Offbeat

Legal

Vaping on the NHS? Don't hold your breath

Cut red tape to revive stalling e-cig revolution, medics tell MPs


Experts told Parliament that a post-Brexit Britain should think about axing the most draconian EU-wide e-cigarette regulations to encourage people to quit smoking tobacco.

The Science and Technology Select Committee heard oral evidence yesterday that the Tobacco Products Directive (TPD2) ban on promoting e-cigs, and its restrictions on liquid strength and product capacity, all put the public at risk. Weak e-liquids meant fewer switchers were likely to stick with e-cigs, and led to vapers consuming more liquid – neither of which was desirable.

The background to the inquiry was twofold: the looming opportunity to remove the daftest elements of TPD2 – and the arrival of "Heat-not-burn" (HNB) products. Current e-cigarette products vaporise a liquid containing nicotine. HNB products (as the description suggests) allow tobacco (or other "materials" of your choice) to be heated and inhaled with far fewer toxic chemicals than a conventional cigarette.

Leading nicotine researcher Dr Lynne Dawkins of the Centre for Addictive Behaviours Research had done tests showing that vapers compensated for lower-concentration liquids by using more. 70 per cent of vapers just cranked up the power.

UK.gov not quite done with e-cigs, announces launch of new inquiry

READ MORE

Dawkins said of the TPD2 restrictions: "There is no rationale for that cap – it seems arbitrary to me. There's no evidence for increased harms of nicotine for levels above 20mg/ml. In light of research by our group, if you reduce the strength you compensate – that's costly financially, and comes with a health cost."

Many people don't want high-power, high-vapour products that hardcore vapers love, she told MPs, they want something discreet, the size of a fountain pen. But it's inconvenient when you need to keep topping these up with liquids all the time.

Another example MPs heard of TPD2 causing harm was the ban on promoting e-cigarettes. This was cited by tobacco company rep Dr Moira Gilchrist, vice president, scientific and public communications at Philip Morris. The company wasn't allowed to slip a paper insert into a cigarette packet promoting an alternative to smoking.

HNBs are the next public health battleground for prohibitionists and industry. Traditional cigarettes heat tobacco at around 600°C to 900°C while HNBs heat the tobacco to 30-350°C, which manufacturers claim is much safer than smoking.

The MPs heard from Philip Morris and British American Tobacco, which have invested heavily in HNB products. Not surprisingly, they wanted to see them regulated lightly, and promoted as smoking alternatives.

"Tobacco is a carcinogen whether or not you burn it," Professor David Harrison said. Harrison is professor of pathology at St Andrews University and chair of the government's advisory Committee on Carcinogenicity of Chemicals in Food, Consumer Products and the Environment. "Heat-not-burn products show a 90-95 per cent fall in cancer-causing chemicals. Some disappeared, some fell by half." He complained about a "dearth" of decent research, though.

But the great vape revolution seems to be stalling. The number of "switchers" from cigs to alternatives had fallen from 800,000 to 100,000 per year. Smoking has been declining for years – now vaping is slowing down, too.

This has alarming consequences since fewer smokers will give up, as Nick Hopkinson explained on the BMJ's blog here.

"Smokers who switch completely to vaping will dramatically reduce their risk of health harms," he writes. It's "95 per cent safer" (1-page PDF, full report here) yet people are going back to smoking because of unfounded health concerns about vaping. Better the Devil you know.

"Misperceptions of the relative harms of nicotine replacement therapy and e-cigarettes compared with cigarettes need to be addressed, particularly among smokers who would benefit from switching to nicotine replacement therapy or e-cigarettes," Public Health England reported recently. The report was compiled by veteran smoking researcher Dr Peter Hajek, head of the Tobacco Dependence Research Unit (TDRU) at Queen Mary, University of London

Vaping ads flout EU rules, even if to promote healthier lifestyles

READ MORE

That's not the only reason. TPD2 is to blame, too, we're told.

"It certainly appears that the number of people switching is plateauing," Sarah Jakes, chair of the Board of Trustees of the New Nicotine Alliance (UK) confirmed. "Many smokers are dissuaded from trying to switch to vaping by arbitrary restrictions in TPD2 and irresponsible and inaccurate reporting of health risks. Many of them will continue to smoke as a result."

Doctor, doctor, give me the vapes

But if vaping is so beneficial for public health, why isn't the health service handing out the products?

Manufacturers told MPs that the regulatory process for approval couldn't keep up with the pace of innovation in the industry. By the time a product had been approved for use in medicine, it was obsolete.

British American Tobacco had tried but given up.

"We've applied for a licence for our Voke and Invoke products some time ago and we got to a place where we decided to focus on our own brands, and try and bring Heat Not Burn products to market. We're not currently doing that," said Dr Gilchrist.

"Products are innovating so fast, it freezes the product at the start of its development. Your product's out of date by the time you reach the end of the process," said Dr Ian Jones, vice president, Reduced-Risk Products, Japan Tobacco International.

And in any case, "smokers don't see themselves as patients," Gilchrist added.

So it's a familiar story for any innovative technology. The incumbents benefit from regulation that keeps out challengers. ®

Bootnote

Dawkins found that "formaldehyde, acetaldehyde and acetone levels were significantly higher in aerosols from the 6mg/mL compared with 24mg/mL puffing regimen. We have observed similar effects based on our real-world puffing patterns from the 20 vapers in the CRUK-funded study (manuscript in preparation)" – from her written evidence, here.

Send us news
53 Comments

Concerns that £360m data platform for NHS England is being set up to fail

Delays said to favor Palantir as health service seeks suppliers to support its top-down data revolution

The top-down approach to the procurement of a £360 million data platform for NHS England is said to favor incumbent supplier Palantir as fears grow the project could be making the same mistakes that led to the failure of the country's infamous £10 billion National Programme for IT.

Reports emerged recently showing that the secretive spy-tech business was making the competition, launched in April this year, a "must-win deal" following its recruitment of Indra Joshi and Harjeet Dhaliwal, key figures in NHS England's data science and AI teams.

Continue reading

UK health privacy watchdog still in talks over who is accessing country's COVID data store

Over a year after discussions began, National Data Guardian continues to pursue transparency in health data use

More than two years after England launched a COVID data store, keeping details of National Health Service (NHS) patients, the country's National Data Guardian (NDG) remains unsatisfied with who is accessing the data.

The COVID-19 data store was launched in March 2020, and would pull together medical and operational data about the spread of the virus across the country.

Continue reading

Phishing operation hits NHS email accounts to harvest Microsoft credentials

You've won $2m! Now just send me a small fee

A phishing operation compromised over one hundred UK National Health Service (NHS) employees' Microsoft Exchange email accounts for credential harvesting purposes, according to email security shop Inky.

During the phishing campaign, which began in October 2021 and spiked in March 2022, the email security firm detected 1,157 phishing emails originating from NHSMail accounts that belonged to 139 NHS employees in England and Scotland.

"The true scope of the attack could have been much larger, as Inky detected only those attempts made on our customers," the company's VP of Security Strategy Roger Kay wrote in a blog post. "But given how many we found, it's safe to say that the total iceberg was much bigger than the tip we saw."

Continue reading

Former NHS AI leader joins US spy-tech firm Palantir

Move coincides with NHS England's procurement of a far-reaching data platform

US surveillance-tech supplier Palantir has hired a one-time director of AI for NHSX – the former UK health service digital agency.

Indra Joshi quit her role at the end of March as NHSX and NHS Digital were merged into NHS England, a non-departmental government body.

Her arrival at Palantir will raise concerns among NHS watchers and privacy campaigners.

Continue reading

NHS England seeks £240m data platform to tackle COVID recovery

Govt org that led controversial Palantir data store seeks overarching system and help to improve services

NHS England is planning the procurement of a data platform with up to £240m million ($312 million) on the table to help in re-organization of the health service and recovering from the COVID-related backlog in care.

The government body responsible for directing £136 billion (circa $176 billion) worth of health service spending in England has set out plans to buy a "Federated Data Platform (FDP)" that it says will be "an essential enabler to transformational improvements across the NHS."

In a tender notice published earlier this month, the non-departmental government body said the FDP would be "an ecosystem of technologies and services implemented across the NHS in England."

Continue reading

Hospitals to use startup's AI tech to predict A&E traffic

Software will figure out number of beds needed – up to three weeks ahead

At least 100 NHS trusts in England are to start using machine-learning software to predict the number of patients expected to be admitted to Accident and Emergency departments each day.

The tool, built by British startup Faculty, aims to help managers figure out how best to allocate staff and resources during predicted surges, up to three weeks in advance.

"By better forecasting patient demand, we are helping staff tackle treatment backlogs by showing them who is set to be admitted, what their needs are, and which staff are needed to treat them," Myles Kirby, director of Health and Life Sciences at Faculty, said in a statement to The Register.

Continue reading

NHS Digital's demise bad for 55 million patients' privacy – ex-chairman

IT and data arm now part of NHS England, which could be pressured into data sharing without proper oversight

Ten months after attempts first began to extract the medical information of 55 million citizens in England, NHS Digital's former chairman is warning the merger of the agency with NHS England threatens the privacy of people's personal data.

Continue reading

Fresh concerns about 'indefinite' UK government access to doctors' patient data

As England's controversial scheme to grab 55 million citizen's medical data is withdrawn, emergency powers are extended

Concerns are being raised over UK government proposals to extend emergency powers introduced during the pandemic, giving it access to patient data held by general practitioners (GPs).

The government has decided to put in place a plan "omitting the expiry date contained within" emergency COVID powers and "to make a consequential amendment to the review provision", with the aim of "establishing and operating information systems to collect and analyse data in connection with COVID-19."

The instructions were sent in February [PDF] to Simon Bolton, then interim chief executive of NHS Digital, by Simon Madden, director of data policy at NHSX, and signed by the Secretary of State.

Continue reading

UK pins hopes on 'latest technology' to whittle down massive National Health Service waiting lists

£500m tech consultancy procurement in the offing

The UK health secretary has invoked "the latest technology" to clear a 6-million-strong waiting list in England as the National Health Service struggles with a patient backlog caused by the COVID-19 pandemic.

The Department of Health and Social Care (DHSC) and its quango NHS England have at the same time awarded millions of pounds' worth of technology consultancy contracts while launching a new £500m procurement for more of the above.

Announcing NHS's Delivery Plan for tackling the backlog yesterday, Sajid Javid said 300,000 people had now waited longer than a year for elective care – non-urgent but necessary treatment or operations – while 6 million were now waiting for care, up from 4.4 million before the pandemic.

Continue reading

Dido Harding's appointment to English public health body ruled unlawful

Hiring of ex-Sainsbury's CEO at NHS Test and Trace also against equality law – court

The appointment of Dido Harding as interim chair of the National Institute for Health Protection (NIHP) has been ruled unlawful by the High Court of England and Wales.

The infamous Queen of Carnage – a moniker she earned after presiding over TalkTalk during its catastrophic 2015 cyber-attack which cost around £42m and saw 157,000 users' financial details divulged – was appointed head of the public body in 2020. NIHP was the replacement for the disbanded Public Health England, an executive agency of the Department of Health and Social Care, during the height of COVID-19 pandemic.

In a ruling handed down today [PDF], the High Court of England and Wales said the September 2020 appointment of Mike Coupe, former CEO of UK supermarket Sainsbury's, as director of testing at NHS Test and Trace (NHSTT), was also unlawful.

Continue reading