An exquisite joy

Well.

After a night on the town (see declaration of interest below) I returned to read this piece of utter crud published in, of all places, the BMJ. It’s a longish read with some superb quotes from Deborah Arnott of ASH in particular, but is ultimately possibly the most delusional load of tripe I’ve ever had the misfortune to read (and that includes the combined efforts of the Daily Fail and the Mirror). If you can’t be bothered to read it I’ll summarise: MHRA and NICE’s tentative acceptance of safer nicotine products as a strategy to reduce the harm done by smoking tobacco is a big tobacco conspiracy perpetrated by ASH, CRUK, NNA and the British Heart Foundation, who have been infiltrated by evil mastermind Professor Gerry Stimson, who once went to a Christmas party at BAT HQ. You couldn’t make it up..well Gournall did.

First off the blocks in reply was Professor Robert West, whose delicately barbed response is a pleasure to read. It’s not long so I’ll reproduce it in full here:

“Unfortunately this is a poorly researched article which misses the point. There are four main parties involved in this debate. 1) Public health activists and bodies who are not experts in the field of tobacco control, who misunderstand what is relatively complex evidence and present their misunderstandings to the wider community. 2) Vapers, many of whom have no financial conflict of interest but feel passionately that a solution to the problem of stopping smoking that they have found should not be vilified or discouraged through mis-representation of the evidence. 3) Vested interest, including the tobacco industry, and their supporters. 4) Tobacco researchers and NGOs that have been working tirelessly in the field for decades and have achieved the considerable amount of progress made thus far but believe on the basis of a careful analysis of the evidence that a comprehensive tobacco control strategy is the way forward, including possibly appropriate regulation of e-cigarettes of the kind currently in force in England. ASH, CRUK, the British Heart Foundation, the UK Centre for Tobacco Control Studies, and Public Health England fall into this fourth group – a group that has no truck whatsoever with the idea of engaging with the tobacco industry. Readers may judge for themselves which group the BMA, the Faculty of Public Health and other high profile commentators fall into.”

http://www.rjwest.co.uk/blog.php

Unfortunately Robert’s criticism is so subtle that it’ll probably be wasted on its intended targets, but was delicious all the same. The beauty of this latest debacle however, is that it displays the raw desperation of the anti camp – they have nothing left bar defamatory ad hominem attacks. We’re winning troops, they just failed the scream test.

So to that declaration of interest.

Last night I joined my good friend Dick Puddlecote at the Forest ‘Smoke on the Water’ event – a boat trip along the Thames. I received 3 free Mojitos – total value approximately £18, but spent more than £20 on overpriced Peroni. I make that at least £2 the pro smoker lobby owes me.

However, that was £20 well spent. I got to while away the evening with a group of fun loving free thinkers, including a guy who makes his own wine from home grown tobacco leaves “just to piss off the puritans” and a lady who stuffs dead rats and dresses them in rat sized jumpers for a hobby. It was an exquisite joy.

The Inhumanity of NHS Smoking Bans

I think we can all understand why it is not appropriate to allow smoking inside a regular hospital. I can just about remember the days when many wards had a ‘TV room’ at one end, in which smoking was permitted. The smell of cigarette smoke would permeate the ward and the surrounding corridors. Of course in those days no one really batted an eyelid but times have changed – non smokers, and especially those who may be sick and immobile, expect to be protected from breathing other people’s smoke, regardless of whether doing so is harmful or not.

More recently, many NHS trusts acting on NICE guidance have banned smoking entirely from the grounds, including the pulling down of smoking shelters. There is absolutely no evidence at all that second hand smoke outside is harmful to anyone, and so their reasoning seems to be that hospitals are healthcare establishments and as such must not do anything to encourage smoking and indeed, should do what they can to discourage it.

Let’s be clear here, no one goes to hospital out of choice. People are there because they are sick, or they are visiting a loved one who is sick. It can be an extremely stressful time for all concerned. Additionally, the vast majority of in-patients are not there even semi permanently – they’re there for no more than a few hours, days or weeks. Is that really the best time to try to force someone to give up smoking?

The NHS smoking bans are already resulting in people in pyjamas and dressing gowns standing outside hospitals holding drips. If the rules were enforceable this would see these people out by roadsides, cold and vulnerable and a long way from help if it were needed. What isn’t as visible are those people who will avoid treatment in hospital because of the bans and who may therefore be putting their health at further risk.

A far more pragmatic solution would be for the NHS to recognise that giving up smoking is not something which can be forced on people, and especially not at a time when they may have far greater things to worry about. Quitting smoking is a decision which people must come to themselves, and then help can be offered. It’s not as if smokers are unaware of the health risks of smoking. Smoking shelters placed appropriately within hospital grounds can offer people a safe place in which to smoke, whilst ensuring that smoke doesn’t enter the building via doorways or windows. Wallpaper them with NRT adverts if you must, at least you have a captive target audience.

The crux of the problem with the NHS ban is that it promotes the ideology of anti smoking above the comfort and safety of patients who smoke. Of course it is always better healthwise that someone gives up smoking as soon as possible – but the best way to help them do so is not to stigmatise them, or to place them in situations where their overall health and well being may be in danger. That is not what a caring health service does.

Simon Clark is getting on my tits.

Ok, firstly, to give him his due, Simon Clark, director of Forest, has been a good advocate for e-cigarettes. I’m not sure I can think of a single thing he has said about them with which I could disagree. Forest explains that it advocates for e-cigarettes because many smokers use them and they wish to represent the interests of those consumers. That’s great, no problem there.

The reason that Simon is getting on my tits is his complete failure to understand vapers. Not smokers who vape, vapers. Just like Simon Chapman, Martin McKee and other assorted cronies he seems to think that vape advocates are some single organised force with a shared position on all things smoking and vaping related. We are not. We are a diverse community of people with a wide range of opinions on smoking. It’s only when the subject turns to vaping that we have broad agreement on anything at all. This is why when we form into organisations, and there are many, we stick to the subject on which we are united – vaping – and avoid subjects upon which we cannot reach consensus.

in a blog published today Simon criticises Fergus Mason for saying:

“When we smoked we were willing to accept sin taxes and restrictions, because we knew that fundamentally they could be justified by evidence.”

The quote was not attributed and no link was posted to provide context, but Fergus’ full blog is here.

It seems clear to me that Fergus is talking about the harms to the smoker, but even if not, if Fergus believes that second hand smoke is harmful to bystanders he is entitled to his opinion. Simon then goes on to ask where the evidence is for a total ban on smoking and various other tobacco control measures, but completely ignores the fact that when these things are discussed in the media, and in particular social media, vapers far outnumber smokers in their criticism of these measures (here is just one example, there are many more).

Pretty much every vaper I have met believes that ecigs are an effective tool for tobacco harm reduction, if we didn’t believe that we wouldn’t vape – we’d still be smoking. In order to believe that you must first believe that smoking is harmful. It’s hardly surprising therefore, that we join forces with existing tobacco harm reduction advocates from within public health and academia. Of course we disagree with some of them when they advocate for illiberal non-evidence based policies which restrict freedom of choice for consumers and we are quick to say so.

If Simon Clark wants to unite smokers and vapers in the fight against such policies he would do well to remember that vapers are not smokers, some may have differing views on smoking, and for our organisations, the battle is the regulation of vaping, and not necessarily smoking. As individuals we choose whether or not to take on particular smoking battles and many of us do just that. Turning smokers against all vapers by picking out individual comments and criticising them as if they were the official view of the vaping community is counter productive.

A (Goose) Step too Far

When the smoking ban in cars with children was first mooted I had a problem with it; not because I thought that smoking in cars with children was a good thing, I certainly don’t, but because it is the first step on the proverbial slippery slope of allowing the state to control our otherwise perfectly legal activities within our own private space.

Of course we have been suffering the effects of the draconian smoking ban in enclosed public spaces for years. The bans are, apparently, popular with the public and there are high levels of compliance even though official enforcement is virtually invisible. Smokers have largely adapted to these bans and the more smoke friendly establishments have found creative ways in which to keep their smoking clientele relatively comfortable. However there would have been no need to do so had the bans been implemented in a fair fashion, for example by permitting separate smoking rooms.

Hot on the heels of the Dept of Health’s announcement that it intends to introduce the ban on smoking in vehicles with children comes this comment from Deborah Arnott at ASH London, which I came across via Chris Snowdon’s prophetic blog on the same subject :

IMG_1246.JPG

Where to start… What she’s saying is that smokers cannot be trusted not to smoke around their own (or other people’s) children in cars so we must have a law. But because adults are affected too, and smokers can’t be trusted to be considerate towards non smoking (or even smoking) adults, we need a law for that too. In other words, if a smoker offers you a lift in their car you need a law to protect yourself from them, because after all, it would be too much to expect you to just walk, take the bus or use your own car instead. But Deborah goes further, because the police won’t have time to count the people in a car as it goes by at 70 mph up the M6 we need to make sure the law encompasses all cars – that way they only have to spot the smoking driver and job done. You’re nicked mate. Easy pickings.

The logical extension to the argument that second hand smoke is also a danger to adults, who should therefore be protected by the law, is that if they are affected in private cars they are also affected in private homes. And not only during the period whilst the smoker is actively smoking, I mean, what about the third, fourth and fifth hand smoke (are we up to sixth yet?)? How long before we see old people forced from their homes for smoking, just as we are seeing in the US? How long before vaping is included in yet further bans to aid the difficulties in enforcement? How far are we going to allow these fanatics to go in their relentless drive to control everything we do, say and consume?

For me the answer is simple. The state can control those places over which it has control as it sees fit (or can get away with) and that should go for any proprietor, but attempt to stick your jack boots into my private space and there’s going to be an almighty fight. Be warned Deborah, this is a (goose) step too far.

Martin McKee – lying troll

In an article published in the Lancet in response to Lorien Jollye’s letter, published last month, McKee attempts to dismiss her comments because, apparently, some e-cigarette advocates attended a seminar at the London School of Hygiene and Tropical Medicine on the subject of the tobacco “endgame” and er…didn’t say anything. Apart from on Twitter of course, where they insulted him, natch. Here is the article written by McKee et al in full:

IMG_1231.JPG

Link including references here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62366-7/fulltext

As far as I am aware, the only people who could be described as e-cigarette advocates at that seminar were myself, Dick Puddlecote and Chris Snowden, mine and Dick’s blogs about the event can be found here and here.

McKee’s assertion that this was an opportunity for us to engage on the subject of e-cigarettes is absurd. The subject of the seminar was “Can the War on Tobacco be Won” and the presentations were almost entirely oriented around the ways in which the tobacco industry can be put out of business. E-cigarettes received no more than passing references, and then only in a derogatory context. The event itself was so utterly one sided and farcical that it was obvious that it was completely pointless to participate. Even in the Q&A session at the end McKee was taking questions from the audience then rewording them as he put them to the speakers as if for some reason the speakers themselves couldn’t hear or understand the originators. Needless to say McKee’s translations of the questions suited his own agenda and barely reflected the original question where that question was a bit too liberal for his liking.

So, to the assertion that we instead insulted the participants on Twitter. I did not tweet at all that evening. Dicks tweets are here:

IMG_1229.PNG

Chris’s are here:

IMG_1228.PNG

Whilst Chris’s comments may be harsh they are hardly surprising given that the fool presenting (and it wasn’t McKee or any of his co-authors) had just tried to persuade us that public health troughers such as themselves are motivated by moral reward, and not financial incentives. Oh really? See this excerpt from an email originating from UCSF re tobacco control among veterans and the military:

“Given that I have learned over the years that there are sometimes pots of funds that are pooled to fund additional grants if people think the work is important, this might be very valuable for us.”

So. E-cigarette advocates are only prepared to engage on their own terms apparently. This coming from the person (people) who have blocked every advocate active on Twitter whether or not they’ve ever spoken to or about them. The same person who refused an invitation to the e-cigarette summit, and also a private invitation to simply have an informal chat over coffee at a place of his choosing. Is that how it works Martin, you will only engage on your own ground and when surrounded by your similarly muddle headed minions?

It seems to me that Martin and friends are so incensed at the temerity of Lorien Jollye, mother, waitress and unpaid vaping advocate extraordinaire, in getting her letter published in what they consider to be their territory, that they have lost control of their senses. Where were the “grossly offensive attacks” from the people who attended your little get together? If a picture of a noose was tweeted I certainly didn’t see it, and what does it have to do with me anyway? Or Lorien Jollye for that matter..

I look forward to McKee’s upcoming workshop on the use of social media. No doubt the module on propagating lies to best effect will be enlightening, as will the one on why lots of people who disagree with him must be being orchestrated. Oh look, they took his name off it. I wonder why. Never mind, here’s how it looked earlier. Don’t worry Martin, I won’t be wasting my money anyway.

IMG_1234.JPG

Read the redhead’s excellent analysis of the Lancet response here.

Nicoccino – the new kid on the block.

Nicoccino – a new recreational nicotine product

I was very pleased to meet Michel Bracke and Frederik Hubinette at GFN14, the founders of Nicoccino Holding AB, which launched the sale of a novel recreational nicotine product in the UK on July 1st 2014. Developed in Sweden, the home of snus, Nicoccino is a small film (about half the size of a postage stamp) which users place under their lip as they would snus. The film is made from alginate extracted from seaweed and apart from nicotine contains natural oil flavourings. Currently it is only available in lemon peppermint flavour and containing 1mg of nicotine, although the company say they will be developing other flavours and strengths.

Unlike snus, Nicoccino strips dissolve completely in the mouth in just a few minutes. From my experience they do seem to deliver on the claim that one 1mg film is the rough equivalent in terms of delivery to one tobacco cigarette (although I haven’t smoked for over a year so current smokers may disagree). Once the film is in place there is a slightly peppery tingling feeling before you start to feel the effects of the nicotine. I have to say I was impressed with this product and used it on the flight home from Warsaw. However, another of my colleagues did not like it at all and found that it left his gum sore. This is a good illustration I think, of why there is no ‘one size fits all’ solution for nicotine consumers and if harm reduction is to succeed a wide variety of products is essential.

The samples I was given came in individual vacuum sealed sachets, held in a small folded card package not unlike a book of matches. The branding is clearly aimed at the recreational market and the company pitch is that they are for smokers to use when they can’t, or don’t want to smoke. I will be fascinated to see how this product is received, not only by smoking and vaping consumers, but also by those in the field of tobacco control. The argument will no doubt be, just as it has been with e-cigarettes, that they undermine their efforts by allowing smokers to circumvent bans (as does NRT of course). God help them if they ever produce a bubblegum flavoured strip.

The really exciting thing for me about this product is that it will be attractive to those nicotine users who many in the tobacco control field have had trouble accepting exist. Those who enjoy the use of nicotine, have no intention of giving it up, but would rather not suffer the adverse health effects of lit tobacco. Those same people do not consider themselves to be patients, and so do not find traditional NRT products appealing. This product could, for some people, fill that gap.

Whether or not Nicoccino will perpetuate smoking by allowing smokers to circumvent bans remains to be seen, but studies in England so far have shown that duel use of cigarettes and clean nicotine products have had no adverse effects on the number quit attempts, and do very often lead to complete cessation of smoking lit tobacco, even if unintended*. E-cigarettes are not for everyone, and Nicoccino won’t be either, but it’s another safer alternative for smokers and as such should be welcomed.

*Professor Robert West et al, Smoking Toolkit Study http://www.smokinginengland.info/downloadfile/?type=latest-stats&src=11

The above was a blog I wrote a few months ago but never got around to publishing. I still use Nicoccino and my views of the product remain the same. I was however disappointed more recently to see the company perpetuate the demonisation of smokers in order to increase sales. Their target customers are smokers and vapers (who are almost exclusively ex smokers) and commissioning surveys which result in further opportunities to stigmatise those groups is likely to backfire. Nicoccino is a good product and it will sell on its own merits – there’s no need to try to force the issue by pandering to the puritans.