Wednesday, 8 October 2014

Thoughts on the Welsh Gov Public Health White Paper eCig Announcement

Yesterday, without any warning, the Welsh (un)Health Minister Mark Drakeford unexpectedly started making initial pronouncements on the outcome of the Welsh Government White Paper. It is quite ironic that he chose yesterday of all days to make the announcement considering that our Petition against the proposed eCig ban in public spaces was publicly presented to the Petitions Committee only a week before, and that the previous day the same Committee approved the Petition and moved to consult Drakeford further on the proposals.

You can watch the announcement and the ensuing debate on Senedd TV on-demand here

If you prefer, you can read the transcript of said meeting here

Unfortunately, the way things went were much as we expected. Drakeford patently fails to understand anything to do with ecigarettes and shows this ignorance with a startling amount of arrogance. As expected he jumped upon the recent pronouncements from the likes of WHO and made several other broad sweeping statements that simply underlined his total lack of understanding of the subject matter.

So, let's start breaking down what he said. For obvious reasons, I am going to concentrate on what he said about ecigarettes,

He started off with the following statement

Wales has a strong and proud record in public health legislation. We have long understood that collective action provides the best basis for improving and protecting the public’s health. We only need to look to the smoking ban in public places to see a good example of how the law can make a real and positive contribution to people’s lives. 

The public health White Paper builds on this radical tradition, making full use of this fourth Assembly’s legislative capability. The need to do so is real and urgent as we address the complex health challenges that we face in Wales. Only last week, the chief medical officer’s annual report again emphasised the need to focus on prevention. We have a responsibility, I believe, to create an environment in which people can make positive health decisions and where, as far as possible, those preventable health problems that blight the lives and prospects of so many can be avoided. In the age of austerity, the imperative to prevent avoidable harm is even more urgent, as finite resources meet a tide of increasing demand.

So he starts off by showcasing the smoking ban as an example of his 'strong and proud record in public health'. This kind of set the tone for what was to come. Interesting that he wanted to emphasise the focus on prevention as that is exactly where ecigarettes have their main focus. He also wants the Welsh Public to make positive health decisions - which is exactly what vapers are doing by switching to the much less harmful ecigs.

He then went on to discuss all of the other elements that made up the Public Health White Paper, rather consciously waiting to bring the most contentious issue as the very last item. So let's examine what he did say.

Finally, we come to electronic cigarettes. Just over half the responses on this matter were copies of a single letter opposing the proposal. Let me be clear once again: there are no proposals in the White Paper to restrict the sale of electronic cigarettes. There are no proposals in the White Paper to ban the use of electronic cigarettes in their entirety. There are no proposals in the White Paper that would interfere with the use of e-cigarettes as an aid to giving up smoking. The White Paper simply proposes bringing the use of e-cigarettes into line with the use of conventional cigarettes. It does so in order to help prevent the renormalisation of smoking; to reduce the risk of e-cigarettes becoming a gateway to smoking itself; and to prevent e-cigarettes from undermining the ban on conventional cigarettes in enclosed public places. 
We received the strongest support for our proposals from those organisations with the most direct experience of these matters. All local health boards, Public Health Wales, local authority enforcement teams and their representative organisations supported the proposal. The British Medical Association in Wales voiced its strong support. In the period since the White Paper was published, I believe that the evidence in support of the Welsh Government’s position has strengthened. Most prominently, the World Health Organization has recommended that e-cigarettes be brought in line with smoke-free regimes, just as we intend for Wales. I remain convinced that anyone charged with safeguarding the future health of the Welsh people would wish to put in place precautionary restrictions on the use of these cigarettes in enclosed public places, as the White Paper proposed. 
 In the very first line of his statement on ecigarettes he makes mention that 'over half' of the responses were template letters. So what ?   Be they template letters or not, the mere fact that people took the time to actually express a view surely tells the Health Minister that people have a strong opinion on this subject and do NOT want them banned from public spaces. I care not for his statement that there is no proposal to ban the sale of ecigarettes (not that he could anyway as that is not a devolved power). We all know that if he gets away with banning ecigarettes in public spaces, he will soon be back to try and extend the ban in such a way as to ban them everywhere and eventually to ban them altogether. That is the way the Bansturbators work. After all, he is already seeking to extend the smoking ban to open spaces.

Once again, he starts banging on about ecigarettes being a Gateway to smoking and that they undermine the smoking ban, despite a plethora of evidence from ASH, Prof West et al that there is NO evidence of such a thing happening. Basically, he has his own agenda on this subject and he is going to be bloody minded and stick to his guns regardless what anyone says. Furthermore, as expected, he jumps upon the WHO recommendations for a ban in public spaces. Why wouldn't he ? It supports his argument down to a tee. It does not matter to him that WHO has not performed a single study on ecigs, nor has it published any research. No, for Drakeford, the fact that WHO support his ideology is good enough evidence for him to press ahead with a ban. He also completely misses the point when he talks about the 'precautionary principle' but we will save that for later in this item.

Then came the turn of the Shadow Health Minister - Darren Millar. Vapers all across Wales know Darren very well by now and know how hard and well he has stood up for vaper,s and been the voice of reason in the Senedd on the subject against the puritanical ideologies of Drakeford. This is what Darren had to say on ecigs.

With reference to tobacco control, I fully acknowledge and support the need for a tobacco retailers register. I think that that is a very positive development. It is something that many organisations have been calling for for a long time. However, the jury is still out on the long term impact of e-cigarettes. As you know, I am not yet persuaded that there is sufficient evidence of harm from e-cigarettes. In fact, to the contrary, there are many people who have come out supporting e-cigarettes as a form of harm reduction and as an opportunity to support smokers to be able to quit. I am not convinced, Minister, that banning their use in confined public spaces in the same way that tobacco smoking is controlled is going to help us to reduce harm from smoking in Wales. If you send people to the smokers’ hut in order to vape, as those people who use e-cigarettes would describe it, it will put them in temptation’s way, among other people who are smoking, and expose them to second-hand smoke risk. 
Way to go Darren. A good opening statement setting out clearly that he does not share Drakeford's views and has not seen any evidence to support Drakeford's stance. He succinctly pointed out one of the first issues of banning vaping in public spaces. That of pushing vapers out into the smoking hut and 'in temptations way'.
You have made reference to the advice of the World Health Organization, but you did not make reference to other research and other articles published in medical journals over the summer recess. People such as Robert West and Jamie Brown of University College London and Ann McNeill, who is a professor in the National Addiction Centre at Kings College London, have all come out and said that there are thousands of lives that could be saved in the UK—hundreds of which would be here in Wales—if smokers made the switch from smoking tobacco to using e-cigarettes. The research that we know is out there suggests that there are one-twentieth of the toxins in e-cigarettes that there are in tobacco cigarettes. As we know, it is not the addiction to nicotine that kills smokers; it is the tar that they also inhale during the course of their smoking. I know that you have some concerns that e-cigarettes will renormalise smoking, particularly for young people. However, the Smoking Toolkit Study in England, which is a monthly survey of the adult population—6,000 people every single month are surveyed—shows that the rise in the use of e-cigarettes has been accompanied by an increase in smoking cessation rates in England and a fall in smoking prevalence. So, some of the information that you are using to shore up your arguments for a ban in some places on the use of e-cigarettes does not fall into line with the evidence that is currently on the table. I admit that further evidence still needs to be gleaned and that still more research needs to be done, and I would far rather see the Welsh Government commission that sort of research before it goes heavy-handed and has an all-out war on e-cigarettes, because I do not think that that is necessarily the right way forward.
He went on to point out how narrow a field of evidence that Drakeford is choosing his evidence from. Darren has clearly been listening to Welsh Vapers who regularly tweet and email him on the issue. He has also plainly been keeping close to the emerging evidence and studies. He is fully aware of where the evidence is coming from and where to find it and shows a level of understanding of vaping that Drakeford simply cannot (or most likely will not) achieve. I personally think he was rather too polite to Drakeford on this subject, but I will forgive him that.
On smoking cessation, the latest research suggests that the use of e-cigarettes in a quit attempt is associated with a 60% increase in abstinence rates compared to other programmes to cease smoking. I think that those are very stark figures, Minister, and we cannot ignore them. So, rather than continue to pursue the view and listen only to certain voices in the e-cigarettes challenge, shall we say, I think it would be much more prudent of the Government, rather than making a knee-jerk legislative response, to commission much more research on this subject so that we can get a better handle on the impact of e-cigarettes, particularly over the longer term. All the evidence to date shows that they reduce harm and that they can reduce the number of deaths. There is very little evidence to suggest that young people are actively taking up smoking as a result of using e-cigarettes too—very small numbers indeed. 
Again, his closing statement above shows that he has done his research. He is using up-to-date information and presents a compelling challenge to Drakeford. Well done Darren !!
So the baton passed back to Drakeford for a response to what Darren had said.
I do not want to spend the whole afternoon dealing with just one strand in the White Paper, but let me say that a good part of what Darren had to say about e-cigarettes I thought was very measured. We have a further year to go before the National Assembly will be discussing the detail of the Bill that we will bring forward, and there will be 12 months of further accumulation of evidence. I was grateful to hear what he said early in his contribution about following the evidence and seeing where the evidence takes us. We are not going, even in that time, to reach a position where there is absolutely definitive evidence on e-cigarettes as to whether they do more harm or whether they do good. The Welsh Government’s position is this: where they can do good, we want to make sure that that good is harvested and that we use it here in Wales. However, where there is evidence that e-cigarettes can do harm—and I believe that that evidence is strengthening all the time—as a Minister for health there is only position that you can take, and that is to be precautionary. You may not be wholly convinced because the evidence will not be there to give you that definitive answer. However, if the risk is there—the risks led the World Health Organization in its authoritative advice to say that e-cigarettes should be legally banned indoors, especially where smoking itself is banned, and that this should be done, as it said, ‘as soon as possible’. That is authoritative advice. If you are charged with the responsibility for protecting the long-term health of the Welsh population, I do not think that it is possible to ignore advice of that sort. It is not advice that is not based on very strong scientific analysis. It is the BMA’s science committee that has led it to support a ban here in Wales and across the United Kingdom. It is the accumulating research evidence of the harm that e-cigarettes can do to children that leads it in that direction. It is why I believe that the balance of evidence is pointing in one direction. We will continue to pursue that evidence over the next 12 months. I hope that Darren will do as he said and continue to pursue that evidence too and continue to keep the dialogue on this important issue going.
Now I actually found this response from Drakeford quite surprising on a number of points. He starts off by acknowledging Darren's 'measured response'. You could take this one of two ways, but the way I interpreted it is that Darren managed to put a significant amount of doubt in Drakeford's mind. The reason I think this is because he said that we have '12 months of further accumulation of evidence'. Now that also indicated to me how slow the whole process is going to be as Drakeford does not expect any of the proposed legislation to make it into law until at least this time next year. This is the first time I have heard any timescale being put to the whole process and I think this provides vapers with a massive opportunity. The evidence against any ban is gathering momentum and more and more of former ANTZ are starting (slowly but surely) to come onside with ecigs. 12 months is a long time in politics (as we found out in the battle against the TPD). We have a massive opportunity to turn this around to our advantage and, as we made great strides in our fight against the TPD (albeit we didn't get the result we wanted, but it could have been much worse), then we can also make great strides here. Drakeford is on very shaky ground. He knows it, and he knows that we know it.

Drakeford clearly wants to find evidence that ecigs cause harm. He stated as much in his response to Darren and even went so far as to state that the 'evidence is strengthening all the time' to support this. Tellingly, he did NOT state what that evidence is. To me, that means he has no evidence and is just praying that 'somebody' will find such evidence over the course of the next 12 months.

However, I am concerned that he considers WHO to be an 'authoritative voice' on this subject. I'm sorry Mark, but WHO are anything BUT an authoritative voice on this subject. They have not conducted any research or studies to be Authoritative. All WHO have done is cherry pick information (just like Drakeford has done) from junk science studies from the likes of Prof Glantz. He then goes on to state how the BMA support what he is doing. The same can be said of the BMA as for WHO. They have not produced one single study or scientific research on ecigs.

Drakeford FAILS to mention that ASH oppose the ban. He fails to mentions that the RCP and CRUK also oppose the ban. These three organisations have as much clout and authority as anything from WHO or the BMA. In fact, in the case of the RCP and CRUK, they HAVE done studies and research. In fact, a large swathe of the currently available scientific studies on ecigs have indeed emanated from the RCP.

There followed a few other AM's speaking, but as they did not discuss ecigs I shall skip over them.

The next person to talk about eCigs was Plaid Cymru's Elin Jones.

On e-cigarettes, very briefly, I am of the opinion that we need to regulate e-cigarettes, certainly in terms of their marketing, their content and their sale to young people and children, and that targeting. I have yet to be persuaded of the need for a ban on their use in public spaces, even after having seen some of the comments made by the World Health Organization. Some people of authority have a different perspective to that, and I am sure that we will discuss that when the legislation is before us.
I think that it is useful, Minister, that you have outlined three tests for yourself and for this Assembly in taking a decision on whether to ban e-cigarettes in public places. Those three tests that you have outlined today are around preventing the normalisation of smoking, reducing the risk of e-cigarettes becoming a gateway, and preventing e-cigarettes from undermining the ban on conventional cigarettes. I look forward to hearing your evidence and the evidence that the Assembly receives on those three tests in particular.
We have heard Elin speak on this subject before and we know that she is 'cautiously' supportive of the vapers point of view. I am not quite sure what she meant by 'regulate ecigarettes' at the start. I think I need to write to Elin to gain some clarification on that. However, I do like the fact that, like Darren Millar, she is not convinced by the evidence presented by Drakeford, not even by the pronouncements from WHO. She states that other 'people of authority' have opposing views and I welcome the fact that Elin recognises this. 
Her closing statement is very telling. I think Elin has seen the evidence from ASH and from Prof West's Smoking Toolkit study. She appears to me to be well aware that ALL the evidence shows ecigs are NOT a gateway, they do NOT undermine the smoking ban and they do NOT renormalise smoking. Elin is playing her cards close to her chest, but I think she knows that Drakeford no such evidence.
Once again, Drakeford was allowed to respond to the latest statement. This time, the answers were thus:
On e-cigarettes, I have heard what she has to say. In the evidence that we received through the consultation, what the people of Wales are concentrating on is the third aspect. A lot of evidence has come in from people working in the field and who say, ‘We are having problems already in enforcing the ban on conventional cigarettes, because it is so difficult to distinguish e-cigarettes from conventional cigarettes’. There has been evidence from some trading standards officers in Wales where prosecutions have failed. They have tried to prosecute people for using cigarettes in taxis, for example, but the person was able to claim that they were using an e- cigarette and not a conventional cigarette, and given the length of time that had elapsed between the event and the court case, the court decided that it was not able to make a finding of guilt. There is an accumulation of evidence in the consultation responses that focuses on the difficulties of enforcing the existing ban. It is why we have organisations right across Wales already enforcing the ban, such as the Millennium Stadium here in Cardiff and the Swansea Liberty Stadium. Why do they do it? It is because, in the concentrated period of times that they have, they cannot afford to have confusion over whether people are using conventional cigarettes or e-cigarettes, because it is making the ban less effective. We have evidence on all three tests, but there is very practical evidence on that one.
 Aah, so people are focusing on the third aspect. Might that be due to the brainwashing the public get from Public Health who are hell-bent on insisting that ecigs are as dangerous as tobacco, even though they KNOW they are not ?

And those poor people 'working in the field'. I'll resist calling them farmers (working in the field, geddit ?), but it must be oh-so-hard to distinguish a tobacco cigarette from my Vamo, Sigelei or VTR. They do look so much like a conventioneal cigarette. After all, they are only SILVER or GREEN in colour and about 20 times the size of a tobacco cigarette. Plus of course, they weigh twice as much and smell a hell of a lot nicer than tobacco cigarettes. How would they know the difference ?

Trading Standards have tried and failed to prosecute people for using cigarettes in Taxis apparently. Now, there are two things to consider here.

No.1 - Since when do Trading Standards investigate or prosecute taxis ?
No.2 - I will assume those Officers have no sense of smell, because I can smell a cigarette from 50 yards away let alone in a taxi. The smell of an ecig lingers only for seconds. If they cannot tell the difference then I would advise them to find another job as they are patently unfit to enforce on taxis.

Again he bangs on about Millenium and Liberty Stadiums banning eCigs. Erm, they are private enterprises. They can ban what the hell they like on their own premises. It does NOT need legislation to help them. Drakeford is patently running out of ideas as he continues to come back to this one time and time again. ASH have even produced an 'idiots guide' on it for christ sake !!
Finally it was time for Kirsty Williams to stand up and have her say. We all know that Kirsty is broadly supportive of vapers. She has even appeared (on video) on VTTV advising vapers what our next steps should be and how to influence Government. 
So here's what Kirsty had to say:
With regard to e-cigarettes, would the Minister acknowledge that there is no consensus of opinion with regard to the evidence yet? He is quite correct in his statements regarding the World Health Organization, but would he not agree that evidence produced this summer, for instance in the journal ‘Addiction’, does point to e-cigarettes being a useful tool for harm reduction? What analysis is the Minister able to ask his officials to carry out with regard to the benefits of e-cigarettes in reducing harm from traditional tobacco as compared with the threats that e-cigarettes pose to public health, which the Minister himself outlined? Is there a way of trying to measure those two factors against one another? However, I would agree with him that we need to continue to look at the evidence and follow that evidence.
 Now I have to admit that I was a little disappointed in the short statement that Kirsty made. However, they had already been warned some time earlier that they were overrunning on time so I will assume that is why Kirsty kept it brief. However, even in her brief statement above, she hits the right notes. She also does not believe the pronouncements from WHO and has also been doing her homework as she appears to have been reading 'Addiction'. She challenged Drakeford for evidence in much the same way as others, but it was just not in the forceful way that we are accustomed to from her.

So, for the final time (on ecigs anyway), Drakeford was allowed to respond to Kirsty. Strangely though, he did not respond directly on ecigs, but rather chose an anecdote.

These debates happen every time a public health advance happens. I spent a bit of my summer reading some Barbara Castle material, from the time when she was Minister for transport and was introducing the breathalyser test and seat belts at the same time. You cannot imagine the abuse that she faced from people who believed that her actions in insisting that people not drink and drive was an assault on human rights and an invasion of the state into areas that the state had no right to go. Yet, we would not dream of going back to the days when people were able to cause deaths on the road in the way that happened then. So, we think about it very carefully, but it does not mean to say that we do not think that there can be times when it is the right thing to do.
 I found this a curious answer (and also disconcerting that he reads Barbara Castle books). He starts by talking about a 'Public Health advance'. I can only assume he is talking about ecigs here as he does not specifically mention them, but if he was referring to ecigs then it interesting that he classed them as a 'Public Health advance' despite his puritanical views. Now the anecdote amused me because if we take Drakeford's 'precautionary principle' as he views it, then seat-belts would not have been allowed to due to the burns they cause in an accident. Seat-belts are most properly likened to ecigarettes - i.e. THEY SAVE LIVES !!

And that was all that was discussed on ecigs. So what have we learnt this ? 


1. We have around 12 months to put a stop to any ban of ecigarettes in public spaces
2. Drakeford is still flailing around for evidence and failing to find it
3. Drakeford is not at all comfortable talking on this subject
4. Drakeford has NOT convinced the opposing parties that a ban is necessary
5. The recently presented eCig Petition will put considerably more pressure on him
6. Vapers still have the upper hand in this argument
7. If the Petition is allowed to be presented to the Senedd, people like Profs West & Hajek and also the likes of Clive Bates will be key in winning the debate. Their presence (if we can get them to speak) would be crucial in not only persuading the Opposition Parties (they seem already clued up), but in persuading any Labour AM's who are wavering.

In ending, I was a little annoyed listening to Drakeford on Senedd TV yesterday, but having had a sleep and gone back to read the transcript this morning, I am probably more hopeful than ever that we Vapers can win this battle - especially now that we know we have maybe another 12 months to go in this fight.

Don't stop believing !!

No comments:

Post a Comment