The BMJ, e-cigarettes and Scotland

The British Medical Journal clearly expects Scotland to lead on its crusade against e-cigs, as it did with the smoking ban and in the way it has not blinked in its pursuit of plain packaging of tobacco. Fiona Godlee, BMJ editor, declares that the Scottish Government's ambition to end smoking by 2034 will go pear-shaped if it does not take a firm line with tobacco. The Scottish Government along with ex-Mayor Bloomberg of New York earn brownie points with Godlee for taking stern measures against food, drink and tobacco and the paper turns on Bloomberg's action in banning indoor use of e-cigarettes before leaving his post recently. (Godlee uses the word 'smoking', although  you would be no more likely to get smoke out of an e-cigarette than you would out of your kettle.)

There is some unhelpful argument here along the lines of tobacco being normalised by the popularity of e-cigarettes, and it seems based on the assumption that tobacco companies are a significant player in the e-cigarette economy. She says, 'E-cigarettes also legitimise the industry, buying tobacco companies a seat as “partners” at the health policy table'. Not only is this untrue (at least in the view of Rose, quoted here), it is also quite irrelevant to health policy.

Another plank of her paper is asserting that the BMJ will not reverse its decision to decline publication of papers that have been funded by the tobacco industry. This is a related error. The veracity of papers is determined by its content: funding is a consideration, which it is why it is declared, but funding does not determine accuracy or otherwise. Tobacco companies are legal entities and players in the market place and there is no reason to dismiss them from public debate, which exists to allow the weighing of different perspectives against each other. Health policy is another arena in which tobacco companies have a contribution to make (balanced by other interests, obviously); Godlee allows her position that tobacco companies have no place in health policy to influence her view on whether e-cigarettes are a beneficial alternative to smoking. This seems to me to be a conflict of interest, since her desire for tobacco control interests to dominate the health policy arena over-rides the health concern. If this results in the banning of a safe alternative to smoking when medicinal alternatives fail to work, there is at least potential for severe adverse health reactions.

As far as Scotland goes, so far they have backed the UK as shown in this Parliamentary motion published last June:

Motion S4M-06979: Stewart Maxwell, West Scotland, Scottish National Party, Date Lodged: 12/06/2013

New Restrictions on Electronic Cigarettes

That the Parliament welcomes the decision by the Medicines and Healthcare Products Regulatory Agency that electronic cigarettes (e-cigarettes) will be licensed as a medicine in the UK from 2016; understands that the new classification will assist in ensuring that the promotion of these products to children and non-smokers is prohibited; regrets however that this decision will not be implemented for a further three years; believes that any change in the classification of e-cigarettes should ensure that they are sold only by appropriately licensed premises; highlights that e-cigarettes are currently unregulated and the associated potential health risks are unknown, and encourages smokers to take the advice of the British Medical Association, which directs patients to regulated products and licensed nicotine replacement products to help quit smoking.

 *S4M-06910 Stewart Maxwell: The Scottish Directors of Public Health and E-cigarettes—That the Parliament welcomes the position of the Scottish Directors of Public Health (SDPH), which, it believes, has strongly advocated that NHS policies on tobacco should treat electronic cigarettes (e-cigarettes) the same way as normal cigarettes; understands that SDPH has claimed that the use of e-cigarettes in NHS grounds perpetuates the idea that smoking is normal behaviour and acceptable in public areas; believes that the potential of e-cigarettes as a tool in harm reduction and the risk that they pose to health and safety is still to be determined; notes that smokers who wish to quit can use evidence-based nicotine replacement therapy products and contact NHS Smokeline to find out further information, and urges them to use one or both of these approaches instead.

This shows that the party leading Scotland to independence in the referendum this coming September has a steep learning curve on the subject of e-cigarettes. Vapers in Scotland should renew their efforts to brief parties that support the independence project with their concerns about regulating e-cigarettes, especially in the event of a yes vote. (In the event of a no vote I predict that not much will change, because Westminster is top-down rule.)

Does the World Health Organization want to kill tobacco growing in Africa?

Antonio Abrunhosa thinks so. He is the CEO of this organisation (International Tobacco Growers' Association) and you can see him in action here:



The Lagos writer of this piece, Torin Orugun, takes issue with the idea that WHO is out to destroy the tobacco industry. He cannot find any direct evidence that tobacco control expects tobacco not to be grown in Africa.

The motions on these topics are lengthy and involved and I haven't looked through them either to find evidence that WHO wants to kill off the tobacco industry in Africa. However the writer has accepted the view that tobacco kills, and that Articles 17 and 18, which concern the development of alternatives to tobacco growing, take into account the impossibility of  rushing this process. He quotes a local Framework Convention Alliance member who accuses the ITGA of being a tobacco front group (the ITGA, representing  several million farmers across the globe, has three staff including its chief executive. If it is funded by the tobacco industry it is not funded well), which wants to undermine the credibility of the World Health Organisation's Framework Convention on Tobacco Control, using the farmers as a vehicle.

The case of the ITGA is that the people working on developing alternatives to tobacco in developing countries do not know about tobacco, and far from wanting to understand the experience of tobacco farmers, they actually exclude them from their discussions. Even government representatives from departments other than health are not really welcome. The delegations then hear criticisms of the contributions of the tobacco industry, including its participation in debt bondage and child labour (see link to Articles 17 and 18 above). This is disingenuous as it is a feature of poverty and characterises other industries as well. This website on child labour mentions tobacco only as one of many forms of child labour: there is no guarantee any form of agriculture replacing tobacco would be able to eradicate it. See also video at the foot of this piece.

Orogun mentions the mechanism by which all parties to the Convention must work by consensus before motions are adopted, denies that there is any plan to ditch tobacco farming and quotes people who criticise ITGA for their lack of positive comment on the positive health impact of the Framework Convention on Tobacco Control. He seems to conclude that representation within the World Health Organisation is fair and effective, and that it is beyond reproach on the basis of its stated aims.

Much as I agree that it is not healthy for a single industry to control agriculture in any country, as tobacco is held to do in Malawi, it is also bad that an international body that is accountable only to its members (delegates who have limited personal experience in tobacco cultivation) should control policy in member countries of the FCTC in a way that denies participatory rights to those involved in the tobacco industry. If tobacco is too dominant, this is not a problem that should be resolved by people outside the country with a clear agenda to reduce tobacco consumption. The conflict of interest is overwhelming. The balance of a country's economic and social needs should be tackled from within.


5 minutes 30 seconds in, report of an Argentinian tobacco project that has led the way locally in eliminating child labour. Source

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.

The vested interests of (ahem) tobacco companies, and private meetings

This month Ms Duffy blogs on the Guardian's revelations that tobacco industry funding had assisted newsagents in their campaign against the display ban, covered in a story here just over a week ago.

ASH Scotland's concern with tobacco industry 'vested interests' is natural. Any industry has 'vested interests' in public policy debates that affect its products. Less wholesome are 'competing interests', especially in the field of tobacco control: this is where a lobbying group claims they are acting in the public interest, even though private interests benefit from their lobbying activities. Even the British Medical Journal published a note of concern about this issue.

Ms Duffy also refers to a meeting that was 'publicised' by the Scottish Licensed Trade Association, where 'retrograde moves' and 'backwards looking, expensive and unworkable' proposals were discussed – the whole thing financed by tobacco companies. Simon Clark has quite rightly pointed out that not only was the meeting private, but also funding it was a matter of necessity. Publicly funded Ms Duffy with no anxieties about her next meal (cool salary offered here, and it's not even the top job)  huffs about tobacco money going to fund private trade meetings on topics vital to their commercial survival.

Interesting that with this kind of track record, pharmaceutical companies – the ones who feed the tobacco control industry – are regulated with such a light touch in Scotland. Incoming MSPs take note.

Education, Education, Education: the global reach of tobacco control training

Increasingly you can get good training in tobacco control in different parts of the world: today we feature India and Romania.

The Public Health Foundation of India, in cooperation with the John Hopkins Bloomberg School of Public Health and the Keck School of Medicine at the University of Southern California offers three-month courses tailored to professionals in health, journalism, law enforcement, the legal profession and administration.

Just in case you wondered about the course content for journalists (I did), it's here. After completing course no. SCJR 2011 for journalists, participants will be able to:

• Understand the basic concepts of tobacco control
• Understand different media approaches to deal with the issue of tobacco control
• Describe the impact of globalization on the civil society intervention in the area of tobacco control
• Examine the effectiveness of media activism in tobacco control
• Understand specific role of Journalists in augmenting tobacco control efforts in India

Doesn't this speak volumes about the autonomy and independence journalists are meant to have these days? Isn't this just a little bit designed to prejudice one's understanding of the issues? There is a lecture on 'the role of journalists in tobacco control'. The courses are for the benefit of those 'full time working professionals who want to make a difference in the communities through tobacco control and enhance their career development'. 

If on the other hand you are based in south eastern Europe, the Smoke Free Partnership is your training provider. Your TobTaxy training takes place in Romania in September, aimed at picking teams of three people to work in each of Romania, Bulgaria, Malta, Turkey, Greece and Cyprus. TobTaxy, believe it or not, means 'Making tobacco tax trendy'. This particular project is funded by the EU till 2013, and is designed to  by improve (ahem) people's understanding of tobacco and taxation issues. They expect an 'increased number of visits and interaction between the public health community and the Ministries of Finance'. That's where to go if you want an all-expenses-paid boost on the tobacco control career ladder.

It may be that many people attempting these courses, whether in India or south eastern Europe, are sincere in wishing to relieve their compatriots of their dependence on the weed. Unfortunately the entire set-up is funded with an agenda that's not about learning: at least, not as I grew up to understand learning. An outcome of TobTaxy is expected to be 'formulation of rebuttal arguments through skilled debate and strategic action'. We used to learn to write essays in order to present an argument, but modern-day learners in tobacco control learn arguments for the sake of putting the other side down.

Carl V. Phillips runs a useful discussion on Conflicts of Interest, showing that 'adamance' (an unyielding attitude) can constitute a conflict of interest, depending on one's stated claims. The stated claims of the entire public health shebang are of course public health improvement. The subtext states that the tobacco industry and its associates must not be allowed to influence health policy, according to article 5.3 of the Framework Convention on Tobacco Control. Carl Phillips:  '... a good test of a position is whether its proponents can make a plausible case for it when the opponent's views are not even considered'; the plain fact is that tobacco control's strategy has relied on stamping out opposition. The whole movement's engine is a conflict of interest, because it seeks to block tobacco and associated interests from access to public policy debates (while the movement itself profits from pharmaceutical funding), all the time claiming an over-riding concern for public health.

Report: global treaty blocked by big tobacco

Yet another report accuses Big Tobacco of obstructive behaviour in face of tobacco restrictions laid down by the WHO FCTC (World Health Organisation Framework Convention on Tobacco Control). This is because it is preparing legal action (in Uruguay in this case), and seeking influence in others.

The FCTC is the first international treaty designed by the World Health Organisation. Among other things it seeks to compel its member organisations to general workplace smoking bans that should extend to 'other public spaces, as appropriate' (Article 8), the provision of smoking cessation facilities (Article 14) and the exclusion of tobacco interests from any policy discussions involving public health (Article 5.3). All this is a lot to demand of member states, because they all have social and economic ramifications, not to speak of their obligations to legislate in the national interest, rather than on the whim of unelected global authorities: however such considerations are less important to the WHO than keeping big tobacco under control.

All this is quite bizarre. Tobacco control is arguably a low priority for many people who are more exposed to communicable diseases than we are in much of the West, or whose income depends on tobacco, or on other people using it. These things are more critical in areas of the world without social security.

The World Health Organisation behaves as if tobacco were really a major health threat to most people. But the tobacco industry is still a legitimate industry and if its legal trading rights are threatened it will think like a company and go to court. And in truth, although the World Health Organisation is a global power it is not economically neutral but promotes interests that compete with tobacco: pharmaceutical interests. Article 14 envisages pharmaceutical alternatives to nicotine being made available and affordable with the assistance of the FCTC. What else do you do with a competitor who is trying to eliminate you from the field, but go to court?

Before I'm accused of being a tobacco apologist, I'll say this. Tobacco is now the world bogeyman, and I do believe in sane tobacco control. I don't mind a few health warnings here and there, and properly enforced age verification. But I do mind being taken for an idiot. The biggest global rival to big tobacco is big Pharma. These people have done a lot of good (like many people, I owe them my life at least two or three times over), but they are essentially huge mega corporations competing with each other. Every so often they do things that really damage their reputations, such as allowing Guatemalan prisoners to be infected with STDs (or even, to take it to absolute extremes, inventing Zyklon B) . But officially we are supposed to trust them.

That's why they are dangerous, and actually far more dangerous than tobacco, because we expect good from their products. This link alleges that what happened 64 years ago in Guatemala is 'just one crime in a long history of medical–government collusion to use humans as guinea pigs'. The public is getting a little more sceptical and increasingly reluctant to take flu jabs. They can see the repeated warnings that turn out to be an anti-climax. This piece on bird flu alleges that key advisers to the WHO on vaccines are also involved in contracts with major pharmaceutical companies. With so much dirt in its own back yard, why is the World Health Organisation making such a fuss about smoking?

How do they expect us to believe the battle between WHO and tobacco represents a clear case of 'health versus wealth' when the personal fortunes of hangers-on to the WHO are at stake, exceeding by thousands the incomes of people whose livelihoods are disrupted by smoking restrictions?