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** 30 January 2023
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** UK
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** Medicines blackout threatens ICS prevention target (#1)
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** Rishi Sunak set to unveil emergency care plan to slash NHS waiting times (#2)
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** Experts warn over vaping packaging (#3)
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** Opinion: Harm built in—why the gambling industry needs a Silent Spring moment (#4)
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** UK
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** Medicines blackout threatens ICS prevention target

The government’s target for England to become smoke-free by 2030 – which integrated care systems are expected to pursue – is being undermined by the unavailability of two smoking cessation medicines.

Champix (varenicline) has been unavailable since October 2021, a situation exacerbated by the absence of Zyban (bupropion), since December 2022.

Both drugs were withdrawn because of concerns about the presence of nitrosamines, which may increase risk of cancer if people are exposed to them above acceptable levels, and will be subject to further tests and regulatory checks if they are to return.

Matthew Evison, a lung cancer and tobacco dependency specialist at Manchester University Foundation Trust, said Champix was clinicians’ “most powerful weapon” against smoking. He said the treatment gap would make the target harder because “smoking prevalence declines will be slower without varenicline”.

He said government should be trying to more urgently to mitigate the problem, telling HSJ: “If we don’t have these medications, then what are we maximising elsewhere in the system to achieve it? Where is the plan to achieve the target?”

He said nicotine replacement therapy was typically not as effective as varenicline, while e-cigarettes are not always available through services . He added: “Without varenicline, you’re potentially going into battle without your most powerful weapon.”

A survey from Action on Smoking and Health run in August and September 2022 of 127 local authorities, shared with HSJ, found only 52 per cent of councils provided e-cigarettes.

ASH deputy chief executive Hazel Cheeseman said: “The government has set a vision for a smoke-free country by 2030 and now it needs to be clear about how we get there, which includes ensuring all smokers have access to the best support to stop”. Varenicline and bupropion had been “wonder drugs for some people, helping where nothing else had before”, she added.

A Department of Health and Social Care spokesperson said: “We are aware of supply issues with both varenicline and bupropion and have issued comprehensive communications to the NHS advising on management options for patients, including alternative treatment options”.

Source: HSJ, 30 January 2023
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** Rishi Sunak set to unveil emergency care plan to slash NHS waiting times

Rishi Sunak will vow to rapidly slash long waiting times for urgent NHS care with a promise of thousands more beds, 800 new ambulances and an expansion of community care backed by a dedicated fund of £1bn.

The health service is engulfed in its worst-ever crisis, with urgent and emergency care in particular under unprecedented pressure in recent months. The prime minister will describe his blueprint for resolving the problems as “ambitious and credible”.

However, the Guardian understands the £1bn dedicated fund being pledged to finance the strategy is not new money. It will come out of cash announced last year for health and social care in the autumn statement. There were also no precise details on who will staff new ambulances and beds.

In the two-year plan for England, the government and NHS England will promise 800 new ambulances, including 100 specialist mental health vehicles, and 5,000 more hospital beds.

A major element of the strategy is to expand urgent care in the community, keeping people away from hospitals and seeing more treated at home.

However, NHS leaders expressed doubts that initiatives such as creating more virtual wards to keep people out of hospital would succeed in reducing pressure while there remained a workforce crisis. There are currently 133,000 vacancies in England alone.

Matthew Taylor, the chief executive of the NHS Confederation, said: “The NHS has been at the mercy of a sluggish and short-term approach from the government in its response to the crisis facing emergency services this winter. The NHS needs the right numbers and mix of staff in place if it is to truly recover the performance of emergency care and other services long term.”

Source: The Guardian, 30 January 2023
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** Experts warn over vaping packaging

Experts and school leaders are warning bright packaging on vaping products may be targeting young people and those who have never previously vaped.

NHS Digital data suggests vaping among secondary school children is rising.

Simon Morton, who is a deputy headteacher at a Nottinghamshire secondary school, said: "It is clear these products are being put in front of young people."

The government has said it has strict rules to prevent children from vaping. The long-term effects of vaping are unknown. However, it is much less harmful than smoking cigarettes.

Brendan Canavan, an assistant professor in marketing at the University of Nottingham, said he believed the bright colours and branding of the products meant they were being targeted towards youth culture.

"It's quite sophisticated, much like you would expect to see in the supermarket down the cereal aisle," he said.

"It's bright and cheerful and it's referencing a lot of youth culture stuff, that could be seen as quite interesting and cool at school.”

Vaping products containing nicotine are required by law to carry a warning label on the box. In 2015, legislation was introduced to ban the sales of vaping products to those under the age of 18.

Source: BBC, 30 January 2023

See also: ASH- Use of E-cigarettes among young people in Great Britain ([link removed]) | ASH- Resources for local authorities, schools and parents on youth vaping ([link removed])

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** Opinion: Harm built in—why the gambling industry needs a Silent Spring moment

Writing in the BMJ, May van Schalkwyk, a speciality public health registrar, brings up Rachel Carson’s 1962 book Silent Spring which describes a world without birds as a result of the use of the pesticide DDT. Schalkwyk writes that this produced a “watershed moment” in public opinion, where prior to the book’s release DDT and other similar chemicals were seen as an essential part of food production, but following it’s release it was seen as a poison and resulted in it's eventual ban and the establishment of the Environmental Protection Agency in America.

Schalkwyk asks when the gambling industry will see it’s own Silent Spring moment, saying that it is an industry which transfers wealth from the vulnerable to the wealthy.

She points to new guidance from the UK’s gambling commission which emphasises obligations from gambling operators to identify vulnerable gamblers and prevent harm. But, Schalkwyk argues, these regulations are illogical and rely on identifying vulnerable gamblers after they have already begun to display indicators of harm.

The author questions whether it would not be better to ensure the product or service was made safer before being released onto the market, as is the case with other consumer products, rather than relying on retroactive interventions carried out by the gambling operators incentivised by profit rather than consumer wellbeing?

Source: The BMJ, 26 January 2023
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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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