Morning Call, BBC Radio Scotland covers e-cigarette banning, Monday 20 January

It's Monday morning, 9.30 GMT. Gerard Hastings just now saying that e-cigarettes is encouraging people to 'self-medicate on nicotine'. (What is use of nicotine patches if not self-medication on nicotine?) Go here for a discussion for the next hour.

Post-discussion
The official contributors to the programme, Sheila Duffy of ASH Scotland and former Health Minister Andy Kerr, attempted to give e-cigarettes a qualified thumbs-up but seemed hung-up on the idea of renormalising smoking, and, bewilderingly, encouraging nicotine addiction. The bright part was the callers. Caller after caller pointed out that banning e-cigarette use was counter-intuitive to efforts to discourage smoking, and many had been able to give up smoking since they started using e-cigarettes. Some of them were conversant with recent research, and able to compare favourably the numbers of children allegedly using e-cigarettes with those experimenting with smoking.

Two callers at the end who opposed e-cigarette use were particularly unconvincing: one of them pointed out that nicotine was a stimulant and nicotine in e-cigarettes keeps smokers addicted, and the other reported that having given up smoking forty years ago she tried e-cigarettes and enjoyed them. Hence they really should be banned as they are clearly a gateway back into smoking!

The confused kind of consensus to emerge out of all this was that e-cigarettes should be regulated rather than banned. Even I agree with regulation to the extent that (for example) there could be limits on nicotine concentrations for the general user. But there was also talk (by Andy Kerr) of regulating the appearance so that there is a less clear resemblance between the e-cigarette and smoking. Age restrictions might also be beneficial – one could have a minimum age of 16 for purchasing e-cigarettes, which would give e-cig users two years' advantage in terms of legal purchase. By the time they reached 18 they might find the cost advantages outweighed the attractions of experimenting with smoking (unless they were already smoking black market cigarettes of course).

Well done everybody who called the programme. Most of you put the case clearly and rejected the proposition of banning e-cigarettes decisively on the basis that they are an effective and safer alternative to smoking.

Sheila Duffy falls back on academic study

Sheila Duffy's latest letter to the Scotsman. Without a hint of embarrassment, she puts forward the 'independent' academic study by Hastings et al. as clear evidence that plain packaging will reduce child smoking:

Alongside the consultation document launched last week, the UK and Scottish governments published an evidence review by Stirling University. This collated 37 academic studies and concluded there was “strong evidence… plain packaging would reduce the attractiveness and appeal of tobacco products”. In one study, 87 per cent of children rated plain packs as “uncool”. 

It seems, therefore, that the evidence is plain to see.

Magnificent: an open admission that a predetermined agenda, supported by a so-called academic review written by people who share that agenda, using sources that address only that agenda and none of the wider issues, is all the evidence that the government needs to pursue tobacco control. My comment:

The academic study referred to by Sheila Duffy acknowledged two weaknesses: one that it isn't possible yet to evaluate the policy in practice, and two that 'a number of types of literature were not covered by the review'. http:phrc.lshtm.ac.ukpapersPHRC_006_Final_Report.pdf 

IMO the study (described by Lansley as an 'independent' academic review) also fails as it doesn't include anyone outside the narrow confines of tobacco control among its list of authors. Nobody qualified to offer expert analysis in branding, marketing, communications or the international black market in tobacco was involved. The range of literature (Table 4.1) reflected this obsession with tobacco control and failed to reflect concerns from beyond the tobacco control community: 'barriers' to plain packaging were a nod to the idea that not everyone agrees with it. Considering we are awaiting judgement in a court case and Ukraine and Honduras have both risked the ire of the Framework Convention on Tobacco Control by challenging the legislation, an independent review should have been authored by all, or at least more, of the interests at stake. 

If you support the policy, and your source material supports the policy, and you don't include anyone who doesn't support the policy, then hey presto, your study will also support the policy.

This letter was a response to this by Robert Dow, who also comments on Ms Duffy's letter.

Let's just do it! says Sheila

Just when I thought we'd finished this topic for the night, Sheila Duffy comes in with her first blog post of 2012.

First quote:

A systematic review of the proper, academic evidence on plain packaging was published alongside the consultation. Produced by Stirling University researchers, this review considered 37 published studies and concluded “that plain packaging would reduce the attractiveness and appeal of tobacco products; it would increase the noticeability and effectiveness of health warnings and messages; and it would reduce the use of design techniques that may mislead consumers about the harmfulness of tobacco products.” [emphasis added]

Dick Puddlecote gives an example of proper academic evidence (illustrating how they showed that plain packaging would speed up transactions). The proper academic evidence is listed in this 'independent' review, carried out by professional tobacco control advocates, starting on page 91. All the studies featured in this review look at the issue of packaging from close range. No study attempts to take a different view, or even substantively addresses the wider legal problems of intellectual property. This is what passes for 'proper, academic evidence': select only studies that support the policy of the government that commissioned you to carry out the review (and select very carefully the authors of the review). Can she actually believe this is objective?

Second quote:

There is clear support for plain packaging from academic researchers, public health professionals and the Scottish public. We at ASH Scotland believe that the debate over the evidence for plain packaging has been settled and that plain packaging will make tobacco products less appealing to young people, resulting in a slow decline in smoking rates as fewer young people are recruited to replace those who quit or who die. The fact that the tobacco companies are so worried suggests that they think so too. [emphasis added]

The debate is over. She does believe it then.

Plain packaging moves across the world

In Australia the case opens in court as the tobacco companies defend their intellectual property against the plain packaging laws. The Australian government is confident of victory, arguing that it will not gain directly by confiscating tobacco brand markings.

The Commonwealth argues that even if big tobacco could prove the government was acquiring their property rights the manufacturers still wouldn't win in court.   

That's because the purpose of the plain packaging legislation - namely to improve public health - is within the scope of the Commonwealth's legislative power under the constitution's commerce, trade and external affairs powers.

This sounds like a blank cheque book: claim health grounds and you have a legal basis for any action. Even if the result were certain to be as the government claim, would this over-ride the legitimate requirements of traders to be able to legally brand their goods?

The legal arguments are beyond me but this link shows that opposition to the plain packaging proposals is shared with many bodies such as the US Chamber of Commerce. The Express has also opposed the policy. This link from Brand Republic gives a number of views including one from its own industry – not heard enough:

"Just focusing on the connection between branding and smoking behaviour may be a distorted way of looking at the way of branding. 

"Branding on pack is about differentiating product and competition on the basis of quality, reputation and price but if all the packs look the same you move very quickly towards a generic commoditised market place and that is typified by price competition. 

"It means there is a loss of incentive for companies to invest in quality and reputations because they have no way to communicate that to consumers. While I’m sure the familiar brands will continue, if you were to launch a new product into the market it can only be a price fighting product and if that is a means of reducing prices to consumers then actually it may result in more people smoking rather than less because it becomes a very price sensitive market.

Here the government consultation on plain packaging has opened: coordinated by the Department of Health to cover all the legislative assemblies as well as England. (It's worth responding: the EC had to publish responses to its Consultation on revising the Tobacco Products 2001 Directive. The public didn't like its proposals and this showed up in the consultation responses. It also showed that the tobacco company was not alone in opposing an extension to tobacco control. The more embarrassment they get the better.)

Simon Clark says in his blog that Andrew Lansley promised an independent review* of the evidence on plain packaging. I haven't read this review yet, but since it is co-authored by a team including Gerard Hastings, Linda Bauld and Crawfood Moodie (refer to front page of the report for their affiliations), it cannot be described as independent. As Simon says, 'there is not a single marketing, communications or branding expert on the panel'. Perhaps they would have been considered vested interests?

*yes he really did! Jesus, they surpass themselves. 'The Department of Health has ... commissioned an independent academic review of the existing evidence on the effects of plain packaging'. Said independent review is authored by a team of ten people, affiliated with the University of Nottingham, the Cancer Research UK Centre for Tobacco Control Research at the Institute of Social Marketing at Stirling University, and the UK Centre for Tobacco Control Studies. I've said this before: Cancer Research includes in its funding conditions for tobacco-related research the provision that research 'support current UK policy priorities', including plain packaging. How the {censored} does he get off with calling this an independent academic review?

h/tip Simon Clark for the link

Freedom of Information is a tool of aggression, says President of the Royal Society

Ten weeks after the furore caused by freedom of information requests by Philip Morris, The Independent, through the voice of Sir Paul Nurse (President of the Royal Society), attacks the use of Freedom of Information as a so-called 'tool of aggression'.

Philip Morris caused consternation by requesting details about research concerning childhood smoking undertaken at Stirling University. The Scottish Information Commissioner demanded that Stirling University should issue a substantive response – as far as I know, this is still pending (but you can hear an interview with the Information Commissioner (and with Gerard Hastings of Stirling University, including a statement from Philip Morris) at the link here).

I'm not familiar with the disruption that such FOI requests can produce. But like many readers, I find it hard to see why publicly funded research should not be put at the disposal of the public. Given that tobacco companies are systematically excluded from any public health discussions involving smoking, there is some justice in allowing them to see the fruits of publicly funded research involving their own product. I don't believe that tobacco companies should dictate public health policy, but nor should they be barred from making any contributions.

Since I don't respect the exclusion of tobacco companies from public health debates, it is unsurprising that I should feel that Stirling University should comply with the FOI request. But there is also the practical point of limiting Freedom of Information. Where would you draw the lines? How would you guarantee that the people who are granted access to the information they seek are not actually related by their third cousin's marriage to someone on the Philip Morris's board of directors?

The point of principles such as Freedom of Information is to provide transparency, and limiting it destroys the concept. There is no point in enshrining a point of principle around sharing information with people that you would happily share the information with if the principle were not in place. Like the principle of habeus corpus, it must apply to anyone if it is to have any meaning at all. There's no point in agreeing not to imprison people without charge 'unless they're terrorists').

Stirling University ran a poll on Facebook which led to a lively discussion. They won the poll, and then withdrew the page because they lost most of the points in the discussion (why remove it otherwise?) I wrote to the University to ask them where the page was: answer here.

Networking: tobacco control, social marketing and real friendship on Facebook

From Dick Puddlecote and CAGE Canada, reporting the disappearance of Stirling University's Freedom of Information Request page yesterday.

As if to demonstrate further the Ivory Towers mentality of tobacco control comes this letter from tobacco control advocates Simon Chapman and Becky Freeman, down under ... leading to this Facebook group. You get in only if you have the right attitude and probably the right friends.

Social marketing in, commercial marketing out ... fair enough to a point, but what's with all the secrecy? For the record, ' We don’t welcome anyone with tobacco industry ties and those who are regularly offensive.' I don't have any ties to the tobacco industry, but I won't waste their time by applying.

Canadian radio broadcast starring Gerard Hastings and the Information Commissioner

Via Bishop Hill comes this link to an interview with Gerard Hastings from Stirling University, defending his case against Philip Morris, and Scottish Information Commissioner, Kevin Dunion.

Edit: A permanent link to the interview is available here:

Professor Hastings makes the point that the studies in question are paid for, not publicly, but by 'a cancer charity', a somewhat cunning disguise for Cancer Research UK. One only needs to read CRUK's research preferences to understand that Philip Morris has clear grounds to assume that Cancer Research is prejudiced against its corporate interests. Professor Hastings may correct in thinking that charity-funded research should not have to comply with Freedom of Information requests – but charities that fund research should not announce their intentions to influence government policy prejudicially against the interests of specific industries. If Government chooses to outsource research to the third sector or universities it shouldn't expect to escape accountability.

After listening to Professor Hastings, listening to the Information Commissioner brings one down to earth. He is clear that the University has not understood the implications of FOI, because of Hastings' insistence that assuring his subjects of confidentiality would automatically exempt him from complying with the requirements of the law. He reiterated that he had ordered the University to provide a substantive response to the FOI request – not necessarily to provide the information requested, but otherwise to give adequate reasons for not supplying it.

Any result will be subject to appeal and could take several months.

Stirling University versus Philip Morris: more links

Yesterday there were yet more stories in the Independent on the tussle between tobacco and the powers that be.


Tobacco giants tell Whitehall to hand over its secret minutes: discusses tobacco companies' search for evidence supporting anti-tobacco legislation. Considering that much recent legislation is manifestly unreasonable, requiring the government to show justification for it seems fair.

If data cannot be safely made public, FOI shouldn't apply: this one is written by Maurice Frankel, director of the UK Campaign for Freedom of Information.  He reckons that disclosure will make the information available to tobacco companies, and this will imperil similar projects in the future. There must be a wider public interest at stake, however, than protecting data from scrutiny by outside observers. (Does Professor Hastings really believe that his insights and work will significantly improve Philip Morris' success in the youth market?) There may be issues on which it is better not to reveal data, but if this represents a dangerous release of data I would suggest FOI isn't a very robust concept.

Reports from the Scottish press include the Scotsman (including a statement from the Information Commission) and the Record, which gives an embarrassingly emotive account of the issues (perhaps Professor Hastings should seek employment with Philip Morris as he seems to have all the insights they need?). We learn that there are 13,500 deaths a year from smoking (no reduction on 2004), and that the academics are quite right to withhold the information.

Finally from Frank Davis' blog, a response to the initial 'Exclusive' on Thursday from Stephen Connor on this issue, which reported how Professor Linda Bauld of Stirling University, also involved in the study, has received abusive communications at home. Can't find much to disagree with here.

Finally: hold the front page! more revelations from Simon Clark at Forest.

Stirling University 0, Philip Morris 1

Today the Independent newspaper reveals that Philip Morris has made a FOI request of Stirling University's Institute of Social Marketing involving data for research on the smoking habits of young people. 

In fact it is old news: the request has already been approved by the Scottish Information Commissioner in a decision dated June 2011 that criticised the University's conduct in the affair.

The tone of the Independent on this whole issue is almost hysterical. No less than three articles by science editor Steve Connor appear in today's edition:

Exclusive: Smoked out: tobacco giant's war on science

(a loaded way to describe a Freedom of Information request); 

Echoes of climate change battles are no accident

(in which tobacco and climate change are treated as identical issues); and

Hair-splitting, brazen denials and six decades of dirty tricks.

Good that you can rely on the press to be even-handed, especially when it calls itself the Independent? I have no objection to dirty tricks being reported, but the report implies that because tobacco companies have been caught in the past being less than economical with the truth their opponents in tobacco control studies have always been and will always be beyond reproach. 

As well as these three pieces we have another by Jean King at Cancer Research (which contributed to funding for the study at issue) : 'This industry should be kept away from young people.' Tobacco is just one thing that many people agree is not a product for young people's consumption. Is this a reason for a major newspaper not to ensure that both sides are properly interviewed in a report about a dispute?

The leader ('The uses and abuses of freedom') is at least slightly measured, and concludes:

Scientific research, which has a value in its own right, but potentially also a commercial and social value, could be seen as the university's exclusive property. If the university and the research, however, have taxpayer funding, should the findings not be more widely available? In the end, the Information Commissioner might have to weigh the arguments – and that might be no bad thing.

This brings us back to the fact that the decision appears to have been made already. I would have expected the writer of a leader to know this: have there been further developments since then? The University was given until 15 August to comply, and it isn't clear what has happened since then. 


Significantly, the studies are funded by the public, and their findings are expected to (at the very least) inform public policy. Gerard Hastings' pleas that the children interviewed during these studies did not expect their data to fall into the hands of tobacco companies suggest that he hasn't fully appreciated what public funding implies. As somebody comments under the article, he should not have given assurances to subjects that would run counter to his obligations under FOI.


Significantly BMJ editor Richard Smith has also agreed that Philip Morris should see the data collected at Stirling. I agree that Philip Morris should have access too, not least because the Institute of Social Marketing and Cancer Research UK are behind the studies. Their agenda is specifically anti-tobacco, and it is hard to imagine that their research can be other than policy-led. This gives Philip Morris a legitimate interest.


Edit: The Scotsman quotes the office of the Scottish Information Commissioner: 

In a statement, the office of Scotland's Information Commissioner, Kevin Dunion, said: "The commissioner has not ordered the university to release the information. He has found that the request was not vexatious, and ordered the university to make a substantive response to Philip Morris International. 

"A substantive response could include release of the information in part or whole, or a refusal to release information with an explanation of why, under the provisions of the FOI Act, the university believes this to be the correct course of action.

Ring-fenced funding, smoking cessation, social marketing and slave labour

Further to this post, a planning document has come to light (h/tip Eddie) entitled The Application of Social Marketing to Behaviour Change in Tayside – A Progress Report. It gives a budget for two items regarding smoking cessation totalling £540,000 and two items on social marketing totalling £162,000.

I am struggling to get hold of what social marketing is really about. Here is a very quick explanation using the smoking example:


Gerard Hastings is an international pioneer on this issue, and loves working with authority at the highest level on interventions supporting the official view of desirable behaviour change. An anonymous commenter on this blog assures me that social marketing is about behaviour change according to people's aspirations, rather than according to the grandiose notions of public health. Perhaps I should have attended this conference?

For the time being, Hastings is the only authority I have consulted, and I've yet to be convinced that there is anything politically radical or right on, or democratic, about 'top down' programmes of behaviour change. Democracy is about being represented – not being managed.*

Social marketing as developed by NHS Tayside is about top-down management. It's about NHS Tayside deciding on a desirable behaviour change, be it handwashing or smoking cessation. I would be the last to claim that the budget here was very high, but still would contend that a handwashing policy in a health service doesn't require a social marketing toolkit. It's basic hygiene.

The smoking cessation programme, with a target of 360,000, has got 800 into its fold of which around half abstain for up to three months. Its target is 1,800 quitters, or 2 per cent, over two years. Nothing startling there in marketing terms, especially if the targets are for a three-month quit. But do we really need to ring-fence that money for a very small number of people to quit smoking? Over half a million pounds?

Reading on we discover that the supermarket vouchers paid out to people passing their carbon monoxide tests probably come from Asda, since Asda is listed among the  'partnerships'.

Asda – now where did that name come up recently? Another initiative to reduce health inequalities? Oh no, it was this:

Unemployed people ‘bullied’ into unpaid work at Tesco, Primark and other multinationals 

Unemployed people are being sent to work without pay in multinational corporations, including Tesco, Asda, Primark and Hilton Hotels, by Jobcentres and companies administering the government's welfare reforms. Some are working for up to six months while receiving unemployment benefit of £67.50 a week or less.

On another page, another company participates in the no-work-no-benefit charade – a registered charity this time:

March 2009 was my first claim. The placement was seven months after. [Before that] I was going to college [to learn English]. I paid £50 for it. Then when I went to the job centre they told me: “Now it's the New Deal. You're going to a placement”. I told them my English was not good but they said: “It doesn’t matter, you have to go. If you're not going, we’ll stop your money.” They told me they would stop my JSA [Job Seekers Allowance] so I stopped my English course.

The first [placement] was with the British Heart Foundation. I worked from 9 or 9.30am to 4.30pm with a half hour break. I did everything. I went for one week and the manager was so rude. One day she ate something and left so much mess in the kitchen. Then she says to me: “Karina, you wash up.” The first time I didn’t say anything. I was scared they would stop my money.

My point isn't to 'get at' Asda or the British Heart Foundation. It's to show how companies that participate in top-down initiatives supposedly to improve our health are capable of profiteering from government initiatives to get people off benefits. Again: 'Instead of being represented, we are now being managed. The governments in all the western countries manage us on behalf of the international system.'*

*with thanks to Tony Benn (reply to second question)

Gerard Hastings: Mandela points out dangers of smoking to prisoners on Robben Island

In this lecture on social marketing (discussed earlier here), Hastings describes how Nelson Mandela made his fellow prisoners aware that getting cigarettes in prison would involve making deals or exchanging favours with prison guards. I think Hastings is pushing the issue by presenting this as a simple attempt by Mandela to stop prisoners from smoking in the interests of their health. He was – I would expect – far more concerned with the vulnerability of prisoners and how this could be exploited by prison guards, than with the issue of smoking as a health concern. The Mandela clip is right at the start of this:



Actually I find his whole message hard to swallow. 'Doing things with, not to, people'? It takes an entire new academic discipline – social marketing – to encourage people towards behaviour change, and simultaneously to encourage them to believe that the changes in behaviour came of their own volition? It may make a kind of sense to some people – but it assumes that a common core of 'health-oriented' goals will motivate everyone, and this is far from being the case. To quote from our banner,

When health is equated with freedom, liberty as a political concept vanishes.

I find it hard to believe that Mandela, as a freedom fighter, would have espoused denormalisation as a strategy, as it is practised against smokers today. One of Mandela's followers, Steve Biko wrote extensively about what he termed 'Black Consciousness' – the necessity for blacks to think 'Black is beautiful', to take pride in black identity, way of life, economy and political cause. Under a pen name Biko wrote through the years after his banning at the age of 26, until his imprisonment and death in incarceration in 1977 aged 30. For example:

What of the white man's religion – Christianity? It seems the people involved in imparting Christianity to the black people steadfastly refuse to get rid of the rotten foundation which many of the missionaries created when they came. To this date black people find no message for them in the Bible simply because our ministers are still too busy with moral trivialities. They blow these up as the most important things that Jesus had to say to people. They constantly urge the people to find fault in themselves and by so doing detract from the struggle in which the people are involved. Deprived of spiritual content, the Black people read the Bible with a gullibility that is shocking. While they sing in a chorus of 'mea culpa' they are joined by white groups who sing a different version – 'tua culpa'. The anachronism of a well-meaning God who allows people to suffer under an obviously immoral system is not lost to young blacks, who continue to drop out of Church by the hundreds. Too many people are involved in religion for the blacks to ignore. Obviously the only path open for us now is to redefine the message in the Bible and to make it relevant to the struggling masses. The Bible must not be seen to preach that all authority is divinely instituted. It must rather preach that it is a sin to allow oneself to be oppressed. ... Black Theology seeks to depict Jesus as a fighting God who saw the exchange of Roman money – the oppressor's coinage – in His father's temple as so sacrilegious that it merited a violent reaction from Him – the Son of Man. (p. 45)

The abuse of power by whites under Apartheid was extreme and decades-old. Denormalisation of smokers and other groups, in its latest manifestation, is a relatively recent phenomenon. It is hard to imagine Biko or Mandela agreeing that health issues, as defined by senior civil servants and professors in social marketing, should define the aspirations of working people or the unemployed. It is particularly hard to imagine them being taken in by the rhetoric of social marketing – manipulating behaviour change of the powerless by the influential. It smacks too much of saying that the powerless want to be just like the influential (70 per cent of them anyway!). Starting with the missionaries long, long ago, says Biko:

Children were taught, under the pretext of hygiene, good manners and other such vague concepts, to despise their mode of upbringing at home and to question the values and customs of their society. The result was the expected one – children and parents saw life differently and the former lost respect for the latter. ...Yet how can one prevent the loss of respect between child and parent when a child is taught by his know-all white tutors to disregard his family's teachings? (p. 110)

 Hastings is correct to credit Nelson Mandela with leadership skills – but not to imagine that Mandela's heart was won over by an anti-smoking campaign that wasn't in progress when Mandela went to prison and was barely perceptible when he came out.

Excerpts from Steve Biko, I Write What I Like, Penguin, 1988 edition.

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.