Tag Archives: Professor John Britton

Four Professors and a Counterfactual

All the fun of the fumes

The long-windedly titled The National Centre for Smoking Cessation and Training (NCSCT) recently produced a video called E-cigarettes safety: The facts explained.

The trouble is that there are precious few facts available at the moment; but there are plenty of opinions.

The film features four Professors who are well known e-cigarette enthusiasts and a layman, Clive Bates, Director of Counterfactual Consulting, whatever that is.

The OED, interestingly, defines counterfactual as ‘Pertaining to or expressing what has not happened or is not the case’ which perhaps explains Mr Bates’s view as stated in the film.

First let’s hear from Professor Linda Bauld, a behavioural scientist, no less:

We know from studies that nicotine is relatively safe.

What studies? What does she mean ‘relatively safe’?

Next we have Professor Robert West, a psychiatrist:

They (e-cigarettes) don’t use tobacco at all.

This is almost true, except that the nicotine in e-cigarettes is derived from tobacco.

Then Ann McNeill, Professor of Tobacco Addiction, explains:

Most things we do in life carry a risk. So, for example driving cars. Cars cause lots of road accidents, lots of people killed on the roads. But we don’t stop people driving. We try to make them (cars) less harmful.

This is a false analogy. Driving is a normal and essential human activity whereas smoking and vaping are not normal activities; they are undertaken only by drug (nicotine) addicts.

Finally we have Professor John Britton, an epidemiologist:

If we try to put a figure on the relative risk of e-cigarettes compared to smoking, my view is that it’s going to be well under 5 per cent of the risk…so we can be confident that electronic cigarettes are much less hazardous than tobacco cigarettes.

His view? How can we be confident? Just because he says so?

Then he makes a curious statement:

Where their safety lies relative to not using anything is much harder to place.

This is nonsense. Obviously there is no risk at all in not using anything, compared to using  cigarettes or e-cigarettes.

He does at least say something sensible – up to a point anyway:

Inhaling a vapour many times a day for decades is unlikely to come without some sort of adverse effect…It would be better avoided, but from the smoker’s perspective it is a far better bet than carrying on smoking tobacco.

A bet? So it’s all a matter of chance? He doesn’t seem to know what his point of view is.

Back to Professor West:

E-cigarettes are substantially less harmful than cigarettes and the reason that we can reasonably infer this is because of the concentration of chemicals that are in e-cigarette vapour compared with the chemicals that are in cigarette smoke.

So he goes from asserting that e-cigarettes are substantially less harmful than ordinary cigarettes to saying that it’s something we can only reasonably infer.

Professor McNeill again:

Flavourings are necessary for electronic cigarettes because people wouldn’t use them if they didn’t have some sort of flavours added. We need to entice smokers to use electronic cigarettes.

Does she realise what she is saying? How about enticing smokers to stop smoking and stop using nicotine in any form?

Professor West:

Some concerns have been raised about…the risks [of] flavourings in e-cigarette vapour…these are flavourings that have been tested and the concentrations are sufficiently low that we wouldn’t expect them to pose a significant health risk.

More opinion, supposition and guesswork. What if his expectations are wrong?

Professor Britton:

The propylene glycol…in electronic cigarette fluid…is used to make theatre fog, it is mildly irritant to the airways but is doesn’t seem to have any lasting long-term effects.

More guesswork. For how long and how often are people exposed to theatre fog? When did you last attend a theatre when there was fog?

He adds:

Glycerol [also present in e-cigarette vapour], likewise, is widely used in food. And again there’s no evidence or reason to expect it will have a significant long term effect on the airway.

Yes, it’s eaten in foods, but this is a different matter entirely from it being inhaled into the lungs!

And continues:

There is evidence that if you [are in a] room with somebody using one of these products (e-cigarettes) that there is nicotine and perhaps other chemicals in the atmosphere around you but at tiny levels. Levels not to be concerned by at all.

How does he know? What is the evidence? I would be concerned about unnecessary eposure to any levels of poisons.

Then he says:

I think if you’re in an enclosed space and somebody’s breathing out clouds of vapour that’s just unpleasant and it’s intrusive and it’s discourteous.

Quite.

Professor McNeill has an extensive list of publications to her name but has she actually treated any smokers? One wonders, when she makes statements like this:

The most effective way of quitting is to use a medication such as nicotine replacement therapy or it could be electronic cigarettes combined with behavioural support.

What does she mean ‘the most effective way of quitting’. Smokers who quit without medication or e-cigarettes combined with behavioural support haven’t done it effectively?

Professor West again:

E-cigarettes [are] there for people who…just want to go out to a shop and buy a product which they can use to stop smoking without seeing a health professional.

Why do you need a ‘product’ to stop smoking? Why not just stop?

And what does our counterfactual consultant have to say?

E-cigarettes [are] an alternative to smoking.

You don’t need an alternative to smoking!

Professor Britton:

E-cigarettes…normalise electronic cigarette use.

That’s the trouble!

And if we could normalise electronic cigarette use for the nearly nine million people in the United Kingdom who are still addicted to tobacco that could only be good thing.

A good thing for whom?

This is a product that can transform health…health-wise [smokers] achieve pretty much what they’d achieve if they quit smoking completely.

A huge assumption.

Do we really want to have millions of people sucking on e-cigarette drug delivery devices many times every day for years on end to gratify their nicotine addiction?

Text © Gabriel Symonds

E-cigarettes: a Public Health Disaster Waiting to Happen?

Heavy smog in Piccadilly Circus, London, December 1952. (Photo by Central Press/Hulton Archive/Getty Images)

Heavy smog in Piccadilly Circus, London, December 1952. (Photo by Central Press/Hulton Archive/Getty Images)

Do you know what a ‘pea-souper’ is? You don’t really want to know, at least not at first-hand. It was the humorous name given to an decidedly unfunny atmospheric condition, not uncommon in the winter months in London in the nineteenth century and up to the 1950s, when a combination of smoke and fog (‘smog’), reduced visibility sometimes to the distance of your hand on your outstretched arm in front of your face. The smoke came from burning coal to heat buildings. Many deaths were attributed to smog.

If you lived in London in those days you had no choice in the air you breathed. Of course, no one would normally choose to breath polluted air, unless, that is, you’re a smoker – or a ‘vaper’ which, as everyone knows, means a person who ‘uses’ e-cigarettes.

Inhaling the smoke from burning tobacco doesn’t sound like a good idea, but if you feel you have to do it, or something similar to get the equivalent effect, then vaping seems to be the answer – at least according to a certain nutty professor who, in concert with other researchers, has declared that e-cigarettes are, by a nice round figure of 95%, safer than smoking conventional cancer sticks. Incidentally, Professor David Nutt also thinks hallucinogenic drugs are good for treating depression.

And now comes news that scientists at the prestigious Karolinska Institute in Stockholm have discovered that vaping can raise blood pressure and start the process of hardening of the arteries leading to heart disease. They also found that the food additives used to flavour the fumes – fine when eaten – don’t do you any good when inhaled into your lungs. On top of all that, they concluded, hardly surprisingly, that using e-cigarettes is not a particularly effective way to stop smoking.

The Swedish researchers made a further interesting observation about e-cigarettes: the average user takes 230 puffs a day or 84,000 puffs in a year. This means, if we assume one sleeps for eight hours and spends two hours a day eating, there are fourteen hours or 840 minutes available for vaping. At 230 puffs per day, the vaper will suck the fumes from the e-cigarette device into his or her lungs on average every 3.7 minutes. And this is supposed to be 95% safer than smoking? I predict it could be a public health disaster waiting to happen.

There are other voices of caution about e-cigarettes, apart from mine, such as that of Professor Martin McKee of the London School of Hygiene and Tropical Medicine. He is concerned about the health risks of e-cigarettes in the long term and wants to regulate them ‘as much as possible’. Does he perhaps mean regulating them out of existence? He is also worried about nicotine itself:

For a start, nicotine is more dangerous than previously thought. It negatively affects the developing brain, helps cancer spread by encouraging the growth of blood vessels around tumours, and increases the risk of dangerous heart rhythms in those who have just had a heart attack.

These eminently sensible comments, however, do not do much to dampen the enthusiasm of some proponents of e-cigarettes such as Professor John Britton of the University of Nottingham, who has a foot in both camps:

We should not let studies rightly highlighting the potential dangers of e-cigarettes blind us to the fact that these devices are much, much safer than smoking tobacco.

For a smoker, moving to e-cigarettes brings a huge health benefit. The decision should be a no-brainer. When you smoke a cigarette you inhale not only nicotine but also more than 4,000 highly toxic chemicals, including carcinogens. And you inhale many of them in fairly high concentrations. So there’s nothing better you can do for your health than to quit smoking. Let’s be clear: e-cigarettes are not harmless and we shouldn’t be complacent. E-cigarette vapour contains toxic chemicals, and tiny particles that can harm lungs and blood vessels. But in terms of the harm they cause, they simply aren’t in the same league as smoked tobacco.

Further, we should not get carried away by the claimed success of e-cigarettes in helping 18,000 people in the UK to quit smoking in 2015, according to research by University College London and Cancer Research UK.

Since there are currently 9,600,000 adult smokers in the UK this reduction in the total number is trivial. Instead of it being presented as a point in favour of e-cigarettes it should be a wake-up call to re-think the whole smoking problem.

Professor Britton again:

Each cigarette, and especially the first of the day, restores normality and feels good – in much the same way as it feels good when someone stops twisting your arm. Most smokers smoke to feel normal. Half die as a consequence.

Too true. But non-smokers don’t have this problem: they are in a normal state and feel good (other things being equal) without nicotine.

You don’t need to smoke to feel normal. You just need to stop smoking!

Text © Gabriel Symonds