0
0
0
s2smodern

Harry Shapiro Director DrugWise

For those of you fortunate enough to be there, I hope you enjoyed the Warsaw GFN conference as much as I did. There was a very rich and diverse mix of science, technology, law, public policy, health and advocacy. Something for everyone in an excellent venue where all the logistics ran with quiet efficiency.

My contribution as conference rapporteur will be published later, but here are just a few headline thoughts.

 

  1. It’s going to be a long haul. One presenter joked that he could cross out 2016 from last years’ presentation and scribble n 2017. He may be crossing out for some time to come. It took maybe 20 years from the earliest days of drug harm reduction to the appearance of harm reduction language to appear in UN drug-related documents and for a service user advocate to be given a brief moment in the sun at a UN drug conference. 
  2. The tobacco companies are not going away. If there is going to be critical mass acceptance of alternative nicotine delivery devices especially in middle and lower income countries, then it is hard to see anybody else having the necessary resources to deliver on appropriate pricing and technology.
  3. It is wrong to paint all public health as part of some axis of evil. Some of the most vehement ideologues in this debate are not from the public health community, but are associated with it because their diatribes fly under a public health flag of convenience, purporting to be ‘in the interests of’ public health.
  4. If anybody knows how to get hold of those white chocolate snacks that appeared next to the coffee machines then…..no, better not.

Meanwhile in other news..

Through the wonders of the interweb, I was led to a quote from Alberto Brandolini, an Italian software consultant who put up a slide at the 2014 Agile Software Development Conference which read ‘The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.” – known as the Bullshit Asymmetry Principle.  The notion has some illustrious antecedents; Baptist preacher Charles Spurgeon’s “a lie will go round the world while truth is pulling its boots on” (1859) probably inspired by Jonathan Swift’s “falsehood flies, and the truth comes limping after it” (1710). 

In the vanguard of the Battle against Bullshit is Clive Bates who, in the interests of bending the ears of Australian regulators, has produced what could be a template response to anti-vaping rhetoric:

https://www.clivebates.com/critical-review-of-professor-chapman-anti-vaping-polemic

It is Clive too, who has come across a recently complete PhD thesis by Jacob Hasselbalch from Warwick University who has studied the EU political response to disruptive technologies, specifically e-cigarettes and fracking. Flipping through to the conclusion, the author notes that disruptive technologies drive a wedge between interested parties: often the legislative process fails to recognise differences and just focuses on what purports to be the science (and maybe the more conservative interpretations given the inherently controversial nature of disruption).

“The policy debate is constructive if it brings to light new information, clarifies which norms should apply, or builds trust among participants.. through commissioned studies, stakeholder consultations, impact assessments, meetings, debates, and press attention we were provided with much clearer pictures of how vaping [and fracking] works and what their consequences are. The mistake that the Commission makes is thinking that this is enough…no amount of further information or more accurate forecasting would have resolved the deeper-lying tensions between the opposed coalitions in the deep structures of the debates. There are limits to what can be achieved in the cognitive realm. In other words, the current regulatory setup for dealing with disruptive innovations is poorly configured for addressing disagreements within the deep structure of policy debates.. When disruptive innovations are treated as purely technical developments, their social dimensions are left unaddressed, potentially leading to deadlock in the policy process or the passing of legislation which is perceived as illegitimate.” 

https://www.academia.edu/33364936/The_Contentious_Politics_of_Disruptive_Innovation_Vaping_and_Fracking_in_the_European_Union

Encouraging news from the UK and the USA on declining rates of smoking.

In 2016, of all adult survey respondents in the UK, 15.8% smoked which equates to around 7.6 million in the population. Those aged 18 to 24 in the UK experienced the largest decline in smoking prevalence of 6.5 percentage points since 2010. At the same time, vaping among this group is among the highest.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2016

Over in the USA, according to the latest CDC data, smoking among young people declined at an unprecedented pace in the last five years, at the same time as the use of e-cigarettes increased dramatically from 1.5% to a peak of 16.0% in 2015 in this group. But now even e-cigarette use appears to be in decline down to 11.3% among high school students with smoking continuing to decline through to 2016. Any chance now of shutting the gate on gateway theory?

https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a1.htm?s_cid=mm6623a1_w

At GFN, Lars Ramstrom presented on 50 years of snus in Sweden. The most telling statistic and one that should shame the anti-tobacco lobby across the EU is that in Sweden, where snus has become the dominant form of tobacco use, tobacco- related mortality is the lowest in Europe, 152 deaths per 100,000 compared with the European average 373 per 100,000. 

The story of snus in Sweden is illuminating. The switch to snus in Sweden was triggered by wide-spread public information of the findings of two medical reports in 1962 and 1964. Snus was taken by those who did not want to quit, not least because at the time it was cheaper than cigarettes. Even though the taxes on snus began to rise, use also rose out of proportion to the rise in cigarettes.  Then between 2006-2016, tax on snus rose by 250% and sales slowed -  against 53% for cigarettes. Of course, the inevitable impact of higher taxation was illegal activity - people selling to tax free warehouses abroad, and then sending it back into Sweden and selling at lower prices.

I asked one Swedish delegate why, if Sweden is so anti-harm reduction, the government didn’t just ban snus. He reckoned that if they had done that, the government would never have won the 1995 referendum to join the EU.

In a special issue of International Journal of Environmental Research and Public Health edited by Konstantinos Farsalinos, Scottish researchers Neil McKeganey and Tiffany Dickson quizzed the attitudes of confirmed smokers (all member of the smokers’ rights group Forest) to e-cigarettes. Few envisaged giving up nicotine; those with an existing health problem were more likely to switch to alternatives than others – but potential conversion rates were still low.

Typical comments were:

Because I enjoy smoking. There seems to be an assumption that every smoker wants to give up smoking. Whilst this is true for some it is not true for all smokers (59 years old female smoker).

E-cigarettes do not appeal to me because they have no tobacco in them. I do not think that I derive enjoyment from the nicotine alone. I think there are other substances in tobacco that are beneficial and enjoyable besides the nicotine (47 years old male smoker).

Respondents saw the main benefit of vaping as having a wider range of venues to use nicotine (although of course many indoor public areas also ban vaping).

The authors concluded, “If public health agencies are going to succeed in increasing the percentage of smokers who are using e-cigarettes, it will be necessary to overcome the various barriers to the wider use of these devices. Whilst much of the current public health information around e-cigarettes has focussed on their lower level of harm.. it was notable that the relative harm of these products was not a prominent feature in our smokers’ reasons for why they had used these devices, nor in their reasons for continuing to smoke. If e-cigarettes are going to appeal to a much wider range of smokers, it will be necessary for the vaping experience to be at least as enjoyable as smoking (in terms of smokers’ perceptions) and very probably more enjoyable than smoking. There is an important need to ensure the continued availability of a wide range of flavours and of a wide range of e-cigarette “kit” encompassing technology which is relatively simple and easy to use (cig-a-like) and that which is more complex and appealing to those who enjoy new technology. There is a need to ensure that that these devices can be used in a wide range of public settings without users experiencing the stigma that is sometimes attached to their use. It will require the continued availability of e-cigarettes at a price that makes them competitive with combustible tobacco products, and it will require the vaping experience to be as similar as possible to the smoking experience (in the speed of nicotine delivery, in the effect on the throat, taste, sensation)”

http://www.mdpi.com/1660-4601/14/6/647

It is fair to say though that any smoker who actually belongs to Forest is likely to be most resistant to change and will want alternative delivery systems to be as similar to the cigarette smoking experience as possible. But some at GFN expressed the view that while they wanted the nicotine, they embraced the new devices precisely because their look and feel did not resemble the cigarettes they were trying to give up.

For those of you fortunate enough to be there, I hope you enjoyed the Warsaw GFN conference as much as I did. There was a very rich and diverse mix of science, technology, law, public policy, health and advocacy. Something for everyone in an excellent venue where all the logistics ran with quiet efficiency.

My contribution as conference rapporteur will be published later, but here are just a few headline thoughts.

  1. It’s going to be a long haul. One presenter joked that he could cross out 2016 from last years’ presentation and scribble n 2017. He may be crossing out for some time to come. It took maybe 20 years from the earliest days of drug harm reduction to the appearance of harm reduction language to appear in UN drug-related documents and for a service user advocate to be given a brief moment in the sun at a UN drug conference.

  2. The tobacco companies are not going away. If there is going to be critical mass acceptance of alternative nicotine delivery devices especially in middle and lower income countries, then it is hard to see anybody else having the necessary resources to deliver on appropriate pricing and technology.

  3. It is wrong to paint all public health as part of some axis of evil. Some of the most vehement ideologues in this debate are not from the public health community, but are associated with it because their diatribes fly under a public health flag of convenience, purporting to be ‘in the interests of’ public health.

  4. If anybody knows how to get hold of those white chocolate snacks that appeared next to the coffee machines then…..no, better not.

Meanwhile in other news….

Through the wonders of the interweb, I was led to a quote from Alberto Brandolini, an Italian software consultant who put up a slide at the 2014 Agile Software Development Conference which read ‘The amount of energy needed to refute bullshit is an order of magnitude bigger than to produce it.” – known as the Bullshit Asymmetry Principle.  The notion has some illustrious antecedents; Baptist preacher Charles Spurgeon’s “a lie will go round the world while truth is pulling its boots on” (1859) probably inspired by Jonathan Swift’s “falsehood flies, and the truth comes limping after it” (1710).

In the vanguard of the Battle against Bullshit is Clive Bates who, in the interests of bending the ears of Australian regulators, has produced what could be a template response to anti-vaping rhetoric

https://www.clivebates.com/critical-review-of-professor-chapman-anti-vaping-polemic

It is Clive too, who has come across a recently complete PhD thesis by Jacob Hasselbalch from Warwick University who has studied the EU political response to disruptive technologies, specifically e-cigarettes and fracking. Flipping through to the conclusion, the author notes that disruptive technologies drive a wedge between interested parties: often the legislative process fails to recognise differences and just focuses on what purports to be the science (and maybe the more conservative interpretations given the inherently controversial nature of disruption).

“The policy debate is constructive if it brings to light new information, clarifies which norms should apply, or builds trust among participants… through commissioned studies, stakeholder consultations, impact assessments, meetings, debates, and press attention we were provided with much clearer pictures of how vaping [and fracking] works and what their consequences are. The mistake that the Commission makes is thinking that this is enough…no amount of further information or more accurate forecasting would have resolved the deeper-lying tensions between the opposed coalitions in the deep structures of the debates. There are limits to what can be achieved in the cognitive realm. In other words, the current regulatory setup for dealing with disruptive innovations is poorly configured for addressing disagreements within the deep structure of policy debates… When disruptive innovations are treated as purely technical developments, their social dimensions are left unaddressed, potentially leading to deadlock in the policy process or the passing of legislation which is perceived as illegitimate.”

https://www.academia.edu/33364936/The_Contentious_Politics_of_Disruptive_Innovation_Vaping_and_Fracking_in_the_European_Union

Encouraging news from the UK and the USA on declining rates of smoking.

In 2016, of all adult survey respondents in the UK, 15.8% smoked which equates to around 7.6 million in the population. Those aged 18 to 24 in the UK experienced the largest decline in smoking prevalence of 6.5 percentage points since 2010. At the same time, vaping among this group is among the highest.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2016

Over in the USA, according to the latest CDC data, smoking among young people declined at an unprecedented pace in the last five years, at the same time as the use of e-cigarettes increased dramatically from 1.5% to a peak of 16.0% in 2015 in this group. But now even e-cigarette use appears to be in decline down to 11.3% among high school students with smoking continuing to decline through to 2016. Any chance now of shutting the gate on gateway theory?

https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a1.htm?s_cid=mm6623a1_w

At GFN, Lars Ramstrom presented on 50 years of snus in Sweden. The most telling statistic and one that should shame the anti-tobacco lobby across the EU is that in Sweden, where snus has become the dominant form of tobacco use, tobacco- related mortality is the lowest in Europe, 152 deaths per 100,000 compared with the European average 373 per 100,000.

The story of snus in Sweden is illuminating. The switch to snus in Sweden was triggered by wide-spread public information of the findings of two medical reports in 1962 and 1964. Snus was taken by those who did not want to quit, not least because at the time it was cheaper than cigarettes. Even though the taxes on snus began to rise, use also rose out of proportion to the rise in cigarettes.  Then between 2006-2016, tax on snus rose by 250% and sales slowed -  against 53% for cigarettes. Of course, the inevitable impact of higher taxation was illegal activity - people selling to tax free warehouses abroad, and then sending it back into Sweden and selling at lower prices.

I asked one Swedish delegate why, if Sweden is so anti-harm reduction, the government didn’t just ban snus. He reckoned that if they had done that, the government would never have won the 1995 referendum to join the EU.

In a special issue of International Journal of Environmental Research and Public Health edited by Konstantinos Farsalinos, Scottish researchers Neil McKeganey and Tiffany Dickson quizzed the attitudes of confirmed smokers (all member of the smokers’ rights group Forest) to e-cigarettes. Few envisaged giving up nicotine; those with an existing health problem were more likely to switch to alternatives than others – but potential conversion rates were still low.

Typical comments were:

Because I enjoy smoking. There seems to be an assumption that every smoker wants to give up smoking. Whilst this is true for some it is not true for all smokers (59years old female smoker).

E-cigarettes do not appeal to me because they have no tobacco in them. I do not think that I derive enjoyment from the nicotine alone. I think there are other substances in tobacco that are beneficial and enjoyable besides the nicotine (47years old male smoker).

Respondents saw the main benefit of vaping as having a wider range of venues to use nicotine (although of course many indoor public areas also ban vaping).

The authors concluded, “If public health agencies are going to succeed in increasing the percentage of smokers who are using e-cigarettes, it will be necessary to overcome the various barriers to the wider use of these devices. Whilst much of the current public health information around e-cigarettes has focussed on their lower level of harm…it was notable that the relative harm of these products was not a prominent feature in our smokers’ reasons for why they had used these devices, nor in their reasons for continuing to smoke. If e-cigarettes are going to appeal to a much wider range of smokers, it will be necessary for the vaping experience to be at least as enjoyable as smoking (in terms of smokers’ perceptions) and very probably more enjoyable than smoking. There is an important need to ensure the continued availability of a wide range of flavours and of a wide range of e-cigarette “kit” encompassing technology which is relatively simple and easy to use (cig-a-like) and that which is more complex and appealing to those who enjoy new technology. There is a need to ensure that that these devices can be used in a wide range of public settings without users experiencing the stigma that is sometimes attached to their use. It will require the continued availability of e-cigarettes at a price that makes them competitive with combustible tobacco products, and it will require the vaping experience to be as similar as possible to the smoking experience (in the speed of nicotine delivery, in the effect on the throat, taste, sensation)”

http://www.mdpi.com/1660-4601/14/6/647

It is fair to say though that any smoker who actually belongs to Forest is likely to be most resistant to change and will want alternative delivery systems to be as similar to the cigarette smoking experience as possible. But some at GFN expressed the view that while they wanted the nicotine, they embraced the new devices precisely because their look and feel did not resemble the cigarettes they were trying to give up.