The Royal Society of Public Health (RSPH) today released a policy paper in response to an undercover investigation that has seemingly identified that nine out of ten vape shops are knowingly selling to non-smokers. The basis of this 'news' is found in the IBVTA Code of Conduct with focus on item three:
Vape products are for current or former smokers and existing users of vaping devices, therefore never knowingly sell to anyone who is not a current or former smoker, or a current vaper.
At the end of 2016 NNA joined forces with NCSCT to produce a series of videos about different aspects of vaping. The first one, 'The Switch', is now available to watch on the NCSCT YouTube channel where you will also find additional videos of each vaper talking about their individual experience of switching from smoking to vaping.
A study into how e-cigarettes can help stop people relapsing after giving up smoking is looking for volunteers.
Researchers are calling for the help of people who have previously used e-cigarettes to give up smoking, in a bid to better understand their effectiveness and inform future ‘stop smoking’ initiatives.
The study, taking place at the University of East Anglia (UEA) Norwich Medical School and funded by Cancer Research UK, requires members of the public who have quit with the help of e-cigarettes and have either stayed stopped, or gone back to smoking.
Dr Caitlin Notley from UEA’s Norwich Medical School said: “Tobacco smoking remains the leading preventable cause of death worldwide, and up to two thirds of long-term smokers will die of a smoking-related disease.
“But the risk can be considerably reduced by stopping smoking, and staying stopped. We need the help of people who have used e-cigarettes, so that we can better understand how they might be used most effectively in the future.”
Amongst all quitters, 90 per cent of attempts to stop smoking end in relapse. In recent years e-cigarette use has boomed, and previous studies have shown many people use them to either cut down or stop smoking entirely. However, a recent survey showed up to 63 per cent of them went back to smoking.
Dr Notley said: “It appears that e-cigarettes have significant potential to aid smoking cessation, and recent evidence suggests they are as effective or more effective than nicotine replacement therapy. But we still know very little about people in the general population who quit smoking using an e-cigarette and their eventual relapse status. We need the help of the public to understand this better. Our ultimate aim is to develop guidance for health professionals so that they can advise people how best to use e cigarettes in the long term, if that is their choice, to stay stopped from smoking”
Volunteers will be interviewed by phone or in person about their experiences of using e-cigarettes for stopping smoking and, if they relapsed, about going back to smoking.
Volunteers can also take part in an online version of the interview if they would prefer.
Dr Notley said: “This study will provide much needed qualitative evidence on e-cigarette use in relation to smoking relapse. This is essential to inform future development of e-cigarette-based smoking relapse prevention interventions. Our findings will be important for policy and practice recommendations, in particular to Stop Smoking services about the best way to advise members of the public wishing to remain stopped from smoking with the assistance of e-cigarettes.”
James Wade, lead advisor at Smoke Free Norfolk, said: “Smokefree Norfolk would like to support those participants who want to quit smoking with the aid of E-Cigarettes. There is still benefit to having the behavioural support alongside the use of the E-Cigarette. So if any participants are attempting to stop smoking with the use of EC and would like support then please contact us on 0800 0854 113.”
The EU Commission is currently consulting on a revision to the Tobacco Excise Directive, which could see reduced risk products such as e-cigarettes being included. Our associate Clive Bates has written an in depth briefing together with NNA which details why this is a very bad idea. The full briefing can be read here. The consultation can be found here.
There is no case on principled or practical grounds to apply excise duties to vaping products and other products that offer a much safer alternative to smoking. The value to health and wellbeing associated with switching from smoking to vaping will exceed any benefits arising from revenue collection.
Just as it was with the Tobacco Products Directive, the inclusion of products which do not contain tobacco in the Tobacco Excise Directive is unhelpful and risks creating confusion in the minds of consumers.
If vapour and other reduced risk products are to be included in the directive then our view is as follows:
Excise policies on reduced risk products can have a significant negative impact for human health and is inconsistent with EU requirements to make policy with a high level of health protection.
The EU principle of 'non-discrimination' requires that products with very different characteristics are not treated in the same way - the vast difference in health risks means that reduced risk products must have zero or very low taxation relative to smoked tobacco products.
There is an opportunity to create a regime which will incentivise use of the safer products.
The risk is that poor policy will reduce this incentive, and so protect the market for smoked tobacco products.
Excise duty is a 'sin tax' and switching to low risk products is a virtue to be encouraged, not a sin to be taxed.
Our recommendations for low risk non combustible products are as follows:
If they are included in the directive then a zero rate duty must be allowed.
There should be a maximum rate set which reflects the very substantial difference in risk compared to smoked tobacco.
We urge the European Commission, European Council and member state tax authorities to take great care in striking the balance between public health, revenue raising and administrative costs. The institutions involved should conduct thorough impact assessments, take a hard look at the risks of causing harm to health and then think again about imposing excise duties on products that are already helping millions of Europeans to improve their health and wellbeing and have the potential to help millions more.
A group of internationally renowned nicotine and tobacco experts including our Chair, Gerry Stimson, have written to the Swedish Government asking it to present the evidence on the opportunity that snus represents, to reduce the harm of tobacco smoking:
Snus and Sweden’s unique responsibility and opportunity
We are writing as independent public health specialiststo noteone of Sweden’s great health successes and indicate the urgency to communicate this internationally. That success is the widespread use of low‐risk oral tobacco (snus) to quit smoking and as an alternative to high‐risk tobacco in cigarettes. To external observers, Sweden has achieved notable success in reducing tobacco-related harm.
Given its contribution to better public health in Sweden, evidence-based information on snus should be shared. States which have ratified the WHO Framework Convention on Tobacco Control gather soon at the biennial Conference of Parties (COP7) in New Delhi, November 7-12, 2016. This is an opportunity for the Swedish government delegation to lead the discussion onpractical ways of further reducing the harms caused by smoking cigarettes.
Sweden’s unique health success.Swedenhas the lowest rate of smoking in Europe at 11%, compared with the EU average of 26% . The recent UK Royal College of Physicians report  notes the contribution of snus to reducing smoking prevalence in Sweden. The mortality attributable to tobacco among men is lower in Sweden than in any other EU Member State and the use of snus has been an important contributor to this situation [3,4]. The risks associated with snus are of the order of 95% to 99% lower than for smoking, hence the reduced burden of tobacco related disease (cancers, COPD, cardiovascular disease).
Tobacco harm reduction.Snus is a popular and acceptable alternative to smoking tobacco among Swedish men. It is a proof of the concept that safer nicotine products are attractive to smokers, and that tobacco harm reduction approaches have a significant role to play in helping people to switch from smoking, or to avoid smoking in the first place. It complements other tobacco control initiatives. Data from Norway show similar health gains since snus has become popular .
Harm reduction is mandated in the Framework Convention on Tobacco Control.Three separate strategies are mandated in the English original of FCTC Art 1d  which states that “tobacco control” means a range of supply, demand and harm reduction strategies’. So far, Harm Reduction has been neglected by the WHO FCTC secretariat and member states. Promoting complete bans on smokeless products and other nicotine products, or overly restricting and regulating them, as seems to be the current ambition of the COP/FCTC, will cause harm instead of reducing harm.
Swedish snus can be produced at a fraction of the cost of other reduced risk nicotine products such as e-cigarettes. This indicates the very large potential for this intervention to reduce smoking in Low and Middle Income Countries. It isregrettable that at the last Conference of the Parties in 2014 (COP6), Sweden signed a declaration that incorrectly equates the dangers of Asian and Africansmokeless products (which can pose serious health risks though less than those of smoked tobacco)with the significantly saferSwedish snus.
As external experts we are surprised by the reluctance of the Swedish government to acknowledge the contribution of snus to improving public health. It is in the interest of public health to provide accurate information to smokers that if they switch to snus, they will dramatically reduce risks to their health . We encouragethe Swedish medical communities and the Public Health Agencyto publicise the Swedish experience and encourage the Swedish government at COP7 to present the evidence that snus represents animportant and possibly unprecedented opportunity to reduce the toll of smoking related death and disease.
Despite current tobacco control efforts, smoking is increasing globally. The Swedish government has the opportunity in New Delhi to show that there are effective and acceptable alternatives that can be used to help bring about an end to smoking.
 Eurobarometer (2014) Special Eurobarometer 429. Attitudes of Europeans towards Tobacco (Published May 2015)
 Royal College of Physicians (2016) Nicotine without smoke: Tobacco harm reduction
 Gartner CE, Hall WH, Vos TH, Bertram MY, Wallace AL, Lim SS (2007) Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study. Lancet, 369: 2010-2014. 10.1016/S0140-6736(07)60677-1.
 RamströmL, Wikmans T (2014)Mortality attributable to tobacco among men in Sweden and other European countries: an analysis of data in a WHO report,Tobacco Induced Diseases, 12:14
Past Chair of the Swedish Medical Association and the World Medical Association, past President of the Swedish Red Cross and the Swedish Confederation of Professional Associations, Stockhol, Sweden
Gerry V. Stimson
Emeritus Professor, Imperial College, London; Honorary Professor, London School of Hygiene and Tropical Medicine, United Kingdom
The Nigel Gray Distinguished Fellow in Cancer Prevention at The Cancer Council Victoria, Australia
Principal Investigator, Fagerström Consulting, Helsingborg, Sweden
Senior Research Rellow, The University of Queensland, School of Public Health, Brisbane, Australia
Emeritus Professor,Department of Epidemiology and Public Health, University College London, UK
Lynn T. Kozlowski
Professor of Community Health and Health Behavior, School of Public Health & Health Professions, University at Buffalo, State University of New York, USA
Jacques Le Houezec
Consultant in Public Health, Tobacco dependence, Rennes, France
Karl E Lund
Research Director - Tobacco, Department of Substance Use, Norwegian Institute of Public Health, Norway
Principal Investigator, Institute for Tobacco Studies, Täby, Sweden
Adjunct Professor, Faculty of Law, University of Ottawa; Centre for Health Law, Policy & Ethics, University of Ottawa; Honorary (Consultant) Assistant Professor, University of Nottingham. UK; Legal Counsel, Non-Smokers’ Rights Association, 1983-2005. Canada
Professor of Clinical Psychology Queen Mary University of London, United Kingdom
Professor of Public Health, Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
Professor, Edmund J Safra Professor ofNeuropsychopharmacologyHead of the Department ofNeuropsychopharmacology and MolecularImagingImperial College London,United Kingdom
Professor of Internal Medicine, Director of the Institute for InternalMedicine and Clinical Immunology,University of Catania, Italy
Onassis Cardiac Surgery Greece, Department of Pharmacology, University of Patras, Greece
Director, Counterfactual Consulting Limited; Former Director Action on Smoking and Health UK (1997-2003), London, United Kingdom
Testimony to the Norwegian Parliament on the relative risk of snus from Professor Anders Milton, ex President of the World Medical Association.
The Freedom Association's Freedom to Vape Campaign has today released a report detailing the vaping policies of 386 of the UK's 417 local authorities. The report makes very grim reading.
Despite the fact that there are no known harms to bystanders from the aerosol from vapour devices, and that many people are using them to quit smoking, only one council, Enfield, has a policy which encourages the use these devices, which are estimated to be a total least 95% safer than smoking tobacco cigarettes.
The key findings of the report are:
112 councils require vapers to use only the designated smoking areas to vape
335 councils have the same, or essentially the same policy for vaping as for smoking
1 council, the London Borough of Enfield, allows vaping indoors and actively encourages smokers to switch to vaping
3 councils allow vaping at desks but only because they don't have a policy
Clearly there are situations where for either operational, public image, or other reasons it may be inappropriate to allow staff to vape, but there is absolutely no excuse for a blanket ban in line with smoking legislation, much less a policy which requires non smokers or those trying to quit with vapour devices to go to a smoking shelter to vape. Indeed on that subject Public Health England says the following:
"It is never acceptable to require vapers to share the same outdoor space with smokers. Where a designated outdoor smoking area has been provided in a public place or workplace, vapers should be allowed to vape elsewhere."
Make clear the distinction between vaping and smoking
Ensure policies are informed by the evidence on health risks to bystanders
Identify and manage risks of uptake by children's and young people
Support smokers to stop smoking and stay smokefree
Support compliance with smokefree law and policies
The policies set by the vast majority of local authorities in the UK ignore some or all of the recommendations by Public Health England, have no justification and will discourage people from switching from smoking to vaping. This is unacceptable. The Freedom Association report includes a handy list of local authorities and their policies - we suggest you locate yours and write them a polite and appropriate letter. If you live in the London Borough of Enfield please write to them to congratulate them for being a beacon of common sense in a sea of lazy thinking. The full report is available here.
Update: our friends at Vapers in Power have made it easy for you to do just that:
INNCO global members support UKCTAS in their critique of the WHO FCTC policy on e-cigarettes.
Today, the International Network of Nicotine Consumer Organisations (INNCO) added its support to a critical report released this morning by leading academics attached to the UK Centre for Tobacco and Alcohol Studies (UKCTAS), in response to the WHO’s FCTC latest report on e-cigarettes (or ENDS as the WHO inexplicably insist on calling them).
The report by the WHO forms the basis for discussions at the forthcoming Conference of the Parties (COP7) in Delhi 7-12 November on the global Framework Convention on Tobacco Control (FCTC). The FCTC’s 180 signatories will decide on future global policy relating to cigarettes and other combustible tobacco products, smokeless tobacco and e-cigarettes.
The last EU meeting to finalise the collective 28-member EU position on e-cigarettes took place earlier this week in Brussels.
Atakan Befrits, INNCO’s press officer said “Reports suggest the EU statement will not contain any positive statements on the risk reduction e-cigarettes offer for smokers, despite recent evidence reviews by Public Health England and the Royal College of Physicians that showed enormous benefits for those who switch”.
INNCO called upon all EU Ministers of Health to give immediate attention to the issues raised in the UKCTAS critique of the WHO report, stating - It is important that the EU collective response to e-cigarettes reflects the positive health benefits conferred on smokers who switch to safer nicotine products and these benefits, as well as potential risks, are assessed objectively.
Judy Gibson, the Steering Group Coordinator of INNCO said “The WHO’s current policy on e-cigarettes is more likely to endanger public health instead of improving it. Once again the WHO remains resolute in refusing to acknowledge scientific evidence and opinions from the world’s leading experts in tobacco addiction. This needs to change - now."
In preparation for the Conference of the Parties of the Framework Convention on Tobacco Control meeting in India next month a report was prepared for WHO on Electronic Nicotine Delivery Devices (ENDS) and related products. The report is available online at: http://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf
John Britton, director of the UK Centre for Tobacco and Alcohol Studies, together with colleagues has prepared a response to the WHO report, which can be read in full here.
John Britton said: "In our view the WHO report takes a somewhat unbalanced view of ENDS, in particular by failing to consider or discuss the potential of these products to complement tobacco control policy by providing smokers who have proved unwilling or unable to quit smoking with an effective and far less harmful means of consuming nicotine. Experience in the UK indicates that the availability of electronic cigarettes is proving beneficial to public health. It is important that these benefits, as well as potential risks, are assessed objectively in the formulation of WHO policy."
Let's hope that that is a message that the UK delegation, whoever they may be, will take to COP7.
Top Scientists Hire Libel Lawyers To Sue The Times - full press release issued by the claimants.
The Times had accused scientists devoted to ending smoking of being in the pay of big tobacco companies
The newspaper has already been forced to publish a detailed apology to one of the experts it named
Cancer Research UK has refused to back The Times’ description of the charity’s viewpoint
A group of senior scientists and public health experts has hired libel specialists at Lewis Silkin to sue The Times for making highly defamatory allegations.
The experts who have devoted their careers to helping to reduce the death toll from smoking, were accused by the paper of being in the pay of tobacco companies. On Wednesday 12 October 2016 under the headline “Tobacco giants fund vaping studies”
The Times wrongly accused the experts of accepting money from the tobacco companies for their work and castigated them as being “Experts making a packet” The Times has already withdrawn that description and apologised to one of the experts it defamed - the former head of Action on Smoking and Health, Clive Bates.
Yet it has not apologised to any of the other experts whom it falsely accused of accepting “tens of thousands of pounds from tobacco companies to carry out research into e-cigarettes”
The Times story led its coverage with the claim that Cancer Research UK had “condemned the scientists” for allegedly taking funding for vaping research. However Cancer Research UK’s Tobacco Control Manager George Butterworth has refused to support The Times report saying that “we don’t condemn any researchers.”
“This is personal,” said Professor Karl Fagerstrom who is world famous in addiction science, and created the Fagerstrom Test for Cigarette Dependence.
“My life’s work has been built on helping reduce the death toll from tobacco smoking. Yet The Times has portrayed me and my colleagues as hirelings of big tobacco. The Times has chosen to traduce our reputations. Now it is time for the paper to profusely apologise or face a battle it will not win,” said Professor Fagerstrom. The Times claimed that he had been paid for research on e-cigarettes. However Professor Fagerstrom has never done any research on e-cigarettes.
"We are some of the world’s best known experts on tobaccco harm reduction. Between us we have published more than 1,000 academic papers. Yet The Times has grotesquely smeared us in a story informed by the ideologue Martin McKee who has never published a single research paper on e-cigarettes” said Professor Riccardo Polosa one of the other academics accused by The Times of publishing e-cigarette research funded by tobacco money.
“The Times should examine carefully its motives for this scurrilous attack. Reducing the uptake of safer tobacco alternatives such as e-cigarettes and snus will inevitably result in more deaths from real cigarettes, currently the biggest killer in the world today. Is this really what they want?” asked Professor David Nutt of Imperial College London who was the lead author of a seminal study that which endorsed e-cigarettes and other forms of tobacco harm reduction. The Times suggested this report was tainted by tobacco money.
Yet the biggest mistake by The Times was not to research the background of the other expert it attacked - Professor David Sweanor of the Centre for Health Law, Policy and Ethics at the University of Ottawa. As well as being a distinguished public health academic and longstanding anti-smoking activist, he is a philanthropist with a fortune made from lawsuits against tobacco companies.
“My reputation has been trashed by The Times. Despite ample evidence of my independence it claimed that I am beholden to big tobacco companies. It is like saying that Robin Hood was in the pay of the Sheriff of Nottingham. I have to fight this,” added Professor Sweanor.
Jonathan Coad, the partner at Lewis Silkin who will be doing the work said; “The long record of irresponsible journalism about matters of grave public interest on the part of this discredited newspaper group continues , as does the failure of IPSO to properly regulate the British press.”
Over the weekend of 14th October, 'Vaper Expo, The Return' saw two NNA Trustees - Dave Dorn and Andy Morrison - address the expo-goers from the main stage. They spoke about how much we need vaper support, A Billion Lives and other matters that really need vapers to get behind and lend their voices and support.
Amazingly, though, the Vaper Expo organisers, who are very, very supportive of the work we do, arranged a donation of £3,300 to the NNA, an amount that will enable us to do much more good work.
At the same time Vapourtrails.tv ran two live shows and featured the work of the NNA extensively - Andy Morrison spoke and collected new sign-ups on their stand.
We are massively grateful to Vaper Expo for not only hosting us, but also raising so much awareness of the NNA - and the donation is gratefully received and will be faithfully applied.
NNA is very proud to be one of the founding members of a new international network of nicotine consumer organisations, INNCO.
Building on the successes achieved by EVUN in Europe, vaping advocacy has now gone global, in a bid to ensure that the voices of consumers are heard loud and clear, wherever they may be in the world.
In its first press release INNCO has criticised the World Health Organisation for its lack of transparency and refusal to engage with the most important stakeholders of all - consumers. Read the full press release here.
The risks and benefits of e‑cigarettes are uncertain but there is emerging evidence that e‑cigarette use may substantially reduce the burden of disease caused by smoking.
August 2nd saw the launch of a public consultation in New Zealand following a statement from the Ministry of Health:
The New Zealand Health Ministry recognises that the legal status of e‑cigarettes is confusing, that the laws are not routinely enforced, and that ‘There is emerging evidence that e‑cigarette use may substantially reduce the burden of disease caused by smoking’. Further, the Ministry of Health ‘proposes to make legislative changes that will maximise the potential benefits of e‑cigarettes and minimise potential risks to smokers and to the wider population.’
NNA have responded to the consultation, and you can read our full response here.
NNA (UK) strongly urge any vaper who has not submitted a response to the consultation to do so ahead of the closing date for submission - 5PM Monday 12 September 2016.
Yesterday NNA attended the National Symposium on e-cigarettes entitled "A new era for tobacco harm reduction", which was jointly organised by Public Health England and Cancer Research UK.
The symposium was very well attended with some 200 delegates including regulators, Directors of Public Health and various practitioners, researchers, consultants and representatives from numerous health interest groups and charities.
In the morning there were presentations from Alison Cox and Professor Linda Bauld from CRUK, Profs John Britton, Ray Niaura, Ann McNeill, Maciej Goniewicz (who now seems comfortable in his role of always being 'the baddy') and Peter Hajek. The afternoon brought presentations from Alette Addison of the Department of Health, Dr Debbie Robson of KCL, and finally a panel discussion which included our trustee, Lorien Jollye.
For avid followers of the vaping debate, most of the information presented was not new. However, as always with these events the real value is always in the bringing together of people, and the introduction of new people to the issues surrounding harm reduction and this event was no exception.
A range of issues were discussed, some of the more notable being the need to continue to build a good evidence base in the UK in order to be able to influence policy both here and abroad, the assertion by the department of health that the UK has already complied with the guidelines laid down by the World Health Organisation at COP6, and a plea from Dr Andy McEwen, that we take a realistic approach to research surrounding vapour products, and always involve the real experts, consumers, in study design and methodology.
Public Health England chose the symposium to launch their new framework guidance for policy making on the use of e-cigarettes in public places and work places, which can be downloaded here.
The new advice from Public Health England expands on the '5 questions' guidance offered by ASH together with the CIEH and makes clear the need for employers and the managers of public spaces to differentiate between vaping and smoking, and to support smokers who are using vapour products in order to stop smoking.
Overall, the feeling at the event was very positive towards the concept of harm reduction via the use of vapour products with very few dissenting voices. That is not to say that those voices do not exist, or that there is not still work to be done. But there were areas of broad agreement, and a willingness to at least talk about the matters on which there were differences of opinion.
In a vote taken at its annual conference the British Medical Association has called for a ban on vaping in public spaces such as bars and restaurants because of fears over renormalisation of smoking behaviour, and what they perceive as the 'risks of passive vaping'. This is despite the fact that there is no evidence at all, anywhere, that their fears have any foundation in reality.
Following a question about the UK's implementation of the TPD asked by Anne Main MP (Conservative member for St Albans) during Prime Ministers Questions David Cameron responded by saying that he would look into the legislation carefully. We felt that it was essential that Mr Cameron received an independent view of the failings of this particular piece of EU legislation and together with Clive Bates, NNA associate and director of Counterfactual Consulting, wrote to Mr Cameron accordingly. You can read our letter here.
Fatal Motion Tabled In House Of Lords To Stop E-Cigarette Regulations
A member of the House of Lords has today tabled a “fatal motion” designed to stop harsh restrictions on e-cigarettes becoming law. The provisions of Article 20 of the Tobacco Products Directive, which come into effecttomorrow, Friday, will be suspended if peers agree to the motion. (Order Paper)
It has been proposed by Lord Callanan who in 2013, as then leader of the ECR group in the European Parliament, led the successful vote by MEPs to prevent compulsory medicinal regulation of e-cigarettes. His move comes after the planned regulations came under intense criticism in a debate in the Lords last week.
Lord Callanan’s motion gives the Government the opportunity to address the remaining problems with the legislation.
These include the:
Ban on stronger nicotine e-cigarettes: Department of Health officials have said that this risks pushing vapers back to smoking. Some 252,000 vapers currently use the higher levels of nicotine which will be banned.
Ban on most advertising: the Department of Health estimates that 90% of e-cigarette advertising will be banned. However, last month the Royal College of Physicians called for e-cigarettes to instead be promoted “as widely as possible” as increasing numbers of smokers falsely believe that vaping is as dangerous as smoking.
Consumer advocates have welcomed the Parliamentary move: “the 2.8 million vapers in the UK will be thrilled if David Cameron takes this opportunity to remove the flaws in this EU regulation which would force so many vapers back to smoking,” said Sarah Jakes of the New Nicotine Alliance.
“Our network of shops are private sector stop smoking centres. The government estimates that the regulations could reduce the choice of products by 96%. It doesn’t take a genius to work out the consequences,” said Shayne Adams, of retail chain Flavour Vapour.
The needs of more than a quarter of a million people don't matter, according to ASH.
According to a report by Action on Smoking and Health (ASH) out today [link], the needs of 252,000 UK vapers don't matter because most people will only be mildly affected by the arbitrary restrictions imposed by article 20 of the TPD. That is a truly astounding attitude, especially in light of the fact that the expected reduction in smoking prevalence delivered by the entire TPD, including the tobacco provisions, is just 2% over 5 years, which in the UK translates to 183,000 people.