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.