Novartis support for smoking bans spelled out

Hat tip to Dave Atherton for this link to Novartis's statement on public policy and advocacy.

Claiming an ethical basis for their activities they give the following on their involvement in smoking:

It is sometimes claimed that pharmaceutical companies exercise undue influence on governments and pursue commercial objectives without taking into consideration society's interests. We consider it our responsibility to provide decision-makers in government with the objective and fact-based information needed to formulate sound health policies. 

Our lobbying and advocacy efforts focus on increasing access to the best medicines and to health information globally, while preserving incentives for research and innovation through competitive pricing. In addition, we believe that it is in the interest of companies striving for a leadership role in corporate citizenship to campaign for policies and regulations which favor ethical business conduct. [emphasis added]

[...] 

An example of how Novartis is contributing proactively to the health policy and disease prevention debate in Europe is the question of smoking cessation. Tobacco is the single largest cause of avoidable death in the EU and over half a million people die each year in Europe as a direct or indirect result of smoking. It is estimated that 25% of all cancer deaths and 15% of all deaths in the EU could be attributed to smoking. 

Until recently, efforts by European regulators to reduce smoking were concentrated mainly on the introduction of 'smoke free' legislation which prohibits smoking in certain environments. Novartis believes that greater public health benefits could be achieved through a policy of smoking cessation, coupled with increased duty on tobacco. 

Novartis is campaigning to encourage policies to complement non-smoking environments with smoking cessation, with nicotine replacement therapy (NRT) as an important component of an EU strategy on tobacco control. 

Together with various NGOs, we helped to foster a 'Smoke Free Partnership.' Our aim is to foster a policy and legislative environment which leads to better public health through strong tobacco control measures and increased availability of NRT in line with the WHO Framework Convention on Tobacco Control.

It clearly acknowledges lobbying for conditions that favour its commercial objectives, namely NRT sales. Perhaps these well-meaning souls actually believe what they are saying, which is effectively that they are whiter than white, use only the best peer-reviewed evidence, care very much about citizens' health (and, of course only incidentally, can make a comfortable living into the bargain).

It is a favourite trick of the tobacco control industry to portray tobacco as 'big business' that is ruthlessly exploiting the little guy. But this company, and the entire pharmaceutical sector, is even bigger business. Somehow tobacco is unduly tarnished on the grounds that it is a big business, even though its rivals in the nicotine market are favoured and allowed to contribute to public policy. They have the ear of government, and can also engage in this kind of activity with the intelligentsia.

One result is that a whole lot of well meaning people with benevolent intentions can reduce people's capacity to make their own, usually faulty, choices about food, drink or smoking. The angle that is not acknowledged is the money that is made in the process. Not only does this benefit large corporations financially at the expense of smaller communities, but it also empowers them at the expense of these communities (probably on many issues beyond the lifestyle ones usually addressed here). Thanks to lobbying of this kind, we have the smoking ban and further restrictions, which have damaged pubs and recreational environments and will go on to damage shops. The whole fabric of economic society is at the mercy of those at the top.

I hesitate to call this kind of thing fascism (the collusion of corporations with the state?). But I still don't like it, because it looks to me as if the rightness of it is taken for granted by the whiter-than-white who engage in making decisions on behalf of everyone else, without apparently caring about the economic ramifications for the wider public – and failing to acknowledge their own dependence on the wider public for their survival.

Non-report on smoking cessation in Aberdeen

Under the heading 'No smoking targets on track', we are told that 'Over 20 thousand people have tried to quit smoking in the NHS Grampian area over the last year'.

They're not even bothered about success now, an attempt is all they're looking for.

In Dick Puddlecote's latest, he links to this, which discusses the use of NRT as a long-term strategy rather than one limited to 12 weeks.

I wonder how they'll express their targets in future ... more people using gum and patches? Yet more people attempting to give up smoking but let's not talk about whether they managed it beyond the first four weeks?

Don't forget to attend to DP's other link:

only a small amount of data is available concerning the safety of persistent NRT use. At the present time we therefore have no basis for declaring that the population of long-term users are under cover (we are only able to state that persistent use of NRT is undoubtedly safer than the continuation of smoking). Consequently, there is a need to conduct large-scale studies with the primary aim of monitoring for misuse of OTC NRT and assessing the possible physical and mental health risks of persistent NRT use.

Sheila's blog recommends quitting for Scotland

ASH Scotland takes up the 'new year quit theme' (although without backing in the form of free nicotine patches from the government, which is being offered by the Department of Health in England), exhorting people to quit smoking in order to save money – for Scotland as well as for the sake of personal financial and health gains.

Sheila Duffy refers to the ASH Scotland report Up in Smoke in support of her plea to stop smoking for Scotland. This report estimates woeful logic and shameless guesses in order to force the figure for smoking-related costs up above the figure for revenue.

Unlike Action on Smoking and Health (UK), Sheila's blog post refers almost positively to alternative smoking cessation treatments and willpower.

There is a lot of help and advice out there to support smokers thinking about quitting. Lots of people can quit through willpower alone – and often find it easier than they thought it would be. Many people find alternative therapies help them.

Admitting that people can quit smoking through willpower alone is new in anti-smoking circles. ASH Scotland's reference to alternative methods of quitting on its website is almost reasonable:

Complementary therapies like acupuncture, hypnosis or laser therapy, help some people to stop smoking but there is a lack of scientific evidence to support their effectiveness and they can be expensive. If you are interested in using a complementary therapy, find out about the therapy and choose a registered therapist before you commit yourself to a course of treatment.

The effect is spoiled by the assertion that NRT and Zyban 'have been tested in scientific trials': even developers of nicotine cessation treatments know this is bunkum. But at least Sheila has acknowledged that some people find that willpower and therapies other than NRT, Zyban and Champix work. Contrast the page on non-NHS therapies on the Action on Smoking and Health website.

Smoking cessation is an industry these days: at least, some people treat it as an industry (and a ruthless one too). Look forward to a major trade conference on smoking cessation drugs and therapies to be held in 2011.

Nicotine based smoking cessation treatments available to Scottish children

This is not a new story: nicotine replacement therapies have been approved for people as young as 12 since 2005. General Practitioners in Scotland were sent updates on good practice in 2007, in order to remind doctors that, following research, NRT was considered safe for 12–18-year-olds and pregnant women as well as other adults.

I came across this story when the Herald reported it in 2007. I wrote it up here (the link to the Herald story is at the foot of the page), and it is clear that the comments (mostly very critical of prescribing NRT to young people) have been edited out.

Two of the people mentioned in the Herald piece, Linda Bauld and John Britton are both leading figures in tobacco control, involved with the UK Centre for Tobacco Control Studies. Their interest in tobacco control as a growing concept is clear, even though they don't have direct personal commercial interest in nicotine products.

Recommending nicotine for young people doesn't seem sound to me but not being a medic I'm not in a position to make detailed comment.  However, I don't like the fact that comments have been censored from the Herald article (the words '0 comments' imply that no comments were ever made, which is patently false).

Three-quarters relapse after four weeks, says smoking cessation researcher

You read it here first. Well maybe not.

Ex-smokers should be kept on medication for much longer to prevent them relapsing, concludes an NHS cost-effectiveness evaluation.

The systematic analysis of trials found the current system - where quitters were supported for four weeks should be extended – with medication prescribed for at least three months.

Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date [emphasis added]

Do they tell you this at the same time as they are saying you are four times more likely to give up with NHS help? Okay then: a method that doesn't work too well could be given three times as long to work (as the austerity cuts bite). That sounds very cost-effective.

Tracking people for longer than four weeks is probably a good idea on the basis that the non-drug support is equally as effective as the pharmaceutical support, and many services probably do it. A Wandsworth GP is reported in this account to be cautious about too much reliance on drugs: 'support is key,' he says. The report on the cost-effectiveness of treatments however is authored by Tim Coleman, a man whose career rests on smoking cessation medications, whose competing interests are listed here. Some promotion of smoking cessation drugs is to be expected from someone with his track record.

Why is it that interests in pharmaceutical companies don't arouse any suspicions in official minds, when corner shops are mistrusted because of their tobacco connection, in spite of their meagre takings per pack? If a competing interest is enough to get you excluded from the policy debate, as the tobacco companies are, why are Tim Coleman and his colleagues still involved? Are they supposed to be above the suspicion associated with competing interests because they are involved in health issues or because the focus of their work is against tobacco?

Jobs for the boys? Get into smoking cessation, son, you'll have a job for life! Government will support all your endeavours!

Other interests also operate in the field of smoking cessation drugs: this report shows a postcode lottery of stop smoking cessation medications depending on commission earned by pharmacies for treating patients with them: earnings between different PCT areas range from nearly £12 to over £140. (That looks like a fair attempt to reduce health inequalities.)

Like anything else, access to smoking cessation drugs depends for most people who want to quit on government funding . Considering the cost issues and the uncertainties and dangers of various treatments, readers who want to stop smoking should be aware of this page. Competing interest: John Polito is a smoking cessation adviser who is opposed to drugs, and he has books to sell.

Banned from claiming that e-cigs are a stop-smoking aid

Authorities are trying to gain regulatory power over the sale of e-cigarettes. The Food & Drug Administration in the US has now informed e-cigarette companies that any claim that their products help people stop smoking are not legal since they are not scientifically verified:

The warning letters state that all five companies have run ads claiming that their products can be used to help quit smoking. The FDA has determined that the liquid in E-cigarettes is a drug and that the E-cigarettes themselves are drug-delivery devices, which the manufacturers dispute. The FDA says in its letters that it is illegal for the manufacturers to claim their drugs can be used as a smoking cessation treatment without FDA approval first. The agency says the companies have conducted no clinical trials or shown scientific evidence supporting their claims.

This kind of thing must make the public – especially those of the American public who have given up smoking using e-cigarettes – wonder about the purpose of anti-smoking legislation in the US. A few states have actually banned e-cigarettes from sale, citing safety concerns. There is no suggestion anywhere, however, that e-cigs prompt nearly as much concern for safety of users as cigarettes do, and one of their selling points is (unfortunately) that they don't give off secondary smoke.

Banning e-cigarettes, while leaving tobacco on open sale, borders on lunacy. Not only because it is illogical in terms of an anti-tobacco policy, but because it shows how clearly this has to do with controlling the market share in nicotine use and smoking cessation. Clinical trials have not demonstrated convincingly that approved smoking cessation medication effectively stops people smoking. Champix is tainted with well grounded safety concerns, documented by users, and is the subject of lawsuits. Tobacco too clearly raises concerns among policy makers, yet remains legal (rightly so). The only product to be threatened with restrictions is the e-cigarette.

Former smokers, who have turned to electronic cigarettes in New York, New Jersey and other states that have leapt on the e-cigarette banned-wagon have had their choices severely limited. Do they give go back to smoking? Or turn to quit products like nicotine replacement therapy? My guess is that they will realise that their product of choice has been taken off the market for spurious reasons, connected with Control, $$, anything in fact other than health, and regardless whether they go back to smoking tobacco their confidence in the authorities will be severely undermined.

Both formally and informally, data and information on e-cigarette use are still being collected.

Decisions about regulation have yet to be announced in the UK. This link considers the implications of regulating/banning e-cigarettes in the UK.