hoc bans. Instead, we will have some order from the chaos and bans will be justified on etiquette grounds and customer consideration and children’s needs. But I doubt these guidelines will prevent further bans or lead to the repeal of current ones. No, I don’t count Nottingham University Hospitals NHS Trust allowing vaping outdoors while banning outdoor smoking. That’s just the smoking ban from a few years ago.

There is a distinct lack of enthusiasm from public health about vaping, it’s had to be dragged kicking and screaming to the harm reduction table and it took overwhelming evidence to convince them vaping is a viable option for harm reduction. There’s an air of “let’s help the poor addicts, they are a lost cause, let’s allow these dinosaurs die in peace” in their approach. Which might miss the one great advantage vaping offers (apart from the whole not dying from lung cancer) it’s a better experience than smoking, it should be celebrated as such. That way it can not only help current smokers but future smokers. Unless you are assuming that there will be no smokers at some point in the future, you have to consider them as well.

Public health matters but so does the public’s right to enjoy habits you disapprove of!