I'm with Clive – former director of ASH questions Public Health England 'story' about smoking and coronavirus

Public Health England may come to rue their 'story' that 'smokers with COVID-19 are 14 times more likely to develop severe respiratory disease.’

On Sunday, in response to a statement issued by PHE on Friday, I noted:

PHE's claim was based on a single study with a sample size of just 78 patients including a tiny number of smokers.

Nor did they mention that other, larger, studies have reached very different conclusions. For example, according to a preliminary meta-analysis published in the European Journal of Internal Medicine (sample size: 1,399), 'Researchers found no link between cigarette smoking and the severity of COVID-19 among cases in China.'

In another, ongoing, meta-analysis, cardiologist Dr Konstantinos Farsalinos has reported that of '2,352 hospitalized cases examined, the observed prevalence of current smoking is <1/3rd the expected.'

Naturally Public Health England failed to mention these studies, probably because they're not 'on message'.

I added that:

As a publicly-funded body, Public Health England has a duty to act responsibly and not cherry pick studies that suit its agenda.

Yesterday, referring to the same 'story' (that has now echoed around the world), Clive Bates, the former director of ASH, tweeted:

I had hoped @PHE_uk would look at the evidence on smoking, vaping and COVID-19 in the round, take expert advice, and update advice on a rolling basis. But what they have done is terrible. It looks like crass PR rather than sound science.

He then linked to the PHE statement, and didn’t stop there. In a series of hard-hitting tweets he wrote:

It draws on a single study from China of 78 subjects who were already very sick with COVID-19-induced pneumonia. Of the 78, 11 deteriorated. Of the 78, 5 were smokers, 3 deteriorated and 2 improved. This is the basis for the 14x headline risk claim.

But this overlooks a very important detail. Of the 78 included in the study, there were only 5 smokers (6.4%). Yet smoking prevalence in China is about 27% (52% men, 3% women). So smokers are dramatically underrepresented in those already very sick with pneumonia. Why?

It gets worse. Of the 11 who deteriorated, 7 (67%) were men. But it is clear men generally are more likely to develop severe symptoms once they have the disease (maybe due to immune system differences). So the smoking effect could be a 'male' effect.

PHE is giving advice on the basis of a single study, which is bad enough. But it ignores the striking underrepresentation of smokers in the sample and misrepresents the findings of the study as general advice to smokers. Where's @SwitchFinder? We need sound science from PHE.

When someone with Clive Bates' background in tobacco control points the finger it really is time for others to take note and start asking questions – about PHE and the anti-smoking industry in general.

Incidentally, the person Clive refers to as @Switchfinder is Martin Dockrell, formerly Deborah Arnott’s right hand man at ASH.

Dockrell joined Public Health England in 2014 (I wrote about it here). Since then his advocacy of e-cigarettes as a quit smoking tool has turned him into a bit of a hero for vaping activists who seem to hang on to his every word or tweet.

I see him in a somewhat different light but it’s worth noting that, as I write, Dockrell has not yet tweeted a link to his employer's claim that 'Smokers [are] at greater risk of severe respiratory disease from COVID-19' which is odd, given his job title – Tobacco Control Programme Lead for Public Health England.

PHE’s credibility is already in danger of being damaged as a result of the coronavirus crisis. Although smokers have relatively few friends in high office, statements that are little more than propaganda won't help PHE's reputation.

Credit, then, to Clive Bates. I have my differences with him, which I’ve written about several times (see 'The canonisation of Clive Bates', 'The canonisation of Clive Bates, part two' and 'I'm with Clive (up to a point)'), but I've never doubted his ability as a shrewd and tireless campaigner and an excellent communicator.

What has frustrated me is his failure to acknowledge that many of the people and bodies responsible for scaremongering about vaping are the very same people who previously published or promoted some very questionable studies about smoking, passive smoking in particular.

The fact that he is now openly speaking out against unsound science when used against smoking is a welcome, if long overdue, development.

It takes courage for a leading vaping advocate to highlight the anti-smoking bias of the one body that, if it known for anything globally, is its relatively liberal attitude to e-cigarettes.

I hope other vaping advocates will do the same. The battle is not between smoking and vaping. It's between sound science and unsound science.

One question they should ask themselves is this. If PHE’s reputation is eventually trashed by stunts like this, why should anyone take anything they say seriously, even on the rare occasions they get it right?

Public Health England will have a positive influence on vaping only as long as it maintains some degree of credibility. Once that is lost - and it is currently hanging by a thread - PHE’s qualified endorsement of e-cigarettes could become a liability.

Comments

[Rose2]

Simon, this is a possible explanation

Nitric Oxide Inhibits the Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus
2005

"Nitric oxide (NO) is an important signaling molecule between cells which has been shown to have an inhibitory effect on some virus infections. The purpose of this study was to examine whether NO inhibits the replication cycle of the severe acute respiratory syndrome coronavirus (SARS CoV) in vitro. We found that an organic NO donor, S-nitroso-N-acetylpenicillamine, significantly inhibited the replication cycle of SARS CoV in a concentration-dependent manner. We also show here that NO inhibits viral protein and RNA synthesis. Furthermore, we demonstrate that NO generated by inducible nitric oxide synthase, an enzyme that produces NO, inhibits the SARS CoV replication cycle."
https://jvi.asm.org/content/79/3/1966

Smokers inhale nitric oxide every time they smoke a cigarette and inhaled nitric oxide is now being tried in hospitals round the world to get more oxygen into the patients.

Remember your article on smoking mountaineers?

Smokers' lungs can help at high altitude says climbing expert
http://taking-liberties.squarespace.com/blog/2011/12/29/smokers-lungs-can-help-at-high-altitude-says-climbing-expert.html#comments

[Pat Nurse]

Tell a lie often enough and it becomes truth as Clive knows when he was part of the anti smoker industry pushing panic and propaganda about alleged passive smoking.

We are where we are because of the likes of Bates. Better he shows some honesty than not at all but it is rather like shutting the proverbial door.

Public health will just ignore him. Others dubious about the dishonest 14 times claim will not highlight it because their jobs and fat salaries depend on it.

Public health needs to stay relevant during a real crisis hence they have jumped aboard the bandwagon and are pushing a hate campaign against smokers during a time of national panic, on a govt website in a bid to validate it. The government should be ashamed of itself for allowing these charlatans to use its resources for such a purpose.

Every lie they get caught out in should result in job losses and resignations but government seems content to keep shoving money into their black hole of smokerphobia while the financial resources they grab could actually be better used in the NHS to save real lives and not just lives imagined lost due to number crunching and dishonesty.

This is the result of their hate campaign. They should be ashamed but they are probably celebrating. http://www.valuewalk.com/2020/04/doctors-refusing-to-operate-on-smokers/