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Journal ArticleDOI

Smoking cessation: The role of e-cigarettes

13 Jan 2017-British Dental Journal (Nature Publishing Group)-Vol. 222, Iss: 1, pp 3-3

TL;DR: It seems to me that the GDC has become an unfit for purpose, bureaucratic behemoth, built and fuelled by parasitic lawyers, that does precious little to protect patients and serves mainly to protect itself and those who profit from it.

Abstractgrossly inappropriate and totally unrelated to the clinical issues involved. They have made a raft of unpleasant allegations against me and suggested that I am a ‘danger to the public’ based on these records alone. They have chosen to ignore my unblemished previous history, two immaculate CQC reports and several glowing recommendations from patients and staff. I have gone to considerable lengths in the last two years to vastly improve my record-keeping (SOE has been installed at the practice, I have had a number of external audits done by an expert at DPS and I have also done much in the way of CPD and remediation and reflective logs) but the GDC has chosen to ignore this and continue to pursue the case. At no point has anyone (including my legal team) made any attempt whatsoever to explore the actual clinical issues involved. My legal team (who I know are doing their best) have pretty much said that I am indefensible because my initial records were poor. This is akin, in my view, to making a definitive diagnosis on a patient based on some old records without even examining them. Frankly, this Kafkaesque procedure has destroyed much of my passion for a profession I once considered noble. If I was of an age and in a position to retire, I would. It seems to me that the GDC has become an unfit for purpose, bureaucratic behemoth, built and fuelled by parasitic lawyers, that does precious little to protect patients and serves mainly to protect itself and those who profit from it. I think the current legal ‘feeding frenzy’ in medicine is doing a great disservice to patients and I feel the Government and the profession should be fighting hard to change this culture. Name supplied

Topics: Smoking cessation (69%)

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Newcastle University ePrints - eprint.ncl.ac.uk
Holliday R, Preshaw PM, Bauld L.
Smoking cessation: The role of e-cigarettes.
British Dental Journal 2017, 222, 3
Copyright:
This is the authors’ accepted manuscript of an article that has been published in its final definitive
form by Nature Publishing Group, 2017
DOI link to article:
https://doi.org/10.1038/sj.bdj.2017.6
Date deposited:
28/02/2018
Embargo release date:
13 July 2017

Sir, I am writing in reference to the ‘Potential quitters turn to e-cigarettes’ upfront news article
1
that
was published in a recent issue of the British Dental Journal, which seemed to imply that e-cigarettes
were undermining smoking cessation attempts. This article was written in reference to a Health and
Social Care Information Centre report
2
which described the continued fall in the use of the Stop
Smoking Services (SSS) and suggested that this ‘may be partly’ due to increased use of e-cigarettes.
This publication was very timely, because almost within the same week, a study which addressed
this exact topic was published in the BMJ
3
. This study, the first of its kind, estimated the population
impact of e-cigarettes usage by undertaking a time series analysis to explore an association between
use of e-cigarettes and changes in quit attempts at a population level. Some key conclusions of this
study were that:
- E-cigarette use by smokers (in England) was positively associated with the success rates of
quit attempts.
- No clear association was found between e-cigarette use and the rate of quit attempts or the
use of quitting aids (except for NRT obtained on prescription, for which there was a negative
association with e-cigarette use).
The authors of the BMJ paper estimated that in 2015 there were 54,288 additional short- to
medium-term quitters compared with no use of e-cigarettes in quit attempts, and on the
assumption that approximately two-thirds of these may relapse in the future, that e-cigarettes may
have contributed about 18,000 additional long term ex-smokers in 2015. The authors point out that
although these numbers are relatively small, they are clinically significant given the huge health
gains of stopping smoking.
This is obviously an important area and continued careful surveillance of the data relating to e-
cigarette usage, quit attempts, and smoking cessation is required. It is also critically important that
we investigate further the oral health effects of e-cigarettes, to contribute to these complex
discussions.
R. Holliday (Newcastle), P. Preshaw (Newcastle) and L. Bauld (Deputy Director of the UK Centre for
Tobacco and Alcohol Studies [UKCTAS]).
1. Potential quitters turn to e-cigarettes. BDJ 2016;211:284.
2. Health and Social Care Information Centre. Statistics on NHS Stop Smoking Services. England,
April 2015 to March 2016. 2016. http://content.digital.nhs.uk/catalogue/PUB21162
3. Beard, E., West, R., Michie, S. and Brown, J. Association between electronic cigarette use and
changes in quit attempts, success of quit attempts, use of smoking cessation

pharmacotherapy, and use of stop smoking services in England: time series analysis of
population trends, BMJ 2016;354: i4645.
Citations
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Journal ArticleDOI
TL;DR: Professor Wilson's proposed advancements in oral health along with the Health Care 2035 vision are already taking place in a rural town in Japan, where a group of dentists has gradually developed a new social system to enhance oral care in a holistic manner with an emphasis on the patients’ values.
Abstract: not sufficient as the health system should be rebuilt in the future as a new ‘social system’ which is integrated to provide values to patients. In 2015, an advisory panel appointed by the health minister of young experts in their 30s and 40s, developed a vision of health care: Health Care 2035.4 Sakata City (100,000 population) is a unique rural community in Japan, having a model with this point of view. Since 1980, a group of dentists (re-educating themselves and other dentists nationally to become ‘oral physicians’ rather than dental surgeons), hygienists, specialists, community nurses, school teachers and government officials have collaborated with the private sector, academic institutions and civil society. The group has gradually developed a new social system to enhance oral care in a holistic manner with an emphasis on the patients’ values.5 Local industries have started to pay for preventive oral care, which benefits employees and their family members and enhances productivity. The group has developed a consortium with large companies to advocate and facilitate the continuum of quality care after patient transfers. The consortium has developed a cloud-based, people-centred health information system. This system integrates various personal data and facilitates a personalised approach to health promotion and disease prevention by empowering each individual to design their own life style, with an ambitious goal, namely ‘KEEP 28’ to keep all of your own teeth for your general and oral health even for a 100-year life span. In 2016, Sakata City legislated for a holistic approach to oral care,6 obviously being influenced by these activities of the group. Professor Wilson’s proposed advancements in oral health along with the Health Care 2035 vision are already taking place in a rural town in Japan. T. Kumagai, N. Kumagai, M. Nishi, K. Shibuya, by email

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Journal ArticleDOI
13 Sep 2016-BMJ
TL;DR: Changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts, and a negative association was found between e-cigarettes use during a recent quit attempt and use of NRT obtained on prescription, where the association has been negative.
Abstract: Objectives To estimate how far changes in the prevalence of electronic cigarette (e-cigarette) use in England have been associated with changes in quit success, quit attempts, and use of licensed medication and behavioural support in quit attempts. Design Time series analysis of population trends. Participants Participants came from the Smoking Toolkit Study, which involves repeated, cross sectional household surveys of individuals aged 16 years and older in England. Data were aggregated on about 1200 smokers quarterly between 2006 and 2015. Monitoring data were also used from the national behavioural support programme; during the study, 8 029 012 quit dates were set with this programme. Setting England. Main outcome measures Prevalence of e-cigarette use in current smokers and during a quit attempt were used to predict quit success. Prevalence of e-cigarette use in current smokers was used to predict rate of quit attempts. Percentage of quit attempts involving e-cigarette use was also used to predict quit attempts involving use of prescription treatments, nicotine replacement therapy (NRT) on prescription and bought over the counter, and use of behavioural support. Analyses involved adjustment for a range of potential confounders. Results The success rate of quit attempts increased by 0.098% (95% confidence interval 0.064 to 0.132; P Conclusion Changes in prevalence of e-cigarette use in England have been positively associated with the success rates of quit attempts. No clear association has been found between e-cigarette use and the rate of quit attempts or the use of other quitting aids, except for NRT obtained on prescription, where the association has been negative. Study registration The analysis plan was preregistered (https://osf.io/fbgj2/).

185 citations