Saturday, 28 January 2017

Public Health Wales - A Case of Deja Vu

A few months ago, a new Welsh Chief Medical Officer - Dr. Frank Atherton - was appointed. One of the very first public statements he made was to declare that eCigarettes should be banned in public enclosed spaces. This despite the bloody nose that was the failure of the Public Health Bill, due to their insistence on including an eCigarette ban, that Welsh Labour were still recovering from. I had my say about that particular incident here.

Fortunately, Welsh Labour had learnt their lesson and omitted the eCigarette ban from the new Public Health Bill. So it seemed that (finally) sense was starting to make an appearance in Wales.

Unfortunately, this week has proven that Public Health Wales are still living in the stone age when it comes to harm reduction as they have released an extremely lazy position statement on eCigarettes.

Whilst there were some welcome significant shifts in the overall position they have taken, one has to wonder why they keep insisting on cherry-picking advice from overseas bodies such as the (heavily pharma-funded) World Health Organisation and even the universally panned US Surgeon General's appallingly bad and evidence-less report on eCigarettes.

Let's start by looking at my old friend - Dr Julie Bishop - announcement that accompanied the position statement.

At this point, I have to admit that I have some history with Dr Julie Bishop in that I have crossed swords with her on several occasions face-to-face. On each occasion I have had to pull her up on her beliefs and statements. Whilst it is true that her position on eCigarettes has moved from being extremely hard-line to somewhat moderately and 'grudgingly' accepting that eCigarettes have a role to play, I still do not believe she fully understands what eCigarettes are all about. It is possible that her clashes with me have changed her attitude, but given what she does for a living I think it is more likely that her stance has been softened following clashes with Linda Bauld and even Deborah Arnott (ok, ok, calm down at the back).

However, her statement that there are 'confusing and contradictory messages' did make me laugh because she is one of the people putting such confusing and contradictory messages out and the Public Health Wales position statement is a perfect example of this.

So let's have a look at the Public Health Wales position statement. 

The use of nicotine by children and young people is unsafe, it can cause addiction and can harm the developing adolescent brain - there are no benefits to children and young people in using ENDS.  There is concern that ENDS are seen as ‘safe’ but this is not the case, while the health risks of ENDS are significantly lower than cigarettes they are not without risk. 

There are countless studies out there that have found that where Youth are using eCigarettes, they are actually using non-nicotine containing eliquids. Furthermore, why is it that bodies like Public Health Wales think that Harm Reduction should only be available to adults over the age of 18 ?
Where Youth already have a cigarette habit, they should be encouraged to move to the much less harmful eCigarette.

   ENDS should feature alongside other health-harming substances e.g. tobacco and alcohol, in all health education for children and young people, and be presented as harmful to health.

Erm, no. 'ENDS' should be featured alongside tobacco as a Harm Reduction tool. It is much less risky habit than either tobacco or alcohol and should be correctly shown as such in any education material. Children WILL try risky behaviour and it is far preferable if they were to use an eCigarette than a tobacco cigarette if they must indulge in such 'risky' habits.

‘Confectionary-like’ flavours of e-liquid should not be permitted, in order to reduce the appeal of ENDS to children and young people.

Ahh, that old nugget again. PHW seem incapable of recognising that adults like sweet flavours too. As a matter of fact, I exclusively vape sweet and confectionary-like flavours, and have done for more than 5 years - and I am far from alone in this. Besides, one can also buy confectionary-like flavours for condoms, lube, edible underwear and quite likely many more products from the sex-aid industry. Like eCigarettes, sex-aids are an age-restricted (i.e. ADULT) product. So why does PHW want to ban confectionary-like flavours for eliquids, but not for all the above mentioned sex-aid products ?

Furthermore, PHW MUST have heard the evidence that Prof Linda Bauld presented to the Health and Social Care Committee evidence sessions during the passage of the failed Public Health Bill. I cannot remember the exact words that Prof Bauld used, but I do clearly remember her stating that all of her research showed NO EVIDENCE that confectionary-like flavours are any more attractive to Youth than other flavours. When she was challenged on this the statement she used was ' If it is the intention of eLiquid Manufacturers to entice children into vaping by offering these flavours, then they not doing a very good job of it' !!

There is some evidence of the potential for ENDS use to have a negative impact on indoor air quality and therefore represent a risk to health. 

Erm, no there isn't and Dr Julie Bishop should be well aware of this as she was present (as was I) when Professor Marcus Munafo made a presentation to the Welsh Government in 2015 which demonstrated clearly the extensive research his University (Bristol) has done into the effect of vaping on indoor air quality. Prof Munafo's research showed that there were more contaminants in the air from outside influences (such as car-exhaust fumes) and that any contaminants into the air from vaping were 'negligible'. This followed on from similar research and results that had been performed by Dr Konstantinos Farsalinos.
   If you are a smoker who is unwilling or unable to stop smoking now, switching completely from smoking tobacco to using e-cigarettes will significantly reduce the risks to your health.  This advice does not apply to pregnant women who should consider using licensed nicotine replacement products.

Why ?   Surely it is preferable for pregnant women to use an eCigarette than to carry on smoking ?
Or is it simply because other (pharma) nicotine replacement products contain magical nicotine that is harmless compared to the (same) nicotine found in some eCigarettes ?

While addiction to nicotine is not desirable, nicotine is not responsible for the vast majority of harm from smoking cigarettes and other tobacco products.  Nicotine is an addictive substance and can be toxic when ingested in large doses.  It may also contribute to cardiovascular disease, and have long-term consequences for foetal and adolescent brain development.

Oh do keep up Public Health Wales. It is supposed to be your job to stay abreast of the latest research in this area. I am astonished that you have not seen the many studies that shown that nicotine is not addictive when used in non-combustible products - and that includes in eCigarettes. A quick Google would have found much of these studies. But to help you along, try typing the following into a Google Search - KARL FAGERSTROM or even KARL LUND. That's your start-point, you can follow the links from there.

     The potential role of widespread use of ENDS in re-normalising smoking, and there remains a gap in the current evidence base in this area and further research is needed. 

     Use of e-cigs may reduce the likelihood of smokers quitting by displacing scientifically proven methods to help people quit.

    The use of ENDS will act as a gateway to tobacco use.  The absence of longitudinal studies in this area means that it is very difficult to answer this question definitively, but evidence suggests that ENDS use is associated with tobacco use, with the relationship being poorly understood. 

   ENDS, while presenting a lower health risk for existing smokers than tobacco use, are not safe.  There is an international consensus that for non-smokers use of e-cigarettes represents a potential risk to health.

For the hard of hearing (that's you PHW) NO, NO, NO and NO.
There is no evidence of vaping renormalising smoking. If anything, it normalises vaping. Even children who have seen me vape recognise that I have quit smokiing and switched to a safer product. If kids can understand that, why can't you ?
Use of eCigarettes does NOT reduce the likelihood of smokers quitting. I am fast approaching the 6th anniversary of the last time I smoked a tobacco cigarette. There are at least 2 million others in the UK who have made the same journey, and that number is increasing on a daily basis.
There NO (i.e NONE, ZILCH, NADA) evidence that 'ENDS' act as a gateway to tobacco use. Tobacco use is falling in all age groups and that should be evidence enough that your so-called gateway does not exist.
Lastly, nobody has ever claimed that eCigarettes are completely safe. But we do know that they are at least 95% safer and likely much higher than that. Besides there is almost nothing in life that is completely safe. There is risk attached to almost everything you do in your everyday life.

Finally, a word on the so-called 'evidence' quoted in the PHW paper.

Why on earth are you quoting evidence from bodies outside of the UK, when much of the leading and most respected advice on eCigarettes can be found in the UK ?
Try talking to your counterparts in Public Health England as they have a far more enlightened and comprehensive view and evidence-base than that from which you are drawing. You should also read and digest PROPERLY the advice imparted by PHE and the RCP in their position statements.

Finally, you keep inviting people such as Profs John Britton, Linda Bauld, Peter Hayek and Robert West nto come down to Wales and give talks in seminars or briefs to politicians. Yet you fail to LISTEN to what these people are telling you every single time. For goodness sakes, LEARN from these people. I know I have !!

In conclusion, whilst I do welcome the considerable distance that Public Health Wales has moved in comparison to almost puritanical position they held less than 3 years ago, they do still have a long way to go. Public Health Wales need to learn to listen to the experts on their own doorstep rather than the pharma-influenced organisations such the World Health Organisation and the plethora of American organisations they strangely seem to hold in such high esteem. The best research of eCigarettes is being done right here in the UK, and across several European countries.

I cannot help but wonder how much of the PHW statement has been influenced by the presence of such a firm anti-vaping proponent at their head - namely Dr. Frank Atherton, Welsh Chief Medical Officer.

As always, an open invitation is extended to both Public Health Wales and Dr Frank Atherton to meet with me and discuss the issues I have highlighted