I, along with other colleagues from Knowledge-Action-Change, have just returned from Australia on a trip to showcase the Global State of Tobacco Harm Reduction report and to support our friends in that country battling against monolithic political intransigence fuelled by smears and whispers from ‘public health’ flat earth activists over tobacco harm reduction. I was honoured to speak at two sessions in both the parliaments of Victoria and New South Wales and engaged anybody and everybody prepared to listen, enjoying very welcome support from Melbourne MP Fiona Patten who chaired that session.
This blog unashamedly takes its title from a very interesting article by Ronald Dworkin who is an American anaesthesiologist, teaches political philosophy at George Washington University and is a Senior Fellow at the Hudson Institute, where he heads up its Medicine, Society, and Culture project.
I am a big fan of The Guardian; its editorial positioning lines up with my left-liberal views and I have been a regular reader of its articles for many years. Recently it has taken up the cudgels against Big Tobacco, which at one level is strange because in most of the countries where the paper is read, smoking has been in steep decline with the companies on the legal backfoot time and again, for instance, regarding new legislation about plain packaging. More generally, the long and tawdry history of tobacco company deceit is hardly news.
The celebrity chef and healthy food activist Hugh Fearnley-Whittingstall interviewed a director who was making a TV campaign to encourage kids to eat more vegetables. The director said that when he told people he was doing this their first response was ‘OK. What’s the twist? What evil company is behind this?’. And that is a perfectly understandable response when major food and drinks companies promote breakfast cereals, fizzy drinks and snacks loaded with sugar directly to children, and every type of store from supermarkets to garden centres have sweets and chocolates deliberately sited near the check-out to put pressure on parents.
Happy New Year to you all as Britain prepares to go one better than the US by building a wall round the country and shutting it down all at the same time.
The blog title is a quote from Hamlet written by W. Shakespeare and set in Denmark because Bill ripped off an old Danish story for his plot. Even so, it’s a pity that the Danish authors of a paper basically alleging that all pro-vaping studies are compromised by associations with the tobacco industry, couldn’t have taken this quote to heart. In fact, so far from the truth is it, that the ever-estimable Carl Phillips has written the most damning indictment of a paper purporting to be ‘peer-reviewed’ that I have ever read. Because if you thought that conflict of interest only applied to academics supping at the table of commerce, then read on. It’s only 4th January as I write, but Carl’s review might already qualify as the ‘must-read’ of 2019. His forensic dissection of this eye-watering farrago of Danish anti-tobacco harm reduction nonsense is awesome. It’s long, but don’t stint yourself.
This will be my last blog of 2018. In 2019, I enter year 40 of working in the drugs field, currently as Director of DrugWise, an online drug information service, and as a member of the UK Advisory Council on the Misuse of Drugs and the Secretariat of the All-Party Parliamentary Group on Prescribed Drug Dependence. The drugs work continues, but little did I know when the charity I worked for, DrugScope, fell over in 2015, that 2019 would also be the year when I would be part of a team taking the message of tobacco harm reduction across the world.
Been dazed and confused for so long it's not true
Wanted a Marlboro, never bargained for you
Lots of people talking and few of them know
Soul of an e-cig was created below, yeah
(With apologies to Led Zeppelin)
So here is how you con smokers, the public, the media and the politicians into believing that safer nicotine products are no safer than cigarettes. The basic framework is pulled from the interweb, so can be applied to many areas of public discourse but resonates with operatic clarity in the world of tobacco harm reduction. Italics are my additions or paraphrasing. Here we go…:
In breaking news, alcohol is really not a safe drug. It is a major cause of non-communicable death and disease; for example, over time it can damage many of your vital organs in ways that no other drugs can, including heroin. Addiction to alcohol can wreck individual lives and the lives of families and loved ones. It is a significant factor in domestic violence and the whole gamut of anti-social behaviour and public disorder. People kill people under the influence of alcohol whether running them over in a car or shooting them in a booze-fuelled rage.
No, I’m not proposing one, but referring to the outcome of the recent WHO Global Conference on Primary Health Care in Astana, Kazakhstan which produced the Astana Declaration. Of itself it isn’t a charter for tobacco harm reduction (THR), but if the WHO is seriously committed to delivering on its vision and not just cherry-picking the areas of health care that suit the organisation and its funders, then it is certainly a template for THR.
A Freedom of Information request was sent recently to the UK Medicines and Healthcare products Regulatory Agency (MHRA) asking for data on reports of adverse effects of nicotine.
The MHRA has an online system called Yellow Card scheme https://yellowcard.mhra.gov.uk/ where anybody can report any adverse effects they have suffered through taking a medicine or which have been reported by doctors or other health professionals. The MHRA is also responsible for collecting data on adverse reactions to e-cigarettes even though the products are not classified as medicines.