Monday 20 May 2019

Plain packaging - what happened?

In the first couple of years after plain packaging took effect in Australia, a number of studies were published claiming to find an immediate effect from the policy. Nearly all of them were co-authored by Melanie Wakefield, who was a leading advocate of plain packaging and was later given the job of evaluating it (have I mentioned before that 'public health' is utterly corrupt?).

The studies took many forms. One of them looked at whether smokers were more likely to cover their cigarette packs up after the packaging changed. One of them found that smokers didn't like the new packs as much as the old ones. Another found that adolescents couldn't distinguish between brands as well as they could before. And another claimed that there had been more calls to quitlines after plain packaging began.

I could go on. There were loads of them. None of them actually found that smokers were giving up as a result of plain packaging, nor that nonsmokers were less likely to start, nor that cigarette sales had fallen (it was later revealed that sales rose), but they served to give the impression that the policy had an almost instantaneous impact.

This was all designed to help Australia win its court case and to encourage countries like Britain to follow suit. For that reason we might not expect the same quantity of policy-based evidence to follow the introduction of plain packaging in Britain, but it is striking that there has been almost nothing. There was some flim-flam about smokers noticing the warnings more, as if that makes any difference to anything, and there was a study claiming that plain packaging caused prices to rise, but that's about it.

Today marks two years since the sale of cigarettes in plain packaging became mandatory. There has been not a word of it in the media. ASH haven't even mentioned it on Twitter. All those years spent campaigning for it. All those millions of pounds spent. And yet there is nothing to say and nothing to report.

Enough time has passed for us to see whether the policy had any short-term effect on the smoking rate. The Smoking Toolkit Study provides monthly estimates of smoking prevalence in England. As the graph below shows, in the first year of mandatory plain packaging, the smoking rate went up.

The rise in smoking from the spring of 2017 was driven by a pronounced increase in the smoking rate among men. The overall rise was steady and sustained in the first year in contrast to the secular decline which had been consistently downwards since late 2014. The downward trend did not resume until around May 2018, a year after plain packaging kicked in. The smoking rate is now more or less where you would expect it to be based on the longterm trend.

It is not obvious why the smoking rate went up between the spring of 2017 and the spring of 2018, nor is it obvious why there was a notable decline thereafter. But if plain packaging was responsible, it had a peculiarly delayed effect.

Note that plain packaging was not the only policy that came into full effect on May 20th 2017. It was also the date of full implementation of the EU's Tobacco Products Directive (TPD). Among other things, the TPD banned the sale of small packs of cigarettes/tobacco and restricted the amount of nicotine in e-cigarette fluid.

Note also that neither the TPD nor plain packaging came in overnight. From May 2016, tobacco and vape companies were given twelve months to clear out old stock. The tobacco industry made sure that there were plenty of branded packs available to retailers before the cut-off date of 20 May 2017 but some plain packs filtered onto the market before then. They remained quite rare until early 2017 and branded packs continued to be more common right up until the final day.

All of these policies were supposed to drive down the smoking rate. Given the amount of time, money and effort that went into turning the TPD and plain packaging into law, you would think there would be more interest in seeing what actually happened afterwards.

What happened was, at best, bugger all.

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