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9th February 2024
There is insufficient evidence to recommend the use of novel nicotine and tobacco products as a ‘harm reduction’ strategy to reduce smoking and aid quitting.
This is according to an updated position statement from the European Respiratory Society (ERS), which states that such harm reduction claims are ‘simply exploited by the tobacco industry for financial gain’.
Since its previous statement on this topic was issued in 2019, evidence has increasingly shown legitimate concern around the long-term health risks of novel products such as electronic cigarettes, heated tobacco products and nicotine pouches, the ERS said.
‘ERS maintains a firm position that all nicotine and tobacco products are highly addictive and harmful, and that quitting smoking entirely is still the best option,’ it added.
Across eight position statements, the ERS details this increasing evidence and suggests that novel tobacco and nicotine products do not help existing smokers to quit, are harmful to public health and constitute gateways towards nicotine addiction and the initiation of smoking among youth.
This can lead to much greater negative effect on a population level, it said.
And it encouraged the use of evidence-based interventions, such as nicotine replacement therapy or tobacco cessation medications when cessation aids are required.
‘Reducing tobacco use and protecting youth from addiction to emerging products that may normalise tobacco use should be a top priority,’ the ERS concluded.
Referring to the EU’s priority of a tobacco-free generation by 2040, the ERS added that it ‘does not recommend any lung-damaging products and cannot recommend harm reduction as a population-based strategy to reduce smoking and aid quitting’.
Commenting on the revised position statement, Dr Filippos Filippidis, chair of the ERS Tobacco Control Committee, said: ‘The argument that novel tobacco products contribute to “harm reduction” lacks sufficient independent evidence. Their potential lung damaging effects, and uptake amongst young people, means that ERS cannot support novel tobacco products and “harm reduction” as a population-based strategy.’
This updated ERS position statement on novel tobacco and nicotine products comes as the UK Government announced disposable vapes and alternatives such as nicotine pouches are to be banned.
The planned measures follow a consultation on smoking and vaping launched in October 2023, and are designed to ‘tackle the rise in youth vaping and protect children’s health’.
As part of the package announced by Prime Minister Rishi Sunak, new powers will be introduced to restrict flavours specifically marketed at children and to ensure that manufacturers produce plain and less visually appealing packaging.
These powers will also allow the Government to change how vapes are displayed in shops, moving them out of sight of children and away from products that appeal to them, such as sweets.
Furthermore, the crackdown on underage sales will see the introduction of a new set of fines to shops in England and Wales selling vapes illegally to children, and trading standards officers will be empowered to act ‘on the spot’ to tackle underage sales.
The number of children using vapes in the UK in the past three years has tripled. Use among younger children is also rising, according to the figures, with 9% of 11- to 15-year-olds now using vapes.
Commenting that ‘marketing vapes to children is not acceptable‘, Mr Sunak said: ‘Alongside our commitment to stop children who turn 15 this year or younger from ever legally being sold cigarettes, these changes will leave a lasting legacy by protecting our children’s health for the long term.’
19th December 2023
The UK’s devolved nations could detect greater numbers of lung cancer cases with improved screening programmes, new analyses by Cancer Research UK have found as the charity calls for governments to ’urgently implement’ such programmes.
Lung cancer is the leading cause of cancer death in England, Scotland, Wales and Northern Ireland and smokers and former smokers aged 55-74 are at greatest risk.
In November 2022, the National Screening Committee (NSC) recommended that everyone in this group be screened but, to date, only England has initiated a screening programme on this advice.
Almost 900,000 people were invited for checks during the pilot stages in England. Of the 200,000 scans carried out, more than 2,000 people were detected as having lung cancer, and 76% of those were identified at an earlier stage (stage 1 or 2) compared to 29% identified outside of the pilot programme in 2019.
Cancer Research UK’s latest analyses suggests that equivalent lung cancer screening programmes in the devolved nations could diagnose around 4,000 more lung cancer patients in Scotland at an early stage over the next decade, as well as 2,400 more people in Wales and 1,400 in Northern Ireland.
If just 50% of eligible people took part in screening, earlier lung cancer diagnosis could save 2,300 lives in Scotland, 1,000 lives in Wales and 600 lives in Northern Ireland over the next 10 years, Cancer Research UK said.
Professor David Weller, professor of general practice at the University of Edinburgh, believes a nationwide screening programme ’has the potential to be a game changer when it comes to reducing the burden of lung cancer in Scotland’.
He said: ’For too long, lung cancer has been perceived as a disease you can’t do anything about, but we know that diagnosis at an early stage really can make a difference.
’Major trials of targeted lung cancer screening show significant reductions in mortality from lung cancer. Pilot studies in the UK and internationally consistently show people being diagnosed with lung cancer at an earlier stage.’
In Scotland, a pilot project called LUNGSCOT – of which Professor Weller is the principal investigator – is exploring the challenges for local lung cancer screening. It is running in Lothian with funding released for Grampian, Greater Glasgow and Clyde, and the Highlands and Islands.
A pilot is also running in Cwm Taf Morgannwg in Wales, where charities including Cancer Research UK are running a public petition in the hopes of raising the issue in the Senedd.
In Northern Ireland, there are no plans or pilots to report due to the lack of a Northern Irish Executive following the 2022 elections. That said, authors of the Northern Ireland Cancer Strategy 2022-2032 have said they intend to implement all NSC recommendations.
Debbie King, Cancer Research UK’s senior external affairs manager in the devolved nations, said: ’Lung screening matters because it means more people can be diagnosed at an earlier stage, when treatment is more likely to be successful.
’A fully-funded national targeted lung cancer screening programme in Northern Ireland, Scotland and Wales is a real chance to reduce the toll of this disease.
’There have been big improvements in how we diagnose and treat other forms of cancer, but long-term lung cancer survival in the UK isn’t much higher than it was 50 years ago. This is unacceptable when evidence shows that earlier diagnosis through targeted lung cancer screening can potentially help thousands of people live longer healthier lives.’
These latest analyses were published shortly after Cancer Research UK released its manifesto for reducing cancer deaths by 20,000 a year by 2040.
While overall cancer deaths have halved over the last 50 years, progress is at risk of stalling in the UK, the charity said.
As part of the manifesto, Cancer Research UK has called on the next UK Government to address variation in treatment across different geographical areas, which includes optimising cancer screening programmes and accelerating the roll-out of the lung cancer screening programme in England.
On the manifesto, former national cancer director at the Department of Health and chair of the National Screening Committee, Professor Sir Mike Richards, said: ’Cancer outcomes in the UK are lagging behind comparable countries like Denmark. We need consistent funding and long-term strategies to make the UK the best in the world for cancer survival.’
11th December 2023
The UK Government will lay legislation this week to allow the General Medical Council (GMC) to begin the process of regulating physician associates (PAs) and anaesthesia associates (AAs).
The legislation will be laid before Parliament via affirmative statutory instruments on Wednesday and the regulations are expected to come into force at the end of 2024.
The GMC will set standards of practice, education and training, and operate fitness to practice procedures, ensuring that PAs and AAs ‘have the same levels of regulatory oversight and accountability as doctors and other regulated healthcare professionals’, the Government said.
The legislation follows a consultation which had also suggested PAs could get prescribing rights in order to relieve pressure on doctors and services.
However, the BMA raised concerns about the legislation saying it thinks this ‘will add further, dangerous confusion’ with patients being left under the impression that they have seen a doctor when they haven’t.
‘The blurring of this distinction between doctors and non-medically qualified professionals can, and has, led to fatal consequences,’ the BMA added.
The union asked doctors to write to their MP ahead of Wednesday‘s Parliament session, so that MPs are ‘aware of this issue, oppose the legislation in Parliament and force the Government to abandon its plans’.
Health and social care secretary Victoria Atkins said: ‘Physician associates and anaesthesia associates are already making a great contribution to the NHS, supporting doctors to provide faster high quality care for patients.
‘This new legislation paves the way for these professionals to be held to the same strict standards as doctors, boosting patient safety.
‘This is part of our Long Term Workforce Plan to reform the NHS to ensure it has a workforce fit for the future.’
GMC chief executive Charlie Massey said: ‘This is a welcome and significant milestone towards bringing physician associates and anaesthesia associates into regulation.
‘We’re pleased to support the development of these valuable professionals recognising the important role they play in the medical workforce. Regulation will help increase the contribution PAs and AAs can make to UK healthcare while keeping patients safe.
‘We are working hard to design and deliver detailed regulatory processes for registration, education, standards and fitness to practise for both professions.’
Most statutory instruments (SIs) subject to the affirmative procedure are laid in the form of a draft SI and are considered by the Joint Committee on Statutory Instruments (JCSI).
Next, the SI will be automatically referred to a Delegated Legislation Committee (DLC). These committees have 16-18 members. Any MP can attend and speak but only members of the DLC can vote.
A DLC considers an SI but does not have the power to stop it. In some rare cases, the SI is not referred to a committee, but is debated in the Commons Chamber if it is of particular interest.
Once the SI has been debated by a committee, it needs final approval by the Commons before being ‘made’ (signed by the minister) and becoming law.
Health Education England (HEE) and NHS England recently warned the BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence.
HEE has published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs until regulation is in place.
At its recent Symposium, the GMC also called on doctors to show ‘multi-disciplinary respect’ towards healthcare professional colleagues who are not doctors.
A version of this article was originally published by our sister publication Pulse.
20th October 2023
A consultation on UK-wide guidelines for the clinical treatment of harmful drinking and alcohol dependence has been launched by the Department of Health and Social Care (DHSC).
Developed in partnership with the UK‘s devolved administrations, the guidelines include advice for alcohol care in acute hospitals as well as other settings such as primary care, community health services and the criminal justice system.
‘Patients with alcohol use disorder present to acute hospitals with a wide range of primary diagnoses and the presence of alcohol use disorder may not always be obvious to the patient or to clinical staff,‘ the guidance states.
It therefore emphasises the need for hospitals to have staff with appropriate skills to identify alcohol use disorders, assess risk and provide specialist treatment interventions.
The importance of implementing a system for identifying health risk from alcohol and gauging the severity of alcohol use disorder among all hospital inpatients is also highlighted as this may impact a patient‘s treatment, recovery and risk of complications.
The guidelines also outline key factors in dealing with acute or medically assisted alcohol withdrawal, managing associated complications and treating patients with co-occurring physical and mental health conditions, including those in crisis.
The need for a seamless transition to ongoing treatment in mental health and community services when discharged is also detailed, with integrated planning identified as a priority to ensure effective wrap-around care.
According to the DHSC, the main aim of the guidelines is to develop a ‘clearer consensus’ on good practice and how to implement NICE-recommended interventions.
The consultation will be open for eight weeks, inviting views from people working in alcohol treatment, the wider health and care sector and those with lived experience of alcohol dependence across the UK.
Neil O’Brien, minister for public health, said: ’This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.’
In May, ministers were accused of not taking alcohol harm seriously enough after a new report revealed that over the last two decades the number of alcohol-related deaths rose by 89% and was continuing to rise sharply since the start of the pandemic.
Despite this, the report found that a ‘staggering’ 82% of dependent drinkers were not in treatment despite success rates of 60% and evidence that treatment delivers £3 of benefit for every £1 invested.
A version of this story was originally published by our sister publication Nursing in Practice.
13th October 2023
The UK Government has launched a public consultation on its plans to create a smoke-free generation at the same time as introducing measures to tackle vaping in teenagers.
It follows proposals announced earlier this month by the Prime Minister that it will become illegal for people born in or after 2009 to buy tobacco products.
Under the plans, the law will stop children turning 14 or younger this year from ever legally being sold tobacco products, raising the smoking age by a year each year until it applies to the whole population.
Several options for cracking down on youth vaping are also included in the consultation after figures form 2023 suggest one in five children has tried it.
Measures will need to balance the need to make vapes available to current adult smokers to help them quit while reducing access and appeal for children and teenagers, the consultation document states.
Possible changes in law range from limits on how vape flavours are described to restrictions on ingredients or flavours, such as tobacco, mint or fruit flavours only.
The public is also being asked for views on regulating displays in shops to being behind the counter but on display or hidden, as with current rules on tobacco products.
Various options for branding and presentation are being considered including banning the use of cartoons, animals and other child-friendly imaging to more stringent restrictions on imagery and colouring used in the packaging.
Questions on whether disposable vapes should be banned are also included in the consultation, and views are also being sought on the cost of vapes compared to tobacco products.
Currently 12.9% of people in the UK are smokers. In setting out the proposals, the Government said no other consumer product kills up to two-thirds of users.
It added that in England, almost every minute of every day someone is admitted to hospital because of smoking, and up to 75,000 GP appointments could be attributed to smoking each month. The consultation also covers Scotland, Wales and Northern Ireland.
Last year a damning review led by Dr Javed Khan into the Government’s ambition to make England smoke-free by 2030 backed England to follow in the footsteps of New Zealand, and recommended ‘increasing the age of sale from 18, by one year, every year until no one can buy a tobacco product in this country’.
Last month, researchers declared that nicotine vaping is the most effective among widely available smoking cessation aids.
Health and social care secretary Steve Barclay said: ‘There has been a surge in vaping amongst children, which is why we’re taking action to reduce the appeal and availability of vapes. Vapes should never be used by children and we’re committed to reversing this trend.
‘We also need to take bold action to protect future generations from the harms of smoking addiction, which damages health at every stage of life and costs the economy billions.’
Professor Chris Whitty, chief medical officer for England said: ‘Ensuring people do not become addicted to smoking, and helping them overcome addiction to stop smoking are two the best interventions for health.
‘Vaping is less dangerous than smoking but still has risks and can cause addiction. Vaping can be useful for smokers to quit, but should not be marketed to non-smokers and marketing them to children is utterly unacceptable.’
Sarah Woolnough, chief executive at Asthma + Lung UK, said the charity welcomed the consultation as it is clear more must be done urgently to stop children accessing vapes.
‘Disposable vapes at their current pocket money prices, with cartoons and bubble-gum flavour options, are far too attractive and easy for children to access,’ she said.
The public consultation is open until 6 December.
A version of this story was originally published by our sister publication Pulse.
28th January 2021
The Moderna vaccine, mRNA-1273, has been shown to elicit high levels of neutralising antibody titres in clinical trials. However, with the identification of COVID-19 variants, a major concern is whether the range of vaccines available are capable of generating sufficient immunity. The UK COVID-19 variant, termed B.1.1.7, has 17 mutations, 8 of which are in the spike protein and two of which, 69-70 del and N501Y, have led to a particular concern that the variant is much more easily transmitted and potentially associated with a higher mortality. The other variant identified, B.1.351, has emerged from South Africa and as with the UK variant, evidence suggests that B.1.351 is more transmissible and produces a higher viral load among those who become infected. In fact, genomic analysis shows that mutations in the S protein are more extensive in B.1.351, with 3 of these present in the receptor binding domain, which is the target for neutralising antibodies which could affect vaccine efficacy. For this recent, but unpublished, study, researchers from Moderna, the vaccine manufacturer, sought to assess the neutralisation of sera from eight patients (aged 18 to 55) who had already received two doses of the company’s vaccine. In an effort to test the effectiveness of m-RNA-1273, the researchers created and tested pseudo viruses, that contained either a partial or a complete set of mutations present in the B.1.1.7 and B.1.351 lineages.
Findings
With respect to the B.1.1.7 lineage, both the partial and complete pseudo viruses, containing the recognised mutations, had minimal effect on the production of neutralising antibodies, i.e., the vaccine was just as effective against this variant as the original COVID-19 strain. In contrast, there was a significant decrease in neutralising titres measured against either the partial or complete mutations found within the B.1.351 variant. In fact, antibody titres were approximately 6-fold lower relative to other variants for the complete set of mutations. Nevertheless, the authors reported that the antibody titres generated against the complete B.1.351 pseudo virus, while lower than for B.1.1.7, were still generally high enough to provide protection if vaccinated with the mRNA-1273.
Citation
Wu K et al. mRNA-1273 induces neutralising antibodies against spike mutants from global SARS-CoV-2 variants. 2021 https://doi.org/10.1101/2021.01.25.427948https://doi.org/10.1101/2021.01.25.427948
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