Tag Archives: Professor Linda Bauld

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

He who sups with Philip Morris should have a long spoon!

The words that came to me as I read this piece in today’s Financial Times were disingenuous, self-serving, cynical and the like.

Philip Morris International has pledged up to $1bn over the next 12 years to an arm’s-length foundation that will fund scientific research designed to eliminate the use of smoked tobacco around the globe.

[Philp Morris]…last week registered the Foundation for a Smoke-Free World as a US charitable organisation, with the stated aim of making grants on ‘how to best achieve a smoke-free world and advance the field of tobacco harm reduction’.

How generous of them! That’s what we need – scientific research (of course they wouldn’t do unscientific research, would they) to eliminate the use of smoked tobacco! And what a noble cause: to ‘advance the field of tobacco harm reduction’!

Then we have the two-faced André Calantzopoulos, chief executive of Philip Morris Ineternational, telling the Financial Times (emphasis added of weasel words and clichés):

Our efforts are squarely focused on ultimately replacing cigarettes with smoke-free products, by offering the millions of men and women who continue to smoke a better alternative. We are standing at the cusp of a true revolution and look forward to the foundation’s objective review of our efforts and efforts of others.

Allow me to re-write this in plain English, saying what I think he really means:

For the millions of people who are addicted to the nicotine in our cigarettes and who therefore find they are unable to quit, we offer an alternative, iQOS, which may (or may not) be a safer way of inhaling tobacco fumes. If everyone were eventually to switch from cigarettes to iQOS our profits would be sustained or may even increase and into the bargain we can present ourselves as a public health champion! (The $1bn is, of course, a drop in the ocean for us.)

Well, I can tell them exactly what they need to do to achieve a smoke-free world and advance the field of tobacco harm reduction – and I won’t charge anything like $1bn for my services. In fact I’ll advise them for free. This is what they need to do, and should do in a much shorter time span than the next twelve years: stop making cigarettes. That will achieve, as least as far as Philip Morris are concerned, the first aim of eliminating the use of smoked tobacco. As for the second aim, that of advancing the field, as they put it, my suggestion will go a long way to achieving that too.

But, of course, what they really want to do, while they keeping merrily on making and selling ordinary cancer sticks, is to plug for all they’re worth their new product with the unpronounceable name of iQOS. For those of my readers who are unfamiliar with what this is, here is a picture of an advertising placard for it, conveniently placed at a child’s eye level in my local branch of Seven-Eleven.

iQOS (or should that be iQOSs?) look like little cigarettes. They are made of tobacco which is heated (not burnt), with the resultant poisonous fumes being inhaled into the lungs. Philip Morris claims this is potentially less harmful than inhaling cigarette smoke – so that’s all right then. And, Bingo! – the field of tobacco harm reduction is advanced!

The misleadingly named Foundation for a Smoke-free World is curiously described as ‘arm’s length’, by which I suppose mean independent. But will it be?

Our old friend Professor Linda Bauld (http://nicotinemonkey.com/?p=1823), however misguided her views on the use of e-cigarettes in pregnancy may be, at least strikes a note of scepticism about this set-up:

I’m very cautiousI’d prefer research completely independent from industry.

Quite right.

Why do I say the Foundation is misleadingly named? Because what they envisage is a world where, even if smoking disappears, millions of people will still continue in the thrall of nicotine addiction.

Text and photo © Gabriel Symonds

Stigmatization and the Corner Shop

When I used to work in obstetrics (care of pregnant women) certain routine tests were carried out at each attendance, such as checking the urine and measuring the blood pressure. The reason was that these tests can give early warning of serious problems such as diabetes and high blood pressure, and then the appropriate action could be taken.

Of course, medical practice doesn’t stand still; sometimes new tests are added and old ones discarded. The latest development in obstetrics, in Britain at any rate, is that at the first and possibly subsequent ante-natal appointments, as part of the routine, a woman should now expect to be breathalysed (unless she opts out) for carbon monoxide (CO). This is to detect pregnant women who smoke and may try to conceal the fact.

What if the test is positive? Assuming the machine is accurate it could be due to a faulty boiler at home or living near a main road, but the most common reason is, of course, smoking. So what is the midwife supposed to say? ‘You naughty girl, you’re a smoker aren’t you? I know you are, the machine proves it! Well, don’t worry, we’ll refer you to your friendly local stop smoking service and they’ll help you to be cured of your nicotine addiction by using a nice nicotine patch or delicious nicotine chewing gum, even though they won’t work very well, instead of smoking those horrid ciggies!’

In the past, if I came across a pregnant woman in my clinic who smoked, I would tell her plainly though politely, that she had to stop smoking today because otherwise she would harm her baby. Paternalistic? Yes. Authoritarian? Yes. Did it work? I hope so.

These days it seems paternalism and authoritarianism are politically incorrect, and instead so-called nicotine replacement therapy is offered. Is it safe in pregnancy? At present there is no evidence that it isn’t safe, which is not the same thing as saying there is evidence that it is safe. And if pregnant women are not wild about using nicotine patches or gum, what about e-cigarettes? Again, although there is widespread belief that these are safer than smoking, there is so far no evidence that this is so.

Now, a professor of health policy at the University of Stirling in Scotland, Linda Bauld, who is also the deputy director of the UK Centre for Tobacco and Alcohol Studies, is quite enthusiastic for pregnant women, if they can’t or won’t stop smoking, to switch to nicotine replacement therapy or to e-cigarettes. Nonetheless, in a recent video talk she rightly sounded a note of caution: ‘What do we know about vaping in pregnancy? Very little, at the moment.’

With her impeccable credentials – although it’s unlikely she has personally treated a single smoker – you would think she would know a thing or two about smoking, but a tiny doubt arose in my mind when, in the same video, she said this:

Pregnant women universally, despite the fact that they find smoking beneficial and enjoyable perhaps before they’re pregnant and still smoke to cope, experience a significant degree of stigma [because others disapprove of their smoking]…we think women [in pregnancy] should be supported to vape if they find it difficult to stop smoking…

It’s regrettable that the bearers of the next generation should be stigmatised in any way, but would Professor Bauld be so good as to tell us why she thinks pregnant women find smoking beneficial, what exactly is enjoyable about smoking for them, and how and with what does smoking enable them to cope? Further, Professor Bauld is evidently unaware that all smokers find it difficult to stop – that’s why they smoke.

If the reason smokers, pregnant or otherwise, smoke is so profoundly misunderstood, what hope is there for getting them to stop? And why should she refer approvingly, as she does, to the new regimen of routine CO breath tests in ante-natal clinics? Does she think that shaming pregnant women who smoke by presenting them with their CO read-outs is the way to reduce their universal stigmatization?

Unless the real reason for smoking is recognised and confronted, the present ineffective and little-liked proffering of medicinal nicotine products and, as Professor Bauld hopes in the near future, prescribing e-cigarettes, will allow the present scandalous situation to continue where any pregnant woman is free to smoke as much as she likes or feels compelled to do.

In her enthusiasm for vaping, Professor Bauld even jumps into the controversy over e-cigarette users having their life insurance premiums loaded in the same way as smokers.

In response to a piece in the online Sunday Post (6 August 2017) that complained that ‘Insurance companies are still hitting e-cigarette users with a “smoker’s surcharge” despite…reports which claim vaping is far less dangerous than using tobacco’, she said ‘Insurers classing people who use e-cigarettes as being the same as smokers is “fundamentally wrong” [and] it is just not fair.’ She added:

As well as being financially punitive to people who vape, it can also send negative messages to those who want to stop smoking…If vapers are regarded as being the same as tobacco smokers it could lead to an attitude of ‘why bother’ and before you know it they are back at the corner shop buying cigarettes.

Here we have it again: the lack of understanding of why smokers smoke and vapers vape. She apparently thinks vapers only vape because they may find some financial advantage in doing so, but if they’re going to be treated in such an unfair way by their insurance companies there’s no point! Why should I stop smoking – that beneficial and enjoyable activity that helps me to cope! – for the sake of my health if I’m going to be hit with extra charges for doing so? I’ll show them! Back to the corner shop!

Even if e-cigarettes are eventually proven to be safer than smoking, in the meantime I can’t say I blame the insurers for loading the premiums of people who suck poison into their lungs all day.

But there’s a win-win situation for would-be non-smokers and all who have switched to e-cigarettes as a less harmful way, they hope, of continuing their nicotine addiction: stop smoking and all use of nicotine products.

The gimmick-free way to do this is easier than you might think.

Text © Gabriel Symonds