Monday, 27 April 2015

Exercise doesn't help people lose weight?!

I've started writing for the Spectator blog. My first post went live today and looks at The Dodgy Science Behind the Claim that Exercise Doesn't Help You Lose Weight. Please pay it a visit.

Price controls: the case of alcohol

Despite the prominence of the Institute of Economic Affairs in the British Medical Journal's smear campaign against opponents of minimum pricing, we've never actually published much about it.* There was a chapter in Jamie Whyte's award-winning monograph Quack Policy, but nobody at the BMJ seems to have read it. Apart from that, nothing.

Last week, however, the IEA published a whole book about price controls and it includes a chapter about minimum pricing by yours truly. In it, I discuss the Sheffield model and the Canadian experience, as well as the likely impact on consumers and the legality of the policy under EU law.

You can download Flaws and Ceiling: Price Controls and the Damage They Cause as a PDF for free here.

(* The author of that piece was the third-rate journalist Jonathan Gornall who, like a third-rate footballer, is now plying his trade in Abu Dhabi. When not stoking the flames of anti-semitism in the Middle East, Gornall continues to write piss-poor hatchet jobs for the BMJ. Having done minimum pricing and sugar, Gornall turned his attention to plain packaging last week with an article so lame that no media reported it. Yet another effort is on its way, apparently. He's already been in touch with us about it.)

Sunday, 26 April 2015

Global Forum on Nicotine 2015

The second annual Global Forum on Nicotine kicks off in Warsaw, Poland on 5 June. I'll be there. Will you?

Speakers include Hon Lik (the inventor of e-cigarettes), Clive Bates, Konstantinos Farsalinos, Martin Dockrell, Ann McNeill, Derek Yach and many others.

Tickets, flights and hotels were all at a reasonable price when I booked them. Early bird discount available until the end of April. Register here.

Friday, 24 April 2015

Irish vaping mystery solved

On Monday, I mentioned the Irish Cancer Society's claim that 5 per cent of smokers had used an e-cigarette before they started smoking. This, they say, is evidence of a possible 'gateway' effect—an effect that has not been seen in any other country. For the avoidance of doubt, this is what they say on their website:

A concerning fact highlighted by our research was that 5% of current smokers used e-cigarettes before they started smoking. 

I have now found the survey results and there is a simple, predictable explanation for this finding. It's ain't true.

The five per cent statistic actually doesn't refer to all smokers, but to smokers who had used or were using e-cigarettes. The relevant data is below.

56 per cent of the smokers had ever used e-cigarettes so we're actually talking about half of one twentieth of one fifth of the population. Actually, you can't even halve the five per cent figure because the e-cigarette users are not representative of smokers as a whole. They are younger, for a start. If more old smokers tried e-cigarettes, the percentage would decline further.

The research did not find that "5% of current smokers used e-cigarettes before they started smoking". It found that 5% of an unrepresentative subset of smokers who had ever used e-cigarettes said that they had used e-cigarettes before they started smoking. To state the obvious, it was not a survey of every smoker in Ireland and the numbers are tiny. Although the survey started out with 1,000 people, there were only 176 able to answer this question. Of those 176 people, only eight gave the answer that formed the basis of the Irish Cancer Society's claim.

Eight! You cannot draw conclusions from such a tiny sample. You can't even be sure that these respondents used an e-cigarette before they started smoking. When dealing with numbers this small, you can't discount people misreading the question, not reading the question or ticking boxes at random. But even if they answered correctly, you cannot infer—as the authors do above—that it is an indication that "e-cigarettes are a [sic] probably gateway to smoking for this cohort."

Contrast those eight people with the thirty people who used to smoke but now only use e-cigarettes. That's thirty people from a smaller sample of 86 current e-cigarette users, meaning that 35 per cent of e-cigarette users used to smoke but no longer do so. Is that not more consistent with the view that e-cigarettes are a gateway from smoking than a gateway to smoking?

And yet the Irish Cancer Society seems to have little interest in the people who quit smoking, a strange oversight for a health group. Instead, their press release led with the claim that 'Two in three e-cigarette users are also smoking tobacco'. This, of course, means that one in three are not still smoking tobacco. Can the pharmaceutical companies that sponsor the Irish Cancer Society claim the same about users of their nicotine products?

Tuesday, 21 April 2015

Vaping in the USA: When the lie's so big

Not a day goes by without some outrageous lie being told about e-cigarettes in the USA. America is currently in a league of its own when it comes to vaping deceit and I simply don't have time to write about it all. Many readers will already be familiar with the $75 million crusade of misinformation in California and the false portrayal of a smoker as a vaper in an attempt to con people into believing that e-cigarettes will make your lungs collapse. It is also worth reading Carl Phillips' account of the recent farce involving the FDA who were asked to make the warning labels on Swedish snus bear some relationship to reality.

It all boggles the mind and I hope someone is taking names and numbers for the inevitable reckoning in a few years time when these frauds will, I hope, be held accountable for their actions. Though far from being the most blatant attempt to mislead, this infographic from the FDA is also worth flagging up.

Amongst the most prominent lies about e-cigarettes is that (a) they don't help people quit smoking, and (b) they encourage young people to start smoking. It is no longer good enough to repeat the "we just don't know" mantra of years gone by. We have plenty of evidence—more of which was published this week—for us to know that these are lies.

An interesting question, less easily resolved, is whether e-cigarettes help to prevent smoking by getting would-be smokers to vape instead. For the fanatics, any evidence that young non-smokers experiment with e-cigarettes—which some will, of course—is evidence of a fictitious 'gateway effect' or is a terrible thing because it gets youngsters 'hooked' on nicotine (which has hastily and falsely been redefined as the scariest ingredient in cigarettes, rather awkwardly for the pharmaceutical industry).

Circumstantial evidence is all we can hope for when looking at would-be smokers because we don't know they are. We know who the smokers are, however, and we know who the vapers are, so if vaping rises sharply and smoking falls sharply there is a good a priori case for assuming that the former led to the latter.

That is exactly what has happened in the USA in the last few years and the wingnuts of 'public health' hate it because it not only scotches their gateway hypothesis but it suggests a prophylactic benefit too. The unavoidable conclusion is that high school students are vaping instead of smoking and that this is a good thing if you are concerned about public health rather than 'public health'.

How has the FDA's Center for Tobacco Products responded? By redefining e-cigarettes as tobacco products, of course, thereby pretending that nothing has really changed...

Click to enlarge, but the key point is that cigarette smoking fell dramatically between 2013 and 2014 at the same time as e-cigarette use rose dramatically. The FDA merely says that "there was no decline in overall tobacco use by students". This bare-faced lie is based on the ridiculous premise that e-cigarettes are tobacco products.

Elsewhere in the infographic, they claim that "more than 4.6 million students reported being current tobacco users". No they didn't. If they had been asked "are you a current tobacco user?" most of them would have said no because, er, they're not. The FDA finds that 2.4 million of their "current tobacco users"—ie. most of them—are actually regular or occasional users of e-cigarettes.

A decline in smoking prevalence from 15.8 per cent to 9.2 per cent in just four years would be something to cheer about if your mission was to improve the health of the nation. It's quite clear that whatever priorities the Center for Tobacco Products has—and pointless regulation seems to be the main one—the health of the nation is not amongst them.

Monday, 20 April 2015

Did 1 in 20 Irish smokers start out on e-cigarettes?

In my post about the Irish Cancer Society's promotion of Nicorette yesterday, I didn't mention one little factoid that will doubtless be parroted by anti-ecig zealots in the Emerald Isle for years to come, namely...

The study also showed that five per cent of people currently smoking started after using e-cigarettes and the potential for them to become a 'gateway' drug for cigarettes was also highlighted by the ICS as a cause for concern.

The Irish Cancer Society (ICS) provides no link to this mysterious study and it has not been published, so we have no clue as to what this claim is based on, but it sounds highly improbable, to say the least.

Estimates of how many smokers there are in Ireland differ wildly, from 29 per cent according to the EU and OECD to 19.5 per cent according to the Irish health department.  With an adult population of 3.8 million, there are between 730,000 and 1,000,000 smokers. Are we to believe that between 36,000 and 50,000 of them had never tried smoking until they tried an e-cigarette?

It would be amazing if no young people ever experimented with e-cigarettes, but research to date is pretty clear in finding no 'gateway effect'. In the UK last year, ASH said "there is no evidence from our research that e-cigarettes are acting as a gateway into smoking". Office for National Statistics data show that e-cigarettes are used almost exclusively by smokers and ex-smokers, and a study earlier this month also found no evidence of a gateway, with its lead researcher saying:

"There are some concerns at the moment that the growth of e-cigarettes may be helping to get a new generation of young people addicted to nicotine. At the moment, that doesn't seem to be the case. There doesn't seem to be too much reason to worry that that's actually happening."

And yet the ICS, citing some unpublished research, reckon that one in twenty smokers started out using e-cigarettes? It defies belief, particularly when you look at the demographics.

It's well known that the vast majority of smokers had their first cigarette before the age of 20. Since e-cigarettes have only been widely available for the last few years, nearly all the people who supposedly used them as a gateway to smoking must therefore be under the age of 25. That narrows the field considerably, as this graph—from the Irish Health Executive—shows:

If, as this graph says, 15 per cent of Irish smokers are under the age of 25, about a third of them (5 per cent) must have been vapers first if the ICS claim is true. I can't prove that this is a lie, but it sounds very much like one. There just aren't enough non-smoking vapers to make it credible. The ICS's own briefing paper on e-cigarettes says:

...there are approximately 134,000 e-cigarette users in Ireland. The vast majority of these are either current tobacco smokers or former tobacco smokers and there is little evidence that the devices are used by people who have never smoked tobacco.

This is borne out by a graph that the percentage of Irish non-smokers who are current users of e-cigarettes is, er, zero.

To be fair, use by non-smokers is not totally non-existent. Four per cent of them have 'tried once or twice'—a quick puff here or there perhaps—and one per cent had 'used in the past', but none of them are vapers in the sense of being regular users. How can e-cigarettes be a gateway when non-smokers aren't interested in them in the first place? What is supposed to be the narrative here? Do non-smokers try e-cigarettes 'once or twice' and then immediately abandon them and start smoking instead? They'd have to do so in massive numbers if the claim that five per cent of the country's entire smoking population—most of whom are over the age of 35, let alone 25—started out with them were true.

As I say, I can't categorically prove that this is a lie, but the fact that non-smokers hardly ever try e-cigarettes, that almost none of them start using e-cigarettes regularly, and that research from the rest of the world has found no evidence of a gateway effect makes it very hard to believe that tens of thousands of Irish people are so keen on vaping that they decide to take the much more expensive and unhealthy decision to start smoking tobacco. The five per cent claim reeks of BS, but that won't stop it being trotted out until the twelfth of never.

Saturday, 18 April 2015

The Irish Cancer Society's hard sell

I see the Irish Cancer Society has just made its contribution to the global campaign of e-cigarette misinformation. From the Sunday World...

A study conducted by the Irish Cancer Society has cast doubt on how useful e-cigarettes are in helping smokers quit.

The survey, conducted in March, found that using e-cigarettes may in fact increase smokers dependence on nicotine as the lack of regulation is creating the potential for long-term use.

Why shouldn't people use them long term? What's it got to do with the Irish Cancer Society? But note, straight away, that it's regulation they want.

They studied 1,150 people and they found that e-cigarettes are now used by 210,000 people in Ireland but 2/3s of those using them also used other tobacco products at the same time.

So a third of them are not smoking and, since we know that the vast majority of e-cigarette users are smokers when they first try them, this fact is clearly good news for 'public health'. If e-cigarettes help 33 per cent of those who try them to achieve abstinence from tobacco then they are an order of magnitude more useful in smoking cessation than any nicotine products produced by Big Pharma. Why don't the pharmaceutical industry's products get this kind of sustained abuse from cancer charities?

"This survey clearly shows that right now e-cigarettes are not a quitting aid as some people are led to believe,” says Kathleen O’Meara, Head of Advocacy and Communications for the Irish Cancer Society (ICS).

The survey quite clearly does that e-cigarettes are a quitting aid for very many people. You'd have to be an innumerate moron not to be able to see that.

“E-cigarettes are becoming an increasingly popular choice for smokers looking for a healthier lifestyle and to save money. But there are better, more proven ways to quit smoking than choosing devices that still have no regulations in Ireland.”

 Is this a sales pitch?

Currently, e-cigarettes are not regulated as a medicinal product by the Department of Health, and the ICS have called on the Department to do so to bring it in line with other Nicotine Replacement Therapies.

That's the pharmaceutical industry's line because they want to stifle the competition with expensive and unnecessary regulation. It's not the line of many people who are involved in smoking cessation and know what they're talking about. Are you sure this isn't a sales pitch?

“Nicotine is addictive and giving up is tough. There are more effective treatments that have been proven to increase your chances of quitting up to four times. E-cigarettes are not one of them.”

Wait, this is a sales pitch. Why would the Irish Cancer Society be lobbying for the pharmaceutical industry? If there's one thing these guys hate it's a perceived conflict of interest, so surely they wouldn't ... they couldn't... Oh yes, they are...


As I said when Alcohol Concern started hawking drugs last year, the mentality is "it's not a conflict of interest when we do it". But the Irish Cancer Society's pitch is so transparent, so unsubtle, and so obviously taken not only from the pharmaceutical industry's playbook but literally from their advertisements, that no sentient reader can fail to see what's going on here.