It strikes me there is a marked difference between the way US and UK governments and their agencies handle information about controversial subjects. In the US, there is an obvious moral underpinning to much of what is published about drugs, alcohol and tobacco. Or what isn't published. As the major donor of the WHO, the US government has previously suppressed WHO reports stating cannabis was no more dangerous than alcohol and tobacco – and another which stated that moderate use of cocaine appeared to have no long term health consequences. Yes folks, this is the WHO speaking.
Back home agencies such as the FDA, CDC, NIDA and others all sing from the same hymn sheet – whether because they all genuinely believe what they publish or simply through fear of lucrative posts lost and funding cuts.
In the UK, and without being too naïve, we do seem to be more willing to tell truth to power and value scientific independence. So apparently despite misgivings by the Chief Medical Officer, Public Health England published its report on e-cigarettes which is now globally referenced. And on another subject, a representative of the Office for National Statistics (ONS) publicly criticised the government for offering incorrect figures about rates of knife crime. It's just not British, don't you know.
So this week the ONS published data showing a fall in the use of cigarettes as people switch to e-cigarettes or quit. The report in The Guardian said;
“The data also shows that 2.3 million people were e-cigarette users in England, Scotland and Wales in 2015, about 4% of the population. Their survey also shows that 4 million more people describe themselves as former e-cigarette users. A further 2.6 million say they have tried them but not gone on to use them regularly. Half of the 2.3 million who were current users of e-cigarettes at the time of the survey said they were doing it to quit smoking. A further 22% said they were vaping because it was less harmful than smoking. Only 10% said they chose to vape because it was cheaper than buying cigarettes. Others – 9% – said they used e-cigarettes mainly because they were permitted indoors. The figures will bolster the arguments of those who believe e-cigarettes have a major role to play in ending the tobacco epidemic”.
I just wonder if a US government agency would have allowed data like that to appear in the public domain. And on the subject of transparency, a scary if true claim from Canada about the government's attempt to block data sharing about vaping. In an opinion piece in the Canadian Guardian, Derek James writes about the anti-vaping Bill S-5 introduced last November. He says one of its provisions, “prohibits manufacturers or purveyors of e-cigarettes from sharing scientific information comparing the health effects of smoking traditional combustible tobacco cigarettes with vaping. This ban is so broad that merely making Canadians aware of a peer-reviewed scientific journal article in a vape shop could result in a fine of up to $500,000 and a two-year prison term. This restriction will almost certainly attract constitutional scrutiny as a violation of the right to freedom of expression”.
Meanwhile Professor Neil McKeganey's Glasgow-based Centre for Substance Use and Research has published a new study showing that e-cigarettes are not increasing the likelihood of tobacco consumption and may in fact be contributing to negative perceptions about smoking among young people. The study, based on semi-structured interviews with 50 vapers between the ages of 16 and 26 - including 28 current smokers, 19 former smokers and 3 never smokers -- found the majority of young people think e-cigarettes are a substantially less harmful alternative to combustible tobacco and don't believe that vaping is increasing their likelihood of smoking.
And e-cigs as a pathway to quitting is also demonstrated in a study from San Diego University who contacted 14 vape shops across the US and asked them to survey their customers. Said Jon-Patrick Allem, one of the study’s co-authors and fellow at the University of Southern California’s Tobacco Center of Regulatory Science, “we found that the biggest motive for purchasing e-cigarettes at a vape shop was to quit tobacco products, about 84% of all participants agreed...The second biggest motive for purchasing e-cigarettes was the “cool factor,” in which 76 percent of all participants agreed... The third biggest motive was “taste” with 54% of all participants”.
In a bout of apparent and well-publicised self-flagellation, Philip Morris' UK subsidiary PML put in a budget submission to the UK Chancellor of the Exchequer, Philip Hammond, for what actually turned out to be a modest rise in taxation on cigarettes in order to encourage smokers to switch to e-cigarettes. But raising the tax on cigarettes is almost a given every time the Budget comes round and the tobacco companies are generally not in favour of large tax hikes as this would likely increase smuggling.
UK smokers already pay tobacco duty at a rate of 16.5% of the retail price plus a 'flat' element of £3.93 on a packet of 20. The flat £3.93 element was due to rise to £4.15. From 20 May, a minimum duty level called the 'minimum excise tax' will be introduced on cigarette packs – but not other forms of tobacco. This will be set at £268.63 per 1,000 cigarettes. Based on a retail price of £7.35 for a pack of 20, the minimum duty will be £5.37. In many cases, this will see smokers who buy cheaper packs paying more, and the Government says the new system will add an average of 35p to a pack of 20 cigarettes.
It remains to be seen if the PMI itself will push for higher taxation in low to middle income countries which would be a much more tangible manifestation of good intentions. Here is a link to the actual budget submission document.
Two good articles from Bloomberg – the first one sets out clearly the reasons why the tobacco control community has every reason to be suspicious of Big Tobacco, but goes on to say that if you are serious about tobacco harm reduction (and the author reckons that many in the community are against harm reduction in principle) – then Big Tobacco is the only game in town. Only they have the resources to push towards a smoke free future.
The second article details Philip Morris' future business strategy in the development of next generation nicotine delivery systems in the wake of the success of iQOS.
And finally an interesting article on the science of why our thinking about subjects is highly determined by what others in our community also think. The article points out the dangers of the way that social media has balkanised thought, so that increasingly people exist in an echo chamber where the only views they hear or express are those that chime with what they already believe to be true..
I am reminded in a way of the novel 'The Machine Stops', a short story by E.M Forster written way back in 1909. The story describes a world in which most of the human population has lost the ability to live on the surface of the Earth. Each individual now lives in isolation in a standard room, with all bodily and spiritual needs met by the omnipotent, global Machine. Travel is permitted, but is unpopular and rarely necessary. Communication is made via a kind of instant messaging/video conferencing machine with which people conduct their only activity: the sharing of ideas and what passes for knowledge. The story was discussed recently on a BBC science programme where some silicon valley geek's response to this dystopia was, 'So what's your problem?