Quote of the day - how bad science and unquestioning journalism might just kill people

From an excellent review of the awful, ignorant moral panic over vaping in the USA:

Journalists' failure to do so during debates over secondhand smoke got smokers banished to the fringes of social spaces. By repeating this failure in the debate over lower-risk competitors to the cigarette, journalists may get those smokers killed.

Absolutely. The UK is unusual, if not unique, in having adopted a largely evidence-based approach to vaping (it's much less harmful than smoking so smokers switching is a big health plus). In the USA we have a profoundly ignorant panic that is destroying what a month or so ago were legitimate businesses employing thousands and, as the quote above reminds us, probably killing tens of thousands of smokers who might otherwise have switched.

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Your caring, sharing NHS at its most cruel

I know the term 'health fascism' is pretty polemical and intended to shock. But the truth is that increasingly public health 'campaigners' (as the newspapers always call them) have created a culture around their obsessions that is unpleasant, officious and even cruel:

What happened I found out in stages - apparently someone saw me at the week-end refilling the vape from the 'sipped case' - and told them. This evening a nurse walked over to me me and said, 'what a sweet little teddy' and proceeded to play with him - 'Oh do you keep your pen in there, good heavens no its a vape'. It was so odd that I didn't twig at first. Well, I got the rules and regulations read to me in such a patronising tone of voice.

This dying woman has one small remaining pleasure removed because the rules - rules without any basis in health - don't allow it. As Dick Puddlecote points out this is a women "on a regime of intravenous Ketamine - the drug designed to stun a rampaging elephant - and Oxycodeine, but apparently nicotine is not to be tolerated." But it's worse - part of this torture is where nurses left the vape pen just out of this paralysed woman's reach.

We're told almost daily how NHS staff are wonderful and caring yet somehow we've reached a point where "as there wasn't evidence to prove that e-cigs were safe or unsafe, they were banned on health grounds" - for people in a hospice receiving palliative care for a terminal illness. Not only is this stupid but it is really cruel. So much for the caring, sharing NHS.

Since you asked, this is what I mean by health fascism.
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Vested interests will always use regulation to protect that interest

From Dick Puddlecote a shocking example of a private business using regulatory pressure to protect its private interests:

The website for Vype e-cigarettes www.govype.com, was seen on 13 March 2017. The home page of the website featured a carousel with four slides. Text on the first slide stated "VYPE PURPLE ePEN STARTER KIT +1 PACK OF PREMIUM CARTRIDGES. FOR £19.98*". Smaller text below stated "*ENDS TUESDAY 28th MARCH 2017. P&P CHARGES WHERE APPLICABLE". The text was next to images of the starter kit, and a link which stated "SHOP NOW>". Text on the fourth slide stated "BUY 5 GET 1 FREE. INCLUDES VYPE PEBBLE CARTRIDGES, ePEN CARTRIDGES & eLIQUID BOTTLES*. SHOP NOW>". On the web page for the Vype Pebble Starter Kit, text stated "The small and mighty Pebble".

This complaint - partly upheld by the Advertising Standards Authority - wasn't from a concerned member of the public or even some shocked anti-smoking campaign group but from Johnson & Johnson, manufacturers of nicorette and other no-tobacco nicotine delivery systems. They're straightforwardly nobbling their competitor with this complaint.

So when we're talking about regulations supposedly protecting health or safety, we should always ask for the independent evidence and should further ask who benefits - which private business - benefits. Johnson & Johnson along with other pharmaceuticals with very profitable nicotine products campaigned very hard to firstly get e-cigs banned, then to get them regulated as medicines and then to hobble their marketing and promotion. Not for reasons of public safety or health but purely and simply to protect their business from competition.

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Vaping in Bradford. Why the Council voted down a more liberal approach.

Last week Labour and Liberal Democrat councillors voted down a motion I submitted to Bradford Council calling for a 'vaping friendly city'. This motion set out how Public Health England and the Royal College of Physicians had described vaping as "at least 95%" safer than smoking and argued that we should be more positive about e-cigarettes as an effective aid to quitting smoking. The proposed resolution was to conduct a review of current policies with a view to being more open to vaping in public places.

Now the dust has settled I thought I'd share with you the main reasons given by those voting down the motion (other than the real reason for Labour's opposition - this was a Tory motion and we don't vote for Tory motions). This is from memory but I think captures the essence of the debate - supporters of vaping will be very familiar with the arguments.

1. "But 5% of something very harmful is still harmful"

2. "People don't like the smell of vaping - and what about asthmatics?"

3. "There isn't enough evidence that vaping isn't harmful."

4. "We've got used to people not smoking in offices, this is a step backwards."

5. "The flavours smell horrible and are targeted a children."

6. "Here's an opinion piece from the British Medical Journal that says vaping doesn't help people quit

7. "There's no evidence that liberalising rules on vaping encourages people to switch"

We then got three very specific arguments.

8. "It would confuse people because our neighbouring authorities have different policies."

9. "We don't have to lead, to fly the flag, all the time, we don't have to do this."

10. "Officers in public health* are too busy to conduct a review."

*Bradford spends best part of a million quid on smoking cessation.

And finally

11. "We should be talking about more important things for the District than vaping."

It was a pretty depressing episode. I've learnt that, even with a pretty modest motion asking that officers look at our approach to vaping, the controlling Labour group will vote stuff down - "Not-Invented-Here Syndrome" I call it and this combines with a knee-jerk tribalism ("must be a bad idea if the Tories are proposing it") to make it hard to make progress.

Where we go from here I'm not sure. Putting another motion to Council won't work and I'd already tried approaching public health and the council's HR department directly (they chose not to reply). We've made - and will continue to make - the case through the press. Maybe Bradford's vapers are happy to muddle through with a mish-mash of different attitudes towards what they do. And perhaps public health (and Labour councillors) are happy to conflate smoking and vaping because it suits their disdain for what seems like a decidedly working-class habit.

In the end any change will only come through the 20,000 or so Bradford vapers putting pressure on the Council to change. Right now I've gone as far as I can take it.

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Smoking cessation: it stopped being about health years ago

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In 2003 Hon Lik registered the patent for the first modern electronic cigarette since when millions of people across the world have stopped or significantly reduced their consumption of regular old-fashioned cancer-sticks. There is no doubt - really, there is no doubt - that this is one of the biggest public health boons ever. Instead of people having their lives cut short by using combustible cigarettes to get a hit of nicotine, they'll mostly be using a delivery system that's pretty near harmless - as harmless as getting a caffeine hit by pouring hot water over coffee beans.

The smoking cessation business (or most of it - there are a few notable exceptions) has spent almost every waking hour and bucket loads of research cash since Hon Lik registered that patent trying to discredit the electronic cigarette and the practice of vaping. Urged on by the pharmaceuticals industry and tacitly back by Big Tobacco these so-call smoking cessation folk have acted to protect their business interests - funding, jobs, research grants - rather than accept that vaping disrupted smoking by making it possible to enjoy the lift from nicotine without the health costs of smoking.

And these people refuse to accept the reality and are still throwing money at research into new smoking cessation devices:

Chemists at the University of Bristol have been awarded £930,000 from the Engineering and Physical Sciences Research Council (EPSRC) to develop potential new aids to help smokers stop smoking.

Professor Tim Gallagher, in collaboration with Professor Adrian Mulholland (School of Chemistry) and Dr Richard Sessions (School of Biochemistry), will use a combination of synthetic chemistry, computational modelling, structural biology and pharmacology to develop potential new smoking cessation agents.

I'm sure the science here is fascinating but do we really need to spend nearly £1 million of taxpayers money (especially in these tough times for public funding) on researching "potential new aids to help smokers stop smoking". That's 'potential' aids not actual aids that can be put on the market for smokers to use. What we'll have instead is some quite interesting chemistry (all those ligands and that partial agonism) but little practical health value. And all this at a time when there's a pretty damned effective aid to quitting that the same government funding this research wants to limit, stop from being effectively promoted and placed in the "we rather disapprove of this sort of thing" category of consumer goods.

As I say, smoking cessation stopped being about health years ago. Now it's more about preserving the jobs of smoking cessation advisors and the funding of researchers. The minute there was a breakthrough disruptive technology - one produced without government research funding and promoted successfully through a free market - the smoking cessation funding should have gone and the research investment directed into other areas of public health challenge. But the public health isn't about health at all really, is it?

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The new vaping regulations are wrong. We shouldn't introduce them next month.

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I could turn this post into something of a rant about the iniquity of the EU and all its works. After all the new vaping regulations are contained in the 2015 Tobacco Products Directive (TPD for short) steered through the European Parliament by Yorkshire MEP Linda McAven and then ignorantly - quite literally as she'd no idea what she was voting on - agreed to by the UK's Public Health Minister (then Anna Soubry MP) at the Council of Ministers. In the latter case after the amendments removing some of the anti-vaping provisions of the TPD were ignored by the European Commission in its recommendations to that Council.

But given there's a debate about our membership of the EU going on out there, I'm going to hold fire on all that for another post nearer the June 23 referendum date. Instead I think that the UK Government has sufficient grounds - evidential grounds - for saying to the European Commission and our EU partners that it would be a mistake to enact the regulations. Not only does the UK Government have the independent report produced by Public Health England that demonstrated how vaping is at least 95% less harmful than smoking but today we also have a comprehensive report from the Royal College of Physicians (RCP) building on this evidence:

The RCP report, published yesterday, acknowledged the need for proportionate regulation but said rules should not be allowed to significantly inhibit the development and use of harm-reduction products, such as e-cigarettes.

The RCP said the long-term negative effects from vaping were ‘unlikely to exceed 5% of the harm from smoking tobacco’.

The regulations under the TPD - bans on advertising, product strength limits, volume controls for e-liquids and an onerous product approval process - in effect put e-cigarettes into the same position as smoking with the result that smaller producers and many retailers of vaping products will simply close. Only the biggest producers and the e-cigarette brands owned by tobacco companies will be able to survive. Vaping is, in effect, denormalised in the same manner that public health has approached the control of smoking. It's true that vaping will still be cheaper (although the EU is discussing imposing taxes on vaping products) but it will no longer have a visible high street presence as a much safer alternative to smoking.

The Government should simply say to the EU that the evidence is that, while the TPD as a whole will benefit public health, it would be even more of a benefit if vaping was allowed to develop freely as an alternative to smoking. Indeed the Department for Health's own impact assessment says just this:

Its impact assessment (pdf) on EU rules to be enshrined in UK law also acknowledges that higher costs for e-cigarette manufactures could lead to price increases and reduction of choice for consumers, leading people to switch back to smoking, which public health experts regard as far more dangerous.

It recognises too that regulations might create new barriers for small- and medium-sized companies, a concern that comes as public health doctors warned of possible consequences from tobacco giants becoming more involved in making e-cigarettes.

The TPD effectively leaves the vaping market to be captured by large companies able to deal with the cost of approval and regulation, which amounts to capture by either or both of the pharmaceuticals industry or big tobacco companies (far be it from me to suggest that this might just explain the enormous investment from these two sectors in lobbying the EU, MEPs and Governments over the TPD). This is not in the interests of public health, small businesses trading legally now but unable to once the regulations arrive or the two-and-a-half million former smokers now getting pleasure from vaping.

I hold out little hope here. But it would be a sensible government that saw when something is wrong and changed what it is doing accordingly.

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Quote of the day - "Just get off our backs"

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From Clive Bates (via Dick Puddlecote):

"You told us to quit smoking. You taxed the pants off us; you've bullied us with your public information campaigns; you've racked up the stigma that we felt. You've tried to stop us using these products wherever we can. You've hit us with massive societal disapproval. Tobacco companies haven't done that, government and public health have done that.

So we've done the right thing. We've got off smoking; we've protected our health; we produce a vapour which doesn't harm anyone; most people aren't troubled by it.

Just leave us alone! Just get off our backs!"

Absolutely right.

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Much public health campaigning is about snobbery not concern for people's wellbeing

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Whenever you read a piece - most typically in The Guardian or Independent although sometimes these days in any media going - that talks about some or other 'public health crisis', the focus is always on things that people other than the writer is consuming. The problem with lager, fags and junk food isn't merely their supposed unhealthiness but that the sort of person who reads a broadsheet newspaper and goes to dinner parties with doctors doesn't consume these things. Indeed many of these writers only see these bad and unhealthy things being used - I'm guessing 'used' is the right word here since the stigma is akin to the taking of drugs - in the parts of society they only frequent vicariously via TV and magazines.

I'm reminded that this casual distaste for other people's choices makes little sense with food - there's no real calorific difference between a Big Mac and the sort of hand-formed, artisan burgers our Guardian reader enjoys on his night out. And let's not poke too closely into the sugar question - suffice it to note that uber-hypocrite Jamie Oliver peddles sugar-laden cakes and puddings in his books, newspaper columns and TV shows while ranting and raving about how much sugar there is in a can of coke.

All of which brings me to the matter of vaping, a practice that is, compared to the other snobbishly rejected bad habits, pretty benign and harmless - at least if we are to take the advice of Public Health England and the National Centre for Smoking Cessation and Training (NCSCT):

We begin by acknowledging that e-cigarettes are considerably safer than smoking cigarettes, are popular with smokers and that they have a role to play in reducing smoking rates

By considerably safer we mean at least 95% less harmful than smoking cigarettes - at least according to PHE. So what's the problem with vaping? Why are those public health officials in every town not rushing to support people switching from fags to vaping? And why aren't places becoming vape friendly, welcoming former smokers back into the warmth of indoors?

Partly the answer lies in a long puritanical campaign conducted - without any evidence - by a handful of well-connected academics and lobbyists. Partly, it's a classic case of 'not invented here syndrome' as public health campaigners and their friends in the pharmaceuticals business fail in believing that a consumer market can resolve the smoking'problem' that they've tried and failed to deal with over decades. But mostly it's just rank snobbery - vaping is something that fat, ugly working class people do. Even when the user is anything but:

It jarred against his crisp tux and stylish stubble, but there was no mistaking the object in Leonardo DiCaprio’s hand at the SAG Awards in January. That was a vape pen, which turns liquid nicotine into vapour.

When photos of the incongruous image began to emerge, the mockery was swift and slightly delirious. “That photo of Leonardo DiCaprio vaping at the awards dinner makes it easier to watch him die at the end of Titanic. #DoucheFlute,” one Twitter user wrote.

The scorn seemed baffling. Why would something designed to help smokers quit incur the snarky wrath of the Internet hordes? But while public-health experts continue to debate the risks and benefits of such smoking-cessation aids – e-cigarettes, as most people know them – cultural critics have reached a decisive verdict: Vaping is incredibly uncool.

The article in question goes on to describe the vaping community as "united in its tackiness" throwing out negative descriptions like this:

It is “vaped” with a gesture that looks disarmingly like a baby drinking its bottle: clutched with the full hand and suckled with pursed lips from a kind of nib.

The journalist in question then runs a quick canter round the usual lies and misinformation about vaping - noting the PHE research but then gleefully celebrating the fact that politicians are ignoring all this, buying the myth of a gateway effect and banning vaping indoors. What's driving this isn't that any of these politicians know whether vaping is dangerous but rather that it's simpler to whack on a ban knowing that those vaping - Leonardo Di Caprio aside - are a bunch of low life losers who are better kept outside.

Vaping is lumped in the same box as cheap kebabs, cans of premium strength lager, fizzy pop and salty corn snacks plus the evilest of evils itself, smoking. Instead of celebrating that Di Caprio has joined millions of others in taking up vaping to reduce harm and quit smoking our health reporters, so-called public health experts put on their finest sneer, peer down their upturned noses and wave away the vape as another distasteful lower class habit to be despised.

Public health campaigns remain unrelentingly snobbish - from forcing children to eat undernourishing salads rather than pies and puddings to clipboard wielding officials lecturing fried chicken shops on reducing salt and sugar, the whole sorry mess is about promoting an approved set of behaviours onto everybody. With the result being a passionless diet of tasteless low salt and sugar free food, an almost total abstinence from booze, the complete rejection of smoking and a preference for giving people dangerous mood altering drugs rather than supporting vaping.

If public health campaigners really cared about people's wellbeing they'd ask why it is that poor people die younger. They'd wonder why the single mum overeats, the unemployed twenty-something smokes and the old soldier drinks rather than simply trying to nudge them out of these habits with the policy equivalent of a baseball bat. But these public health fanatics don't ask these questions, they just ban stuff, control stuff, lecture, nanny and fuss. Public health campaigning isn't about health, it's about the snobbish promotion of a lifestyle set by passionless middle-class puritans.

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So ads for vaping don't 'normalise' smoking - no surprise (except to nannying fussbuckets)

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We know that the public health fraternity don't know the first thing about advertising, let alone understand how it works. Despite having assortments of higher degrees, the typical public health 'expert' still holds to the 'if advertising doesn't work, why do business advertise' line that's popular amongst thirteen-year-olds and sociology professors (except the latter will add the word 'neoliberalism' into their ignorant statement). Of course the rest of us know that advertising works by promoting the brand rather than the category. We also know that advertising of brands in one category absolutely doesn't promote the use of a different, competing category.

The latest study into ecig and vaping advertising confirms all this and is reported here (although the writer seems also not to understand that ads promote brands not categories):

The major study finding was that neither the flavored nor non-flavored e-cigarette advertisements affected the appeal of smoking to youth. This includes advertisements for e-cigarettes with candy flavors like bubble gum or chocolate. Instead, the study found that flavored e-cigarette advertisements affect youths' interest in trying and buying electronic cigarettes.

Importantly, the study also found no effect of exposure to e-cigarette advertisements on smoking susceptibility or the perceived harm of cigarettes.

The study concluded that: "Exposure to adverts for e-cigarettes does not seem to increase the appeal of tobacco smoking in children."

And, as the author then observes:

Advertising for a product that is being marketed as a more appealing alternative to a different product is going to increase the appeal of that product, not the inferior product. It also makes sense that e-cigarette advertising does not undermine youth's appreciation of the severe hazards of smoking. If anything, one might expect that e-cigarette marketing helps to reinforce the public's understanding of the hazards of smoking, since e-cigarettes are being presented as a favorable alternative to cigarettes.

Even the thirteen-year-olds will get this, I suspect. Will the nannying fussbuckets?

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The whole point about vaping and harm reduction

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So we're sat in a cafe in Bradford having something to eat. Outside the cafe there's a little gathering, about ten or twelve young people - boys and girls - aged 14 or 15. They're behaving exactly like you'd expect young people this age to behave - joshing with each other, lots of braggadocio from the boys, preening and giggling from the girls. All pretty normal and almost certainly a bunch of nice kids.

And three or four of them were vaping.

Now before you get all shocked, imagine the scene a few years ago. A dozen working class fifteen year olds in Bradford away from parents in the City centre - three or four of them would have been smoking good old-fashioned cigarettes. Instead they're vaping - doing something that Public Health England tell us is at least 95% safer than smoking.

It may be that you'd prefer these young people to do nothing - no smoking, no vaping. And maybe you're right in your preference. But if they're going to do something surely it's better they choose the least harmful option? Just like I was back in the 1970s, the young people are doing the naughty thing they're told not to do - in my case it led to being a heavy smoker for thirty years. For these young people their choice means they won't have the coughs, the shortness of breath and the massive risk of lung or throat cancer that I had.

Which is why it's very stupid to try and make vapers and vaping equivalent to smoking.

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In which the medical profession reminds us how monumentally stupid it is

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Seriously these doctors are utterly ignorant, they have not the first conception of human behaviour:

Norway's biggest medical organisation wants to ban the sale of cigarettes to adults.

In a drive towards a smoke-free society by 2035, the Norwegian Medical Association (NMA) is pressing the government to back its proposal for a ban on tobacco sales to citizens born after the year 2000.

What could go wrong here? Right now it's anyone younger than 16 which I'm guess means they can't buy fags anyway. They do however have friends who are 17 and can buy fags. And since the stupid doctors don't intend to ban possession of cigarettes, this secondary market (doubtless a pretty profitable one) still exists and won't go away until the last of those 17 year olds has died in about eighty years time. All this, of course, is without the capacity of Norwegians to pop to Sweden, Denmark, Germany, Finland, the Baltic States from where they can bring back - perfectly legally - loads of cigarettes.

Fortunately Norway has some politicians with a modicum of common sense:

Yet despite the NMA's hopes, health spokespeople for the Conservative, Labour, Centre and Christian Democrats parties in the country told Aftenposten the idea was not currently feasible.

Indeed the idea will never be feasible. In other news teen smoking in most places - including Norway and the UK - is at its lowest ever level. Something that's down to vaping and nothing to do with public health at all. Not that the health fascists and nannying fussbuckets will ever admit to this.

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"The days of the traditional cigarette are numbered" - but only if we let vaping succeed

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The e-cig - vaping - is a game changer. Here's the the senior tobacco analyst at Euromonitor:

“Up until now there has been no direct competition for cigarettes in a meaningful sense, and nicotine replacement therapies were certainly not providing that,” said Mr MacGuill. “The days of the traditional cigarette are numbered – the only question is how long that process will take – and e-cigarettes have the potential to drastically shorten the shelf life of traditional tobacco products.”

See that statement - the end of the cigarette is coming and not because of traditional tobacco control and prohibition tactics but because someone's created an effective, safe and pleasant way to get a hit of nicotine.

And it's no surprise that those whose livelihoods depend on the cigarette - the public health industry, academics in assorted centres for tobacco research as such like, plus Big Tobacco itself - are bothered. Vaping has pushed aside the ineffective (and unpleasant - I speak from experience here) nicotine replacement products like gum, spray and patches.

Let's hope that those dumb politicians don't let the pharmaceutical industry and its lackeys - keen to protect their lucrative market - don't prevent vaping achieving what it promises: the death of the cigarette.
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Quote of the day - from ASH on vaping and renormalising smoking

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This just about sums up the evidence on vaping and renormalising smoking - the biggest stick used to beat up on vapers:

"There are people in the public health community who are obsessed by e-cigarettes. This idea that it renormalizes smoking is absolute bullshit. There is no evidence so far that it is a gateway into smoking for young people."

And this quote isn't from a pro-vaping lobby group but from Deborah Arnott, Chief Executive of Action on Smoking and Health - ASH - the granddaddy of anti-smoking groups.

This fact hasn't stopped councils, hospitals, universities, pub chains and a host of other places from banning the use of e-cigs:

While the university recognizes that these may be useful aids to those wishing to give up smoking, it has taken the view that e-cigarettes could undermine the policy of banning smoking in the work place as it gives the impression of normalising smoking in the work place. (Head of health and safety in the human resources division at Manchester Metropolitan University, Chris Bolam)

The Trust has taken the decision to not include e-cigarettes as part of our approach to support abstaining. The decision has been taken as there is currently insufficient evidence about their impact on health or risks associated with their usage. (Guys & St Thomas Hospital)

We do not allow the use of electronic cigarettes either. They are difficult for you the Managers to police and it would be the Managers as well as the Brewery who would be fined if persons were caught smoking the real thing (Humprey Smith, Director, Sam Smiths Brewery)

I could continue with hundreds of other pathetic, mealy-mouthed excuses for banning e-cigs - organisations from Alton Towers and Weatherspoons through to the Association of Conservative Clubs and Starbucks have all taken the decision to stop you vaping on their premises. Mostly the excuses given are one (or more than one of the following):

1. The WHO (or BMA or some other bunch of fussbuckets) has said we 'don't know enough about the health risks'

2. It looks like smoking and someone might light up a real cigarette meaning we get fined for breaking the smoking ban

3. It looks like smoking which makes smoking look normal and we have children as customers

The comment from ASH's boss should give the lie to all of these excuses. What would be good would be for some of these public health sorts to start telling premises that they should allow vaping inside rather than hiding behind the supposedly blazing row in their profession.

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Public health campaigners must want smokers to die

You've all seen the news reports about the Welsh government's proposed ban on using e-cigs in enclosed public places - the same places where smoking is banned. This proposal is another small piece in the seemingly relentless barrage of misleading - downright lies in many cases - misleading messages from people who claim concern about public health. On the Welsh ban, Chris Snowdon sums it all up:

The last few years have seen an extraordinarily dishonest campaign of misinformation against e-cigarettes that is as bad as anything I have seen from the ‘public health’ lobby. There has been a concerted effort to portray e-cigarettes as a ‘gateway’ to tobacco, despite all the evidence showing that they are a gateway from tobacco. They have been accused of ‘renormalising’ smoking without a scintilla of evidence. Misleading research has led to numerous unfounded scare stories in the press. Newspaper columnists have written ridiculous articles without doing the most basic fact-checking. Senior medics have explicitly told the public that e-cigarettes are no safer than real cigarettes. At the same time, ordinary vapers who never had any intention of becoming campaigners – and, indeed, are not campaigners – have been accused of being shills for e-cigarette and/or tobacco companies for doing no more than trying to put the record straight.

I have seen this attitude live - Bradford Council enacted a ban on new fast food takeaways close to schools despite there being no evidence to support their proposed ban and despite the Director of Public Health telling the Executive that the proposals would not make any difference. And I have seen other organisations - from the Association of Conservative Clubs and Wetherspoons through to just about every transport provider - using the British Medical Association's anti-vaping position as justification for their own ban.

These organisations - many of them funded by the producers of pharmaceutical nicotine - have set about denormalising vaping, telling people who quit smoking or cut down smoking through using e-cigs that they are just as bad as the smokers and must stand outside in the rain, wind and traffic pollution. Quit or die is the message - and this means that die is the choice made, for all sorts of reasons, by the smoker.

“This is not an area in which you should wait for proof that harm has conclusively happened. We need to take action now to prevent the possibility of harm.”

Read that statement from the Welsh health minister. Read it again - he's saying that he wants the ban because there might be the possibility of harm. The possibility of harm from water vapour. This isn't a public health argument, it's a "we hate you because you're a smoker" argument. Just as the passing of rules to ban fast food is the result of a squeamish "eurggh, all that greasy, smelly food that common people eat" attitude. Plus the argument for 'minimum unit pricing' for booze - "we won't pay extra for our nice New Zealand sauvignon blanc but that smelly man in the Tesco Express will pay more for his disgusting cheap cider."

Today's public health campaigns aren't about health, they're about values. The imposition of a New Puritan attitude to pleasure - an attitude wrapped up in fake science about dopamine and addiction - where only approved pleasures are allowed. And the assertion that everything in our lives must have a purpose, no longer the glorification of god but rather the search for eternal life here on earth. The option of choosing a pleasure now knowing it may have a health consequence is not to be allowed. Above all the loud, brash, public consumption of pleasure - especially the booze, fags and burgers regular folk like to consume - is to be discouraged if not actually banned.

Vaping is a harmless pastime. Better still it's getting people to stop smoking or cut down smoking. But public health folk don't like vaping because it's not promoted by smart men from a pharma company but by a bloke with tattoos and a beer gut in a cheap shop on Yorkshire Street in Oldham.These public health people are commissioning 'smoking cessation' activities, holding meetings to discuss anti-smoking strategies - and pretending that e-cigs don't exist or worse that they're the latest evil plot from Big Tobacco.

When I started to look at public health, I believed that it was a force for good and that the people could be persuaded by evidence and the realities of life for people (especially people in our poorest communities). Sadly I've not seen this but rather an ideological commitment to undermining the freely made choices people make simply because they might be "unhealthy". And the attack on vaping encapsulates the problem - there is no evidence, no justification for the ban but they proceed with it because they disapprove of vaping.

I can only conclude, as many others have done, that public health campaigners must want smokers to die.
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On our relationship with public health...

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In an excellent piece on vaping and e-cigs, Clive Bates describes our relationship with public health - or rather public health's relationship with us the public:

They are the ‘public’ in public health. They should be a matter of professional interest to you.  In your profession,  you need to understand them and why they do what they do, in order to make professional public health judgements. You need to do this with high standards of professional conduct and to approach them with humility and empathy. You probably have something to learn and you might even get to understand what inspires them. But they have no similar obligation to you. They have other jobs, other lives and no professional need to understand you or engage with you. If you think “there is a lot of mistrust & misunderstanding on both sides” that is your problem, not their problem.   Their interest in you, if any, is that you might spoil what they are doing, that you are making provocative or unfounded remarks about them or what they do, or you are dismissing their experience as mere anecdote.

I do feel that this fact about relationships is a lesson for public servants everywhere and especially those in public health who seem to believe they have some sort of duty to remove our rights to choose.

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In which I help NHS England with the answers to questions about eicigs

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NHS England seem to be having some difficulty answering questions about e-cigs. Their latest effort is described as (thanks to Red Head Full of Steam):

KSS REAG (Respiratory Expert Advisory Group) meeting we had a very interesting discussion about e-cigarettes, the pros and the cons and potential uses, to try to form a consensus on where we stood as clinicians regarding e-cigarettes and their use

The questions they wanted to answer are below. To help them, I've provided the pretty definitive answers. So now you know NHS England, just get on with it!

1. Are e-cigarettes a safer alternative to smoking?  Answer: Yes

2. Should we be encouraging their use to aid quitting?  Answer: Yes

3. Are e-cigarette users counted as smokers?  Answer: No

4. Should e-cigarettes be banned on Smokefree sites? Answer: No

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Plain packs, e-cig bans and the triumph of ignorance

Today marks the publication of the Chantler Review into standardised packaging for cigarettes, which follows the proposal from the Welsh government to ban the use of electronic cigarettes in enclosed public spaces. I haven't read the whole of Chantler's review but it's summary contains the observation that:

There is very strong evidence that exposure to tobacco advertising and promotion increases the likelihood of children taking up smoking. 

We know that advertising does not act to raise demand both generally and specifically for products such as cigarettes. So I have to assume that the 'evidence' relied on by Chantler is primarily the qualitative studies undertaken by tobacco control researchers that essentially show how children prefer pretty colours to drab colours. This may be true but there's a leap from 'I like pink' to 'I'll start smoking because I like the pink pack' that simply doesn't have evidential support.

Chris Snowden points out that Chantler finds only a 'moderate' impact on uptake - something that would be very difficult to prove one way or another especially since advertising (even where it is still permitted) has only a marginal impact on the decision of a person to experiment with smoking. More importantly Chantler says that this impact will only be realised 'over time' creating more vagueness and imprecision. I remain unconvinced that this is the best option for public intervention if our aim is either (or both) to reduce levels of smoking adoption or increase rates of smoking cessation.

Indeed, if the evidence is right that it is the person's environment (do parents, other family members and peers smoke) that plays the dominant role in the decision to experiment with smoking then the emphasis should be on smoking cessation rather than smoking adoption. And this brings us to the proposal in Wales to apply the same restrictions to using electronic cigarettes as apply to smoking tobacco.

The Welsh health minister, Mark Drakeford, said officials were considering a ban amid concerns that the products could "re-normalise" the use of conventional cigarettes.

He said there were also concerns that their spread could undermine the ban on tobacco smoking in enclosed public spaces, making it more difficult to enforce.

This is a truly egregious proposal since we know that electronic cigarettes are widely adopted by smokers to either quit or reduce their use of tobacco and that they eliminate nearly all the personal as well as all the environmental risks associated with smoking tobacco. Worse still, the argument made here contradicts the rationale for the smoking ban - protecting the health of others in the smoking environment.

Since we want fewer smokers then we should be supporting the adoption of electronic cigarettes by current smokers. Not just to benefit the health of those smokers but to reduce the probability of their children, brothers, sisters and friends taking up the habit. By seeking to denormalise electronic cigarettes, the Welsh government is describing the devices as no different from tobacco with the result that children are as likely to adopt the latter as the former. Plus, of course, increasing the likelihood that the vaper will switch back to tobacco - a point succinctly put by Tim Stanley:

Force me to stand outside and I’ll calculate that I may as well go back to the Marlboro Lights.

Although these proposals are filled with analysis and wrapped up in stuff that looks like science, they are at best selective and at worst simply ignorant. In the case of packaging, the review relies on studies by non-marketers working in tobacco control research and completely ignores the substantial body of research evidence on the role and effectiveness of brand advertising. And for electronic cigarettes, the assumption is that they will act as some sort of gateway for tobacco rather than (as the evidence suggests) quite the reverse.

It does seem that what we have here isn't an example of good evidence-based policy but rather a victory for anti-smoking obsession and a triumph of ignorance.

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Health Fascism - the new normal for public health

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Today marks a new low - we've got used to the endless dribble of health scare stories in the media but there has been a shift. Where response was once left up to our judgement - if the Daily Mail told us some bloke in a white coat had found that bacon causes cancer we were left with a choice of whether to ignore his advice. Now though, officialdom throws out misinformation, scares and exaggeration in order to prosecute their philosophy - I've called them nannying fussbuckets for some while now but this no longer fits, it's too friendly, too cuddly.

These people are fascists. Health Fascists.

Here's today's selection of their health fascism:

The winner is Dame Sally Davies, Chief Medical Officer with another demand for sugar taxes based on the complete fiction that "overweight is seen as the norm". Perhaps she can explain that to this woman who was told she was 'obese' by Dame Sally's cohorts.

Not content with talking rubbish about obesity, Dame Sally then launched into an idiotic attack on soap operas. Apparently there's too much drinking:

Hard-drinking soap characters offer an "irresponsible" portrayal of excessive alcohol consumption, according to the Chief Medical Officer for England

Elsewhere we've got:

The doctor who thinks e-cigarettes are like methadone. Seriously.

Or the people who want to ban cigarettes for everyone born after 2000 - which means come the end of this decade some adults can buy fags and some can't. These people are barking mad.

Still we can rely on academia to provide some bad research. Like that showing e-cigs don't aid quitting.

Plus public health people complaining because Council's have directed public health spending into things like reducing road accidents, improving air quality, reducing excess winter deaths in the elderly and improving food safety education or enforcement. Aren't all these things actually public health? It appears the doctors don't think so.

Health fascism everywhere you look. For public health it's the new normal.

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Why we shouldn't be banning vaping

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Via the estimable Dick Puddlecote comes the report on this piece of research:

Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review

The authors look at 97 studies examining the health impacts of vaping. And what do they find:

Currently available evidence indicates that electronic cigarettes are by far a less harmful alternative to smoking and significant health benefits are expected in smokers who switch from tobacco to electronic cigarettes. Research will help make electronic cigarettes more effective as smoking substitutes and will better define and further reduce residual risks from use to as low as possible, by establishing appropriate quality control and standards. 

Note that folks - "significant health benefits are expected in smokers who switch". We should be encouraging these things not trying to ban them or ban their promotion.

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An e-cig tale from Bradford Councillor Imran Khan - sometimes I despair

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I was in the local paper being quoted about e-cigs. This followed the awful decision of West Yorkshire Metro to ban vaping on buses and in bus stations. I'd written a letter - here's an excerpt:

Forcing e-cigarette users out into the cold and wet with regular smokers is a stupid idea and one that will merely encourage people to go back to smoking regular – and much more dangerous – cigarettes.

Perhaps Metro and its partners would care to explain how they justify this ban, especially since there is no secondary or sidestream smoke risk and the devices are acting to reduce the users harm from smoking.

I suspect the argument will be as crass as “well it looks like smoking”, which is frankly pathetic. 

This prompted a little article where Bradford Councillor, Imran Hussein, a vaper, said this:

 “I think there’s a big difference between traditional smoking and vaping. If there wasn’t, there would be no need for me to use an e-cigarette. But it’s a matter of public perception.

“I think the sight of adults vaping could encourage children to try cigarettes. If they see vaping as not harmful, it could be the first step to smoking.”

The man is an idiot - doesn't he realise that it's the very similarity with smoking that makes vaping work? And am I the only one who finds the who "it looks like smoking, it must be bad" argument a little tiresome? There is precisely no evidence to suggest that e-cigs are dangerous to health but the BMA and others among the health fascists persist in pretending that somehow these things are scary.

E-cigs are saving lives. This is really all you need to know about them. Millions of people have switched from lethal cigarettes to take up vaping. And that's millions of people less likely to be in the lung cancer and heart attack queue. Isn't that what we want?

Sometimes I despair

Update: The eagle-eyed will spot I made an error - got the wrong Imran! The Council Deputy Leader is a vaper (so an easy mistake) and is called Imran. Nothing much to add except 'oops sorry'!

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