Are we in the endgame for smoking?

Now what?

Endgame: noun
1. Chess. the final stage of a game, usually following the exchange of queens and the serious reduction of forces.
2. the late or final stages of any activity: the end game of the negotiations.

There is a thread of discussion in the world of tobacco control devoted to what is known as the ‘endgame’… it is a kind of blue sky thinking about end of tobacco use and the policies needed to bring it about.  It includes a set of policy proposals set out in the May 2013 supplement of the journal Tobacco Control and has become the subject of conferences, journal papers, presentationsop-eds and thought pieces by leading academics and speeches by the Director General of WHO (which actually has some good advice in parts).  But what does the data tell us?

Continue reading “Are we in the endgame for smoking?”

The Worst Letter of 2014 – a review

Click to view letter on The Lancet web site
Winner! The Worst Letter of 2014

The 13 December letter by Professors Glantz, McKee, Chapman and Daube published in The Lancet wins my prestigious Worst Letter of 2014 award. There now follows a detailed review…

Continue reading “The Worst Letter of 2014 – a review”

Anti-complaint about e-cigarette advertising

Holding back the vaping insurgency

I’ve recently been stressing the unintended consequences of regulatory interventions on vapour products… and that these are almost always ignored by public health activists, to the detriment of public health.  This applies to overly cautious restrictions on advertising. The idea is that too much restriction will reduce the appeal and vaping buzz, degrade the communication of the vaping ‘value proposition’ to smokers, inhibit communication of innovation and limit brand building.  In other words, it will weaken this important insurgent technology relative to cigarettes, protect the incumbent and lead to fewer switching, more smoking and more disease.  My contention is that the unintended consequences will outweigh the intended consequences of most advertising restriction by some distance. Continue reading “Anti-complaint about e-cigarette advertising”

E-cigarette advertising code consultation

Are you scandalised or pleased by this?
Scandalous? Or a smart way of selling an aspirational and life-saving switch from smoking to vaping?

On 27 February, the UK Committee of Advertising Practice published a consultation document on new rules to cover advertising of e-cigarettes – the closing date for responses is 28 April.  This would cover all UK e-cigarette advertising until the Tobacco Products Directive Article 20(5) is implemented in 2016, and would continue to cover all advertising not then banned under the TPD.   I hope the TPD advertising ban will be subject to legal challenge – it deserves to be – and will be replaced by something much more like these rules.  The Tobacco Advertising Directive 2003/33/EC bans all tobacco advertising that can theoretically have cross-border effect (TV, radio, publications, internet etc), but this is justified at Recital 3 on the basis that smoking kills in excess of 500,000 people per year in the EU. No such justification applies to e-cigarettes.  The proposals from the UK regulator are are much more proportionate and realistic balancing of the various risks and opportunities.  Here is my response to the consultation, which I hope also gives my views on why I think e-cigarette advertising is positive for health, justifying a liberal approach to the commercial freedom to advertise … Continue reading “E-cigarette advertising code consultation”

Reasonable people saying sensible things about low-risk alternatives to smoking (update)

Nicotine molecule
Warning: nicotine may induce authoritarian urges, warped judgements and loss of purpose

Updated 24 July 2013. Smokeless tobacco products, e-cigarettes and novel nicotine products have astonishing potential to reduce the expected one billion premature deaths from tobacco in the 21st Century.   Yet some health organisations are spreading misinformation, stoking up unwarranted fears and pretending there is much more risk and uncertainty than there really is.  So to provide some balance here is a collection of on-the-record quotes from researchers, experts and others who have grasped the important and disruptive significance of these developments. Enjoy!   Continue reading “Reasonable people saying sensible things about low-risk alternatives to smoking (update)”

It could be worse – winter fuel payments

In my last post I asked for nominations for a worse policy than the proposed ‘Health in Pregnancy Grant’. An anonymous contributor proposes the Winter Fuel Payment, which is designed to help pensioners fight off the cold over winter. I think ‘anonymous’ may be on to something…

As the chart shows, this unconditional payment has now reached about £2 billion per year, and over £12 billion has been spent on this since 1997 [data from PQ, 27 Jan 2007]. Payments of £200 are made to over-60s and £300 to over-80s [guide] ostensibly to see older people through higher winter fuel bills. So this shares with the pregnancy grant two characteristics: very poor targeting of the needy group and very poor link to the stated objective. But it is much larger, and therefore is a bad policy on a larger scale. Could this be done better? It could hardly be done worse… Continue reading “It could be worse – winter fuel payments”

Is this the worst policy announcement ever?

There seems to be a plan to give pregnant women £200 and training in nutrition – it will be a ‘Health in Pregnancy Grant’ [Pregnant women to get healthy food grant – Telegraph] [BBC]. Despite the recently announced end of spin, this was spun in the media several days before its real announcement, in a speech by the Health Secretary. By the time of the speech, the payment was less precise – it would be “substantial” and “sufficient to help every mother eat healthily during her pregnancy“. Perhaps some sums have been done… Continue reading “Is this the worst policy announcement ever?”

Achieving culture change

An excellent new publication from the Prime Minister’s Strategy Unit, Achieving culture change: a policy framework. It’s open for discussion until 31 August and will be finalised once they have had views in. It’s an important area because many policy objectives depend on influencing, or are thwarted by, deep-seated attitudes and entrenched behaviours… environment, skills and employability, anti-social behaviour, and public health to name a few.

This develops work on ‘behaviour change’ (see my posting on soft paternalism for a discussion) to reflect the idea that behaviour is embedded in culture: a stock of attitudes and beliefs – and that behaviour is conditioned by culture, but that changed behavioural norms are eventually consolidated into culture (see graphic from report). If that sounds either obscure or so obvious it isn’t worth stating, I think it is worth having a read of the report – it’s an excellent synthesis of the knowledge and experience in this area with some good analytical tools…

I attended the launch of this report and was asked to give some remarks in response. My six main points were as follows: Continue reading “Achieving culture change”

Urban flooding – 15 things to do

We’ve had some horrible urban flooding impacts recently. But the outlook is pretty bleak too – the chart is from the 2004 Foresight Report Future Flooding, showing both potentially high future costs (rising from £270m to up to £15 billion) and large uncertainties involved. Now we have been reminded how bad it can be, what’s to be done? Let me set out some views on the problem, which is far from straightforward and little to do with flood defences, and then 15 ideas for how to respond… Continue reading “Urban flooding – 15 things to do”

England goes smoke-free – wider lessons

Long awaited 1st of July arrives, and most enclosed workplaces (including pubs and restaurants) in England will go smoke-free today [BBC]. It’s a triumph for all involved – both campaigners and government insiders – following a sustained struggle. It’s also a vital next step in dragging down smoking rates – see chart based on ONS and Tobacco Advisory Council data care of Cancer Research UK, [XLS]. Still at about 25%, that’s a huge number of people using an addictive product that kills one in two long term users – and does a lot of damage before death.

The ban on smoking in public places has always been justified around protecting non-smoking workers, for which there is the strongest civil liberties and legal basis, but its biggest public health benefit will come from ‘denormalising’ smoking – removing the societal support for smoking as a normal activity and role-modelling effects – and raising the cost of smoking in terms of time and hassle. The effect should be an acceleration in quitting and fewer starting. There are many wider lessons that can be drawn from this measure. Continue reading “England goes smoke-free – wider lessons”