Professor John Britton's UKNSCC conference address supporting e-cigs, summer 2013

Having predicted that e-cigarettes will destroy tobacco control I decided look further for signs of hostility on the part of major tobacco control players towards e-cigs. I started with Professor John Britton, a leading light in the UK Centre for Tobacco Control Studies.  Professor Britton spoke in favour of the motion 'The field should be positive about the development of e-cigarettes' (the only part of the debate that seems to have been recorded). His opposer was Jean King of Cancer Research UK. The debate is accessible from this link and includes a slide presentation.

The debate addresses tobacco control's fears that tobacco companies use the e-cigarette market in e-cigarettes to buy respectability and even a place at the public health table, from which the tobacco industry is excluded.

I have to admit that Britton surprises me in some ways in this address: first by describing the non-medical nature of e-cigarettes as a 'strength'. He sees it definitely as an asset that smokers are using e-cigarettes heavily. His evidence tells him that smokers use them overwhelmingly as a tool to stop smoking, and in general he is in favour of them.

He also points out the involvement of pharmaceutical investment in the smoking cessation conference itself, and notes that pharmaceutical investment is an accepted part of life. Not only does he ask whether it is acceptable to take money from pharmaceutical companies and decline it from others, he goes so far as to point out that pharmaceutical companies have in some respects a murderous safety record. (I'm now trying to work out exactly what he means by this: surely not that tobacco money is acceptable?)

As to whether the tobacco industry's involvement should be a cause for alarm, he illustrates deftly how hard it would be to advise smokers against specific electronic products, because ownership and investment in these by tobacco and other companies shifts all the time. The key, he concludes, is to regulate the product, not the manufacturer. I'd love to hear Jean King's case against this, indeed the rest of the debate.

Britton's closing slide shows a technician at his university who has stopped smoking 'on his own' with the help of an e-cigarette. The technician doesn't want him (as a tobacco control policy leader) to interfere with the flavourings. It seems clear that at least some professional tobacco control practitioners feel ownership of this new tool in the box that they can use to help people stop smoking. But the technician, using the e-cigarette, has not needed Britton's professional help.

If anyone knows whether the rest of the debate was recorded I'd love to hear it!

Persuading families not to smoke at home: a how-to guide from the UK National Smoking Cessation Conference

From Laura Jones at the University of Nottingham comes this review of research on initiatives to discourage people from smoking in the home, presented in an audio clip and slide show.

The abstract page contains (as standard) a declaration of no interest, even though it was funded from the UK Centre for Tobacco Control, some of whose staff have clear interests in the nicotine replacement therapy market.

Personally I found the soundtrack quite difficult to listen to, especially when Dr Jones says that inadequate rules about where smoking is allowed in the household (that is, rules that don't amount to a complete ban) might as well not be in place at all. I find it difficult to accept that level of what is politely called 'intervention' where I live (in fact I need not worry on that score as I neither smoke nor have children).

I can see tobacco control experts being content with an absence of legislation in this area: all the more reason to undertake further research into the most effective ways to persuade people not to expose their children to 'second-hand' smoke. But at what point (to paraphrase the title of Chris Snowdon's blog) will the velvet glove become the iron fist?

And will the children whose health is of such concern today find themselves at the receiving end of an iron fist in the future?

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.