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Friday
Mar152019

Dear Tracy Brabin

Today sees the second reading of the Smoking Prohibition (National Health Service Premises) Bill.

It's a private members' bill proposed by Labour MP Tracy Brabin and few people expect it to become law.

Sometimes however what begins as a backbench initiative - even by an Opposition MP - develops legs and is adopted by government.

Anyway, Brabin was interviewed on BBC Look North on Wednesday and we might have gone head-to-head had I not been driving back from Cardiff. (I was asked if I was available but I wasn’t.)

The programme is no longer online but my comment that banning smoking on hospital grounds is “inhumane” was put to her and she did appear a bit uncomfortable.

She admitted that calling the police to remove a smoker from the grounds of Hull Royal Infirmary, as the hospital is alleged to have done, is probably not the best use of police time.

And she revealed she had been asked by an NHS hospital trust (Mid Yorkshire, I think she said) to put forward her bill.

You might think that NHS trusts have better things to do than lobby MPs to enact new legislation but it shows just how political these taxpayer-funded bodies are.

A BBC source told me the trust had also lobbied the local council to introduce a bye-law to make it an offence to smoke on the trust’s grounds but the council wasn’t interested.

If the local authority won’t act why the hell should central government get involved?

Anyway, I took the opportunity yesterday to write to Tracy Brabin and this is my email:

Dear Ms Brabin,

Please find attached a copy of our new report, Prejudice and Prohibition: Results of a study of smoking and vaping policies on NHS hospital trusts in England.

The accompanying press release can be read here:

In particular I would like to draw your attention to the foreword which I have posted below.

We completely understand why hospitals do not want to be seen to encourage smoking. Nevertheless, many smokers take comfort from smoking, especially when they are stressed or upset. It calms them and in an environment where much of their independence has been taken away, the act of smoking also offers a small sense of autonomy.

Again, we understand why hospital authorities don’t like the sight of people smoking around hospital entrances. Nevertheless, talk of people having to walk through clouds of tobacco smoke is greatly exaggerated.

Forcing smokers to leave the site and stand on public roads is, in our view, unreasonable and occasionally inhumane. In particular it discriminates against those who are infirm or immobile without third party assistance.

Our report recommends a compromise. One, restrictions on vaping should be lifted to give the smokers the choice of switching to a safer nicotine product. Two, to incentivise smokers to move away from the hospital entrance, NHS trusts should be encouraged to install comfortable, well-signposted smoking areas (or shelters).

We believe strongly that a caring, compassionate society should not be threatening people with fines or other penalties for the ‘offence’ of smoking in the open air, especially at a time when they may be at their most vulnerable.

I appreciate that behind your bill lies the best of intentions but there are two sides to this debate and I would be grateful if you would at least read the foreword to our report (below).

I also invite you to read this article, published yesterday by the online magazine Spiked following the publication of our report.

The headline, I should add, is a little misleading. No-one is suggesting smoking should be allowed back inside hospitals (although the problem of people smoking by the entrance is a direct result of the closure of the old hospital smoking rooms). We are however asking for some common sense and compassion when it comes to smoking outside.

Finally, can I draw your attention to the remarkable incident at Hull Royal Infirmary, reported by BBC Look North yesterday (on which you were interviewed). Incredibly, despite it not being illegal to smoke on hospital grounds, the police were apparently called to escort a smoker off the premises. How can that possibly be considered a productive use of police time?

Unfortunately, should your bill become law, the police could regularly be called to investigate such ‘offences’ with the result that otherwise law-abiding people could find themselves in court charged with the ‘crime’ of smoking in the open air where they are harming no-one but (possibly) themselves.

I do hope you will take these points into consideration before proceeding with your bill.

Kind regards.

Yours sincerely,

Simon Clark
Director, Forest

If I get a reply I’ll let you know.

Update: The second reading of Tracy Brabin’s bill has been put back to Friday March 22.

Thursday
Mar142019

Piers Morgan v. Philip Morris

In case you missed it, yesterday was No Smoking Day.

No-one can accuse Philip Morris of missing an opportunity to promote its relentless anti-smoking campaign and there, up with the larks on Good Morning Britain, was Peter Nixon, MD of Philip Morris UK.

The only problem was, the interviewer was professional antagonist Piers Morgan.

I'll leave you to judge how the 13-minute interview went. Personally I found parts of it quite uncomfortable to watch and the Mail Online's subsequent headline didn't beat about the bush:

Piers Morgan ridicules Philip Morris boss for 'staggeringly hypocritical' campaign to 'end smoking' with help of less harmful alternatives - despite still selling cigarettes

I get that it's not realistic to expect Philip Morris to stop selling cigarettes any time soon. Shareholders would be in uproar and, as Nixon says, consumers would simply switch to other brands.

But, I'm sorry, there is something nauseatingly hypocritical about a company that repeatedly urges smokers to quit or switch to a 'better' product while continuing to not only sell cigarettes worldwide but to actively promote them (via advertising) in countries such as Singapore.

It is disingenuous too for PM to predominantly target its anti-smoking campaign at UK consumers when the company's share of the UK market is, I believe, less than ten per cent and the principal impact will be felt by competitors whose market share is far bigger.

While part of me felt sympathy for Nixon as he struggled to answer his inquisitors (the question about his salary was a bit intrusive), the reality is that as long as Philip Morris sells cigarettes whilst sticking rigidly to its 'quit smoking' mantra, accusations of hypocrisy will never be far away.

As I've said before, a more logical and defendable position has to be that adopted by companies such as British American Tobacco, JTI and Imperial.

BAT, for example, talks not of quitting the cigarette market but of "extending choice" by offering consumers a range of products including e-cigarettes and heat not burn.

JTI is equally committed to harm reduction but a page on its website is quite explicit: “We believe in the freedom of adults to choose whether they smoke or not.”

As for Imperial, chief executive Alison Cooper made that company's position clear last year:

"I think in terms of the current cigarette smoking population, many of them very much enjoy smoking. We know it’s a controversial product but therefore it’s even more important that responsible companies still continue to deliver that product to smokers, so I see that being a very important part, still, of Imperial’s story, but at the same time we very much want to develop the vaper business, Blu and Myblu in particular, and really start seeing smokers switch more into those products.

In contrast, and however well-intentioned they may be (Philip Morris responds to accusations of “staggering hypocrisy”), PM's position leaves the company wide open to the sort of attack Peter Nixon experienced yesterday on GMB, which in turn lead to this rather desperate attempt at damage limitation:

There was also this brief exchange with Forest:

Wednesday
Mar132019

‘Adopting a more sensible approach to vaping does not justify further restrictions on smoking’

As promised, here's my foreword to the Forest report, Prejudice and Prohibition: Results of a study of smoking and vaping policies on NHS hospital trusts in England.

If you’re in any doubt about Forest’s position, read on ...

At Hull Royal Infirmary they used to have a smoking shelter. Regrettably it was demolished and replaced with a stark ‘No Smoking’ sign. Today patients are forced to go off site to smoke. “It’s humiliating having to stand at a bus stop,” a 21-year-old woman wearing a nightgown and a catheter told BBC Look North. “It’s like being punished for smoking.”

The same report featured another patient ambling slowly off site with the aid of crutches. Walking alongside her was a “stop smoking specialist” who could be heard saying, “I was wondering if you’d like to take this opportunity to stop smoking.” Was he helping or harassing her? Either way, it looked and felt wrong. Last year a hospital in West Yorkshire installed a public address system that at the press of a button plays messages to ‘shame’ smokers to stub out their cigarettes. Elsewhere a local radio presenter, no fan of smoking, has described how his terminally ill father was denied the ‘pleasure’ of a cigarette while he was in hospital because smoking was prohibited throughout the site.

Equally distressing scenarios are being enacted across the country. Banning smoking on hospital grounds may seem reasonable to many people but the policy demonstrates a staggering lack of empathy and compassion, targeting, as it does, people who may be feeling particularly vulnerable – stressed, upset and in some cases in need of a comforting cigarette. I would go further and argue that it’s cruel and a shocking indictment of our ‘caring’ NHS. Where’s the compassion in forcing someone to go off site before they can light up? They may be infirm, physically and mentally. It could be dark, late at night and they might be alone. No-one who is already suffering from ill health or may be recovering from an accident or serious operation should be treated in such a callous fashion.

Yes, it can be unsightly if a group of people are smoking directly outside a hospital entrance, but this is one of many unintended consequences of the workplace smoking ban. Unable to light up indoors in a dedicated smoking room, smokers are forced to stand outside. Understandably they prefer to remain close to the entrance under a canopy that provides shelter from bad weather. If the powers that be don’t want people to smoke next to the entrance incentivise them to move further away by providing a comfortable smoking shelter. Don’t ban smoking everywhere on site because that’s disproportionate to the problem. Some people may not like the smell of tobacco smoke but there’s no evidence that smoking in the open air is a health risk to anyone other than the smoker.

Even in these difficult financial times a smoking shelter represents money well spent. Enforcing outdoor smoking bans means CCTV cameras, public address systems and tobacco control wardens ordering smokers to ‘Put that cigarette out!’. What a waste of public money and scarce resources. The public appear to agree. According to polls conducted by Populus for Forest, tackling smoking has consistently been considered the least important in a list of ten priorities for the NHS. The most important issues were investing in new doctors and nurses, addressing response times at A&E, and improving general waiting times.

Tobacco, lest we forget, is a legal product. Despite this anti-smoking campaigners justify the constant war on smokers by estimating that the cost of treating smoking-related illnesses is £2.7 billion a year in the UK. To put this in perspective, smokers contribute a staggering £12 billion to the Treasury annually through a combination of tobacco duty and VAT. In short, using a discredited financial argument to justify further discrimination against smokers is not only wrong, it’s unjust.

If there is some good news it’s the fact that an increasing number of NHS trusts are adopting a more relaxed attitude to vaping. The overwhelming majority of vapers are ex-smokers or smokers who wish to cut down or quit smoking altogether so banning the use of e-cigarettes on hospital premises never made any sense. It’s encouraging therefore to see more trusts amending their policies to allow vaping on site and even in hospital buildings.

Adopting a more sensible approach to vaping does not however justify further restrictions on smoking. Hospitals can be stressful places and for some smokers – patients, visitors and even staff – a cigarette provides comfort at a difficult time. The NHS has a duty of care to protect people’s health but that doesn’t include the right to nag, cajole or bully smokers to quit or switch to a state approved e-cigarette.

Just as bad is the despicable threat to punish staff who enable patients to smoke outside hospital buildings. In theory this could result in a member of staff, with years of dedicated service to their name, being disciplined because, with the best of intentions, they assisted or turned a blind eye to a patient who wanted to smoke and whose immediate mental well-being may have been helped by being allowed to have a cigarette.

The level of pettiness is such that smoking is not only prohibited outside the majority of hospital buildings but even in hospital car parks and private vehicles while they are on NHS sites. Common sense and decency are being sacrificed on the altar of ‘public’ health. Increasingly, it seems, hospitals are in the hands of tick-boxing bureaucrats with little empathy and no compassion for those who don’t conform to today’s anti-smoking orthodoxy.

To download the full report click here.

Update: I have just taken a call from BBC Look North. From today, No Smoking Day, Hull Royal Infirmary will ‘strictly enforce’ its no smoking policy.

Smokers are being escorted off the grounds to public roads and in one case, according to the BBC, the police were called to escort somebody off the premises.

Think about that for a moment. As if the police have nothing better to do, someone working for our caring, compassionate NHS has called the boys in blue even though it is not illegal to smoke on hospital grounds.

Wednesday
Mar132019

Managing the news

Happy No Smoking Day to all my readers!

I hope you'll join me (in spirit) when I light up later today. (I'm currently in Cardiff looking for venues with a smoking terrace.)

Quick update on Forest's hospital smoking/vaping report (Prejudice and Prohibition). Given Brexit I think we did pretty well to get the coverage we did. To the list I reported on Monday I can also add the Telegraph (print edition).

Meanwhile Rob Lyons has written an excellent article for Spiked. See Why we should allow smoking in hospitals: patients are meant to be treated not bullied over their ‘bad habits’.

The New Nicotine Alliance has also posted a piece on its blog – Government messages are still not getting through to NHS trusts.

I was amused too to see that the vaping company Totally Wicked reported our findings on its website (55% of hospitals ban vaping on their grounds) without mentioning or crediting Forest for the data.

The reason our press release – and the subsequent media reports – led with the issue of vaping is because in this context it’s far more newsworthy.

Had we issued a press release headlined '76 per cent of NHS hospital trusts ban smoking' few journalists would have considered that news and the report would have disappeared without trace.

It's called news management.

Nevertheless the war on smoking remains our principal concern and this afternoon I’ll post the foreword to the report which makes it pretty clear where our priorities lie.

Monday
Mar112019

New report: smoking and vaping policies in NHS hospital trusts

Brexit will dominate the news this week so today may not be the best moment for Forest to publish a new report.

Nonetheless the snappily-titled ‘Prejudice and Prohibition: Results of a study of smoking and vaping policies on NHS hospital trusts in England’ is topical for two reasons.

One, it’s No Smoking Day on Wednesday.

Two, on Friday (March 15) Labour MP Tracy Brabin will present the second reading of the Smoking Prohibition (National Health Service Premises) Bill.

Researched and written by Mark Tovey, Prejudice and Prohibition is based on data gathered via a series of Freedom of Information requests sent to 200 NHS trusts in England.

The 64-page report summarises the policies that regulate smoking and vaping in the 170 trusts that responded and how their policies may change in 2019.

The key findings were:


Smoking

  • Three quarters (76 per cent) of the 170 responding trusts said they did not tolerate smoking anywhere on hospital grounds.
  • 94 per cent did not tolerate smoking even in their car parks.
  • Four in five (79 per cent) prohibited smoking in private vehicles on site.
  • Smoking shelters were provided by one in five trusts (78 per cent).
  • 18 trusts (10 per cent) plan to tighten restrictions on smoking in 2019 by removing smoking shelters and extending no-smoking areas.

Vaping

  • The use of e-cigarettes was prohibited by 55 per cent of NHS trusts.
  • Mental health trusts were more tolerant of vaping with 65 per cent allowing the use of e-cigarettes compared with 39 per cent of acute (hospital) trusts.

  • 24 trusts (14 per cent) said they planned to amend their policies in 2019 to lift restrictions on vaping.

Enforcement

  • Of the 170 trusts that responded to the survey 88 per cent said they used signage to enforce smoke-free policies.
  • 34 per cent expected medics, nurses, kitchen workers and other staff to act as enforcers.

  • 32 per cent said they had installed shame-a-smoker buttons that members of the public could press to trigger anti-smoking messages to play over public address systems.
  • 18 per cent said they used security guards to do walk-arounds and provide support to other members of staff when they got into trouble confronting smokers.
  • 14 per cent said they used CCTV to monitor smokers and vapers, twelve per cent said they provided advice and nicotine withdrawal therapy to keep patients from violating their smoke-free policies.
  • 9 per cent said they used leaflets, information on patient appointment letters and welcome pack literature to spread information.
  • 8 per cent said staff could face disciplinary action if they violated their policies or assisted patients in doing so.
  • 2 per cent said they reserved the right to confiscate smoking and vaping equipment from anyone caught using combustible or electronic cigarettes.

The report concludes with these recommendations:

  • NHS hospital trusts should permit vaping in all outdoor areas.
  • The use of e-cigarettes should be allowed inside hospital buildings (including wards) at the discretion of hospital management.


  • Individual trusts should be allowed to devise policies on smoking in outdoor areas that best suit their patients, visitors and staff.


  • Options should include designated smoking areas, designated smoking shelters or no restrictions on smoking in the open air.

  • Smokers should be incentivised to smoke away from hospital entrances with the provision of comfortable smoking shelters, clearly signposted.

  • Where smoking bans are in place trusts must take steps not to discriminate against patients who are infirm or dependent on others to accompany them off site to smoke.

To read the press release click here.

To download the full report, click here.

Update: Yesterday I did a recorded interview for Global Radio, a soundbite from which may (or may not) be included in the news bulletins this morning. I shall also be talking about the issue with Nick Ferrari on LBC at 8.50.

The Press Association has covered the report so it's getting quite a lot of coverage online. See, for example, these PA-based reports on ITV News, Mail Online and Metro.

The Sun has put its own spin on the report here.

Saturday
Mar092019

My week

Quick recap on the week.

It kicked off on Sunday with a call by the All Party Parliamentary Group on Smoking and Health - run by ASH - for an increase in the legal age for purchasing tobacco from 18 to 21.

We came late to the story - I think it must have been given to the Observer as an exclusive - but Forest’s reaction was subsequently picked up by the Press Association which led to us being quoted by the Daily Mail, Metro and a number of local papers online including the Manchester Evening News, Belfast Telegraph and several more.

It was then reported that the Scottish Government is to consider the same measure, conjuring up images of a race between Westminster and Holyrood although, to be fair, the UK Government has so far shown no appetite to introduce the policy.

Anyway, I was subsequently interviewed on BBC Radio Scotland alongside Deborah Arnott of ASH and quoted by The Times (Scotland), the Herald, Scotsman and Scottish Daily Mail.

There was also a story in Dundee about Ninewells Hospital using children's voices to ‘encourage’ people not to smoke outside the hospital entrance. The children concerned are aged 9, 10, and 12.

My reaction - I described the initiative as “Orwellian” and “emotional blackmail” - was reported by the Scottish Daily Mail and Dundee Evening Telegraph.

While all this has been going on we have been busy disseminating a new report.

I can’t say more because it’s under embargo but it’s a substantial document that has taken the best part of six months to put together. I’ll reveal all on Monday.

Meanwhile, here's that report in The Times.

Tuesday
Mar052019

Double standards and the futility of making personal attacks on journalists

The Telegraph has just published a series of articles attacking e-cigarettes.

All bar one is behind a paywall but the headlines tell you all you need to know.

On Friday one read 'Instagram promoting vape products to children as young as 13, Telegraph investigation finds'. 

Another reported 'Children as young as 14 are becoming addicted to e-cigarettes, head of Britain’s biggest addiction clinic says'.

On Saturday the paper ran two further reports. One was headlined 'Tobacco companies are using e-cigarettes as a 'Trojan Horse', experts warn'.

The second ('E-cigarettes are creating a generation of nicotine addicts, top scientists warn') started reasonably but then took a more propagandist turn:

E-cigarettes are hotly debated by health experts, with some viewing them as an effective quit smoking device while others are concerned that they have become a popular accessory for young people.

PHE has thrown its weight behind vaping and maintains that it is “95 per cent” less harmful than smoking, a position it took in 2015.

But academics have told the Daily Telegraph that this figure is “simply not credible”, as they say that “very clear picture is emerging” about the dangers that e-cigarettes pose, particularly for young people.

The ‘top scientists/academics’ quoted by the paper were ‘prominent tobacco control activist’ Prof Stanton Glantz, director of the Center for Tobacco Control Research and Education at California University; Prof Simon Capewell, ‘an expert in public health’ at Liverpool University; Prof Martin McKee, ‘an expert in European public health’ at the London School of Hygiene and Tropical Medicine; Prof John Ashton, former president of the Faculty of Public Health; Dr Gabriel Scally, president of epidemiology and public health at the Royal Society of Medicine; and Mike Daube, emeritus professor of health policy at Curtin University in Perth, Australia.

All these names will be familiar to anyone who has followed the war on smoking for the past two decades. The irony is that I don’t recall many (if any) of the current cheerleaders for vaping criticising them for their repeated fearmongering about the dangers of smoking.

As I have stated many times, I accept that on current evidence the health risks of smoking and vaping are miles apart. Nevertheless, if Glantz, Capewell, McKee, Scally etc can be so wrong about vaping, surely that should prompt a review of some of their more exaggerated claims about smoking, the dangers of 'passive' smoking in particular?

Apparently not.

The same people who are castigating these 'top scientists' for their views on vaping are quite happy it seems to accept without quibble all their claims about smoking.

Double standards?

Meanwhile, another story that broke on Saturday evening was first posted on the Guardian website. Written by Observer journalist Jamie Doward, a regular conduit for ASH-inspired stories, it was headlined 'MPs call for legal smoking age to be raised to 21', and began as follows:

Smokers will be banned from buying cigarettes until they are 21 as part of measures to improve public health being considered by the government.

An influential cross-party group of MPs has proposed raising the minimum smoking age and introducing a levy on big tobacco companies to fund measures to encourage people to quit and to prevent youngsters taking up the habit.

The parliamentary group on smoking and health, backed by 17 health charities and medical organisations, also wants to tighten the rules on showing smoking on TV and in films.

I came late to the story because I was away but I subsequently sent a quote to the Press Association that was picked up by a number of newspapers online including the Daily Mail:

“These proposals infantilise young adults. If you’re 18 and old enough to vote, drive a car and join the army you’re old enough to make an informed decision to smoke.”

(For Forest’s full response click here.)

Needless to say there has been barely a peep about the APPG’s proposals from vaping advocates, most of whom are so deeply aligned with today's anti-smoking agenda that they fail to see that every tobacco control policy will, sooner or later, be used to combat the use of e-cigarettes.

Anyway, back to the Telegraph. The common link between those anti-vaping reports was education editor Camilla Turner, not science editor Sarah Knapton who has been the subject of repeated abuse from vapers and vaping advocates on social media.

I’m not defending Knapton but attacking journalists is rarely the way to win friends and allies. As I wrote here (Rough guide to dealing with the media):

I know what it is to metaphorically bang your head against a brick wall. It's incredibly frustrating when reports are published that appear one-sided, factually incorrect or both. I've experienced this for many, many years. No-one, I believe, has more experience of the futility of engaging with certain journalists who are deaf to the likes of you and me. Nevertheless it must be done and my advice is that abusing individual journalists, often directly, on social media is wholly counter-productive.

Yes, it will make them aware of the extent of your anger and frustration but you can do that privately. It makes little sense to set the dogs on them, which is effectively what you're doing by encouraging others to steam in with similar comments of their own. Human nature is such that if people feel they are being bullied by a mob they will react negatively. The idea that they will suddenly choose to see your point of view is naive.

I'm not saying it's right that journalists don't check the facts or chase contrary viewpoints but it's no use taking it out on individual correspondents. Whatever the rights and wrongs of the report that offended the vaping community earlier this year, for example, some of the subsequent attacks on the Daily Telegraph's science editor Sarah Knapton were deplorable.

I'm not a conspiracy theorist so it's hard to say whether the persistent criticism of Sarah Knapton precipitated the recent flurry of anti-vaping reports in the Telegraph, but I can't imagine it helped.

If I was advising the vaping industry the first thing I would do is suggest a meeting with Knapton and Turner. I'd invite them to visit an R&D facility and they would be top of my list of potential guests to attend the UK Vaping Industry Forum in May.

In the meantime I'd advise the vaping community to stop making personal attacks on journalists. Human nature being what it is, it rarely ends well.

Thursday
Feb282019

Hockney: “I just need a cup of tea and a cigarette”

Early start (4.00am) to drive my daughter to Heathrow to catch a flight to New Orleans.

Returning home I listened to David Hockney being interviewed by James Naughtie for the Today programme.

They were in Amsterdam for the opening of an exhibition featuring the works of Britain’s greatest living artist and Vincent Van Gogh.

As luck would have it, Hockney and Naughtie were in a group of ten people who got stuck in a lift in an Amsterdam hotel before the opening of the exhibition.

According to the Guardian:

The incident happened when the 81-year-old artist was heading for a cigarette, before being interviewed for the BBC Radio 4 Today programme.

Too many people tried to get into the lift at Amsterdam’s Conservatorium hotel – not helped by some journalists who were carrying heavy cameras and microphones – which then became stuck ...

After about 30 minutes, Hockney and the others, who told jokes to keep spirits up, were released.

Hockney – cigarette in hand and desperate for a smoke – cheerfully posed for photographs with his rescuers afterwards. He also asked for a cup of tea.

The report also referred to ‘the next chapter in his life beginning this weekend’:

“I’m just going to Normandy because we’ve got a house there,” he said. “It is surrounded by trees, it is going to be marvellous for me because I’ve got a new location and I’ll draw it.

“I can’t think of anything better in life than watching the spring happen in Normandy in 2019, I mean what better thing can I do? I can’t think of anything. Van Gogh would love it.”

Hockney returned to his adopted home city of Los Angeles after several years painting the Yorkshire Wolds. Asked if he might return to paint Britain, he was dismissive. “I’ve no plans. Not at the moment. I think France is a lot more smoker-friendly … I take that into consideration as well.”

The Daily Mail, whose editor Geordie Greg was credited by the Guardian as the man who got the hotel to call firefighters to release the group, devoted the whole of page three to the incident.

Hockney, the paper noted, seemed none the worse for his ordeal:

He was offered a glass of whisky to help him recover but simply said: “No, no, a nice cup of Yorkshire tea would be perfect. I feel fine, I just need a cigarette.”

He’s not alone.

Update: Just published, Smoking with David Hockney. Some great quotes.

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