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** 9 November 2021
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** UK
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** Vaping saves lives — we’re right to promote it (#1)
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** McManus and Fell in a contest to be ADPH president (#2)
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** 50,000 illegal cigarettes seized in North East Lincolnshire (#3)
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** International
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** US study suggests potential link between e-cigarette use and stroke risk during middle age (#4)
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** Tobacco plain packaging momentum continues worldwide, with 38 countries and territories moving forward with regulations (#5)
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** US: PMI meets with FDA to make its case for IQOS in patent dispute (#6)
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** UK
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**
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** The Times has published a series of letters responding to a recent article ‘Vape nation: how did Britain end up so hooked on e-cigarettes?’ ([link removed]) which described England as an “outlier in promoting vaping as a safe alternative to smoking.” This article focused on the recent announcement from the Medicines and Healthcare products Regulatory Agency (MHRA) that they have invited e-cigarette manufacturers to submit their products for approval to be offered on prescription via the NHS in England.

John Britton, emeritus professor of epidemiology, Nottingham University, argues that the evidence around e-cigarettes supports their use as a cessation product. “Use of e-cigarettes in the UK is almost exclusive to smokers trying to quit smoking; Their efficacy in this role is confirmed by authoritative Cochrane and National Institute for Health and Care Excellence evidence reviews; and despite (or perhaps because) of vaping, smoking among young people is at an all-time low.” He concludes by saying although “vaping is not safe but is safer than smoking and helps smokers to quit. UK policy is right.”

Matthew Martin, a former smoker, said, “I switched to vaping about three years ago and haven’t had a cigarette since — nor do I want one. Vaping is obviously safer than smoking, and for people addicted to cigarettes I can understand why it has been suggested that the NHS should prescribe a starter kit. It’s a good idea.”

Deborah Arnott, chief executive of Action on Smoking and Health (ASH), states that “England is not an outlier on vaping: it is a frontrunner. Smoking is a public health disaster, estimated to have killed more people last year than COVID-19. Although we all know it is lethal and taxes are high, nearly six million people still smoke in England. Why? Because this is not a lifestyle choice but an addiction.

“That’s why smokers using nicotine replacement therapy to help them quit much more likely to succeed. E-cigarettes are a novel form of this, but around twice as effective as those that already have medicinal licences.

“A third of smokers incorrectly believe that vaping is as harmful as smoking, and a similar proportion has never tried vaping. These are the smokers who could be reassured by an e-cigarette that has a medicinal licence and that their doctor can prescribe for them.

“Your article is wrong to say e-cigarettes are the heart of England’s public health strategy. But they are a necessary additional tool in the toolbox.”

Source: The Times, 7 November 2021
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** The current interim president of the Association of Directors of Public Health, Jim McManus, is running against the organisation’s honorary secretary Greg Fell in an election to decide who will become its next president.

Jim McManus became interim president last month when the previous president Jeanelle de Gruchy was appointed deputy chief medical officer, responsible for jointly leading the new Office for Health Improvement & Disparities (OHID). Mr McManus is the public health director of Hertfordshire CC. He led ADPH policy work on local outbreak plans and COVID-19 suppression and was previously ADPH’s vice president.

Greg Fell hit the public spotlight during the coronavirus pandemic in his role as Sheffield City Council’s director of public health. Before joining Sheffield in 2016, he worked as a consultant in public health in Bradford in the city’s primary care trust, then Bradford City MDC. He is a biochemistry and physiology graduate who has also worked as a social researcher in a maternity unit, health promotion, and other public health roles. Whoever wins the vote will hold the presidency for the next three years. The results are expected to be announced later this week.

Source: LGC, 8 November 2021
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** North East Lincolnshire Council has seized more than 50,000 illegal cigarettes and nearly 30kg of illicit tobacco in the first six months of the year. The clampdown is part of Operation CeCe, a joint initiative between National Trading Standards and HMRC.

Nationally, more than five million illicit cigarettes have been seized, and over 1,700kg of illegal tobacco removed from the streets. In North East Lincolnshire, 54,640 (2,732 packets) of illegal cigarettes have been seized as well as 29.8kilos (596 x 50g pouches) of hand-rolling tobacco.

Wendy Martin, Director, National Trading Standards, said: “Operation CeCe seeks to protect local communities from the harm that the illegal tobacco trade brings.

“Beyond the significant effects of tobacco on people's health, the illicit tobacco trade is often part of other criminal activity including drug smuggling, people-trafficking and illegal alcohol and DVD production.

“This operation marks the first collaboration between National Trading Standards and HMRC, and I am delighted that the first six months have been hugely successful in removing a significant amount of illegal tobacco products off our streets and disrupting this illicit trade.”

Source: Grismby Live, 8 November 2021
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** International
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**

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** E-cigarette users may be more likely to suffer a stroke in middle-age than traditional smokers, research suggests. Academics in New York — who tracked almost 80,000 Americans — found smokers were up to six times more likely to suffer a stroke than vapers. The researchers examined data from a national survey of 79,825 adults with a history of stroke, and checked patient records to establish who used cigarettes, e-cigarettes, or both.

Results showed smokers were most likely to suffer a stroke (6.75%), followed by those who both vaped and smoked (3.72%) and those who vaped (1.09%). The researchers also found that although stroke was more prevalent among cigarette smokers, e-cigarette users had a 15% higher risk of having a stroke at a younger age. The academics did not define which ages specifically.

There was no placebo group in the study, meaning the scientists could not establish whether vapers were more or less likely to suffer strokes than the general population. There was also no data on the type and severity of strokes suffered, and on whether participants had other conditions such as high blood pressure that made the condition more likely.

Scientists not involved in the study pointed out the study did not consider whether people who vaped beforehand had been smokers previously. Dr Leonie Brose, a smoking expert at King’s College London who was not involved in the research, said: “The survey they used is a cross-sectional survey. This means respondents had a stroke in the past (maybe years before they completed the survey) and were using e-cigarettes or smoking at the time of the survey. At least some of the strokes would therefore have occurred before e-cigarette use. The strokes then could not have been caused or made more likely by e-cigarettes.”

Emeritus Professor John Britton, an epidemiologist at Nottingham University, pointed out that smokers overall were much more likely to suffer a stroke than vapers. He added it had the “potential to tackle the stark disparities in smoking rates across the country, helping people stop smoking wherever they live and whatever their background.”

Source: Daily Mail, 8 November 2021
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** See also: American Heart Association Scientific Sessions 2021 presentation 209 ([link removed])
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**
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** An international report released by the Canadian Cancer Society (CCS) shows tremendous momentum worldwide for tobacco plain packaging. There are now 38 countries and territories moving forward with plain packaging, with 21 adopting the measure, 3 having it in practice, and 14 working on it.

The CCS report documents global progress on plain packaging, ranks 206 countries and territories on the size of their health warnings on cigarette packages and lists countries and territories that now require graphic picture warnings. The report found that 134 countries and territories now require picture health warnings on cigarette packages, increasing from 117 in 2018. This represents 70% of the world's population. Canada was the first country to require picture health warnings in 2001.

The report supports the implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). The FCTC has an obligation for parties to require health warnings that “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” and maybe in the form of or include picture warnings. There are now 182 parties to the FCTC.

Source: Yahoo News, 9 November 2021

See also: Canadian Cancer Society - CIGARETTE PACKAGE HEALTH WARNINGS ([link removed])
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** Philip Morris International (PMI) met with the US Food and Drug Administration (FDA) on Friday (5th November) to present its argument for why the tobacco giant and Altria should be allowed to import and sell IQOS devices in the US.

The meeting with regulators is the latest development in a patent dispute with rival R.J. Reynolds, a subsidiary of British American Tobacco. The International Trade Commission (ITC) ruled that the IQOS device infringed on two of Reynolds’ patents in late September.

The Biden administration is conducting a 60-day administrative review until 29th November to decide if the sale and import of the cigarette alternative will be banned.
The US Trade Representative will make a recommendation to President Joe Biden after listening to input from several agencies, including the FDA, which regulates tobacco products.

If the administration sides with R.J. Reynolds in the dispute, IQOS could be off US shelves for months as it waits for a decision on a separate claim from Reynolds with the US Patent and Trademark Office. In the worst-case scenario for Altria and Philip Morris, the two companies would have to go back to the drawing board, moving production to the US or changing up the design enough to avoid patent infringement claims.

Source: CNBC, 8 November 2021
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ASH Daily News is a digest of published news on smoking-related topics. ASH is not responsible for the content of external websites. ASH does not necessarily endorse the material contained in this bulletin.

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