Tag Archives: ‘may

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

One cigarette ‘may lead to habit for more than two-thirds of people’

More than two-thirds of people who try just one cigarette may go on to become regular smokers, new research suggests.

Researchers found that just over 60% of adults said they had tried a cigarette at some point in their lives, with almost 69% of those noting that they had, at least for a period, gone on to smoke cigarettes daily.

“[This shows] prevention, providing [fewer] opportunities or reasons for young people to try a cigarette, is a good idea,” said Peter Hajek, co-author of the research, from Queen Mary University of London.

The research, published in the journal Nicotine and Tobacco Research, is based on data pooled from eight surveys conducted since the year 2000, including three each from the UK and USA, and a further two studies from Australia and New Zealand.

Together, the surveys included more than 216,000 respondents, with between 50% and 82% saying that, after trying a cigarette, they had gone on to smoke on a daily basis – at least temporarily. Further analysis showed that, taken together, an estimated 68.9% of individuals smoked daily for a period after trying a cigarette.

The team also looked at whether the results were likely to be skewed by smokers being less likely to respond in surveys than non-smokers, but no strong effect was found. However, the authors note that the study also has other limitations, including that the findings are based on respondents self-reporting information, meaning the resulting figures are only an estimate.

“It is possible that somebody who is a lifetime non-smoker did try a cigarette when they were a kid but it didn’t make any impression on them, and they forgot it or don’t see that it is important enough to report,” said Hajek. But, he added, “I think even if you assume there is a recall issue and other things, you are talking about more than a 50% [conversion rate from trying a cigarette to daily smoking].”

Decline in British smoking since 1974

Hajek added that declining rates of smoking among younger people suggested that measures such as restrictions on sales and a shift away from portraying it as glamorous were having a positive effect. But, he noted, the influence of e-cigarettes should also be explored, since the decline in smoking rates in England has accelerated since the devices came onto the market.

Linda Bauld, professor of health policy at the University of Stirling, said the study highlighted the importance of preventing smoking in the first place.

“Tobacco use starts in childhood for two-thirds of smokers in the UK, and this study suggests that even trying a cigarette becomes regular use in most cases,” she said.

“Fortunately, in the UK, youth smoking rates continue to decline – but we shouldn’t be complacent,” she added, noting that according to recent figures every year approximately 200,000 children in the UK try cigarettes for the first time. According to recent reports, there were almost one billion smokers worldwide in 2015, with numbers expected to rise – despite a drop in prevalence – as the global population grows.

Global smoking prevalence

Bauld also agreed that the role of e-cigarettes merited further study, pointing out that while it had been assumed that experimentation with e-cigarettes would also lead to regular use, that does not appear to be the case. “

While rates of e-cigarette experimentation amongst young people have risen in recent years, rates of regular use in teenagers who have never smoked remain at well below 1%, she said. “We need to be clear about this distinction and keep our focus on doing everything we can to prevent smoking, which we know is deadly, rather than demonising vaping, which all the evidence suggests is a hugely less harmful behaviour.”

Victims of disgraced surgeon Ian Paterson ‘may have been missed’

More victims of a disgraced breast surgeon, who was jailed for 20 years for performing needless operations, could have been missed, campaigners have warned.

Cancer survivors operated on by Ian Paterson have called on his old employers – Heart of England NHS foundation trust (Heft) and the private healthcare provider Spire Healthcare – to ensure all former patients have been contacted.

This April Paterson was found guilty of 17 counts of wounding with intent after it was found that he had carried out needless surgery on patients. The NHS has so far paid out almost £10m in compensation to more than 250 of the surgeon’s patients, and Spire agreed in September to settle a further 750 cases.

This month the government announced an independent inquiry into Paterson’s malpractice and the wider lessons to be learned. It will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Deborah Douglas, who helps run the Breast Friends support group, said: “For me the big thing now is how many other people were affected. We want those facts – we want those figures.”

Douglas, who was “mutilated” by Paterson in a mastectomy operation, said she did not think the inquiry would uncover significant new information as it had no powers to compel people to give evidence. But she said it could provide a “step forward” if full statistics on patient numbers, both those still alive and those who had since died, came out as a result.

“The NHS have got some figures now. They have got the mastectomy figures,” she said. “In the private sector we haven’t got any figures. We haven’t got the data for those patients that were involved. What we have got is a promise that we will have those figures. And that would be a step forward.”

Reviews were carried out by Spire in 2014 and Heft in 2013, with the NHS hospital trust saying it had reviewed or cross-checked nearly 24,500 patient records to assess whether Paterson was involved in their care.

Douglas said she had regular communication from former patients of Paterson who had not been contacted by the NHS or Spire. “He was a general surgeon as well as a breast cancer surgeon. How many people out there, with wide local excisions, had recurrences and had secondary cancer?”

Heft said it had not contacted all patients who had had other breast operations by the surgeon, but in 2011 and again in 2016-17 it had reviewed samples of those who had had other breast cancer operations and “no concerns were identified”.

The trust said: “A review of the deceased patients cannot repair any damage that has already been caused, nor is it likely to inform the trust of anything that it is not already aware of or provide any tangible benefit to the survivors in this cohort.

“It is reasonable to assume there were similar deficiencies in the treatment of the deceased patients, which may have impacted adversely on their period of life without disease and their survival.”

During a seven-week trial this year, jurors heard that the surgeon had carried out “extensive, life-changing operations for no medically justifiable reason” on 10 patients between 1997 and 2011.

The court was told that Paterson regularly “miscoded” procedures, charging for more expensive treatment. He was accused of carrying out the often pointless surgery for “obscure motives”, which may have included a desire to earn extra money.

For several years before the trial, concerns had been raised about his practice of carrying out what he called “cleavage-saving mastectomies”, a controversial operation that left breast tissue behind for cosmetic reasons after the removal of cancerous cells. This method meant that the chances of a relapse within five years doubled.

Victims of disgraced surgeon Ian Paterson ‘may have been missed’

More victims of a disgraced breast surgeon, who was jailed for 20 years for performing needless operations, could have been missed, campaigners have warned.

Cancer survivors operated on by Ian Paterson have called on his old employers – Heart of England NHS foundation trust (Heft) and the private healthcare provider Spire Healthcare – to ensure all former patients have been contacted.

This April Paterson was found guilty of 17 counts of wounding with intent after it was found that he had carried out needless surgery on patients. The NHS has so far paid out almost £10m in compensation to more than 250 of the surgeon’s patients, and Spire agreed in September to settle a further 750 cases.

This month the government announced an independent inquiry into Paterson’s malpractice and the wider lessons to be learned. It will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Deborah Douglas, who helps run the Breast Friends support group, said: “For me the big thing now is how many other people were affected. We want those facts – we want those figures.”

Douglas, who was “mutilated” by Paterson in a mastectomy operation, said she did not think the inquiry would uncover significant new information as it had no powers to compel people to give evidence. But she said it could provide a “step forward” if full statistics on patient numbers, both those still alive and those who had since died, came out as a result.

“The NHS have got some figures now. They have got the mastectomy figures,” she said. “In the private sector we haven’t got any figures. We haven’t got the data for those patients that were involved. What we have got is a promise that we will have those figures. And that would be a step forward.”

Reviews were carried out by Spire in 2014 and Heft in 2013, with the NHS hospital trust saying it had reviewed or cross-checked nearly 24,500 patient records to assess whether Paterson was involved in their care.

Douglas said she had regular communication from former patients of Paterson who had not been contacted by the NHS or Spire. “He was a general surgeon as well as a breast cancer surgeon. How many people out there, with wide local excisions, had recurrences and had secondary cancer?”

Heft said it had not contacted all patients who had had other breast operations by the surgeon, but in 2011 and again in 2016-17 it had reviewed samples of those who had had other breast cancer operations and “no concerns were identified”.

The trust said: “A review of the deceased patients cannot repair any damage that has already been caused, nor is it likely to inform the trust of anything that it is not already aware of or provide any tangible benefit to the survivors in this cohort.

“It is reasonable to assume there were similar deficiencies in the treatment of the deceased patients, which may have impacted adversely on their period of life without disease and their survival.”

During a seven-week trial this year, jurors heard that the surgeon had carried out “extensive, life-changing operations for no medically justifiable reason” on 10 patients between 1997 and 2011.

The court was told that Paterson regularly “miscoded” procedures, charging for more expensive treatment. He was accused of carrying out the often pointless surgery for “obscure motives”, which may have included a desire to earn extra money.

For several years before the trial, concerns had been raised about his practice of carrying out what he called “cleavage-saving mastectomies”, a controversial operation that left breast tissue behind for cosmetic reasons after the removal of cancerous cells. This method meant that the chances of a relapse within five years doubled.

Victims of disgraced surgeon Ian Paterson ‘may have been missed’

More victims of a disgraced breast surgeon, who was jailed for 20 years for performing needless operations, could have been missed, campaigners have warned.

Cancer survivors operated on by Ian Paterson have called on his old employers – Heart of England NHS foundation trust (HEFT) and the private healthcare provider Spire Healthcare – to ensure all former patients have been contacted.

This April Paterson was found guilty of 17 counts of wounding with intent after it was found that he had carried out needless surgery on patients. The NHS has so far paid out almost £10m in compensation to more than 250 of the surgeon’s patients, and Spire agreed in September to settle a further 750 cases.

This month the government announced an independent inquiry into Paterson’s malpractice and the wider lessons to be learned. It will begin in January and report in the summer of 2019, and will be chaired by the Right Rev Graham James, the bishop of Norwich.

Deborah Douglas, who helps run the Breast Friends support group, said: “For me the big thing now is how many other people were affected. We want those facts – we want those figures.”

Douglas, who was “mutilated” by Paterson in a mastectomy operation, said she did not think the inquiry would uncover significant new information as it had no powers to compel people to give evidence. But she said it could provide a “step forward” if full statistics on patient numbers, both those still alive and those who had since died, came out as a result.

“The NHS have got some figures now. They have got the mastectomy figures,” she said. “In the private sector we haven’t got any figures. We haven’t got the data for those patients that were involved. What we have got is a promise that we will have those figures. And that would be a step forward.”

Reviews were carried out by Spire in 2014 and HEFT in 2013, with the NHS hospital trust saying it had reviewed or cross-checked nearly 24,500 patient records to assess whether Paterson was involved in their care.

Douglas said she had regular communication from former patients of Paterson who had not been contacted by the NHS or Spire. “He was a general surgeon as well as a breast cancer surgeon. How many people out there, with wide local excisions, had recurrences and had secondary cancer?”

HEFT said it had not contacted all patients who had had other breast operations by the surgeon, but in 2011 and again in 2016-17 it had reviewed samples of those who had had other breast cancer operations and “no concerns were identified”.

The trust said: “A review of the deceased patients cannot repair any damage that has already been caused, nor is it likely to inform the trust of anything that it is not already aware of or provide any tangible benefit to the survivors in this cohort.

“It is reasonable to assume there were similar deficiencies in the treatment of the deceased patients, which may have impacted adversely on their period of life without disease and their survival.”

During a seven-week trial this year, jurors heard that the surgeon had carried out “extensive, life-changing operations for no medically justifiable reason” on 10 patients between 1997 and 2011.

The court was told that Paterson regularly “miscoded” procedures, charging for more expensive treatment. He was accused of carrying out the often pointless surgery for “obscure motives”, which may have included a desire to earn extra money.

For several years before the trial, concerns had been raised about his practice of carrying out what he called “cleavage-saving mastectomies”, a controversial operation that left breast tissue behind for cosmetic reasons after the removal of cancerous cells. This method meant that the chances of a relapse within five years doubled.

Kidney disease drug recommended by Nice ‘may do more harm than good’

The UK’s drug guidelines body is recommending a type of medication to treat chronic kidney disease despite no firm evidence that it benefits patients – and some signs that the drugs may do more harm than good, experts have warned.

Phosphate binders are commonly prescribed to lower blood phosphate levels in patients with advanced kidney disease, including those on dialysis. High phosphate has been linked to worse patient outcomes, including bone and muscle problems, a build-up of calcium in the blood vessels causing them to stiffen, and an increased death rate.

Experts say current recommendations by the National Institute for Health and Care Excellence (Nice), which advocate the use of phosphate binders, are based on little evidence that they benefit patients.

“No one has ever shown that reducing [phosphate levels], in a trial, actually improves the wellbeing of the patients,” said Prof Phil Kalra, the national specialty lead for renal disorders at the National Institute for Health Research, pointing out that high phosphate levels might simply be a marker of other problems.

Moreover, there are concerns that calcium-based phosphate binders – which are the cheapest option and are recommended by Nice as the “first line” drugs – could do more harm than good. Research suggests that they could worsen the build-up of calcium in blood vessels, linked to increased risk of cardiovascular disease.

According to NHS data seen by the Guardian, and backed up by figures available online, more than 167,000 prescription items for phosphate binders were dispensed in community in England in 2016 alone, amounting to a total cost of £9,442,845.86. Almost 70,000 of these were calcium-based.

“There are many of us who believe that there should be a trial to actually see if lowering phosphate per se, by whatever means, benefits the patient,” said Kalra, adding that studies should also consider the different types of drug. “There is a risk here [that] by thinking we still need to treat phosphate, and by following the Nice guidance, we may be doing more harm to some patients than if we left them alone,” he said, although Kalra stressed that patients currently taking such drugs should not stop their medication.

Newly updated guidelines from the global non-profit kidney foundation Kidney Disease – Improving Global Outcomes (Kdigo) reflect the lack of evidence, acknowledging there have not been enough trials on phosphate binders to make firm recommendations for their use. Instead, the team merely “suggest” that elevated phosphate levels be lowered, whether by diet or drugs, and similarly urge that the use of calcium-based phosphate binders be restricted.

David Wheeler, professor of kidney medicine at University College London and co-chair of Kdigo, said he did not think Nice’s recommendation of calcium-based phosphate binders as the first-line drug was based on evidence.

“My own view is that if non-calcium based binders were as cheap as calcium based binders, we would only be using non-calcium based binders,” he said.

But, Wheeler added, while non-calcium based phosphate binders are less likely to cause problems of calcium build-up in blood vessels, even for these drugs there is a dearth of evidence that they improve patient outcomes, and that clinical trials comparing the different types of drug with each other, and with a placebo, were crucial.

“I think there is an urgent need to address these questions,” he said, adding that trials to tackle the issues had suffered from a lack of funding.

Dr Richard Haynes, a consultant at Stoke Mandeville Renal Unit, agreed. “The short answer is no, we don’t have a robust evidence base at all to support what we are doing in terms of what the guidelines currently say,” he said. “The worst case scenario is that we are trying to intervene on something which is not important and by doing so we are causing harm,” he added. “There is no evidence to say that is definitely what is happening at the moment, but it does make me cautious.”

Dr Sankar Navaneethan, a co-author of a 2011 Cochrane review into phosphate binders, said that at least on the surface, the use of such drugs made sense: “The main biochemical marker that has been consistently associated with cardiovascular disease and mortality is serum phosphorus.”. However, he agreed that clinical trials were needed to explore whether the drugs do indeed benefit patients, but added that such trials might be hindered by ethical concerns – particularly for patients on dialysis.

Commenting on the current guidelines, a Nice spokesperson said: “In light of the available evidence the independent guideline committee on chronic kidney disease felt that, on balance, a recommendation for phosphate binders was more likely to have a beneficial effect than not.”

But, they added, Nice is currently in the process of reviewing the latest evidence for people with late stage chronic kidney disease, including those on dialysis, to explore whether phosphate binders are effective.

Anti-smuggling proposal ‘may let tobacco industry in by back door’

Tobacco campaigners are concerned that new draft proposals from the European commission for a system to prevent cigarette smuggling may let the industry in by the back door.

The illicit trade in cigarettes has become a major problem worldwide. A study in 2009 by the US-based Campaign for Tobacco Free Kids estimated that 11.6% of all internationally traded cigarettes were illicit. They said that was equivalent to 657bn cigarettes a year, losing governments more than $ 40bn in tax revenue.

The tobacco industry claims the problem is counterfeit cigarettes, but even its own data shows that the majority of illicit trade is in packs the big companies have manufactured themselves.

Documents show that tobacco companies have historically been involved in smuggling their own cigarettes as a way of evading the high taxes imposed in some countries and increasing sales. Even as recently as 2014, British American Tobacco (BAT) was fined £650,000 by HM Revenue and Customs for flooding the market in Belgium, which resulted in its brands being illicitly diverted back to the UK. BAT denied complicity, saying it could not tell who would buy cigarettes at lower prices in another European country and bring them back to the UK.

Under the World Health Organisation’s tobacco treaty, a protocol on illicit trade was agreed in 2012, requiring among other things for all cigarette packs to have overt and covert markings to ensure they can be traced. The industry has produced its own system, called Codentify. Developed by Philip Morris International and shared with other major companies, it was then passed to a third party organisation called Inexto, which the industry says is independent even though it is run by former tobacco industry executives.

The European commission’s proposals say an organisation or company can be considered independent if it gets no more than 20% of its income from the tobacco industry. Campaigners say they fear this may still let the tobacco industry have control over any track and trace system.

Deborah Arnott, chief executive of health charity Ash, said, “We’re delighted that the EU is consulting on the regulations needed to put in place a European-wide tracking and tracing system for tobacco products, which is vital to prevent Big Tobacco from facilitating smuggling of its products. The UK, which continues to have a big problem with smuggling, must be part of such a system whatever happens with Brexit.”

But she said it was not clear that an organisation running the system would be completely independent of the industry under the commission’s proposals.

“We need to go through the draft regulations with a fine-tooth comb, but from an initial look we already have some concerns. It’s possible that Codentify, Big Tobacco’s tracking and tracing system, might fit the bill because it has been transferred to a third party. So it might look financially independent, despite the fact it’s an industry product which is run by former tobacco company executives. For a tracking and tracing system to be fully effective it has to be truly independent of Big Tobacco – that’s the bottom line.”

The Smoke Free Partnership, an anti-tobacco NGO which has been a major campaigner on the issue in Europe, said it was very pleased the commission managed to submit its proposals on time, but it is concerned.

“What we are going to look at very specifically is the notion of independence and whether the different commercial organisations and entities will fit the bill,” said Florence Berteletti, its director. “The notion of independence would be so much simpler if they had said zero links to the tobacco industry.”

In a statement, the partnership said: “We trust that the commission and member states will be vigilant and resist attempts by the industry to push for its own system through third parties or position itself as a partner of national authorities in the tracking and tracing of its products.”

Anti-smuggling proposal ‘may let tobacco industry in by back door’

Tobacco campaigners are concerned that new draft proposals from the European commission for a system to prevent cigarette smuggling may let the industry in by the back door.

The illicit trade in cigarettes has become a major problem worldwide. A study in 2009 by the US-based Campaign for Tobacco Free Kids estimated that 11.6% of all internationally traded cigarettes were illicit. They said that was equivalent to 657bn cigarettes a year, losing governments more than $ 40bn in tax revenue.

The tobacco industry claims the problem is counterfeit cigarettes, but even its own data shows that the majority of illicit trade is in packs the big companies have manufactured themselves.

Documents show that tobacco companies have historically been involved in smuggling their own cigarettes as a way of evading the high taxes imposed in some countries and increasing sales. Even as recently as 2014, British American Tobacco (BAT) was fined £650,000 by HM Revenue and Customs for flooding the market in Belgium, which resulted in its brands being illicitly diverted back to the UK. BAT denied complicity, saying it could not tell who would buy cigarettes at lower prices in another European country and bring them back to the UK.

Under the World Health Organisation’s tobacco treaty, a protocol on illicit trade was agreed in 2012, requiring among other things for all cigarette packs to have overt and covert markings to ensure they can be traced. The industry has produced its own system, called Codentify. Developed by Philip Morris International and shared with other major companies, it was then passed to a third party organisation called Inexto, which the industry says is independent even though it is run by former tobacco industry executives.

The European commission’s proposals say an organisation or company can be considered independent if it gets no more than 20% of its income from the tobacco industry. Campaigners say they fear this may still let the tobacco industry have control over any track and trace system.

Deborah Arnott, chief executive of health charity Ash, said, “We’re delighted that the EU is consulting on the regulations needed to put in place a European-wide tracking and tracing system for tobacco products, which is vital to prevent Big Tobacco from facilitating smuggling of its products. The UK, which continues to have a big problem with smuggling, must be part of such a system whatever happens with Brexit.”

But she said it was not clear that an organisation running the system would be completely independent of the industry under the commission’s proposals.

“We need to go through the draft regulations with a fine-tooth comb, but from an initial look we already have some concerns. It’s possible that Codentify, Big Tobacco’s tracking and tracing system, might fit the bill because it has been transferred to a third party. So it might look financially independent, despite the fact it’s an industry product which is run by former tobacco company executives. For a tracking and tracing system to be fully effective it has to be truly independent of Big Tobacco – that’s the bottom line.”

The Smoke Free Partnership, an anti-tobacco NGO which has been a major campaigner on the issue in Europe, said it was very pleased the commission managed to submit its proposals on time, but it is concerned.

“What we are going to look at very specifically is the notion of independence and whether the different commercial organisations and entities will fit the bill,” said Florence Berteletti, its director. “The notion of independence would be so much simpler if they had said zero links to the tobacco industry.”

In a statement, the partnership said: “We trust that the commission and member states will be vigilant and resist attempts by the industry to push for its own system through third parties or position itself as a partner of national authorities in the tracking and tracing of its products.”

Manchester cancer hospital fire ‘may have destroyed vital research’

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Cancer Research UK institute likely to have lost millions of pounds of life-saving equipment in blaze, says its director

Years of research and millions of pounds of life-saving equipment are feared to have been destroyed in a devastating fire at a cancer hospital in Manchester, its director has said.

Prof Richard Marais, the head of the Cancer Research UK Manchester Institute, said researchers had been able to save 25 years of clinical samples, but other vital work was lost in the “heartrending” blaze at Christie hospital.

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