More wafflling on health from Lansley: White Paper

Health Secretary Andrew Lansley wants more intervention and more personal responsibility. No evidence needed really on plain packaging because Australia will get round to it first.

The White Paper has clarified very little. Health budgets are to be ring-fenced.  How's this for clarity?

Much of today is about structural change [public health will be a council responsibility rather than one of health boards], with a nod towards the philosophy the Government intends to pursue. It will ring-fence the public health budget, a move welcomed by public health directors who were continually frustrated under Labour by the money being swallowed up by acute hospitals. 

Great stuff. Less money for acute care and more for public health interventions.

There will be an appointment of 'champions' of healthy living, set up by local councils, and a Health Inclusion Board, chaired by Professor Steve Field [yes, that Steve Field], who recently stood down as chair of the Royal College of GPs. His task will be to look into the causes of deprivation and health inequalities. And there will be a new public health premium, which will give councils money for delivering improvements in health inequalities.

Overriding all this, is the Government's desire to distance itself from accusations of the 'nanny state', for which Labour was often criticised. Instead it will use 'Nudge', a slightly hazy concept of helping the public towards reaching the right decision rather than making them do something like stop smoking, or losing weight, which they may not feel inclined to do.

Steve Field is charged with 'looking into the causes of deprivation and health inequalities'. It will be edifying if he gets beyond counting the calories, drinks and smokes people get through to the more fundamental issues of low pay and high housing costs. Charging public health improvement to local councils could be a plus if done comprehensively. Instead of this there seems to be a huge confusion between whether the government wants to nudge or shove people in the direction of good public health behaviour.

CATCH-3: Frank Davis adds his 2 cents to the discussion

More against the smoking connection with lung cancer here.

Smoking banned at State Hospital, Carstairs

I'll have more to say about this travesty in due course, but for now, let's just applaud the wisdom of depriving inmates of Carstairs of tobacco, with nothing to support the idea but the idea that smoking is bad for you (and if it's bad for you it must be bad for people around you). Except the staff seem more concerned than relieved that this measure (to include the hospital grounds, inexplicably) is being introduced.

The Sunday Mail article records staff concerns, but is remiss in other ways. The detail of what people have done before being sent there are relevant only insofar as they portray particularly agitated individuals. Their violent misdeeds have been judged by the courts to be a result of mental disorder. Sadly this seems to have prompted one or two individuals to conclude these evil people should be allowed no privileges – after all, law-abiding people are not allowed to smoke.

All very well, but the only reason these incarcerated people are being deprived of any tobacco whatever is that there are people prepared to exercise the power to stop them smoking. For the good of their health? Any guesses what they might take instead? Twenty years down the line, if we record the longevity of smokers spending most of their life in prison before compared with after the ban, I don't mind betting we will find very little difference.

WHO GAINS?


You tell me.

The other thing that the Sunday Mail reported inadequately was the Rampton judgement south of the border. The prisoners did fail to convince two judges, but did convince a third judge, who set out his reasoning in the judgement under the other judges' conclusion. There is nothing in this article even mentioning the third judge.

I will find a link later (EDIT: here). But from memory, he made the sound point that a total ban in a hospital setting such as Rampton meant complete abstinence from tobacco for patients who were never allowed to leave the building, and since such complete abstinence had not been explicitly considered as an outcome, it could not be said to have been endorsed.

COP-4, sadism and selfish economics

I'm not an agricultural economist, however I feel entitled to agree with the sentiments behind this post. Attempting to destroy the market value of a crop in a country such as Malawi where living into one's fifties is a luxury, in order to attempt to buy few years of life, is an act of sabotage and quite unspeakably self-centred. No doubt there are people who will claim that it is the tobacco industry that is tying farmers to poverty, but they are happy to contemplate ruining the market for burley tobacco without first being assured that there are alternative crops that will grow in areas previously given over to tobacco farming, and for which there are markets.

***

The Tobacco Free Association of Zambia has attacked its government's stance on the World Health Organisation, says the Framework Convention Alliance.

The Tobacco-Free Association of Zambia (TOFAZA) says it is against such wild accusations, and against calling for amendments to relevant Framework Convention on Tobacco Control (FCTC) articles. As a result TOFAZA is calling on its government to apologise to WHO for its unwarranted attacks.

The Zambian Government does well to defend an industry on which impoverished farmers depend. The farmers are caught by the tobacco industry, not because tobacco industry is inherently evil, but because that is the way that industry behaves to vulnerable actors within its grasp. All industries would behave the same if not regulated, and in industries were not regulated in this country, children would still be going up chimneys and down mines. Would the right answer have been to have banned the energy industry or stopped people lighting fires? Of course not ... regulation has to occur if the powerless are to be protected – but not by closing it down.

 ***

Anyone wanting to see some photos of the proceeding of COP-4 may proceed here. Note the installation of large cigarettes in front of the conference venue: are they trying to make people desperate to smoke?

BBC's Marr quizzes Lansley, Westminster health policy in confusion

I was going to say, 'plus ça change', but it's such a cliché. It's hard to know what else to say about the Westminster situation, however – the Labour Party managed to bring in the smoking ban in spite of its election promises, and the Coalition has broken many of its post-election promises, now deciding after all that liberal paternalism is the best course of action. Enjoy Lansley's interview by Andrew Marr, who questions whether a policy of mandatory plain packaging will work. Lansley's reply is that Australia will provide the evidence, but somehow its inclusion in this week's White Paper is not expected to be conditional on absolute evidence that it has 'worked' in Australia.

This begins to resemble Scotland, where no party of any colour questions the public health industry's dogma (although individual politicians have questioned it loud and clear. See 'Crying Shame' halfway down this column).

Talk of plain packaging has caused more speculation that the display ban will be ditched, as there is no need to ban the display of plain packaging. But not all commentators believe that the Government will proceed with the plain packaging idea.

Time, and the White Paper, will tell. This blogger expects many echoes of the past.

CATCH-2: The case for the defence

Hot on the heels of CATCH-1,  here is CATCH-2 from Rich White (blog here).

CATCH-1: Smoking and lung cancer: the case for the prosecution

A full day in advance of its advertised time, here is CATCH-1.

Significant risk? Video from superpower of the Third Sector

No, it's not ASH Scotland (but what an apt description!). It's the NSPCC. The Third Estate writes a spirited criticism of their video below:



The Musicians' Union issued advice to music teachers advising them against touching children two years ago, in order to protect them from malicious or mistaken allegations. Clearly, contact with children by teachers attempting to correct posture and technique can cut down on hours of explanation, the drawing of diagrams, etc. and music teachers have naturally resented any suggestion that most contact with children is intended as anything other than helpful.

The video and others in a series entitled Keeping Children Safe in Music are produced by the Musicians' Union and the NSPCC. The Musicians' Union seems to be clear that 'a cello teacher should have a cello to show a pupil what to do. There should be no need to touch.' It insists 'the best advice' is to avoid any physical contact, and this should avoid any misunderstanding. The videos also touch on other issues including discipline and suspected abuse. They are to some extent useful but only hope to show a teacher how to avoid handling a situation 'inappropriately' , without addressing the power relations at work in the music teacher–pupil relationship.

The vetting and barring scheme proposed in late 2009 (now being reviewed by the Coalition government) also came under the Third Estate's fire. The NSPCC supported this system when it came out last year, and still hopes that it will be implemented. Instructions to case workers made under this proposal are described here. The authorities are required to reach decisions using evidence about prospective carers and teachers that is verified only 'on the balance of probabilities', rather than 'beyond reasonable doubt'.  Third Estate correctly concludes:

If it can be show (sic), from any particular source of information, that somebody may or may not have done anything in particular, then a faceless caseworker can exclude them from a vast range of jobs and social activities. It goes without saying that the basic principle of a free society is that the government cannot severely punish or sanction its citizens without due process. The reason that we insist that a man or woman’s guilt is proven is not simply to stop bad things happening to good people (although this is important). It is also to stop government from victimising anybody who it happens to find troublesome.

James Underwood commenting in The Telegraph (first comment) adds:

The ISA justify the difference between their standards and those of a court (or even the [General Teaching Council]) by claiming that inclusion on the list is not a punitive sanction. Considering to a teacher inclusion means loss of job and future career it is hard to agree with this: '3.8.3 The decision to include in the list is not a punitive sanction but is a protective measure to safeguard children and vulnerable adults.' 

How far will these quangos go to avoid having their actions tested in law? Denying that a sanction that involves a teacher being labelled unsuitable to work with children or vulnerable adults is punitive? Instructing that an absolute standard of proof is not required in order to reach such a conclusion?

It is hoped that the current review will restore some perspective.

Third Estate's description of the NSPCC  resonates!

they are, in fact, a superpower of the third sector, whose (arguably warped) perspective is highly influential on government policy. Nothing is done in the world of child protection without speaking to them ... 

We have our own body in the anti-smoking world that government finds similarly persuasive, and with the same conviction that a series of harmless acts leads to something deadly. Case workers working with vetting and barring are instructed (with NSPCC approval) : 'You must look out for instances of behaviour which, although not “relevant conduct” or otherwise in themselves determinative of the potential for risk, give rise to concerns when looked at cumulatively that someone may pose a risk of harm to children or vulnerable adults.' Anti-smoking logic to a tee, right down to the use of the word 'may'.

Does smoking cause lung cancer: invitation to online debate (CATCH)

Two bloggers, Frank Davis and Chris Snowdon, will open a debate tomorrow (Sunday 28 November) on this issue: Frank Davis invites you to participate (see this link for an explanation of CATCH).

The suggestion came following a report of Chris Snowdon's participation in The Moral Maze last Wednesday (link included in this post). Chris's 'concession' that smoking causes ill health in smokers came under Frank's fire in his report of the broadcast here, whereupon a debate was suggested (see first comment).

Please have a read of Frank's invitation and share with anyone who might like to contribute! Starts tomorrow night, and lasts as long as it lasts.

Estimate-riddled study concludes passive smoking causes 1 per cent of deaths globally

Completely disregarding the tenuous link between risk and causation, The Lancet has published a study telling us that passive smoking causes 1 per cent of deaths globally, all without one single identified case. I imagine they do it by calculating the excess of exposed over non-exposed people in 192 countries, using indicators such as cotinine in hair to estimate exposure levels. (Is this any more subtle than saying children are dying from the effects of secondary smoke simply because their parents smoke?) The data in the study were taken from 2004.

The study itself is hidden behind a paywall [late edit: no payment required, registration is free], but appears to start with estimates of exposure, and proceed to conclude that the exposure caused death in thousands of people, including children, globally. Getting at the actual reasoning would be interesting, but it doesn't look subtle. Funding is from the Swedish government and Bloomberg Philanthophites.

The Independent's report is the most detailed, with such beauties as this:

The harm done by passive smoking has been known for decades but it is only in the last 10 years that the scale of the damage – and ways to prevent it – have become clear. Controversy has surrounded the issue because of the disproportionate risks of passive smoking. A non-smoker who lives with a person who smokes 20 cigarettes a day has third of the risk to health of their partner, even though they are actually exposed to only 1 per cent of the smoke, equivalent to one cigarette every five days.

How can 1 per cent of the exposure amount to 33 per cent of the risk?

The scale of the risk has met with disbelief and scientists have struggled to convey why it is so high. Evidence shows that the effect on the blood of toxins in tobacco smoke peaks at low levels of exposure. The toxins increase the stickiness of the blood (the tendency of the platelets to aggregate) and inflame the arteries, increasing the risk of thrombosis, a blood clot forming that that triggers a heart attack.

Oh, for goodness sake ... is this why only studies on lifetime exposure get anywhere close to a positive correlation between exposure and mortality?

Part of the agenda behind all of this can be found in the Caledonian Mercury's report. Sheila Duffy of ASH Scotland is quoted, inevitably homing in on the reported damage to children.

Although we have made great progress in Scotland by making public places smoke-free, exposure to this poisonous substance is still commonplace in homes and cars. Children can be particularly badly affected by exposure to tobacco smoke, increasing their risk of developing respiratory problems and other conditions.

In Scotland, around 300,000 pre-teen children live with at least one parent who smokes. Because we know second-hand smoke can cause so many avoidable health problems, reducing exposure must be a priority. We need to see much more work done to raise the awareness of harm that tobacco smoke causes, and a positive campaign to highlight the benefits to families of introducing smoke-free homes and cars in Scotland and to help people understand how to protect themselves and their children effectively.

So it gives ASH Scotland ammunition to push forward its agenda to 'intervene' in people's homes and cars in order to reduce the second-hand smoke exposure of children. Not unexpected. And on the world stage, from the study authors:

Prompt attention is needed to dispel the myth that developing countries can wait to deal with tobacco-related diseases until they have dealt with infectious diseases. Together, tobacco smoke and infections lead to substantial, avoidable mortality and loss of active life-years of children

Clearly the study authors want to divert health money to tobacco control, rather than spend more on infectious diseases.

I don't see the logic under any circumstances of prioritising 'unhealthy' lifestyle choices above treating and preventing communicable diseases. This study seems designed for no other purpose than to justify tobacco control activities at all levels by claiming that children are dying as a direct result of tobacco smoke (without being able to identify who they are).

New government, new colours?

Not so new any more, perhaps. High hopes of less intrusive government, morph into a realisation that we [ruled from Westminster] are just going to get more of the same.

The Grocer sounds a note of optimism about the tobacco display ban (conclusion so far unannounced), on the grounds that it would make no sense to introduce a display ban and plain packaging. Well I suppose that's optimism of a sort, although it doesn't challenge the self-styled supremacy of the Department of Health too much.

In case anyone misunderstands, the Department of Health has a place and position, in ensuring the delivery of health services. Ensuring the delivery of health is the responsibility of the Almighty, and the Department of Health shouldn't interfere with it. Removing tobacco displays on the vaguest chance that it might stop people smoking is ludicrous. Even if it succeeded in its objective of stopping people from smoking (there is very little reason to suppose it will), it doesn't guarantee that people will live more healthily. There are so many ways to live unhealthily, probably varying from person to person, that the task would be impossible.

That goes for Scotland too. They really don't understand the business they are trying to regulate, nor the need to have evidence and/or relevant ideas before they get stuck in. I love this quote from the Tobacco Retailers' Alliance website:

The idea that retailers should be discouraged from selling tobacco, and encouraged to sell other things in its place, is one that keeps coming up and I expect we’ll hear a lot more of it over the next few years. I once asked an official in the Scottish Government just what exactly retailers could sell in place of tobacco – what product would bring a hundred customers through a newsagent’s door every day, give him a profit equating to four Mars Bars per transaction and drive more add-on purchases than any other product category? After a long pause for thought, she shrugged her shoulders and replied, “Apples?”

I had to check that there was actually a Cabinet Minster and government department responsible for business in Scotland. (It's John Swinney, Cabinet Secretary for Finance & Sustainable Growth.) Someone should defend business interests in government against the combined policy interests of the Cabinet Minster for Health & Wellbeing and the Minster for Public Health and Sport – if nothing else, someone should be responsible for regulating business, so that the forces behind health and wellbeing can  concentrate on health service provision, which is what we pay them for. But the Health & Sport Committee has taken the lead on regulating tobacco displays in shops. Has it really nothing better to do?

Low EMF radiation not harmful to health, says WHO (but scores higher than secondary smoke)

Low level radiation from electro magnetic fields has not been found harmful to health, according to the World Health Organisation. So I am told by the Energy Directorate of the Scottish Government, following an enquiry regarding this post. My enquiry to Energy Secretary Jim Mather ran as follows:

In your capacity as Energy Minister I am interested in your views on how a power line can be authorised and not undergrounded in a heavily populated area, even though the relative risk of childhood leukaemia in areas close to high voltage power lines can be up to 4 (compared with relative risks of lung cancer and heart disease resulting from exposure to secondary smoke commonly given as 1.2–1.3, yet is held to be dangerous enough to justify a comprehensive smoking ban).

The reply indicated that Scottish Ministers can authorise or reject overhead lines, and they do not have authority in respect of putting lines underground. Further,

In respect of the health concerns, the Scottish Ministers take advice from the Health Protection Agency (HPA), and their view accords with that of the World Health Organisation – that despite extensive research, there is no evidence to conclude the exposure to low level Electro Magnetic Fields (EMF) is harmful to human health.

The writer of this letter made no allusion to risk levels from secondary smoke exposure.

The radiation off power lines shows at the bottom of the scale. But does this mean that the risks are non-existent? Not being an epidemiologist I am approaching this with considerable caution. The results I have found from this study in Canada give a relative risk from exposure to EMF of 1.72 (95% CI 0.54–5.45) and concluded no significant risk. From Germany, in pooled studies that included separate studies of night-time exposure, relative risks went up to 5.81 (95% CI 0.78–43.2 [is this an error?]).

Comparing the results with secondary smoke exposures: 1.4 (95% CI 0.9-2.2) for the total population and 1.2 (95% CI 0.7-2.1) (described by our good friend RT as a Killer Finding), it is clear that the risks for EMF score higher.

The letter from the Energy Directorate indicates that the situation regarding exposure to leukaemia from power lines will be carefully observed: clearly they diagnose the problem as lower than borderline significance. But then how do they (with World Health Organisation approval) get the whole world panicked about secondary smoke exposure, when it never seems to give a relative risk higher than about 1.4?

Scotland's spending on tobacco control, 2010-2011

Tobacco Control Activities, 2007–2008 to 2010–2011

	2007-08	2008-09	2009-10	2010-11
	£	£	£	£
Overall Budget Available	13,545,000	19,996,230	20,358,046	20,295,596
1. Smoking Cessation-Related Activity	9,160,500	12,711,230	13,128,096	13,013,096
2. Voluntary Sector Activity	1,005,112	983,950	983,950	971,500
3. Smoke-Free Laws	2,596,000	2,550,000	2,550,000	2,500,000
4. Smoking Prevention	148,125	3,165,000	3,098,000	3,065,000
5. Tobacco Communications	550,000	521,000	550,000	300,000
6. Surveys	70,000	62,000	33,000	18,000
7. Miscellaneous/Contingency	15,263	3,050	15,000	3,000
8. Tobacco and Primary Medical Services (Scotland) Act 2010 - Implementation				425,000

Notes:
1. Smoking cessation figures do not include the £2 million per annum contained within NHS boards’ unified budgets.
2. The above figures do include the budget for enforcing the smoke-free legislation and is provided by means of a block grant.


ASH Scotland ('Voluntary sector activity') earnings for the coming year don't seem to have reduced much.

The biggest section of the budget is smoking cessation related-activity. If local authority money is included, this gives over £15 million to smoking cessation this year. The Scottish Daily Mail today declared on page 32 (no url), 'Scots smokers failing to heed £20m health drive', and tells us that the Scottish Government has failed to achieve a 22 per cent smoking rate by the end of this year. Dr Richard Simpson MSP appears to experience a moment of clarity in this article when he says: 'I also have concerns about the amount paid to pharmacies. We need to be sure this is not the same people who keep coming back when the first lot of patches has not worked.' Appearing not to hear him, Public Health Minister Shona Robison says, 'It's good news that we've seen a significant increase in the number of people using NHS services to quit the habit': didn't anyone tell her what the headline of the story was? Since the number of smokers has remained constant, Dr Simpson could be right that they have created a revolving door syndrome


Smoking prevention is a big issue in budgetary terms. A survey of young people carried out by Young Scot (remember this picture?) was completed in 2007. Interestingly, it doesn't  refer to brightly coloured packaging or the visibility of tobacco in shops as contributing factors to young people smoking. The three most popular options chosen by participants were peer pressure, 'looking good' and curiosity. The range of options offered to young people in the survey did not include either option (the survey questions are listed at the back of the document). Clearly nobody read this report before drafting the law that would ban tobacco displays. 


All in all, disappointing that most of this money isn't used elsewhere in the Scottish health service or Scottish society generally.  

Scottish display ban consultation report, and proof of age war

The Scottish Government yesterday published responses to the consultation on tobacco display ban regulations, which closed in the summer. However, consideration is not complete, because of legal action:

In light of the ongoing legal challenge relating to the display ban provisions of the 2010 Act, the Scottish Government is putting on hold meantime finalising the Display of Tobacco and Prices Regulations. This analysis is, therefore, confined to the other 4 sets of regulations.

The Press and Journal has reported that failure to register as a tobacco retailer can invoke fines up to £20,000 or imprisonment. Selling to under-age persons can bring fines of £200, increasing with each offence, and courts can ban repeated offenders.

On proof of age the Press and Journal report also states: 'Proof of age will be a driving licence, passport, or a national Proof of Age Standards Scheme (Pass) card, such as a Young Scot Pass card.' This includes Citizencard.

Citizencard provides proof of age backed by the Home Office PASS (Proof of Age Standards Scheme). It is hologram protected and uses laser-etched photography, to reduce the risk of forgery. Its principal stakeholder is the Tobacco Manufacturers' Association (along with No ID, No Sale). This card is mentioned in the consultation report:

While the majority of those who expressed a view backed the use of Young Scot as a PASS accredited card as an alternative for those who do not have a driving licence or passport, the use of another PASS accredited card, CitizenCard, was specifically endorsed by tobacco manufacturers. Health interests suggested, however, that nothing should be done to lend credence to the tobacco industry-supported CitizenCard. 

This is the Young Scot card, another useful age verification device. It is available to anyone over the age of 16, and proves that someone is either young enough to apply for concession fares, or old enough to smoke and drink, whichever applies. (Its health message for smokers is very unflattering, with its page on smoking including a young person with a mouthful of dogends.)

Note the pressure that is brought to bear on the government by health experts, who don't want tobacco interests to get any credence for their contribution to age verification campaigns age-restricted goods. No Sale, No ID is another campaign sponsored by the Tobacco Manufacturers' Association, and is the only one that I can think of that is featured in shops and newspaper kiosks everywhere. The health gurus don't like it because it puts tobacco manufacturers in a good light.  The Scottish Government's conclusion on age verification?

The Scottish Government notes that the majority of respondents who expressed a view are content with the draft regulations. In terms of the issues raised at paragraph 4.3, we would emphasise that this is not really a matter for the draft regulations. It should be noted, however, that the Scottish Government will continue to put its weight behind the Young Scot PASS card and that it also has the full backing of the Association of Chief Police Officers in Scotland (ACPOS), Scottish local authorities and leading retailer representative bodies.

Bit of a cop-out really. Citizencard is a PASS card, and has not been ruled out, but rather than make this clear, the Government mumbles about this 'not being a matter for the draft regulations'. Pure poppycock. Where do you specify what is valid ID if not in the regulations? Public Health Minister Shona Robison says herself: 'For the first time, this legislation will put a duty on retailers to verify that a potential purchaser is not underage - and it also specifies what methods of ID are acceptable.' As for Young Scot having the full backing of ACPOS and so on, all well and good: No ID, No Sale also has a wide range of sponsors.

People are still getting used to the PASS, and Citizencard has had problems because employees at some outlets have failed to recognise it. Getting age verification wrong is such a threat that many employees reject it simply through lack of training, and because of the heavy sanctions applied to people who make mistakes, but also some companies have policies in favour of passports or driving licences only. Efforts to iron out these problems are under way, but it appears that not all companies do accept PASS cards yet.

The main issue here is what is legally recognised as proof of age. That is, people selling age-restricted items can avoid making mistakes by refusing forms of identification that are not an acceptable proof of age. This appears to show that Citizencard is legally acceptable in Scotland. Even if the health nuts don't  like it, there is no reason that the Citizencard should not be used.

Plain packaging will remove last form of marketing (since display ban removed last advertising loophole)

The goalposts are moving ... The Press and Journal's report on plain packaging (treating it as a reserved issue) said this:

A spokeswoman from the Department of Health said colourful packs were widely accepted as the last form of marketing available for tobacco companies to recruit new smokers. [emphasis added]

Go back to the Stage 3 debate on the Tobacco and Primary Medical Services Act, 27 January this year, however, and the First Minister Minister for Public Health and Sport declares at Col 23103:

Therefore, I contend that the evidence for banning displays exists. For me, the most compelling point is the need to remove the last advertising loophole. [emphasis added]

In the Daily Record last June, she was quoted as saying:

"... for me it's about the fact that point of sale displays are important to the tobacco industry. Why are they important - because they are the last remaining advertising that they have. 

"For me that's the most compelling point, that we should remove that last advertising loophole." [emphasis added]

As a clincher to the argument as to whether the evidence supports the display ban (which Ross Finnie felt at that time was 'extremely inconclusive') this is poor stuff. Less than a year later they (at any rate their English counterparts), are describing branded packaging as 'the last loophole'.  Are they going to present every restriction as 'closing the last loophole'?

I can't wait for them to identify another 'last loophole'. Anti-smokers cannot trust tobacco companies to act in the spirit of the legislation, apparently unable to understand why they don't all dissolve themselves in a fit of goodwill to mankind, rather than continue to sell their products. Complying with the legislation is not enough: doing so inevitably involves 'exploiting a loophole' (such as making their displays bigger once actual advertising is illegal). I'll be looking for the next 'last loophole' that they find, and will give it about nine months.

Guardian poll on plain packaging

ASH Scotland's barmy tax calculations reported again

Today's Edinburgh Evening News sees this report, which doesn't appear online:

Smoking VAT row

The health benefits of a tobacco-free society would outweigh the VAT paid by cigarette firms, a city charity has said. 

Many argue that tax paid on tobacco is irreplaceable but ASH Scotland said smoking costs the country £1.1 billion, more than the VAT received. 

A few points here.

1, I think 'VAT paid by cigarette firms' should read 'duty'.
2, This story came out nearly two weeks ago, so why is it being slipped into the middle of the Edinburgh Evening News (and inaccurately too)?
3, Has ASH Scotland asked for a reprint? Do they really believe banning tobacco would save the country money? Or is it just the Evening News trying to fill up space?

Who are these people? Quite apart from the objections that have already been raised about these so-called calculations, there is a clear assumption that anyone who stops smoking will go on to adopt a healthier lifestyle, without developing any other habits that might cost the health service dear. People who give up smoking will take to wholesome diets and take lots of exercise (not that such choices are a guarantee of a wholesome, painless or inexpensive end), and they won't be tempted by any other kind of drug, or even excessive eating.

The original calculation by ASH Scotland (costs of smoking amount to £1.1 billion as against income of £940 million) is a shameless attempt to make the economic costs add up to more than the economic gains of smoking, based on speculation, flawed reasoning and guesswork.

Scotland, Malawi and tobacco ingredients ban

According to this BBC report, tobacco farmers in Malawi could lose 60 to 90 per cent of their livelihoods, if an ingredients ban is implemented. The Scotland Malawi Partnership (whose website sports a thumbnail picture of Jack McConnell, former First Minster, whose main claim to fame was introducing the smoking ban) has operated since 2004, but it remains to be seen whether it will offer any support to Malawi in the defence of its tobacco growers. Working mostly with non-government organisations, it acknowledges that 'Malawians know best (a) ... (b) what challenges and issues there are in Malawian civil society; and (c) what mechanisms or interventions could help address these challenges'. Will this reasoning apply to anyone who wants to defend the tobacco plantations?

And does the Scotland Malawi Partnership make any attempt to work with official bodies that will represent the government viewpoint, as well as NGOs?

A quick look at the Scotland/Malawi links reveals a concern for child labour in Malawi's tobacco plantations, touched on here. This is a typical anti-smoking take on any tobacco industry: the fact is that child labour occurs everywhere and in any occupation in which children are vulnerable.  UNICEF tells us that one in six of the world's children is engaged in child labour, so talking of child labour as if it were specific to tobacco plantations is dishonest (or naive), but what is expected of reporters today. If it is common in Malawi, this is because of Malawi's heavy reliance on tobacco. Destroying Malawi's staple industry will do nothing for the welfare of its children.

So has Scotland any plans to address the issue of the tobacco industry in Malawi? Well, yes it has. Is it likely to help tobacco growers' interests? Probably not: the MSPs Michael Matheson (SNP) and Karen Gillon (Scottish Labour) have buried their differences to invite us to this meeting, both supporters of anti-smoking legislation. Speakers are Dr Jeff Collin and Dr Nathaniel Wander of Edinburgh University, both named as external co-workers of Professor Anna Gilmore.  It is hard to imagine that this meeting will agree to help Malawi to defend tobacco farmers against the ambitions of the global tobacco control community.

Greeks still defiant on smoking ban: government thinks again

I've found only one version of this story. After a two month smoking ban that the Greeks defied from day 1, it appears that the government feels the need to retreat, at least partially. This is magnificent, not least because it was felt that previous bans had only failed in Greece because they were partial – not comprehensive. Now that they realise that a comprehensive ban is also impossible to enforce on the Greeks (a reported 80 per cent violation rate), one wonders what excuse they will dream up next.

Plain packaging on the way, Westminster and/or Holyrood

Has Andrew Lansley, who has been weighing up whether to implement the display ban as passed into law, found an even stronger form of deterrence? The BBC announces that the Department of Health will consider requiring plain packaging for tobacco products, and that it will put together a White Paper on the subject (it also says the government 'will ask' shops to cover up displays from next year: the wording is too mild to suggest that any final decision has been made).

Compelling the sale of tobacco in plain packaging cannot fail to make counterfeiting easier and cheaper, but legislation requiring such a move has already been mooted in Australia. The Scottish Government has also expressed interest in this, but does not have the powers to pass legislation on packaging. An SNP spokesman said: “The SNP is favourably disposed to this idea, and if Westminster will not do it then the powers should be transferred to the Scottish Parliament".

It would seem that the SNP might not need the extra powers, if the Westminster government proceeds to bring in legislation. Is this a factor behind the Department of Health's interest in the idea: 'being in the lead in tobacco control'? (or do they wish to prevent the devolution of further powers?)

Within Scotland, the effectiveness of plain packaging as a deterrent to smoking is disputed. Enrico Bonadio of Abertay University predicts a price war, but Crawfood Moodie (of the Institute for Social Marketing – yes, them again!) believes that the deterrent effect will outweigh any price war. The tobacco industry has concerns over its right to a brand image, and warns of legal trouble in the event of any legislation.

Nothing would be less surprising than an aggressive policy of this kind in Scotland, where ASH Scotland rules supreme. The same cannot be said of England however, where even many Tories have felt grounds for hope that the Coalition would adopt a less 'nanny state' line of policy. Dick Puddlecote has been enjoying disabusing them of their hopes of a better future under the Coalition.

LiberalVision also comments: also disillusioned with its leaders over more central control and illiberal governance, in contrast with its promises. More criticism from the Scottish blogosphere would be welcome: surely not everyone in Scotland approves of this policy?

Anti-smoking group in Scotland celebrates studies promoting tobacco display ban

Two studies published in Tobacco Control on Thursday, both endorsing the display ban on the basis of research done in Ireland. One study (Evaluation of the removal of point-of-sale tobacco sales in Ireland) recorded high rates of compliance, reports of quitting made easier and lower estimates of youth smoking. The other study (Economic evaluation of the removal of point-of-sale tobacco sales in Ireland) shows that the display ban has had no impact upon shops, and not led to any decline in tobacco sales over and above long-term trends.

Both stories originate with the University of Nottingham (UK Centre for Tobacco Control Studies), and both are funded by Cancer Research UK. It is thus of little surprise to read that Sheila Duffy welcomed the studies: 'the tobacco retail display ban, which has been in place since 1 July 2009, has changed young people's attitudes to smoking and not resulted in any harm to businesses'. She could hardly not support them:

1. Because the studies were published in Tobacco Control, part of the British Medical Journal group of journals. 
2. Because the studies were funded by Cancer Research. 
3. Because most of the authors have good credentials in tobacco control (and/or social marketing!)

Both institutions have a clear agenda to promote tobacco control, indeed Cancer Research explicitly states that research projects that seek funding from the Tobacco Advisory Group should favour further tobacco regulation.

This is in essence policy-driven research, and not good.

ASH Scotland, funded by the Scottish Government, promotes the display ban because of uncertainty about whether  the Coalition will choose to enact the legislation south of the boarder. (This is why I had no qualms in asking people to request MPs to vote against the English display ban. I had no doubt at all that antis would be at work lobbying MPs to vote the other way.)

And what do the studies tell us?

• Lower product recall in adults and young people.
• Fewer young people estimated that over one-fifth of young people smoked.
• Fourteen per cent of smokers thought that the law made quitting smoking easier.
• Thirty-eight per cent thought fewer kids would take up smoking. And from the economic study:
• No significant short term change in tobacco sales.

This is all about perception: whether it is perceived that fewer young people currently smoke, that more people can easily stop smoking and that fewer young people will take it up. And no change in tobacco sales. Hardly a ringing endorsement of the policy, or worth much of Cancer Research UK's money.

But perhaps Cancer Research and Tobacco Control involvement are enough to make some readers think that the studies' results must provide unequivocal support for the tobacco display ban?

Uruguay Conference (COP-4) fails to gain concensus: Philippines gets the blame

Although claiming success, the fourth Conference of the Parties, held this week in Uruguay, gained agreement in only limited areas of its agenda. According to this report, it agreed only on getting smoking cessation and training for relevant personnel to be funded by governments (and voted for support for the state of Uruguay against legal action brought against it by Philip Morris International). On the issue of government funding of smoking cessation, this is a huge diversion from existing health problems. It cannot be said to be high on the agenda of countries with major burdens in transferable disease. But now it is mandated by the WHO Framework Convention on Tobacco Control.

The conference failed to get agreement on the banning of ingredients, or further control of the illicit trade.

Afterwards the Framework Convention Alliance took it out on the Philippines:

According to the Framework Convention on Tobacco Control Alliance, Philippines (FCAP), the COP-4 delegation of the Philippines served as the tobacco industry's mouthpiece in criticizing the draft guidelines on regulating the contents of tobacco products and requiring disclosure of tobacco products contents.

"Despite existing scientific evidence and international experience, the delegation decided to protect the interests of tobacco manufacturers, whose sole objective is to profit from the harms on the people’s health caused by tobacco use," said Dr. Maricar Limpin, FCAP executive director.    

They didn't have a consensus and so rounded on the rebels. I can't comment on the delegation in detail, however, it was headed by a delegate from the Trade & Industry department, with one Health department representative, one from Agriculture and one from the College of  Law. This was felt by  some to be 'unfair' as the Department of Health was under-represented. However since the conference was about global tobacco rules, this seems a fair enough mix to me. Law, Agriculture and Health all got a seat, and the DTI got three.

The problem of course is that the FCTC has sought to create consensus by excluding the opposition to its agenda from any meeting. Any opposition is construed as being orchestrated by the tobacco industry – even the composition of the delegation comes under criticism: '"Considering that the WHO FCTC is a public health treaty, it is inexcusable that the public health sector is severely underrepresented at this important conference." said Emer Rojas, a cancer victim and president of [New Voice Association of the Philippines].' Only domination by health department delegates will satisfy. The Philippines delegation was 'the tobacco industry's mouthpiece', and actual farmers assumed to have been organised by the tobacco industry as well.

It is good to know that there is significant disagreement even within this self-censoring organisation.

***

The COP-4 bulletin #108 (available here, foot of page) tells of Tanzania, where farmers have extricated themselves from the tobacco market: a brutal regime where sometimes they were not paid months after delivering their crops to market. Tanzania Tobacco Control Forum advised farmers to transfer to alternative crops, and enough of them did to create a glut by the end of the season. The reporter even admits that 'sesame has a market, although buyers cheat farmers by using fake scales'. (Ah: so exploitation and dailylight robbery of small farmers isn't limited to the tobacco market? Good that you picked that up!) The TTCF has arranged warehousing and advance payments for farmers, in cooperation with the Ministry of Agriculture. This may have removed those farmers from a very tight situation, but their analysis that tobacco is what hurts farmers is false. All small farmers and producers are vulnerable to exploitation, late payment and consequential debt problems, whatever their crop. The work of  TTCF would be valued more if it didn't limit its beneficiaries to tobacco farmers.

Edit: According to a more recent report, COP-4 recommended that 'additives used to make cigarettes more appealing to new smokers should be restricted or banned', and that governments pass legislation accordingly. Being a BBC report, it tells us that the agreement was 'adopted by consensus'. But clearly, gatekeeping is so robust at this conference (all conceivable opposition left at the door and even the composition of delegations condemned if not dominated by health interests) that consensus was inevitable.

Irish by election candidate wants review of smoking ban

It is unlikely that Anne Sweeney's words will be reported in the Irish Examiner, so let's spread the word here.

Out in the cold: more elderly residential homes go non-smoking

By next month temperatures will max at freezing point in Burlington, Vermont, and by January they will sink to 10 degrees Fahrenheit (-12 celsius). These are temperatures that citizens of the area have known all their lives, so it should come as no surprise that they haven't stopped the introduction of a smoking ban at Decker Towers, a public housing unit for elderly and disabled people operated by the Burlington Housing Authority.*

In an article that has been deleted but is quoted on the Smokers Club Forum, we learn

BHA Executive Director Paul Dettman said the new policy, announced in late February in a letter to residents, is part of a national trend encouraged by the U.S. Department of Housing and Urban Development, which provides funding for the housing. The shift is motivated by concerns about the effects of second-hand smoke on residents and by safety concerns.

It continues,

He said BHA has not tested the flow of second-hand smoke in the three Burlington high-rises but has received “infrequent” complaints about smoke from some tenants. 

So: no tests, few complaints, but federal approval. So let's go for it.

Family housing has not been included in the ban because it doesn't create the same fire hazard. So the young and fit are exempt from a ban that will see elderly and incapacitated people lose their homes. How can these people sleep at night?

Senior citizens are now a target of no-smoking evangelists. You can get accreditation for providing smoke-free facilities – see slide 26 in slideshow linked below.

Enjoy this slideshow (and remember that ASH Scotland wishes to remove existing exemptions to the smoking ban – see page 7, 'Beyond Smoke-free' document).

* BHA is committed to equal housing opportunity and will consider reasonable accommodations upon request.

Lung cancer studies and confidence intervals

Author Chris Snowdon introduces the latest lung cancer study, in a post that reviews his research of lung cancer studies in the past, and points out that there are far fewer published now than up to five years ago.

I have found the discussion today (comments beneath the blog post) of particular interest, and helpful in explaining such mysteries as relative risks and confidence intervals.  If when testing the probability of lung cancer from SHS exposure, they get a confidence interval between 0.6 and 1.8, it spans a negative value and a positive value ... this surely means that the results could give a negative value. And yet there are people out there (mentioning no names) who want to persuade us that this is a statistically significant result involving people's actual deaths.

I think the participants in the discussion make it clearer!

Edit: A review of the new lung cancer study (Brenner, BMC Cancer, 2010) , supplied by its author in the comments to Chris's post, can be read here. The study considers exposure to passive smoke in non-smokers with lung cancer, and their exposure to paints and solvents, and to smoke-soot and exhaust. The results for passive smoke are not significant, the results for the other contaminants are significant, nearly trebling the risk of lung cancer (and the confidence intervals do not span zero!).

Where's a union when you need it? summary dismissal for e-cig use

A summary sacking has befallen a bus driver caught using an e-cigarette. Summary dismissal, on a charge of gross misconduct, when the offender was not even driving a bus at the time. An e-cigarette. Really, equating the use of an e-cigarette with assault and theft (other forms of gross misconduct) is too silly.

You can read the account here. A link is provided if you wish to complain to the bus driver's employer, Country Liner.

I apologise if my heading sounds belligerent to unions. No union is mentioned in the blogger account and I don't even know if the driver is a member of a union. Nonetheless, unions must take note, if they haven't already, of the kind of action they can expect against their smoking members (or even members who look as if they are smoking), if the bus company concerned is allowed to get away with this.

The debate is over, is it?

The climate change debate has always been beyond me. I see too little of the world to be able to make meaningful comparisons about shifts in the weather. I am not a believer in anthropogenic global warming (AGW). Nor am I sceptic or a denier – I simply don't know. But when I hear the words 'the debate is over', this inclines me to the view that it most certainly isn't over and possibly hasn't been allowed to start.

It's what the US Surgeon General's (2006) report said about the dangers of passive smoking.

It's also over for the BBC, says James Delingpole, launching an attack with this interesting paragraph:

When the history of the greatest pseudoscience fraud in history  -aka “Climate Change” – comes to be written, no media organisation, not even the Guardian or the New York Times, will deserve greater censure than the steaming cess pit of ecofascist bias that is the BBC. That’s because, of all the numerous  MSM outlets which have been acting as the green movement’s useful idiots, the BBC is the only one which is taxpayer funded and which is required by its charter to adopt an ideologically neutral position.

You don't need to believe that this is the biggest pseudoscience fraud in history to realise that the BBC has a big credibility problem here, and Delingpole seeks to show that the BBC deliberately dropped its impartiality on the climate change debate, in what looks like an exercise in social marketing. 

How this was achieved is recounted in the report Submission to the Review of Impartiality and Accuracy of the BBC’s Coverage of Science, by Andrew Montford and Tony Newbery. Their report centres on a seminar held by the BBC in January 2006, under the title 'Climate Change – the Challenge to Broadcasting'. A report published by the BBC Trust the following year opined: 

The BBC has held a high-level seminar with some of the best scientific experts, and has come to the view that the weight of evidence no longer justifies equal space being given to the opponents of the consensus. [emphasis added]

To cut a long story short, there is little evidence of any 'scientific expert' at the conference at all, and two observers were appalled at the level of research that BBC personnel appeared to have done on the issue of climate change. The BBC also refused to reveal the identities of those attending the seminar under a Freedom of Information request, and legal clarification has been sought on the exemptions relied on by the BBC. It is quite unacceptable that a publicly funded body should seek to conceal the identity of participants in such a key seminar. 

The report's conclusions recommend (to the Review of Impartiality and Accuracy of the BBC's coverage of science) that due attention is paid to the BBC's commitment to impartiality and any necessary corrections are made to public records, and to why the participants of the seminar, many of whom were attached to environmental NGOs, were allowed to formulate BBC policy on climate change.

The Review is to be chaired by Professor Steve Jones and will report next Spring. I hope its report is thorough. 

Former MSP attacks ASH Scotland

Yet another attack on ASH Scotland has appeared, this time in The Scotsman:

(click to enlarge)

(A substantial chunk of this appears here.) Brian Monteith is not the first to find fault with ASH Scotland's calculations of smoking costs. More can be found here, here and on this blog.

In the meantime Simon Clark also has a cautionary note for those who think that ASH (or ASH Scotland) can be challenged on the basis of being 'fake charities', and links to this document by Blad Tolstoy, a veteran campaigner on smoking/prohibition issues. The document concerns the English ASH organisation and English charity law, but the point remains that charity law is not the best line of attack on ASH Scotland. The atrocious quality of their publications and their support of nonsense (like the 17 per cent reduction on heart attacks that supposedly resulted from the smoking ban in Scotland) are good lines of attack, but (says Simon):

Last week I was quoted in a retail trade magazine. 'Tobacco control groups are no longer interested in educating people about the health risks of smoking,' I said. 'Their strategy is to denormalise and stigmatise adults who consume a legal product.'

Today the tobacco control lobby is more interested in coercing people to quit smoking, with groups such as ASH using every "confidence trick" in the book to achieve their goal of a 'smokefree' (sic) world.

Illiberal smoking bans, display bans, claims that smokers are harming (and even killing) those around them - this has nothing to do with health and everything to do with denormalising not only a legal product but the consumers of that product.

Thanks to charities like ASH, many people's social lives have been ruined, businesses have closed and jobs have been lost. I fail to see what's "charitable" about that and for that reason alone I am happy to call ASH a fake charity.

I think that will do for me too.

EDIT: a reply has been printed in The Scotsman letters page today. Please add yours!

Scottish blogging: Political Innovation event

I missed this event at the weekend, but found some interesting accounts.

This one, which gave me the impression that blogging in Scotland was all about nationalism, and providing an outlet for nationalist views that are not accommodated by the mainstream Scottish media.

And this one, less nationalistic in outlook, but while acknowledging the anti-nationalist bias in the media, maintained a broader outlook. 'It's not the only issue on which the Scottish media gets it wrong', says writer Peter McColl, listing other Scottish issues neglected by Scottish media (a new Forth road bridge being one example). To such issues I would of course add tobacco control and smoking ban-related issues. 'There’s more to politics than the national question, and the case for more powers would be stronger if it were less one dimensionally put by nationalist bloggers.'

I've never been nationalist in outlook and particularly dislike the indignation expressed about unionists who disagree with issues such as minimum pricing. Having a different view about whether a policy will be effective is not the same as wanting to condemn Scotland's poorest to a life of drink. Taking the moral high ground and claiming a monopoly on caring about Scotland's health does not serve the issues but just turns people into political pawns. It will also not help nationalists to be taken more seriously by Scotland's media, if they claim to be the only ones with a passion for their country and people, and surely not what our supposedly non-adversarial politics with a circular chamber was meant to bring to Scotland.

Having said that, the realisation that Scottish nationalists know that there is something deeply disconnected about Scotland's mainstream media should be common ground.

Peter McColl's gripe was with the quality of political discussion over the last two decades and, more recently, with the failure of participants on Saturday to take hope from the size of the student demonstration in London last week. I also enjoyed his conclusion:

While I’d seen the events in London as evidence that young people are anything but apathetic, the conversation worked from an assumed position that young people are more apathetic. For an event that was meant to be about political innovation this was deeply disappointing. If you think innovation in politics is taking a marketing approach, or making it more like “The X-Factor” then we’re faced with a pretty dire future. The poverty of analysis was matched only by the lack of ambition. The problem with politics is precisely that it is bedevilled by a marketing approach and failed attempts to be like “The X-Factor.” The managerial politics of the last 20 years, marked by an ever more presidential style, has gone a long way to killing politics. If you never discuss anything interesting you make politics boring.

The event itself attracted over 80 participants, and is an ongoing project. Here is one of the organisers' accounts, with links to Twitter and Facebook for those who want to follow developments.

Trade groups reject WHO guidelines on tobacco: tobacco trade unites Zimbabwe

The International Tobacco Growers' Association reports that leaders of the Asia, Pacific and Caribbean Group of States (ACP) and other major trading groups reject recommendations of the World Health Organisation Framework Convention on Tobacco Control. Thankfully national political leaders are defending the interests of tobacco growers in their respective countries. Story here.

The threat to tobacco livelihoods is felt so strongly in Zimbabwe that parties who have warred for the last two decades have felt the need for co-operation against the World Health Organisation's attack on the global tobacco trade. Zimbabwe's tobacco accounts for 26 per cent of GDP, and many resent losing such a contribution to the national wealth on the say-so of the World Health Organisation. An account of Zimbabwe's tobacco trade in the context of civil disturbance in the country is here (a couple of the comments are worth looking at).

You can learn more about the ITGA and sign a petition here.

Health chiefs plead retention of tobacco display ban

Once again, health experts have taken to the broadsheets (i.e. written to The Guardian) to plead their case that abandoning the tobacco display ban in England will put children's health at risk. Like Peter Kellner in his Open Letter to Vince Cable in the New Statesman a couple of weeks ago, they suggest that the government must choose between 'the tobacco lobby' and 'the British people'. In the Politics column of The Guardian, a Lib Dem councillor suggests rather dismissively that shopkeepers have naively 'fallen for the industry spin'.

Personally I feel that shopkeepers are better equipped to understand the tobacco trade than the authors of the Guardian letter, and the dichotomy of tobacco lobby versus British people is a false one.

The Grocer also speculates: Tobacco display ban to be delayed. A delay would be good, but evidence that the display ban would fundamentally affect youth smoking is not substantiated.

An announcement from the Health Secretary is awaited.

World ban on tobacco ingredients threatens livelihoods

The World Health Organisation's Framework Convention on Tobacco Control seeks to restrict global tobacco farming, and to ban certain ingredients used in blending tobacco. They meet in Uruguay next week, and this report from Zimbabwe explains how the country's economy will be hit.

A report from the Framework Alliance, an outlet supportive of the FCTC, explains that tobacco farming is really not in the interests of poor farmers (the link will also take you to the FCTC). It includes a report of the Uruguay president's resistance to 'pressure' from Philip Morris International on the issue of graphic warnings on packaging. The pressure that will be exerted on millions of farmers globally when their livelihoods are banned (as recommended by the Framework Alliance) is regarded as somehow benign by comparison.

I can't comment in detail on the agricultural economics of growing tobacco, but I can point out that it is not only tobacco companies that are opposed to the FCTC. The Framework Alliance claims that the FCTC, which includes 171 Parties, 'represents 89% of the world's population': it does not represent the farmers (link from Philippines):

In a statement, [International Tobacco Growers' Association] ITGA said that in spite of ringing the alarm bells, the ITGA’s request for 'a seat at the table' has been rejected by the WHO, who has allegedly considered farmers as 'interferences'.

'We are the people most affected by these guidelines', says Antonio Abrunhosa, CEO of the ITGA. 'Yet people with very limited understanding of how tobacco is grown are deciding on our fate at the throw of dice, without even consulting us.'

No doubt these worthy global governors believe they have done their homework: 'Articles 17 and 18 of the FCTC address economically sustainable alternatives to tobacco growing', says the Zimbabwe piece. The Framework Alliance gives the problem of economics a nod by saying 'tobacco farming does not alleviate poverty', but does not remark on the issue of how tobacco farmers should cope with a ban on their crop.

There are huge problems with this: for example the refusal to allow anyone who opposes the Convention's prohibitionist agenda to sit at the table, and a commitment to prohibition that far outstrips any concern for the livelihood of farmers, or realistic proposals to compensate them for what promises to be a devastating blow to their livelihoods. Of most concern of all is the global agenda of this juggernaut. In none of the stories do national politicians figure in this momentous issue of restricting a basic crop on which vast numbers rely.

Will national governments be expected to police bans imposed by WHO on agricultural produce? Just how expendable are these farmers' interests?

Serbia introduces severe ban in educational establishments but a relatively lenient ban in bars

Thanks to Chris Snowdon for this. When I saw headlines about a Serbian smoking ban, for some reason I imagined it would be thorough.

This is 'thorough'.

Smaller bars and cafes can decide to be smoke-free or not, while bigger ones, as well as restaurants have to provide a non-smoking space that would occupy more than a half of the premises and be properly ventilated.

And: 'Companies are allowed to provide a smoking area ...'

True the ban does extend to some outdoor areas, and the penalties for managers that infringe the law are 200 times those applied to individuals, but the smoking doesn't stop people in the hospitality industry from practising basic hospitality.

What is it with the UK and its devolved assemblies?

ASH Scotland's new nonsense on smoking costs up in smoke

Even an almost erudite sounding website named Egovmonitor takes ASH Scotland's word entirely at face value. Its claims of the smoking costs are laughable, but they are uncritically stated. Smoking costs Scotland £1.1 bn a year, says ASH Scotland's Up in Smoke campaign.

Clearly the whole point of this exercise is to ensure that costs to the economy attributed to smoking minus Scotland's share of tobacco revenue gives a negative balance. Scotland takes £940 million in revenue directly from tobacco. So did ASH Scotland make its point? It makes the following claims:

• treating smoking attributable disease in the NHS costs £271 million
• productivity losses due to excess absenteeism, smoking breaks and lost output due to premature death cost £692 million
• premature deaths due to second-hand smoke exposure in the home cost £60 million in lost productivity
• clearing smoking-related litter from the streets costs £34 million
• fires caused by smoking in commercial properties cost £12 million.

Even the first point raises alarm bells. 'Attributable' does not mean 'caused by'. It means 'could have been caused by'. It is all guesswork, evident where the relevant web page states the costs are 'conservatively, around £1.1 billion'.

But lost productivity because of premature death or disability amounts to a private cost borne only by the smoker (since health care costs are accounted separately). And how do they come by 'second-hand exposure in the home'? How does ASH Scotland know, when they cannot even identify who is dying of the effects of exposure to secondary smoke, 1) where casualties are exposed and 2) at what age they died. Using ASH Scotland's figure of 1,000 deaths from the effects of secondary smoke every year, this means a productivity loss of £60,000 per person who died (assuming all 1,000 died of inhalation in the home). But again, how does this loss affect the economy? The only studies giving even marginal significance to the risks of secondary smoke exposure refer to lifetime spousal or occupational exposure, so even if it could be shown that 1,000 people die annually from secondary smoke exposure, many of them would be beyond retirement age.

This does not equate to a loss over £940 million. Also tobacco is a healthy investment these days, and Edinburgh is a city deep in financial institutions. A few fund managers include tobacco in their investment portfolios, and tobacco features even in some local government pension stocks.

***

'By contrast', says ASH Scotland, 'effective interventions to reduce tobacco harm offer excellent value for money'. Sheila can't have read this yet: 'Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date.'

Sheila Duffy, smoking ban on cars and social marketing

This letter appeared almost a week ago. Sheila Duffy remarks that, of all the proposals presented in Beyond Smoke-Free, people were interested only in the proposal of a smoking ban on cars.

But she doesn't want a smoking ban on cars.* She wants a debate and a public consultation on a smoking ban in cars (on a proposal that she claims not to want to be brought into law – doesn't she know we're all tightening our belts now?), and a social marketing campaign on smoking in cars.

Social marketing again. Has she got shares in it?

She might as well advocate a brainwashing campaign, or re-education. What's wrong with a good old-fashioned educational campaign? Not persuasive enough?

* Unlike Dame Helena Shovelton (British Lung Foundation).

Financial Times writer deplores bad use of science in Scottish heart attack studies

I know. Sorry. Again. But the Scottish Government stood by this absurd claim in repeated correspondence last year, when we criticised its use in the mental health consultation document – the document that was supposed to consult the Scottish people about whether to remove the smoking ban from psychiatric hospitals Unequivocally it said (without supplying even a reference list) that among the benefits of the smoking ban had been 'a 17 per cent reduction in heart attack admissions'. (The current state of proceedings on the smoking ban exemptions are recorded here.)

This is what John Kay has written in the Financial Times. The article is generally accessible online but you need to register (free of charge). His title is unflattering ('Even a filthy habit deserves a fair hearing'), but his analysis is commendable. Writing about unconvincing claims made to justify policy, he refers to the English and Scottish heart attack claims, and 'the more extravagant claim that the similar ban in Scotland had an effect of 17 per cent. The evidence for the former proposal [2.4 per cent] is weak, and the latter claim is implausible'. He points out the long term declines in heart attack admissions, and observes that the slightly higher than average drop in heart attack admissions in 2007 was reversed the following year. He describes the researchers' methods as 'torturing data' to produce results that 'either fit the researchers' preconceptions, or the sponsor's policy objectives, or both'.

His conclusion is very welcome at a time when the logic of social marketing holds sway (namely, that the end justifies the means): 'these observations [that smoking is unpleasant and possibly harmful to bystanders] do not justify blurring the distinction between genuine scientific analysis and propaganda disguised as science. Policy should follow evidence, not evidence policy.'

More mainstream media observations like this are essential. Considering the Scottish and English claims on heart attacks together, in the same article, shows the absurdity of the 17 per cent claim.

No doubt the Scottish Government still stands by the claim and defends the wording of the mental health consultation.

Fostering, adoption, smokers and legal kidnapping

The troubled question of whether smokers should be allowed to foster or adopt children in the city of Aberdeen has reached Michael Siegel, veteran blogger and critic of tobacco control. Siegel is a believer in smoking bans, but he deplores the tactics of the international tobacco control community and rightly castigates a complete ban on prospective foster and adoptive parents who smoke as contrary to the interests of children. He rightly points out that there are no other hard and fast laws governing the lifestyle choices of prospective foster or adopting parents, and that the first casualties of this outright ban on smokers (until they can show they have stopped smoking for 12 months) will be the children who need homes and families.

Is conflict about to break out between Aberdeen city council and the British Association for Adopting and Fostering (BAAF)? It would seem that we are witness a divergence of priorities here.

No comment needed really: refusing people who offer children a home simply because they smoke can't be defended, and is bound to exacerbate any shortage of families eligible to look after children.

***

As if the whole issue of children in trouble were not distressing enough, there seems to be increasing controversy surrounding the circumstances of children being taken into care. Smoking issues aside, this seems to be a story of authorities determined to stigmatise parents on the slightest pretext. Judging by the high number of comments, the story appears to resonate with many people.