Tuesday 31 March 2020

'Public health' groups want you to die for their dogma

It’s been encouraging to see the private sector using its money, ingenuity and supply chains to help tackle the coronavirus pandemic. Mercedes F1 has been producing breathing aids. Dyson is manufacturing 10,000 ventilators. Diageo and several e-cigarette companies have been turning their skills towards producing hand sanitiser.

Meanwhile, the lifestyle wing of ‘public health’ has never looked more out of touch and irrelevant, reduced to lying about vaping and carping about big business. Today, a bunch of them have written to the British Medical Journal demanding cigarette-style warnings on petrol. Their inability to read the room in the last few weeks has been astonishing.

According to Matt Ridley, the rot goes all the way to the top:

Last week, I mentioned the temperance group whining about Diageo’s generosity. This week it is the turn of the anti-smoking fanatics. The Bureau of Investigative Journalism, which is best known for getting fake news on Newsnight and nearly destroying the programme, is now being funded by uber-nanny statist Mike Bloomberg to produce articles attacking ‘Big Tobacco’. It was behind last month’s Dispatches programme about Philip Morris (PMI) and it has come up with an equally lame gotcha this week.

Philip Morris International, the world’s largest multinational tobacco company, has been accused of a “shameful publicity stunt” by a leading campaigner after it donated ventilators to the Greek government as coronavirus infections mount in the country.

One of PMI's affiliate companies donated fifty ventilators to Greek hospitals, the bastards. The 'leading campaigner' who is outraged by this is our very own Deborah Arnott of the state-funded pressure group Action on Smoking and Health:

“This is a shameful publicity stunt by Philip Morris International, which owns Papastratos and has a 40% share of the Greek tobacco market.” 

But if this is first you’ve heard about it, it’s because PMI didn’t seek publicity. As Moira Gilchrist, PMI’s refreshingly vocal vice-president explains...

My old pal Dick Puddlecote has often said that the obsessive puritans who have weaselled their way into the ‘public health’ movement are not interested in health. This little story illustrates that perfectly. These people would rather see people die in agony than allow one of their disfavoured industries to provide life-saving equipment.

It's one thing to die for your beliefs, but expecting other people to die for them is a step too far.

The current pandemic will leave us poorer and weaker in many ways, but if, when the dust settles, people realise what the bottom feeders of fake 'public health' are like, some good many yet come of it.

Sunday 29 March 2020

Whatever happened to Public Health England?

Public Health England has been strangely quiet during the pandemic. Its CEO Duncan Selbie, who earns more than the prime minister, has been nowhere to be seen. The job of tackling coronavirus has been left to the NHS and the Chief Medical Officer while PHE has been reduced to retweeting the Department of Health.

Only a tiny fraction of the £4 billion spent on public health in England goes towards the prevention of infectious disease. Far more is spent hassling people about their lifestyles. I have long called for the WHO and other public health agencies to focus on genuine public health problems rather than lifestyle regulation. Nothing could have fully prepared us for coronavirus but you'd think £4 billion a year would at least get us a decent supply on face masks.

I discuss this and more with Claire Fox and Tom Slater in the latest episode of the Last Orders podcast. Have a listen.

Public Health England is a beacon of competence compared to the wretched World Health Organisation. Patrick Basham has produced a shocking timeline showing the WHO's mismanagement of the pandemic and its creepily pro-China stance. It's well worth reading.

I was also talking to Mike Graham on TalkRadio last week about the economic implications of the lockdown.

Friday 27 March 2020

Corona-vultures in the temperance movement

The International Order of Good Templars has changed its name to Movendi International, presumably in the hope that adopting a bland, corporate name will make people forget that it is one of the world's oldest gospel temperance groups.

The Anti-Saloon League and the UK Temperance Alliance did the same thing and are now trading as the American Council on Alcohol Problems and the Institute of Alcohol Studies, respectively. What is it about their origins that they are so ashamed of?

Like nearly every other single issue pressure group these days, the folks at 'Movendi' are trying to exploit the coronovirus pandemic for their own ends. They are very concerned about - you guessed it - the alcohol industry.

Major alcohol producers have announced their commitment to helping fight the novel coronavirus, COVID-19. Alcohol producers are shifting production to make hand sanitizers.

The alcohol industry is doing valuable public health work. That must sting.

While this is welcome, there are several reasons for caution and concern.

Such as?

Producing hand sanitizers and taking care of employees is the least the alcohol industry can do in this crisis.

Other people and professions are contributing with far greater efforts to the fight against the pandemic.

But not Movendi, because Movendi is a puritanical lobby group that has nothing to offer.

Movendi International cautions against the promotion of alcohol brands, free media coverage and PR-celebrations of an industry that is not and has never been a responsible corporate citizen. Political leaders and the media should refrain from providing a platform for brand exposure and free coverage of a health harmful industry.

Yeah, because people thinking well of the alcohol industry is the real issue at the moment, isn't it? Get a grip.

Corporate social responsibility initiatives are known to be strategies by the alcohol industry to do well by appearing to do good.

They are doing good. Suck it up.

Movendi's demands won't surprise you...

Declare alcohol retail outlets non-essential and find effective ways to provide services for all people, alcohol users and non-users, affected by alcohol harm during the crisis.  

This is straight out of the Anti-Saloon League's playbook. Remember this?

They continue...

Alcohol is not an ordinary commodity and alcohol harm is multifaceted and pervasive. A major dimension of alcohol harm is the damage to others than the alcohol user. Comprehensive impact assessments should be conducted and will lead to the conclusions that alcohol retail outlets are non-essential businesses...

They will, will they? I know that the quack social science of 'alcohol control' styarts with the conclusion and works backwards, but you're not supposed to say that out loud.

Be gone with you 'Movendi'. We need you now less than ever.

Thursday 26 March 2020

The corona-vultures circle

Dr Farsalinos and colleagues have been updating their working paper on smoking, vaping and coronavirus. The evidence for either activity increasing COVID-19 risk remains virtually nonexistent.

Not that this has stopped the pretend 'public health' lobby muscling in on a genuine public health problem. The Mayor of New York has been urged to ban tobacco and e-cigarette sales, and South Africa has just announced that it will effectively ban the sale of tobacco and alcohol during its 21 day lockdown.

In the Alice in Wonderland world of tobacco control, the myth about smoking increasing COVID-19 risk has become an established fact. Cherry-picking the one study that suits their purposes and ignoring the rest, they have come to the usual conclusion: they need more taxpayer cash:

The role of smoking in the contraction, transmission and mortality rate of Covid-19 should be given research attention, and countries should allocate resources to health stimulus packages, scientific research, and actions to further reduce smoking rates.

The corona-vultures are circling. Most 'public health' professionals wouldn't know one end of a microscope from the other. They are all about politics and lifestyle regulation and are therefore useless in a pandemic, but they can smell authoritarianism in the air and are keen to piggy-back it with their usual obsessions.

Take this nit-wit, for example. Terrifyingly, he is the WHO's external relations officer. Speculating wildly, he links to a Daily Mail article as supporting evidence:

Meanwhile in Britain, Greg Fell, Sheffield's low IQ public health director, is hopeful that COVID-19 will speed up the 'endgame' of total prohibition.

Today I read about an anonymous group that has just been set up under the name Lower The Baseline. Its website address was registered a few days ago but it has already got some media attention for an open letter which appears not to have been published anywhere. Their solution to COVID-19? Minimum pricing for alcohol and a lower speed limit.

Expect much more of this. The authoritarian nightmare in which we are temporarily living is Utopia for some.

Wednesday 25 March 2020

Vaping, smoking and coronavirus - the facts

Never letting a good crisis go to waste, a few prohibitionists have been exploiting people's fear of coronavirus to clamp down on vaping and smoking. The evidence that smoking increases the risk of dying from this disease is very weak - if anything, smokers seem to be have been under-represented in the coronavirus death toll in China (see here, here and here). The evidence against vaping is simply nonexistent; no studies have yet included data on vaping. Nevertheless...


In the USA, 'all tobacco products' includes e-cigarettes.

Roberto Sussman and Carmen Escrig have produced a thorough and well referenced fact sheet looking at the issues of vaping and smoking in relation to COVID-19. With permission, I am publishing an edited version of it here...


WHY THIS DOCUMENT? The spread of the SARS-CoV-2 pandemic provides fertile ground for spreading misinformation on vaping. Vapers must be equipped with solid information and data to counterargue.

ON SMOKING. The relation between smoking and the progression to severe conditions of COVID-19 is still uncertain, though identified vulnerability conditions for this progression (cardiovascular and respiratory disease, diabetes) in mostly senior patients are strongly correlated with long term harms from smoking.

ON VAPING. There is no evidence that vaping (intrinsically) increases the risk of infection or progression to severe condition of COVID-19. When evaluating risks to vapers it is necessary to consider that most are ex-smokers or still smokers. Vapers with a long previous smoking history could exhibit conditions seen in vulnerable patients. However, this would not be an effect of vaping but of previous smoking. Since completely switching from smoking to vaping improves cardiovascular and respiratory conditions, smokers who switch to vaping are expected to have a better prognosis if infected by SARS-CoV-2

ON PROPYLENE GLYCOL (PG) AS DISINFECTANT. Because of its hygroscopic nature PG vapor (not droplets) can act as environmental disinfectant wiping out pathogens under specific physical conditions. However, there is no evidence on whether this effect will work on SARS-CoV-2 and in the context of vaping.

ON ENVIRONMENTAL VAPOR. While there are no reported and verified cases of contagion, the saliva droplets carrying SARS-CoV-2 virus are much heavier than the rapidly moving volatile droplets of exhaled vapor. Therefore, vapor exhaled by an infected vaper is likely to spread as much viruses as in normal respiration in the personal breathing zone, far less and far closer than spreading by sneezing or coughing.

RECOMMENDATIONS. The precautions to prevent contagion from virus carried by e-cigarette vapor are the same “social distancing” measures recommended to all the population including non-vapers: avoid physical contact and proximity to others. For vapers specifically: vape with low powered devices, avoid vaping in public indoor spaces and in outdoor spaces vape at least 2 mts away from others.

The misinformation pandemic

Unfortunately, the spread of the SARS-CoV-2 pandemic follows a long pandemic of serious misinformation on vaping. One of the main spearheads of this misinformation is undoubtedly Professor Stanton Glantz from the University of California at San Francisco. In his professional blog [1] Professor Glantz squarely puts vaping and smoking on equal footing as serious risk factors for progression to COVID-19. Specifically, Glantz justifies this assessment by stating that:

The recent excellent summary of the evidence on the pulmonary effects of e-cigarettes reported multiple ways that e-cigarettes impair lungs’ ability to fight off infections

This statement is followed by a list of adverse effects of vaping on respiratory infections, all taken from studies examined in the review by Gotts et al [2] (the “excellent summary”). While recognizing that Vapers’ risk of viral infections has not been studied much, the popular journal Scientific American [3] has cited Glantz and has also recycled some of the results reported by Gotts et al.

The review by Gotts et al, which Glantz and Scientific American take as source, is extremely superficial, biased and selective. It cites uncritically only studies reporting adverse effects, all of which are either acute effects without clinical relevance or cross sectional studies based on small samples of vapers in which the huge confounding effect of previous smoking history was not properly handled (see a critique of such studies in a much more balanced and extensive review of respiratory effects [4] of vaping). Moreover, Gotts et al (and Glantz quoting them) interpret the results in a very selective manner. A representative example of their modus operandi is furnished by their assessment of the results obtained by one of the revised studies by Saudt et al [5]. From Glantz’s exact quote of Gotts et al we have

Healthy non-smokers were exposed to e-cigarette aerosol, and bronchoalveolar lavage was obtained to study alveolar macrophages. The expression of more than 60 genes was altered in e-cigarette users’ alveolar macrophages two hours after just 20 puffs, including genes involved in inflammation.

Curiously, Gotts et al and Glantz omit mentioning that the effects examined in [5] were acute and that the same study reports that “No significant changes in clinical parameters were observed”. Gotts et al and Glantz quoting them also omit mentioning evidence pointing in the opposite direction: as reported by several studies reviewed in [3] the usage of e-cigarettes actually reduces the presence of pathogens and respiratory infections. A significant decrease of respiratory infections in e-cigarette users has also been reported in a large scope randomized controlled trial researching smoking cessation [6], a result based on a 12 months long clinical observation on a large sample of subjects. This result (and similar results in other randomized trials reviewed in [7]) are real life observational results that are more relevant to assess the immune response of vapers in the context of COVID-19 than the adverse acute effects in idealized lab studies reported uncritically by Gotts et al in [2] and recycled by Glantz and Scientific American.

Professor Glantz is perhaps the most vocal spearhead, but he is far from being the only academic in the vast USA sourced anti-vaping activism, which is now presenting the relation of vaping and the SARS-CoV-2 pandemic through the grossly biased assessments from reviews like that of Gotts et al, conflating carelessly the risks of vaping and smoking and ignoring all contrary or critical evidence. It is very unfortunate that mainstream academia, politicians and the media in the USA is predominantly fed by this constant flow of misinformation, as can be seen in statements by the Major of New York City, Bill de Blasio [8], and by various media outlets [9].

COVID-19 and smokers

A good reference reviewing the available evidence on the relation between smoking, vaping and COVID- 19 is the article written by Farsalinos, Barbouni and Nyaura [10] (see also the professional blog entry of Farsalinos [11]). The authors conclude after reviewing the data from five studies on patients infected by SARS-CoV-2 that the relation between smoking cigarettes and the severity of COVID-19 in infected Chinese patients is uncertain and even protective (bearing in mind that 52.1% of Chinese men smoke whereas only 2.7% of women do). In his blog entry Farsalinos examines in more detail the data from the study with the largest sample [12]: 1096 patients, of whom only 12.5% were current smokers (1.9% ex- smokers), which (as in the other studies) is a much lesser proportion than that found among the population bearing in mind that 58.1% of the sample were men and practically 100% older than 15 years (to be representative of the population we would expect the proportion of smokers in the sample to be 29%). Of the 1096 patients:

• 926 were reported without severe affectation (11.8% smokers)
• 173 were reported with severe affectation (11.8% smokers)
• 67 were reported in critical situation with intensive care, mechanical ventilation or dead (25.8% smokers)

These numbers indicate a higher proportion of smokers among those with severe outcomes, but still lower than in the general Chinese population given the high smoking prevalence among Chinese men. Evidently, smoking contributes to identified vulnerability conditions, such as cardiovascular ailments, diabetes or chronic lung disease, moreover, there seems to be no evidence that smoking in itself is the dominant or determinant factor.

The effect of COVID-19 on vapers

Contrary to statements by misinformation sources, there is simply no evidence suggesting that vaping has the capacity to affect negatively the immune body response in order to produce the development and progression of the diseases caused by SARS-CoV-2 on e-cigarette users.

To better understand the possibility of a progression of infection leading to COVID-19 in vapers it is necessary to bear in mind that the overwhelming majority are smokers or ex-smokers, some of them dragging long histories of previous smoking. This smoking history is very likely an important factor that could easily render as vulnerable a vaper who (say) smoked 20 or 30 years, even if he/she has been (typically) 2-3 years vaping without smoking. Such vaper would be more susceptible to the complicated etiology of COVID-19. However, this is not an intrinsic effect of vaping, but of smoking, and thus it does not justify casting vaping as a risk factor on equal footing as smoking (as inferred from misleading statements by Glantz that have been recycled by the media).

In fact, bearing in mind that smokers improve their biomarkers and their respiratory and cardiovascular conditions when they switch completely to vaping, it is highly plausible (as Farsalinos argues [11]) that they would have a better prognosis under possible progression of COVID-19 if they no longer smoke, even if they have smoked before. This effect would be even more pronounced if it turns out that smoking is a determinant factor in the evolution to severe complications from COVID-19. It is also important to stress that there cannot be contagion of SARS-CoV-2 virus through e-liquids containing the virus. Pathogens have been detected on e-liquids, however it would be practically impossible to become infected by vaping e-liquids containing the SARS-CoV-2 virus or any other pathogen. The e- liquid becomes heated at 180-220 degrees Celsius. No pathogen can survive these temperatures (they stop functioning as the macromolecules making them up fragment).

Exhaled vapor as a possible path to spread SARS-Co-V2

A worrying theoretically possible path of infection of the SARS-Co-V2 virus is by breathing environmental aerosol (i.e. “vapor”) exhaled by vapers, a diluted and volatile aerosol composed almost entirely of droplets made of PG, glycerol (VG) and humectants (the visible “cloud”) suspended in a gaseous medium made of the same compounds (nicotine and aldehydes and metals are present at trace levels).

Can this exhaled vapor spread SARS-CoV-2? As stated by Rosanna O’Connor, director of the Tobacco Alcohol and Drugs of Public Health England [19], and Professor Neil Benowitz of the University of California at San Francisco [20], currently there is no evidence of contagion through vapor exhaled by users of e-cigarettes. As a contrast, the Scottish microbiologist Tom McLean, chief scientific advisor of the Nanotera Group, claims [21] that exhaled vapor can spread the virus, even comparing exposure to exhaled vapor as “being spit in your face”. As we show below, McLean’s statements are completely mistaken and contradict basic principles of aerosol physics.

It is known that SARS-CoV-2 contagion occurs by exposure to the virus in airborne saliva droplets exhaled in the breath of an infected person (at short distances) and, in a more efficient form (at larger distances) when the infected person sneezes or coughs [22]. When using an e-cigarette the exhaled vapor is a tidal flow that is bound to carry into the environment any buoyant material (possibly including pathogens) contained in the respiratory system of the vaper, just as it happens when breathing, but vaping in itself would be a distinct unique mechanism (it is impossible vape and sneeze or cough at the same time).

As opposed to normal breathing, coughing or sneezing, the airborne saliva droplets carried by exhaled vapor would be suspended on a different chemical medium of PG/VG droplets and vapor (other compounds like nicotine and aldehydes are found at trace levels). While it is impossible to rule out the action of a disinfectant effect as reported in [14,15,16] through the condensation of PG vapor on the saliva droplets carrying the SARS-CoV-2 virus, this remains a highly unlikely and merely speculative and theoretical possibility without any empirical support. The most important criterion to examine the possibility of SARS- CoV-2 virus transmission though the exhaled vapor is the dynamics of possible saliva droplets dragged by this flow.

The exhaled vapor is a diluted aerosol made almost exclusively of very light and rapidly moving PG/VG droplets (the “particles”) with mean diameters of about 100-300 nm [23,24] (one nanometer nm is 1 billionth of a meter). These droplets evaporate very rapidly (20 seconds per puff) and the whole gaseous system is supersaturated and disperses completely in less than 2-3 minutes. Some of these droplets will impact walls or fall to the ground before evaporating. Chamber and laboratory experiments reveal that most droplets are not transported large distances: at 1.5 meters from the exhalation source they are barely detectable, with their particle number density almost indistinguishable from background values for all particle sizes (submicron, PM2.5 and PM10). For low powered devices this distance is likely to be less than 1 mts.

The spreading of the virus can be understood in terms of the dynamics of an airborne biological aerosol made by an ensemble of “viral particles” of about 100 nm typically contained in saliva droplets that are large particles of 5-10 microns (one micron is 1000 nm) of diameter [22,25]. The exhalation of normal breath under sedentary conditions is a low velocity nearly laminar air flow, so it will spread few droplets at short distances, whereas sneezing is a high speed explosive turbulent flow that can spread up to millions of droplets at larger distances (coughing can spread thousands of droplets). The saliva droplets transporting the virus can (in principle) remain buoyant for long time, though in real life conditions they are very susceptible to environmental conditions: temperature, relative humidity, solar radiation, evaporation, fall by gravity and impactation in surfaces [22,25]. Although such droplets have been reported traveling up to 2.5 meters away (probably from somebody sneezing), this distance is a maximal value so that under normal environmental conditions the average distance traveled before evaporation or impactation should be much less, probably around 1.5 meters (even less in dry and hot environments) and even less (the breathing zone of about 30 cm) when exhaled by normal breathing.

The exhalation flow associated with vaping is in terms of velocities an intermediate flow between the two extremes given by the near laminar flow of normal breathing and the fast turbulent flow of sneezing or coughing [22]. However, the saliva droplets carrying up to thousands of viral particles behave dynamically different from the rapidly evaporating PG/VG droplets in the e-cigarette aerosol: they stay buoyant for much longer times and are also much heavier and thus present a lot of inertial dragging to the exhaled flow.

Therefore, it is unlikely that the heavy saliva droplets dragged by the exhaled flow of an infected vaper would be transported as far as distances of 1.5 meters where the much lighter PG/VG droplets are barely detectable (their particle number density almost blends with environmental control values [23,24]). For low powered devices the exhaled vapor flow is slower and closer to being laminar, not much different from that of the normal respiratory flow, hence the distance reached by saliva droplets dragged by the exhalation should be even less, likely comparable to the personal breathing zone (30 cm). Thus, Rosanna O’Connor from PHE and Professor Benowitz are right: there is no special risk of contagion of SARS-CoV-2 from exhaled vapor that would require more strict measures with respect to non-vapers. The contagion risk from exhaled vapor cannot be compared to that from spreading the virus through sneezing or coughing, as claimed by Tom Mclean. It is reasonable to expect that, depending on the power of the vaping device, exhaled vapor from an infected vaper would spread roughly the same amount of saliva droplets containing SARS-CoV-2 virus as the normal respiration of a non-vaper in his/her breathing zone. Keeping the same 1.5 to 2 meters distance recommended for non-vapers should prevent any contagion from a vaper.

[1] S.A. Glantz, Reduce your risk of serious lung disease caused by corona virus by quitting smoking and vaping. https://tobacco.ucsf.edu/reduce-your-risk-serious-lung-disease-caused-corona-virus-quitting- smoking-and-vaping

[2] J.E. Gotts et al. What are the respiratory effects of e-cigarettes? BMJ 2019;366:l5275. doi: https://doi.org/10.1136/bmj.l5275

[3] Tanya Lewis. Smoking or Vaping May Increase the Risk of Severe Coronavirus Infection. Scientific American. 17 March. https://www.scientificamerican.com/article/smoking-or-vaping-may-increase-the- risk-of-a-severe-coronavirus-infection1/

[4] Polosa R, O’Leary R, Tashkin D, Emma R & Caruso M (2019) The effect of e-cigarette aerosol emissions on respiratory health: a narrative review, Expert Review of Respiratory Medicine. https://www.tandfonline.com/doi/full/10.1080/17476348.2019.1649146

[5] Staudt MR, Salit J, Kaner RJ, Hollmann C, Crystal RG Altered lung biology of healthy never smokers following acute inhalation of E-cigarettes. Respir Res2018;19:78. doi:10.1186/s12931-018- 0778-z pmid:29754582

[6] Peter Hajek, Ph.D., Anna Phillips-Waller, B.Sc., Dunja Przulj, et al. A randomized trial of e-cigarettes versus Nicotine Replacement Therapy. N Engl J Med 2019; 380:629-637 DOI: 10.1056/NEJMoa1808779 https://bit.ly/2RWdcd0

[7] Hartmann-Boyce J, McRobbie H, Bullen C, Begh R, Stead L, Hajek P. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2016 Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216. http://onlinelibrary.wiley.com/cochranelibrary/search/

[8] https://www.reuters.com/article/us-health-coronavirus-usa-vaping/smoking-or-vaping-increases- risks-for-those-with-coronavirus-nyc-mayor-idUSKBN20V0Z0

[9] https://nypost.com/2020/03/21/vaping-may-be-cause-of-coronavirus-cases-in-young-americans- experts-say/ https://www.dailymail.co.uk/health/article-8136069/Experts-question-vaping-drives-rise-young- Americans-COVID-19.html http://www.msnbc.com/morning-joe/vaping-one-the-best-ways-trash-your-lungs-and-maybe-die-if-you-catch-coronavirus

[10] K. Farsalinos, A. Barbolini, R. Nyaura. Smoking,vaping and hospitalization for COVID-19. Queios ID: Z69OBA.2. https://doi.org/10.32388/Z69O8A.2

[11] K Farsalinos. Smoking, vaping and the coronavirus (COVID-19) epidemic: rumors vs. evidence http://www.ecigarette-research.org/research/index.php/whats-new/2020/278-corona

[12]Wei-jie Guan et al. Clinical characteristics of Coronavirus disease in China. N Engl J Med 2020; https://www.nejm.org/doi/full/10.1056/NEJMoa2002032

[13] https://twitter.com/i/topics/news/e137920411?cn=ZmxleGlibGVfcmVjc18y&refsrc=email

[14] Robertson O.H., Bigg E., Puck T.T., Miller B.F., Technical Assistance of Elizabeth A. Appell. The bactericidal action of propylene glycol vapor on microorganisms suspended in air: I. J Exp Med. 1942 Jun 1;75(6):593-610. https://www.ncbi.nlm.nih.gov/pubmed/19871209

[15] Puck T.T., Robertson O.H., Lemon H.M., The bactericidal action of propylene glycol vapor on microorganisms suspended in air: II, the influence of various factors on the activity of the vapor. J Exp Med. 1943 Nov 1;78(5):387-406. https://www.ncbi.nlm.nih.gov/pubmed/19871337

[16] T.T. Puck, The mechanism of aerial disinfection by glycols and other chemical agents. I Demonstration that the germicidal action occurs through the agency of the vapor phase. J Exp Med. 1947 May 31; 85(6): 729–739. doi: 10.1084/jem.85.6.729

[17] Czogala, J., Goniewicz, M., Fidelus, B., Zielinska-Danch, W., Travers, M. and Sobczak, A. (2013) “Secondhand exposure to vapors from electronic cigarettes”. Nicotine Tob Res (11 December 2011 (Epub ahead of print). DOI: 10.1093/ntr/ntt203

[18] J Liu, Q Liang, M J. Oldham, A A. Rostami, K A. Wagner, G Gillman, P Patel, R Savioz, M Sarkar. “Determination of Selected Chemical Levels in Room Air and on Surfaces after the Use of Cartridge- and Tank-Based E-Vapor Products or Conventional Cigarettes”. Int. J. Environ. Res. Public Health 2017, 14, 969; doi:10.3390/ijerph14090969

[19] Coronavirus and vaping: Can e-cigarette clouds pass on Covid-19? https://www.standard.co.uk/news/world/vaping-coronavirus-ecigarette-cloud-expert-advice- a4386996.html

[20] Coronavirus will NOT spread in vape clouds unless the e-cigarette user coughs when they exhale, scientists claim. Daily Mail. March 23rd 2020. https://www.dailymail.co.uk/news/article- 8143385/Coronavirus-NOT-spread-vape-clouds-unless-e-cigarette-user-coughs.html

[21] ‘Someone spitting in your face’: Coronavirus: Scottish expert warns of vaping dangers. Glasgow Evening Times. 16th March 2020. https://www.glasgowtimes.co.uk/news/18309649.someone-spitting- face-coronavirus-scottish-expert-warns-vaping-dangers/

[22] J.M. Macher, J. Douwes, B. Prezant and T. Reponen, Bioaerosols. Chapter 12. Aerosols Handbook, Measurement, Dosimetry and Health Effects. Second Edition. Edited by L.S. Ruzer and N.H. Harley. CRC Press. Taylos & Francis Group, Boca Raton, London, New York 2013

[23] Tongke Zhao, C Nguyen, Che-Hsuan Lin, H R. Middlekauff, K Peters, R Moheimani, Qiuju Guo & Yifang Zhu (2017). Characteristics of secondhand electronic cigarette aerosols from active human use, Aerosol Science and Technology, 51:12, 1368-1376, DOI: 10.1080/02786826.2017.1355548

[24] D Martuzevicius, T Prasauskas, A Setyan, G O’Connell, X Cahours, R Julien, S Colard, Characterization of the Spatial and Temporal Dispersion Differences Between Exhaled E- Cigarette Mist and Cigarette Smoke, Nicotine & T obacco Research, 2018, 1–7 doi:10.1093/ntr/nty121

[25] Van Doremalen N. Et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMc2004973?query=TOC

Friday 20 March 2020

Avoid like the plague

The shelves are emptying around Britain as the nation prepares to self-isolate, but some products won't sell under any circumstances.

Via @oliviapienaar

Stay well and make sure your elderly friends and relatives stay home.


And another one...

Friday 13 March 2020

Are there any libertarians in a pandemic?

The kind of people who say ‘if you like freedom so much, why don’t you move to Somalia?’ think that libertarians have been “owned” by the coronavirus. If you oppose the nanny state but want to contain the epidemic, you are apparently some kind of hypocrite. How can libertarians ever support mandatory quarantine and nationwide lockdowns?

Quite easily, as it happens. I can’t speak for all libertarians (who can?) but I see libertarianism as applied economics. The government should leave businesses alone unless there are demonstrable market failures and it should leave people alone unless they are doing direct harm to others.
In case it is not obvious, infecting somebody with a potentially fatal virus counts as direct harm to others.

Let us assume that Coronavirus is far more dangerous than seasonal flu and has the potential to kill millions. If so, it is a classic public health problem. It carries serious negative externalities and can only be dealt with by collective action. There are things you can do as an individual to reduce your risk - wash your hands, cancel non-urgent appointments, etc. - but you will still be at risk.

Libertarians want to keep coercion to the minimum. We would prefer mass vaccination, but there is no vaccine yet. We would prefer voluntary self-isolation, but we cannot rely on people doing this even if they are aware that they have the virus. Lock-downs and quarantines are economically damaging and illiberal. They might be a last resort, but they should not be off the table. They do not fall under the umbrella of ‘nanny state’ because they are designed to protect other people from you and you from other people, not you from yourself.

Most of what passes for ‘public health’ policy these days has nothing to do with public health in its true sense. Factories pumping smoke into a congested city and travellers arriving at Heathrow with Coronavirus pose a clear risk of harm to others that can justify some degree of coercion. It is not the scale of the risk nor the number of people affected that turns a health problem into a public health problem. It is the lack of consent from those who are at risk and their inability to escape danger without other people taking action.

By contrast, if I eat too much, it won’t make you fat. If I smoke or drink too much, it might create a private health problem for me, but it doesn’t create a public health problem for society. These are not issues for the collective and they do not require collective action to address them, led alone coercion from the state. My body, my rules.

Personal lifestyle habits have been redefined as ‘public health’ issues in recent decades because it gives the impression that government action is appropriate when it is not. It is a rhetorical trick. But, as we are seeing now, genuine public health crises can still arise, even in rich countries. When they do, our response should be proportionate. We want to keep restrictions on liberty to a minimum and we do not want to damage the economy, but we may have to accept a bit of both - temporarily - if we are to protect ourselves. This is not the nanny state. It is the prevention of harm from an external threat.

[Reposted from the Telegraph]

Thursday 12 March 2020

Scientists at work

Research in progress

With the Coronavirus now officially a pandemic, it's all hands to the pumps for public health groups who are desperately trying to warn people about... salt.

The Royal Society for Public Health has been talking about little else - for it is salt awareness week. Action on Sugar/Salt did their usual thing of reporting the amount of salt that is 'hiding' in various products and declaring their findings to be 'shocking'.


The George Institute did likewise...


The photo in this tweet shows all too clearly how mundane this 'research' is. They buy a load of food products and look at the labels. When the salt content is shown on the packaging, it's not really 'hidden', is it?

Another study crossed my radar yesterday to illustrate the feeble nature of modern, deskbound 'public health' research. It looked at the amount of money 'Big Food' gives to various academic institutes. It doesn't show that the donations influenced results, not does it show whether these institutions produced better or worse research than those which remain 'independent'.

It doesn't even show how much money is involved because the whole thing is based on a Google search.

This study has several limitations. Our search missed donations that were not highly publicized, those on websites that had deleted older information or not disclosed such information, or donations from shell foundations and companies. Another limitation of our study is that the data on the growth in donations over time may be attributable to secular trends in Internet use, recent public pressure to increase transparency in industry donation practices, or removal of older donation information from websites. Finally, it is possible that our Google search terms produced biased search results that may have led us to miss relevant websites. For example, we used search terms such as “[company name] [synonyms for donation]” but not “[company name] endowed chair” or “[company name] hospital”, meaning our search procedures likely produced an incomplete list of the food industry’s relationships with academic programs. 

 One for the Nobel committee to consider this year.

Wednesday 11 March 2020

Brexiting the nanny state

The splendid Brian Monteith has set up a new website called Brexit Watch to keep you in the loop about the opportunities and risks of Britain leaving the EU.

I’ve written an article for it, looking at what the government can do in the area of smoking, vaping and tobacco harm reduction. Have a read.

Monday 9 March 2020

'Public health' conference puts public health at risk

There is a big temperance conference masquerading as a public health conference happening this week. Perhaps it shouldn't be.

The Department of Health, and Minister Simon Harris, have so far failed to respond to questions put to them asking if they had put in place measures, recommended by the World Health Organisation [WHO], to minimise the risk of a COVID-19 outbreak at an international event the Department is co-hosting next week. They have also both failed to respond to questions about how they will minimise the harm to the general population of Ireland should an outbreak occur at that event.

The Global Alcohol Policy Conference, a 3 day event, is due to take place in Dublin from Monday the 9th of March. That event will see somewhere in the region of 1,000 participants, from all over the world, coming together to discuss how best to ‘reduce alcohol-related harm worldwide’.

The conference is organised by the Global Alcohol Policy Alliance, one of many groups set up by the temperance diehard Derek Rutherford.

The WHO has issued a document, “Key planning recommendations for Mass gatherings in the context of the current COVID-19 outbreak”, which details the plans and procedures that should be put in place for mass gatherings due to the increased risk of an outbreak of COVID-19 that these events represent.

Gript has reached out to the Department, on multiple occasions, and Minister Harris directly to confirm that the Department has carried out the plans and procedures recommended by that document, but both the Department and the office of the Minister have so far not confirmed the existence of any of the plans recommended by the WHO.

Oh dear. I hope everyone's going to be OK.

You can follow the conference on the Twitter hashtag #GAPC2020. So far, it seems to be the usual assortment of false assertions and fanaticism.

Friday 6 March 2020

Anti-smoking loonies

The anti-smoking movement jumped the shark years ago. All you can do now is stand and watch, open-mouthed, as this unaccountable, morally bankrupt racket abuses science, reason and common sense.

Here are two examples from this week.

1. Underage smoking is becoming so rare in the USA that the fanatics are having to move the goalposts dramatically to keep the panic going.

Twenty-six years old! Won't somebody think of the relatively young adults?

2. The preposterous notion of thirdhand smoke made one of its occasional reappearances yesterday. Laughing in the face of Paracelsus, some alleged scientists went looking for trace chemicals that they associate with tobacco and found some in cinemas.

CNN's report was typical of the credulous media's coverage:

You can tell the dude sitting next to you in the movie theater is a smoker or vaper; you can smell it on his clothes. But since he's not lighting up and puffing smoke your way, it's OK, right?

Not at all.
A new study out of Yale University says thirdhand smoke -- the tobacco contaminants that adhere to walls, bedding, carpet and other surfaces until a room smells like an ashtray -- can actually cling to a smoker's body and clothes as well.
Those potentially toxic chemicals, including nicotine, can then be released into environments where smoking has never occurred, like your movie theater, according to the study.
Even more disturbing: The study found those chemical exposure levels could be the equivalent of between one and 10 cigarettes by the end of the movie.
This is a lie and quite an obvious lie at that.

Just in case the reader can't work out the true purpose of this flim flam, a crackpot cardiologist from New York makes it explicit:

"If the findings hold true, the implication is that essentially we are going to need to make everything smoke-free," Narula said. "And the only way that you will be able to do that is nothing short of banning smoking everywhere."

How convenient!

The Guardian put this garbage on the front page. The concept of 'thirdhand smoke' has been around since 2009 but has never really taken off, except in the looniest parts of California, because it is so patently absurd. Perhaps its time will come in the lobotomised 2020s.

Thursday 5 March 2020

Banning menthol cigarettes doesn't work

I was surprised to learn recently that 17.5 per cent of female smokers in England smoke menthol cigarettes. The rate for both sexes combined is 12.4 per cent, a much higher figure than seen in most countries.

They'd better get ready for May 20th when the EU bans them from sale, unless the British government is going to take back control by then, which seems unlikely.

The EU decided on this piece of 'market harmonisation' despite no member states having banned menthol cigarettes and no member state seriously discussing such a ban. There was never any serious science behind it. They got away with it because menthol smokers are a minority within a minority.

I understand that menthol filter tips will not be banned, so smokers who roll their own should be OK, but for everybody else the only options will be switching to normal cigarettes or buying on the black market. It will be interesting to see how the illicit trade adapts to this new opportunity, not just in Britain but across the EU.

A working paper published last month by the National Bureau of Economic Research, based on real world evidence from Canada, gives us an idea of what we can look forward to. Spoiler: it won't reduce the smoking rate.

It found...
...strong evidence that individuals responded to provincial menthol bans in a variety of ways that are consistent with substitution and evasion. Specifically, the results in the top panel for youths indicate that menthol bans were associated with statistically significant increases of 1.7 percentage points in the likelihood of past 30 day non-menthol cigarette smoking, consistent with the idea that young menthol smokers switched from menthol cigarettes to non-menthol cigarettes in response to the bans. 

It didn't make smokers switch to vaping...

The other possible substitution that the public health literature has identified as a target of concern is e-cigarettes, which we examine in column 2 of Table 5. We find no evidence that provincial menthol bans were associated with statistically or economically meaningful increases in e-cigarette use

But it did drive people to find alternative suppliers...

Finally, the bottom panel of columns 3 and 4 of Table 5 provide strong evidence of another behavioral response to provincial menthol bans: evasion. Specifically, we estimate that menthol bans were associated with statistically significant increases in the likelihood a respondent reports that she purchased cigarettes on or from a First Nations reserve in the past six months, an effect on the order of 4.3 percentage points. This is very large relative to the pre-reform mean and is most consistent with substitution behavior from regulated sources to unregulated sources.

In conclusion:

In the words of former FDA commissioner Scott Gottlieb, “menthol-flavored products represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes.” Our results are not consistent with this broad claim for youths aged 11- 17: banning menthol did not reduce smoking initiation by these youths as measured by the likelihood they smoked 100 cigarettes in their lifetime. We similarly did not find evidence that menthol bans reduced smoking among adults. We also found that the lack of systematic reductions in overall smoking rates is due to two factors: first, youths substituted toward non-menthol cigarettes; and second, adults evaded the new regulation by shifting purchases toward First Nations reserves which are exempt from compliance.

Yet another 'public health' win!

Wednesday 4 March 2020

BBC regurgitates a press release from the temperance lobby again

Here we go again. The minimum pricing campaign created a template in which temperance groups funded by the Scottish government promote SNP party policy while the Scottish media and the BBC regurgitate their press releases without reply from those who have a different point of view.

With minimum pricing in place, the SNP are pushing for bans on alcohol advertising. This is a pet policy of Alcohol Focus Scotland and SHAAP, both state-funded campaign groups. It is difficult to tell who is pulling whose strings at this point, but the pressure groups are effectively doing the PR for the SNP again.

Alcohol Focus Scotland have today put out a press release calling for a ban on sport sponsorship by alcohol companies, a policy that would give many small sports clubs, including pub teams, serious financial problems. It cites 'new research from Institute for Social Marketing and Health at the University of Stirling' which concluded:

The findings show that alcohol producers and distributors do sponsor some professional football and rugby union teams/organisations in Scotland.

Eye-opening stuff, I'm sure you'll agree, but the study was published in January so it is neither new nor newsworthy.

The press release contains a quote from Alcohol Focus Scotland's Alison Douglas and a quote from SHAAP's Eric Carlin. Both quotes are included in the BBC's coverage of this non-story. The BBC also included a quote from the SNP's minister for public health, sports and wellbeing who wants to restrict alcohol advertising. This will come as no surprise to anyone who has read the Scottish government's Alcohol Framework, published in 2018. The SNP is desperate for an advertising ban.

Alas, the BBC did not include a quote from anyone who opposes the policy, not does the article include any arguments against it.

Yet again, the BBC is in breach of its own editorial guidelines on impartiality which state:

We must be inclusive, considering the broad perspective and ensuring that the existence of a range of views is appropriately reflected.

In applying due impartiality to news, we give due weight to events, opinion and the main strands of argument.

We must always scrutinise arguments, question consensus and hold power to account with consistency and due impartiality.

The BBC gets a lot of stick from people who believe it is politically biased, but their journalists would never dream of covering party politics in the flagrantly unbalanced way they cover 'public health' issues.

PS. Meanwhile, look at this rubbish that is relieving taxpayers of £400,000.


The BBC has now added a quote from somebody at Scottish rugby. 

Tuesday 3 March 2020

Another minimum pricing prophecy fails

In yesterday's blog post I mentioned that the number of alcohol-related admissions to Scottish hospitals rose slightly in 2018/19. This was the first year of minimum pricing, with the policy being in force for eleven of the twelve months.

The number of hospital admissions rose from 38,199 to 38,370. The age-standardised rate rose from 668.8 per 100,000 to 668.9 per 100,000.

These are small changes, to be sure. There hasn't been much change in the rate since 2014/15 when it began to level out after a substantial decline. Still, one can't help but notice that the figures are going up rather than down.

So let's just take a moment to reflect on what was promised by the Sheffield Alcohol Policy Model. The most recent Scottish version of the computer model, which was hopelessly flawed but so influential that it had its own study written about it, predicted that minimum pricing would make the number of alcohol-related hospital admissions plummet by 1,299 in the first year alone.

This factoid has been widely circulated. Here's the SNP's Shona Robson speaking in the Scottish Parliament in 2017, for example:

The benefits of minimum unit pricing will be substantial. As an illustration, last year, Sheffield University modelled that a price per unit of 50p would lead to 58 fewer alcohol-related deaths in the first year, with a cumulative total of 392 fewer alcohol-related deaths within the first five years. The reduction in alcohol-related hospital admissions at that price would be similarly substantial. In the first year, a price of 50p would lead to 1,299 fewer alcohol-related hospital admissions, with a cumulative total of 8,254 fewer alcohol-related hospital admissions within the first five years.

 Here's the Scottish government's consultation document from December of the same year:

The modelling has consistently shown that Minimum Unit Pricing will have most impact on those who drink the most alcohol.

Most importantly the modelling estimates there will be a fall in the number of people admitted to hospital and who die from alcohol-related illnesses.
The model estimated that if a Minimum Unit Price of 50 pence was introduced in the first year there would be:
  • 58 fewer alcohol-related deaths
  • 1,299 fewer alcohol-related hospital admissions

The figure also appeared in the government's impact assessment and in various news stories and 'fact sheets' from pressure groups.

But it didn't happen, did it? Didn't come close.

The model is, was and always will be worthless, but that won't stop the contracts coming in. Despite - or perhaps because of - incontrovertible evidence showing that they changed their methodology when Public Health England paid them to, the Sheffield team were contracted by the Australian government to do the modelling for its drinking guidelines review. And they were recently given a wodge of taxpayers' money to play Numberwang with their model to promote minimum pricing in various English regions.

We see this time and time again in 'public health'. Excitable promises are made loudly and persistently, but when the prophecies fail there is only tumbleweed. Failure brings no consequences.

Last Orders with Andrew Doyle

In the new episode of Last Orders we welcomed back comedian and satirist Andrew Doyle. We discussed whiteness, the BBC, coal fires and Stanton Glantz.

Listen here or here or on whatever device you've subscribed with.

Monday 2 March 2020

Minimum pricing travels back in time (again)

With minimum pricing introduced in Wales, someone in Scotland has taken another opportunity to make a silk purse from the SNP's pig's ear.

From STV:

The number of alcohol-related emergency hospital admissions has fallen by almost 6500 in the last 11 years, according to analysis.

Figures from the Scottish Parliament’s Information Centre show that such admissions have dropped by 16.2% from 39,857 in 2007/08 to 33,366 in 2018/19.

Great, but so what?

It comes after NHS research released in January showed that the volume of pure alcohol sold per person had dropped in Scotland since the introduction of minimum unit pricing.

It didn't come after the questionable sales claim. The hospital figures were published last November. So why are hearing about them now?

SNP MSP David Torrance said: “The SNP’s approach to tackling alcohol abuse in Scotland is working and the data suggests that minimum pricing is already saving people’s lives."

Minimum pricing was introduced in May 2018, so it is - to put it mildly - a stretch to give it credit for a decline in hospital admissions that took place between 2007/08 and 2018/19.

The only year in which minimum pricing could have possibly had an effect was 2018/19 but - guess what? - the number of alcohol-related hospital admissions rose in 2018/19 from 38,199 to 38,370. Alcohol Focus Scotland's Alison Douglas said at the time...

"It’s disappointing that the overall level of hospitalisations in 2018/19 has remained similar to the previous year."

But never mind, eh? Let's put out these four month old stats under headlines such as 'Drop in alcohol-related emergency hospital admissions' and 'Hospitals see fewer alcohol cases' and hope readers assume the present tense.

This has echoes of the BBC's shameful attempt to pretend that alcohol-related deaths were falling in Scotland last year (which it eventually corrected). The Beeb ludicrously suggested that a decline in deaths between 2006 and 2012 was somehow caused by minimum pricing.

Today's garbage was not only promoted by STV but by the Scotsman, Glasgow Live, and the Evening Express. All four articles are identical - word for word. Journalists are literally just copying out press releases from (I assume) the SNP.

Minimum pricing begins in Wales

From today, it will be illegal to sell a unit of alcohol for less than 50p in Wales. Without the benefit of a computer model, I predict that there will be significant cross-border sales and that the Welsh government will blame the English when the policy fails to reduce alcohol-related deaths. They will join forces with the SNP in pressuring Westminster into 'following their lead'.

Wales Online has a half-decent article about minimum pricing which gives examples of all the popular drinks that suddenly became more expensive today. This is followed by the health minister Vaughan Gething claiming that:

'The minimum price won’t affect moderate drinkers...'

OK, Vaughan. If you say so.

It also quotes some nameless chump from Alcohol Change UK (neé Alcohol Concern) saying:

"If it becomes clear that MUP is increasing supermarket alcohol revenues, we will be calling for any additional profits to be channelled via taxation into services to support people with alcohol problems."

Consider for a moment how any of that would work. I guess you don't have to worry about practicalities or unintended consequences when you work for a tunnel-visioned, state-funded pressure group.

It also includes a quote from me:

The Institute for Economic affairs head of lifestyle economics, Christopher Snowdon, said: "Early evidence from Scotland suggests that minimum pricing has no impact on alcohol-related deaths and little, if any, impact on alcohol sales.

"Many Welsh residents will be able to avoid higher prices by doing their shopping on the English border.

"Those who drink excessively will continue to do so. The only winners will be supermarkets in Chester and Bristol.”

Prove me wrong.