QUISLING (/ˈkwɪzlɪŋ/; A person who collaborates with an enemy occupying force.
QUISLING (/ˈkwɪzlɪŋ/; A person who collaborates with an enemy occupying force.
The following article is to accompany those which have already been published on the Outlaw – in an attempt to offer a plausible explanation for the inordinately high numbers of suicides that have occurred in Bridgend, South Wales since 2007.
What appears below is a draft that was to be published in the Sunday People, but it was pulled at the last minute – no reason being given.
It is being re-published here in the event that the source ‘disappears’.
‘In November last year government theatre and arts expert Philip Blight took a ligature and hung himself from a beam in a tiny Welsh hamlet. The Coroner ruled the 53 year old married father of two had been depressed when he refused counselling and took his own life.
Phil Blight died seven years after the first teenage victim of the Bridgend suicide cluster had hung himself in a seaside fairground near the town.
But Phil Blight killed himself just three weeks after he’d been accused of responsibility for the deaths of the 79 youngsters in the Welsh borough and triggering the biggest teen suicide cluster in modern history.
Claims were made during a radio station interview the 53 year old Arts Policy Officer of the Welsh Assembly had helped plant powerful suicide triggers in dramas and theatre workshops produced for community outreach projects.
The claims were made in blogs and on a right of centre digital TV station and focus on Phil Blight’s time as a trustee and manager of the Cardiff based NoFitState Circus.
Their stunning performances have been acclaimed by critics throughout Europe but they contain repeated imagery of suicide by hanging which are powerful and disturbing. The potential for harm from these scenes is now being underlined by leading suicide experts.
And the Sunday People has learnt Mr. Blight had a very unusual CV. He was an expert in powerful psychological techniques like neuro linguistic programming and the use of mind triggers known as ‘nudges’. In blogs he styled himself the ‘Jedi Nudger’.
We have learnt too he attended courses run by the Intelligence Service at MI5’s top secret GCHQ base in Cheltenham. He also arranged for Welsh assembly bureaucrats to go on similar courses at GHQ which are understood to include advanced ‘management’ skills like neuro-linguistic programming or NLP.
As well as NLP Mr. Blight went on courses to study other, semi hypnotic, mind control techniques like “disruptive innovation”, subliminal behaviour modification and cognitive edge training He also had strong links to the growing ‘population decline’ lobby including some radical eco groups which are calling for an 80% human depopulation of the planet.
The allegations against him were made by a neighbour in the tiny hamlet of Rudry near Caerphilly where Mr. Blight and his wife Samantha set up home around 2006. The couple quickly became involved with the unelected village community council and the management of the village hall.
Tim Rogers, who lives next door to the hall, had been in conflict with the committee over noise and disturbance for some years. But when a play filled with Satanic imagery and depictions of suicide was put on at the village hall he complained to Phil Blunt and the committee.
Said Mr. Rogers, “I couldn’t understand why children were being made to watch what I believed was dreadful material that would mess with their heads. I went head to head with Blight and within days a police harassment order was made against me.
“I have been in conflict with him since that time until his death. I make no bones about it I decided to go online and look for any skeletons I could find on him. I was looking for divorces, court cases, bankruptcy. I couldn’t believe what I did find. At first I was shocked then I was angry. His background was all NLP, MI5 and extreme eco groups.
“While I studied what nudging and NLP were all about I was also looking at his work with the circus. I saw they were putting on repeated depictions of suicide in the most stunning settings with hypnotic music. They seemed to be romanticising suicide and glamorising it. Then I saw Blight was with them in Bridgend as a manager just before the suicide cluster started and I began to believe the two were connected.
“For the last 18 months I have been trying to get the authorities to listen but I think there’s a cover up which is no surprise in the UK we live in today. The only people who would listen were Christian groups and eventually I was interviewed on the radio show. I’ve repeated the allegations online.
“Someone in the village told me Blight had expressed the fact he was extremely worried by that broadcast and the next thing I knew he’d taken his own life. I don’t know if the two things were connected.
“I believe it is imperative that someone in authority takes the link between theatre and suicide very seriously. Radical theatre in the UK is awash with suicide themes and images of suicide and it cannot be healthy. Why are so many youngsters turning to suicide as a solution to their problems? I believe it’s because it has been glamorised.”
The Sunday People approached some of Mr. Blight’s colleagues on the parish hall committee in Rudry at the time including his wife Sam Minas-Blight who said………
We also spoke to Lindsay Foyster who was a committee member and is a suicide expert and director of the mental health charity Mind in Wales. She was previously involved with community theatre and is believed to have worked with Phil Blight on productions in the Bridgend area.
The village hall chairman, scientist Dr. Christopher Allender, is a biological warfare expert.
NoFit State Circus had historical links to Bridgend which was the site of their training camp in the early days before they won acclaim for their highly skilled performances. They were back in the borough in August 2006 to stage their highly praised production ImMortal at the Grand Pavillion on the coast at Porthcawl. ImMortal, like another production Bianco, has cleverly staged hanging scenes with young women slowly hauled up on ropes which appear to be nooses.
Outreach groups connected to NoFit State are also believed to have been active in the Bridgend area putting on workshops and skill studios until November. However exact information on NoFit State activities from 2005 to 2007 is difficult to find. The companies own timeline blog which catalogues their activities over 20 years has apparently had those years redacted. They are not included in similar lists on theatre websites and neither are they available in NoFit State’s annual submission to the Charities Commission.
During that time troubled young man called Dale Crole, 18, hung himself in a disused shed on the Coney Beach funfair in Porthcawl. His body was found on January 5th 2007 and his death is said to predate the first of the cluster although he actually committed suicide four months earlier in September.
It also understood that four other youngsters took their own lives in the Bridgend area before Dale’s body was found and a cluster was declared. A journalistic investigation of the cluster is difficult as the media does not report cases on the request of the police to stop copy cat suicides – a phenomenon known as the Werther Effect.
Two of the world’s leading experts on suicide looked at the suicide imagery in the NoFit State productions and both expressed grave concern and called for an urgent investigation.
It’s believed most of the seventy nine young people in the Bridgend cluster hung themselves and the productions – ImMortal and Bianco – were singled out for particular criticism by the experts. Both productions advertise there is no lower age limit on audiences.
There was speculation that social media may have been the responsible for spreading the contagion of suicides in Bridgend but it’s understood police didn’t have the resources for a time consuming examination of victims online accounts to see if there was a link.
In 2010 the media agreed to a police request to stop reporting suicides in the area because of the fear of copycats. However this effectively prevents detailed journalistic investigation of the underlying causes.
Leading UK suicide expert Dr. Arthur Cassidy, formerly of Queen’s University Belfast, says such scenes contravene the Suicide Act which forbids the glamorising of suicide.
He said, “I have viewed images and videos from these productions and on a scale of 1 to 10 of the worst suicide representations I have seen in Europe these rate eight or nine.
“They are glamorous and beautifully staged with great sound tracks and I believe they represent a real danger to young people as hanging is a profoundly powerful symbol in the human psyche.
“This is a very difficult area for the media to investigate thoroughly as editors have agreed not to report cluster cases because of the danger of copy cat suicides. However the role of the Sunday People must be to draw this to the attention of the authorities.
“I have viewed the images without any preconceptions about the cause of the Bridgend cluster but it needs to be addressed urgently and these productions should be voluntarily halted or the controversial scenes omitted until it has been.
“The police should be looking at this as a possibly serious breach of the criminal law under the Suicide Act. They should be examining whether powerful semi hypnotic tools like NLP have been introduced into the productions and workshops. The government should also be examining this as an urgent public health issue.
“I find the ImMortal and Bianco productions particularly disturbing with their romantic and enticing imagery of women who appear to be hanging by the neck.
“One of the things that has emerged from suicide clusters is the perception that many vulnerable youngsters seem to believe they were in some way immortal. Death isn’t permanent, they think, it’s a transition you go through. Then you come out in some different state, almost like a butterfly metamorphosing, to join your friends again. Productions like ImMortal seem to be directly feeding that terribly dangerous perception.
“I also question the use of theatre and drama workshops introduced into cluster areas as a strategy to prevent more suicides. They use the same techniques and actually show children more images of hangings. Local councils rightly believe media reporting of suicides can cause copycat incidents. It follows then that showing more images of suicide to children as a therapy is also likely to have a Werther effect? Such interventions are deeply misguided.
“I also question why the people who put these productions on haven’t thought about the effects of what they are doing? They must be intelligent adults. Has it not crossed their minds.”
Professor Steve Stack is the world lead on links between art and suicide and is editor of an academic book called The Creative Arts and Suicide.
He said, “I have never seen any theatre so extreme in terms of suicide imagery here in the States. There may be many factors influencing a suicide cluster in an area like Bridgend in Wales; unemployment, use of drugs, social media. There’s also the issue of copy cat deaths – the so called Werther Effect.
“Such compelling imagery in live theatre could indeed provide another trigger. It would not necessarily have to be seen by all those who join the cluster.
“It could provide what we call a second step trigger. One person could see the production or be involved in drama workshops, assimilate that powerful experience. They would be the first step then they would pass it on in contagion to their friendship groups perhaps through social media.
“This has to be investigated by the competent authority to find out just what the effect of theatre has been because on the face of it these productions could be culpable.”
Professor Stack recommended a radical approach using ‘CSI across the grave.’ He said, “The authorities need to urgently find out if drama is a factor in these clusters.
“They should first perform psychological autopsies on the victims of the Bridgend cluster. The first stage of this would be a fairly simple form listing factors that could then be ticked off by the loved ones and friends of the victims. It would be simple matter to have theatre experiences in that list.”
Prof. Stack had one more observation. When told that no age limit was set on the NoFixedState productions of ImMortal and Bianco he said, “I find that completely bizarre.”
By 2008 a multi-agency board in Bridgend had drawn up a suicide prevention strategy targeting schools, colleges and youth groups. £2m of Lottery funding was made available for initiatives like a telephone helpline and peer support training of youngsters.
The charity Mind was given £1m to fund interventions but it’s understood they introduced drama as a therapy. A film called Wristcutters is said to have been shown in the area which has an opening scene of a young man slitting his wrists and another scene of a young boy with a rope around his neck who wants to hang himself.
A cartoon called Lucky for Some is also believed to have been shown featuring a dog attempting suicide in various ways, including hanging, before he is run over by a bus.
The director of Mind Cymru , the Welsh arm of the charity, is Lindsay Foyster who is believed to have been involved with NoFitState circus in 2006 when she lived in Bridgend. She was appointed Mind Cymru director in the same year.’
As a Welshman who sees himself as a patriot, and somebody who is fearlessly proud of his heritage, I would consider myself a traitor to not only my ancestors, but to everything I hold dear – if I did not voice my opinion on something that fills me with not only a great sense of disappointment, but intense anger.
A senior Welsh politician, namely Dafydd Iwan, a former Plaid Cymru president, has called for the song ‘Delilah’ to be banned from being sung at the Millennium Stadium before matches, due to it’s ‘inappropriate subject matter.’
‘Delilah’, for those who may not be aware is a Tom Jones song, considered a classic, and has long been considered the secondary national anthem at International Rugby Matches.
The song is also shared by Stoke City Football Club, and preceding matches at the Millennium stadium, the lyrics are boldly displayed on the big screen by the Welsh Rugby Union.
The song itself, which was first recorded in 1968, centres around the revenge killing of a woman by a scorned lover.
‘La Marseillaise’ and ‘The Flower of Scotland’ for example, both feature lyrics with references to violence, but Dafyyd Iwan, now says the iconic anthem should be abandoned – in his opinion, simply, for promoting domestic violence
So where does this behaviour and opinion, which is slowly, but very successfully destroying this nation’s identity come from?
The victim mentality, the aggressive feminism, the gay rights movement, the fictitious statistics, the hastily rewritten history, the endless lies, the incessant demands, and all the odious paraphernalia that accompanies it – where does it come from?
For the first time in history, the British are frightened of what they say, to speak their minds in public and to be especially wary about anything they write – even to a degree, how they think.
They live in in a climate of continuous fear, where using the wrong word, or a word seen as being offensive or insensitive, or racist, ageist, sexist, or homophobic, makes one become instantly – a social outcast.
It seems to have appeared from nowhere and has slowly, but steadily permeated almost all levels of society, to where it has spread throughout the country virtually unchecked.
It is known simply as “Political Correctness.”
A name which began as something of a joke, it originated from a comic strip, and although many people still think of it as only being half-serious, and mainly dismiss it, I can assure you it is anything but a joke.
Not a joke that anyone could recognise as being humorous anyway.
It is deadly serious and it would not be an exaggeration to say that it has become one of the great rampaging diseases of this century.
It is a plague that has left tens of millions of people dead not only in Europe, but in Russia, China, and around the world.
It is a scourge, it is a disease, it is extremely virulent and is a disease of something known as ideology.
Political Correctness is not funny whichever way you look at it.
Political Correctness is serious, deadly serious in fact.
If you look at it in some detail, if you consider it from a historical viewpoint, it is a simple matter to discover exactly what it is.
Political Correctness is another term for cultural Marxism.
It is Marxism translated from economic into cultural terms, and it goes back not to the 1960s and the hippies and the ban the bombers, but back to the heady days of the Great War.
All you have to do is to compare the two, and it will become blindingly obvious.
To begin with, both are ideologies totalitarian in nature.
The totalitarian nature of Political Correctness is most clearly visible in schools, universities and colleges, where the student or tutor who dares to cross any of the invisible lines set up by any of the “victim” groups that political correctness hinges upon, quickly finds themselves, ‘up to their necks in trouble’.
Whether they be militant feminists, anti-semitic, homosexual-rights activists, or the local muslim, black or asian groups that exist within it’s environs.
From that starting point, from the very seats of learning which churn out the next generation of adults – who will assume their roles in a society, which is already mapped out for them, suitably armed with the already ingrained ideology of political correctness instilled by their education – you can see the future.
A future incidentally, that political correctness and it’s many hidden allies, intends for this nation as a whole.
Decades of propaganda, public ignorance, apathy and a nonsensical education system has created an image of world history, that bears little resemblance to reality.
One example of such distortion, and one which still exists after seventy-eight years, is woven around the 1936 Olympic Games, which were, as some of you may know, held in Berlin.
This truly international event, the first incidentally, to be broadcast ‘worldwide,’ is often quoted in the mainstream, in the context of it being the Olympics at which the American Jesse Owens, ‘Humiliated Adolf Hitler, the whole of Nazi Germany and totally destroyed the myth of Aryan superiority.’
But was that what really happened?
Jesse Owens, was undoubtably a fine athlete, but was also a citizen of a country whose own levels of racism would have embarrassed any resident of Germany at that time.
Owens, who was a likeable and humble ex-cotton picker, would without a doubt, have found the contrast between the two countries remarkable.
In Hitler’s Germany, Jesse Owens could share a bus or tram ride with anybody.
He would have been treated equally in all respects under German law, inasmuch as he could sit in a cinema next to white people, use the same public toilets, dine in the same restaurants, and stay in a hotel of his choice without any visible discrimination being shown towards him.
The reality was there was much that he could do in Hitler’s Germany that was forbidden to him back home in the United States.
In the United States during the 1930’s, black athletes were required to eat separately from their white team-mates.
If they were allowed to share the same hotel at all, which was highly unlikely, there would be a strictly enforced rule that they only used the tradesmen’s back entrance.
There were no black players on any American major league baseball team nor were there any black swimmers.
And this was in the relatively enlightened north.
In the southern states there was no possibility of a black athlete being allowed to participate in any sport, unless they competed with others of the same colour.
For Jesse Owens, the short time he spent in Hitler’s Germany must have been have been a real eye-opener for him.
It was there that he received the kind of welcome, and probably for the first time, that would have been unthinkable in his own country – it is said that the German people idolised him.
When he arrived at the stadium where he was competing, the mere appearance of Jesse Owens below the stands would cause sections of the crowd to chant his name.
Most mornings at the Olympic village, he was woken up by crowds of fans and amateur photographers, who had gathered outside his bedroom window for a glimpse of him before one of his many media appearances in Berlin.
“Jesse Owens was cheered as loudly as any Aryan.” – Saturday Evening Post. November 7th 1936.
Another of the associated tales that has been written into history, and duly perpetuated by the media, is that at the 1936 Games, Adolf Hitler publicly snubbed Jesse Owens by refusing to shake his hand.
In reality, Adolf Hitler on the first day of the Competition, did indeed shake the hands of several successful competitors from Germany and Finland.
However, later that evening, Hitler received a message from Count Baillet-Latour, President of the International Olympic Committee, in which it was respectfully pointed out to the German Leader that as he was merely a guest of honour at the Games, he should congratulate all – or none of the athletes in public.
Hitler, as was the case with every other national leaders before and since, chose the latter as being the most sensible course of action.
With 156 gold medals being awarded at various locations and times that would overlap each other, it was just not physically possible to personally congratulate every winner.
So although Jesse Owens was not personally congratulated by the Fuhrer, which tallies with the historical account, neither were any of the other successful competitors – be they German, white or otherwise, at the personal request of the President of the I.O.C.
What should be added, as it is rarely included whenever this story is narrated, is that Jesse Owens’ own President Roosevelt, also failed to honour this great athlete and did in fact refuse to meet him, despite there being no restrictions imposed upon him.
Jesse Owens himself said: “When I passed the German Chancellor he got up, waved his hand at me, and I waved back at him. I think the writers showed bad taste in criticising the man of the hour in Germany.”
Even following the Olympics, when Owens and his coach, Larry Snyder arrived in London, they complained bitterly that they were treated like, and felt like ‘trained seals’.
During their time there, they were also subjected to a barrage of ‘fraudulent publicity offers’, so many in fact, they refused to attend any further engagements.
Even when he arrived back home to the United States, Jesse Owens was treated like a freak and became a figure of curiosity that can only be compared to a performing animal.
“Before curious crowds he raced horses (and won). He ran against cars, trucks, dogs, and baseball players with a head start.”
His homeland was a country where black people had to use separate public toilets and public transport; went to all-black schools, and couldn’t mix with white people in restaurants, cinemas, hotels, or sporting events.
His was a 1930’s America that had seen 26 lynchings in one year – all of whom were black men.
Men like Rubin Stacey, who was lynched the previous year in Ft Lauderdale, Florida.
This man’s terrible crime was ‘scaring a white woman in her home by attempting to knock on her door.’
Being out of work and hungry, he was simply trying to get something to eat.
Hitler’s Germany and the German people must have seemed very welcoming by comparison to Jesse Owens.
Hitler’s Germany won a total of 101 medals, 41 of which were gold and 223 points at the 1936 Berlin Olympics.
Their only serious opposition was the team from the United States, which although three times larger in population to select their athletes from, amassed 40% fewer medals and points.
25 gold medals in all – 4 of which were won by Jesse Owens – and just 132 points.
Hitler’s Germany, with a population of some 80 million, won more gold medals than the United States, Great Britain, India, Canada, Argentina, France, and Norway.
A combined population of 1,160 millions, which was around 14 times larger than Germany’s.
A German humiliation?
Not judging by the official results.
“LOOKING IN THE WRONG DIRECTION”
Those who run things are far cleverer than any of us – they control almost everything you eat, everything you wear, how your children are educated, what medicines you ingest, what you see in the media, what car you drive, what healthcare you receive, how you spend your money, and they even manipulate your religious beliefs and steer your political allegiances.
They also engineer what most people see as ‘reality’ in the present, in the same way as they have re-written history in order to make the events they also originally made happen, fit together almost seamlessly.
To appear ‘real’.
To be taken as being the ‘truth’.
Historical ‘facts’ that cannot be challenged by the majority.
And that, is the the situation which the same majority of the human species has found itself.
Isn’t it entirely possible that any one person, or a group of people, who have the financial means and the appropriate platform, who then decide to convince people to believe the world is flat, or the moon is made of green cheese – then in a very short space of time, then that is exactly what they become?
That’s the reality.
Many of you, as well as your children were/are told in school and by the media that the Nazi’s under Adolf Hitler ‘invented’ concentration camps.
They didn’t – the reality is that Nazi Germany merely subscribed to the original British invention that was used to control the Boers in South Africa.
Stating It publicly, however, will label you a ‘Racist’.
As a nation, the British believe that everyone else is to blame for the global opium and heroin trade – the reality being that Britain originally started a war in 1839 with the Daoguang Emperor of China because he had the audacity to ban the import of Opium…. From plantations owned and controlled by the British East India Company!
Stating it publicly, however, will label you a ‘Conspiracist’ or a ‘Traitor’.
The Chinese still haven’t really forgiven Britain for that by the way.
Those are only two examples that show how so many people can be and have been distracted by a re-written historical event, and are then carried along with the subsequent hysterical and absolute belief in every further instance of a similar event – which in reality, are being drip-fed to them by sources which are themselves not averse to openly lying, spreading propaganda and twisting of basic facts.
Which again, appears to have gone unnoticed by the vast majority.
Remember, while you are looking in only one direction – your attention is diverted away from whatever else may be going on.
As the best-known and most widely used powerhouse of online search engines, there is a fair chance that most people use Google on a daily basis.
However, it seems that very few people actually know how to use it properly in order to unlock it’s full potential.
I rarely use it on my own machine, as I find it far too restrictive for certain types of research and specialised searching, but in Libraries and where other public access machines are available, it usually happens that your choice is limited to the Mountain View behemoth and very little else.
So if you have to use it, it may prove useful to know your way around it.
BASIC GOOGLE SEARCHING:
Use quotation marks ” “ to find an entire search string.
eg. “love of Cheese” will only return results with that exact search term or ‘string‘.
Mark important words with a ” ” + (Plus)
If a search term must contain certain words or phrases, mark it with a + symbol. eg: +”William Shatner” book signing, will return all the results containing “William Shatner” but not necessarily those pertaining to a book signing.
Remove unwanted words with a – (Minus)
You may wish to search for the term “Sopranos” the TV Series, which will also return a generalised list of music related links as well.
In order to slim this search down and get a faster result, type: “sopranos” -music. This will then give you all search results with “sopranos” and NOT any related to ‘music’.
SPECIFIC WEBSITE SEARCHING:
You can of course just type the full Uniform Resource Locator (URL or web address) if it’s known, but there also ways to discover more about that particular site if you so wish.
For example: “link:www.outlawjimmy.com”
This will display a list of all pages which Google has located which link to this site (or yours) or a favourite site. I should imagine that many website owners use this facility to gauge how popular their site is - (although they would never admit to it.)
A Web Cache is a mechanism for the temporary storage (caching) of Internet documents, such as HTML pages and images, to reduce bandwidth usage, server load, and lag. Google’s cache link in its search results, provides a way of retrieving information from websites that have recently gone down and is a way of retrieving data more quickly than by clicking the direct link.
An example of cache searching could be: “cache:www.outlawjimmy.com web” which will show the cached content of the site with the word “web” highlighted.
Another method is to use the query term ‘info:’, which will present information that Google has stored about that particular web page.
Eg: “info:www.outlawjimmy.com” will show information about the Outlaw’s homepage.
Always ensure that there is no space between the “info:” and the web page address.
If you want to search for a specific file type within a website, (.mp3, .avi, .doc, .odt, .jpeg, mpg, .ogg, .mov, .mp4) or omit a file type being returned, use the + (plus) or – (minus) signs in front as for a regular search.
If you begin a search using ‘allinurl:’ Google will restrict the search to only those words which follow that exact search query.
Eg: “allinurl:dogging hangouts” will only show documents which contain both ‘dogging‘ and ‘hangouts‘ in the results.
Note: You would be surprised to see how often that particular search term is ‘Googled’.
This also works in a less precise manner by using ‘inurl:’ which will still restrict the search to documents containing those words, but not always together.
As an example, “inurl:dogging hangouts” will return pages that contain the word ‘dogging‘ and the word ‘hangouts‘ which may be elsewhere in the document.
If you want to search certain words in the title of a website, ‘allintitle:’ can be used.
For example, “allintitle:truth matters” will search only for documents that have both ‘truth‘ and ‘matters‘ in the title.
Other useful search queries, are ‘allinlinks:’ which searches links only, not in the title or contained text, and “allintext:” which searches only with the contained text, not the links or title of the page.
However, no matter how good you perceive online searches to be as a resource, there is still no real virtual substitute for actually getting your hands dirty and searching actual places, scouring dusty documents and reading otherwise unobtainable books and papers.
Alternative Search Engines
‘Vaping’ has, over the last few years, become a multi-billion pound industry.
With that in mind, it has attracted the attention of not only Big Tobacco, but also the Medical profession and the Media, who are, as expected, running around like headless chickens, entirely undecided, but erring on the side of extreme caution.
The WHO and the BMA for example, among others, have already warned about the ‘potential dangers’ and see electronic cigarettes primarily ‘as a threat to public health’.
There is ample information to be found online, most of it contradictory, but the following article, which was published on the website of the British Journal of General Practice, is among the most balanced I have read, and mentions that Health Professionals, “could expect a reduction of more than 6000 premature deaths in the UK each year”.
Which cannot be such a bad thing surely?
Electronic Cigarettes – Fact and Fiction
Robert West, Jamie Brown
First published 1st September 2014
There are a number of public health advocates who appear to consider electronic cigarettes (e-cigarettes) primarily as a threat to public health, and bodies such as the British Medical Association (BMA) and the World Health Organization (WHO) are warning smokers about their potential dangers. This editorial takes a close look at the evidence.
WHAT ARE E-CIGARETTES?
E-cigarettes are devices designed to give much of the experience of smoking and usually contain a certain amount of nicotine without exposing the user to the highly carcinogenic tar and harmful carbon monoxide gas that cigarettes deliver. Many of them look broadly similar to cigarettes but are often larger and sport different colours; some look very different from cigarettes. Some have a tip that glows red, blue, or green when the user sucks on them. They contain a battery-powered heating element that is activated either manually or automatically when the user sucks on the end. This element heats a liquid mostly made up of propylene glycol or glycerol, usually with some nicotine and flavourings. The resulting vapour is inhaled and delivers varying amounts of nicotine, typically less than from smoking, depending on the device and experience of the user. Some of the vapour is exhaled as a visible mist.
Given that smokers smoke primarily for the nicotine but die primarily from the tar, one might imagine that e-cigarettes would be welcomed as a means to prevent much of the death and suffering caused by cigarettes. For every million smokers who switched to an e-cigarette we could expect a reduction of more than 6000 premature deaths in the UK each year, even in the event that e-cigarette use carries a significant risk of fatal diseases, and users were to continue to use them indefinitely.
SAFETY OF E-CIGARETTES
This raises the question as to why some in the public health community are so vociferous in their opposition to them. One concern is over safety. Given how long it took to discover the link between smoking and lung cancer when the risks were so great, we have to accept that it will probably be more than 30 years before we would have a chance of being able to use epidemiology to quantify risks from e-cigarette use. In fact we may never be able to do so because we are chasing a moving target in terms of the products and their development.
This means that we must make judgements based on the toxicology of the vapour. Despite alarmist commentaries, studies on the toxicology of the vapour tell us that, while propylene glycol is an irritant and some toxins are present in measurable quantities, the concentrations are in fact very low. Some reviews have bizarrely concluded that we do not know whether e-cigarette use is safer than smoking, ignoring the fact that the vapour contains nothing like the concentrations of carcinogens and toxins as cigarette smoke. In fact, toxin concentrations are almost all well below 1/20th that of cigarette smoke.
EFFECT OF E-CIGARETTES ON SMOKING PREVALENCE
The second concern is that widespread use of e-cigarettes may ‘re-normalise’ smoking, leading to an increase in smoking prevalence, or at least a slowing down of the rate of decline. Yet, in England, where the ‘Smoking Toolkit Study’ surveys the adult population every month, the rise in prevalence of e-cigarette use has been accompanied by an increase in smoking cessation rates and a continued fall in smoking prevalence. The proportion of those aged 16–25 years who have ever smoked regularly has stayed constant at 30% over the period when e-cigarette use has increased.
E-CIGARETTES AND SMOKING CESSATION
The third concern is that there is only limited scientific evidence that e-cigarettes can help smokers to stop smoking. Two randomised controlled trials (RCTs) of now obsolete products that delivered little nicotine found those products to yield success rates broadly similar to licensed nicotine products. More trials of newer products are needed but these will only give us part of the answer. The number and variety of products, the rate of development, the time taken to conduct these trials, and the difficulty in generalising to people who are not willing to be randomised mean that we will have to supplement randomised trials with other kinds of study.
A review of surveys suggested that e-cigarette use by smokers might hinder quitting. However, the studies reviewed could not address the question satisfactorily because they failed to address differences in important factors such as nicotine dependence among those using e-cigarettes versus other smokers, and/or did not address whether the e-cigarettes were used as part of a quit attempt. A recent study has addressed these deficiencies. It used a survey methodology that had previously confirmed RCT findings that behavioural support and licensed nicotine products and varenicline obtained on prescription all improve smokers’ chances of stopping, while confirming findings from other studies that licensed nicotine products when bought over the counter may not improve the chances of stopping. The latest study, involving almost 6000 respondents, found that use of an e-cigarette in the most recent quit attempt was associated with a 60% increase in the odds of still being abstinent compared with using no aid and with using a licensed nicotine product bought over the counter. This difference persisted after adjusting statistically for a wide range of potential confounding variables. This is just one correlational study but it is an important piece of the jigsaw.
E-CIGARETTES AS A GATEWAY TO SMOKING
The fourth concern is that e-cigarettes may act as a gateway into smoking. The gateway hypothesis has been widely debated in relation to ‘soft’ and’ hard’ drugs and it has been recognised that simply counting the numbers of people who try a ‘soft’ drug and go on to use a ‘hard’ drug does not address the question. The reason is obvious: the association could easily be due to a pre-existing disposition on the part of the people concerned. To date, studies that have been claimed as addressing the gateway issue in relation to e-cigarettes have not in fact done so. Moreover, warnings about a rapid rise in e-cigarette use among the young have been based on the proportion of young people who report ever having tried an e-cigarette, not the proportion of current users. In England, the proportion of current users in people who have not smoked regularly remains extremely small at 0.2%.
THE NEED FOR OBJECTIVITY
This brings us back to the question as to why some individuals and bodies involved in public health are so opposed to e-cigarettes. It may be a concern over how things might turn out in the future given commercial incentives, puritanical ethics, distaste for any industry profiting from a psychoactive drug, inappropriate application of a medical rather than a public health model, or even just a gut feeling that e-cigarettes are bad. Whatever the reasons, it is important that interpretation of the evidence and communication with policy makers and the public is not distorted by a prior judgement.
© British Journal of General Practice 2014
NOTE: Commissioned; not externally peer reviewed.