Tuesday 29 June 2021

Cyber-stalking, anti-vaping fanatics

From a study in the Health Promotion Journal of Australia...  

The public health sector is clearly divided about the use of e-cigarettes. E-cigarette proponents promote the devices as an integral policy solution for reducing smoking prevalence. By contrast, Australian leading health authorities have noted the documented harms associated with e-cigarette use, the growing evidence linking use with smoking initiation among youth, and the insufficient evidence on the efficacy of e-cigarettes as smoking cessation aids. On this basis, they have adopted a precautionary approach, as recommended by the World Health Organization, and called for (a) urgent efforts to reduce the accessibility of e-cigarettes and (b) the continued promotion of only those cessation therapies that have been independently tested for efficacy and safety.

It's not hard to work out which side of the fence these authors sit on, is it?

Not for the first time, the anti-vaping wing of 'public health' (which, in Australia, is nearly all of them) are annoyed that vaping advocates are telling the truth on social media. 

Given claims made about e-cigarettes on social media platforms have the potential to influence the decisions of consumers and policymakers, an examination of the information being disseminated is warranted. Accordingly, the present study sought to explore the claims being made by Australian proponents of e-cigarettes via their Twitter feeds.

Trawling through Twitter is what passes for 'public health' science these days. 
The methodology is hilarious...

Experts in tobacco control policy and practice from three leading Australian public health agencies were approached by email and asked to identify proponents of e-cigarettes in Australia who are also prolific providers of social media commentary related to these devices. The experts identified five proponents meeting these criteria: four individuals (all of whom are medical practitioners) and one organisation. Proponents are unable to be named or directly quoted due to the anonymity conditions required by the Human Research Ethics Committee that approved this research.

As Sinclair says at Catallaxy Files... 

Tobacco control activists – not named in the research (why?) – were asked to nominate their ideological enemies – who cannot be named (why?).

These individuals (and one organisation) were then cyberstalked.

So what were these dangerous dissidents saying?
Nearly a third of tweets (29%) criticised the arguments made by various public health agencies and/or individual advocates opposed to the use and legalisation of e-cigarettes. 
Good. I'm surprised it wasn't more.
The general sentiment of these tweets was that the precautionary principle adopted by these agencies/advocates was ineffective compared to a harm reduction approach. 
It is. Although I'm not sure that banning the sale of products that help people quit smoking can really be described as a 'precautionary approach'.
Many of these tweets suggested that the position of public health agencies/advocates lacks an appropriate evidence base and hence they were (a) fabricating and/or exaggerating the risks of e-cigarette use, (b) denying and/or ignoring the benefits of e-cigarette use and/or (c) making nonsensical and weak arguments based on low-quality evidence at the cost of smokers’ health and lives.

They are. And even if they weren't, what academic value does this 'study' have?

Calls to legalise e-cigarettes featured in a fifth of tweets (18%). These tweets typically argued that legalisation would facilitate smoking cessation and reduce smoking rates and smoking-related harm and deaths in Australia. For example, many of the tweets claimed that the ban on e-cigarettes made it easier for smokers to continue smoking and/or harder for smokers to quit, with anecdotes used in some tweets to support these claims. It was also claimed that the ban on e-cigarettes was contributing to a plateau in the decline of smoking rates in Australia, while smoking prevalence is declining at an accelerated rate in countries where e-cigarette use is legal.
This is all true.

The extent to which proponents advocated for the legalisation of e-cigarettes is problematic as it has the potential to create an impression that there is greater opposition to current policy and more widespread support for policy change than really exists. Ongoing surveillance of the extent to which Australian proponents are calling for the legalisation of e-cigarettes, and the evidence being used to legitimise these calls, should be an important component of public health and policy agendas, especially given social media activity has the potential to be an effective means of influencing public policy.
You what?? Who do these people think they are?
They must mean it because they repeat their Orwellian demand in the conclusion.
The results of the present study indicate that Australian proponents of e-cigarettes are using their Twitter accounts to (a) criticise the evidence-based [sic] claims of public health agencies and advocates opposed to the devices and (b) influence public policy by advocating heavily for the legalisation of e-cigarettes. Ongoing surveillance of the tweets of e-cigarette proponents in Australia and efforts to minimise their reach should be included in strategies to curtail increasing use of e-cigarettes in this country. 

Unbelievable. As Sinclair says...

I’m actually surprised that a university ethics committee has signed off on a project that involves anonymity on this scale, cyberstalking (x2), and ends with calls for public censorship. Four of the authors appear to be employed by universities – and calls to censor their twitter feeds would be a violation of their academic freedom.

Last Orders with Martin Durkin

Martin Durkin has returned as a guest on the Last Orders podcast. Martin makes all the best documentaries and he's produced another cracker with his new film about race in America.

We also discussed Covid policy and the hounding of Katherine Flegal

Listen here.

Friday 25 June 2021

Boris the nanny

On Boris's food advertising ban in the Spectator...

Within hours of the new policy being announced, Boris Johnson tweeted a photo of himself tucking into a Jam ’n Cream Ring at the Fox’s Biscuits factory in Batley. Had his spin doctors let him down with bad timing? Or was it a cry for help from a Prime Minister who finds himself pushing nanny state policies that were too extreme for his predecessors and which he would have ridiculed without mercy if he was still a journalist? 



Wednesday 23 June 2021

Smileys revisited

I've written for CapX about the latest smiley variant. The arguments continue to mutate and become more virulent.

This is all nonsense and easy to disprove. The more interesting question is why they want to believe the vaccines are useless. Why are people who were insistent that there would be no second wave last winter because of herd immunity so sure that there will be a massive wave this winter despite 87% of adults already having antibodies? Why has there been such a shift towards anti-vaxxing among lockdown sceptics, including some of the most prominent figures, such as Piers Corbyn, Michael Yeadon and Naomi Wolf (all of whom have been kicked off Twitter)?

When I wrote about the smiley phenomenon in January, I pointed to the power of confirmation bias. None of us wanted this pandemic and its lockdowns. If someone tells us that it is all hoax and it’s just the flu, we want to believe them. But why would anyone want to believe that there is no end in sight?


Tuesday 22 June 2021

The WHO's war on vapers

I had an article up at ConHome last week about the WHO's forthcoming conference on tobacco and why vapers should care about it. 

The World Health Organisation’s decision last month to give a special award to India for banning the sale of e-cigarettes was proof that the agency has no intention of taking an ethical and evidence-based approach to tobacco harm reduction. This puts it squarely at odds with countries such as the UK and New Zealand which have successfully embraced vaping as part of their tobacco control strategy.

In November, the WHO will hold its ninth Framework Convention on Tobacco Control Conference of the Parties (COP9). The Framework Convention on Tobacco Control (FCTC) is the first and, to date, only international treaty of the World Health Organisation. Adopted in 2003 and signed by 168 countries, it explicitly defines tobacco control as “a range of supply, demand and harm reduction strategies”. Unfortunately, harm reduction is unlikely to feature much at the conference, except as an object of derision and contempt.

.. But there is a phrase in medical ethics that is relevant to this debate: “Nothing about me without me”. Vapers have little chance of being even being allowed to view COP9 online, let alone being permitted to speak at it. Their only hope is to contact their elected representatives and demand that pressure be put on the FCTC to take a more open and evidence-based approach. COP meetings fly under the media’s radar and that is how the FCTC Secretariat likes it. It thrives in darkness.

Journalists should ask more questions about what goes on in these meetings. Governments which recognise vaping’s potential to lower smoking rates and save lives should make that case strongly at COP9. They should pick strong, articulate advocates as their delegates, not bureaucrats. If the WHO continues to spread misinformation about e-cigarettes and if COP9 is held in secret again, these governments should withdraw their funding of the FCTC Secretariat. The FCTC Secretariat should be put on notice. COP9 is the last chance for the WHO FCTC to mend its ways and operate as a transparent and evidence-based organisation. If it cannot be reformed, it should be disbanded.

The conference is being held entirely online this year. In a sane world, that would mean that it is live-streamed so everyone can see it. I doubt that will happen, but vapers need to make as much noise as possible because I have a feeling the hammer is going to fall quite soon.
As evidence, I present you with the recently published WHO Technical Report 1029 which mostly looks at heated tobacco products. It's a weighty document of more than 300 pages and must have taken someone quite a bit of time to write. They needed have bothered because the conclusions were preordained. In particular, it tells governments...
to apply the most restrictive tobacco control regulations to heated tobacco products (including the device), as appropriate within national laws, taking into account a high level of protection for human health;

to prohibit all manufacturers and associated groups from making claims about reduced harm of heated tobacco products, as compared with other products, or portraying heated tobacco products as an appropriate approach for cessation of use of any tobacco product and to ban their use in public spaces unless robust independent evidence emerges to support a change in policy;

to ban all commercial marketing of electronic nicotine delivery systems, electronic non-nicotine delivery systems and heated tobacco products, including in social media and through organizations funded by and associated with the tobacco industry;

to prohibit the sale of electronic nicotine delivery systems and electronic non-nicotine delivery systems in which the user can control device features and liquid ingredients (that is, open systems);

You can read the whole article here.

Monday 21 June 2021

The hounding of Katherine Flegal

Way back in 2013, I wrote about a meta-analysis published in the Journal of the American Medical Association which assessed 97 individual studies encompassing a total sample group of 2.88 million people. It found that people who are overweight have a slightly reduced risk of mortality compared to people of 'healthy' weight (RR = 0.94 (0.91-0.96)).

I first wrote about it when it was published because the BBC was using the old trick of putting criticism of the study front and centre. 

There are two ways to report news that divides opinion.
The first is to report what has happened and then include comments from those who have a view on it, including critics. 
The second is to lead off with disparaging comments from the critics so that the news itself becomes incidental. 
This latter approach amounts to poisoning the well and is mainly favoured by propagandists and media outlets which have a blatant editorial bias. So, with that in mind...

From the BBC:

'Weight is healthy' study criticised

A study which suggests being overweight can lead to a longer life has caused controversy among obesity experts.

One labelled the findings a "pile of rubbish" while another said it was a "horrific message" to put out.

The criticism from certain people was fierce. So fierce as to suggest a religious schism rather than a scientific debate. Tam Fry, from the National Obesity Forum, said: 
"It's a horrific message to put out at this particular time. We shouldn't take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux." 
That was a bit of a straw man, but it was constructive and courteous compared to the quote from veteran anti-obesity crusader Walter Willett of Harvard School of Public Health:

"This study is really a pile of rubbish and no one should waste their time reading it."
As I wrote at the time...

How heartening it is to see the spirit of intellectual enquiry thriving at the Harvard School of Public Health. Perhaps Dr Willett and his friends will make a bonfire out of copies of the Journal of the American Medical Association and dance around it.

And that is pretty much what he did. As Nature subsequently reported, Willett "organized the Harvard symposium—where speakers lined up to critique Flegal's study—to counteract that coverage and highlight what he and his colleagues saw as problems with the paper."
The study's lead author, Katherine Flegal, has now written a full account of what happened and it really shows what you leave yourself open to when you get on the wrong side of 'public health' activists. The data she had was fine and her findings have been replicated many times. Her critics' problem was not really with the data but with 'the message' her findings supposedly sent out. This was obvious from Tam Fry's comment above as well as subsequent comments made by Walter Willet, such as...

Studies such as Flegal's are dangerous, Willett says, because they could confuse the public and doctors, and undermine public policies to curb rising obesity rates.

“There is going to be some percentage of physicians who will not counsel an overweight patient because of this,” he says. Worse, he says, these findings can be hijacked by powerful special-interest groups, such as the soft-drink and food lobbies, to influence policy-makers.
... Willett says that he is also concerned that obesity-paradox studies could undermine people's trust in science. “You hear it so often, people say: 'I read something one month and then a couple of months later I hear the opposite. Scientists just can't get it right',” he says.
“We see that time and time again being exploited, by the soda industry, in the case of obesity, or by the oil industry, in the case of global warming.”

And so she was attacked and hounded. It turns out that this process had been going on since 2005 when, as a scientist at the CDC, she published a study which...
...found that overweight was associated with slightly but significantly fewer deaths than normal weight. A quick glance at the literature suggested that our findings about overweight were not particularly unusual. We were unprepared for the firestorm that followed.

You should read the whole article (no paywall), but here are a few lowlights from her experience:

I fielded dozens of press calls as soon as our article was published. To my surprise, after the first few hours, many of the journalists who called me had already spoken to a professor, Walter Willett, (let's call him Professor 1) from a prestigious school of public health (PSPH). He was not a statistician and had no expertise in estimating the number of deaths associated with obesity. Our article was not intended to have anything to do with his work. He had apparently begun pre-emptively contacting the press, inserting himself into the discussion, positioning himself as an expert, and providing negative and antagonistic comments on our article before reporters had spoken to me. He used strong language to disparage our article, describing it as “really naive, deeply flawed and seriously misleading”.

.. In the same year, a post-doc at PSPH posted the following on a blog: “Numbers from Flegal's paper had been subsequently RETRACTED [sic] by the CDC, and she has subsequently been demoted at the CDC for writing the erroneous paper.” Every single one of these statements was false. CDC had not retracted our findings, and I had not been demoted. In fact, our paper had received CDC's highest science award, the Shepard award, in 2006.

.. Around the same time, some unusual statements were anonymously inserted in the Wikipedia entry on “overweight.” These statements asserted with no references that our article had been “widely discredited and regarded as fatally flawed by researchers from the Harvard School of Public Health, Harvard Medical School, American Cancer Society, and even the CDC agency itself, which has backtracked on the findings from the Flegal report.” This was part of what appeared to be an ongoing campaign to present our article incorrectly as having been repudiated by reputable sources.

.. In 2007, I accepted an invitation to give a named lecture at the 2008 meeting of a scientific society. The invitation included no mention of a rebuttal. When I received the final program a month before the meeting, to my surprise Professor 2 from PSPH had been added as a rebuttal speaker. This is an unusual way to treat an invited lecturer. As part of Professor 2's rebuttal, he presented a slide supposedly “based on” our research that strangely showed precisely the opposite of what we had found. It turned out that Professor 2 and his group had misunderstood a table in our published article and misinterpreted the results. Although I wrote him an email to clarify the table, Professor 2 and his colleagues nonetheless submitted an article for publication with the same errone- ous analysis. Fortunately, their article was rejected. This led me to realize that if such an article were to get published with such an erroneous analysis, it would likely be quite difficult for me to ever correct the situation. This episode as well as others also led me to realize that some, perhaps many, of our critics had very little understanding of our article.

.. Another line of attack was something like “this is just one study.” According to the 2007 hit piece in Scientific American, “Decades of re- search and thousands of studies have suggested precisely the opposite ...”, adding “Flegal is not necessarily wrong, but the preponderance of evidence clearly points in the other direction.” In fact, many other studies had already shown no excess mortality associated with overweight. The 2013 obesity guidelines put out jointly by the American Heart Association, the American College of Cardiology and The Obesity Society, also reported the finding that overweight did not appear to be associated with excess mortality, rating the strength of the evidence as “moderate.” Professor 2 was a coauthor of these guidelines. 

The initial intent of these attacks seemed to be to discredit our work completely. They employed denigrating and insulting remarks (“rubbish,” “ludicrous,” “complete nonsense,” “fatally flawed and widely discredited”) implying that our work was not worthy of serious consideration. There were also suggestions that we were unqualified, and my integrity and competence were questioned. Some attacks were surprisingly petty. At one point, Professor 1 posted in a discussion group regarding salt intake that JAMA had shown a track record of poor editorial judgment by publishing “Kathy Flegal's terrible analyses” on overweight and mortality. Similarly, again using a diminutive form of my name, Professor 1 told one reporter: “Kathy Flegal just doesn't get it”. It became clear that one of the things that critics found disturbing was that what they called the “lay media” or the “popular press” (which apparently extended to the New York Times, Scientific American and even Nature, a leading scientific journal) had reported on our findings as though they were worthy of serious discussion. One of the effects of the public insults may also have been to deter or intimidate other investigators. An anonymous researcher was quoted elsewhere as saying if character assassination is the price for publishing data that contradicts established beliefs, fewer academics will be willing to stick out their necks and offer up fresh thinking.

This is the 'public health' playbook. When the evidence doesn't go your way, resort to appealing to authority (as Flegal says, Willett is a leading academic in nutrition but not in the kind of work she does). Resort to the media (the BBC was only too happy to slant its coverage in their direction). Resort to editing Wikipedia, to holding one-sided symposiums, to fiddling the figures and to personal abuse. 
We've seen it before with the Australian sugar 'paradox' and very recently with vaping. Even John Snow got this treatment when he contradicted miasma theory. As far I can tell, the only part of the playbook that was not employed in this instance was accusing Flegal of being funded by 'Big Food', but I bet they were tempted. 

It's an incredible amount of defensiveness for an issue that shouldn't really matter. It's not an 'obesity-paradox' because people who are overweight are not obese. It should be possible to accept that people who exceed the entirely arbitrary BMI threshold of 25 - but who are not obese - do not suffer significant health risks, while those who exceed the threshold of 30 do - and that the fatter they get thereafter, the greater the risk.

But 'public health' doesn't really do nuance, does it?

Tuesday 15 June 2021

The Impact of COP9 on Vapers

We have discussed the Framework Convention on Tobacco Control's (FCTC) Conferences of the Parties on this blog many times. Typically, they are cursed events - by Ebola in Moscow in 2014, by air pollution in Delhi in 2016 and by Covid in the Netherlands in 2020. The Netherlands meeting was cancelled and rearranged for this year, but the decision has now been made to hold it online only.

This would be a good opportunity to broadcast it to the world, but I expect the usual extreme secrecy at this taxpayer-funded World Health Organisation (WHO) event. 

That would be a shame because the conference has never been more important to vapers. In the last eighteen months, the WHO has gone completely off the rails on this issue. At the start of the pandemic, it tweeted a series of bizarre lies and half-truths about vaping. Last month, it gave India a special award for banning the sale of e-cigarettes nationwide
I've now written a brief history of the COP meetings for the Property Rights Alliance: The Impact of COP9 on Vapers.
It concludes...

Governments differ on how they view tobacco harm reduction, but those which recognise its potential to lower smoking rates and save lives should make that case strongly at COP9. They should pick strong, articulate advocates as their delegates, not bureaucrats. If the WHO continues to spread misinformation about e-cigarettes and if COP9 is held in secret, they should with-draw their funding of the FCTC Secretariat. The FCTC Secretariat should be put on notice. COP9 is its last chance to mend its ways and operate as a transparent and evidence-based organisation. If it cannot be reformed, it should be disbanded.

You can download the report for free here.

Saturday 12 June 2021

A Swift Half with Dolly Theis

In the latest episode of The Swift Half with Snowdon I spoke to Dolly Theis who is doing a PhD in 'public health'. We spoke about obesity, the nanny state and her mission to achieve gender balance in parliament. Watch below.

Thursday 10 June 2021

Did Brits drink more under lockdown?

As the Daily Mail reports, people in the UK supposedly drank more alcohol than usual during the first lockdown...
Alcohol consumption fell in countries across Europe during the Covid pandemic – but not in the UK.

Across 21 European countries, the UK was the only one to see an increase in drinking, a study has found.

Researchers surveyed almost 32,000 people across Europe, including 836 in the UK, between April and July last year.

So the claim about the UK comes from a survey of 836 people? This doesn't sound good.

The study, such as it is, has been published in Addiction. It was not just a survey, it was an online survey that people heard about via "social media and postings on institutional websites, via press releases, or student and professional networks". This self-selecting group of people filled in the survey, presumably just once, between 24 April and 22 July 2020.
Based on this sliver of information, the authors conclude that there was a 10 per cent increase in alcohol consumption in the UK.
Of all the countries examined in our project, only the United Kingdom reported a significant mean increase in alcohol consumption. In Ireland, no statistically significant change was reported.

The problem is that we don't need to survey a few hundred people to find out how much people are drinking. We literally have the receipts. In the UK...

The total volume of alcohol sold during lockdown (the 17 weeks to 11 July 2020) fell to 1.3bn litres, down from 2bn the previous year, data from Nielsen Scantrack and the CGA found, despite value sales through the major retailers rising £1.9bn over the same period.

Sales of booze at the supermarket during the four month period hit £7.7bn, it said, however with the on-trade remaining shut, the overall volume of alcohol bought in the UK was far lower than last year, despite the increase in value.

Overall, according to the Euromonitor International Proprietary Alcoholic Drinks data, alcohol sales fell by 10.1% in the UK in 2020 and by 6.6% in Ireland

We also have the tax receipts from HMRC which show that the government received less alcohol duty revenue in April-July 2020 than in the previous year. The decline shown below actually understates the size of the drop because there was a switch from beer to wine and spirits under lockdown. A unit of beer is taxed at a lower rate than a unit of wine or spirits. The number of units sold therefore declined more sharply than the amount of tax received.

And if you're wondering whether people were just drinking all the alcohol they stockpiled before the lockdown, alcohol duty receipts in January to April were also lower than in 2019. (It should be noted that the pandemic caused some delays in tax payment, but the totals for 2019/20 and 2020/21 were no higher than 2018/19.)

This kind of evidence is pretty hard to argue against. Unless the British public were making moonshine on in industrial scale, there is absolutely no chance that they were drinking more under lockdown, or in 2020 as a whole, than they normally would. 

All the study in Addiction shows is that people in 'public health' can get any old rubbish published in a peer-reviewed journal. If this is what they are doing when their claims can be easily tested, what are they getting up to the rest of the time?

Strange bedfellows in the moral crusade against gambling

Mary Whitehouse at the Festival of Light, 1971

Of all the 'anti' groups I write about, the anti-gambling coalition is the most unusual. It includes the Salvation Army, a leftwing think tank (the IPPR), a rightwing think tank (the Centre for Social Justice), problem gambling charities, the Times, the Guardian, the Evangelical Alliance, various bishops, and elements of the rival arcade, casino and pub industries.  

This loose alliance formed over the fixed odds betting terminal issue and was already in the making when the moral panic about 'super-casinos' emerged in the early 2000s. They have now got the band back together to campaign against internet gambling, as I mention in A Safer Bet

No one is keener on this campaign than the Guardian who yesterday reported...
ITV criticised for not banning gambling ads during Euro 2020
Did anyone expect gambling ads to be banned during Euro 2020? This is the first I've heard of it.
You can always tell whose side a newspaper is on by how they frame the story. For example, when the Guardian uses the headline 'Oxford college criticised for refusal to remove Cecil Rhodes statue', you know they think the statue should have been removed. If they had been against it, they would have found someone who agreed with the decision and written 'Oxford college praised for refusal to remove Cecil Rhodes statue'. If they had just wanted to report the news, they would have said 'Oxford college refuses to remove Rhodes statue'. 
In the case of gambling ads during Euro 2020, there is no real climate of opinion against them. In 2019, the gambling industry introduced a whistle-to-whistle voluntary ban before 9pm (foolishly in my opinion), so there are not going to be many gambling ads on TV anyway. It is a non-story, so the Guardian has tried to create a story by finding one person who is unhappy.

The head of the social policy group Care has written to the chairman and chief executive of ITV criticising its decision not to suspend gambling adverts during the Euro 2020 football tournament, which starts on Friday.

... In a letter, Nola Leach, the chief executive of Care (Christian Action Research and Education), called on the ITV chairman, Sir Peter Bazalgette, and the chief executive, Carolyn McCall, to forgo gambling ad revenue during the tournament.

“As the CEO of an organisation which is working to raise awareness of gambling-related harms and see them reduced through legislative action I was deeply disappointed by this response, which confirms that you do not intend to take any further action to reduce the number of adverts shown,” she said.

The news story is all about this one letter. You can find someone who will write an angry letter about anything so what is it about this organisation that makes it newsworthy? On the face of it, Christian Action Research and Education does not sound like the kind of group the Guardian normally pays much heed of.

Indeed, Care's original name was the National Festival of Light. Formed in 1971 by Malcolm Muggeridge and Mary Whitehouse, the Festival of Light was seen as a reactionary movement even at the time with its demands to 'clean up TV' and restore Christian mortality. 
It became the Christian Action Research and Education in 1983 and, until yesterday, only ever featured in the Guardian for lobbying against gay rights, campaigning to change abortion laws and promoting gay conversion therapy.  

It's not terribly surprising that they are also against gambling. What is more surprising is that they have found common cause with the UK's main 'liberal' newspaper on this issue, but perhaps the moral censors of the left have more in common with the moral censors of the right than they think.

Wednesday 9 June 2021

A smoke-free by 2030 - ASH's plan

ASH's All Party group put out a twelve point plan to make the UK 'smoke-free' by 2030. I looked at the proposals for Spiked...

ASH has made itself slightly redundant in recent years as a result of governments capitulating to its every whim. Having portrayed cigarette packaging as the one remaining way in which the tobacco industry ‘lured’ in new customers, the introduction of plain packaging in 2017 made it difficult for them to argue that people picked up the habit for any other reason than that they enjoyed it. Since then, they have resorted to moaning about smoking in reality TV shows and trying to get smoking banned outdoors.

There are two hooks for the new ASH / APPG report. First, when Theresa May was prime minister she set Britain the target of going ‘tobacco-free’ by 2030. This was barely noticed at the time. She didn’t consult anybody about it, let alone smokers, nor did she suggest how it could be achieved. But the target now hangs in the air as if it were a genuine collective commitment.

Secondly, lots of people have just died in an epidemic and ASH is keen to draw a parallel with the ‘tobacco epidemic’. The APPG report says: ‘We are taking the necessary steps to end the coronavirus pandemic; we must do the same for smoking.’ This argument is the flipside to the claim sometimes made by some lockdown ‘refuseniks’ who say that since the government has not banned smoking, it should not do anything about Covid-19. Neither argument stands up because a highly infectious, potentially fatal disease spreading through the community is a collective-action problem whereas people smoking tabs is not. It really is that simple.

ASH’s All-Party Group has a dozen recommendations which it reckons will set the course for a ‘Smokefree 2030’. Let me take you through them...

Tuesday 8 June 2021

On June 21st everything must go

On a rare trip to London last week, I was struck by how the London Underground makes a mockery of the remaining coronavirus restrictions. Passenger numbers are down on pre-pandemic levels, but although people are less likely to be crammed face-to-armpit, they are still in very close proximity in a barely ventilated, confined space. I was also struck by the number of tourists getting off at Leicester Square and Piccadilly Circus, many of them no doubt on their way to spend a couple of hours in a windowless room watching a film or play. 

Good on them. Most adults – 28 million of us – have now had two doses of a vaccine. Another 13 million have had one jab and millions more have acquired immunity through having Covid-19. Case numbers are rising again, but they have so far not resulted in a commensurate rise in hospitalisations or deaths. With the vast majority of vulnerable people fully immunised, any third wave should be a low mortality event. Covid-19 will remain a non-trivial health issue for months, probably years, but it should no longer be a civil liberties issue. 

Read the rest at the Telegraph.

Sunday 6 June 2021

Bloomberg's dark money

If you're going to write a lengthy article in a peer-reviewed journal accusing scientists of having undisclosed competing interests, it helps if you don't have undisclosed competing interests of your own. 

On Thursday, I mentioned the BMJ article which falsely claimed that studies showing smokers to be at lower risk of SARS-CoV-2 infection have been "roundly disproved" and implied that the whole thing was a tobacco industry ruse to promote nicotine. At the moment, my Rapid Response is the only one accepted for publication by the BMJ. The main target of the article - Dr Konstantinos Farsilinos - has written a response but it has not been published. 

In my reply, I noted that one of the article's two authors works for the 'The Investigative Desk', a Dutch organisation that has received money from Bath University. This is a red flag for anyone who follows the e-cigarette debate because Bath University is the home of Anna Gilmore's Tobacco Control Research Group which has received $20 million from Mike Bloomberg (it also received a gong from the WHO last week, another bad sign for vapers).

Bloomberg is the world's leading anti-vaping crusader. He openly endorses prohibition and has so far ploughed $160 million into getting e-cigarette flavours banned. Gilmore's team specialises in ad hominem arguments, portraying scientists and advocates as hired guns on the basis of tenuous, false and/or irrelevant financial links to the vaping and tobacco industries. It is a remarkably similar approach to that used by The Investigative Desk. 

The smoking/Covid studies are the hook for the BMJ article, but it is mostly an attack on tobacco harm reduction and those who advocate it. If the authors have been funded by a billionaire anti-vaping fanatic, that should be listed as a competing interest. 

A document unearthed by Dr Farsilinos suggests that Bath University is being used as a middle man in a transaction between Bloomberg and The Investigative Desk. A Supplier Form for The Investigative Desk written on Bath University headed paper states that Bloomberg is providing the money for 'the project'. 
Moreover, the contract explicitly forbids The Investigative Desk from saying that they are directly funded by Bloomberg.
The Contractor shall not make any statement or otherwise imply to donors, investors, media or the general public that the Foundation directly funds its activities.

Strictly speaking, they are not being directly funded by Bloomberg, but they certainly seem to be indirectly funded by Bloomberg, with the University being used to essentially launder the money. Since Bath University is listed as a funder on The Investigative Desk's website, it seems reasonable to assume that this contract was signed.

Is this kind of thing considered OK at universities? It certainly can't be considered OK at the British Medical Journal when it is publishing an article by The Investigative Desk about hidden financial ties. 
Some people would call this 'dark money'. The BMJ article is a pyramid of piffle regardless of who funded it, but it is an extraordinarily hypocritical pyramid of piffle if it has been covertly funded by Mike Bloomberg.

Thursday 3 June 2021

A lazy hit job from the BMJ

The BMJ put up a story today claiming that studies showing smokers at less risk of infection from SARS-CoV-2 have been "roundly disproved" and predictably implying that the whole thing is a tobacco industry ruse. You can read it here and see my "Rapid Response" here or below.

Dear Editor,

I didn't encourage anyone to 'Smoke fags, save lives'. That was the provocative headline put on an article I wrote last April. I don't write the headlines, but looking back at the article I notice that it gives a more accurate overview of the topic than Horel and Keyzer manage here.

The work of Professor Jean-Pierre Changeux cannot be dismissed on the basis of past funding from a "tobacco industry front group" although the fact that this funding took place a quarter of a century ago shows that there is no statute of limitations for ad hominem arguments. If I were to stoop to playing the man rather than the ball, I would note that The Investigative Desk receives funding from Bath University whose Tobacco Control Research Group has received $20 million from Bloomberg Philanthropies. Bloomberg Philanthropies was founded and is funded by Michael Bloomberg, a billionaire who uses his vast wealth to campaign against e-cigarettes. Why isn't this listed as a competing interest?

On the more substantive issue, the authors assert that it has been "roundly disproved that smoking protects against covid-19". This is simply untrue. Of the four studies they cite as evidence, only one (Jackson et al. [1]) suggests that smoking is a risk factor for Covid-19 - and that was based on an online survey.
Of the others, Hopkinson et al. [2] found that smokers were more likely to report a 'classic symptom' of Covid-19, which is perhaps unsurprising since one of the main symptoms is coughing, but it also found that "smoking was negatively associated with the risk of having a positive PCR for SARS-CoV-2 infection (OR (95% CI) 0.73 (0.65 to 0.81)".
Holt et al. (a preprint [3]) found no statistically significant association with smoking. Horel and Keyzer assert that Williamson et al. [4] "found that smoking, when adjusted for age and sex, was associated with a 14% increased chance of covid-19 related death". In fact, it found a statistically significant reduction in risk for smokers in the fully adjusted model (HR 0.89 (0.82–0.97)) and no statistically significant association in either direction after further adjustments were made (HR 0.98 (0.90–1.06)).
Horel and Keyzer do not mention the thorough ongoing meta-analysis by Simons et al. [5] which reports that: "Current compared with never smokers were at reduced risk of SARS-CoV-2 infection (RR = 0.71, 95% Credible Interval (CrI) = 0.61-0.82, τ = 0.34)."
The Simons et al. meta-analysis was last updated in early May. A number of peer-reviewed studies have since been published supporting the 'nicotine hypothesis'. For example, a study from Luxembourg found smokers to be half as likely to have been infected with SARS-CoV-2 (RR 0.50 (0.30–0.83; 0.004)) [6]. A study of healthcare workers in Chile found smokers to be 62 per cent less likely to have had COVID-19 (HR 0.38, 95% CI 0.16–0.93; p = 0.03) [7]. A study from Spain found smokers to be 77 per cent less likely to have had COVID-19 (OR 0.23 (0.20-0.27)) [8]. A study from Iran found that: "Patients with positive history of smoking were less likely to die of COVID-19 than their counterparts." [9]

These are some of the studies that have been published in the last month alone, in addition to preprints such as the large study from Germany which found that regular smokers were half as likely to have had COVID-19 (aOR 0.5, 95%CI 0.3-0.7) [10] and the study from Spain which reported a similar finding (OR 0.57 (95% CI: 0.42-0.79)) [11].

Far from being "roundly disproved", the evidence that smokers are at reduced risk of SARS-CoV-2 infection is much stronger today than it was when the hypothesis first emerged last March. This evidence cannot be dismissed on the basis of tenuous financial links of a handful of researchers to the tobacco and vaping industries. Why do we keep seeing this strong inverse association between smoking and SARS-CoV-2 infection? Is it the nicotine? Is it the smoke? Is it something else? We do not know and we are not going to find out by burying our heads in the sand.


[1] Jackson SE, Brown J, Shahab L, et al. Covid-19, smoking and inequalities: a study of 53 002 adults in the UK. Tob Control 2020 (published online 21 Aug). doi:10.1136/tobaccocontrol-2020-055933.

[2] Hopkinson NS, Rossi N, El-Sayed Moustafa J, et al. Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people. Thorax 2021 (published online 5 Jan). doi:10.1136/thoraxjnl-2020-216422.

[3] Holt H, Talaei M, Greenig M, et al. Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK). medRxiv 2021 [preprint]. doi:10.1101/2021.03.27.21254452.

[4] Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature2020;584:430-6. doi:10.1038/s41586-020-2521-4. pmid:32640463

[5] Simons, D., Shahab, L., Brown, J and Perski, O. The association of smoking status with SARS-CoV-2 infection, hospitalisation and mortality from COVID-19: A living rapid evidence review with Bayesian meta-analyses (version 11) [preprint] https://www.qeios.com/read/UJR2AW.13

[6] Holuka, et al. Adverse Life Trajectories Are a Risk Factor for SARS-CoV-2IgA Seropositivity. Journal of Clinical Medicine 2021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157140/pdf/jcm-10-02159.pdf

[7] Iruretagoyena, M. et al. Longitudinal assessment of SARS-CoV-2 IgG seroconversionamong front-line healthcare workers during the first wave of the Covid-19 pandemic at a tertiary-care hospital in Chile. BMC Infectious Diseases 2021; 21: 478. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149923/

[8] Candel, FJ. et al.  The Demography and Characteristic of SARS-CoV-2 Sero-positive Residents and Staff of Nursing Homes for Older Adults in the Community of Madrid: the SeroSOS Study. Age and Ageing, afab096 2021 https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afab096/6263923

[9] Sohrabi, M. Sociodemographic determinants and clinical risk factors associated with COVID-19 severity: a cross-sectional analysis of over 200,000 patients in Tehran, Iran. BMC Infectious Diseases 2021 21: 474. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146170/

[10] Harries, M. et al. SARS-CoV-2 seroprevalence in Germany - a population based sequential study in five regions 2021 [preprint] https://www.medrxiv.org/content/10.1101/2021.05.04.21256597v1

[11] Belen, VS. Seroprevalence of SARS-CoV-2 Antibodies and Factors Associated with Seropositivity at the University of Salamanca: The DIANCUSAL Study 2021 [preprint] https://europepmc.org/article/ppr/ppr335544

'Public health' priorities in a pandemic

The media love a good story about banning smoking outdoors. Radio stations get the phone ringing off the hook. I'm not quite sure the latest one justifies all the media attention. As far as I can see, Oxfordshire council have said that it would be nice if there were fewer smokers. Banning smoking outside hospitality venues has been mentioned but seems unlikely to win a vote, not least because the hospitality industry would be up in arms.

Nevertheless, the vultures at ASH have been all over it and it has made headlines so I've responded in the Telegraph today...

The policy, such as it is, is being spearheaded by Dr Adam Briggs, a public health consultant best known for his modelling of the sugar tax, which he reckoned would result in a measurable reduction in the obesity rate (spoiler: it didn’t).

Echoing recent remarks from Chris Whitty, the Chief Medical Officer, he said that “we have got a condition that is entirely a commercially driven cause of death and disease” and noted that the annual estimated death toll from smoking-related diseases is larger than the number of people who died from Covid-19 last year. If smoking-related diseases start spreading from person to person via bacteria or viruses, this statistic will be of relevance to public health. Until that day comes, smoking will remain none of Dr Briggs’s or Oxfordshire Council’s damn business.

The pandemic has been a useful reminder of the difference between societal health threats which require collective action and personal health risks which don’t. If people enjoyed getting Covid-19 and could not pass it on to others, there would be no moral argument for the Government to intervene. If lots of people opted to contract it at the same time, the threat to the NHS could be used as a plausible objection – but even this does not apply to smokers, who pay vastly more in tax than they cost in healthcare.

The paternalists’ argument that we must stop people smoking because it is deadlier than Covid is as specious and illogical as the lockdown sceptics’ counter claim that the Government should do nothing about Covid because it hasn’t banned smoking. Both wilfully ignore the issue of infection, which is what turns a health problem into a public health problem.

Battered by lockdowns, the hospitality industry is unlikely to welcome a policy that encourages its customers to stay at home. Since there is no conceivable threat to health from outdoor second-hand smoke, and Britons have not yet descended to Californian levels of hypochondria, a ban offends our sense of fair play and tolerance. As a proposal, it is probably dead on arrival. Nevertheless, it is interesting to see where the “public health” lobby’s priorities lie.


Wednesday 2 June 2021

Another car crash week for the WHO

Even by the WHO's standards, this week has been a car crash. They've given an award to for banning e-cigarettes. They've put the pariah states Belarus and Syria onto their executive board. And they've come up with a ludicrous system for naming variants of concern to replace the common sense system that nobody had a problem with. I've written about it for CAPX...

If the World Health Organization wanted to prove beyond doubt that it is no longer fit for purpose, it couldn’t have done a better job than to make the announcements it has made this week. 

On Monday, the WHO celebrated World No Tobacco Day by giving its Special Director-General Award to India’s Health Minister, Dr Harsh Vardhan. What life-saving work has Dr Vardhan done to merit such a prestigious gong? One thing stood out, as WHO boss Dr Tedros Adhanom Ghebreyesus explained on Twitter: ‘His leadership was instrumental in the 2019 national legislation to ban E-cigarettes & heated tobacco products. Thank you, Minister!’


India has 120 million smokers. Thanks to Dr Vardhan, they no longer have the option of switching to a vastly safer substitute. The main beneficiary of the ban on e-cigarettes has been the India Tobacco Company, which is part owned by the Indian government. This should merit international condemnation. Instead, the WHO has slapped the Indian government on the back.