Stirling is proud to present ...

... The 'independent' academic review on plain packaging. The Department of Health has so described this document in this statement: last paragraph on the first page.

The Stirling Observer finds its local university at the centre of the plain packaging campaign, and is justifiably proud. It quotes Professor Linda Bauld:

Professor Bauld added: “This systematic review forms the basis for the UK wide consultation on whether plain packaging should be introduced. The studies we identified and describe in the review were remarkably consistent in their findings

(well, there's a surprise)

and clearly set out what effect plain packaging could have. 

“The public consultation will take place from April to July and will help the government to decide whether the UK will follow Australia’s lead, where plain packaging will be introduced by 2013. 

“I’d encourage people to have a look at the evidence set out in our review, make up their own minds about the issue and respond to the consultation.”

Thanks for that, Linda. (In case anyone wishes to take up this invitation, this is worth reading, from Dick Puddlecote.)

Equally proud is the adorable Richard Simpson MSP:

*S4M-02667 Richard Simpson (Mid Scotland and Fife) (Scottish Labour Party): Plain Packaging of Tobacco Review of Evidence—That the Parliament congratulates the academics from the University of Stirling Management School, who have conducted a systematic review of plain tobacco packaging, which it believes has led to the UK Government’s consultation on whether tobacco should be sold in standardised, or plain, packaging; notes that the study team included Professor Gerard Hastings and Professor Linda Bauld, both of whom are members of the UK Centre for Tobacco Control Studies; notes that the review of evidence focuses on whether cigarettes should be sold in plain packs to reduce the attractiveness of the brand packaging and making the health warnings clear; further notes that the study claims that, in over three dozen other studies, it was shown that plain packaging can help smokers in three ways, by increasing the prominence and effectiveness of health warnings, by making the pack, and thereby smoking, less appealing and by removing the confusion about the relative harm that pack design can cause, and calls on all those who have concerns about the substantial number of new smokers each year in Scotland, who it understands are predominately young people, to respond to this consultation.

(Richard Simpson MSP is to be remembered for denying there was any need for a watertight case that the display ban would work. No doubt he feels the same about plain packaging.)

The 'independent' academic review in question is 'independent' only insofar as it is not officially part of the Department of Health. At least four of its six authors and at least two of their four institutions are set up to fight tobacco use and are funded for that purpose: to 'discover' (ad nauseum) the harms of tobacco and recommend restrictions on its use. Hardly objective or even a study, this is an attempt to assemble a brief in support of what government plans to do. Calling it an independent academic review is disgraceful and dishonest, and sadly what we have come to expect from the government in relation to tobacco control.

Just wouldn't it have been nice to have included the views of Ukraine, the US Chamber of Commerce, TransAtlantic Business Dialogue and other US business organisations that have protested, the International Chamber of Commerce, Brand Republic or even British American Tobacco? Perhaps an 'independent' academic review could have ensured representation of these views in the report, and even academics from relevant disciplines for assistance in compiling it.

But the wisdom of the health lobby trumps all of them.

Nicotine patches: change of tune from the UK Centre for Tobacco Control Studies

From this:

The prevalence of smoking is higher among Pakistani and Bangladeshi males than among the general population. Smokers who receive behavioural support and medication quadruple their chances of stopping smoking, but evidence suggests that these populations do not use National Health Service run stop smoking clinics as frequently as would be expected given their high prevalence of smoking. [emphasis added] 

To this:

FREE nicotine patches or intensive counselling via an NHS helpline do nothing to help smokers quit, says a Government- funded study.

This latter study is led by Tim Coleman, and the earlier study was co-authored by Rachna A. Begh, both of the UK Centre for Tobacco Control Studies. Three years elapsed between the two pieces.

What are the policy implications? The concluding paragraph of Tim Coleman's study is non-committal:

In England, where support for smoking cessation is available to all smokers either free or at relatively low cost, adding additional proactive telephone counselling or an offer of free nicotine replacement therapy to usual quitline care did not affect smoking cessation rates. On the basis of this study, providing these through a quitline is not recommended.

and:

What is already known on this topic

• Quitlines can support large numbers of smokers in achieving smoking cessation.
  
  
• The most effective and cost effective methods of support through quitlines need to be determined.

What this study adds

• Among callers who sought help to stop smoking through the English quitline, offering free nicotine replacement therapy was no more effective than standard support by the quitline.
  
  
• Cessation rates were not improved by offering additional telephone contacts with advisors providing proactive counselling.
  
  
• Offering free nicotine replacement therapy or proactive support were no more effective than standard reactive quitline support

It is tempting to ask what nonsense we have been fed for the last few years about NHS being four times more likely to quit. Freedom2Choose has raised this question more than once in the past (also here).  Three years ago the mantra 'four times more likely to quit with NHS help' was received wisdom.

The Department of Health page making this claim is now archived.  However, new Department of Health guidance, dated 2011/2012, lists Nicotine Replacement Therapy with an A evidence rating ('the recommendation is supported by good (strong) evidence').  Make of this what you will. (The same document gives Champix an A evidence rating, and states there is 'no clear evidence' of a link between taking Champix and increased depression or suicidal thoughts.)

This is an extremely messy picture. The notion that NRT doesn't work is backed by other evidence besides Tim Coleman's study, but it is not supported by the Department of Health guidance linked above. Nor is it reflected in the Scottish 'Give it up for baby' campaigns, which routinely supply free patches, and pay expectant mothers to make use of the quitting service. The  body promoting 'Give it up for baby' is, rather sinisterly, named NMSC (National Social Marketing Centre), with the slogan 'leading behaviour change'. Instead of evidence-based persuasion, we have psychological manipulation of people's behaviour to suit the whims of policy makers and planners. Behaviour change could well take priority over the supporting evidence, with planners claiming that 'the ends justify the means'.  (Incidentally Tim Coleman has also recently 'discovered' that patches don't help pregnant women stop smoking either.)

Prediction: the UK Centre for Tobacco Control Studies will call for 'more research' to solve the problem of quitting; the Department of Health and National Social Marketing Centre will continue to promote the use of nicotine patches.

More on Wales: vending machines ban goes live

I'm a week late on this but it's still worth including because of the debate between Simon Clark and the ASH Wales representative, Carole Morgan-Jones. Caught out early on by the BBC interviewer, who asks Morgan-Jones how she knows the quantities of cigarettes sold illegally through vending machines that need to be banned because they cannot be monitored, she fails to substantiate other than by saying 'studies done by the UK Centre for Tobacco Control Studies', and essentially suggesting that the policy is formulated on the basis of anonymous surveys. She then all but claims that radio controlled or other vending machines would not stop children buying tobacco because bar staff are too busy to check ID properly (this line of argument emerges at the end when time has run out). This is nonsense: anyone dealing with age-restricted goods has to carry out age verification.  The only real modification that radio controlled vending machines would have required would have been ensuring age verification awareness for personnel in hotels, launderettes, cafeterias and other outlets where machines were accommodated.

Angela Harbutt (Liberal Voice) crosses swords with Lord Faulkner

Further criticism of Lord Faulkner's article yesterday comes from Angela Harbutt, new entrant to the world of professional campaigning who is now working on the hands off our packs campaign. Angela's voluntary campaigning has produced blog posts like this in the past.

She takes issue with Lord Faulkner's view that tobacco companies have undue influence with politicians by pointing at the raft of recent legislation restricting smoking, and points instead to the disproportionate influence of tobacco control.

If there is a need for transparency – it is a need for government to come clean on just how much public money is being spent on Tobacco Control and just how far the tentacles of Tobacco Control have reached into government health policy. It might not be a bad idea to also get a truly independent body to evaluate how effectively this money has been spent. In August 2010 Eric Pickles MP announced that the government was going to stop "government lobbying government". This must surely apply to Tobacco Control.

She points out that like many of us in the population, her campaigning has so far been voluntary.

What drove me to campaigning? A richly funded and politically active health lobbying industry that has agitated constantly to price out of reach, limit access to, or otherwise bully people into ending consumption of, things deemed undesirable or unhealthy.

She has accepted payment from Forest to undertake a campaign against plain packaging.

Perhaps not surprisingly, her piece was published with Lord Faulkner's response immediately below.  It has since been edited, but the original read as follows:

For Angela Harbutt to compare "Big Tobacco" to organisations devoted to improving public health is laughable, but hardly surprising from someone who admits to being funded by FOREST, an organisation set up by the Tobacco Manufacturers Association to promote the interests of the tobacco industry.

Leaving aside the point that Angela Harbutt has not been paid for her previous five years of campaigning, rendering the point he makes inaccurate, Lord Faulkner somehow also has the belief that Forest was started as a tobacco industry front group. Its actual funding from tobacco companies is listed on the front page of its website. Simon Clark of Forest wrote to the PoliticsHome website pointing out the error, and clearly His Lordship has no evidence for his belief (other than that it is received tobacco control wisdom): hence the corrected version.

All that is left to Lord Faulkner after his attack on Angela Harbutt are (1) the somewhat pointless supposition that not smoking would save many hundred thousand lives, (2) the assertion that it is important that universities participate in studying the causes of disease (is that what happens in universities party to the UK Centre for Tobacco Control Studies, which seems to have a loaded name) and (3) the suggestion that tobacco is the only consumer product that kills when used as intended. That old chestnut – never mind the fact that alcohol, salt and now sugar are catching up fast.

Does that mean that the health lobby will be fighting within itself for resources soon? That will show them as the one-trick ponies they are.

EDIT: background to latest edit of Lord Faulkner's response.

Start Champix earlier in quit attempt and it might work, says Pfizer study!

Pfizer's new study claiming that starting earlier on Champix would improve its effectiveness couldn't come at a better time. This drug has maimed countless lives, and is the subject of a black box warning. Peter Hajek of the UK Centre for Tobacco Control Studies (no competing interests of course) and colleagues 'compare the effect to making food look unappealing. "The level of hunger pangs may be the same, but it is easier to resist a food that has become less tempting," they note.'

This is a poor comparison. Messing with someone's brain doesn't resemble disfiguring somebody's dinner. 

The people at the UK Centre for Tobacco Control Studies know how ineffective many quit attempts are.  Another member, Tim Coleman expressed this view in November:

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

His solution was to attempt to get funding for people to take smoking cessation drugs (NRT) in the longer term as a kind of damage limitation exercise. A similar assessment comes from the Tobacco Control blog, discussing Turkey's new anti-smoking facilities:

It’s worth remembering that, if the Turkish experience mirrors international evidence, every hotline call represents several other smokers who have decided to quit on their own. Even in countries with excellent, and often free, quit resources, more than 80% of smokers quit cold turkey (pun intended!) on their own.

An editorial discussing this study comments: 

One in five Americans smokes [...] and only between 4 and 7 percent of those who try to stop succeed. 

 These people know what a poor success rate smoking cessation drugs have. Yet huge amounts of money are spent promoting them, even on solutions like Champix which occasionally spell disaster for those taking it and their families.  

ASH Scotland is on a crusade to persuade the managers of Scottish mental health facilities to remove smoking rooms. Their next event will 'explore the new implementation guidelines' published by the Scottish government. No doubt they will be urged to ensure that smoking cessation meds are always available to patients who are forced into a no-smoking regime at a catastrophic time in their lives. Stopping people from smoking trumps every other consideration.

UK National Smoking Cessation Conference 2011

The dates and venue have been announced for this year's major annual trade conference in the calendar of the anti-smoking industry. It'll be held in London on Monday 13 and Tuesday 14 June, at the Novotel London West Hotel.

Further details will be released closer to the date, but expect a line-up of seasoned tobacco control advocates from throughout the UK, sponsorship from major pharmaceutical companies and the manufacturers of breath-testing equipment, and hundreds of publicly funded delegates assembled to learn how to push medicinal nicotine (they'll all walk out of the conference with folders and hessian bags emblazoned with the UKNSCC logo).

These are guesses based on last year's conference. A few of us waved banners outside the Radisson Hotel, Glasgow last June, and it did have an impact: one or two delegates seemed genuinely astonished that anyone would want to protest against their conference.

Our placards: the slogan on the right has also been used on demos in the US

Eddie poses with Sheila Duffy: Radisson Hotel, Glasgow

You'll get an idea about the likely agenda of the conference here. The home page of the UKNSCC site gives a brief preview of the 2011 conference (we can look forward to a nicotine vaccine, for example), mentioning  treatments that are 'known to be effective such as nicotine replacement therapy'. See this paper to discover how untrue this is: 'Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date,' says Tim Coleman of the UK Centre for Tobacco Control Studies, in a bid to keep smokers on nicotine cessation medication for the longer term.

For the smoking cessation industry, smoking restrictions represent marketing opportunities. Smoking bans already exist in workplaces, but last year's conference reported local projects that discourage parents from smoking at home: this slide presentation features a Glasgow project. Using potential damage to children as a pretext, 'intervention' to make smoking difficult at home will become more popular among enforcing authorities (discussed today at Dick Puddlecote's place).

Pressuring people to use nicotine substitutes rather than expose their children to smoke will become more common: this seems to be what the smoking cessation industry means by 'harm reduction'. Given the lack of any significant evidence linking passive smoking to specific cases of ill health or mortality, I find it hard to believe that exposing children to smoke is usually harmful (and the idea that it can be described as child abuse is absurd). The idea that pharmaceutical companies are helping to create pressure to 'denormalise' smoking in the home is far more likely than the idea that secondary smoke harms kids, in homes where fresh air is reasonably abundant.

So I will be looking out for the agenda of this conference. It won't be the only smoking cessation conference this year, but it involves significant players in the UK anti-smoking industry.

Anti-smoking group in Scotland celebrates studies promoting tobacco display ban

Two studies published in Tobacco Control on Thursday, both endorsing the display ban on the basis of research done in Ireland. One study (Evaluation of the removal of point-of-sale tobacco sales in Ireland) recorded high rates of compliance, reports of quitting made easier and lower estimates of youth smoking. The other study (Economic evaluation of the removal of point-of-sale tobacco sales in Ireland) shows that the display ban has had no impact upon shops, and not led to any decline in tobacco sales over and above long-term trends.

Both stories originate with the University of Nottingham (UK Centre for Tobacco Control Studies), and both are funded by Cancer Research UK. It is thus of little surprise to read that Sheila Duffy welcomed the studies: 'the tobacco retail display ban, which has been in place since 1 July 2009, has changed young people's attitudes to smoking and not resulted in any harm to businesses'. She could hardly not support them:

1. Because the studies were published in Tobacco Control, part of the British Medical Journal group of journals. 
2. Because the studies were funded by Cancer Research. 
3. Because most of the authors have good credentials in tobacco control (and/or social marketing!)

Both institutions have a clear agenda to promote tobacco control, indeed Cancer Research explicitly states that research projects that seek funding from the Tobacco Advisory Group should favour further tobacco regulation.

This is in essence policy-driven research, and not good.

ASH Scotland, funded by the Scottish Government, promotes the display ban because of uncertainty about whether  the Coalition will choose to enact the legislation south of the boarder. (This is why I had no qualms in asking people to request MPs to vote against the English display ban. I had no doubt at all that antis would be at work lobbying MPs to vote the other way.)

And what do the studies tell us?

• Lower product recall in adults and young people.
• Fewer young people estimated that over one-fifth of young people smoked.
• Fourteen per cent of smokers thought that the law made quitting smoking easier.
• Thirty-eight per cent thought fewer kids would take up smoking. And from the economic study:
• No significant short term change in tobacco sales.

This is all about perception: whether it is perceived that fewer young people currently smoke, that more people can easily stop smoking and that fewer young people will take it up. And no change in tobacco sales. Hardly a ringing endorsement of the policy, or worth much of Cancer Research UK's money.

But perhaps Cancer Research and Tobacco Control involvement are enough to make some readers think that the studies' results must provide unequivocal support for the tobacco display ban?

About Government Lobbying Government

Forest's new report, Government lobbying Government, shows the amount of public money used to fund organisations, including charities, that campaign in favour of smoking restrictions. 

Highlights (lifted from report)

• Action on Smoking and Health (ASH UK) received a direct grant of £142, 000 from the Department of Health in 2009 (£191,000 in 2008 and £210,400 in 2007). In addition, it received £110,000 from the Welsh Assembly Government in 2007.
• In 2008-09, ASH Scotland received total funding of £921,837 from the Scottish Government.
• In December 2009, ASH Scotland received a £500,000 grant from the BIG Lottery to fund a major three year research project into smoke-free homes in Scotland.
• ASH Wales received £115,800 from the Welsh Assembly Government (tobacco control services) in 2008-09 and £113,000 in 2007-08.
• The charity No Smoking Day received £221,600 from the NHS regions (through the Department of Health), £25,000 from NHS Scotland, £8,000 from the Health Promotion Agency for Northern Ireland and £30,000 from the Welsh Assembly Government Health Promotion Division in 2009-10.
• The Department of Health does not appear to know how much public money is spent overall on the Smokefree network of tobacco control groups that have developed over the last 10 years.
• In 2008 Smoke Free North West secured funding totalling almost £1.9 million from the PCTs to “complement core national funding”.
• The UK Centre for Tobacco Control Studies has been funded with £3,694,498 over five years, commencing June 2008. It was also awarded a £1.2 million grant to develop and pilot several projects to implement smoking cessation services.[emphasis added]

ASH Scotland is remarkable both for its size (27 staff, as opposed to eight for the UK section) and for the central grant it attracts from the Scottish government, which, last count, was nearly a million pounds. Sheila Duffy claimed last year when giving evidence to the Health & Sport Committee regarding the tobacco display ban that she is not permitted to lobby using government money (she got Cancer Research money for her latest report Beyond Smoke-free, which is outright policy advocacy). This money is used only for carrying through government policy. The grant, over £900,000 last year, enables ASH Scotland to act virtually as an extension of a government department – so why is it designated a charity? The money it gets from the public in the form of voluntary contributions is derisory.

I suspect Sheila Duffy will quarrel with the title of Forest's report and insist that she is meticulous about what she spends on lobbying. However I suspect the public perceives her as a lobbyist in spite of the 2 per cent that her budget allows her to spend on lobbying. ASH Scotland's status as a charity still comes into question, even if the latest External Review was quite uncritical of the organisation's funding and methods (Scottish Government summary of the organisation's findings). Although the organisation might tick a few charitable-sounding boxes, such as trying to narrow health inequalities by its efforts to reduce smoking levels, it has distinct political and policy objectives, and should not be treated as a charitable body. 

***

Pleas for exemption from the cuts have come from both sides of the border: from Sheila Duffy herself in a letter to the Caledonian Mercury, and from members of the body scattered round various British universities known as the UK Centre for Tobacco Control Studies, in a letter to The Lancet. Both plead the case for continued government funding of smoking cessation (insisting that smoking is 'preventable' in spite of their minimal success in preventing it). The letter to The Lancet concludes by saying:

We declare that we have no conflicts of interest.

Even Sheila hasn't got that much cheek.

Professor Pell: tribute from Snowdon, Blastland and Dockrell

Chris Snowdon's blog has this, reproduced from early 2009, to amuse us while he's away. Since Professor Jill Pell recently came back into the news with her asthma-drops-by-18-percent story, I decided to link to it here.

Michael Blastland's critique of Jill Pell's 17-percent-heart-attack study dates from November 2007: although not the first criticism, it was probably the first dedicated thumbs-down to emerge from the BBC, but this did not prevent the study's findings going three times round the solar system and back before the study itself was published in the New England Journal of Medicine the following summer.

It's quite incredible (or ought to be) that representatives of the UK Centre for Tobacco Control Studies seriously considered Pell's study has any foundation in sound science when a comparable English study found only a 2.4 percent drop in heart attacks – and even this study was not borne out by statistics. The researchers guessed that there were 'already' smoke-free venues in England, and this accounted for a lower drop in heart attacks in England than in Scotland. A considerably lower drop, in fact. Actually the English tried for a 10 percent drop before they settled for 2.4 percent, but even though 2.4 sounds more believable and carefully calculated, it still doesn't rely on the data.

The third party in this story is ASH (UK)'s policy officer.

What do you mean, no conflict of interest?

An interest to declare – go to the UK Freedom-2-choose blog for this one. These people were heavily involved in the 2010 UK National Smoking Cessation Conference that took place in Glasgow in June. Yet they feel they have no interest to declare when writing to protest to the government that their services are being cut.

Smokers paid to quit in Perth, Scotland, in spite of dismal success rates in Dundee

More chaos in the world of smoking cessation as Perth becomes the next place where smokers will be paid to stop smoking.

To its credit, the Courier points out that a very low proportion of Dundee smokers have succeeded in quitting in spite of an investment of £530,000. It claims that 'fewer than one in ten are known to have quit for good' - the only surprising thing about this is seeing it in mainstream news media.

Chemist & Druggist have a view here, acknowledging that the success of cessation schemes is low but suggesting that paying pregnant smokers to quit may get better results. This was (of course) covered in a session at the 2010 UK National Smoking Cessation conference, by Linda Bauld of the UK Centre for Tobacco Control Studies, a body with publicly declared conflicts of interest. It is quite phenomenal that a drug that is known to work in a very low number of cases is supported not only with publicly paid prescription charges but also with funds to encourage people to make use of it. Academics whose careers depend on promoting smoking cessation medication, and those who profit directly from the sale of such treatments, seem able to do both without arousing public ire.

Last word to Johann Hari, who comments in an unrelated piece:

The Cranfield School of Management studied 170 companies who had used management consultants, and it discovered just 36 percent of them were happy with the outcome - while two thirds judged them to be useless or harmful. A medicine with that failure-rate would be taken off the shelves. [my emphasis!]

I wonder if he has ever studied the issue of smoking cessation medication?