A welcome step forward for public health

Nesta Lloyd-Jones says the Public Health (Wales) Bill shows we’re serious about public health.

In any discussion on the differences between the health systems in the four devolved nations, it is likely that you will hear the statement that Wales has placed a much greater emphasis on public health than elsewhere in the UK.

This is something the NHS in Wales is rightly proud of – it is not always easy to take a long term view in the face of immediate and unrelenting pressures on services.

The Welsh Government’s Public Health (Wales) Bill, and last week’s additional draft Bill to introduce a minimum unit price for alcohol, both have potential to add even more weight to our claim of being a nation that is serious about public health.

The principles of the Bill are currently undergoing scrutiny by the Assembly’s Health Committee, and the Welsh NHS Confederation has submitted evidence on behalf our members, the seven Local Health Boards and three NHS Trusts in Wales. In it, we support the measures put forward by the Welsh Government but we also highlight areas where we think the Bill could go further.

The headline issue which has dominated much of the debate so far is the ban on e-cigarettes in enclosed public places.  While some have argued that e-cigarettes can be used as an aid to quit smoking, we believe that a consistent approach is needed to bring e-cigarettes in line with current legislation on smoking in public places.

Continuing to allow the use of e-cigarettes in enclosed public places has the potential to undermine some of the gains that have been made through the smoking ban. It can be hard, particularly from a distance, to differentiate between those smoking tobacco and those using e-cigarettes, which makes enforcement of the ban difficult.

Current research on this issue is limited, but rather than helping people to quit, e-cigarettes could also act as a gateway to conventional tobacco by appealing to young people. They can give the impression that they are a safe alternative, even though they still include addictive and high levels of nicotine.

In some cases, e-cigarettes might have eight times as much nicotine as a traditional cigarette.  But because they are not so strictly regulated, the nicotine dose is not always monitored or clearly displayed on the packaging.

And while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.

While the debate on e-cigarettes will no doubt continue, the scope of the Bill goes much wider, and in some cases, we believe some of the other measures it includes could be strengthened.

One such measure is the proposal to create a mandatory licensing scheme for businesses carrying out ‘special procedures’, namely acupuncture, body piercing, electrolysis and tattooing.

This is something that we strongly support, as the consequences of leaving this industry unregulated have an impact not just on health, but on safeguarding and child protection.

Our evidence calls for this measure to be widened to include procedures such as body modification, injection of any liquid into the body (e.g. botox), colonics, dental jewellery, chemical peels, and laser treatments such as used for tattoo removal.

As things stand, the public has absolutely no idea when they go to premises offering these procedures, whether they are safe, whether they are clean, or whether the person is competent. This is a serious concern. There is the potential risk, whenever there is anything sharp that is reused, that it may not be sterilised properly and infection can be transmitted.

We also support the Bill’s proposal to outlaw intimate piercing of anyone under 16. A recent look-back exercise in Gwent found that six people under 16 had intimate piercings, with girls as young as 13 undergoing nipple piercing.

We feel this is an area where we have lagged behind in safeguarding young people, and the Bill provides an important opportunity to address it.

An important addition to the Bill was the Welsh Government’s announcement last week of its intention to introduce on a minimum 50p unit price for alcohol.  There is a strong evidence base for the link between alcohol affordability and levels of harm.  This prudent initiative has received support across the board, and we are hopeful that it will be an important step in reducing the harmful effects that alcohol has on our health service and society as a whole.

One area that the Bill does not specifically address is the rising level of obesity, and further concerted action is needed across all sectors to try and reverse this.

We acknowledge that this is an issue that may require a UK-wide approach, particularly where proposed legislation concerns the food and drink industry. The idea of a “sugar tax” on some fizzy drinks and unhealthy snacks has been floated. However, many of the levers to change the way food processing and labelling is governed are not within the powers of the devolved nations, but instead lie with the UK Government or Europe.

Something that is within our gift here in Wales is to strengthen the Bill’s measures on the regulation of food standards in settings such as hospitals, pre-schools and care homes.  Maintaining food standards, particularly in health settings, has huge potential to influence the public’s perception of what foods are considered acceptable and healthy.  Mandated criteria for the provision of healthier items in hospital restaurants would help hospitals in Wales to fulfil their responsibility for improving the health of the population they serve.

As the Public Health Bill continues its passage through the Assembly, the Welsh NHS Confederation will continue to stress that public health must not be seen as a standalone issue to be addressed solely by the NHS.

It is the responsibility of a wide range of sectors which need to work together and develop a ‘health in all policies’ approach to tackle the issues that we face.

This will require a more sophisticated view of health and wellbeing, looking widely at economic opportunities, such as availability of jobs, education, and strategies to tackle poverty; and the social environment, such as the quality of neighbourhoods and housing, and sport and leisure opportunities.

It is vital that we do this to reduce levels of ill health, and to reduce our increasing and unsustainable reliance on health services.  The Public Health Bill is a welcome, positive step, but we would like to see a clear vision of what it intends to achieve and how success will be measured.

At the same time, we cannot be complacent about what legislation alone can achieve.  We must continue our determination, across all sectors, to improve the health and wellbeing of the people of Wales through all the means available to us.

Nesta Lloyd-Jones is Policy and Public Affairs Officer for the Welsh NHS Confederation.

39 thoughts on “A welcome step forward for public health

  1. Can you share the evidence with us that “e-cigarettes could also act as a gateway to conventional tobacco” please? It is clear that experimentation with electronic cigarettes is not currently proving to be a gateway to smoking amongst young people.

  2. The idea that the Bill has a wide scope, I think, is misguided – it doesn’t. E-cigarettes, tattoo and piercing parlours, public toilets, and now minimum pricing on alcohol – that’s it. There is no holistic thinking with this Bill, and no radical approach to public health, which is so desperately needed in Wales. On e-cigarettes, the lack of evidence to support your comments is as resounding as the lack of evidence to support the Minister’s position. I am a former smoker, and using an e-cigarette has helped me kick the habit. Taking a public health approach to this issue, that, surely, is better than banning e-cigarettes in public places with no evidence to suggest that they cause any damage or illness. I accept that more research is needed in this field, but politically, I find it bizarre that one would ban something with no solid reasoning behind it. How sad that you have lazily supported the Welsh Government’s position on this when there is so, so much more they could do.

  3. According to some reports NASA are now looking for ‘Intelligent’ life on Earth – Told them to give Welsh Assembly a miss – Not only we now have an Orwellian rule by few Druids who have hijacked Welsh Labour but Social Engineering into a tribal language of the few is not enough so more compulsion through brainless public health initiatives. Say NO to a vile nanny state and stand up for freedom to live without Government’s interference!

  4. “Nesta Lloyd-Jones is Policy and Public Affairs Officer for the Welsh NHS Confederation.”

    Say no more! Can’t think of a single piece of Welsh legislation that has made anything better than it was before and this will be no exception. We need less government not more! We also need fewer ‘governments’ but better, cheaper, properly researched government and there is a wealth of evidence to show the WG is just part of the problem not part of the solution. Just GO!

  5. I think using terms such as “linked to cancer” are a bit conveniently misleading and not very scientific. Of course nicotine can be linked to cancer – is it classified as a carcinogen – not by any evidence I have seen and it’s been around a long time.

    The term “linked to” can be used to suggest a false idea. Is it a trigger for cancer – no-one suggests that, from what I can see. Is it implicated in angiogenesis or metastasis – yes, and so are many components of the foods we eat and the beverages that we drink

    We are surrounded by carcinogens and we consume things which are linked to cancer all the time. Some even suggest that low levels of some carcinogens are essential for the development of our immune system. The terminology is meaningless and for better or worse, we don’t ban alcohol on that basis or products like nail varnish remover, household bleach , barbecued burgers or burnt toast, which could all be “linked to” cancer. I would imagine a bowl of cornflakes would be very capable of playing a role in metastasis and as such could be linked to cancer.
    This is a case where we need to inform the public using arguments based on science, not on selective interpretation of studies, facts or personal prejudices.

    Nicotine receptors are ubiquitous and nicotine will invariablly be implicated in the progression of any disease. In terms of cancer, studies have shown it’s potential role in angiogenesis and metastasis, which is not surprising – studies on seemingly healthy food ingredients, might lead to similar conclusions. This is very different to laying the inference that it may cause or promote cancer – a link which has never been established. compounds such as N-nitroso derivative of nicotine and its metabolites have been shown to be carcinogenic, but N-nitroso derivatives of almost any chemical present in cooked foods are know to be carcinogenic. We don’t ban barbecued food, simply because it is loaded with N-nitroso derived carcinogens.

    Our environment is naturally loaded with carcinogens and our bodies have mechanisms to combat those and our immune system needs exposure to them – we ban potent carcinogens, which includes many of the chemicals present in tobacco smoke, but we do not ban chemicals simply because they are linked to cancer, since that would include almost everything.

    The next step would be to ban nicotine replacement therapies, which have EMEA/FDA approval and have passed appropriate toxicology screening. No doubt more testing should be done, but this debate is not driven by science and I suspect it has arisen following an evening dinner party in the Vale, where everything from litter to dog fouling or ghastly e-cigarette use are far more interesting than food banks and the likely return of work-houses in the soon to be survival of the lucky and fittest society we are now being driven towards..

  6. Well said Aledf – Imagine a football field, heavy rain looming and a grounds-man places a large bucket in the middle of the pitch. Rain starts and all the rain just goes into the bucket. Welsh Government’s stance on nicotine is just as bizarre!

  7. This blog, and the evidence we submitted to the Health and Social Care Committee, is based on extensive conversations with the Directors of Public Health (DPHs) in all the Local Health Boards across Wales and Public Health Wales NHS Trust. We acknowledge that research in the area of e-cigs is still limited but, in submitting our evidence to the Committee, we have taken into account the work that DPHs do day-in-day out to protect and improve population health. As highlighted within the blog, the scope of the Bill goes much wider than e-cigarettes and the Bill is a positive opportunity to reduce levels of ill health in Wales. We believe it is important to have an open and honest debate around how we are going to achieve this in the future and welcome people’s views around the whole Bill.

  8. If you are serious about public health,it is worth being honest about vaping and smoking.The ONS survey for Great Britain found this:

    “However, from 2007 to 2012 the rate of smoking has remained largely unchanged.”

    The most recent annual report from the Stop Smoking Service recorded 1,100 1 year quits(2012/13 – nothing published since).

    The ASH survey on ecig use showed 1.1m smokers had quit using ecigs – pro-rata this would mean 50,000+ in Wales.The recent decline in smoking in Wales is wholly due to ecigs yet you propose further restrictions which can only put off prospective quitters.

    Can you really not put all these facts together and come up with a sensible public health policy?What matters is real quits – not dogma,egos and jobs in Tobacco Control.

  9. Dear Nesta Lloyd-Jones, the research in the area of e-cigarettes is not limited. There is so much data available, that most informed people are happy to say, that e-cigarettes are between 95% and 99% safer than tobacco cigarettes.

    There has been research that has given negative results, all of which has promptly been found to have glaring errors in it, or to have been misinterpreted. This normally happens due to ignorant researchers operating the equipment ineptly, and in a way that bears no resemblance to reality.

    If anyone working in the field of public health dares to say, “We don’t know”, on the subject of e-cigarettes. It can be taken as an outright admission of ignorance, and a failure to carry out the necessary review of the literature.

  10. Nesta, You really are running the risk of ‘first doing harm’. If you read ALL of the e-cig research and learnt enough about research methods and statistics to interpret the data objectively, there really is only one conclusion.
    Yes, it’s possible that, once we have 20 years of data that there might be a small risk attributable to e-cigs. However, on the data that we have at the moment, there is little doubt that e-cigs should be encouraged as an alternative to lit tobacco. There is no evidence of a gateway effect (save one away from tobacco). There is evidence of efficaciousness – albeit largely anecdotal – 2.1 Million UK people is a big anecdote, after all.
    And what is most frightening are the financial interests against e-cigs – Pharma, tobacco and government. Think-on

  11. “In some cases, e-cigarettes might have eight times as much nicotine as a traditional cigarette.” Can you provide a source for this please, genuinely interested. I’m presuming you mean per puff? I’d like to know anyway, thanks.

  12. ”In some cases, e-cigarettes might have eight times as much nicotine as a traditional cigarette. But because they are not so strictly regulated, the nicotine dose is not always monitored or clearly displayed on the packaging.

    And while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.”

    This is evidence free scaremongering! Shameful disregard for facts in the drive to over-regulate, your speculation is not in the least bit helpful in encouraging further smokers to quit . Over 125,000 use e-cigs in Wales with just over 50,000 sole users, it is the message you convey to the 75,000 dual users who are transitioning to quitting that is the most dangerous. Do you honestly believe that this irresponsible post will further reduce smoking numbers or just possibly may increase numbers? I agree an open honest debate is most definitely required ,but the Welsh Govt and its supportive bodies seem incapable of listening or engaging with the public . This is much to the detriment of genuine PUBLIC Health

  13. Saying ecigs are a gateway to tobacco cigarettes is like saying water is a gateway to Alcohol.

  14. Having read your statements on e-cigarettes I would like to know where your “facts” have come from? Independent tests have proved vaping does NOT normalise smoking, it does NOT encourage children to smoke and it is NOT more dangerous than smoking. You appear to have cherry picked statements, and your intent to treat e-cigarettes the same as tobacco is purely prejudicial. Most e-cigarette users have switched to these devices in order to get away from the deadly effects of tobacco, they have chosen them as a way to stop smoking and using an e-cigarette is NOT smoking, if you choose to make non smokers (which in effect they now are) use a smoking area you are putting their health at risk from second hand smoke. If you choose to subject my family members and other vapers to this danger as a reward for giving up smoking you should be ashamed of yourselves.

  15. So you’ve consulted with Public Health and Local Health Boards “Across Wales”! Have you ever thought of delving into the scientific research produced by genuine epidemiologists, addiction specialists or even Stop Smoking Services in other parts of UK? Cast your net even wider and you’ll find peer reviewed evidence for the fact that vaping is at least 95% safer than smoking from scientists in the U.S. France, Germany Scandinavia. It is scandalous that you brush aside the fact that lung cancer cases could go down in favour of some wild theory that other cancer rates “might” increase – on what evidence is this based? It is said that in Wales 350,000 deaths per year are due to smoking-related disease; for a country of fewer than four million souls that is an horrendous statistic.

  16. If you belive that you’ve had an “open and honest debate” Ms. Lloyd-Jones my question is with whom did you have it? Apparently it wasn’t with the people of Wales who judging from the comments think this is just more bs from the willfully uninformed at DPH. There is now a plethora of ecig related studies most of which tell us there is NO Gateway effect and that the vapor presents no harm to any bystanders Whilst you may not be able to distinguish smoke from vapor as you claim most of can tell from the smell which one is smoke! Smoke lingers for a bit while vapor disipates rather quickly.

  17. With tens of thousands of welsh smokers heading for an early painful death like millions before them why would “Public Health” want to deter them from taking up a safer alternative? Just maybe the power (money) of the Pharmacutical industry and the tobacco industry are just too much for the Welsh government to resist?

  18. E-cigarettes are currently shown to be at least 95% safer than conventional cigarettes.
    The evidence regarding use by young people indicates some experimentation but there is little indication of regular uptake and no evidence of a ‘gateway effect’ to tobacco use.
    Their rate of nicotine absorption (which is the significant criteria for addiction) is shown to be somewhat slower than conventional cigarettes.
    Nicotine has been studied for decades and there has been no evidence of a link between nicotine and cancer in the absence of tobacco nitrosamines.

    So you are asking us to believe that because using an e-cigarette may occasionally look a little like smoking a conventional cigarette that the thousands of lives that could be saved are not worth the minimal manhours that would be required for additional staff training.

  19. Since when has nicotine been a cancer concern? and if there is evidence to back this claim, then why is NRT being promoted? e-cig research is only limited within closed minds and as far as lumping e-cigs in with the rest of the bill is no more than smuggling

  20. “Continuing to allow the use of e-cigarettes in enclosed public places has the potential to undermine some of the gains that have been made through the smoking ban.”

    Despite the lack of current regulation on vapour products, there is little evidence to be found across the UK and even the EU that they undermine any current smoke-free laws. Heck, even the information gathered by the CDC in the US demonstrates *tobacco prevalence* is down wherever vapour products are popular.

    “Current research on this issue is limited, but rather than helping people to quit, e-cigarettes could also act as a gateway to conventional tobacco by appealing to young people.”

    Again, surveys and studies conducted by Cancer Research UK, ASH Wales, ASH Scotland and ASH UK do not indicate that this is the case. Uptake of tobacco smoking is falling, and those never-smokers that take up the use of vapour products remains less than 1%.

    “And while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.”

    There is extensive research into Nicotine dating back to the first studies into tobacco smoking. None of these studies have identified *any* substantial negative health implications from nicotine on its own.

    @Nesta Lloyd-Jones

    I too have submitted a response to the call for evidence, which is sadly restricted to four pages of A4. Sadly, the amount of evidence I could gather from both sides of the argument (which would simply be article titles, authors and links) would easily fill those four pages on its own without addressing the contents of the consultation itself.

    It is clear that the Health Minister has sadly ignored advice from leading charities (Cancer Research UK, ASH Wales, ASH Scotland and ASH UK amongst others) in proposing the inclusion of vapour products into current smoke-free laws, along with ignoring the responses to the Green paper where 79% of respondents were against such an inclusion.

    I can only hope, based on the evidence submitted to the HSCC that the part referencing vapour products (electronic cigarettes) is overturned in the face of a substantial body of evidence.

  21. @Nesta Lloyd-Jones

    “We acknowledge that research in the area of e-cigs is still limited”

    Except it isn’t, is it? Research on e-cigs is extensive and thorough. What you mean is that *research on e-cigs that supports your position* is limited, and what does exist has all been exposed as either incompetent or actively fraudulent.

    You know perfectly well that the “gateway” argument has been repeatedly debunked by Action on Smoking and Health as well as the Smoking Toolkit Study. You know perfectly well that it’s extremely easy to distinguish a modern e-cig from an actual cigarette. You know perfectly well that nicotine is not a carcinogen. And your bizarre claim that e-cigs can contain eight times as much nicotine as a cigarette is simply a lie.

    You are paid with public money. You have a duty to tell the public the truth. Please start doing so.

  22. 79% in your vote online stated not to ban vaping but this has been completely ignored. I look forward to your ‘open and honest’ debate as it will be neither. Your actions will assist in smokers having to continue smoking and vapers that may have to return to smoking.

  23. You are promoting public health by discouraging people from attempting to quit smoking? Further the regulations would prevent a lone commercial vehicle driver from practising tobacco harm reduction whilst they are at work, do you suggest they simply pull over on a busy highway, surrounded by fast moving vehicles, obscure the road and stand in a vehicle emission laden environment?

    Minimum unit pricing, that was tried in Canada, it failed, spectacularly, and it is, a punitive, regressive policy that only targets the less well off in society, families who’s budgets are already stretched to breaking point, I honestly thought the labour party stood to support working class families, the last 15 years has proven that is clearly not the case, if anything, the Tories are now MORE engaged with the public health wants and needs of most people, namely interfere as little as possible, offer advice, without passing vindictive punitive legislation designed to force social change on a population that does not in all honesty need or want it.

    And labour wonders why their supporters are flocking away in droves? I pity the people who will suffer under this puritan nanny state regime.

  24. Nesta,

    that is simply NOT TRUE. E-cigarettes were included in the bill in the hope that, amongst the actually useful parts, it would simply get swept in.

    There is, and has been for some time, plenty of study, plenty of evidence. Whether you and your colleagues have been hoodwinked, have failed to undertake due-diligence in studying the data or have outright chosen to ignore it I don’t know. This is behaviour we’ve seen from the BMA as well, despite ASH UK , NCSCT, Dept of Health, Public Health England etc all coming down on the side of NO BAN.

    Let me give you a few of the research/study examples;

    No passive effect http://www.mdpi.com/1660-4601/12/5/4889
    No passive effect/no nasties http://www.sciencedirect.com/science/article/pii/S0273230014002505
    No gateway effect http://www.ash.org.uk/files/documents/ASH_891.pdf
    No gateway effect http://www.ajpmonline.org/article/S0749-3797(14)00555-8/fulltext
    Harm Reversal http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053879/

    Those who put themselves forward claiming to help protect the public have a duty to ensure they are FULLY up to date and conversant in what they speak on.



  25. Can you see a pattern in these responses Nesta?

    Users and non-users can see the flaws in the argument for banning e-cigs. Unless there is another agenda I would suggest you pay heed to the evidence provided and public opinion.

  26. Sadly another article full of scaremongering half truths.

    “we believe that a consistent approach is needed to bring e-cigarettes in line with current legislation on smoking in public places.”

    Why?, no smoke is produced from an ecig, are there any other items that do not produce smoke that you also wish to include – kettles?, disco fog machines?, quitters sucking on a pen?

    “Continuing to allow the use of e-cigarettes in enclosed public places has the potential to undermine some of the gains that have been made through the smoking ban”

    Do you really think that NOT smoking can undermine a smoking ban?, have you ever seen an ecig?, do you really think that anyone could confuse them?

    “Current research on this issue is limited”

    Current research is anything but limited, I suspect you mean that there is only limited evidence to support your point of view, if health really was the priority, the extensive evidence suggests that actively promoting the use of ecigs to smokers would result in the best overall reduction in harm.

    “And while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.”

    If all smokers switched to ecigs, lung cancer rates would plummet, if nicotine is a suspected carcinogen, surely you should be equally concerned about nicotine gums, patches and inhalable sprays.

  27. @Nesta Lloyd-Jones

    The claims you have made in regard e-cigarettes are not based on the current evidence, evidence which ,it is fair to say, exsists in reams. You have made totally unsubstantiated claims in regard nicotine, in that it ‘may’ cause cancer and that e-cigarettes contain 8 times as much as a tobacco cigarette , these are claims that, to the less well informed smoker, could very possibly deter them from switching to a vastly safer alternative to smoked tobaco. I find this reprehensible, I have personally spoken to smokers who have been scared away from switching to e-cigarettes because of unsubstantiated fearmongering claims such as these and it is, without doubt , singularly damaging to the health of the smokers concerned as it perpetuates smoking and smoking diseases which we are told ,repeatedly ,kill tens of thousands of people a year. As previous respondents have mentioned , every scrap of currently available evidence shows that e-cigarettes instead of acting as a ‘gateway’ to tobacco smoking are having the exact opposite effect. Smoking rates are falling , tobacco sales are falling and this is happening faster than before e-cigs were available. Youth smoking is at an all time low. If any such gateway exsisted these numbers would be rising and rising quickly , it simply is not happening. E-cigarettes need sensible consumer regulation this bill does not offer that , it offers peacemeal prohibition and suggests punishing e-cigarette users for quiting smoking, bringing in punative measures to equate vaping with smoking. Smokers who switch to e-cigarettes have quit smoking in a way that all evidence shows is the easiest and most effective way for them to stop inhaling lit tobacco smoke quickly and efficiently and immediately halt the damage that causes. Any move to lessen the availability and ease of use of e-cigarettes will be a move that promotes tobacco smoking. This bill does just that.

  28. I would be interested to see even a shred of evidence for the claims you make here about e cigarettes

  29. Oh, and Nesta, IWA. If nicotine causes cancer there’s quite a few other things you’ll need to ban;

    Green Tomatoes

    And of course, anything made from the above. And yes, there’s less in them than in tobacco. But I don’t feed my kids tobacco chips with tobacco sauce……

  30. Regulations are meant to protect the public, if the public are arguing against the regulation …

  31. If ever there was a good example of evidence free policy making then the Public Health Wales Bill proposals relating to e-cigarettes are it. There are many factual errors in the above post. Equally notable is the liberal use of terms like “may”, “might”, “could”, “not yet known”. Essentially you do not have a shred of hard evidence to support your claims. The whole basis of this policy is based on “concerns” about what might happen, rather than evidence and statements of fact.

    Most alarming is your statement “while cases of lung cancer could go down as a result of the use of e-cigarettes, what is not yet known is whether some other cancers may actually be linked with nicotine.” Essentially I think you understand that stopping smoking (even if replaced with e-cigarettes) reduces the risk of lung cancer. E-cigarettes do not emit the large number of carcinogens, many of which are linked to combustion, of traditional cigarettes, so you agree that this is a benefit. Remove the combustion and you remove much of the risk, and furthermore e-cigarettes also contain only trace levels of TSNA’s (typically at a similar level to other purified products such as nicotine patches) which are another risk associated with tobacco.

    But you go on to dismiss this massive win (reduced lung cancer risk) because of a “not yet known” risk of other cancers “linked with” nicotine. Nicotine is not currently known to be a carcinogen. Aledf above has explained eloquently about the relationship it does have with cancer. Why should the reduction of a known risk, and lung cancer is the third most common cancer, be outweighed by a risk of something that by your own admission is not yet known? This is the kind of wrong headed thinking that sums up these proposals. Have you by any chance been taking advice from the BMA?

  32. Dear Nesta,

    It must be pretty obvious from the previous comments that e-cigarettes are far safer than tobacco and I find the lack of critical thinking that leads to any ban on vapers almost incomprehensible.

    Smokers are slaves. Over a lifetime, a couple of pack-a-day smokers will spend around £300,000 on tobacco. That’s enough to buy a house, afford pre-school child-care, and basically have a good life. In addition, the tax payer will be funding the costs of the healthcare due to numerous smoking-related diseases.

    Yourself and many of your colleagues have become unwitting pawns in a anti-ecig neoliberal corporatist agenda to keep smokers smoking. The 5 main beneficiaries are:
    (a) Big Tobacco
    (b) Big Pharma and their NRT/Champix products (which don’t work btw)
    (c) Big Pharma and the money they make from smoking-related diseases
    (d) Government taxes
    (e) Anti-smoking organisations (who are out of a job when nobody smokes)

    Pharmaceutical companies that we believe are there to make people better have a vested interest in keeping people sick. All e-cigarette bans around the world are probably due to political influences from Big Pharma.
    This is clearly being played-out at pharma-funded organisations such as FDA, BMA, WHO and ASH (to a lesser extent). I can’t think of a single independent (of pharma) health organisation who oppose e-cigarettes.

    A true socialist who wants to lift the poor out of financial repression would surely oppose any e-cigarette ban. What do you think Nesta?

    In time, epidemiologists will be able to quantify the number of deaths attributable to the Welsh ban on e-cigs. You, Nesta, will be seen as a participant in the massacre and I wouldn’t wish that guilt on anyone’s conscience.

    Please oppose the ban on e-cigs.

  33. In my first comment I quoted a figure of 350,000 deaths p.a. in Wales – I really wanted to see whether anyone actually reads the opinions and evidence of vapers. Apparently not. The overall UK figure for smoking – related deaths in UK is 200,000 p.a., in Wales it is in the region of 6,000 with 27,000 hospital admissions. But why worry? These are smokers – and the article makes it painfully clear that no-one is concerned that e-cigs could reduce cancer rates, improve the overall health of the Welsh public, preserve the thousands of jobs created by the vaping industry and see smoking become history. No-one cares about anything but Party dogma and that worked out so well last May.

  34. To Nesta, All the AMs supporting this bill and Public Health Wales,

    Compare and contrast the “evidence” (http://www.senedd.assembly.wales/documents/s42221/HSC4-21-15%20Paper%203.pdf) submitted by Public Health Wales, and the recent report by Public Health England (https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update).

    It’s quite clear the former is full of dogma and absurd hypotheticals, whereas the latter is full of real hard evidence.

    PHE’s document doesn’t just come to a different conclusion, it completely demolishes all of PHW’s arguments.

    Vaping is AT LEAST 95% safer than smoking and kind of ban or public restriction sends entirely the wrong message to the population.

    If the Welsh Government persist with the e-cigarette ban, then the Welsh public will have no reason to trust AMs and the people responsible for the health of Wales ever again.

  35. Anyone interested in how the NHS Wales could save £1.3 million pounds each and every year?
    This might be used for more nurses, a pre-NICE approved drug fund, more neo-natal care units… take your pick. If you want to know where £13 million per decade could come from just ask me.

  36. There are a number of ways the NHS can say money. Only give free treatment to British residents who have paid into the health care system (national insurance) and non-British residents who have the proper insurance. But what would you do with an illegal immigrant who requires urgent medical attention. Increasing the number of staff nurses which would reduce the number of bank nurses, who are paid at bank rates, would save money. Fine people who miss their appointments, missed appointments are a big drain on the NHS. Reduce the expenses for consultants, no more flash cars or expensive meals. Stop freebies to flash conferences. Besides the NHS saving money the WAG could divert money from other areas. Close down the parks, stop teaching art, ballet etc, reduce evening courses. All of these would be unpopular. My son wants to do boxing, my daughter wants to do art, my daughter wants to do ballet. None would overcome the root cause of the problem. To give free universal health service the NHS in England and Wales is a bureaucratic monster, top heavy with management. Only a complete root and branch reorganisation of the NHS, in England as well as Wales will resolve the issues with the NHS.

  37. What a very disappointing article full of half/mistruths, I would have expected a lot more to prompt and reasoned debate on the issue. The Welsh Government wrongly consider vapers another easy win.

    All the evidence and the Ministers climb down show what how wrong a poor and misinformed person can be in an article.

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