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** 19 August 2021
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** UK
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** Philip Morris tightens grip on Vectura (#1)
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** Four ICSs and four trusts placed in new 'special measures' regime (#2)
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** Opinion: Scottish Government must understand complex reasons behind rise in alcohol-related deaths (#3)
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** International
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** Government funders 'suppressing health research', says study (#4)
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** Smoking exposure during childhood may increase risk of rheumatoid arthritis, finds study (#5)
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** Mexico: iconic Mexico City street declared smokefree (#6)
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** UK
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** Philip Morris International (PMI) is closing in on the acquisition of Vectura after it bought more than a fifth of the company’s shares. PMI said that it had acquired 135.5 million shares at 165p per share, representing about 22.6% of Vectura’s share capital, and was seeking to make further purchases.

PMI issued its offer document to Vectura shareholders on Monday 16th August and said that its offer would remain open for acceptances until September 15th. It has engaged DF King, a proxy solicitation firm, to help engage shareholders and is being advised by Bank of America Merrill Lynch.

PMI needs only the support of a majority of shareholders to take control of Vectura having switched its offer from a scheme of arrangement to a formal takeover. However, more than 65% shareholder support would allow PMI to delist Vectura from the London Stock Exchange and more than 90% support would enable it to ‘’squeeze out’’ the remaining minority shareholders to take full ownership.

Among Vectura’s top 20 investors, Samson Rock, Columbia Threadneedle, and Ostrum Asset Management have already sold their shares to PMI. Other major US shareholders including Brown Capital and Vanguard are expected to side with PMI. However, there is a growing unease among City fund managers about the ethics of the deal, and PMI cannot count on AXA Investment Management, Berry Street Capital and TIG Advisors, who backed the previous Carlyle offer.

One fund manager said: “This deal is making a lot of us uncomfortable. It has triggered big internal debates. Our job is not always the maximisation of profit but the optimisation.”

Source: The Times, 18 August 2021

See also: Mail on Sunday - Malboro maker tightens grip on inhaler firm Vectura as it snaps up a 22.6% stake ([link removed])
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** Four Integrated Care Systems (ICS) and four acute trusts have been put into NHS England’s replacement for the special measures regime, even though ICSs have yet to be given statutory footing. The four ICSs, Devon, Lincolnshire, Norfolk & Waveney, and Shropshire, Telford & Wrekin, have been classed as requiring “intensive mandated support” in the new “recovery support programme”.

NHSE will now subject the four systems to strict control measures, including the ability to enforce changes to the ICS board and executive team and appointing an improvement director. It can also bring in an external third party to provide intensive support and there are stringent approval processes over finances and decision making.

The new support regime was introduced this March, to place trusts, clinical commissioning groups, and ICSs into one of four categories, the fourth of which replaces the special measures regime. The segmentation considers NHSE’s previous ratings on financial performance as well as Care Quality Commission’s quality ratings.

HSJ understands the other 38 ICSs have been placed into the other support categories, the third of which involves some mandated support. Sixteen NHS trusts have also been placed in segment four of the programme, 12 of which were already subject to the old special measures regimes. NHSE said it does not publish the full segmentation details.

Source: HSJ, 18 August 2021
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** Ian Hamilton, Senior Lecturer in Addiction and Mental Health at the University of York writes that the Scottish Government must recognise the complex and multifaceted reasons for the rise in alcohol-related deaths this year if it is to address the problem.

Data released by the National Records of Scotland yesterday (18th August) revealed that deaths due to alcohol rose by 17% in the last year, with 1,190 people in Scotland losing their lives. This is the highest recorded number in over a decade.

Hamilton argues that existing inequalities are a key factor in alcohol misuse and death. Twice as many men as women die due to drinking whilst those in the most deprived areas are four times more likely to die from alcohol than those in the most affluent areas. Moreover, Hamilton notes that there are often a confluence of addictions. Most of those who have alcohol recorded on their death certificate will also be smokers and most of those who die of heroin will have regularly used alcohol and tobacco.

Hamilton says that factors such as trauma, poverty, lacking hope, and having a pre-existing psychological problem, each related to structural inequalities, are key causes for alcohol-related deaths. He says that these factors were amplified during the pandemic and that the pandemic exacerbated the risk for the already vulnerable, rather than generating new risks for new groups.

Hamilton argues that politicians across the UK are failing to grasp the role that structural inequality plays in this issue. Unless there is a serious attempt to narrow the wealth gap, Hamilton says that alcohol will continue to be the medicine of choice for some people, leading to even higher numbers of alcohol related deaths being recorded in the future.

Source: The Independent, 18 August 2021

See also: National Records of Scotland - Alcohol-specific deaths in Scotland increase ([link removed])
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** International
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** A new study has suggested that one in five public health researchers around the world have come under pressure from government funders to change or conceal the results of their studies. The study, conducted at Australia’s University of Newcastle and published in Plos One on 18th August, involved more than 100 authors of papers reporting trials of nutrition, sexual health, smoking, and substance use interventions conducted around the world between 2007 and 2016.

It found that one in 10 public health researchers said that funders had discouraged the publication of their findings and a similar proportion reported attempts to alter their research conclusions. One in 14 respondents had been pressured to delay the publication of their results until a “more favourable” time like after an election.

Five percent of respondents said funders has asked them not to publish findings at all whilst the same proportion reported requests not to present their results to certain groups. Six percent said that their backers had demanded changes to study methods or analyses and 6% said that funders had attempted to discredit study team members. Overall, 18% of authors reported at least one form of funder intervention but the paper said that this was probably an underestimate given that the research methodology did not allow access to authors whose work had been completely buried.

Lead author Sam McCrabb said that the most surprising takeaway was that it was government rather than industry funded research that was most liable to funder interventions. “We thought it would be more industry-funded researchers who would report these kinds of things. It may be that they [experienced] different kinds of suppression that we weren’t asking [about],” she said.

Source: Times Higher Education, 19 August 2021

See also: Plos One - “He who pays the piper calls the tune”: Researcher experiences of funder suppression of health behaviour intervention trial findings ([link removed])
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** A new study published by researchers from Brigham and Women’s Hospital in the USA has found a potential link between exposure to parental smoking during childhood and increased risk of seropositive rheumatoid arthritis (RA) later in life. Parental smoking during childhood was found in the study to increase the risk of RA by 75%.

The findings were published in the journal Arthritis & Rheumatology and involved longitudinal data from between 1989 and 2017 from 90,923 women. Passive exposure to smoke was broken down into three categories including maternal smoking during pregnancy, parental smoking during childhood, and years lived with smokers since age 18.

The study found that the risk of developing RA increased in participants who themselves became active smokers. However, maternal smoking during pregnancy and years lived with smokers beyond age 18 showed no significant association with risk of developing RA. The study was limited by the absence of men and the research team intends to continue with more studies also encompassing men.

Source: Medical Xpress, 18 August 2021

See also: Arthritis & Rheumatology - Passive Smoking Throughout the Life Course and the Risk of Incident Rheumatoid Arthritis in Adulthood Among Women ([link removed])
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** Smoking has been banned on one of Mexico City’s most iconic streets, Madero Street in the historic centre. The city’s Historic Center Authority has installed no-smoking signage along the length of the street. During the first month of implementation, smokers will be asked to put out their cigarettes and will not face fines if they comply. From mid- September, however, anyone smoking on the street will face fines of 896 to 2688 pesos (£32 to £97) or mandatory community service.

Source: Mexico News Daily, 18 August 2021
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