Thursday 16 March 2023

Sweet Jesus, not plain packaging again!

Oh joy, a new study...

Objective  To examine the association of fully branded and standardized e-cigarette packaging with interest in trying products among youths and adults in Great Britain.


Results  This study included 2469 youths (1286 female youths [52.1%]; mean [SD] age, 15.0 [2.3] years) and 12 046 adults (6412 female [53.2%]; mean [SD] age, 49.9 [17.4] years). Youths had higher odds of reporting no interest among people their age in trying the e-cigarettes packaged in green (292 of 815 [35.8%]; adjusted odds ratio [AOR], 1.37; 95% CI, 1.10-1.71; P = .005) but not white (264 of 826 [32.0%]; AOR, 1.16; 95% CI, 0.93-1.44; P = .20) standardized packaging compared with the fully branded packaging (238 of 828 [28.7%]).


Conclusions and Relevance  The findings of this survey study suggest that standardized packaging measures may reduce the appeal of e-cigarettes among youths without reducing their appeal among adults.


They showed a bunch of people some mocked up e-cigarette packaging, some of which was 'plain'/grotesque, and found that people preferred the normal packaging. Fancy that! 
The people were also less likely to say they would try vaping if the packaging was 'plain'. I suppose they would, wouldn't they?
From this the authors conclude that there would be less underage vaping if e-cigarettes were sold in plain packs.
Action on Smoking and Health (ASH) were straight out of the blocks demanding legislation (without mentioning that two members of their tiny staff had co-authored the study).
Anyone else getting a sense of deja vu? There were literally dozens of survey-based studies like this published before plain packaging for tobacco was introduced. Many of them were authored by the same people who published this new study, including ASH's very own Deborah Arnott. 

They were all wrong! Plain packaging didn't work! 
Has everyone forgotten that already?
It turns out that the stated preferences of people answering leading questions in surveys are a poor predictor of behaviour in real world settings. Who knew?!

Why am I so confident plain packaging didn't work? Partly because I've read the post-implementation review (PIR) that was quietly slipped out last year. The very fact that it was released without fanfare is a bit of a clue that the policy didn't quite live up to expectations.
The authors of the PIR claimed that the plain packaging regulations "had met their original objectives, without producing any significant unintended consequences", but you only had to read it to see that this was outrageous spin. 
The Department of Health commissioned a review from the University of Stirling to explore "the response of consumers, retailers, and tobacco companies to standardised packaging". The lead author was Crawford Moodie, an anti-smoking fanatic who had produced two reviews promoting plain packaging during the course of the campaign for the policy and who wrote many of the studies he was reviewing. 
His PIR review looked at eleven studies, seven of which had been co-authored by Moodie, focusing on issues such as compliance, pricing strategies and self-reported consumer responses. None of them examined smoking trends or cessation.
In a desperate cope, the PIR noted an unusually large decline in smoking prevalence between 2015 and 2016. The authors attribute this to plain packaging despite plain packs not being mandatory in shops until May 2017 and very few tobacco products being sold in plain packaging before January 2017.
The only study mentioned in the PIR that looked at smoking rates is this one which used monthly smoking prevalence data to build a model which found "a statistically significant level decrease in the odds of being a smoker after May 2017 (adjusted OR 0.93; 95% CI: 0.87 to 0.99)". But the decline was even greater when May 2016 was chosen as the start date. Since plain packs were hardly ever sold until 2017, the authors resorted to the laughable speculation that the smoking rate fell because smokers had heard that plain packaging was one its way:
‘the suggestion is that smokers were influenced more by the prospect of standardised packs … than the actual adoption of standardised packaging.’

This is obviously bollocks and since the only study cited in the review that looked at cigarette sales found "no clear deviation in the ongoing downward trend", I'm going to go ahead and say that plain packaging didn't work.

Are we really going to have to gone through this again? Are we going to have to tolerate more years of survey-based junk science being published to promote plain packaging for another product?

Didn't ASH swear on a stack of bibles that this is exactly the kind of thing that wouldn't happen?

Why, yes they did! In 2012, ASH said: 
... the “domino theory” i.e. that once a measure has been applied to tobacco it will be applied to other products is patently false. The same argument was used against the ban on tobacco advertising, but 9 years after the tobacco ban in the UK, alcohol advertising is still permitted with no sign of it being prohibited.
ASH have deleted that webpage now (it's still available thanks to the Wayback Machine), which is just as well seeing as the Scottish government is consulting on banning alcohol advertising and ASH is actively campaigning for plain packaging for be "applied to other products".

The Science Media Centre got some crank from the UCL Tobacco and Alcohol Research Group to comment. I suspect it is a sign of things to come:

“In the UK, plain packaging requirements for cigarettes and hand-rolled tobacco have been in place since 2017 – and data suggest smoking rates have fallen as a result..."

How can they lie like this?

... so there’s precedent for this type of intervention."

A 'slippery slope', if you will, with tobacco being the first domino to fall.

But while cigarettes look very similar across brands (meaning packaging is the main opportunity for branding), e-cigarette devices come in a wide range of shapes and colours which may still appeal to young people once the packaging is removed. So while standardising packaging may go some way towards reduce e-cigarettes’ appeal to youth, it’s likely to only be part of the puzzle.”

So not just standardised packaging then, but standardised e-cigarettes, and all with the backing of the vapers' frenemies at ASH.
It's not the flagrant mendacity. I'm used to flagrant mendacity in 'public health'. It's the tedium and predictability of it all that gets me.

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