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** 13 April 2022
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** UK
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** Systems push back on NHS England’s ‘financial break even’ ask (#1)
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** International
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** Study suggests genetics could explain why some lifelong smokers don't develop lung cancer (#2)
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** FDA bans Imperial Brands’ myblu vapes in US (#3)
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** Vapers in Ireland think flavour ban would create a black market, survey shows (#4)
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** UK
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** Multiple health systems are pushing back on their financial targets for 2022-23 and seeking to negotiate more ‘realistic’ plans after being told by NHS England (NHSE) to break even this year. According to the Health Service Journal (HSJ), several Integrated Care Systems (ICSs) have warned NHSE in recent weeks that they face deficits of more than £100m, even after factoring in challenging efficiency plans.
Richard Murray, chief executive of The King’s Fund think tank, said all ICSs breaking even was not going to happen: “I look at the succession of detailed financial plans [requiring all trusts or systems to break even] we’ve had since 2015, not one of them has come within a country mile of being met. One of the problems that we’ve had over recent years is the belief you can performance manage away reality. And you can’t, just shouting even louder doesn’t make anybody more able to do it.”
The NHS faces a challenging financial outlook in 2022-23, as the extra funding it received for the pandemic is withdrawn. The draft guidance issued by NHSE said ICSs would be expected to balance budgets within their system, as financial planning moves from individual trusts to a system level. Systems have submitted initial drafts of their financial plans to NHSE, with final versions expected in late April.
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Source: Health Service Journal, 12 April 2022
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** International
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** While smoking is overwhelmingly the main cause of lung cancer, a new study may shed some light on why not all lifelong smokers develop the disease. The study, published in Nature Genetics, suggests that some smokers may have more robust mechanisms that limit cell mutations causing lung cancer. The study authors, based at Albert Einstein College of Medicine in New York, say the findings could help identify smokers who face the greatest risk for the disease and therefore require even closer monitoring.
Smoking is believed to cause lung cancer by triggering DNA mutations in normal lung cells. This study adds reliable weight to this theory via an improved method for sequencing entire genomes for cells and more accurately identifying cell mutations. The study used this new sequencing method to compare the mutations in normal lung cells from two groups: 14 non-smokers aged 11 to 86 and 19 smokers aged 44 to 81, who had smoked a maximum of 116 pack years (1 pack year = 1 pack of cigarettes smoked per day for 1 year).
Significantly more mutations were found in the lung cells of the smokers, accumulating as they aged. "This experimentally confirms that smoking increases lung cancer risk by increasing the frequency of mutations, as previously hypothesised [...] This is likely one reason why so few non-smokers get lung cancer, while 10% to 20% of lifelong smokers do" Dr Spivak, one of the study authors, said. The study also found that the number of cell mutations detected in lung cells increased with the number of pack years of smoking, increasing the risk for lung cancer as well.
However, the rise in cell mutations halted after 23 pack years of exposure. Researchers believed this was because these people had proficient systems for repairing DNA damage or detoxifying cigarette smoke. "The heaviest smokers did not have the highest mutation burden. Our data suggest that these individuals may have survived for so long in spite of their heavy smoking because they managed to suppress further mutation accumulation." Dr Spivack added.
Source: Metro, 12 April 2022
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See also: Nature Genetics - Single-cell analysis of somatic mutations in human bronchial epithelial cells in relation to aging and smoking ([link removed])
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** US regulators have banned Imperial Brands’ myblu vaping device after a review found there was a lack of evidence they would protect public health, in a blow for the tobacco industry’s touted transition from cigarettes and the company’s new strategy.
The order comes just weeks after Stefan Bomhard, Imperial’s chief executive, and its US management team, hosted an investor event, presenting the strategy for a refreshed consumer marketing plan for myblu. Imperial plans to appeal and said it expects the authority will not seek to enforce the orders during that process
Analysts at Goldman Sachs said Imperial remained a “small player” in the US next generation products (NGP) market, with revenue of £56 million, about 30% of its group NGP revenue and less than 1% of overall group revenue. NGPs are not Imperial's only focus, with the company's new strategy also set on improving sales of its combustible tobacco products. Analysts at JP Morgan said “the earnings impact [on Imperial] should be immaterial and we believe the market ascribes limited value to Imperial’s US vapour business due to the ongoing declines”.
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Source: The Times, 13 April 2022
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** More than nine in ten users of e-cigarettes in Ireland would not favour an outright ban on flavoured vapes, according to a survey. The survey, conducted by Red C, a market researcher in Dublin, consisted of 221 face-to-face interviews in March 2022.
According to they survey, nearly half of vapers would stop vaping altogether if a flavour ban was introduced. About 84% of vapers believe a flavours ban would create a black market for the products, while a majority (59%) said they would source the products abroad or online. The most common flavours are tobacco, menthol and fruits. Of those surveyed 42% said that they were in favour of a ban on flavours aimed at young people.
The survey found that “a large majority” of vapers are ex-smokers. The vapers in the survey acknowledged the “important role” vaping had in helping them reduce the amount they smoke or quitting altogether and that it had been more effective in helping them do this, compared with other means like patches and gum.
Source: The Times, 13 April 2022
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