Safe levels of secondary smoke possible?

As a non-scientist I'm not particularly keen on reading technical pieces about chemistry or air quality but I was intrigued by this piece on an experiment in Staffordshire, where an environmental officer said that a study 'found a child [in a car] inhales three times the amount of smoke that would be considered safe to inhale over the course of a day'?: previously discussed here.


It is part of the faith of anti-smoking authorities the world over that there is no safe level of secondary smoke. Google the phrase and read about it being quoted everywhere in the world. But inevitably the protest arose that 'no safe level' was scientifically nonsensical and represents only a value judgement on the act of smoking itself.  


A measurable level of toxicity in the air can be dealt with. Air cleaning systems improve all the time: they are more sophisticated than creaking fans in the ceiling. But the anti-smokers have never wanted the problem to be dealt with rationally. Even though smoke is not as hazardous as other substances in the working environment it is not an industrial by-product, so can be excluded by means of prohibition and really because there is no safe level, only a ban will eradicate exposure. Any other toxin can be dealt with by calm efficiency, but ETS (secondary smoke) has magic qualities that allow it to evade effective control.


This piece provides an account of an OSHA measure of secondary smoke achieved by measuring nicotine only, rather than compounding it with measurements of formaldehyde and benzene, which form part of background pollution. Unfortunately the piece, though entitled 'OSHA sets safe level of second hand smoke', fails to link to OSHA itself, which is rather odd.  Yes, it's from a pipe smoking web site but I found it informative.


This famous table ('The Dose Makes The Poison') gives a breakdown of toxins found in smoke, and their toxicity.


Surely it is essential to uphold the notion that all risks are measurable, and that only by establishing a safe level of any risk is it possible to deal with it. 'No safe level' implies that something kills on impact. Deadly substances have to be contained and isolated if contact with them presents a clear danger to human life. Secondary smoke has formed the backdrop of life in the licensed trade and informal social life and many workplaces for generations and clearly doesn't fall into this category, since our elderly people are living longer than ever. 


Anyone who wants people to fear the impact of secondary smoke, when there are so many airborne chemicals resulting from the industrial-scale incineration of minerals, is guilty of shameless scaremongering, and enormous social and economic damage.  

A lesson for Grampian

In common with other hospitals, Royal Derby Hospital and others in Nottingham and Leicester are reviewing their smoke-free policies after they have been (according to policy) 'smoke-free' since 2006.

Patients, visitors and staff are all still smoking on site. The hospital spokesman recognises a need to restore smoking areas on compassionate grounds because of stress levels involved in being in a hospital environment – even for people who are 'receiving treatment themselves'. What a difference from the punitive approach adopted to all smokers adopted by both NHS Grampian and the Scotland Patients' Association.

The obvious solution to on-site smoking is a large comfortable, airy smoking room that will attract smokers away from the doorways. The law is an ass!

If anyone wants to advise the Scotland Patients' Association or NHS Grampian of these developments, contact details are here and here. English news stories don't always reach the Scottish public.

Scotland Patients' Association falls short on smoking issue

The Scotland Patients' Association will be twenty years old next year. A small organisation, it possesses just two office bearers, and is supported by half a dozen or so sponsors. In the past few years it has published statements on a number of health service shortcomings

Its consultation response document, Better Health, Better Care, shows awareness of a range of issues surrounding patient care, including the anxiety of patients and their relatives on entering hospitals, communication breakdowns infection control (leaking intravenous drips, for example, p 6), a culture of secrecy (p 8). On the face of it they seem to be on the patients' 'side', taking pains to point out what is clear to the patient, but sometimes less clear to medical staff, about the experience of being on the receiving end of NHS treatment.

Therefore the unimaginative approach of Chairperson Margaret Watt to NHS Grampian's ambition to turn its properties into a smokefree zone comes as something of a surprise. The proposals, to reiterate recent posts on this blog, include banning smoking on all premises, indoors and out, making the carrying of tobacco a disciplinary offence, and actually denying patients treatment if they refuse to co-operate.

Following a media storm, NHS Grampian took the decision to shelve implementation of the policy for six months. Their decision was driven by concerns that it would be hard to enforce different parts of the policy. Astonishingly the threat to withhold treatment from patients as a punishment if they failed to co-operate with the policy raised no protest from the Scotland Patients' Association. The trade union representative (Tommy Campbell from UNITE) did his bit by protesting on behalf of workers, but Margaret Watt said that she 'could not understand the delay'. 'It doesn't matter how bitter the pill is, you just have to swallow it and carry it out': unfortunately this advice ceases to be relevant when a policy has nothing to do with a specific clinical case and everything to do with following dogma.

Even courts do not punish people by withholding health care: should a nationalised health service be allowed to withdraw care from a patient for refusing to desist from smoking? Shouldn't a Scotland Patients' Association even be asking the question?

Smoking rate fall 'shows no need for a ban' (Grocer). Or does it?

Is there a need for further drastic measures to reduce smoking among youth? The Grocer last Saturday said no. Quoting the journal Addiction, it claimed that since raising the age of purchase to 18, the youth smoking rate is already in decline, and no further action is needed.

Just a week later, the BBC pointed out that more shops were failing test purchases in Lincolnshire.

Coincidence? Did the Grocers article cause alarm among supporters of legislation and get them looking for a story of uncontrolled youth tobacco purchasing? You decide.

I am in no doubt that underage sales occur, but the idea that hiding tobacco in shops will make them any less likely is completely out of the box.

Trade warns of more illegal tobacco trading if display ban goes ahead

The daily news bulletin of ASH Scotland on Wednesday included several links to Scottish papers and the trade press reporting the warnings of the trade that the display ban will cause smuggling to grow. A further version of the story appeared yesterday south of the border.

Sheila Duffy can't see the problem with the display ban:

Throughout the debate over removing tobacco displays, a measure intended to protect young people from tobacco promotion, the tobacco industry has tried to divert attention away from the important health issues at stake by exaggerating fears based on unfounded claims.

The reality is that there is no substance to these claims. There is no reason to think that adult smokers who currently buy their product legally from responsible retailers will suddenly switch to illegal sources because the product is no longer on display. Smokers will be able to go on buying what they normally buy, where they normally buy it. Why would they suddenly go somewhere else?

What about price?

'Putting tobacco under the counter will make smokers feel like they’re doing something illegal when they buy tobacco from a shop' [says a shopkeeper]. 'If they think that, they might as well get it from a smuggler who sells it at half the price I can.'

There's also the stigma and the sheer bloody inconvenience, to say nothing of the fact that tobacco sales will slow down queues, to the (real or imagined) annoyance of other shoppers.

The English version of the story states that Andrew Lansley, Health Secretary, has been swayed by a rise in smoking rates in Canada since the display ban was introduced there. I hope the Scottish Health & Sport Committee is paying attention!

Sheila's attitude to the retail trade is extraordinary. It is part of her faith that tobacconists, who sell tobacco every day for many more hours every day than she spends working for ASH Scotland, rely completely on the manufacturers for knowledge of the tobacco trade. As for this:

This [the idea that a ban on displays would encourage the black market] looks to me like a classic case of tobacco industry smoke and mirrors. They spread misinformation and alarm amongst retailers, survey the concerns they create, and present the results as if they were genuine evidence.

A direct description of the way the scare of Third Hand Smoke was created.

Evening Times runs poll on funding smoking cessation

Just for the record, I don't take newspaper polls seriously. They are notoriously easy to rig by repeat voting, and the sample voting rarely includes more than a fraction of 1 per cent of the population. That said it's a pleasant surprise to see Evening Times readers voting decisively against dedicating further funding to smoking cessation. The poll was running at 60 per cent against further funding when I voted four hours ago and now runs at 76 against.

Still, official enthusiasm for government-funded smoking cessation runs high. See confirmation of this conference that will run at Dynamic Earth, Edinburgh, in November. Free of charge, of course.

Yes in general I believe in public health free at the point of need. But clearly there is a danger with any guaranteed free service that somebody will abuse it. The government feels bound to give people free drugs, but big pharmaceuticals have now decided that the wealthy and well are better customers than the sick and impoverished. This perspective is enlightening. Or as Sheila Duffy points out, even though malaria kills people (generally at a much younger age than tobacco), 'mosquitos don't have PR agencies and expensive promotions budgets'. D'oh!

Sheila's blog updated

In case you missed it (I did) here is the second entry in Sheila Duffy's blog. Sheila is CEO of ASH Scotland. Unfortunately she's left the comments off again and the mirror blog hasn't caught up with it yet either.

69 per cent of smokers want to quit

Well I thought the figure was 70 per cent, which has been the standard figure dished out by the authorities for years. Indeed the figure appears to apply everywhere. Everyone uses the same figure. It's an industry standard (see question 3)!

Everyone uses it except Sheila Duffy, who puts the figure at 69 per cent. Well, since the Scottish Household Survey has found a 1 per cent drop in smoking prevalence, perhaps that's reasonable.

What do you mean, no conflict of interest?

An interest to declare – go to the UK Freedom-2-choose blog for this one. These people were heavily involved in the 2010 UK National Smoking Cessation Conference that took place in Glasgow in June. Yet they feel they have no interest to declare when writing to protest to the government that their services are being cut.

Anti-smoking video, with counter-attack!

This is shameful, but Leg Iron provides an entertaining analysis!

Sandwell update

Short of Scottish news on the denormalisation of smoking for the day or so: here is commentary and update on Sandwell ... the deplorable case of Sheila Martin, fined for dropping cigarette ash. Frank Davis has an update (and interesting commentary on asymmetric warfare) and a link to Anna Raccoon's blog, where the campaign was launched – the story is taken up in the comments thread.

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MP joins fight against the display ban

Mike Weatherley MP (Hove, Conservative) has joined the fight against the tobacco display ban, and promised to pursue it with written questions in Parliament, according to the Sunday Express.

The Sunday Express itself has launched a campaign to save our newsagents, launched shortly before the General Election. Mike Penning, Shadow Health Minister at the time, promised that Conservatives would review the legislation if elected, and the Express vowed to campaign against any attempts to bring in 'this unfair legislation'. Their decision is awaited.

Meanwhile in Scotland, Imperial Tobacco has challenged the legislative competence of the Parliament to pass the ban in Scotland. The case was heard in July and the result is awaited.

Finally Finland (well, why not?), where prohibition appears to be on the way. A display ban has been passed, much to the delight of Action on Smoking and Health (ASH), which has sent a message of congratulation. Their statement to Medical News Today:

Across the UK those who make and sell cigarettes have been fighting tooth and nail to overturn this legislation but the tide is running against them. Laws for smokefree public places started in a few small jurisdictions and rapidly spread across the globe.

They love calling all the opposition to their plans 'those who make and sell cigarettes'. In the memorable words of the late Gian Turci, late CEO of Forces International:

In the minds of these deranged fanatics all those who:

• Oppose smoking bans
• Defend the freedom of choice
• Uphold real science, and condemn the epidemiological trash science used to justify suppression
• Fight for ethics in science, politics and in the media
• Advocate peaceful coexistence, civilized behaviour and social tolerance, or
• Fight for the survival of their businesses

ARE the tobacco industry when it comes to smoking, ARE the food industry when it comes to eating, ARE the alcohol industry when it comes to drinking, and ARE the oil industry when it comes to denouncing the global warming hoax!

Whatever one thinks of the global warming theory, the validity of Gian's point is beyond question. Opposition to the health agenda is equated directly with commercial interest in some offending industry. If there is no connection they seek to create one in the minds of the public while quietly forgetting, for example, that by far the biggest cut from tobacco is taken by government in the form of taxes.

Back to ASH on the subject of Finland.

We are seeing exactly the same process here, the only question is: Will the UK be one of the first major economies to implement a display ban or will it be the first to cave in to tobacco industry pressure and reverse a law that has already been passed by parliament?

For tobacco industry pressure, of course, read 'pressure from the general public and from tobacco retailers who would like to be viewed as partners in the effort to keep tobacco out of the hands of children, rather than as potential criminals (p. 5)'.

Pensioner fined for littering (cigarette ash)

Over to Anna Raccoon, who has launched a campaign to assist Sheila Martin, fined for allowing cigarette ash to drop from a half-finished cigarette. Fighting 'em on the Sandwell.

Smokers paid to quit in Perth, Scotland, in spite of dismal success rates in Dundee

More chaos in the world of smoking cessation as Perth becomes the next place where smokers will be paid to stop smoking.

To its credit, the Courier points out that a very low proportion of Dundee smokers have succeeded in quitting in spite of an investment of £530,000. It claims that 'fewer than one in ten are known to have quit for good' - the only surprising thing about this is seeing it in mainstream news media.

Chemist & Druggist have a view here, acknowledging that the success of cessation schemes is low but suggesting that paying pregnant smokers to quit may get better results. This was (of course) covered in a session at the 2010 UK National Smoking Cessation conference, by Linda Bauld of the UK Centre for Tobacco Control Studies, a body with publicly declared conflicts of interest. It is quite phenomenal that a drug that is known to work in a very low number of cases is supported not only with publicly paid prescription charges but also with funds to encourage people to make use of it. Academics whose careers depend on promoting smoking cessation medication, and those who profit directly from the sale of such treatments, seem able to do both without arousing public ire.

Last word to Johann Hari, who comments in an unrelated piece:

The Cranfield School of Management studied 170 companies who had used management consultants, and it discovered just 36 percent of them were happy with the outcome - while two thirds judged them to be useless or harmful. A medicine with that failure-rate would be taken off the shelves. [my emphasis!]

I wonder if he has ever studied the issue of smoking cessation medication?

Safe levels of secondary smoke confirmed

Remember this piece from the Staffordshire Sentinal where a West Midlands environmental health officer was quoted describing a study that a study 'found a child [in a car] inhales three times the amount of smoke that would be considered safe to inhale over the course of a day'?

The study referred to is not online, but a powerpoint presentation that shows the results of a similar study can be seen here. The lead author of this presentation is Hilary Wareing, Co-director of the Tobacco Control Collaborating Centre, Warwick, who also authored the study featured in the newspaper article.

The authors compare the exposure of children to smoke in a car with the EU allowable daily exposure of 25ug/m^3. Conveying a sense of shock, they say that children absorb three times more smoke in a ten-minute (or an eighty-minute) journey than is permitted by the European Union in 24 hours.

The maximum length of journey undertaken in either study was 83 minutes. This is roughly one-seventeenth of day. Giving the exposure of smoke during a journey as three times the EU permitted level would be accurate only if the journey was 24 hours long and the smoke exposure was constant throughout.

The authors don't seem at all concerned by the length of exposure to smoke: the powerpoint graphs don't include the length of time exposed. They find that 'concentrations of PM2.5 found in all journeys, even when a single cigarette was smoked, were three and a half times higher than the recommended daily exposure'. In other words regardless of the number of cigarettes smoked (and the length of the journey undertaken), exposure was constant. They also find that 'open windows or an active ventilation system resulted in lower concentrations but levels remained above the EU daily exposure limit'. This acknowledgement that managing the air makes a difference is a significant one. (The quotations are taken from the paper version of the single-author version of the study, hard copy only.)

Concentrations of fine particulate matter, which is measured by PM2.5, provide a limited indication of the dangers presented by aerial pollutants. Actual toxicity matters, as well as particle size. As Michael McFadden observes:

[the environmental officer quoted by the Staffordshire Sentinal] is equating the FPM 2.5 produced by cars, commercial high temperature incineration, and general industrial and chemical processes with the FPM 2.5 produced by the quiet low-temperature combustion of tobacco and pretending they are the same thing just because the particles are the same size. That's actually not much different than comparing a teaspoon of arsenic crystals with a teaspoon of sugar crystals and concluding they are equally dangerous to eat because the crystals are the same size ....

Finally, as noted above: FPM 2.5 is VERY disproportionately produced by tobacco burning at smoking temperatures. That's why the Antis have turned it into their holy grail for talking about "smoking pollution." It actually has nothing to do, all by itself, with any determination of the "danger" of the pollution involved except that such small particles, just like vapors, can go deep into the lungs.

All that said, the admissions that one can measure smoke exposure, and also reduce its concentration by air management systems, are important, especially coming from a tobacco control organisation.

Surrey Primary Care Trust axes pharmacy-based smoking cessation services

Sad to learn that the funding for pharmacy-run smoking cessation services will be axed in the autumn! Surrey Primary Care Trust has announced that it will no longer fund pharmacies to offer smoking cessation after October. GP services will not be affected.

This (I understand) doesn't mean that you won't be able to buy Niquitin from the chemist. It means that pharmacies won't get incentive payments for enrolling patients on to smoking cessation services. See Appendix 2, para h in this Warwickshire PCT report from 2008/2009 that describes payments for every patient who names a quit date, successfully quits at this date, or, incredibly, fails to quit at this date.

Chemist & Druggist is aggrieved and to some extent I can sympathise with the argument that the services offered by pharmacists are being sacrificed so as to avoid antagonising the GPs and the BMA, and that the pharmacy has much more regular and convenient access to the public than the average GP. However it's difficult to get worked up about who gets the lion's share of the smoking cessation market. Even ASH UK acknowledges the treatment is a patch-up job (see 'Habit, not nicotine prompts cigarette cravings').

That's what we are talking about here: who gets the market share of a product that promotes official anti-smoking agendas, and who gets the sweeties for delivering the marketing service. There is surely a wider tale to tell of rivalries between pharmacies and medically trained personnel in delivering health care ...

Nova Scotia Judge: Tobacco display ban violates tobacco merchant's rights

Legislators north and south of the Scottish border should take note of this ruling. Bob Gee has won the first stage of his case against the provincial government. This is great news but much hangs on the next stage of this case, which will take place on 6 October, when the provincial government will argue the case for the legislation.

The newly elected UK government is also set to review the tobacco display legislation. In Scotland, regulations on the detail of the legislation are still to be approved following a consultation that ended on 20 July. It is unlikely that the Scottish Government would willingly consider a review of this legislation, since only the handful of Scottish Conservative MSPs in the Parliament opposed it. However, Imperial Tobacco has challenged the competence of the Scottish Government to pass the legislation, and the result of this case is expected in the next few weeks.

The consultation responses on the latest consultation (display regulations) on the Scottish legislation have now been published.

And the righteous NEVER sleep.

1988 and the Piper Alpha oil rig goes up in a ball of flames killing 167 oil rig workers.

The fire is believed to have started after explosions at about 2230 BST (2130 GMT) on the Piper Alpha drilling platform, 120 miles (193km) off the north-east coast of Scotland

We should all know by now that working offshore on an oil rig is dangerous and stressful work. Oil rig workers are like soldiers that are sent to a war zone for months at a time, cut off from their family and friends, under stressful conditions and working long, long shifts, never knowing what fate may throw their way. It's the kinda work that me and you would not, or could not do, we don't have the balls that rig workers have but we are happy to reap the benefits that comes from their long, hard labour as we stuff our over taxed petrol into our cars, we care not one jot how it got into that petrol pump we have in our hands!

Oil rig workers are paid handsomly for their long, dangerous toil, and rightly so. They are given, by their employers good subsidised food in onboard restaurants that are equivalent to any 5* eatery you may find in your high street. Who would deny these workers a little comfort in their working schedule eh? Not me, nor, I suspect, you.

Step up to the plate NHS Grampian who are not interested in their [oil rig workers] health and wellfare while they stressfully go about their working lives, but the fact that they get cheap cigarettes irks them so much that they are calling for a change in the law to deprive them of cheap smokes.

NHS Grampian today called for an end to cheap cigarettes for oil workers.

Health bosses want workers on rigs and vessels offshore to be prevented from buying cut-price tobacco.

And they urged the Scottish Government to extend new restrictions on tobacco sales to cover offshore.

Where the hell do these health fascists get off?

You may be thinking that the Piper Alpha tragedy may never happen again due to newer health and safety regs...think again!

Three more fined at Ninewells including on-call emergency nurse

An emergency on-call nurse has been fined for smoking during her break time at Ninewells Hospital, Dundee. The details are here.

In spite of a commenter declaring 'public support = 0', personally my support for this person is high, because she's on a hiding to nothing. The enforcement officers have issued a fine to someone who is contractually bound, as an on-call duty officer, not to leave the grounds. She was unable to comply with the smoking policy's requirement to go off the site. Such a person is supposed to accept a requirement to renounce smoking throughout her shift or face criminal sanctions. Had she gone off site to smoke she would also been in breach of her contract. . I also don't see why people should expect employees of a health service (especially one that is free at the point of need) to be walking exemplars of how to live healthily in all their break times. Are we expected to raid nurses' lunch boxes and extract anything with too much sugar or salt in it?

I don't see why the Health Board should be entitled unilaterally to change her conditions of service without issuing a new contract of employment, in pursuit of anti-smoking dogma.

Just give them a big, airy room with ash trays, tea and coffee facilities, and comfortable seating. That will solve the doorway smoking problem instantly. Oh sorry, have I said that before?

Tell your Irish friends ...

... Forest has come to Ireland.

The fight against denormalisation spreads to where the smoking ban began its recent history in Europe, where it was (of course) a raging success. Dave Molloy of the Office of Tobacco Control denied that any damage had been caused to pubs (of course he would know better than the hospitality industry, wouldn't he?)

Pro-choice: Daily Mail letter, 9 August 2010

The article on which Eddie was commenting is here. (The letter can be viewed here on a larger scale.) He challenges the description of Freedom to Choose (Scotland) as 'pro-smoking'. We neither advocate smoking nor condemn it, but we do oppose the anti-smoking movement, as its tactics have allowed people to vent their frustrations on smokers. We can see in the moves by NHS Grampian signs that institutionalised discrimination against people who smoke becomes acceptable in the eyes of authority.

When people are attacked as a group they need to be able to defend themselves as a group. There are parallels with South Africa and apartheid ... which developed into an extreme situation that led to routine and regular institutionalised violence against enemies of the system. Blacks were told that they were not single group, they were many groups: Xhosa, Zulu, etc, and progressively deprived of their participation rights: not only voting but they were excluded from many classes of labour, access to civic amenities and many other things.

In order to defend themselves they had to identify themselves as a group, as they did by developing the Black Consciousness movement among others.

Things have moved on since those days. If smokers are now told that discrimination against them is acceptable because they are not a protected group, this is when all society needs to pitch in, because it means that human rights is no longer a universal concept. It means that unless you are protected by race, gender or other protective laws you are fair game. Protecting people because of their gender, race or sexuality is understandable in view of the disadvantages that some of these groups have experienced in the past, provided it is done in the spirit that inspired the Universal Declaration of Human Rights. Clearly the notion that you are 'not covered' under such a declaration makes a nonsense of the whole thing.

It is well known that 'pro-choice' actors in the field of smoking and lifestyle choice include lifelong non-smokers, including the originator of Freedom2Choose Robert Feal-Martinez and the present Chairman of The International Coalition Against Prohibition (TICAP), Bill Gibson. I hardly ever smoke myself!

Our movement includes smokers, non-smokers and 'vapers': users of e-cigarettes: in other words, people. And we are people who will not apologise for our choices.

PS I just found this account of smoking and employment law: any readers from across the pond might know whether it became unlawful to discriminate against employing smokers.

Four degrees of separation

Obesity gains ground in the fight for funding in the United States. The Robert Wood Johnson Foundation is now spending over ten times as much on obesity as on anti-smoking.

We learn two things:

The rationale for designated smoking areas was based on the stated premise that secondhand smoke is medically dangerous to nearby people who might inhale the fumes.

There is no question that secondhand smoke can be unpleasant; few nonsmokers want to sit in a cloud of tobacco dust or have tobacco smell on their clothing or hair. But is it dangerous to your health? A study of 35,561 spouses of smokers followed for 38 years published in the British Medical Journal in 2003 showed that second-hand smoke is an irritant, but does not cause life-threatening disease. Actually, "secondhand eating" may be more dangerous.

With it so far. But it continues:

When people with whom we are closely associated gain weight, such as a spouse, sibling, neighbor or friend, we are also at an increased risk of gaining weight. For example, if your friend becomes obese, you have a 177 percent increased risk of becoming obese. If your friend's brother becomes obese, your risk is still increased. The increased risk goes out to four degrees of separation.

Okay. But what happens if they lose weight? And why is your friend putting on weight if you're not putting on weight?

As usual with such absurdly focussed studies, this leaves more questions than answers.

Secondary smoke has allegedly left one thousand a year dead in Scotland and seventy-nine thousand in Europe, without us knowing with any certainty who any of these people are. It is nice that Dennis Gottfried points out that smoke is actually only an irritant, even if only to convey the idea that obesity is a more urgent problem than smoking these days.

If this is any indication of the quality of 'obesity-related science', it looks even more akin to witchcraft and/or guesswork than the 'science' of secondary smoke.

A Philadelphian Perspective addressed to Hungary

Observers both inside and outside Hungary are less than impressed with the prospective smoking bans that will hit Hungary in less than two months. This outside view comes from Michael McFadden, a prolific writer on the subject of smoking bans whose book Dissecting Antismokers' Brains is included in the links on this blog.

£20,000 on enforcement officers v. threats to Fife and Tayside services

As already reported in recent posts, Tayside Health Board has brought in enforcement officers to police smoking on the grounds of Ninewells hospital. The project costs £20,000, and they have issued one littering fine so far, which means they have another 399 fines to issue before they break even. People might restrict their illicit smoking activities to the 152 hours per week when no officers are present ...

Meantime public health minister Nicola Sturgeon will be chairing the NHS Fife's annual review meeting in order to face the public over the issue of cuts in A&E services in the area.

The Courier has launched a Burning Issues campaign in order to draw attention to problems in the health service. It covers areas like Evidence of abuse at Perth Royal Infirmary, Superbugs link to cleaning cuts denied, Sick NHS workers cost £260,000 a week – but there is also evidence of a strong level of support from the public: Former patients full of praise for health service staff.

When a couple of smoking enforcement officers are added to this mix they must fade into obscurity. The money spent on these is small but everywhere you look there are more pressing problems. High levels of abuse directed at staff and high levels of sick pay are both significant problems: is policing smoking in the grounds of the hospital likely to help either situation? Isn't abuse of staff vastly more objectionable than smoking in a doorway out of the rain? Is a smoking ban designed to promote a spirit of mutual respect and dignity for everybody concerned

Last word to Planet Politics, in an excellent blog piece which points out that the hospital does not have an indoor smoking problem, and that 'zero tolerance' does not mean that enforcement is effective.

To contribute to Burning Issues on any aspect of NHS performance in Tayside call 01382 575291 or email courier@dcthomson.co.uk.

One Fine Issued at Ninewells Hospital, Dundee

On the second day, they managed to impose a £50 fine on someone for dropping a cigarette butt. Well, that's democracy in action. ASH Scotland couldn't resist including this report in their daily news bulletin, even though there was no url as the story appeared only in its paper edition.

The enforcement officers came to Ninewells on Monday, at the start of what is expected to be a year-long campaign. Smokers were approached. but since they complied when requested to stub out, no fines were issued.

You can almost hear them counting the cost of this exercise. Why don't they just open a large, pleasant, airy waiting room with ashtrays and tea and coffee facilities and the doorway area will be cleared of smokers in a trice.

Incidentally, it was good to see the contribution from Lesley Riddoch to the NHS Grampian debate on Monday. It is only available to subscribers unfortunately but we have had the benefit of correspondence from readers since it appeared: A ban too far yesterday, and Smoking ills today.

It gets worse ...! Radio interview

Enjoy this exchange between Talksport's Duncan Barkes and Freedom to Choose (Scotland)'s Treasurer Michael Davidson. On Steve Field's allegations of child abuse, denormalisation, social control and more.

Barbados bid to comply with Framework Convention on Tobacco Control

Barbados, with a smoking ban due to be implemented on 1 October, is also introducing other tobacco control measures in a bid to comply with the World Health Organisation Framework Convention on Tobacco Control: the measures include doubling the import duty, eliminating duty free concessions and moves towards pictorial warnings on cigarette packaging.

The person announcing Barbados's eagerness to comply with this international diktat is Dr Kenneth George, Senior Medical Officer of Health with responsibility for chronic non-communicable diseases.

According to Dr. George, the FCTC is the first negotiated public health treaty under the auspices of the World Health Organisation. This treaty is evidence-based and commits to the highest standards of health care.

Now it actually strikes me as astonishing that the Framework Convention on Tobacco Control should have been the 'first negotiated public health treaty under the auspices of the World Health Organisation'. Why are 'non-communicable diseases' considered a higher priority than communicable diseases, for example ... surely communicable diseases are more likely to strike people early in their lives, and be altogether more problematic than non-communicable diseases.

How can a focus on non-communicable diseases be understood as a commitment to the 'highest standards of health care?

There may be instances where international obligations justifiably over-ride national democratic processes, but the WHO FCTC is not one of them. In this paper, delivered at the 2010 conference of TICAP, international tobacco scholar Kamal Chaouachi called on countries to break away from this treaty (he starts by explaining that he was warned that by addressing the conference he would identify himself as pro-tobacco, and his career would be irrevocably damaged).

Back to Barbados. As anywhere, doubts are expressed about whether a smoking ban is good legislation ...

A Hungarian Perspective

Hungary has been trying to bring in a smoking ban for some time. Not everyone agrees with it, though.

Newsnight: Worthies discuss health issues

I've just watched last night's Newsnight after a tip-off from a commenter over at Taking liberties (9 August, 23.53). Health was discussed by Professor Steven Field, Caroline Flint and an epidemiologist, who seemed to look forward to a day when warnings on cigarettes would read 'Smoking can seriously affect your access to the NHS'.

No opposition was offered to the combined view that people's bad habits are a serious problem, and patrician intervention was the only right course of action, if only we knew how to do it. The 'people' themselves might as well have been zoo animals, for all the insight they were allowed to offer.

I telephoned the BBC to complain the last time a smoking story appeared with only a spokesperson for the anti-smoking side. The person who answered seemed to struggle with the idea that the problem had at least two sides and that more than one view should be represented. Doesn't appear that they learned very much.

Safe level of secondary smoke discovered!

In an interview with the Staffordshire Sentinal, a West Midlands environmental officer claims that a study 'found a child [in a car] inhales three times the amount of smoke that would be considered safe to inhale over the course of a day'.

Heresy! The Surgeon General said so ...

So did the World Health Organisation, urging countries everywhere to ban smoking indoors.

So did Ottawa City Hall, urging outdoor smoking bans everywhere.

So what level of secondary smoke is it safe for someone to inhale? I think we should be told ...

No smoking, or no treatment!

The text below is lifted from the comment thread in the blog of David Milliband. The post discusses 'bold plans to save Britain's pubs', which concern regulation of the beer tie. Arguments are advanced in the blog about whether this will help pubs. Milliband does not consider the smoking ban worth touching in this context.

Is this comment typical of modern medical professionals?

Just prior to the smoking ban being enacted in 2007, I and other like minded people got together and set up an anti-smoking patrol watch in our local community. I have organised and run this watch with much success to date.

We gather photographic and camcorder evidence of anyone flouting the law of smoking in public places. We approached our local dentists and GPs, who then told us that anyone who smoked illegally would be refused treatment should their names appear on their patients’ lists. We also have the full support of our local police Superintendent – who agreed that this strategy would help in time to reduce smoking within our community. So far we have had no come back about Freedom of Information.

After several prosecutions we have seen the tide turning, but still need to remain vigilant on behalf of all our residents, after all it’s their health that’s at stake.

You have to remember that over 30,000 people are killed each year by SHS (second hand smoke), and this figure is rising year on year. We are still unclear about how many are affected each year by THS (third hand smoke), although there is good epidemiological evidence to show how dangerous it is to the health of young children.

I wrote to the then health secretary at the time Patricia Hewitt, who fully supported our efforts and asked to be kept up to date with our progress, which of course we did. I would like to see this kind of programme being rolled out across the country.

We are also supported by ASH UK, ASH Scotland, BHF and of course CRUK.

Dr Steven Johnson GP

[emphasis added]

Is there any other crime in the criminal justice system judged so adversely that it would merit the withdrawal of medical treatment? It is just not ethical for medics to pick on a specific group of (alleged) lawbreakers and deny treatment. I find it absolutely shocking that this comment has gone uncensored on the blog of a contender to the Labour Party leadership.

This story relates the intentions of NHS Grampian to treat smokers similarly – to punish them for flouting the legislation.

Withdrawing treatment on any other than clinical grounds must be considered very dangerous territory.

How bad can it get?

It was bad enough to start with ... the penalty for smoking in an enclosed public place is £50. Peanuts to many people of course so they created an additional penalty of allowing smoking, and doubled the fine ... fifty times over. I never learned whether Hamish Howitt, Tony Blows or Nick Hogan saw their customers fined at a rate that matched the number of times they were convicted of allowing smoking.

In Barbados, imprisonment for persistent indoor smoking applies both to smokers and the proprietors of now 'smoke-free' premises. (The fine for allowing smoking is only ten times the fine for smoking. The fine for smoking is $500. The exchange rate today: BD$1 equals 31p.)

Nobody to my knowledge has been imprisoned for contravening the legislation yet, but Nick Hogan was imprisoned for non-payment of a fine (and released after the funds were raised by the public).

The worst example I've seen of a penalty for smoking was in Saudi Arabia in 2009 where a man was sentenced to 30 lashes (albeit persistently and after requests to stop).

Interestingly a further account of this incident is found on a web site calling itself Middle East Censorship News. It is most unlikely that judicial tradition in Europe will accept this kind of penalty for smoking (or for allowing smoking), but one wonders whether the World Health Organisation envisaged the consequences of encouraging extreme anti-smoking policies in parts of the world with a greater tradition of censorship and physical brutality towards their people.

Oh, to be in Wandsworth ...

where they have a smoking ban enforcement crisis. Read more ...

More about hospitals

Good news from NHS Grampian – a delay in its decision to implement its no- smoking policy for six months pending further consultations.

The threat of withholding treatment from smokers who breached NHS Grampian policy did not stop the Patients' Council spokeswoman from saying that she could 'not understand the delay'.

Another board member's view that 'the integrity of the board is at stake' if they fail to come up with an enforceable policy reflects the board's position that only a narrowly defined and very dogmatic interpretation of 'health promotion' will satisfy.

Freedom to Choose (Scotland) takes the view that the integrity of the board will take a leap if it listens to the problems detailed in the consultation executive summary (2009) – including the clear possibility that a doctrinaire anti-smoking policy will deter people from treatment – and abandons its dogmatic approach. In these economically-straitened times the prospect of spending up to £80K (Daily Mail, 3 August, p. 25) on destroying smoking shelters for no clear gain, only to have more people wandering off the site in their pyjamas, seems quite bizarre.

YET ANOTHER HOSPITAL STORY BROKE TODAY – Ninewells Hospital, Dundee, was reported in The Scotsman to have called in the environmental officers to 'fine people up to £50 for flouting its smoking policy'.

Of course, the environmental officers can apply fines for smoking only in enclosed or partially enclosed places. A phone call to Tayside Health Board quickly clarified that the enforcement officers had been called in to enforce the law – not the policy of no smoking in the grounds, which is not law.

For convenience I have added the link for Smoking, Health and Social Care Act (Scotland) 2005 to the side bar of the blog for easy reference.

And one more point:

the sign on the left must mean that prohibitions on smoking are banned, mustn't it ...?

Resistance News

Resistance joins blogosphere!

Contracts in Smoking Cessation and the Tobacco Display Ban: good money after bad?

An international public relations firm, Weber Shandwick, has won a double contract with the Scottish Government. In case you thought enough money had been spent on smoking cessation, this company, with offices in 77 countries, will 'signpost and motivate adult smokers wishing to quit to contact Smokeline'. An absolutely indispensable frontline service, wouldn't you agree?

The credentials of Weber Shandwick to do this kind of work are clear – they've been doing it for years. For example, two years ago they discovered that 9 out of 10 New Year's quitters in Australia were back on the fags by June, in a report for Pfizer.

The other contract is to educate the public about the tobacco display ban (Tobacco and Primary Medical Services Act), which was voted into law in January and will be enacted in October 2011. This Act is currently the subject of court action after a legal challenge from Imperial Tobacco: a verdict is awaited.

Employing PR companies seems an expensive way to convince the public to do something it doesn't want to do, or to sell unpopular government policy to the public. I look forward to Weber Shandwick winning a contract to sell a comprehensive hospital smoking ban package. I wonder how the people in the relevant Scottish Government departments feel about having their work of explaining policies and making them more publicly acceptable handed to an outside contractor. As a member of the public I find my confidence in the Scottish Government eroded a little, but my confidence in their tobacco policy is not high to start with.

Corporate Watch has a useful section on PR companies and the lobbying industry.

Afterthought: I've added to the sidebar our response to the Scottish Government's recent consultation on display and pricing in respect of the tobacco display ban legislation, submitted last month.

Government of the people, by the people ...

Just a week ago I asked How long before we get such an opportunity in Scotland? Well, it turned out to not to be such an opportunity after all, since in spite of thousands of responses to invitations to get rid of unwanted legislation, Whitehall has declared itself content with things as they are.

The smoking ban itself gathered hundreds of responses, but it would seem that in spite of the most radical redistribution of power from the state to the people for 200 years, nowt's gonna happen. In spite of glowing promises, the civil servants are in control of the politicians.

The most recent update on Directgov seems to date from 1 July.

We'd never have fallen for it in Scotland, would we?

The source publications (also including the Guardian and the Daily Mail) don't give links to the actual government department responses. I've had a quick look but can't find anything from the horse's mouth so far. Hat tip to Dick Puddlecote for the story.

Air Quality Standards

These are the front and back of our postcard produced jointly with the UK-wide Freedom to Choose group. What is the matter with being sensible about air quality standards?

Update on NHS Grampian ban

The decision to ban smoking throughout NHS Grampian sites has been deferred for six months following concerns that it would not be enforceable, the BBC has announced. Freedom to Choose (Scotland)'s misgivings about the legality and enforceability of the measure have been vindicated.

Other health boards have acknowledged that there is no legal grounding to the ban. This article has come out today: the site manager of Ninewells Hospital in Dundee is quoted saying:

we can only ask them to respect our policy on smoking but if they say they don't respect it, and ask ‘What are you going to do about it?', then we have to walk away.

Furthermore yesterday another story came out yesterday from Cornwall with much the same message.

The Scottish Government has other ideas and asserts that NHS Grampian is acting within its powers. This implies that the smoking ban legislation has always been capable of being applied outdoors without further primary legislation. Yet NHS Grampian today decided that enforceability was too big a problem to force on its workforce and the Grampian public, at least until further discussions have taken place.

Last year the Scottish government held a consultation that was designed to engineer Scottish mental health services in a no-smoking direction. This would have had the result of removing the exemption that currently applies to smoking rooms in psychiatric units, but further questions were added in the mental health consultation asking respondents whether smoking should be banned outdoors too.

Meanwhile the NHS and Health Scotland have run a seminar on Health Improving Health Services – health services with a vengeance. Ridden with jargon about working together, it refers to 'the discussion of how we make hospitals exemplar centers for health and wellbeing'; 'asking for and valuing patient feedback', and finally 'clarifying, and then enforcing, our stance on issues such as smoking on hospital grounds'. Quite a confusion of objectives here. But the seminar does demonstrate that the effort to make hospitals smokeless zones is government-led.

The issue is simple. The NHS is there to deliver medical treatment to sick people. It employs people to treat patients and otherwise service the hospital. There seems no good reason to employ any of the staff as exemplars in public health. It makes no economic sense for staff to challenge visitors to the hospital for smoking, nor does it help anyone's health. Threatening disciplinary action against staff who possess tobacco and expecting them not to smoke in break-times on shifts that can extend to 12 hours marks an extraordinary departure from normal conditions of service.

Threatening to withdraw treatment from patients who smoke on a blanket basis, or depending whether they observe no-smoking requirements in hospital, is discriminatory treatment: not a decision made on clinical grounds.

Recorded Interviews on Smoke Ban, NHS Grampian

Eddie Douthwaite on Five Live, Monday 2 August, 13.15

Michael Davidson on STV, Monday 2 August, 18.00 (North)

Look for Eddie again at 8.15 tomorrow (Tuesday) morning on Radio Scotland.

Update: Here is the recorded interview with Eddie Douthwaite. It was recorded today (Tuesday.)

Freedom to Choose (Scotland) Live Interviews, NHS Grampian smoking ban, today!

Eddie will be interviewed at 13.15 on Radio Five Live.

Michael will be interviewed on the evening news (we think 18.00) on STV North. For viewers not in Grampian go to this page after 7 pm and click on 6 o'clock news.

Also Eddie has been interviewed by a BBC Grampian reporter and will be heard on BBC Radio Scotland tomorrow morning at 8.15.

What a day ...

Impending Ban on E-cigarettes

The date is uncertain but e-cigs look like going the same way as smoking in bars. This time over to Frank Davis.

The approach of the whole process seems to have a staggered approach. First they banned smoking in pubs. Then they tried to reason that having 'protected' the adults from secondary smoke, it would be criminal not to protect the children, and increasing calls were made for bans in motor cars and the promotion of (for now voluntary) no-smoking homes. If they had considered the children first they might have preferred to mandate the use of extraction systems, and allowed pubs to keep smoking rooms.

Next: we banned e-cigs, yet we still allow people to use tobacco!

Photo: F2C Scotland Chairman Eddie Douthwaite interrogates (soon to be unemployed?) e-cig company representative at recent smoking cessation conference in Glasgow.

Licensed to Abuse?

Comment at 19.42 on this story in the Daily Mail, two days ago: 'It's time we started abusing smokers physically.'

After writing to the Daily Mail about this, I went to a local cop shop this morning (just out of curiosity), with the offending words. Their advice was that it wasn't a police matter, and that the matter should be reported to the Daily Mail. I asked under what circumstances it would be a police matter (for example whether it would be a police matter if directed at another specific group of people) and the officer on duty said each case depended on the exact wording. She said I had done the right thing by complaining to the Daily Mail in this instance, and would be welcome to check any other instance with the police.

So that's what to do: use the feedback form if you want to make your displeasure known. Or letter or any other form of complaint that you can.