Sheila's blog recommends quitting for Scotland

ASH Scotland takes up the 'new year quit theme' (although without backing in the form of free nicotine patches from the government, which is being offered by the Department of Health in England), exhorting people to quit smoking in order to save money – for Scotland as well as for the sake of personal financial and health gains.

Sheila Duffy refers to the ASH Scotland report Up in Smoke in support of her plea to stop smoking for Scotland. This report estimates woeful logic and shameless guesses in order to force the figure for smoking-related costs up above the figure for revenue.

Unlike Action on Smoking and Health (UK), Sheila's blog post refers almost positively to alternative smoking cessation treatments and willpower.

There is a lot of help and advice out there to support smokers thinking about quitting. Lots of people can quit through willpower alone – and often find it easier than they thought it would be. Many people find alternative therapies help them.

Admitting that people can quit smoking through willpower alone is new in anti-smoking circles. ASH Scotland's reference to alternative methods of quitting on its website is almost reasonable:

Complementary therapies like acupuncture, hypnosis or laser therapy, help some people to stop smoking but there is a lack of scientific evidence to support their effectiveness and they can be expensive. If you are interested in using a complementary therapy, find out about the therapy and choose a registered therapist before you commit yourself to a course of treatment.

The effect is spoiled by the assertion that NRT and Zyban 'have been tested in scientific trials': even developers of nicotine cessation treatments know this is bunkum. But at least Sheila has acknowledged that some people find that willpower and therapies other than NRT, Zyban and Champix work. Contrast the page on non-NHS therapies on the Action on Smoking and Health website.

Smoking cessation is an industry these days: at least, some people treat it as an industry (and a ruthless one too). Look forward to a major trade conference on smoking cessation drugs and therapies to be held in 2011.

Free patches for a smoke-free New Year

Chris Holmes, a hypnotherapist and campaigner against NHS expenditure on nicotine replacement therapies urges us to join the campaign to consign these ineffective treatments to history. He starts with a government plan to provide one week's supply of nicotine patches free of charge to assist people with their new year's resolutions.

Read what he has to say, share the story with your friends, and then write to your MP, MSP, assembly member, local and national press, health board, or if you have any further ideas let us know. We picketed the 2010 UK National Smoking Cessation Conference in Glasgow last June, which was all about pushing medication.

Drug companies benefit far more from smoking bans than tobacco companies suffer from them.

Scottish call for relaxation of smoking ban

Scottish licensed trade representatives have joined the call for a reversal of the Scottish smoking ban – the article includes a contribution from Eddie Douthwaite of Freedom to Choose (Scotland).

I don't go along with the call for a licensing system for allowing smoking personally. As a non-smoker it never bothered me to have smoke about and I don't know that it's one of the things that councils should be trying to make money from. Allowing smoking in licensed premises makes for a bit less mess in the streets and that's one saving before they even start charging licence fees. But it's good to see that the Scottish Licensed Trade Association has identified air quality as the pertinent issue, and air cleaning equipment as the solution. 'Ventilation works in industrial situations where the air needs to be clean,' says Paul Waterson (SLTA chairman). 'Why can't it work in pubs?' This would mean redeploying council staff from the unsavoury duty of prosecuting their friends in the community for smoking-related offences, to that of assisting licensees in keeping the air clean, not only of smoke but of any other airborne toxins – recommending appropriate air cleaning equipment, ensuring that filters get cleaned out and replaced when needed. They're environmental officers, aren't they?

The Press and Journal's editorial on this issue is feebly written and  muddled. 'Unsightly huddles of smokers... are a poor byproduct of the ban,' it says, adding that this is 'outweighed' by protection from secondary smoke. Having just pointed out that ventilation equipment has been put forward as a solution to this issue, it fails to explain why such equipment will not work. It would seem that even if we live in the space age and the nuclear age, we still need to have smokers outdoors because air cleaning equipment doesn't work. I don't like what this says about our priorities. This line of argument also suggests that the leader writer of the Press and Journal lacks vision. What kind of leader writer defends a government for trying to saving face rather than admit they got the answer wrong?

The leader then goes on to say that 'mixed messages' would be sent out by revising the ban, and that it would 'seem inconsistent' to revise the ban after recently applauding it. Sorry to say, but this kind of excuse comes of consulting only one side of the issue seriously. Sheila Duffy, quoted in the Press and Journal news story (first link) has claimed health benefits from the ban, such as heart attacks (no time to link to these stories at present but you know the ones I mean), finding less evidence of smoke in bar staff's breath after the ban than before it, finding bar staff sneezing less in June 2006 than March 2006. This kind of 'evidence' will be relied on to 'prove' how helpful the smoking ban is. ASH Scotland seems to be the only authority the Scottish Government (and much of the press) recognises on smoking issues.

It is hard to imagine the Scottish Government doing any research into what kind of air management system will remove smoke particles from the air, or listening to anyone who has done such research. As the Press and Journal editorial points out (although weakly), such an approach would do little to support the denormalisation of smoking (it would 'send out mixed messages'), and that is why the Scottish Government is against it.

And in by the back door ...

I'm travelling soon so many preparations to make but here in the meantime (reported from Malta) is a story of how smoking rooms are returning. (For some.)

Even as Spain prepares to ring in the New Year with a smoking ban in bars, renegade nightspots in Paris and Berlin are bucking the European trend, opening designer smoking rooms, complete with pianos, pool tables and cigar lockers.

Enjoy.

Junican won by confounding the results

At the end of October Tobacco Control Blog recently ran a competition to come up with the best way to improve the rhetoric of anti-smoking campaigners. The short list and results can be seen here, and the clear runaway winner, 'JWatso', took 77 per cent of the votes.

JWatso (also known as Junican) is a regular contributor to blogs, and is very far from being a supporter of tobacco control. Although the results of the poll/competition have been fairly clear for some time (I for one haven't checked them since the cold weather started), they weren't announced until yesterday in a rather stiff congratulatory note from the blog's editors – the editors realised of course that the winner of their poll, who scored just over three times as many votes as the combined totals of the other participants, was an enemy to the cause of tobacco control!

Frank Davis reproduced Junican's reply. Junican should be a professional blogger. This piece corrects all the assumptions and half-veiled accusations put forth in the editors' congratulatory note to him, and with style. I'm still waiting for it to be added to the Tobacco Control Blog as a comment, because [the editors] 'do not reject comments simply because the editors do not agree with them'.

Aye, right.

Stopping smoking makes you wealthier

So says the latest ASH Scotland press release (by inference). They really seem to believe that the best way to tackle what is widely termed 'health inequalities', much lolly has to be thrown in the direction of tobacco control.

'Research in Scotland has found that smoking is a greater source of health inequality than social class. This can no longer be ignored.' Is that really so? What is a 'health inequality'? Is it more than a fancy term for simple 'inequality' (a term which carries the implication that those on the lower end of the scale are worse off than those at the top end)? Or does it mean 'unequal health outcomes'?

Laurence Gruer, of NHS Health Scotland, Glasgow tries to help us out in his address: How does smoking cause health inequalities. 'Contrary to popular belief, recent research shows clearly that low-income non-smokers live longer than high-income smokers.' Is that so? I'll suspend disbelief temporarily. But it gets more incredible yet:

Over the past 60 years, smoking rates have declined much faster in higher than lower socio-economic groups. This may now account for as much as 80% of the differences in death rates between higher and lower socio-economic groups in the UK.' 

Eighty per cent? Er ... okay, although this looks like a very simplified view of the range of problems to which less affluent people are exposed (and it may be that their problems are about to get worse, especially if winters continue as bitter as this year). To sum up, he has now decided that those people who still smoke come chiefly from the lower quartile of society and feels compelled to explain why this is:

Why do more people in lower income groups in the UK become regular smokers? Regular smoking usually starts in the teens or early twenties. Important factors include other smokers in the family, low parental supervision, friends who smoke, and lower intelligence and educational attainment. Young people not in employment, education or training have very high smoking rates, young offenders even higher. 

Misguided, easily led, badly educated low achievers form the highest rates of smokers. In other words, the difficult-to-persuade hard core ... Dr Gruer's solution is:

Increasing the cost of cigarettes, reducing their accessibility and visibility, and enforcing laws on legal age of sale are the most likely ways discouraging disadvantaged young people from starting to smoke. A comprehensive package of new Scottish legislation has this aim and its impact on health inequalities will be evaluated.   

Is he really trying to persuade this disadvantaged hard core by raising cigarette prices and making cigarettes invisible at the point of sale? Has he even heard of the illegal market?

His logic is absurd. These people, hard-core smokers, still smoke and their health is worse as a result. Take away the temptation to smoke and they will cease to become feckless, easily-led and irresponsible and start being a good example to their children, perhaps even start working and earn themselves out of the poverty trap ...

They still haven't got it: the temptation to smoke does not come from a tobacco display or visible prompts. Not everyone in life is grabbed by superficiality, as these anti-smokers clearly are (and as they imagine that everyone else is too). Many people like smoking. But if it is associated with poverty and chaotic lifestyles there could be a reason for that too: It is calming. Poverty and chaos in the lifestyle are stressful, and probably in themselves major contributors to ill health. Of course medics will argue that the comfort from smoking is illusory, but if the illusion is comforting, why should the smoker care if he or she is just trying to get through each day? (Some people say the same of religion.) To put it simply if you want to stop poor people needing to smoke, help to eradicate their poverty, homelessness and chronic insecurity. Don't just point at the symptoms of poverty and persecute people for exhibiting them [yes I know you care about them and are just trying to help them by 'denormalising' their habit ... bampots].

ASH Scotland's press release mentions the 'widening health inequalities gap'. One is tempted to ask why the health inequalities gap is still widening after nearly six years since the smoking ban was voted through Holyrood, and why, having failed to narrow these inequalities with a smoking ban, we are still paying tobacco control advocates to come up with other fantastic schemes.

Keeping warm in winter with the NHS!

God bless them! The NHS has issued advice to help keep us warm in winter, quoting winter death rates of up to 30,000 in the UK. It defines the vulnerable groups, including the elderly, disabled, those with heart and lung conditions and those on low incomes.

According to the General Register Office for Scotland winter deaths are on the decline, and it appears to deny that  Scots are dying from the effects of the winter cold: “There is no single cause of additional deaths in winter. Very few are caused by hypothermia. Most are from respiratory and circulatory diseases such as pneumonia, coronary heart disease and stroke. In only a small proportion of deaths is influenza recorded as the underlying cause.” The video on the NHS link however explains the link between cold weather and heart trouble and advises people with heart conditions to avoid extremes of temperature.

Do the people who give such advice consider that it does not apply to the millions of smokers – many of them elderly or disabled – who are expected to expose themselves to the cold outdoor air whenever they wish to smoke? The NHS link also points out the dangers of isolation and depression, especially for elderly people living alone. In order to satisfy those who fear the long-term effects of exposure to secondary smoke, we are putting society's most vulnerable in imminent danger from the combined effects of cold air, and extremes of temperature. The 'social and welfare clubs', pubs and cafés where people could pass the time of day in company with neighbours are, in many places, no longer fit for purpose and have sometimes not even survived.

Approaching 20,000 people died in the December 2009–March 2010 period in Scotland: a startlingly high figure compared with the figure quoted by the NHS as cold weather-related deaths for the UK. I don't understand why this total should be so high in relation to the national (UK) figure. The General Register Office seems confident of a continued downward trend, in spite of austerity measures in general and rising fuel prices in particular.

Lift the smoking ban so that people can use pubs and clubs as the uncensored and welcoming social meeting places that we want them to be, and that people need all the more in times of severe weather.

ASH Scotland gives mixed message on Champix

ASH Scotland's latest media briefing on Champix (also Chantix or varenicline) states in its opening series of bullet points: 'there is emerging evidence that varenicline is safe and effective for people with mental health problems'.

A review of the evidence in Expert Opinion on Drug Safety[26] has concluded that although the risk of potential neuropsychiatric events is evident through voluntary reporting systems and reported cases in the literature, multiple studies and case reports support the use of varenicline in the mental health population.

The referenced study supporting the paragraph says (abstract): 'Cautious treatment initiation, patient education, and close follow-up, monitoring for mood and behavior changes during therapy are recommended, especially in the psychiatric setting'. It also says:

Although the risk of potential neuropsychiatric events is evident through voluntary reporting systems and reported cases in the literature, multiple studies and case reports support the use of varenicline in the mental health population.  

I have no idea of the rate of successful outcomes compared with adverse events. It is clear however that not only those with a history of mental illness or psychological problems suffer from the side-effects of taking Champix – a fact clearly acknowledged by ASH Scotland in its page featuring Champix:

However depression, suicidal thoughts, suicide attempts and completed suicides have been reported in patients taking varenicline who have no known pre-existing psychiatric conditions, and in patients who continue to smoke.

This page gives a clear message in bold type that anyone experiencing side-effects should stop using the drug and get medical help without delay. The confusing part is how this squares with the idea that Champix is 'safe and effective for people with mental health problems'. It would have taken very little to add 'on the understanding that the patient is carefully monitored, and it is not recommended as a treatment of first resort'.

Plaintiffs in court cases on Champix claim that Pfizer 'neglected to test Chantix adequately before its release, deliberately hid evidence of serious side effects and failed to sufficiently warn consumers about its risks'. There was no thorough testing of the drug on people with psychiatric problems, and this incomplete testing has become an issue as more reports of adverse reactions emerged over the years. (Neither of the users of Champix featured in this link had a history of serious mental health problems. One user took her life and the other experienced psychological disturbance following a twelve-week course, that led to a suicide attempt.)

The sheer bloody unpleasantness of taking something that completely unbalances you can't be stated too strongly: even without leading to suicide, it is not easy to put such an experience behind you. (I had an averse reaction to myself to a natural thyroid hormone: after three days on a minute dose I was ready to throw heavy things out of windows. I have been angry before but this was well beyond any previous experience. And the doctor who prescribed it for me found it hard to believe.) There are more stories here from people who wanted to make their stories public.

I can't help but think that ASH Scotland views people who experience such effects as unfortunate statistics – collateral damage in the war on smoking. They've made the warning clear on their website, but still find it easy to call the drug 'safe' for users of mental health services.

Assange, Pilger and the freedom to read

You can link here to live news on Wikileaks but be careful what you read or quote especially if you are in any way associated with the US Government, news media or certain academic institutions even from your home computer:


John Pilger defends WikiLeaks & Julian Assange from John Pilger on Vimeo.


The story of Assange is nothing if not confusing: I can't see how it is possible that someone who was detained in conditions of solitary confinement allegedly on a charge of sexual assault (even two charges) can be said not to have been held for political reasons. As Pilger says, Assange's revelations could have been made by the mainstream media corporations if they had been doing their job, and it is beyond farcical that news organisations are now being threatened in order to prevent them from making stories of Wikileaks revelations.

There is more than a head of steam building behind this story now. It is the media's role to investigate why events occur, not to concur with government on the need for official discretion.

Interviewing John Pilger on the video is Amy Goodman: more of her reporting can be found here. A further account of Wikileaks from Goodman can be found here.

Wars on drugs and smoking don't work

First, Devil's Kitchen writes about Bob Ainsworth's call to consider the legalisation of drugs. I haven't read in much depth about the wider drugs situation, but I understand that since hard drugs were criminalised in the early 1970s, drug use has taken off exponentially, no doubt aggravated by huge escalations in unemployment in the following decade, and the chief beneficiaries have been the dealers. Big-time dealers are scary people: small-time dealers might get involved in order to send their sister to university or achieve some other benevolent outcome, and are probably the ones most likely to fall foul of the law.

Costs in treatment of drug addiction, and the chaos that ensues for many drug users and their families, are hard to quantify.

Despite the fact that drug use is now far worse than it was when drugs were legal, any suggestion that drugs should not be illegal is met with the objection that 'we can't condone drug use'. Same old, same old. The idea that prohibition actually works underlies this objection. It's exactly what hospital trusts say about smoking in hospital grounds, and is similarly irrelevant.

Overnight legalisation of all hard drugs may not be sensible, but ways must be found to prevent 'recreational' drugs being sourced through criminal gangs. Price mechanisms, for example, must be used with care: they keep getting it wrong with tobacco, assuming that large tax increases deter people from smoking, when they are as likely to fuel the market of contraband salesmen again. Whether the government will listen to sense is another issue. As DK points out, both coalition leaders were ready to take action when in opposition, but less eager now that they are in power – just as on the smoking issue.

Two posts from Chris Snowdon show the failure of the smoking ban to make any impact on the nation's health or its smoking rates. The Scottish 'heart attack miracle' not only clearly never occurred in the first place,  but there is no evidence of any sustained drop in heart events since 2006. The Irish are seen to smoke more heavily now than in 2004. Chris also shows in another post that a recent attempt to claim a similar heart attack miracle on the Isle of Man, using calculations based on a tiny population, is flawed and unreliable.

Prohibition doesn't work, and neither do smoking bans.

Ireland watches Greece

Ireland, where ministers could boast that the smoking ban has been successfully implemented since 2004 (even if it's widely ignored outside towns and cities, which I've heard said but can't confirm), comments on Greece, where it is abundantly clear that it hasn't been and probably can't be implemented, even after the Greek Government has imported enforcement officers from overseas to advise them.

Both countries have also experienced austerity measures at the hands of the EU.

Richard Pine, the writer, states that the smoking ban was immediately accepted in Ireland, and clearly feels that the Greeks have a problem with smoking – but do I pick up a sense that he profoundly respects the Greeks' ability to defend their national sovereignty and their national passion for smoking?

CATCH-16, Chris Snowdon again

Chris returns to argue further that smoking causes lung cancer.

Dutch MP explains smoking ban decision

On this clip, a Dutch MP explains his decision to retract the smoking ban on the small bars in Netherlands. If you've listened to the clips in this post you will recognise some of the voices, notably a few happy customers in a smoking-permitted and a less-than-happy Cecilia Farren (ASH). Cecilia appears to feel that vested interests only exist in the tobacco industry, in order to sully what would otherwise be an open-and-shut case like asbestos. She doesn't see that a life is a continual battle of conflicts of interest – even though GASP, her own organisation, is a commercial entity that promotes smoking cessation and tobacco control.

The Dutch MP, Anne Mulder, speaks for the new Coalition government in the Netherlands. He explains that the decision is ideological, based on people's responsibility for making their own decisions. Economic considerations are minor, even though they are likely to be a factor in people's decisions: he doesn't see this as a problem – anti-smoking interests argue that the economic interests of the licensed trade or tobacco industry are a dangerous distraction (and any pharmaceutical interests of their own are of course irrelevant because their intentions are beyond reproach).

People smoke. Other people wish to provide recreational venues for them. We don't need to interfere.

I think that was the solution that the Coalition Government was meant to come up with. Instead they came up with Nudge, and misunderstood it. To nudge people to stop smoking, you have to improve their standard of living, because people with a better standard of living smoke less. Spending precious health budgets on tobacco control freakery couldn't be more irrelevant.

***

If you have plenty of time on your hands listen to this clip too: Wiel is interviewed by Jason Mohammed on BBC Wales, along with Dr David Bailey of the BMA in Wales. Public reactions take this discussion to nearly two hours, but there is much of interest near the beginning. Interesting: it sounds as if BBC reporters have accepted that the ban has damaged trading conditions for the hospitality. They ask, should we amend the smoking ban and save our pubs? I never cease to be amazed by members of the general public, faced with publicans who personally witnessed their takings plummet between June and July 2007, or over the following weeks and months, who insist that their problems are nothing to do with the smoking ban. One licensee complained of such criticism, 'I was obviously hallucinating when I watched my takings go through the floor after the smoking ban came in'. Dr David Bailey is one such know-all, who appears to have thought it unlikely  that Wiel's association of twelve hundred publicans had experienced any economic hardship (even though some of them had lost up to 70 per cent of their takings).

Wiel on Talksport

Now (Wednesday night from 10.00) you can listen to and participate in the debate on Talksport. Lots of opposition to the ban being expressed.  Go here and listen in. The number is 08717 223344 if you wish to call the show. The show ends at 1.00 am: the discussion ends when people stop calling and emailing the show.

11.00 pm: the debate is still going strong ...

Guest post from Sheila Duffy of ASH Scotland

Just kidding. You can read it here.

CATCH-15: Dave Atherton adds his thoughts

Dave Atherton enters, arguing that smoking does cause lung cancer.

Dutch smoking ban partially repealed: BBC interviews all day

As reported here, the Netherlands has repealed its smoking ban for bars under seventy square metres with no employees. This has been announced with some media fanfare in the UK, with the question even being asked on air whether a partial revocation of the ban would work over here. (By over 'here', I mean the UK. I am sorry to say that this reversal in the fortunes of anti-tobacco has not been reported in the Scottish press [edit: see first comment]).

Interviews went on throughout the day. It started with a broadcast with Paul Greer interviewing Wiel Maessen and Cecilia Farren. The story in the clip is badly presented with nil research evident on how to spell Wiel's name or even what gender he is. But it's worth hearing the interview, in which Cecilia Farren (ASH) accuses opponents of smoking bans of conducting a campaign of terror. She also suggests that the tobacco-related interests of a single sympathetic MP outweigh the interests of around twelve hundred rebel bar owners, and are sufficient to characterise the reversal in the smoking ban as the result of tobacco industry lobbying.

A debate on Radio Five Live from 9 this morning (Nicky Campbell) was spirited and showed anything but consensus. Brian Binley MP, who has campaigned to reform the smoking ban, participated.

An interview on the World Service (start from 49) follows with Paul Greer interviewing Wiel and Southampton publican Simon Bell who runs Talking Heads and another pub in the city. Wiel explains the history of the ban's reversal, the huge losses that publicans had experienced following the ban. Simon Bell obligingly opines that the Dutch system would be adaptable to the UK provided that extraction and air cleaning were in place.

In The World Tonight (at 40.00), Paul Greer distresses Cecilia Farren by conducting a group interview inside a smoky pub. The locals' views reflect support for the move, commenting mostly on viability and an improved atmosphere, and the move is declared popular with English visitors. The landlady comments that people have clearly missed the experience of pub smoking and come into the bar because they see people smoking inside. Paul Greer again invites Simon Bell to reiterate that it would be possible in the UK to provide separate accommodation for smokers and non-smokers.

Finally BBC News 24 saw a head-on confrontation between Nick Hogan, the celebrated licensee of the Swan Inn in Bolton and the Swan with Two Necks in Chorley (both sadly now closed), and Paul Hooper of ASH. It happened at 9.30 pm, and is worth a look if anyone can find it. Nick does not flinch through Paul Hooper's denials that the smoking ban hit bars and the licensed trade, and his insistence that passive smoking kills and that heart attack rates have materially changed, but argues the point for a change in the law.

After a long day of interviews, Wiel's assessment surely gives grounds for optimism. The smoking ban and similar legislation are based on a failure to negotiate. The smoking ban has been defeated by people who know how to negotiate, and who will not allow doctrinaire attitudes to dominate. The solution to the smoking issue is not to be found in excluding part of the community but by actively resolving conflicting preferences. No solution that starts out by attempting to marginalise or denormalise is acceptable, and the Dutch have proved it.

What's the Dutch for Congratulations? Proficiat! And Cheers? Proost!

European Union seeks wider anti-tobacco powers: petition and consultation

Forest presents a video on the EU tobacco control consultation, which closes on Friday.



Please sign petition here, consider replying to the consultation, or take both actions. A campaigner for e-cigarettes writes:

Plans to hand all nicotine sales rights to pharmaceutical companies are moving along. There are now proposals from the EU and WHO to bring nicotine under tobacco control regulations where it hasn't been medicalised. To complement that move, new end game strategies from tobacco control on removing it from tobacco products have been announced.

There may be more outright bans or just trading restrictions, border quotas, internet sales bans, advertising bans, postal bans, extortionate taxes, etc.

Please take action, it is important for nicotine traders and users to be vocal to have our wishes heard, all policy and regulatory considerations so far appear to be by and for corporate pharmaceutical and tobacco control interests.  The EU consultation presents at least a pretence of  democracy but the WHO have no intention of anything but totalitarian control.  Are we subordinate drones in the collective or humans with self determination and free will?

Respond to the EU and WHO proposals and please spread the word to other nicotine users.  Don't let them take away the rest of our choices without a fight.

The consultation document is 11 pages long, far shorter than many such documents. The format is fairly simple: it presents an aspect of the problem, such as legislation about smokeless tobacco, and gives three options. Option 1 is usually to retain control for policy within member states. Options 2 and 3 are generally Europe-wide solutions with Option 3 generally being more hard-line. (You may wish to support Option 2 in Question 2, which provides for the legalisation of snus and other smokeless tobacco throughout the EU.)

Clearly the Commission wants to be given a mandate to legislation for the whole of Europe. Please respond to the Consultation if you can, recommending that member states retain control over tobacco control policy.

The deadline is Friday 17 December. Instructions for responding are all contained here.

CATCH-14, Frank Davis writes

Frank claims victory!

(I haven't announced all the instalments, just when I had the time to fit it in. Please go to home page and scroll down for any that you've missed!)

Smoking ban debate hits BBC airwaves: Wiel v ASH

There will be a live link up on Radio 5 Live and BBC World Service on Tuesday morning, 14 December at 7.40am (GMT). Paul Greer will be presenting the programme where Wiel Maessen (Forces International President & TICAP BoD member) will debate with Cecelia Farren of ASH Bristol (GASP).

Weil Maessen is a leading figure in the Dutch publicans' successful campaign to restore choice to licensees in the Netherlands where pubs without employees are now permitted to choose whether to allow smoking. He persuaded politicians that 'protecting the workers' would not work as an argument in favour of banning smoking where only owners of the business work. The battle does not stop there for Wiel, however, since so many people find the alleged dangers of secondary smoke either unconvincing, irrelevant – for adults who are able to decide where to spend their recreational time or where to seek work – or both. Winning the battle will involve victory of citizens over lobby groups over decisions about how they spend their recreational time, and restoring accountability to the political process.

Since Cecelia's runaway success in creating persuasive anti-smoking messages led her to convert her anti-smoking campaigning group into a business, she has been selling posters like this and other merchandise, including wonderful games and toys like these as aids to educating people about the evils of smoking. She's nothing if not enthusiastic! – but surely her commercial incentive for success in the anti-smoking business should raise questions.

This is a rare opportunity to hear opposing views on smoking bans publicly aired on the BBC.

Broadcast interviews from 7.40 UK time (GMT), Tuesday 14 December on Five Live.

Smoking ban in homes

Action on Smoking and Health (in the UK) is getting more fanatical by the day. In this BBC report, Martin Dockrell, ASH's policy officer, concludes:  'There is a strong case for social and private sector landlords designating some entire blocks as smoke-free to respect the choice and the health of the great majority of their tenants.'

This directly contradicts Deborah Arnott's words reported by The Independent only yesterday: 'While we can't pass legislation to prohibit smoking in the home, smoking in cars can and should be prohibited by law' [emphasis added].

The background to Dockrell's urgent about-face? A study led by Jonathan Winickoff (who invented third-hand smoke) declaring that children who live in apartments are more exposed to smoke than children in detached houses. They tested children across the US for cotinine, which is found (but not exclusively) in tobacco.

Researchers limited the sample in this study to children who live in a household where nobody smokes.

No control, then?

Overall, researchers found that 84.5% of children who were living in blocks of flats had a cotinine level that indicated recent tobacco-smoke exposure, compared with 79.6% of children who were living in attached houses and 70.3% who were living in detached houses.

So nearly three-quarters of children of non-smokers in detached houses have a high degree of cotinine in their systems, and children in smoking households were not studied. Exposure to nicotine is measured, but not the effects of exposure, which we are left to imagine. The study carries the authority that one expects from the man who coined the phrase 'third-hand smoke'.

Martin Dockrell should be ashamed to peg ASH's policies on such rotten calculations.

Banning smoking in cars

The Northern Ireland Assembly and Westminster are both under pressure to extend the smoking ban to include cars that carry children as passengers.

Deborah Arnott, of Action on Smoking and Health (unlike her pal Sheila Duffy at ASH Scotland) definitely wants legislation: 'While we can't pass legislation to prohibit smoking in the home, smoking in cars can and should be prohibited by law.'

Reports on Northern Ireland (link above) say that nine out of ten households want a smoking ban in cars. This suggests that most people are likely to consider the perceived sensitivities of children to smoke, and that legislation is not needed.

I adopt the general view that respiratory problems in children have increased while smoking has decreased and see no reason to attribute breathing problems in children to smoking. I don't have children, nor do I drive and only smoke on a very irregular basis so don't have any personal slant on the issue.

My big question is, if they suspect that secondary smoke is dangerous, why have they left protecting children so late in the day? They have been campaigning on secondary smoke since the 1970s:

... the last 40 years have seen an incredible amount of expenditure on studies, press releases, TV ads and such things all designed to play up the fear of wisps of smoke in pursuit of the strategy laid out at the 1975 World Conference on Smoking and Health chaired by Sir George Godber.  The consensus of that conference was that to achieve the public support needed to eventually eliminate smoking it would first be necessary 'to foster an atmosphere where it was perceived that active smokers would injure those around them.'

Since they had all this ammunition at their disposal, the simplest thing would have been to protect the children by first of all campaigning about them. They didn't do that: they decided to protect adults instead, and run the risk of further exposing children in the process. Now their strategy is to come back and say: 'the adults are protected: it's only right that now we protect the children', yet bydoing things in this order they have left children 'exposed' for years.

Their objective is and always has been opposing smoking, not protecting health. Had children's health been a factor they would not even have run the risk that parents would smoke more at home. Given the number of pub closures over the past four years it is very hard to believe stories like this: but even if they are true, the possibility of displacing parental smoking to the home, given the dangers now posited, should have made the smoking ban untenable.

I really doubt whether home smoking has done very much damage. I was brought up in a 'smoking household', in that my father smoked until I was ten. But we lived in a big draughty house. I have lived in houses where the smoke was more noticeable. One was a converted flat, where condensation on colder mornings would gather in puddles on the window sills and drip on to the floor. Someone did smoke there, but the problem was not smoke, it was over-tight windows, no chimney, etc.

We were brought up learning that damp housing hurt people's health. Substandard housing and bad air will hurt children's health. The debate on cars must be left to people with more experience of children's health and car interiors, but really the call to ban smoking in cars has come far too late in the day to take seriously as a major health risk. Dame Helena Shovelton of the British Lung Foundation declared: 'Smoking just one cigarette, even with the car window open, creates a greater concentration of second-hand smoke than a whole evening’s smoking in a pub or a bar.' By not tackling this stupendous problem before tackling smoking in pubs, they have ruined their own case.

'Psychotic' Surgeon General under fire at Fox News: one cigarette can kill you

The latest message from the 'psychotic' Surgeon General Regina Benjamin ('if that's her real name'), that one cigarette can kill you leaves this Fox News panel sceptical and critical.

Living on the edge, even flirting with smokers, starts to become enlightened behaviour.

Yes, Minister (Dublin version)

Discussing the budget, following the Irish government's failure to raise taxes on tobacco.

CATCH-11: Chris Snowdon returns

On the question whether smoking causes lung cancer.

ASH Scotland calls for new anti-smoking laws

Or does it? I have to say I am a little confused.

A writer in The Scotsman says ASH Scotland wants further legislation.

Sheila Duffy says it doesn't.

ASH Scotland's paper on the issue is pretty non-committal.

ASH Scotland's recent CRUK-funded paper Beyond Smoke-free backs up Sheila's position to an extent. It talks about interventions, consultations, social marketing projects. It does not refer to further legislation, but does  wish to remove current exemptions from smoking bans in the short term. In the long term, says the paper:

There is public support for more comprehensive tobacco control policies and a strong ethical justification for additional measures aimed at reducing exposure to second-hand smoke. In order to make advances and substantially reduce exposure to second-hand smoke in Scotland, new approaches are required to tackle this complex issue.

But just what does public support mean? 'Support' for removing the mental health exemption is claimed to be found in this paper (which has 'demonstrated support for this move') The paper includes strong criticisms of the consultation paper on removing the mental health exemption and also says (page 12):

Just over one-third (35%) of those who responded to this question recommended that the existing exemption which permits smoking in designated rooms be removed by amending the existing legislation.  [...]

The vast majority (81%) of patient representative groups advocated the retention of the status quo, as did 6 out of 10 of respondents who identified themselves as current service users

It also says: 'Around one in ten (12%) of respondents advocated producing detailed guidance material without amending the legislation.' This was the option the government has taken, and the guidance will appear early next year.

From ASH Scotland's contacts with smoking cessation practitioners at local level in Scotland, we know that services are awaiting government leadership on this issue. The Scottish Government plans to produce guidance to support psychiatric units to close their smoking rooms – we await publication with interest.

Thus ASH Scotland says there is 'support' for a policy that 81 per cent of patient respondents have opposed and only one-third of all respondents supported.

Based on their assessment of the facts, I conclude that The Scotsman's version of events is correct and that Sheila Duffy does want legislation that will ban smoking in cars and even in the home.

Giving up smoking makes for joy and an elevated mood

Medical News Today can be trusted to be hostile to smoking, but this study, as reported here, would make a classic.

The subjects of the study are '236 male and female smokers who wanted to give up'.

Among those who managed to quit for a while, the researchers found that they were in very high spirits (happy) during the check-ups when their smoking cessation was being successfully carried out. However, after failing their moods darkened significantly, and in many cases to lower depths than before the whole study began.

Kahler said that enhanced mood and periods of abstinence went hand-in-hand – the correlation was clear.

[...] 

Kahler believes it is possible to extrapolate from this study and generalize over the whole population, even though his participants were relatively heavy drinkers. He refers to a 2002 study of smokers who had all experienced episodes of depression in their lives, but did not all drink.

The authors added that the link between happiness and smoking cessation was strong, regardless of whether the participant was drinking less or the same – the constant was successful smoking cessation. 

 Observation: 10 out of 10. Inference: 0 out of 10.

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Asthma attack followed by call for tough action on doorway smoking, Cumbria

Every so often I despair of public attitudes on smoking, before reminding myself that a few thoughtless comments tacked on the end of a newspaper story does not represent humanity.

A patient's coughing fit was triggered as he entered the Cumberland Hospital via a doorway where people were smoking. Taking half an hour to recover, he considered that smokers should not be in the doorway, which is not an unreasonable point of view.

The only reason people are there is that they have been denied the comfort of a smoking area to sit down in. For some reason this is considered to be in everybody's best interests, including those patients who 'have' to exit the building for a smoke. Public outrage is expressed if anyone who dares to smoke when hospitalised continues to benefit from NHS care.

How simple can this get? The business of whether anyone smokes when s/he is ill is taken by the patient either alone or in consultation with his/her physician. It is not a hospital management decision. The decision of whether someone visiting hospital to visit a patient smokes is not even a clinical decision. Nor is the issue whether staff smoke. This is the only thing that approaches being a management decision, but a blanket ban on smoking during working hours seems to me peculiarly unwise.

It is absolutely none of the business of the general public.

The way to resolve the problem of smoking in doorways is to provide at the very least a comfortable  and robust shelter at the front of the hospital where it is easily reached by everyone including outpatients with mobility problems, and that provides a preferable solution to standing in a cold doorway. Seating and shelter would help. Coffee facilities in a proper room with comfortable seating would be even better. Nobody who is attending a relative they are anxious about wants to be stuck behind the hospital where they cannot be reached. Nobody in a wheelchair or on crutches will want to trail to the back of the hospital either. If you don't want smokers to be seen at the hospital by the world at large, give them a room that they will want to use. Just how difficult is that?

This is how to use 'nudge' properly. Give people a better alternative and they will choose it over an option that inconveniences everybody – or at least most of them will.

Here is some sense from a Czech legal expert.

It is often said that history repeats itself, but only rarely are we invited to look at the preponderant role of dogmatic ideologues in this recurring phenomenon. As always, they insist that the state should re-educate their fellow citizens by imposing their vision of what is “good,” and this is the case with anti-smoking activists, who are now leading the charge of the partisans of “progress.” Over the last few years, they have successfully campaigned for the introduction of increasingly severe anti-smoking legislation in most European countries, and in so doing, they have taken advantage of a widespread phenomenon in Western civilisation: the drift towards a nanny state and the growth of a culture that is hostile to even the slightest risk.

[...]

Experience has shown that social engineering projects that aim to curtail fundamental freedoms often have unexpected results and in most cases prove to be unqualified failures. This is the future that I foresee for the very strict repressive measures that the EU may be about to impose on smokers, who represent more than a third of the population of Europe’s member states. A few years from now, this kind of legislation could make smoking a symbol — and not just for smokers — of resistance to intrusive and paternalist public authorities and the relentless appetite for regulation in the EU, which is an increasing source of exasperation for a growing number of its citizens.

This observer sees any public health goals of the war on tobacco backfiring, reversing all the good that was done by tolerance.

Meanwhile the Third Estate has picked up the story of the ban throughout the buildings and grounds at The State Hospital at Carstairs: Scotland's secure hospital. Reuben points out that inmates/patients at Carstairs should have the dignity of choosing, just like the rest of us are meant to have.

CATCH-8 and CATCH-9

Chris Snowdon and Rich White add further contributions to debating whether smoking causes lung cancer.

Nicotine based smoking cessation treatments available to Scottish children

This is not a new story: nicotine replacement therapies have been approved for people as young as 12 since 2005. General Practitioners in Scotland were sent updates on good practice in 2007, in order to remind doctors that, following research, NRT was considered safe for 12–18-year-olds and pregnant women as well as other adults.

I came across this story when the Herald reported it in 2007. I wrote it up here (the link to the Herald story is at the foot of the page), and it is clear that the comments (mostly very critical of prescribing NRT to young people) have been edited out.

Two of the people mentioned in the Herald piece, Linda Bauld and John Britton are both leading figures in tobacco control, involved with the UK Centre for Tobacco Control Studies. Their interest in tobacco control as a growing concept is clear, even though they don't have direct personal commercial interest in nicotine products.

Recommending nicotine for young people doesn't seem sound to me but not being a medic I'm not in a position to make detailed comment.  However, I don't like the fact that comments have been censored from the Herald article (the words '0 comments' imply that no comments were ever made, which is patently false).

Malawi tobacco and child labour

The Guardian has produced a video about child labour on Malawi's tobacco plantations (the Bill and Melinda Gates Foundation is also linked on the page). Although it points out that child labour is not unique to tobacco plantations, a serious and erudite looking gent near the end of the video reminds us that we can't trust the tobacco industry whatever efforts they make to eliminate child labour because they are the tobacco industry and really one has to control them and not trust them.

The video points out that tobacco farmers don't get paid until after the tobacco plantations have deducted costs from the income of each harvest. That is tenant farming in any commodity that does not offer advance payments to farmers. These are the conditions that persist for millions throughout the world. Featuring tobacco farming as an educational snapshot of the issue teaches us more about global conditions for tenant farmers than it does about the tobacco industry.

Malawi's tobacco accounts for a high proportion of its export earnings. It is absurd to state that no one employed in the management of this industry has any sense of responsibility for children. Proposals to ban the employment of children do very little to solve the problem that children can't learn on an empty stomach. The video mentions the Malawi tobacco industry's campaign against child labour, and even says that those involved seem genuinely committed to the issue – although we are still reminded at the end that the tobacco companies are only in it for profit.

Malawi tobacco has also hit the spotlight because of the plan of the WHO Framework Convention on Tobacco Control (recently discussed at COP-4 in Uruguay) to ban additives that improve the flavour of tobacco. This could significantly affect the market value of tobacco in Malawi, and is likely to worsen the conditions for families employed on plantations. Malawi is not a member of the FCTC, and an organisation known as Smoke-Free Malawi has recommended that Malawi should join in order to allow representation in discussions like COP-4 (however it would also have to implement other articles further restricting tobacco use and the influence of tobacco companies). It also recommends that Malawi face the reality that global markets in tobacco will decline in future because of the health threat from tobacco, and seek alternative sources of revenue.

At least some of those involved in making the Guardian video wish to represent the tobacco industry as the big demon in Malawi, the cause of child labour in Malawi, the cause of bonded labour conditions. Child labour, claims UNICEF, is rife throughout the world involving up to 1 in 6 children (its introductory page on child labour does not even mention tobacco). Does this focus on Malawi originate from Malawi's non-membership of the FCTC, in order to generate further pressure on it to join this anti-democratic organ of world governance? Or is it just another excuse to score points off the tobacco industry as a whole?

Moving goalposts: dismissed for e-cigarette use at work

Remember this story?

The bus driver who was dismissed for gross misconduct (e-cigarette use at the bus turnaround) has contributed to this thread, which first reported the incident.

She quotes the exact terms of the letter of dismissal ('using your electronic cigarette while sitting in your cab'), and those of the original letter notifying drivers of the rule restricting e-cigarette use ('you must not use this instrument while driving').

On the face of it (and assuming we have all the relevant facts), the bus company has no grounds for complaining of misconduct. The 'wilful failure to carry out a reasonable and lawful instruction' does not apply as she did not disobey the instruction: she was not driving.

Even had she been guilty of smoking a real cigarette in these circumstances she wouldn't have been endangering the public (even though she would have been in breach of the law). I struggle with the idea that this can be characterised as gross misconduct, meriting dismissal as gross misconduct without warnings.

CATCH-7: Two doctors add their thoughts

Two new contributors, Ian Dunbar and Phil Button, join the debate.

For previous contributors go to main blog site and scroll down.

And they got it wrong in the Irish Republic too ...

... by not giving the right answers on tobacco smuggling.

Smoking ban compared with Third Reich: Chris Carter

Chris Carter's latest court appearance is reported here, and here, with some of the background here. Mr Carter believes that the law was passed using inaccurate and misleading information and has been seeking a judicial review to correct matters. Last year he was refused leave to cite three NI government ministers as witnesses and earlier this year his application for a judicial review was refused. He was then granted leave to challenge the law again before different judges.

The initial offence, smoking in North Downs Borough Council offices, drew a fine of  £1,250: he narrowly escaped prison last year after stating that he would not pay. His purpose was to challenge the law by bringing it to a judicial review. No decision was reached in court yesterday.

He has used a photograph in the court of a cancer patient allegedly made to smoke outdoors. Part of his case hinges on the inhumane treatment of smokers.

A four-figure fine for lighting up in an office is an absurd outcome. Prison for non-payment is equally absurd. There are real problems with real crime on the streets and such a fine is justified only by the perception that Mr Carter was imperilling the lives of North Downs council officers by lighting up. Of course, his judicial review should be heard, because his evidence will show how unlikely this is.

He will be permitted an appeal if the current judgement goes against him.

Stopped in its tracks!

Very sad to announce that the finale of ASH Scotland Local Tobacco Control Alliance (a meeting entitled How far have we come? How far can we go?) has had to be cancelled because of the weather.

The ASH Scotland Local Tobacco Control Alliance project is now in its fifth and final year under the present funding structure from the Scottish Government and NHS Health Scotland.

This is the final event organised by the project.  All those involved with local tobacco alliances in Scotland are invited to celebrate the success of their work, identify future needs of their tobacco control alliance, how these needs can be met and how alliances can continue to share knowledge post the project.

Read more here. (This is what they missed out on today.)

The answer to their question is that we don't know where they are going (and neither do they as their planning day was cancelled), but since Scottish Government spending on tobacco control will reach over £1 million this year (scroll to foot of page for information)  (including local authority allocations), they will at least get paid for their efforts.  

Note that this ill-fated jamboree was funded by NHS Scotland. 

Catch-5: Frank Davis continues the discussion

Questions about smoking and lung cancer distribution found in Frank's latest contribution here.

Department of Health delays display ban decision while ASH says nudge isn't enough

In a Channel 4 News interview (below), Deborah Arnott of the English Action on Smoking and Health says that nudge is not enough when it comes to children's health. Regulation was necessary to bring in the smoking ban, a necessary law that everyone likes. Her opponent in the debate Nadhim Zahawi MP supports the 'nudge' doctrine but since he considers the smoking ban a form of 'nudge', a benevolent way to present issues in order to persuade people to make the 'right choices'. Does this man have constituents?



Deborah Arnott feels that regulation is essential alongside a 'nudge' approach. But nudge seems to be what Health Secretary Andrew Lansley seems to be interested in. Claiming to discard the nanny state, he wants to hand responsibility for public health to local councils and encourage them to compete on performance levels and hand out vouchers for walking to school. It may be a matter of semantics, but this kind of nudging seems a bit nannyish to me.

Tim Lang, professor of food policy at City University London said: 'Firstly, the hype around "nudge" as the best way to change behaviour should be treated warily. It's an individualised approach to what ought to be addressed at a population, society-wide level. The term nudge is in fashion, but no substitute for public policy. There is a danger that the nudge will become a fudge.'

The wish to change people's behaviour seems to dominate everyone in public life – effectively there is no difference between nudge and the nanny state. Politicians understand 'nudge' as imposing a smoking ban, a display ban, the imposition of plain packaging and the banning of vending machines simply because none of these measures actually amounts to a prohibition of smoking. They simply have no concept or concern for the impact of their little nudges on traders, any more than they are concerned about the consequences of denormalisation. Christopher Snowdon was right when he said on The Moral Maze last week that in the smokers' world, nudge went out years ago: all these restrictions amount to 'shove', rather than nudge.

What will the Health Secretary do about the tobacco display ban? Deborah Arnott says the matter of stopping people from smoking is too important to be left to 'nudge' and needs regulation (at least she acknowledges that regulations are more serious than 'nudge'). Supporters of the legislation clearly feel that Lansley will let them down and bow to tobacco interests. Local shopkeepers point out that both Coalition parties opposed the legislation before the General Election, and criticise continued delay in a policy announcement, as well as the announcement that plain packaging might be on its way:

Minister[s] must act now to provide reassurance to retailers. We remain convinced that the best option is to abandon plans for a display ban, and there is now an unanswerable case for an immediate freeze on the projected compliance deadlines.

Their demands seem fairly reasonable to me:

Ken Parsons, chief executive of the Rural Shops Alliance (RSA), said, “This is an area where actions really need to be based on evidence. Suddenly this [plain packaging] proposal has come out of the woodwork, with no evidence to back it up one way or the other.

Retailers are being left without any guidance as how this might affect the tobacco ‘going dark’ issue. At the very least, if the minister needs longer to reach a decision, then he must postpone the proposed timetable for implementing display restrictions. It is the retail industry being kept in the dark, not tobacco.

I don't envy Lansley.

CATCH-4: Chris Snowdon responds to Rich White and Frank Davis

Chris Snowdon returns to continue his case that smoking causes lung cancer.

Tactful and proportionate hospital smoking policies needed, so what happened?

Extract from minutes of Scottish Workforce and Staff Governance Committee, 14 May 2010 at Victoria Quay, Edinburgh

Mary Cuthbert and Lorna Renwick presented an update to the Committee on recent guidance regarding workplace anti-smoking policies in NHS Scotland. Cooperation with staff on the issues involved were agreed to be a priority for any effective lasting progress. It was pointed out that the NHS Healthy Working Lives Criteria [link added] would need to be adjusted, most usefully by considering the relevant rules of the European Network of Smoke-free Hospitals (ENSH),which considers a very holistic view of patient and staff data.

It was emphasised by the Committee that this area of debate is necessary to approach with care, not least because of the estimated 40,000 NHS Scotland employees who smoke and would be affected by any change to national or Board level guidelines. It was expressed that in practice whole-hospital-grounds smoking bans were in the main impossible to police and undeliverable. [emphasis added]

The need for staff to be treated consistently across NHS Scotland was underlined. The particular difficulty of dealing with care-in-the-community guidance was discussed. It was generally concluded that Board Policy for Staff on Premises needed to be re-examined. The Committee expressed firm, unanimous support for the principle of reduction of staff smoking levels, but reiterated that regulations would need to be both tactful, proportionate and implementable. The need to balance employee rights with any drive towards smoking cessation was emphatically asserted by all members. [emphasis added]

All this commendably prioritises the need for a consensual approach, and several weeks ago I would have thought it spelled good news. Yet three months after this meeting we had this story about NHS Grampian, this story about Ninewells Hospital Dundee, and yesterday this story about the Carstairs State Hospital. Why, when the health service staff and managers tell Scottish Government representatives unanimously and 'firmly' that smoking bans in hospitals don't work and cannot be implemented, and that equality, proportionality and tact are as important as smoking cessation, do we get more health boards insisting that smoking must cease in the grounds of hospitals (and probably just as much pressure on the issue of smoking cessation)?

More on Freedom to Choose (Scotland)'s challenge to smoke-free mental health services here.

Meetings of the group are listed here. Minutes of more recent meetings (August and November) don't appear to have been posted yet.