Friday 3 March 2023

Martin McKee: still wrong about vaping after all these years

When a man points at the stars, McKee stares at his finger

The heavily overweight Zero Covid crank Martin McKee had a letter published in The Times yesterday in response to an op-ed from the paper's resident puritan Alice Thomson (whom we have come across before). Thomson has spotted a real problem - the sharp rise in vaping among teenagers, especially those using Elf bars - but characteristically comes up with the wrong solutions: banning flavours, banning colours and getting Public Health England (which she thinks still exists) to "treat vaping in the same way as cigarettes".
This is music to the ears of Fatty McKee who is claiming that his ignorant and dishonest campaign against e-cigarettes has been vindicated.

Sir, Sadly, the massive growth in e-cigarette use among adolescents comes as no surprise to those of us who warned that this would happen (“ ‘Harmless’ vapes are creating teenage addicts”, Mar 1). Unlike public health organisations worldwide, Public Health England (now the Office for Health Improvement and Disparities) has been promoting these products heavily, arguing that restricting the features that make them most attractive to young people, especially flavouring, would deter the adults they wanted to switch from cigarettes. Although no longer using the discredited “95 per cent safer than cigarettes” claim, it at least accepts that e-cigarettes are not risk-free but seem oblivious to the evidence linking their use to heart disease. We always knew that it would be a struggle to counter the efforts of the tobacco industry to get a new generation addicted to nicotine but, sadly, in England, those who should have been protecting these young people did not even try.
Professor Martin McKee

London School of Hygiene & Tropical Medicine

What is this "evidence linking their use to heart disease" to which McKee refers? Presumably he isn't referring to this study from last year which said...
We did not find a significant difference in the cardiovascular risk of exclusive e-cigarette use compared with nonuse of cigarettes and e-cigarettes

Nor can he have been referring to this study which found a "positive cardiovascular impact" among vapers who had quit smoking, with e-cigarettes being no worse for the heart than nicotine patches.
I can only assume that he is talking about cross-sectional studies which find that people who have been smoking for many years have a higher risk of heart disease even after they've switched to vaping. Disingenuous activist-academics present such findings as evidence that vaping, rather than prior smoking, increases the risk. Control for past smoking, however, and the association disappears
McKee's anti-vaping wingman Stanton Glantz had a paper retracted after it turned out that the heart attacks among vapers occurred before they started vaping. Perhaps that's the study he's thinking of?
As for the Office for Health Improvement and Disparities no longer using the '95% safer than cigarettes' claim, let's see what they have to say about that: 
We are aware that summarising the relative risks of vaping versus smoking across a range of different products and behaviours and assessed across multiple biomarkers can be simplistic and misinterpreted. Based on the reviewed evidence, we believe that the “at least 95% less harmful” estimate remains broadly accurate, at least over short term and medium term periods. However, it might now be more appropriate and unifying to summarise our findings using our other firm statement: that vaping poses only a small fraction of the risks of smoking. 
This is arguably a better way of putting it, since it is vanishingly unlikely that vaping carries five per cent of the risk of smoking.
John Britton replied today...

Sir, Martin McKee (letter, Mar 2) is right that the recent increase in vaping by young people is a cause for concern but I disagree that this represents a failure of public health policy. Between 2011, when vaping entered the mainstream, and 2021 (the most recent available national data), UK smoking prevalence has fallen from 20.2 per cent to 13.3 per cent — a fall roughly 50 per cent larger than in either of the preceding two decades, and equivalent to about three million smokers. While many of these former smokers are still vaping, the facts that smoking kills half of all long-term smokers and that vaping is unquestionably far less harmful than smoking make this a massive public health gain. We need to ensure that existing laws protecting children from e-cigarette promotion and under-age sale are observed and enforced, but ought not lose sight of the reality that vaping has contributed to a record reduction in the UK’s biggest avoidable cause of premature death and disability.
John Britton

Emeritus professor of epidemiology, Nottingham University

Britton is right about the solution. The law needs to be enforced. Notwithstanding the black market, which is the consequence of nanny state policies, it is generally very difficult for people under the age of 18 to buy cigarettes (and alcohol) these days. There is no reason why it should be any easier for them to buy e-cigarettes. 
There will be more media hysteria about Elf bars this year, I'm sure, but we already have the laws needed to limit underage vaping.

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