Monday, 20 April 2015

Did 1 in 20 Irish smokers start out on e-cigarettes?

In my post about the Irish Cancer Society's promotion of Nicorette yesterday, I didn't mention one little factoid that will doubtless be parroted by anti-ecig zealots in the Emerald Isle for years to come, namely...

The study also showed that five per cent of people currently smoking started after using e-cigarettes and the potential for them to become a 'gateway' drug for cigarettes was also highlighted by the ICS as a cause for concern.

The Irish Cancer Society (ICS) provides no link to this mysterious study and it has not been published, so we have no clue as to what this claim is based on, but it sounds highly improbable, to say the least.

Estimates of how many smokers there are in Ireland differ wildly, from 29 per cent according to the EU and OECD to 19.5 per cent according to the Irish health department.  With an adult population of 3.8 million, there are between 730,000 and 1,000,000 smokers. Are we to believe that between 36,000 and 50,000 of them had never tried smoking until they tried an e-cigarette?

It would be amazing if no young people ever experimented with e-cigarettes, but research to date is pretty clear in finding no 'gateway effect'. In the UK last year, ASH said "there is no evidence from our research that e-cigarettes are acting as a gateway into smoking". Office for National Statistics data show that e-cigarettes are used almost exclusively by smokers and ex-smokers, and a study earlier this month also found no evidence of a gateway, with its lead researcher saying:

"There are some concerns at the moment that the growth of e-cigarettes may be helping to get a new generation of young people addicted to nicotine. At the moment, that doesn't seem to be the case. There doesn't seem to be too much reason to worry that that's actually happening."

And yet the ICS, citing some unpublished research, reckon that one in twenty smokers started out using e-cigarettes? It defies belief, particularly when you look at the demographics.

It's well known that the vast majority of smokers had their first cigarette before the age of 20. Since e-cigarettes have only been widely available for the last few years, nearly all the people who supposedly used them as a gateway to smoking must therefore be under the age of 25. That narrows the field considerably, as this graph—from the Irish Health Executive—shows:

If, as this graph says, 15 per cent of Irish smokers are under the age of 25, about a third of them (5 per cent) must have been vapers first if the ICS claim is true. I can't prove that this is a lie, but it sounds very much like one. There just aren't enough non-smoking vapers to make it credible. The ICS's own briefing paper on e-cigarettes says:

...there are approximately 134,000 e-cigarette users in Ireland. The vast majority of these are either current tobacco smokers or former tobacco smokers and there is little evidence that the devices are used by people who have never smoked tobacco.

This is borne out by a graph that the percentage of Irish non-smokers who are current users of e-cigarettes is, er, zero.


To be fair, use by non-smokers is not totally non-existent. Four per cent of them have 'tried once or twice'—a quick puff here or there perhaps—and one per cent had 'used in the past', but none of them are vapers in the sense of being regular users. How can e-cigarettes be a gateway when non-smokers aren't interested in them in the first place? What is supposed to be the narrative here? Do non-smokers try e-cigarettes 'once or twice' and then immediately abandon them and start smoking instead? They'd have to do so in massive numbers if the claim that five per cent of the country's entire smoking population—most of whom are over the age of 35, let alone 25—started out with them were true.

As I say, I can't categorically prove that this is a lie, but the fact that non-smokers hardly ever try e-cigarettes, that almost none of them start using e-cigarettes regularly, and that research from the rest of the world has found no evidence of a gateway effect makes it very hard to believe that tens of thousands of Irish people are so keen on vaping that they decide to take the much more expensive and unhealthy decision to start smoking tobacco. The five per cent claim reeks of BS, but that won't stop it being trotted out until the twelfth of never.

Saturday, 18 April 2015

The Irish Cancer Society's hard sell

I see the Irish Cancer Society has just made its contribution to the global campaign of e-cigarette misinformation. From the Sunday World...

A study conducted by the Irish Cancer Society has cast doubt on how useful e-cigarettes are in helping smokers quit.

The survey, conducted in March, found that using e-cigarettes may in fact increase smokers dependence on nicotine as the lack of regulation is creating the potential for long-term use.

Why shouldn't people use them long term? What's it got to do with the Irish Cancer Society? But note, straight away, that it's regulation they want.

They studied 1,150 people and they found that e-cigarettes are now used by 210,000 people in Ireland but 2/3s of those using them also used other tobacco products at the same time.

So a third of them are not smoking and, since we know that the vast majority of e-cigarette users are smokers when they first try them, this fact is clearly good news for 'public health'. If e-cigarettes help 33 per cent of those who try them to achieve abstinence from tobacco then they are an order of magnitude more useful in smoking cessation than any nicotine products produced by Big Pharma. Why don't the pharmaceutical industry's products get this kind of sustained abuse from cancer charities?

"This survey clearly shows that right now e-cigarettes are not a quitting aid as some people are led to believe,” says Kathleen O’Meara, Head of Advocacy and Communications for the Irish Cancer Society (ICS).

The survey quite clearly does that e-cigarettes are a quitting aid for very many people. You'd have to be an innumerate moron not to be able to see that.

“E-cigarettes are becoming an increasingly popular choice for smokers looking for a healthier lifestyle and to save money. But there are better, more proven ways to quit smoking than choosing devices that still have no regulations in Ireland.”

 Is this a sales pitch?

Currently, e-cigarettes are not regulated as a medicinal product by the Department of Health, and the ICS have called on the Department to do so to bring it in line with other Nicotine Replacement Therapies.

That's the pharmaceutical industry's line because they want to stifle the competition with expensive and unnecessary regulation. It's not the line of many people who are involved in smoking cessation and know what they're talking about. Are you sure this isn't a sales pitch?

“Nicotine is addictive and giving up is tough. There are more effective treatments that have been proven to increase your chances of quitting up to four times. E-cigarettes are not one of them.”

Wait, this is a sales pitch. Why would the Irish Cancer Society be lobbying for the pharmaceutical industry? If there's one thing these guys hate it's a perceived conflict of interest, so surely they wouldn't ... they couldn't... Oh yes, they are...

 

As I said when Alcohol Concern started hawking drugs last year, the mentality is "it's not a conflict of interest when we do it". But the Irish Cancer Society's pitch is so transparent, so unsubtle, and so obviously taken not only from the pharmaceutical industry's playbook but literally from their advertisements, that no sentient reader can fail to see what's going on here.

America's conflict of interest with e-cigarettes

This well made video nicely explains why California (and other US states, for that matter) are so keen to clamp down on e-cigarettes. People talk a lot about conflicts of interest, but this is a real one.






Friday, 17 April 2015

Tim Stockwell: merchant of doubt

The campaign to pretend that moderate alcohol consumption isn't good for you continues this month in the pages of Addiction and it's no surprise to find Tim Stockwell taking up the cudgels. Stockwell is one of the world's leading neo-temperance activists, the author of the Canadian Minimum Pricing Miracle study, and is determined to return us to the days of Scientific Temperance Instruction when alcohol was deemed unsafe at any level.

The methods of these people are becoming clear. They find heterodox evidence, exaggerate its importance, ignore the wider literature and declare victory. They are particularly fond of using what Deborah Arnott once described as "literally a confidence trick: the appearance of confidence both creates confidence and demoralises the opposition." They behave as if the benefits of moderate consumption were a bizarre urban myth and sporadically declare that the conventional wisdom which, they claim, has long been teetering has finally collapsed.

Stockwell did this in 2012 and got delightfully smacked down by two scientists. He did it again in 2013 in an op-ed titled 'Another serious challenge to the hypothesis that moderate drinking is good for health?' Mike Daube did it a few months ago in the BMJ in an op-ed titled 'Alcohol’s evaporating health benefits' which said the consensus view was based on "outdated evidence and wishful thinking". And Stockwell is at in once more in Addiction this month with an op-ed titled 'Has the leaning tower of presumed health benefits from ‘moderate’ alcohol use finally collapsed?'

Perhaps they think that the scientific consensus can be defeated by opinion pieces in journals? Where exactly is their evidence? The study Stockwell was getting excited about in 2013 found that moderate drinkers had a 24-46 per cent lower rate of death from cardiovascular disease and that "never alcohol users also had a greater risk of death than lifetime light users". It included this graph showing a clear J-Curve.


The study that Mike Daube treated like a game-changer in February used a crude statistic trick to downplay clear evidence in its own data that drinkers had lower mortality rates than teetotallers. It's going to take more than this piffle for the deniers to overwhelm the mass of evidence supporting the alcohol J-Curve.

In a characteristic move, Stockwell brings up the old 'sick quitter' hypothesis (first mooted way back in 1988) and talks about possible confounding. He even cites a study from 2005 which raised this question, but he fails to cite any of the studies that have tested the hypothesis by excluding people who were (a) sick, and/or (b) quitters. These studies found that moderate alcohol consumption was still associated with lower rates of cardiovascular mortality and/or lower overall mortality—eg. here, here, here and here. Stockwell doesn't mention them. I wonder why.

The more you study these people's behaviour, the harder it is to make the obvious comparison. They ignore the majority of the evidence, they focus on outlying studies that support their argument and they persist in arguing about statistics long after the arguments have been resolved. These are the tactics that got the tobacco industry labelled 'merchants of doubt' in the twentieth century. And that is what neo-temperance activists are when it comes to the alcohol J-Curve in the twenty-first century.

Thursday, 16 April 2015

Party manifestos - the lifestyle issues

All the major political parties have now published their general election manifestos. As predicted, they are mostly lacking detail on issues of 'public health'—ie. lifestyle regulation—but such detail as there is suggests that the nanny state will be thriving for at least another five years. Here are the main points from each manifesto...


Conservatives

Non-specific on most lifestyle issues. They claim to be "helping people to stay healthy by ending the open display of tobacco in shops, introducing plain–packaged cigarettes and funding local authority public health budgets." There is no mention of any other anti-smoking policies, presumably because they're waiting for ASH to tell them what to do.

They say they're going to "take action to reduce childhood obesity and continue to promote clear food information" but don't say how. There is a similarly vague promise to "become smarter when it comes to crime prevention, dealing with the drivers of crime such as drugs and alcohol."

And that's about it. No mention of e-cigarettes, food, soft drinks or alcohol. However, they say they will "create a blanket ban on all new psychoactive substances, protecting young people from exposure to so-called ‘legal highs’." This is very naive. Legal highs are not imported or marketed as psychoactive substances, but as pond-cleaners, plant foods and so on. If it was as simple as bringing in a "blanket ban", the government would have done it years ago.

Verdict: Disconcertingly vague. A pig in a poke.

Labour

Labour says it will "take targeted action on those high strength, low cost alcohol products that fuel problem drinking" but does not say how. Tellingly, minimum pricing is not mentioned; Ed Miliband distanced himself from it several months ago.

They will also "will set maximum permitted levels of sugar, salt and fat in foods marketed substantially to children." This could be construed as mandatory product reformulation or as an advertising ban by the backdoor. Whatever the intention, there are lots of products that cannot be reformulated so say goodbye to commercials for chocolate bars, for example, before 9pm. A bit depends on how they define "marketed substantially to children", but this is terrible idea that will be bad for consumers, bad for broadcasters and won't do a thing to reduce obesity.

There is also a mention of "a levy on tobacco firms" which amounts to arbitrary looting. The Tories consulted on this idea recently and decided that there were too many unintended consequences. Also difficult to see how they are going to tax the profits of companies that are based in Switzerland.

On gambling, Labour says it will "give new powers for communities to shape their high streets, including power over payday lenders and the number of fixed-odds betting terminals." This sounds like the "healthy high streets" fascism I wrote about last month.

Other than that, no mention of any anti-smoking or temperance policies. In fact, the entire section on "prevention and public health" only lasts one paragraph. Like the Tories, they know it's not a vote winner.

Verdict: Pretty dire, but would probably have been even worse if they listed everything they had in mind.

Lib Dems

The Lib Dems plan to "Introduce Minimum Unit Pricing for alcohol, subject to the outcome of the legal challenge in Scotland". Like the Tories, they boast about "taking tobacco off display in shops and introducing standardised packaging", but don't seem to have come up with any other ridiculous anti-smoking policies other than introducing a "tax levy on tobacco companies" (subject to a consultation).

They also want to "Restrict the marketing of junk food to children, including restricting TV advertising before the 9pm watershed". There is no definition for 'junk food' so I assume they mean High in Fat, Salt and Sugar (HFSS) in which case say goodbye to commercials for bacon, cheese, cakes, biscuits, most soft drinks and numerous other food products before 9pm. This is just censorship. And they plan to "Encourage the traffic light labelling system for food products", although they can't mandate it because it is an EU competence.

Like Labour, they want to "Protect high streets and consumers by granting new powers to Local Authorities to reduce the proliferation of betting shops and substantially reducing the maximum stakes for Fixed Odds Betting Terminals."

The Lib Dems are the only party to explicitly mention e-cigarettes in their manifesto, saying that they will: "Carefully monitor the growing evidence base around electronic cigarettes, which appear to be a route by which many people are quitting tobacco, and ensure restrictions on marketing and use are proportionate and evidence-based. For example, we support restrictions on advertising which risks promoting tobacco or targets under 18s, such as those introduced in 2014, but would rule out a statutory ban on ‘vaping’ in public places."

Verdict: Typical Lib Dems. They might be democrats but they certainly ain't liberal.

UKIP

UKIP explicitly opposes minimum pricing and will "reverse plain packaging legislation for tobacco." They will also amend the smoking ban "to give pubs and clubs the choice to open smoking rooms provided they are properly ventilated and physically separated from non-smoking areas".

As a bonus, they plan to save half a billion pounds a year by "Clamping down on so-called ‘fake charities,’ or state-funded political activism." Excellent and very relevant since the nanny state enterprise is led by state-funded 'charities'.

These sensible policies are slightly offset by a promise to "update licensing laws" by limiting the maximum stake on fixed-odds betting terminals from £100 to £2.

As they intend to hold an EU referendum, the awful e-cigarette regulations in the Tobacco Products Directive won't apply if the public votes to leave (this also applies to the Tories if Cameron keeps his promise).

No mention of food or soft drinks, presumably because they plan to leave them alone.

Verdict: Liberal in the uncorrupted sense of the word.

Greens

Bonkers from beginning to end, the Green manifesto is an orgy of bans and taxes. A ban on the sale of foie gras, a ban on fracking, a ban on hunting any animal for sport, a ban on circus animals, a ban on keeping rabbits in cages etc., etc. The main lifestyle policies are as follows:

"Put a minimum price on alcohol of 50p per unit." Yawn.

"Reduce the alcohol limit for drivers to as close to zero as is practicable." Predictable for a party that hates motoring in any form (unless it's chauffeur driven).

Increase the tax on tobacco and alcohol by £1.4 billion per year (!), equating to a roughly 10 per cent annual rise. Idiotic and illiberal.

"Extend VAT at the standard rate to less healthy foods, including sugar, but spend the money raised on subsidising around one- third of the cost of fresh fruit and vegetables." They think this will suck another £6.7 billion out of people's pockets. Perhaps it will.

They don't mention fixed odds betting terminals. This must be an oversight since I'm sure they'd like to ban them too.

They do, however, say they want "an evidence-based approach to the step-by-step regulation, starting with cannabis, of the drugs currently banned under the Misuse of Drugs Act as well as ‘legal highs’, with a view to introducing a system that reduces harms and brings the market under state control as a potential tax revenue generator." So it's not all bad. Quite.

Verdict: The perfect party for people in 'public health'—bossy, socialist and authoritarian.

Wednesday, 15 April 2015

Hurrah! A stupid law is wrecking an industry!

Last December, the Scottish government lowered the drink-drive limit from 80mg to 50mg per 100ml of blood. As has been widely reported, this has led to a 30 per cent drop in pub sales and is another hammer blow to the pub trade courtesy of the 'public health' racket.

This is depressing news, unless you are a journalist at the Independent, in which case damage to the economy is an end in itself...

Scotland's new drink-driving law is so successful it's damaging the economy, according to Bank of Scotland report

Scotland’s tough new drink-driving law is proving so successful at stopping people from indulging that it is damaging financial growth, according to one of the country’s top economists.

Wow. Is that what it's come to? Apparently so, as the theme was further developed in a pisspoor article in Vice yesterday that was positively gleeful about the coup de grace being delivered to Scottish pubs...

Scotland's New Drunk-Driving Law Is So Effective It’s Damaging the Economy

A new Scottish drunk-driving law introduced in December is proving to be so effective that it is actively damaging the economy, according to a Bank of Scotland (BoS) report published yesterday. It's a report that raises a number of questions, the most pressing of those being: Yo, how much of the Scottish economy is built on the cornerstone of people drunk-driving?

To which the answer is: Yo, being drunk has got nothing to do with it. The point of drunk-driving laws is, quite obviously, to stop people driving whilst drunk. When the breathalyser replaced roadside sobriety tests, the limit was set at a level below which anybody could reasonably be described as drunk. Indeed, it erred on the side of caution so that it would be a safe level for a little old lady and a heavyweight boxer alike.

Scotland has decided to jettison that limit and make the limit effectively zero, as 'public health' campaigners demanded. This has not only scared people off drinking one pint during the day, but from drinking much in the evening in case they are tested the next morning. It is this effect on people's evening drinking habits that really motivates the neo-temperance lobby. For the teetotalitarians, the negative consequences are a feature, not a bug. It's got nothing to do with road safety. It is about making people drink less, full stop. As the Independent notes...

The new law, which came into force in December, reduced the legal alcohol limit for Scottish motorists from 80mg to 50mg in every 100ml of blood. Drivers have been warned that having “no alcohol at all” is the only way to ensure they stay within the limit – and to avoid planning car journeys for the morning after a night drinking.

The thing is, people who drive with 50-79mg of alcohol in their system are not drunk and therefore cannot be drunk-drivers. They were not drunk last year and they do not magically become drunk just because a bunch of worthless politicians suddenly moved the goalposts. It is no more a 'crackdown' on drunk-driving than raising to age of consent to 21 would be a crackdown on paedophilia. It's an irrelevance, a distraction, a gimmick.

Reducing the drink-drive limit is a classic example of legislating for the sake of it. Everyone disapproves of drunk-driving so Something Must Be Done. You could try to enforce the law as it stands or you could piddle around with a new law with socially and economically damaging consequences. No prizes for guessing which option the Scottish government went for. Why bother going after the small minority of inebriated motorists when you can hassle people who have a swift half after work or who had a few drinks the night before? When you can't govern, legislate.

What's interesting about the Independent and Vice articles is that they are rejoicing in people drinking less in pubs as if that were the measure of success. Results have been divorced from putative intentions. The aim of drunk-driving laws is not—or, at least, should not be—to arrest people who are perfectly fit to drive, nor is it to close pubs down. The aim is to reduce alcohol-related traffic accidents.

On that score, there is very little evidence that reducing the blood alcohol limit makes any difference at all. 'Public health' and temperance campaigners often complain that the UK's limit is higher than nearly every other European state. This is true. Only Malta and Switzerland have a limit of 80mg, so they—along with the UK—must have more alcohol-related traffic accidents, right?

Er, no. I can't find the figures for Malta but the WHO have data on what percentage of road accidents involve alcohol. As you can see below, the UK and Switzerland both do better than average.


Looking at the total number of deaths on the road (per 100,000 motor vehicles) Britain and Switzerland also do significantly better than average.


This is not to say that Scotland won't see a decline in traffic accidents. Perhaps it will. But if it does, it will probably be because the government has reduced the number of journeys people make and thereby reduced the amount of traffic on the roads, not because it has deterred people from drunk-driving.

Tuesday, 14 April 2015

Packaging doesn't make people start smoking - study

This study was published in the European Journal of Public Health a couple of weeks ago. You won't have seen it reported anywhere and no 'public health' campaigners have mentioned it on Twitter, for reasons that will become obvious.

It looks at the factors that influence young people's decisions to start smoking.

Respondents were allowed to select up to three among the following response options: ‘your friends smoked’; ‘your parents smoked’; ‘you liked the packaging of the cigarettes (or other tobacco products)’; ‘you liked the taste or smell of tobacco’; ‘you liked menthol cigarettes’; ‘you liked cigarettes with a specific sweet, fruity or spicy flavour’; and ‘cigarettes were affordable’. Respondents who indicated that they started smoking because their friends smoked were classified as having initiated smoking under the domain of ‘peer influence’ and those who mentioned that they started smoking because their parents smoked were classified as under the domain of ‘parental influence’. All other responses were grouped together as ‘tobacco product features’, as the numbers of respondents who indicated each one as an influence were small.

Small, indeed. In fact...

No significant association between design and marketing features of tobacco products and an early initiation of regular smoking was observed (OR = 1.04; 95%CI 0.83–1.31).

The researchers found "no significant within-group differences were observed for design and marketing features of tobacco products". The results are shown below.


'Tobacco product features' include not only the packaging, but also flavours such as menthol. As any smoker knows—and as this study confirms—these factors simply do not register as a cause for people to start smoking. Nevertheless, the EU is legislating to ban menthol and the UK is legislating for plain packaging.

The reason for that, folks, is that 'public health' is not an evidence-based enterprise.