Latest smoking ban/heart attack study is pure junk science

Last September, I mentioned an article in The Sunday Times which signalled that a new smoking ban/heart attack study was marching with ill-deserved confidence in our direction.

The ban on public smoking has caused a fall in heart attack rates of about 10%, a study has found.

Researchers commissioned by the Department of Health have found a far sharper fall than they had expected in the number of heart attacks in England in the year after the ban was imposed in July 2007.

This was truly remarkable news because, as regular readers of this blog and Dr Siegel's blog will know, NHS hospital admissions data clearly show that incidence of acute myocardial infarction (AMI) has continued to decline at the same rate as before the smoking ban.

This posed a problem for Dr Anna Gilmore, the ASH board member who was charged with turning this wholly unexceptional data into a new 'heart miracle'. Earlier junk studies from Scotland (Pell et al., 2008) and Helena, Montana (Sargent, Shephard & Glantz et al., 2004) had claimed a fall in heart attacks of 17% and 40% respectively. Pell did it by ignoring the NHS data set, picking an unusual time-frame and using a very idiosyncratic definition of a heart attack. Glantz did it by simply finding an unusual blip in a very small community.

But all the signs were that Gilmore would be using the full hospital admissions data record for England, which was already available online and which showed that heart attack admissions were falling by less than 5% every year before and after the smoking ban. How would she do it?

In January, I showed England's heart attack data for the second year of the smoking ban. This only confirmed the lack of any effect, and I even apologised for telling you about yet another heart miracle no-show.

The story is always the same, and I apologise for boring readers with one null study after another. But spare a thought for Dr Anna Gilmore, whose job it is to turn this mundane data into a newsworthy study showing that the smoking ban has saved thousands of lives. She may be working on it at this very moment.

The one limitation of the data used by myself and Dr Siegel was that they showed AMI admissions in the financial year (April to March). The smoking ban started on July 1 2007. We still had data for 21 months after the smoking ban, which was more than enough to show that there was no nose-dive in admissions. Still, it would have been better to have the data from July to June.

And now we do, because Anna Gilmore has published her long awaited paper in the British Medical Journal. This is what her figures show:

As expected, there are small discrepancies between the two data sets. (There tends to be slightly more admissions in the April-March set because the timeline goes further back, and Gilmore only shows one year after the ban.) But the story is the same in each—the rate of decline was the same after the ban as it was before. 

If you want specifics, here are the figures Gilmore uses (table 1 of the study)...

Emergency AMI admissions in English hospitals

2002/03: 61,498

2003/04: 60,680 (a fall of 1.33%)

2004/05: 58,803 (a fall of 3.1%)

2005/06: 55,752 (a fall of 5.19%)

2006/07: 53,964 (a fall of 3.21%)

2007/08: 51,664 (a fall of 4.26%)

As you can see, the decline in admissions in the year after the smoking ban was larger than the year before but smaller than the year before that. In fact, the average in the previous two years was 4.2%—almost exactly what it was in the year after the ban (4.26%).

Faced with this evidence, from a nation of 49 million people, what else can you do but hold up your hands and admit that smoking bans have no perceivable effect on a nation's heart attack rate?

So what's Gilmore's conclusion?

We therefore conclude that the implementation of smoke-free public places is associated with significant reductions in hospital admissions for myocardial infarction

Huh?

And the accompanying press release reads:

Smokefree legislation linked to drop in admissions for heart attacks

A 2.4 percent drop in the number of emergency admissions to hospital for a heart attack has been observed following the implementation of smokefree legislation in England, researchers from the University of Bath’s Tobacco Control Research Group have found.

The legislation was introduced on 1 July 2007 and this study, funded by the Department of Health and published this week in the British Medical Journal, is the first to evaluate its impact on heart attacks.

The team, led by Dr Anna Gilmore, Director of the Tobacco Control Research Group, part of the UK Centre for Tobacco Control Studies, found there were 1200 fewer emergency hospital admissions for myocardial infarction, commonly known as heart attacks, in the year after the legislation was introduced...

Dr Gilmore said: “Given the large number of heart attacks in this country each year, even a relatively small reduction has important public health benefits. This study provides further evidence of the benefits of smokefree legislation.”

Huh?!?!! 

This is a joke, right?

I'm afraid she's serious. Desperate to spin gold from straw, Gilmore throws everything she can at the data. She makes adjustments for surface air temperature, flu seasons, population size and Christmas holidays but she does not address more significant factors like smoking status, diet, exercise or stress (that's not her fault—the NHS does not have this data—but let's not pretend she is isolating smoking in public as the sole uncontrolled risk factor). 

None of these calculations are shown or can be verified, but these manipulated data are then fed into a series of computer programs to arrive at an adjusted average daily admissions figure. Although Gilmore uses the July-June figures for all pre-ban years, she goes up to September 2008 for her post-ban year, thereby leaving in July and August, which is when the AMI rate is invariably at its lowest. It's baffling and more than a little suspicious. Why not go up to June 2009? Or at least stop at June 2008?

From this almost incomprehensible mass of heavily adjusted data, she arrives at the figure of 2.4% mentioned above. This 2.4% is the supposed decline in AMI admissions that she directly attributes to the smoking ban. Since the total decline was only 4.26%, this means that the smoking ban was responsible for more than half of the drop; hence the newsworthy but entirely spurious 'smoking ban prevents 1,200 heart attacks' claim. 

Although the AMI rate had fallen by 3.21% and 5.19% in 2005/06 and 2006/07, we are expected to believe the decline would only have been 1.86% in 2007/08 if the smoking ban had never happened. 

In short, we are expected to believe that there was going to be a smaller than average decline in AMI in 2007/08, and that the smoking ban saved the day. The fact that the decline in AMI was unexceptional in 2007/08 is therefore used as proof that the smoking ban had an exceptional effect! 

This is fairy-tale science. It is sheer statistical manipulation and it is breath-taking in it scope and ambition. But then, as I have said before, it always had to be.

More on this tomorrow, I'm sure...

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The glory of Anna Gilmore

Anna Gilmore has been very busy of late. In the last few months she has produced a slew of ever more blatantly partisan 'studies' which are little more than a preordained policy conclusion buttressed by the fruits of a Google search. These efforts include 'Let's grass up Europeans who sell snus', 'Businesses try to make money', 'The illicit trade is tiny, honest gov'nur, and taxes have got nothing to do with it', 'The tobacco industry never used the term "tobacco harm reduction" until after the term was invented. Bit suspicious, that.' and 'Industries lobby', although she gave them different titles.

Disappointingly for Gilmore, even the usually supportive Guardian and Independent have failed to report much of this 'research', perhaps because it is transparently policy-oriented propaganda from a person who sits on the board of not one, but three, anti-smoking organisations (ASH, Smokefree SouthWest and the UK Centre for Tobacco and Alcohol Studies - see Dick Puddlecote for details on how taxpayers' money swishes between them).

Her latest two articles, published eight days apart in preparation for the Cyril Chantler review of plain packs have also received little press attention. This is a shame because they are absolutely hilarious. The most recent, published today, is an attempt to swing the burden of evidence away from those who want plain packs to those who don't. 'A critical evaluation of the volume, relevance and quality of evidence submitted by the tobacco industry to oppose standardised packaging of tobacco products' may have taken its inspiration from an outrageous study from 2013 which saw campaigners for minimum pricing 'evaluating' the arguments made by those who opposed it and concluded—surprise, surprise—that they were weak.

It is, of course, for the government to decide which evidence and arguments it finds most persuasive, not one side or the other. If you asked a Spurs fan to evaluate the quality of Arsenal's football team, you would get a conclusion that was not commensurate with the latter's position in the league. Spurs fan do not, however, typically have easy access to influential journals, nor would they necessarily have sympathetic peer-reviewers. For this reason, they are less able to present their warped opinion as scientific fact.

Having made herself judge, jury and executioner, Gilmore declares that most of the evidence presented by the tobacco industry is 'weak' and 'irrelevant'. Anyone familiar with the evidence presented by campaigners such as Gilmore in favour of plain packs—or, indeed, has read anything written by Anna Gilmore ever—will see the irony here. Plain packaging has always been presented as a policy designed to reduce smoking initiation by minors, but all the studies they present—and Lord knows there are lots of them—either ask minors which packs they find more attractive (ie. very 'weak' evidence) or ask adult smokers whether they think cigarettes from plain packs taste worse or whether they've considered quitting (ie. 'irrelevant' evidence). 

How does Gilmore justify her conclusion that her side's evidence is of higher quality than the tobacco industry's? She has just two criteria: (1) whether the evidence was funded, or in any way linked, to the tobacco industry, and (2) whether the evidence was peer-reviewed. Sadly, she does not list the evidence itself, so we can't see what mental gymnastics went into tagging evidence as being 'linked to' the tobacco industry, but we have seen before that anti-smoking campaigners can broaden that definition to include everybody except themselves. Ultimately, this is a not a qualitative evaluation, but a blind dismissal of any research not funded or conducted by their own side (Gilmore's own study is funded by CRUK, who have been campaigning vociferously for plain packs for several years, but this does not stop it being 'independent' by Gilmore's criteria).

The second study, published on February 5th, is even better. 'How Does the Tobacco Industry Attempt to Influence Marketing Regulations? A Systematic Review' appears to be the result of a drunken evening spent on search engines looking for "tobacco industry arguments" which, upon closer inspection, are just arguments used by all sorts of people, including anti-smoking campaigners, in political debate. Her list of "tactics" to look out for is hilariously comprehensive, as is her warning that they are "repeated across jurisdictions" The same arguments being used in different countries? Oh, the humanity!

Here, in all its glory, is Gilmore's list of "tobacco industry arguments" (click to enlarge).

Again, there is no attempt to evaluate whether the arguments are valid, although it is strongly implied that they are not. If they are invalid it poses a problem for political debate because most of them are used by different interest groups all the time.

The second argument (about job losses), for example, was used by the staff of London Underground when they went on strike last week.

The third argument (about some people being affected more heavily than others) is used by campaigners against the Bedroom Tax.

The fourth argument (about negative effects on the economy) are used on a daily basis, often legitimately, by every campaigner and politician under the sun.

The sixth argument (about negative effects on public health) is used routinely by public health campaigners.

The eighth argument (about "other negative unintended consequences") is so absurdly broad that it is used by every human being in the world, as is the argument that "regulation is more extensive than necessary".

I could go on, but I think you get the picture. In her attempt to divert attention to the weaknesses of her own arguments, Gilmore damns the entirety of political discussion.

Meanwhile, after fifteen months, we continue to wait for a scintilla of evidence from Australia showing that plain packaging has deterred a single minor from starting to smoke.

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Tobacco exceptionalism?

Is tobacco a unique product or not? Let's ask comedy professor Anna Gilmore.

Anna Gilmore, 2007:

'The International Monetary Fund encourages privatization of state-owned industries, including tobacco industries, to help address macroeconomic problems and promote economic growth; however, it fails to consider the unique nature of an industry whose product kills.'

 

Anna Gilmore, 2019:

'Tobacco is a unique product in that it kills half of its consumers. It is the only consumer product that is subject of a global treaty, the WHO Framework Convention on Tobacco Control (FCTC), with over 180 Parties including all but one OECD member. The FCTC is now embedded in the UN Sustainable Development Goals, enshrining the tenet that good governance in public health involves treating tobacco companies differently from the rest of industry.'

 

Seems like a clear 'yes'. And yet at a neo-temperance meeting recently, she was humming a different tune:

 

“For NCDs we should be able to move forward, we need to get beyond tobacco exceptionalism,” said Professor Anna Gilmore, Professor of Public Health and Director of the Tobacco Control Research Group at the University of Bath

 

This is our old friend the slippery slope again, isn't it? Not surprising from someone who turned the UK Centre for Tobacco Studies into the UK Centre for Tobacco and Alcohol Studies. It surely can't be long before it becomes the UK Centre for Tobacco, Alcohol, Gambling and Ultra-Processed Food Studies.

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Anna Gilmore returns

Anna Gilmore's new study doesn't seemed to have generated much media attention, perhaps because any editor looking at the headline of the press release is likely to think "well, duh":

Smoke free legislation linked to drop in second-hand smoke exposure among adults

Levels of second-hand smoke exposure among non-smoking adults fell by almost 30 per cent after smoke free legislation was introduced in England in 2007, researchers in the Department for Health have found.

...Professor Anna Gilmore, who directed the study, said: “The importance of this study is that it examines the impacts of smoke free policies on adults’ exposure using a specific biological-marker of smoke exposure (rather than self-reported exposure) while simultaneously controlling for underlying declines in exposure.

“To our knowledge it is the first study to do this. The fact it shows marked declines in adult exposure provides further evidence of the important public health benefits of smoke-free policies.”

What, if any, are these "public health benefits"? The study looked at cotinine readings in nonsmokers before and after the English smoking ban and found that they fell by 27%. Cotinine itself is perfectly harmless, but it is a bio-marker for nicotine which is, in turn, is a proxy for "secondhand smoke exposure". Nothing wrong with that, nor is there anything surprising about cotinine readings falling as a result of a total smoking ban in 'public' places.*

The graph below (which comes from the study) shows saliva cotinine levels in nonsmokers before and after the ban (click, as ever, to enlarge).

'SFL' indicates the start of the 'SmokeFree Legislation'. What is most striking about this graph is how much cotinine and, it must be assumed, secondhand smoke exposure declined before the smoking ban. After the ban, cotinine levels did not change for people living in smoking households and Gilmore found that people in social classes IV and V experienced no reduction in secondhand smoke exposure at all (inevitably, this leads to her calling for "further efforts to reduce SHS exposure to benefit those who remain most exposed.")

Only nonsmokers from social classes I to III who live in nonsmoking households saw a decline in their saliva cotinine levels. Gilmore claims that this decline was greater than would be expected from the long-term trend, although none of her graphs appear to support this.

Gilmore's track record gives us no particular reason to trust her assertion that the smoking ban accelerated the existing trend towards less secondhand smoke exposure. However, it is obviously very plausible that a smoking ban would have this effect so, for the sake of argument, let us agree that there was a 27% drop in saliva cotinine readings as a result of the ban.

Her data show that before the ban (1998 to 2007), average cotinine levels in nonsmokers' saliva fell from 0.36 ng/ml to 0.14 ng/ml. After the ban, this declined continued and, by the end of 2008, cotinine levels were at 0.071 ng/ml.

The question is: so what? Is this decline—which sounds impressive when described as a 30% fall in secondhand smoke exposure—of any practical significance? How do these levels compare with actually smoking?

A systematic review of cotinine readings found that the average smoker has a saliva cotinine reading of 318 ng/ml. This is more than 2,250 times greater than levels found in nonsmokers before the ban.

This difference is so vast that it is difficult to show it visually. The graph below shows cotinine levels of nonsmokers in 1998, 2007 (pre-ban) and 2008 (post-ban) compared with a typical cotinine reading from a smoker. If you click to enlarge, you may just be able to see the nonsmokers' data.

While smokers have average cotinine readings of 318 ng/ml, the smoking ban reduced the average nonsmokers' levels by 0.0019 ng/ml. This is beyond negligible. Whether before or after the ban, we are talking about truly homeopathic levels of exposure. It takes a leap of faith to believe that reducing 'exposure' levels from 0.03% of a smoker's level to 0.02% of a smoker's level really constitutes "the most significant and beneficial public health intervention for a generation". Far from showing us how effective the smokefree legislation has been in tackling the passive smoking peril, this study reminds us how overhyped the peril was in the first place.



* However, it is wrong of the press release to describe a 27% fall in nonsmokers' cotinine levels as meaning that "second-hand smoke exposure among non-smoking adults fell by almost 30 per cent". This suggests that if all secondhand smoke was eliminated, cotinine levels would fall to zero. This would never happen because nicotine, and therefore cotinine, exists at low levels in various nightshade vegetables.

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You can't rip people off, that's our job!

Blackadder: How would you like to earn some money?

Comte de Frou-Frou: I would not like to earn it. I would like other people to earn it and give it to me. Just like in France in the good old days!

On a few occasions over the last decade, Action on Smoking Health have got upset about (alleged) price-fixing between tobacco companies. It happened in 2003:

"We ... hope that the OFT carry out a thorough probe and are not fobbed off by industry spin," said Amanda Sandford, of anti-smoking group Action on Smoking and Health. If the consumer is being ripped off then this should be exposed."

And again in 2008:

“The hypocrisy of the industry knows no bounds,” said Deborah Arnott, the director of Action on Smoking and Health. “While complaining bitterly about tax increases, these companies have been raising the price of cigarettes to fill their own coffers while hiding behind the screen of tax rises.”

Coming from people who call for higher cigarette prices at every opportunity—and who barely conceal their contempt for the consumer—this righteous anger might seem baffling. If raising the price of cigarettes reduces smoking, what does it matter whether it is the government or the industry that does it?

But that is to disregard two of the key components of the modern anti-smoking movement: fanatical hatred of the tobacco industry and an unquenchable thirst for money.

Readers will be no doubt be thrilled to hear that Prof. Anna Gilmore, the world's greatest scientific mind and a woman of unimpeachable integrity, has now started dabbling in economics. In an article published the impeccably peer-reviewed Tobacco Control magazine, Gilmore uses the concepts of market failure and barriers to entry as an excuse to curtail tobacco industry profits. The only problem is that she doesn't understand what market failure is and the barriers to entry are entirely the result of tobacco control's own policies (ie. banning advertising).

Like ASH, Gilmore wants higher cigarette prices, but not unless the state (and state-funded researchers in the anti-tobacco industry) get to keep the spoils. Here's a sample paragraph...

This situation benefits the tobacco industry while disadvantaging the consumer, and reducing potential benefits to population health and the public purse. The extreme profitability of cigarettes gives tobacco companies both the incentive and the resources to fight public health measures designed to reduce tobacco consumption, and an enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market. The pricing power of these companies also creates significant economic rents for the tobacco companies which ought to be captured by the state and used for wider social benefits.

Where to begin with such guff? We could start by asking when tobacco control suddenly started worrying about smokers being "disadvantaged" by higher cigarette prices or anything else? We could ask exactly which "public health measure" has been successfully fought by the tobacco industry in recent years? And does not the industry have a right to defend itself, and its customers, against Gilmore and her ilk in any case? Who really has an "enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market"? Was it the industry that banned snus in the EU? Is it the industry that is banning the e-cigarette around the world? Or is it the puritan wing of tobacco control aided and abetted by the pharmaceutical industry? And in what kind of society do profits from a legal industry get "captured by the state" for no reason other than that its opponents resent its wealth and wish to have it for themselves?

Carl V. Philips has written an excellent post about Gilmore's latest train-wreck of a study over at ep-ology ('Anna Gilmore adds junk economics to her junk epidemiology portfolio') so there's no need for me to say any more. Here's a sample...

So this is their “radical” idea? Putting a new label on basically what is already being done, perhaps with a bit of nationalization of the companies, and making the absurd claim that this has something to do with the economic theory of market failures?

The most charitable interpretation is that this is just an attempt to use junk science as an excuse for a preferred policy, to transfer corporate profits to the government (something that can be done any number of ways that would work better if that is what government decides to do).

Well, I suppose given Gilmore’s demonstrated abuse of epidemiology there was no reason to expect anything else.

Incidentally, Gilmore's is the second article to be published recently in Tobacco Control which discusses ways of forcing the tobacco industry to hand its money over to public health 'professionals'. The other wants a 'polluter pays' principle and is discussed on the seldom updated TC blog (check out the swivel-eyed contribution from James Repace in the comments)

Is the anti-smoking lobby getting worried about where the next billion dollars is coming from? In these difficult economic times, it's always possible that someone in government might find better things to spend money on than a clique of unaccountable zealots whose policies don't deliver what they promise and whose research methods fall somewhere between charlatan and comedian.

One alternative way of raising money never seems to occur to them, but I will throw it out there. As downwiththatsortofthing notes, support for anti-smoking policies is always 80%. So why not ask all those hundreds of millions of people who support the movement to chip in a few dollars each? Y'know, like legitimate grass-roots organisations and charities do. No? It wouldn't work, you say?

Coercion and extortion and it is then.

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Conspiracy theorist sacked by Bristol University

David Miller has finally been sacked by Bristol University. Professor Miller runs two grubby conspiracy websites, SpinWatch and Powerbase, and seems to be rather obsessed with 'Zionists'. See how many times Powerbase's entry on 'neoconservatism' mentions Jews, for example.  

Miller had already been suspended by the Labour Party (and later quit) for accusing Keir Starmer of taking "Zionist money" and he has called Jewish students "pawns" of Israel. 

Less well known is Miller's involvement in the wingnut faction of 'public health'. His 'join the dots' paranoia and theories about 'webs of influence' align nicely with the fixations of people like Anna Gilmore at Bath University where Miller worked as a sociology professor for most of the 2010s. 

Despite having no qualifications in health, Miller was taken on as an 'investigator' at the UK Centre for Tobacco and Alcohol Studies alongside Petra Meier, Gerard Hastings and others. 

From 2012, Gilmore and Miller worked together as PhD supervisors for an EU-funded project that was literally called 'Web of Influence'. 

The student will conduct their research under the supervision of Professor David Miller and Professor Anna Gilmore. 

The Project

The successful applicant will assist with a research team working on a new research programme within a large-scale project funded by the European Commission, ALICE RAP. ALICE RAP aims to critically examine and analyse currently fragmented research and strengthen scientific evidence to inform a new dynamic platform for public and political dialogue and debate on current and alternative approaches to addictions.

The specific project titled the ‘Web of Influence’ focuses on the poorly understood role of economic actors in public policy formation. The project will examine the ‘web of influence’ of four ‘addictive industries’ (Food, Tobacco, Alcohol and Gambling).

As recently as last October, after he had been suspended by the Labour Party and long after the first accusations of antisemitism had been made against him, Miller sat on a panel discussing corporations, neoliberalism, etc. with Anna Gilmore and Mark Petticrew - both of whom will be familiar to regular readers of this blog - at the World Congress of Public Health. 

To my knowledge, none of Miller's old colleagues have gone as far down the rabbit hole as he has, but it is interesting that someone like him can get so far in 'public health' without his crank tendencies being noticed, is it not? 

One of Prof Miller's contributions to academia

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Smoke without fire?

A study titled 'Should IQOS Emissions Be Considered as Smoke and Harmful to Health? A Review of the Chemical Evidence' was published two weeks ago. The study comes with a big red flag:

The authors acknowledge the support of Bloomberg Philanthropies’ Stopping Tobacco Organizations and Products funding (www.bloomberg.org). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors also thank Prof. Anna Gilmore and Sophie Braznell from the University of Bath and Dr. Ed Stephens from the University of St. Andrews for valuable discussions and reviewing the content of this article.

Why anyone would ask advice from Anna Gilmore and one of her PhD students when writing about chemistry is a mystery that is only partially solved by the knowledge that they are also on the Bloomberg gravy train. Gilmore is deeply involved with Bloomberg's 'Stopping Tobacco Organizations and Products' (STOP) front group. How can the funder be said to have had no role in the analysis when she reviewed and commented on the study? I guess different rules apply in 'public health'. The authors report no conflicting interests.

IQOS is a heated tobacco product produced by Philip Morris International (PMI). It doesn't burn the tobacco, it heats it. Consequently, there is no smoke and the products are considerably safer than combustible cigarettes. This has been acknowledged in the UK by the Committee on Toxicity and in the USA by the Food and Drug Administration (FDA). The FDA allows IQOS to be marketed as a Modified Risk Tobacco Product, an honour that is rarer than hen's teeth and requires an abundance of evidence to earn.

Mike Bloomberg and his minions loathe reduced risk nicotine products and are determined to crush them, even if it means turning scientific terminology on its head. One strategy is to portray the emissions from heated tobacco products as 'smoke'. This has regulatory implications in many countries and this new study seems designed to be printed off by campaigners and laid on the desk of gullible regulators. It concludes:

The HPHCs [harmful and potentially harmful compounds] present are the same as in conventional cigarette (CC) smoke, albeit in lower concentrations and formed at lower temperatures, analogous to the emissions from the earlier generation of HTPs [heated tobacco products], which were classed as smoke. Also, IQOS emissions contain carbon particles with most of the compounds released being formed by chemical reactions provides further evidence that IQOS emissions fit the definition of being both an aerosol and a smoke.

 

Unlike Anna Gilmore, I am happy to admit that this is beyond my expertise so I invited Dr Roberto Sussman from the Institute of Nuclear Sciences at the National Autonomous University of Mexico to write a guest post. Here is what he has to say...

 

“Must a name mean something?” Alice asks Humpty Dumpty, only to get this answer: “When I use a word… it means just what I choose it to mean – neither more nor less.”

Paraphrasing this Alice in Wonderland dialogue with “a name” replaced by “smoke” and “Humpty Dumpty” replaced by “Tobacco Control orthodoxy” illustrates the determination of the WHO technocracy to attach the term “smoke” to the IQOS aerosol. Earlier this month, scientists funded by Bloomberg Philanthropies attempted in this article to provide technical backbone to this “re-classification” of IQOS aerosol as some form of smoke. It was written by Clement N. Ugana and Colin E. Snape, both from the University of Nottingham's Faculty of Engineering.

Let us first clear the semantics: What is “smoke”? Any textbook on aerosol physics defines “smokes” as aerosols (particulate substrate in a gaseous medium) sharing the following characteristics:

• the particles are fine and ultra fine (diameters less than 1 micrometer)
• can be solid or liquid
  
• are generated by a combustion process.

What is a combustion process? Chemical reactions that involve a combustible are oxidizing and exothermal (i.e. require oxygen and external energy supply).

So how do Uguna and Snape claim that IQOS aerosol can be characterized as a “smoke”? Basically, they follow the suggestion of a questionable 2017 paper by Auer et al. titled 'Heat-not-burn tobacco cigarettes: Smoke by any other name' which claims that IQOS aerosol contains “compounds from pyrolysis and thermogenic degradation that are the same HPHCs as for conventional tobacco cigarette”. 

Uguna and Snape extend this to :

• The same endothermic physicochemical processes that occur when inhaling cigarette smoke might occur in IQOS aerosol: evaporation/condensation of vapors, distillation (separation of liquid/solid phases), pyrolysis and pyro-synthesis (larger molecules decomposing in smaller ones and and recombining).
• IQOS aerosol contains detectable solid black carbon particles (a generic name for carbonaceous particles)
• Some spots in the tobacco of the IQOS might reach higher temperatures than the recommended range below 350 C
  

Uguna and Snape are mistaken in assuming that IQOS aerosol can be cast as a smoke on all these counts.

Let us deal with the first issue. While there is no smoke without combustion (or without oxygen), different smokes might evolve through many other derived physicochemical processes, such as the ones mentioned by Uguna and Snape. However, these are derived processes acting on smoke that has already been produced by oxidizing exothermal reactions. In other words: these processes are not needed to generate a smoke and their occurrence does not by itself imply combustion. This is easily illustrated by looking at the specifics of tobacco smoke.

What we call “tobacco smoke” is really two distinct aerosols, both originating from the same smoke produced by the burning (external energy supply) of the combustible (tobacco leaf). Each aerosol evolves differently: the sidestream emission making 75-80% of the produced smoke at the burning (800-900 C) and smouldering (450-500 C) tip of the cigarette is directly released to the environment and the mainstream emission, the remaining 20-25% that is inhaled by the smoker and undergoes several physicochemical processes, such as distillation, condensation/evaporation, pyrolysis and pyro-synthesis and forced convection and cooling (from 800-900 to 40 C) as the smoker inhales through the cigarette rod.

The confusion of Uguna and Snape is clear: they assume that the IQOS aerosol can be a sort of “smoke” because it may go through some (or even all) of the derived processes (condensation/evaporation, distillation, pyrolysis) in the evolution of 20-25% of the cigarette smoke that forms the mainstream emission of cigarettes. However, such processes do not define combustion and are not necessary to generate smoke (for example, sidestream smoke). Neither are they sufficient to do so: they can occur without combustion with exothermal processes that do not involve oxidizing reactions.

The lack of combustion in the aerosol generated by a heated tobacco device was proven in a rigorous experimental test by PMI scientists (Cozzani et al. 2020). A heated tobacco device in an oxygen-free laboratory environment was capable of aerosol generation. This proves that the aerosol was not generated by combustion, which is an exothermic oxidation process that cannot occur without oxygen and a combustible.

Evidently, depending on the temperature (and thus on the supplied battery power) in which the heated tobacco device is operated, the derived processes (distillation, condensation/evaporation, pyrolysis or pyro-synthesis) might occur in the aerosol evolution, but this does not prove that the generated aerosol is a smoke because 20-25% of cigarette smoke undergoes similar processes. The key difference is that this fraction of tobacco smoke was previously generated by combustion, whereas Cozzani et al. proved that the aerosol from a heated tobacco device is not.

Another reason why Uguna and Snape claim that IQOS aerosols can be characterized as some sort of smoke is the presence of black carbon solid particles. The particulate phase of IQOS has been examined in laboratory studies by the industry, in particular by two comprehensive laboratory studies (the second funded by PMI): Pacitto et al. (2018) and Amorós-Pérez et al. (2022).

Although neither of these is cited by Uguna and Snape, both laboratory studies concluded that particles in IQOS aerosols are quite distinct from those of tobacco smoke that are clearly identifiable with combustion particulate matter (PM). They have much larger volatile content and are overwhelmingly liquid and produced by condensation. Uguna and Snape only cite several sources that have detected black carbon particles in minute concentrations relative to tobacco smoke (for example, less than 1% in Ruprecht et al.). They cite Auer et al., which merely speculates on IQOS aerosol particles.

While Uguna and Snape recognise that IQOS operates at temperatures of less than 350 C, considerably below combustion temperatures, they hint that the tobacco undergoes an inhomogeneous heating, with the creation of spots possibly reaching higher temperatures. However, this is mere speculation without any actual laboratory proof under normal operating conditions of the devices.

It is really unnecessary to go any further on re-classifying IQOS aerosols as smoke, in the presence of black carbon particles, or in arguing that its toxicity may be comparable to that of tobacco smoke, as these claims were irrelevant in the extremely rigorous testing of the characteristics and relative safety of product that was validated by the FDA in its review of the PMTA application submitted by PMI. The FDA openly recognised that its evaluation roughly agrees with the claims by the manufacturer on all technical issues, with substitution of cigarette smoking by usage of an IQOS device representing for users a significant reduction of their exposure to HPHCs, thus granting the devices the status of “appropriate for the protection of public health”.

Going back to the semantics: perhaps the definition of “smoke” can be stretched to include any aerosol with (even a minimal) presence of solid non-volatile particles and undergoing any one (or all) the physicochemical processes in the formation of the mainstream emission inhaled by smokers. After all, other than the need to facilitate scientific communication, there is nothing sacred about terminology. While stretching the definition of smoke in this way would encompass aerosols from heated tobacco products (HTPs), it would make communication harder and more confusing by also encompassing aerosols that mostly originate from combustion sources (such as cooking aerosols and air pollution) which are not known as “smokes”. Therefore, it could be counterproductive.

Finally, it is interesting to inquire why the pressing need of tobacco control orthodoxy to characterise aerosols from HTPs as smokes? The main reason is political: this characterisation fulfills the need of the technocracy to keep the ongoing crusade against the manufacturers of these devices: the tobacco industry and in particular Philip Morris International (PMI). For this purpose the technocracy is now missing the target of reducing cigarette smoking and giving more preference to keeping the industry in its eternal role of the ultimate evil force deceiving the public. However, the industry's claim that replacing tobacco cigarettes with HTPs such as IQOS significantly reduces user exposure to harmful compounds has been scientifically validated by the US FDA, whereas the most extreme of contrary claims have been only validated by politics and technocratic hubris.

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Anna Gilmore attempts some economics again

Anna Gilmore's latest effort has received virtually no press attention, but it's another gloriously inept entry into her canon. She argues that recent tobacco industry warnings about high taxes fuelling the illicit trade are hypocritical because nearly half the rise in cigarette prices is due to industry price-gouging.

She sets the scene by introducing a report that was produced by JTI in 2012...

In November 2012, Japan Tobacco International (JTI), which has approximately a 40% share in the UK market, published a report, The Billion Pound Drop, on tobacco smuggling in the UK, which claims, inter alia, that tobacco tax increases fuel the illicit tobacco trade. Statements such as ‘the tax on a pack of premium brand cigarettes...has risen by more than £1... As a result, we have seen levels of non-UK duty paid consumption increase by almost 20% so far this year,’ litter the report.

She then examines cigarette price data...

We took brand-specific cigarette price and sales data from Nielsen covering the period November 2006 to November 2009 in Britain... Table 1 shows that across this 3-year period, approximately half (48%) of the total price increase across all brands combined was due to the tobacco industry increasing prices, the other half (52%) being attributable to tax increases.

Can you spot the trick? Here's ASH to give you a clue...

From 2001 until 2008 tobacco taxes rose only in line with inflation.

In fact, there was no above-inflation rise until the budget of November 2009 which—by an amazing coincidence—is when Gilmore stops analysing the data. Thereafter, there was a slew of tax hikes...

In 2009, tobacco duties were increased by 2% on the basis of a deflationary forecast in the Retail Price Index of -3%, thus representing a 5% increase in real terms. In 2010, the Chancellor announced that tobacco duty would rise by 1% above inflation for the current year and made a commitment to raising tobacco duty by 2% above inflation from 2011 to 2014. This was implemented by the new Conservative-led coalition Government in the 2011 Budget. In addition, duty on hand-rolled tobacco was increased by 10%. In 2012, the Chancellor raised tobacco duty by 5% above inflation.

That's a lot of tax rises in four years and if you read the JTI report, it's obvious that these are the tax rises they're talking about. The following is the full text of the report's introduction which Gilmore quotes selectively (see above)...

When we published our last report on the UK’s illegal tobacco market in 2010 we were greatly concerned about what might happen to levels of smuggling and cross-border shopping if the Government went ahead with a) plans to increase tobacco taxes and b) proposals to ban the display of tobacco products in retail outlets.

Since then the tax on a pack of Premium brand cigarettes, for example Benson & Hedges Gold, has risen by more than £1, an increase of 20%, and now sells at £7.72 RRP1. As a result, we have seen levels of non-UK duty paid consumption increase by almost 20% so far this year.

Gilmore could have easily obtained the relevant data for November 2009 to November 2012, but she chose not to. Funny that. Instead she goes back to the Blair/Brown years when the tobacco duty escalator had been abolished and tax on cigarettes was rising only in line with inflation.

And why was the tobacco duty escalator scrapped in 2000? Because the illicit trade was getting out of hand.

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Bashing Diageo

From the Beeb:

Drinks company Diageo is to pay for 10,000 midwives in England and Wales to be trained to offer advice on the dangers of alcohol during pregnancy.

The Department of Health hopes the training initiative will in turn help more than one million expectant mothers over three years.

This sounds like pretty good news. I imagine that nearly all women are aware they should drink little or nothing during pregnancy already—indeed, only 4% do not reduce their drinking when they get pregnant—but no doubt there is more that could be done. So this sounds like a sensible scheme to prevent damage to unborn children, based on solid evidence that heavy drinking can cause Foetal Alcohol Syndrome.

The National Organisation for Foetal Alcohol Syndrome is very happy about it...

Susan Fleisher, from the charity, said the scheme would have have huge benefits.

"The thing that's so fantastic is that they're helping us with prevention, we can actually prevent children being born with foetal alcohol brain damage," she said.

"But it costs money, and thanks to Diageo we expect we will be educating in the next three years 10,000 midwives. Ultimately, if it all goes well, they will reach at least a million women."

Hurrah! Everyone's a winner and no need for bans, taxes or coercion. What kind of misery-guts could possibly find reason for gripe about this?

Vivienne Nathanson from British Medical Association said there were concerns over the scheme.

"They certainly have a conflict of interest because it's in the interest of the drinks industry for people to continue to drink and it's in the interest of health for people to drink much less, and certainly not to drink during pregnancy or to drink really minimally."

Only someone whose income has always comes from the state could interpret the role of business in such a simple-minded and misanthropic manner. As far as Nathanson is concerned, if it wasn't for the angels of government, the drinks industry would be telling pregnant women that drinking makes babies big and strong while selling whisky doped with heroin outside schools.

Because businesses only cares about profit, don'cha know? It's not as if they're run by men of flesh and blood who want the world to be a better place like the rest of us do. No, they want babies to be born retarded and adults to die of liver disease. And if this kills their customers and ruins their company's reputation, then so be it, because not only are business-owners fiendishly clever, they are—by a strange paradox—also incredibly stupid.

At least, that's how it is if your understanding of business started and ended when you read a book by Naomi Klein, as seems to be the case with most 'public health professionals'.

There is an element of sour grapes here because, as I mentioned in March, a bunch of fake charities and temperance groups—including the BMA—spat their dummy out and "walked away from the table" in protest at the government including industry in these discussions. And a good thing too. The policy announced today is the kind of reasonable, effective and efficient use of money they would have dismissed out of hand.

Over at The Guardian—where naysayers dominate the news story—none other than Anna Gilmore, professor of no fixed ability, tries to join in the industry-bashing...

But Prof Anna Gilmore, a public health expert from Bath University, said there was a fundamental conflict of interest in the "responsibility deal". She said: "These large corporations, whether they sell tobacco, food or alcohol, are legally obliged to maximise shareholder returns. They therefore have to oppose any policies that could reduce sales and profitability – in other words, the most effective policies."

Sorry? Corporations are "legally obliged" to maximise shareholder returns? I know Labour made a lot of laws when they were in power but I hadn't heard of this one. Have there been many prosecutions? Do business get raided by police if they launch a duff product? Are there advertising executives languishing in jail for making poor use of the marketing budget?

Or is this just more proof of Anna Gilmore's estrangement from reality? It's almost as if she's being sponsored to go around getting things wrong on as many different subjects as she can. No wonder Uncle Stan looks so proud.

UPDATE: Leggy has more on this, including a gem of a quote from that massive hypocrite Don Shenker.

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Five years of junk in one place

As the fifth anniversary of the English smoking ban approaches, there was always going to be a lot of bollocks talked about it, so it's nice of The Guardian to put all the fish in one barrel ready for shooting.

This could very well be the most factually inaccurate newspaper article of the year, based as it is on the scribblings of Stanton Glantz, Anna Gilmore and Jill Pell. Our credulous scribe begins as follows...

Five years after the smoking ban drove nicotine addicts out of pubs and into huddles on the pavements, the fug-filled restaurants and bars are little more than a hazy memory. But it is not just our clothes that smell better – evidence is accumulating to show that the UK population is in better health too.

Strap yourself in.

The ban did not, as opponents warned, drive people out of pubs and into their homes to smoke.

Since the smoking rate didn't go down and 11,000 pubs went bust, it would be interesting to know where the smokers are smoking now. Have they all decided to start smoking in their gardens?

Whatever their domestic smoking arrangements, there can be no argument that smokers were driven from pubs and that pubs have been literally decimated by the ban:

Ban Damage

ASH: Hopeless liars

Pub share prices

Pete Robinson unleashed

A final word on ban damage

The big worry was that an increase in smoking at home would harm children, who were not subjected to so much secondhand smoke in restaurants and pubs. But a study carried out in Scotland, published in the New England Journal of Medicine in 2010, suggested their health has improved. Fewer have been admitted to hospital with asthma attacks since the Scottish ban on 26 March 2006, more than a year before the English ban.

The researchers looked at more than 21,000 asthma admissions between 2000 and 2009 for children under 15 years. Before the legislation, admissions among preschoolers were rising by more than 9% a year, while for older children they were stable. After the ban, they dropped by 18.4% for preschool children and 20.8% for those aged five to 14.

Utter bilge from the pen of Jill Pell and easily debunked by looking at the actual hospital admissions data. If that isn't good enough for you, compare and contrast these two statements made three months apart in 2011:

Ms Haw cited a study by Glasgow University which showed a 15% reduction in the number of children with asthma being admitted to hospital in the three years after the ban came into force.

Asthma UK said the number of emergency admissions had remained unchanged for a decade - suggesting the asthma of many young people was still being badly managed... "there has been no noticeable change in the unacceptably high emergency hospital admissions for children and young people with asthma in the last decade."

The first statement is based on the work of Ms. Pell. The second is from an asthma charity and is based on actual hospital admissions. They both refer to the same country and the same time. Who do you believe? More details here.

The biggest health impact has been a drop in heart attack emergency admissions – the "Montana effect", which has since been identified in many other places that have brought in smoking bans. Helena, in Montana, brought in a smoking ban in June 2002, but it was scrapped that December. During those six months, however, researchers publishing in the British Medical Journal found a drop in heart attack admissions to hospital.

The Helena miracle? Is that zombie study still walking?! The BMJ's decision to publish Stanton Glantz's innumerate masterpiece of cherry-picking shames the journal forever more. Details here. There is also the small matter that, no matter how you juggle the figures, a reduction in heart attacks of 40%, or even 4%, is mathematically impossible.

Anna Gilmore and her colleagues, at Bath's school for health, analysed heart attack hospital admissions for England between July 2002 and September 2008 and found a small but significant drop of 2.4% after the July 2007 ban. It was the equivalent of 1,200 fewer heart attack patients, they said in their paper in the BMJ.

Anna Gilmore's study was pure junk science.

But overall, it is pretty clear that smoking bans have made a difference to heart health. A Cochrane review, which scrutinised the data from 10 studies from North America, Italy and Scotland, found a drop in hospital heart attack admissions in all of them and a drop in the numbers of deaths in two.

Garbage in, garbage out. The Scotland study ignored the actual hospital admissions and was debunked by the BBC five years ago in addition to being included in The Times' Top 10 Junk Stats of 2007 (now behind a paywall). The Italian study was beyond a joke. And the biggest study conducted in America found no association whatsoever between smoking bans and heart attack reductions.

I hope you enjoyed that walk down memory lane. Here's to the next five years!

Meanwhile, back on planet Earth, the police are still raiding pubs and arresting landladies to enforce that "popular" smoking ban of ours.

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Desperate ASH demand plain packaging for rolling papers and filter tips

The tax-spongers at Action on Smoking and Health are really scraping the barrel now. Palpably desperate to find new dragons to slay, they want plain packaging for rolling paper and filter tips

 

We welcome this report’s recommendations.

The UK Government should apply standardised packaging laws to all tobacco products and accessories, including filters and papers. https://t.co/pzenxfG6mb

— ASH (@ASH_LDN) December 3, 2020

 

If they weren't such a hateful organisation, you could almost feel sorry for them. 

The hook for this latest demand is a flimsy report from CRUK which cobbles together some junk science from the activists at Bath and Stirling Universities, Anna Gilmore being amongst them. 

The first piece of research, from Bath, falsely claims that the 'rate of decline for tobacco sales doubled around the introduction of standardised packaging'. 

 

On average seven million fewer sticks were sold per month pre-implementation whereas an average of 13 million fewer sticks were sold per-month post- implementation.

This can easily be debunked as we saw when the same activists made a similar claim in July. 

HMRC's tobacco bulletin keeps track of tobacco sales. It shows a steep decline in (legal) cigarette sales until 2016/17, no doubt largely thanks to the emergence of e-cigarettes, after which the downward trend slowed appreciably.

 

For roll-your-own tobacco, sales bottomed out in 2016/17 and have since risen by 20 per cent.

 

It's nigh on impossible for a credible academic to turn this pig's ear into a silk purse. And so the job was left to Anna Gilmore of Bath University's Tobacco Control Research Group, which is now awash with Bloomberg cash.

 

John Britton and his team of anti-smoking zealots had to reluctantly concede that the same point in a study published in 2018:

Conclusions

The implementation of standardized packaging legislation in the United Kingdom, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes, but no clear deviation in the ongoing downward trend in total volume of cigarette sales.

 

Nevertheless, Gilmore and co. are once again claiming that black is white. 

 

The other piece of research, from Stirling University, comes to the unsurprising conclusion that tobacco companies didn't start selling cigarettes in plain packaging until they had to.

 

Tobacco companies used the full 12-month transition period to delay the removal of fully-branded products and gradually phase in standardised packaging.

 

The Stirling research actually contains some mildly interesting and useful information. Tobacco companies made sure there was plenty of branded stock on the market until the ban on selling branded cigarettes began on 20 May 2017. I don't think I saw any branded packs until 2017 and this research suggests that I wasn't alone.

Of the 20 fully branded products monitored, 18 continued to be sold throughout the transition period but some changed name. Almost all new names included a colour descriptor and adjective. 

 

No standardised variants were sold in the first five months. It was not until March 2017 (two months before mandatory compliance) that the average number of standardised products sold by each retailer exceeded the number of fully branded products.

So, although cigarettes had to be manufactured in plain packaging from May 2016, there can't have been any impact on consumer behaviour until 2017 because hardly any consumers had seen them. This further undermines Gilmore's study which compares sales in May 2015 to sales in April 2018. Cigarettes were only widely sold in plain packaging for a third of this period and were not even manufactured in plain packaging for the first third. 

Both the Bath and Stirling studies claim that cigarette prices 'increased as standardised packaging was implemented' in direct contradiction to the Britton et al. study mentioned above. 

All in all, it's the kind of quack science we expect from tobakko kontrol. It's a bit sad to see CRUK endorse it, but never mind. 

The report concludes that the government should ban bevelled edges on cigarette packs, extend plain packaging to filters and rolling papers, and ban the 'use of colours or other descriptors in product variant names'. 

This is desperate stuff, but if you make it to the last page, there are some telling comments.

Unresolved research questions

To date, the evidence we have on the market and industry response to standardised packaging shows that, despite tobacco industry’s tactics to undermine the effect of the legislation, this legislation has been effective in reducing tobacco sales and in tobacco industry revenues in the UK. However, there are still gaps in the academic literature that must be addressed in order to fully evaluate the impact of the legislation. While by no means an exhaustive list, the following key research gaps have been identified:

Smoking behaviours

1. What was the impact of standardised packaging of tobacco products on smoking prevalence in the UK?

2. As standardised packaging was intended to reduce youth uptake of tobacco products, what was the impact of standardised packaging on youth smoking prevalence and consumption in the UK?

In other words, they still don't know whether plain packaging works. Four years after it was introduced, you might hope they'd have an answer by now. 

Spoiler: it doesn't.

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Did plain packaging work?

We haven't heard much about plain packaging for a while. I assumed that ASH et al. were happy to let everybody forget about this damp squib while they moved onto the next thing. A study published John Britton and his team of anti-smoking zealots in 2018 had to concede that the policy hadn't had the promised effect on tobacco sales:

Conclusions

The implementation of standardized packaging legislation in the United Kingdom, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes, but no clear deviation in the ongoing downward trend in total volume of cigarette sales.

That must have stuck in the craw, but it could hardly be denied. HMRC's tobacco bulletin keeps track of tobacco sales. It shows a steep decline in (legal) cigarette sales until 2016/17, no doubt largely thanks to the emergence of e-cigarettes, after which the downward trend slowed appreciably.

For roll-you-own tobacco, sales bottomed out in 2016/17 and have since risen by 20 per cent.

 

It's nigh on impossible for a credible academic to turn this pig's ear into a silk purse. And so the job was left to Anna Gilmore of Bath University's Tobacco Control Research Group, which is now awash with Bloomberg cash. You may remember Gilmore as the activist-academic who claimed, falsely, that the smoking ban led to a 10 per cent fall in heart attacks.

In a study published in the risible Tobacco Control journal, she once again claims that black is white. Rob Davies at the Guardian is one of the journalists to have fallen for it.

UK tobacco sales fell faster after plain packaging rules came into force 

Cigarette sales have decreased by about 20m a month after plain packaging rules and tougher taxes were introduced three years ago, researchers have found.

Prof Anna Gilmore, director of the Tobacco Control Research Group (TCRG), said: “The underlying rate of decline in tobacco sales almost doubled after these policies were implemented.”

It then says:

 

Monthly sales were almost 3.29bn individual cigarettes in May 2015, but fell to 3.16bn in April 2018.

 

That is nowhere near a decline of 20 million a month. Why is May 2015 being used as the starting point anyway? Plain packs weren't in circulation until early 2017 and were not mandatory until May 2017.

 

The study itself claims that....

Postimplementation, the average monthly decline in stick sales was 6.4 million (95%CI 0.1million to 12.7 million) sticks faster than prelegislation, almost doubling the speed of decline.

None of this bears any relation to the truth, but the truth is whatever the 'public health' lobby wants it to be. That the study can be debunked in five minutes by anybody who is familiar with the data is besides the point. It has generated a few headlines in Britain and can be cited as evidence by campaigners abroad. And that's all that matters.

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The nanny state trough

If you told me that there was a massive pile of cash to be dished out to 'public health' academics and asked me to guess which two people would be first in line for it, I would say Anna Gilmore and Petra Meier. And sure enough, they were. This week it was announced that they're getting £15 million between them to build yet another little empire, on top of SIPHER, SPECTRUM and the rest. It is, as I say on my Substack, a racket. 

 

Anna Gilmore has her finger in so many pies that it is difficult to keep up. She made her name back in the day by pretending that England’s smoking ban reduced the number of hospital admissions for heart attacks. Having demonstrated that she will say anything for money, she was made a professor and spent the 2010s in a flurry of activity, displaying an extraordinary degree of ineptitude in a range of disciplines, including economics. She became director of the Tobacco Control Research Group at the UK Centre for Tobacco Control Studies, an organisation that received millions of pounds from the (state-funded) UK Clinical Research Collaboration despite doing no clinical research. Spotting new funding opportunities, the UK Centre for Tobacco Control Studies became the UK Centre for Tobacco and Alcohol Studies in 2013. She has since branched out into ‘research’ on fossil fuels which she says, not unpredictably, should be subject to ‘tobacco control style regulation’.

In 2018, she got $20 million from Mike Bloomberg to set up an ‘industry watchdog’ and in 2019 she got a grant from SPECTRUM to research ‘unhealthy commodity industries’. SPECTRUM is the preposterous acronym for Shaping Public hEalth poliCies To Reduce ineqUalities and harM. It was funded to the tune of £5.9 million by the UK Prevention Research Partnership, a largely taxpayer-funded body created in 2017 to provide yet another source of cash for nanny state quackademics.

Gilmore is also the co-director of something called the Centre for 21st Century Public Health which doesn’t have much to say about itself but is more than likely paid for by you and me.

 

Read on. 

Also, there's a new Last Orders to listen to.

Happy Easter!

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The cronyism of the sockpuppet state

The Economic and Social Research Council is funded to the tune of £212 million by the Department for Business, Energy and Industrial Strategy. In 2017, it announced the creation of the UK Prevention Research Partnership (UKPRP), a £50 million project aimed at developing ‘robust new knowledge which contributes to demonstrable changes in policy and practice’ by ‘working closely with policy makers'.

I suggested in Still Hand In Glove? that this had the hallmarks of another slush fund for political pressure groups. Some news yesterday removed all doubt...

We are delighted to announce that UKCTAS has been successful in securing future funding through a multi-funder research initiative; the UK Prevention Research Partnership (UKPRP). UKTCAS academics joined forces with new collaborators and a range of public and private sector organisations to apply to the UKPRP. The new consortium has now been awarded £5.9 million funding over five years and is called SPECTRUM (Shaping Public hEalth poliCies To Reduce ineqUalities and harM). 

UKCTAS is the UK Centre for Tobacco and Alcohol Studies. It claims that it is not a ‘lobbying group, but we do have close links with advocacy organisations and will assist them where appropriate.’ As a result of its ‘meaningful and sustained collaborative relationships with advocacy organisations’, UKCTAS is able to list the following political victories:

'We performed new analyses for the Scottish Government on the comparative effectiveness of Minimum Unit Pricing and alcohol taxation, and this work formed a key part of their successful defence of Minimum Unit Pricing in the Scottish courts...'

'Academics from UKCTAS worked with Scottish groups including Alcohol Focus Scotland and Scottish Health Action on Alcohol Problems to advocate for a reduction in the ‘drink-drive limit’ in Scotland...'

'Legislation prohibiting smoking in cars carrying children in England and Wales came into force in October 2015. UKCTAS played a leading role in bringing this legislation into place...'

'Legislation to introduce standardised packaging for tobacco was passed in the UK parliament in the spring of 2015 and will be fully implemented from May 2017. This covers all parts of the UK. UKCTAS research played a key role in this decision.'

Linda Bauld is the Deputy Director of UKCTAS. She has also been ‘closely involved in the development of the UKPRP and is a member of the steering group for this new initiative’.

Guess who's just been appointed director of the £5.9 million Spectrum project? Linda Bauld. Small world, eh?

The list of SPECTRUM's 'co-investigators' features some other familiar faces, including John Britton (director of UKCTAS), Alan Brennan (Sheffield University fantasy modeller), Anna Gilmore (Tobacco Tactics conspiracy theorist) and Mark Petticrew (anti-alcohol crank), plus two senior staff from Public Health England.

And it gets worse [or does it? See update below - CJS]. Look who else has got their snout in the trough...

A new consortium involving the Alcohol Health Alliance has been awarded £5.9 million funding from the UK Prevention Research Partnership, a group of twelve funders including charities, research councils and government. 

The SPECTRUM Consortium (Shaping Public hEalth poliCies To Reduce IneqUalities and harM) is one of four consortia successful in the inaugural round of UKPRP funding. SPECTRUM builds on and expands the work of the UK Centre for Tobacco and Alcohol Studies, one of the AHA members.

SPECTRUM’s focus will be on the commercial determinants of health and health inequalities, considering alcohol, tobacco and unhealthy food. Commercial determinants are strategies and approaches used by commercial companies to promote products and choices that are detrimental to health.

SPECTRUM brings together the AHA as well as the Obesity Health Alliance, Smokefree Action Coalition and other alliances...

This is a scandalous use of taxpayers' money. At least UKCTAS has the decency to pretend to be a serious research organisation. These groups don't even pretend. The Alcohol Health Alliance is a political lobby group, plain and simple. So is the Obesity Health Alliance. So is the Smokefree Action Coalition. They exist solely to campaign for policy changes and make no bones about it, so why hell is the Economic and Social Research Council giving them our money? 

These are the financial arrangements of a failed state. While 'public health' groups complain about (modest) cuts to the 'public health' budget, there seems to be a bottomless trough of money for a small clique of activists to give to their mates.

Earlier this week, I wrote about the £635,000 of public money that has so far been given to the pressure group Obesity Action Scotland. Last year we discovered that the National Institute for Health Research had given £1.5 million to a handful of blatantly partisan academics to evaluate the sugar levy, including Martin White who just happens to be the Director of the National Institute for Health Research's Programme Advisory Board.

The cronyism is becoming increasingly blatant, with the same people appearing again and again with their fingers in ever more pies. Anna Gilmore, for example, was a board member of Action on Smoking and Health before joining UKCTAS and becoming the director of the Tobacco Control Research Group. She sat on the Steering Committee and Programme Board of Smokefree Southwest during which time Smokefree Southwest granted £135,000 to Gilmore’s Tobacco Control Research Group, and NHS Southwest gave the Tobacco Control Research Group £165,284 for ‘research and evaluation support’ for Smokefree Southwest. She is now on the board of Spectrum which, in turn, is funding UKCTAS.

Taxpayer funding for overt lobby groups such as the Obesity Health Alliance is the final insult. It is now seven years since Eric Pickles called on local government to "cease funding ‘sock puppets’ and ‘fake charities’". Pickles is gone but the sockpuppetry continues. The only thing that has changed is that they cannot get their cash direct from government departments and have to launder it through organisations like Public Health England, the National Institute for Health Research and the Economic and Social Research Council, as well as through newly created organisations like the £5 million Obesity Policy Research Unit - and now SPECTRUM.

Whatever your view of alcohol, tobacco and food policy, this is a racket.


UPDATE

Linda Bauld has been in touch with some good news. She assures me that the alliances that are involved with SPECTRUM will not be seeing any of its money.

She writes:

'Just to clarify - the funders are led by the Medical Research Council, not the ESRC. There are 12 funders involved (research councils, charities, government). The alliances like AHA etc are not receiving any funding - in fact in contrast they are contributing staff time in kind, as is PHE, Health Scotland, Public Health Wales and the two small companies involved. The funding is for academic staff time (primarily post docs etc) and data costs like extending the Smoking and Alcohol Toolkits that UCL runs to Wales and Scotland.'

UKPRP's core funders are: British Heart Foundation, Economic & Social Research Council, Engineering and Physical Sciences Research Council, National Institute of Health Research and the health departments, Medical Research Council, The Wellcome Trust.

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