Charity Cancer Research UK's income drops

Who knows what has caused this drop in the income of Cancer Research UK – whether it is another symptom of the recession or whether other considerations play a part. As we enter a day when record public sector strikes are expected, it is clear that much of the general public, who fund charities, are under severe and continuing financial pressure.

Regular readers of this blog will know that I have a specific gripe with this page from the Tobacco Advisory Group on the CRUK web site, in which they virtually dictate the results of any study that they fund on tobacco:

TAG particularly funds research and activities that support:

• Current UK policy priorities, e.g. see the 'Beyond Smoking Kills' report.
• Greater regulation of all products containing tobacco and nicotine.
• Greater tax and/or smuggling measures in the UK.
• Tackling health inequalities and addressing the needs of groups with particularly high rates of tobacco use.

The only way to describe this is policy-led research: in other words it is politically motivated – not led by an open-minded investigation of the science surrounding tobacco and health, but led by the desire to restrict tobacco consumption. If anybody wonders about the sheer volume of studies that emerge on a weekly basis on tobacco this kind of agenda will help to explain it, along with the likes of TRDRP in the US. Funds exist solely to ensure that studies with a specific anti-tobacco agenda see the light on a daily basis.

In Scotland, the Tobacco Advisory Group of Cancer Research UK has been particularly active, contributing significantly to major policy papers on which the Scottish Government is expected to base its tobacco policy – this information is obtained by searching Sheila Duffy (ASH Scotland) on the CRUK site. Search Deborah Arnott (Action on Smoking and Health in London) and you will get similar results. 

I also don't think a charity should be writing government policy on tobacco control. ASH Scotland is a voluntary organisation that calls itself a charity, which employs (at last count) 27 personnel and has collected nearly £1 millions in Scottish government grants in recent years. (This submission responds to a call for evidence from the Scottish Government's finance committee for 2012/13, and seems to say in outline that they need money to discourage people from smoking, and yet more money to ascertain whether the money they spent in the first place was effective.) It is effectively a substantial arm of the government (last I was aware, there were only four staff at Administrative Officer level or above dealing with illegal drugs in the Scottish Government, plus secretarial support). Already heavily funded by the Scottish Government, ASH Scotland gets additional support from Cancer Research UK. This, to me, is an improper use of resources contributed to charity.

I would be interested to know whether Eddie (comment #1) is correct in his supposition that the public's awareness of this use of Cancer Research UK's money has contributed significantly to its decline in fortunes . I haven't purchased anything in a CRUK shop since I became aware of the extent of its policy-led anti-tobacco funding. I don't mind scientists discovering that tobacco is dangerous if they approach their research in an open-minded way, but I do mind it when a result justifying further restrictions on the tobacco trade is made a condition of funding of this research (it can't even be called medical research if these are the conditions set). 

Passive smoke 'danger' exposes Scottish Government to legal action

A prisoner has effectively called the bluff of the Scottish Government by suing it for passive smoke exposure – paving the way for many more cases against the government if the prisoner wins.

Reading through the worst claims about secondary smoke, one can see why a prisoner (still exposed to secondary smoke because of exemptions built into the 2005 law) might be worried. The fact that not a single fatality has been identified should offer some reassurance, but a prisoner who lives in dread of smoking-related conditions (which all affect vital body organs) might still seek compensation – why not? (Madame Labate's case might give a reason why not – see most recent link above).

Which way will the Scottish courts fall on this one? Admit no harm, or expose the Scottish public to a bill for compensation?

Will this be a push towards banning smoking in prisons – effectively removing the smoking ban exemption in prisons (as ASH Scotland aims to do)?

Will this be a political decision or one based on the evidence?

ASH Scotland: Assaulting smokers with bilge about third-hand smoke

The anti-smoking professionals are getting a bad press this week, but this gets even worse.

A briefing called Third-hand Smoke has appeared today. It was only a matter of time as ASH Scotland has been gathering information on Third-hand Smoke for some months now. The opening is classic ASH Scotland:

• the ‘three r’ definition of third-hand smoke is that it describes residual tobacco smoke pollutants which remain on surfaces and in dust after tobacco has been smoked, are re-emitted back into the gas phase, or react with oxidants and other compounds in the environment to yield secondary pollutants
• even without understanding what third-hand smoke is, people have long been aware of its presence and are beginning to understand how it can affect clothes, hair, cars and homes, and create stains and odours
• existing evidence on THS suggests a strong need for further research to close gaps in the current understanding of the chemistry, exposure, toxicology, and health effects, as well as behavioural, economic, and socio-cultural consequences
• whereas there is a long-established evidence base for the health impact of second-hand smoke, there is still a lack of human health studies on the potential health impact of third-hand smoke
• the greater and more quantifiable health dangers from SHS suggest that health professionals should focus on reducing exposure to SHS, including by promoting smoke-free homes and vehicles. [italic emphasis added]

In other words, 'people know that smoke is smelly and stains things over time, but we haven't be able to demonstrate any health effects in the literature yet. We can still carry on pestering you about secondary smoke though.' Well, that was worth a shed-load of taxpayers' money. Curiously, it then goes on to explain that residual smoke reacts with oxides and other chemicals including nitrous acid, which is 'produced in engine exhaust emissions but is also a common indoor pollutant produced by poorly vented domestic gas appliances'. Wouldn't it be better to maintain regular checks on these gas appliances than to mess about warning people on third-hand smoke, which they don't even know is dangerous? Researchers have so far failed to find harmful doses of any substances in third-hand smoke even when increasing nitrous acid concentrations to levels much higher than normal. But that won't stop belief in the concept. One respondent even cites third-hand smoke as a reason to ban electronic cigarettes.  

The third-hand smoke briefing from ASH Scotland shows limited understanding of second-hand smoke too. In one sentence to describe second-hand smoke it says: 'Research demonstrates that tobacco smoke is a toxic substance with no safe level of exposure, and that the risks from exposure are largely dose-related' [emphasis added]. If it's dose related, why won't a tiny little dose cause negligible damage? (oh, dear!) 

This third-hand smoke concept is insidious. It fits so well with the denormalisation of smokers. Having removed smoking from the public sphere, it now follows them to the private sphere. Question – What could be the intention of this kind of statement?: 

A 2010 study* indicated that third-hand smoke accumulates in smokers' homes and persists even after homes have been vacant for two months and are cleaned and prepared for new residents; the study suggested that non-smokers living in former smoker homes are exposed to THS in dust and on surfaces. (* Matt, George E et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tobacco Control, 2011;20:e1. http://tobaccocontrol.bmj.com [Accessed 06 May 2011])

Answer – to devalue the effects of smokers: the properties they own, or rent. To impoverish them, basically. And to devalue smokers as buyers of property and (especially) as tenants. Note that this study emerged in 2010, and they still, half-way through 2011, don't have any evidence that third-hand smoke harms anyone. Yet they are printing this rather inflammatory material  It talks of a potential health hazard to infants: no sick babies to hand, just potential research contracts.

A further purpose is to continue pushing ASH Scotland's agenda to get people smoking outside. ASH Scotland's strategy document Beyond Smoke-free includes the following in its short-term aims:

We must develop robust intermediate and endpoint targets to reduce second-hand smoke exposure in the home and in vehicles, in order to support awareness raising work and work in communities.

And the following in its medium-term aims:

We need to be realistic about the difficulties some people have. We must promote effective harm reduction strategies, including the use of nicotine replacement for temporary abstinence, to protect children from exposure to secondhand smoke in the home. 

All the more easy for them, if they can persuade enough people of the dangers of third-hand smoke without needing to prove it or even show any understanding of it. The briefing does say that the research on third-hand smoke is not conclusive. But it is 'aimed at parents and carers', talks about infants crawling across the carpet and generally attempts to stir the shit on the basis of lucrative speculation, in pursuance of its agenda.

Regular reviews on Tobacco Harm Reduction

Tobacco harm reduction is a controversial area. I can't comment on the science but I can give an outline. The premise of tobacco harm reduction is that smoke, rather than nicotine, is what makes smoking dangerous. Consequently smokers who want to give up can use smokeless tobacco or e-cigarettes more safely than smoking tobacco.

The emerging tobacco harm reduction market has benefited from scares about the dangers of smoking to by-standers. Urging people to give up smoking has always been easier if you can persuade them that smoke is killing their loved ones. In fact ASH Scotland uses the term 'harm reduction' here (a section from Sheila Duffy's epic 'Beyond Smoke Free' document), to mean that using nicotine replacement therapy beats smoking in front of your children. She seems to feel that smokers should be content with a 'sticking plaster', rather than a satisfying experience.

Users of e-cigarettes and other smokeless tobacco have found themselves faced with the threat of prohibition far more quickly than smokers. The market for e-cigarettes has clearly competed for the same customers that might otherwise have bought nicotine patches and gum from global pharmaceutical companies. Pharmaceutical companies want to develop drugs based on natural substances like tobacco, and the entire anti-smoking establishment has sought to make e-cigarettes unavailable to consumers, in the hope that it will create a captive market for pharmaceutical cessation products (see forum discussion here).

Users of e-cigarettes know that banning their product is not to do with health (even though spurious claims are made about uncertain health risks). They can see cigarettes still on the market, while the product they resorted to in order to stop smoking has been banned – leaving them with the options of stopping smoking without any help or buying the products of pharmaceutical interests.

Smokers have lived with their chosen product being taxed to the heavens: e-cig users live with the threat of their product of choice being made unavailable (for much the same reasons as the rest of us will no longer be able to buy calendula lotion or other common herbal products after 1 May). For most people an e-cigarette ban remains a threat rather than actuality (New York State being closest to an outright ban in the US, and full bans operating in Brazil, Singapore and in Canada except where the e-cigarette is free of nicotine – see here for details).

This guide to essential reading on tobacco harm reduction offers further links and insights. Stories include a possible workplace ban on e-cigarettes in Georgia (together with suggestions for local action) and the opposition of students at the University of Massachusetts to a smoking ban that included e-cigarettes and smokeless tobacco in its reach. There's much more where this came from, and the list will be regularly updated.

NHS Grampian: full retreat from hospital smoking ban

An unexpected pleasure to read NHS Grampian's new view of the smoking restrictions proposed last summer. Not to put too fine a point on it, the smoking ban 'would cause huge problems', according to medical director Dr Roelf Dijkhuisen. In a revolutionary statement that health boards up and down the country should note, Dr Dijkhuisen said, 'patients addicted to smoking could not be expected to “take their drip and go and stand at the bus station” to have a cigarette'.

Quite obviously this is an absurd requirement in an institution designed to improve people's health.

Nor does Dr Dijkhuisen approve of the solution reported in the Press and Journal just days ago.

"I’m not a fan of shelters. They are ugly bus stops and extremely expensive. Maybe we will designate an area where we will have to do no building work. Rather than spending £150,000, we should look at alternative ways of providing designated areas without forcing people to stand in the rain."

It remains to be seen what the Trust will propose as a solution, but it would seem that Dr Dijkhuisen's recommendations are intended to be a permanent solution, rather than a sticking-plaster job pending a total ban in a few years' time.  He is not the only board member who doesn't see the need for a complete ban in the foreseeable future:

Yesterday members welcomed the medical director’s recommendations – which included improving employees’ knowledge of the locations of smoking areas and clearer signs – but chief executive Richard Carey said it was important to remember this was not ideal and that a ban should still be a target.

Chairman Dr David Cameron disagreed, saying while the “aspiration” was for premises to be smoke-free, the board’s role was to “encourage people not to smoke rather than ban them”.

Does this sensible qualification from Dr Cameron mean that we have started to retreat from the ideal of a smoke-free Scotland? Surely no Scottish government would now legislate to make smoking on NHS premises a crime, as they seem to want to do in Wales? Some of ASH Scotland's ambitions as laid out in their recent (Cancer Research UK-funded) report Beyond Smoke-free also seem unrealisable.

We must ensure that all Scottish health and education services have smoke-free grounds.

A permanent solution, accommodating smokers in comfortable indoor accommodation that will entice them away from the doorways, will only be possible when the law is changed.

ASH Scotland calls for new anti-smoking laws

Or does it? I have to say I am a little confused.

A writer in The Scotsman says ASH Scotland wants further legislation.

Sheila Duffy says it doesn't.

ASH Scotland's paper on the issue is pretty non-committal.

ASH Scotland's recent CRUK-funded paper Beyond Smoke-free backs up Sheila's position to an extent. It talks about interventions, consultations, social marketing projects. It does not refer to further legislation, but does  wish to remove current exemptions from smoking bans in the short term. In the long term, says the paper:

There is public support for more comprehensive tobacco control policies and a strong ethical justification for additional measures aimed at reducing exposure to second-hand smoke. In order to make advances and substantially reduce exposure to second-hand smoke in Scotland, new approaches are required to tackle this complex issue.

But just what does public support mean? 'Support' for removing the mental health exemption is claimed to be found in this paper (which has 'demonstrated support for this move') The paper includes strong criticisms of the consultation paper on removing the mental health exemption and also says (page 12):

Just over one-third (35%) of those who responded to this question recommended that the existing exemption which permits smoking in designated rooms be removed by amending the existing legislation.  [...]

The vast majority (81%) of patient representative groups advocated the retention of the status quo, as did 6 out of 10 of respondents who identified themselves as current service users

It also says: 'Around one in ten (12%) of respondents advocated producing detailed guidance material without amending the legislation.' This was the option the government has taken, and the guidance will appear early next year.

From ASH Scotland's contacts with smoking cessation practitioners at local level in Scotland, we know that services are awaiting government leadership on this issue. The Scottish Government plans to produce guidance to support psychiatric units to close their smoking rooms – we await publication with interest.

Thus ASH Scotland says there is 'support' for a policy that 81 per cent of patient respondents have opposed and only one-third of all respondents supported.

Based on their assessment of the facts, I conclude that The Scotsman's version of events is correct and that Sheila Duffy does want legislation that will ban smoking in cars and even in the home.

Bad science in a good cause is bad science: social marketing under a spotlight

John Davies, a professor with scruples, explains why bad science in a good cause is still bad science.

The object of his attack is social marketing, which is manipulating/influencing people to achieve societal goals, as opposed to marketing in a commercial context, which clearly aims to influence people for commercial gain. Social marketing prides itself on manipulating people for their own benefit. However I don't know a huge amount about this area so have included this link from the Open University, which introduces some of the ideas behind social marketing. It says that social marketing relies on voluntary compliance rather than coercion. My thoughts: velvet glove, iron fist (h/tap Chris Snowdon).

Social marketing appears critical of commercial marketing, however the book Social Marketing carries the subtitle 'Why should the devil have all the best tunes?' Proponents such as Gerard Hastings, the book's author, clearly have much to learn from commercial marketing about the techniques of persuasion, but will they be any more honest than their commercial counterparts? 

The Open University link above explains social marketing as 'marketing to achieve social goals'. But whose social goals? Is there a social consensus about the matters that social marketing is involved with, namely health and the environment? Certainly not, I would suggest, these days.

Social marketing is mentioned frequently in anti-smoking initiatives, indeed John Davies refers to the passive smoking concept as an example in his video. ASH Scotland's recent report Beyond Smoking refers to it in both section 2 (Cessation) and section 3 (reducing exposure to second-hand smoke). In both these sections social marketing is employed to influence people into behavioural changes. The end is clearly felt to justify the means (John Davies tells how it is also employed in education about cocaine use). 

Social marketing also popped its head up at the 2010 UK National Smoking Cessation Conference in Glasgow, in the shape of at least one session featuring the use of social marketing: it featured telling the stories of real life quitters and was presented by Andy Lloyd and Martyn Willmore of Fresh Smoke Free North East (their group is also featured in the recent Forest report, from page 10). Lloyd, interestingly, is Media, Communications and Social Marketing Manager for their organisation, which gives some idea how central social marketing is to the tobacco war. 

We are grateful to John Davies for putting the question: once you start telling lies, or disguising the truth in a good cause, where does it stop? I think he did not quite ask, Who decides what the truth should be? Where's the accountability? All good questions, and ones that the public increasingly begin to ask.

Liberal Vision declares ASH Scotland a waste of money

News indeed! a mainstream political party's blog expresses astonishment at the level of funding given to ASH Scotland. It says: Time to bin ASH before they trash another part of the economy.

The writer has just read Beyond Smoke-free, ASH Scotland's recently published blueprint for the future of smoking in Scotland. It is also reviewed by Katherine Graham of the Tobacco Retailers' Alliance in a report here. The Liberal Vision blog is far more damning of ASH Scotland than Katherine Graham, though both despair of their understanding of business, whether at the level of the small shop or indeed the entire Scottish economy. ASH Scotland's suggestion that the Scottish Government should offer shops a realistic incentive to stop selling tobacco illustrates this lack of understanding. The cost of making this work would run into billions, and there has probably never been a less appropriate time to make such a suggestion.

The other suggestion that attracts remark is the proposal to increase the tax on tobacco by 5 per cent a year: since there is already a thriving illicit tobacco market, as both Katherine Graham and Angela Harbutt of Liberal Vision point out, this is unlikely to result in a drop in smoking rates.

I particularly like Angela Harbutt's description of 'the ludicrously well-funded ASH Scotland (which has somehow reversed the Barnett Formula, receiving copiously more than its (also over-funded) English partner organisation'. Also, her conclusion that the Save our Pubs and Clubs campaign should rename itself Save our Pubs and Clubs and Newsagents.

Katherine Graham's piece is a tad too gentle with ASH Scotland for my liking but her conclusion, that raising people's general standard of living is the best way to drive down smoking rates (rather than attacking the symptoms of deprivation, such as smoking), is sound and pertinent in present conditions. In the face of the biggest round of spending cuts in decades, lavish spending on anti-smoking pressure groups like ASH Scotland is particularly bad economics, especially if this money is coming out of health budgets.

(If you have a Liberal MP or MSP, especially in Scotland, do send them a link to the blog post, won't you?)

ASH Scotland's vision of a new dawn

For some reason my pc won't cope with pdfs just now, so I went to another place to read the new Beyond Smoke-Free document issued yesterday by ASH Scotland. Surprisingly it doesn't describe a smoke-free Scotland, but one in which tobacco is increasingly regulated. They are less ambitious than I thought, and the name of the document is definitely a misnomer (they are still at the stage of 'Towards Smoke-Free').

The opening image shows a family of four blissfully jogging in the sunshine. I think the implication is meant to be that smokers don't (or perhaps can't) jog.

A brief summary of the doc is as follows.

Part 1: Prevention
Short term
More youth involvement in prevention initiatives
Targets for young people post-2014
Prevention work at local level
Display ban
Tackle illicit tobacco
Tobacco control issues included in Curriculum for Excellence

Medium term
Further reduce visibility: promote law in the UK for standardised, unbranded packaging
Money seized from smuggling to go to youth prevention initiatives
Award scheme for retailers that choose not to sell tobacco

(note: 'TOBACCO IS UNIQUELY DANGEROUS ... it is not a normal product and should not be sold as such': I am not sure if this is thought be a scientific claim.)

Part 2: Cessation
Short term
Already effective and cost effective but more needs to be done: evidenced based, wide variety of solutions should be offered
Service should be more accessible to hard-to-reach groups
Create quality standards and identify gaps in training provision
Engage in evidenced based social marketing to highlight the dangers of  taking up smoking at any age
Encourage government to replace information about tar and nicotine content with general information about the dangers of smoking and where to go for advice on giving up
Tax increases 5% per year

Medium term
All health professionals should be able to discuss smoking with their clients
All health professionals trained in discussion of tobacco and appropriate referral
Support for developments in smoking cessation

Long term
Significant increase in price of hand rolling tobacco and prohibiting tax and duty free tobacco in the UK

Part 3: Second hand smoke exposure
Short term
Extend laws to areas currently covered by exemptions (prisons, mental health facilities)
Social marketing campaigns to increase people's awareness of the dangers of smoking in vehicles
Interventions to prevent smoking in the home, provision of training in implementing such measures
Consultation on legislation to ban smoking in vehicles
Targets for zero exposure at home and in vehicles: awareness raising

Medium term
All health and education institutions to have smoke-free grounds
Effective harm reduction strategies (e.g. NRT to stop people smoking at home)

Long term
Further limitations to exposure

Part 4: Government, society and industry
Short term
Develop a multi-agency national tobacco strategy for each area of Scotland
Transparent reporting on tobacco interests in article with Article 5.3 of the FCTC
Develop reduced ignition propensity cigarettes: four out of 10 home fire deaths result from tobacco smoking – ensuring that tobacco industry has no say in health policy and no increase in customer base

Medium term
Scottish Government will continue to influence UK government on tobacco control
Government will regulate tobacco promotion, marketing, information provision and sale
More tobacco industry accountability on ingredients
Use influence with developing country partners such as Malawi to improve conditions of tobacco growers, with the aim of cultivating other crops instead.

Long term
Tobacco industry to be made more accountable, tobacco proceeds to finance tobacco control.

***

Well there you have it. One or two measures, affecting packaging, product information and the availability of duty-free products, are reserved issues and cannot be taken forward by Scotland alone.

The issue of what information goes on to a pack of tobacco is included in the present consultation on revising the EU tobacco products directive, which is worth looking at: they wish to get a green card from the whole of Europe to maximise government regulation at a Europe-wide level. You can download the consultation here, and anyone can respond.

Please note that the removal of exemptions in the smoking ban legislation is included as a short-term aim. I don't know whether it includes long-stay hospices or care homes, or only the mental health facilities that we already know are under threat.

Sheila Duffy wants ASH Scotland to be insulated from cuts

Well she would, wouldn't she? She wants to be assured that we don't get carried away by short-term concerns (life-saving treatments for example, crisis accommodation perhaps or investment in protection against STDs?) because smoking prevention is so important as to trump all these things. She reckons the cost of quitting is around £500 per quitter (without assuring us that this is a long-term quit rate and not a four-week one).

ASH Scotland is a charity that underwent an external review in 2007, containing the most recent figures I can access quickly (Table 6.1). As you can see from the review, Scottish Government provided about 60 per cent of the funding, with the rest split between the British Heart Foundation, Health Scotland (another government body), supporters/patrons and its own income from consultancy work. Charities are allowed to donate only to other charities, and so British Heart Foundation (privately funded for the most part) can only donate money on the strength of its charitable status. Voluntarily donated funding in 2006/7 ran to nil, with only £2,000 in previous years (a fraction of the money taken from government, £353K in 2005/6).

Why does this charity exist, since only those with a tobacco control agenda support it?, and without charitable status it would get no money from BHF either.

Sheila's blog post today says that Cancer Research UK funded the latest report, Beyond Smoke-Free (link in later post). Seems to be going round the houses for the Scottish Government to fund ASH only to have CRUK also fund it to frame tobacco control policy. As far as Sheila's appeal to retain ASH Scotland's funding is concerned, her recommending an extensive consultation on (among other things) the banning of smoking in cars, a policy she herself claims not to advocate, suggests that she hasn't grasped the seriousness of the economic climate.