Stubbing out the public health problem of an era | Blog piece by Tim Coleman | #myresearchlegend

Sir Richard Doll had an illustrious career. Through his efforts, the world learned much about the causes of cancer and the dangers of asbestos, radiation and, of course, smoking. Following his research into smoking and lung cancer during the 1950s, the realisation dawned that tobacco use was the public health problem of the era and not a harmless pastime. We all know what’s happened since. How many other 20th century epidemiologists have had such a transformative impact on peoples’ understanding of the determinants of disease?

myresearchlegendricharddollblog

To what extent do I consider Sir Richard Doll to be a research ‘legend’? I’m not sure I’ve earned the right to bestow that honour, so I’ve taken advice. The Cambridge English Dictionary says a ‘legend’ is “someone very famous and admired, usually because of their ability in a particular area”. Just considering the one area of Doll’s work emphasised above, this is a no-brainer; ‘legend’ threshold is clearly surpassed. Don’t take my word for this, though, Google ‘Richard Doll’ and see if you can find reason to disagree.

Am I hasty in allocating ‘legend’ status? Doll certainly changed the world’s knowledge of many illnesses; shouldn’t an NIHR research legend demonstrate clear NHS impact too? Fortunately Doll’s influence here doesn’t disappoint, even if one again only considers smoking. I am a GP. How would this be different if Sir Richard had never lived? Firstly, I’d probably smoke. A pipe would give me more gravitas than cigarettes and I’d have to either smoke in my consulting room, like some doctors did, or schedule regular ‘pipe breaks’ into my day. I would be blissfully ignorant about harms from smoking and more likely to offer patients cigarettes than help with stopping, even if they developed lung cancer or heart disease.

Smoking Kills

Thankfully, Sir Richard did exist. Although I tried smoking as a teenager, a friend’s mum made me think again and I didn’t ever fully adopt the habit. Immature, teenage me was saved from smoking because Doll had shown how harmful smoking is. Fast forward to my GP work in 2018; again due to Doll, I fully realise that smoking kills my patients and wrecks their lives.

crop.jpgAlso, due to research which was only possible because of his early work, I can offer smokers numerous types of cessation support. It’s even possible to refer on to Stop Smoking Services (SSS) for specialist help, though a major cloud on the horizon is that these vital services are no longer universal; they are endangered.

Through their work at the Statistical research Unit of the MRC, Doll and Hill demonstrated that smoking causes lung cancer; before this smoking was ubiquitous across social classes and many doctors smoked. By 1954, the government accepted the link and the middle classes started quitting in droves. When he died in 2005, Doll would very likely have been delighted that UK smoking rates were falling fast. However, improvements were chiefly amongst the better off, so smoking had become disproportionately concentrated amongst society’s poorest. Given his well-documented non-conformist views, my bet is that he would have been saddened that those with most to gain benefited least from such massive social change. Nevertheless, he might have been heartened by the government’s national and vigorous action against smoking. Back then, although SSS were a very new NHS entity, it was mandatory for Primary Care Trusts to deliver them and SSS were closely performance-managed by the then Department of Health. Any smoker could access services’ evidenced-based support to increase their chances of permanent cessation.

Smoking Prevention

Worldwide, legions of researchers, including me, have followed Doll by trying to find ways of treating or preventing smoking. Few epidemiologists have caused such a seismic shift in the international research agenda. Take a look at the thousands of randomised controlled trials (RCTs) reviewed in the tobacco section of the Cochrane Library. All of these studies test interventions against smoking. This necessary work continues today and NIHR is a leading supporter funding, for example, the largest ever RCTs of Nicotine Replacement Therapy used in pregnancy* or for ‘preloading’.

The NHS is 70. Celebrating research legends is a great idea but it’s important we remember what they did and why they are lauded. It took almost half a century after Doll and Hill’s landmark paper for the NHS to implement national treatment services for smokers, and sadly less than 20 years later these have become an optional extra with patchy coverage across the country. Smoking is less prevalent than in the past but there are still millions of UK citizens who want to stop and can’t manage this alone. Smoking is still a national problem and requires a national NHS response. A crucial component of this response should be to help quitters by giving them the very best support.

Sir Richard’s work has had a great impact, as all research should. The demise of SSS suggests we risk forgetting this when instead we should continue to build on his significant achievements.

*More information on the trial: Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy (NRT) in pregnancy – SNAP is available on the NIHR Journals Library website.

Tim Coleman, Professor of Primary Care, Faculty of Medicine & Health Sciences
University of Nottingham and NIHR Senior Investigator

The NIHR is highlighting seven research legends whose work has shaped the NHS, as part of its celebrations for the NHS’s 70th birthday and the NIHR’s I Am Research campaign.

Original post on NIHR website. – Posted: 04 May 2018

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Alcohol Policy in Practice | Continuing Professional Development Course | 11th-13th September 2018

Following the successful Alcohol CPD courses held in 2014-2017; we are delighted to announce the line-up for our 2018 course, featuring some exciting new inputs!

This year’s course will feature inputs from Prof. Anna Gilmore and colleagues from the University of Bath, Dr Carol Emslie from Glasgow Caledonian University, Dr James Nicholls from Alcohol Research UK, and Professor Karine Gallopel-Morvan from the EHESP School of Public Health, France. We also welcome the return of highly-rated inputs from leading experts such as Katherine Brown from the Institute of Alcohol Studies and Colin Shevills of Balance North East.

What previous participants said:

“Great range of content and world-class speakers. Organisers did an amazing job including looking after us all while we were here. The mix of lectures / Q & As / panel discussions was great. Really worth taking time away from work/home to attend this.”
“Extremely informative course and relevant to current alcohol policy challenges. Good venue, convenient location and lovely setting. Module well organised and brilliant range of speakers.”
“Thank you very much. It was a great privilege to listen and attend this course. Lectures and lecturers were outstanding.”
“Very informative useful training, well worth my time and travel.”
“Wonderful networking opportunity.”
“Thank you for such a brilliant training event – the content was spot on, all the presentations and sessions were really, really good and I came away feeling that I had learned masses: a rich diet of fact and opinion. I can honestly say that I have rarely – if ever – enjoyed such an event quite as much as this one.”

Anyone wishing to gain an in-depth understanding and up to date insight into evidence and innovative practice in alcohol policy in the UK and internationally.
Previous participants have included people working in public health, local and national alcohol policy, or alcohol research; from Iceland to New Zealand.
Places are filling up fast and the early-bird rate applies until Friday 15th June 2018! 

Apply Here!

UKCTAS welcome the introduction of Minimum Unit Pricing for alcohol in Scotland

It’s been a long road but doctors and health experts are finally welcoming a minimum unit price for alcohol as the pioneering law comes into force in Scotland. The new 50p floor price aims to tackle Scotland’s unhealthy relationship with drink by raising the cost of cheap,  ­high-strength products.

The Scottish ­Government warned retailers they will have no grace period to alter prices and shops will be targeted for spot checks.

Minimum pricing was delayed for a decade by opposition MSPs and a legal ­challenge led by the Scotch Whisky ­Association. Holyrood opponents eventually changed their minds and the Supreme Court upheld the ­legislation last November.

Research by Sheffield University suggested the 50p price floor will save 60 lives in its first year, rising to 300 lives a year after a decade.

If your drink of choice is already being sold for more than the minimum price, then it will likely remain unchanged. But if it is currently being sold for less than the minimum price, you can expect the cost to rise to at least the minimum level.

For example, if a 9.8 unit bottle of wine is currently being sold for £3.50 in your local supermarket, it will set you back at least £4.90.

Dr Peter Bennie, chairman of the British Medical Association in Scotland, said:

“It has been a long road but I am delighted that the ­persistence of alcohol campaigners, with strong BMA support, has paid off and minimum pricing has finally taken effect. 

Minimum unit pricing is a policy that will help to save lives and reduce alcohol harms in ­Scotland. It will help to reduce the burden of alcohol on our health service, on society, and most ­importantly on ­individuals and their families. 

This is an important milestone for Scotland. Other parts of the world will now be watching the implementation with great interest.”

Bennie said the alcohol industry discovered it cannot expect to block ­policies designed to protect health.

“Alcohol causes 1100 cases of cancer every year in ­Scotland. The less alcohol you drink, the lower your risk of cancer. A minimum unit price is one action among many that will help reduce how much alcohol is consumed in ­Scotland.”

Professor Linda Bauld, Deputy Director of UKCTAS

The law only covers Scotland, leading to ­loopholes for online purchases. Guidance last month stated that supermarket meal deals where wine is included are unlikely to be affected. Retailers are also advised that “click-and-collect” purchases won’t be covered by the law if cheap drinks are first sent from outside Scotland. Customers can buy over the internet or by phone from a business in England. A delivery firm down south would be allowed to send drink to customers in Scotland.

“I am proud the eyes of the world will once again be on Scotland with the introduction of this legislation.”

First Minister Nicola Sturgeon

“Scotland has the highest rate of alcohol-related deaths in the UK. I hope we will see that change.”

Health Secretary Shona Robison

Doctors and health experts welcome minimum pricing for alcohol as law comes into force – Daily Record

Minimum Unit Pricing implemented – WiredGov

Minimum unit pricing for alcohol: Everything you need to know – Edinburgh Evening News

New Publication from the Sheffield Alcohol Research Group: Model-based appraisal of the comparative impact of Minimum Unit Pricing and taxation policies in Wales

Three quarters of all alcohol consumed in Wales is drunk by less than a quarter of the adult population who are hazardous or harmful drinkers and spend up to £2,882 per year on booze, research has revealed.

A report looking into the potential impact of minimum unit pricing and taxation policies in Wales was published Thursday 22nd February by the Sheffield Alcohol Research Group at the University of Sheffield.

The publication, which found that the 3% of the population who are harmful drinkers, account for 27% of all alcohol consumed, comes after the Welsh Government announced a new Bill that, if agreed by the National Assembly, will introduce a minimum price for the sale of alcohol.

The Bill, which is designed to reduce hazardous and harmful drinking would make it an offence for alcohol to be supplied below that price.

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Health Secretary, Vaughan Gething said: “People who drink alcohol at hazardous and harmful levels drink 75% of the alcohol consumed in Wales.

“The introduction of a minimum unit price would be effective in reducing alcohol consumption among these groups, as well as reducing the number of alcohol-related deaths and hospitalisations.”

The availability of cheap, strong alcohol is estimated to lead to 50,000 alcohol-related hospital admissions a year, costing the Welsh NHS £120 million annually and, in 2015, there were 463 alcohol-related deaths in Wales.

The report reveals the population of Wales buys 50% of its alcohol for less than 55p per unit, 37% for less than 50p per unit and 27% for less than 45p per unit, with heavier drinkers being more likely to buy alcohol sold below these thresholds.

Mr Gething said: “The report shows the greatest impact of a minimum unit price would be on the most deprived harmful drinkers, while moderate drinkers would experience only small impacts on their alcohol consumption and spending.

“This is because moderate drinkers tend to buy alcohol which would be subject to little or no increase in price under the policy.

“If passed, this law will potentially save lives.”

The research also shows harmful drinkers spend an average £2,882 a year on alcohol, or around £7.80 per day, compared to £1,209 for hazardous drinkers and £276 for moderate drinkers.

The Sheffield Alcohol Research Group, commissioned by the Welsh Government in June 2017 to update a 2014 appraisal of the likely impact of a range of minimum unit pricing policies, concluded a minimum unit price set at between 35p and 70p would be effective in reducing alcohol consumption among hazardous and, particularly, harmful drinkers.

Research highlights:

  • Moderate drinkers drink an average of 211 units of alcohol per year compared to 1,236 for hazardous drinkers and 3,924 for harmful drinkers.
  • Harmful drinkers spend an average £2,882 a year on alcohol compared to £1,209 for hazardous drinkers and £276 for moderate drinkers.
  • Alcohol-attributable deaths and hospital admissions are concentrated in hazardous and particularly harmful drinkers who are more deprived.

External news coverage:

75% of alcohol in Wales is drunk by just over a fifth of the population according to new report – ITV News

Minimum alcohol price help call for ‘hazardous’ drinkers – BBC News

75% of alcohol drunk in Wales consumed by 22% of the population, report says – Guernsey Press

Nicotine & Tobacco: Current issues, Policy and Practice / 21st – 24th May 2018 / University of Stirling

Building on our previous CPD courses on tobacco control and alcohol policy, the UK Centre for Tobacco and Alcohol Studies is delighted to be offering our Nicotine & Tobacco CPD course at the University of Stirling in 2018!

Please note: If you book on/before 28th February 2018, the cost is: £499, or £649 for students seeking accreditation. 

The course, successfully introduced in 2015, is aimed at professionals working in a range of organisations who are interested in public health and policy in the UK or internationally. In addition to the topics covered at previous tobacco CPDs, this year we will be examining the current, up to date evidence on tobacco harm reduction, electronic cigarettes and other nicotine-containing devices.

On successful completion of the module, students will be able to:

• Describe and discuss patterns of tobacco consumption, prevalence and addiction and the rise of e-cigarette use.
• Assess key milestones in tobacco and nicotine policy and the contribution of policy in developing and implementing effective interventions.
• Critically discuss the role of commercial interests, including the tobacco industry, in promoting tobacco use and recent controversies regarding the e-cigarette industry.
• Describe and discuss the range of effective interventions to reduce tobacco use and the place of tobacco harm reduction, including e-cigarettes, in addressing tobacco use.
• Assess the potential impact of current and emerging tobacco control priorities on different population groups, including tobacco harm reduction approaches.
• Discuss principles of media advocacy as applied to current issues in tobacco control.


*NEW FOR 2018*

ADDITIONAL BREAKOUT SESSIONS RELEVANT TO INTERNATIONAL TOBACCO CONTROL!

TAXATION & ILLICIT TOBACCO
Deborah Arnott, Action on Smoking & Health (ASH)
SMOKELESS TOBACCO
Prof. Kamran Siddiqi, University of York
TOBACCO MARKETING
Crawford Moodie, University of Stirling

New Systematic Review: Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm

This systematic review, published in Alcohol and Alcoholism, assessed the effectiveness of mass media messages to reduce alcohol consumption and related harms. Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. This was the first comprehensive systematic review of evidence of the effectiveness of mass media to reduce alcohol consumption, allowing those who make decisions about whether and how to develop and implement such campaigns to do so informed by a synthesis of the evidence base.
a&a1The search produced 10,212 results and 24 studies were included in the review. Most of the campaigns used TV or radio in combination with other media channels. There was little evidence of reduction in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low.The evidence suggests mass media health campaigns about alcohol can be recalled by individuals and can achieve changes in knowledge, attitudes and beliefs about alcohol, based mainly on weak quality studies. Findings of studies that measured alcohol consumption suggest campaigns have not reduced consumption, although most did not state that they directly aim to do so.

The finding that campaigns can be recalled suggests appropriate media channels, targeting strategies, durations and intensities have been utilized to reach target audiences. These campaign characteristics were not always reported by studies so it is not possible to draw a link between types of campaign strategies and levels of recall or exposure. Recall of tobacco mass media campaigns has been shown to be positively associated with smoking cessation (Jepson et al., 2007) so the outcome may be an important first step towards subsequent behaviour change in populations.

Most campaigns that aimed to improve knowledge were shown to be effective. This was particularly evident in areas where knowledge was initially low, for example, knowledge of unit consumption guidelines and of the link between alcohol and cancer. Mass media can yield sustained knowledge, which may lay the groundwork for reductions in consumption that are achieved using other public health measures.

There was evidence of increases in information seeking and treatment seeking. However, alcohol campaigns have not presented the simple call to action of tobacco messages (‘quit’) or provided offers of tangible help such as ‘quitlines’. Furthermore, as alcohol support services have historically been aimed at very heavy drinkers there may be a perception that current services do not cater for those who drink less. Mass media might therefore have limited utility in promoting service uptake.

Most studies found no impact on alcohol consumption, consistent with the conclusion of a previous review that there should be modest expectations of behaviour change from such campaigns (Snyder et al., 2004). Longer term evaluations conducted following sustained and repeated exposure to campaigns might be expected to be better able to detect effects on behaviour. However, the relationship between tobacco mass media campaign duration and effectiveness has been difficult to gauge due to confounding influences and trends over time (Durkin et al., 2012). The context in which alcohol health promotion campaigns operate is particularly challenging because of the ubiquity and power of alcohol marketing (de Bruijn et al., 2016) and pro-alcohol cultural norms (Gordon et al., 2012). This is another key difference to tobacco, where health campaigns in recent years have run in a context where most tobacco marketing has been banned or strictly regulated and social norms have become increasingly anti-smoking. The current review found evidence of impact on short term intermediate outcomes, suggesting mass media can play a supportive role for other actions which are more likely to have an impact on behaviour. These might include price-based measures (Babor et al., 2010), advertising restrictions (Siegfried et al., 2014), limiting availability and access to alcohol (Anderson et al., 2009) with the targeting of high risk groups (Foxcroft et al., 2015).

Alcohol and Alcoholismhttps://doi.org/10.1093/alcalc/agx094
Published: 10 January 2018