Sunday, 27 February 2011

Tobacco display ban: The Observer, the Newsagents' federation, tobacco companies and ASH

The Observer's wholehearted endorsement of the tobacco display ban today can be expected in view of this paper's support for tobacco restrictions to date. Its reasoning is also typical. Even though it admits that the facts don't entirely support a ban, it still manages to present a ban as the only rightful course of action.
Whether a ban deters young people from smoking is fiercely contested. Several Canadian provinces that introduced a ban have witnessed a significant fall in youth smoking. But provinces that did not introduce a ban have also seen falls.
The evidence is inconclusive, as the Scottish Government also knows, but evidence is far from being the key issue.
The researchers concluded the ban helped to "de-normalise" tobacco in the minds of children. The truth, long recognised by the tobacco industry, is that these displays are just another form of advertising and so, in the case of cigarettes, should be consigned to history.
The key issue is that tobacco companies are getting away with 'free advertising', just like any other supermarket commodity. Denormalising tobacco in the minds of 'children' (what age?) does not in any way guarantee that the children will forgo smoking once they find out where their elder siblings and friends get tobacco. The intention to break an association between tobacco and shops clearly carries the risk that people will get tobacco from illegal sources.

Another article, this one yesterday in the Guardian, is dangerously wide of the mark. It reports the National Federation of Retail Newsagents is tainted by association with the tobacco industry in its efforts to oppose the tobacco display legislation.
In 2009, when MPs were first deciding on whether to back the ban, the federation took out full-page advertisements in the Times opposing the move. When a federation member asked officials who had paid for the ad he was told, "don't ask". Finch said he was alarmed at the federation's secrecy, adding: "It's supposed to be a trade association, not the Plymouth Brethren."
Members of the NFRN are entitled to ask questions about campaigns by its leadership. But deciding the display ban issue is another problem entirely. Deborah Arnott from Action on Smoking and Health concludes simply that any view that has been even tainted by association with the tobacco industry must be resolved against the tobacco industry's area of interest. Automatically and without prejudice to other issues.
However, allegations that a trade body that has lobbied MPs has been influenced by tobacco firms will be seized on by health campaigners. The UK is a party to the World Heath Organisation convention on tobacco control, which compels governments to ensure the drafting of policies is free "from vested interests of the tobacco industry".
"The government is required to protect its public health policies with respect to tobacco from the commercial and vested interests of the industry," said Deborah Arnott, director of the anti-smoking campaign group, Ash. "If the government repeals or significantly delays the display ban it will have utterly failed to live up to its international treaty obligations."
Article 5.2 of the Framework Convention on Tobacco Control does indeed compel governments to 'protect health interests from tobacco industry interference'. This particular provision is inherently undemocratic, on the basis that anybody has the right to influence government in its area of interest. Informed debate should be guaranteed by government, the media and the courts: such debate is impossible if key industries are excluded.

If a government feels that an industry's activities have a harmful effect on the population it should ensure that issues resolving that industry should allow other affected voices to be heard. Conflicts of interest are what make up society's business. Government is not entitled to exclude the key industry completely from deliberations, or to assume that any conflict in which tobacco participates (or is perceived to participate) must be decided against it regardless of the the arguments put forward. Tobacco interests, according to the WHO, include 'other vested interests', effectively disenfranchising retail interests or any others perceived to benefit from tobacco sales.

Deborah Arnott doesn't care about the issues brought forward regarding the display ban. She appears to care only about the enforcement of an international treaty that effectively gags tobacco companies (and associates) from any contribution whatever to legislation concerning their product. I don't believe that tobacco companies should have uncontested influence over government, but neither should they be prevented from having any influence at all. Tobacco companies do participate in government consultations, but in the current climate participation at this level is unlikely to help them.

ASH Scotland opens page on research into third-hand smoke

Thanks to auntieban (commenting on the previous post) I visited ASH Scotland's page on 'latest research on second-hand smoke'. It's now entitled:

Third-hand smoke was discovered in a telephone poll and has already become a tool for further denormalising smokers. Just one of the titles featured on this page of 'research', 'when smokers move out and non-smokers move in' (Matt, Quintana et al., Tobacco Control, 2010), is enough to make the skin crawl, especially to any smoker seeking to rent living space, and especially on the other side of the Atlantic.

I am reminded of the famous raid on Tommy Sheridan's home, when the police accused his wife of the theft of whisky miniatures. The police saw the miniatures during their lengthy raid on the Sheridans' property and thought they would charge her with stealing them. She was suspended by her employer British Airways before BA checked its own records and discovered that the miniatures had not been stolen. But by that time Gail Sheridan's name had been dragged into the mud. No issue, no evidence, no crime, but ill will and gullibility lead to a sordid outcome.

The genesis of the third-hand smoke phenomenon is described by Chris Snowdon here: an intriguing story of researchers manipulating the evidence: 
Having come up empty-handed using a real-life smoking environment, the researchers had resorted to using nicotine vapour on cellulose substrates in an experiment that could not be replicated outside of a laboratory. Even then, they had not found NNN in any of the experiments and the only TSNA to appear in any quantity was NNA. This posed a problem because NNA doesn’t actually cause cancer, as the authors admit: “NNA carcinogenicity has not been reported.”
 In a nutshell, people are making a fuss about something because there is a market for fuss, and a market means money. There's money in making a fuss about nothing. This is what makes ASH Scotland so powerful.

Friday, 25 February 2011

Strathclyde Chief Constable: smoking ban may be responsible for more killings

Inevitably not everyone agrees, but the logic is persuasive. Cheap drink, combined with a policy denormalising smokers in a hard drinking culture, has led to more domestic violence. The smoking ban has inevitably brought more drinkers home.

(ASH Scotland, of course, has all the answers.)

Thursday, 24 February 2011

Contra la ley antitabaco

My Spanish is very poor but I like what's happening here. More at La ley del tabaco mata a la hostelerĂ­a (Facebook)

ASH declared interest in GlaxoSmithKline, 2001

In 2001, then head of Action on Smoking and Health Clive Bates wrote to the Chief Executive Officer of GlaxoSmithKline, protesting at the appointment of a tobacco industry representative Derek Bonham on its board of directors. Bates felt that a conflict of interest was involved: the public already in 2001 had identified collusion between pharmaceutical and tobacco interests:
There are already campaign groups that claim the tobacco industry and pharmaceutical industry have a symbiotic relationship that is parasitic on the smoker. I believe it would be highly damaging to the category, to the company and the industry as a whole would be highly damaging to feed that cynical perception.
News to me if the public had any such 'cynical' perception ten years ago.

The letter says:
  1. that Action on Smoking and Health had a 'small holding' in GSK
  2. that Action on Smoking and Health was instrumental in getting smoking cessation treatments accepted by the Department of Health in London
It identifies policy measures, such as raising prices and increasing regulation of tobacco, that benefit 'the smoking cessation market' at the expense of the tobacco market.  'Every time a smoker switches to "lights" as
an alternative to quitting the market for smoking cessation is diminished.' Clive's letter lists measures that he believes promote the smoking cessation market at the expense of tobacco:
  • Restrictions on smoking in public places and workplaces
  • Marketing restrictions on tobacco companies
  • Higher tobacco taxation
  • Greater NHS involvement in smoking cessation
  • Regulatory measures to be applied to tobacco products.
Tobacco companies and pharmaceutical companies carrying nicotine replacement treatments are competing for the same market: that of smokers. To that extent, there is a logical conflict of interest.

Nicotine replacement therapies became available on the NHS in April 2001. The Guardian was excited about this move soberly  reporting John Britton's then-cautious estimate that NRT doubled a smoker's chance of quitting (the claim escalated to a quadrupling of the cold-turkey quit rate). In those days one could say:
'this doubled success rate only applies if you are ready to stop. Taking NRT cannot make you more committed to giving up smoking or transform you into a non-smoker, although it can help end the psychological habit of reaching for a cigarette.'

Even giving nicotine treatments to kids as young as 12 didn't raise any scepticism among Guardian writers on health.

The early days saw campaigners fighting for greater availability of NRT, using the same harm reduction arguments now used by campaigners for e-cigarettes. Said Anne McNeill (now at the UK Centre for Tobacco Control Studies): 'It's simple really - the more the regulators place stringent regulations on the use of NRT, the more likely it is that people will continue to smoke, and then die as a result.'

My question is – the smoking cessation market is important to Clive Bates. No doubt he believed it would help smokers to give up smoking. But what is it worth (as an investment) to the NHS, when it's clear that much of it will go out free on prescription?

Just asking.

Tuesday, 22 February 2011

Hypothermia: the wrong message

The Lothians have seen a rise in hypothermia cases, says the Scotsman

This could be only the 'tip of the iceberg', as this article discusses winter deaths in general: many are not defined as hypothermia, as they take the form of respiratory or cardiovascular events but their incidence increases in cold weather. The jump seen this winter undoubtedly results from record cold temperatures in December. And yet countries with colder climates than the UK have better records than we do.

I've always been a little surprised at the silence of charities for the elderly on the subject of the smoking ban. Or did I miss something? 

Under the smoking law it is illegal to stand and smoke in a doorway. A smoker, regardless of his/her age or condition, is required (even in the absence of law enforcement agents) to expose him/herself to the elements rather than seek shelter in a doorway. A smoker, to fulfil the requirements of the law, must ignore his/her own most basic instincts to seek shelter, to the peril of his/her life.

Of course we have all seen smokers in doorways of an evening smoking. Enforcement officers issue warnings, then toddle off home at 5 pm, leaving smokers at the mercy of their fellow drinkers. There is much moaning about doorway smoking, but who would force a smoker out of a doorway? I have no idea, I've never seen it happening and can only hope that most anti-smoking vigilantes would draw the line at forcing a person bodily to stand in the rain/wind/snow.

Extreme changes of temperature and alcohol are both bad for maintaining body heat. Requiring people to leave drinking establishments to smoke in the open air (especially in winter) seems counter indicative. Surely, protection from hypothermia requires the maintenance of a regular temperature, and this is more important the older one gets, especially after a drink.

So much for pub-goers. What about those who stay at home? A recent study has emphasised people's need for social interaction, showing that isolation can have bigger health indicators than smoking itself:
Data across 308,849 individuals, followed for an average of 7.5 years, indicate that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity). 
Those who don't wish to subject themselves to the indignities of the smoking ban (and others housebound for any reason) will fall all the more readily into the habits accompanying isolation, such as sitting still for long periods and failing to keep warm.

The recent struggles of acute hospital trusts to bar smoking from hospital premises spring from a fear that offering any shelter to smokers will 'send the wrong message'. Those trusts are entirely wrong about this. It is not the wrong message that people should  have access to 100 per cent shelter (when smoking), especially when they are ill or in distress, and especially when they have to emerge from warm hospital to the chill outdoor air of a British winter. It is the wrong message that the advice given for decades to elderly and vulnerable people for avoiding hypothermia (and indeed isolation) are suddenly dispensable when it comes to advising smokers. The risks of exposure to cold air are clear and present; of subjecting anyone to risk from passive smoke are distant and hypothetical. How are we to take official advice to keep warm seriously when we are ordered into the cold for the sake of using a (legal) tab?

No doubt Cameron's cronies in Downing Street aim to teach us our civic duty of caring for our elderly neighbours re the new social relationships of the Big Society. But do they appreciate how much harder the task is, now that the nation's social institutions have been snatched and remodelled so as to leave so many out in the cold?

Sunday, 20 February 2011

Scottish Government guidelines for smoke-free mental health services

Here at last are the guidelines directed to health trusts, designed to show them how to implement a completely non-smoking regime in institutions and facilities dedicated to psychiatric care.

A recent post on this blog shows that, far from being demanded by respondents to the 2009 Scottish Government consultation on smoke-free services, both the guidelines themselves and the achievement of a smoke-free mental health service have been opposed by most of the patients' groups that responded.

Andy Kerr, Scottish Minister for Health at the time the smoking ban legislation was passed in 2005, said the following in committee:
The approach was largely humanitarian and involved common sense, in my view. Residential homes are where people live and have their home. We felt that, as long as there was a smoking policy in such places, people would have the right to smoke where it was deemed to be their home, just as others in the community have that right. That applies to adult care homes, but not to children's homes.
Adult hospices are on the list of exempt premises for obvious humanitarian reasons. Psychiatric hospitals and units are included on the list because clinicians and others told us that that would be appropriate, if individuals' overall mental health and well-being were to be looked after. There were obvious humanitarian and other reasons for that exemption [...]
As we have asked before, what has changed?

Has anything actually changed? The small print, as far back as December 2005 (pp. 13–14 in a document signed by the same Health Minister, Andy Kerr), said:
However, the Scottish Executive recognises that the physical health profile of those with mental illness in Scotland is poor and smoking rates are traditionally high. It is committed to reducing the health inequalities experienced by this group of patients and will work with service providers to implement a programme of targeted cessation, which may allow the exemption for designated rooms to be reviewed in due course.
Ever since announcing the exemptions, the Scottish Government has been working to get rid of them:

It is clear from this that the Scottish Government's wish is for mental health services to go smoke-free. We now know that the consultation responses did not show public support for comprehensively smoke-free mental health services. Not that a rejection rate of around four-fifths of patient group participants is anything for the government to worry about.

And here is the resulting government press release:
"This is a further step towards our vision of a smoke-free Scotland. Patients and staff in mental health services should have the same opportunities to enjoy the benefits of a smoke-free environment as the rest of the NHS in Scotland.
"Allowing smoking in residential mental health services, when it is completely banned in all other NHS settings, simply perpetuates inequalities.
"Removing smoking rooms in mental health settings will undoubtedly be challenging but there is evidence that smoke-free policies can be effectively introduced and this guidance will help health boards to achieve that.
We're still waiting for a comment from Andy Kerr (and have been since December 2010).

Another Triblogology

1. Time to catch up with tripartite The Loneliness Triblogology from the Freedom-2-Choose (non-Scottish) blog through the medium of Frank Davis's essay by the same name (which links to all three parts). He links the smoking ban very convincingly with social disintegration, which may not be evident in busy city bars or to people whose social environment has never involved pubs or smoking. However social disintegration is necessarily a result of legislation that deliberately sets out to marginalise a culture, where social interaction is circumscribed by official standards of what is 'acceptable'. People who smoke will now be accused of 'excluding themselves' if they find themselves out on a limb.

2. Also see Leg-Iron's piece on adaptation 'The Ultimate Reality Game', (and as a quick aside, 'A Small Victory for Commonsense' from Subrosa whose conclusion is unarguable).

3. Finally Gildas the Monk writes on 'Scandal of the Care of the Elderly' (and also see 'The NHS: A True Story' from Simon Clark).

After reading all this, come back and argue that any money spent on anti-smoking groups and projects is well spent.

Friday, 18 February 2011

Cincinnati votes against smoking ban

Family responsibilities have taken me away for a few days. To get back in the water slowly here is a story from Cincinnati, where a vote has overturned the smoking ban on what seem to be libertarian grounds, combined with a heap of scepticism about tobacco control propaganda.

I like this:
the majority in the room – some of them offering a standing ovation – won the battle. Many said they didn’t believe studies that showed the harms of secondhand smoke, noting some of them are sponsored by foundations that oppose smoking.
Some criticized doctors and the medical community for taking a position on the issue. Ban critic Charlie Coleman, a county resident for more than 60 years, drew raucous applause when he compared anti-smoking efforts to tactics used by dictators such as Hitler.
Good to see that 'vested interests' are acknowledged to exist in tobacco control. As for the comparisons with Hitler, I'm not up on the historical detail. But it is clear that a persecution mentality exists within tobacco control, as is evident from Michael Seigel's post on US medical establishments refusing employment to anyone with nicotine traces in their system: whether from cigarettes, secondary smoke or even from nicotine patches or e-cigarettes from people who are attempting to quit smoking. Such bans on employing (passive or ex-) smokers are even too much for the New York Times

We are told that “At least 88 people … could die, or will die, in 2011” from secondary smoke exposure as a direct result of the vote against the ban. The population of Cincinnati is over 333,000. Any speculation identifying the cause of any death as secondary smoke exposure has to be very tenuous. Why don't they campaign against the war in Afghanistan instead?

Monday, 7 February 2011

American public health charity calls for moderation in tobacco education

Although the USA largely subscribes to the idea that passive smoking kills, the American Council on Science and Health (like Michael Siegel) criticises more extreme claims made by other public health bodies. It takes the following example (which also typifies the kind of claim often criticised by Michael Siegel), claiming that it risks rendering all tobacco education too incredible to be taken seriously.
The report states, “[T]here is no safe level of exposure to tobacco smoke and that smoke causes damage immediately to the cardiovascular system. Even low levels of tobacco exposure lead to disease and death, including heart attack, stroke, weakened immune system, and asthma attacks.” 
 “Has the Lung Association damaged its credibility in making such a dramatic, unqualified assertion?” asks Dr Elizabeth Whelan of ACSH, not for the first time. This body does not shrink from criticising the Surgeon General's report, which includes similar claims about secondary smoke, and calls for a zero tolerance policy towards tobacco smoke:
Upon reading this statement, ACSH’s Dr. Gilbert Ross is left wondering whether basic toxicology and cancer-causation principles were considered in the drafting of the Surgeon General report. “Whether indirect exposure to tobacco smoke leads to disease is a matter of dose — the amount of smoke it takes to trigger adverse health outcomes such as heart disease or cancer — but the question of dose-response and exposure levels never made it into the report.” 
ACSH stops short of recommending spending much time exposed to tobacco smoke, but their suggestion to observe dose:reponse principles could be well observed by other bodies, especially in the United States, where they take the concept of third hand smoke seriously. University of Berkeley, California, scientists have pretty much dispensed with any such principles in their study of third hand smoke, as tobacco researcher and author Chris Snowdon writes here.

Noting that ASH Scotland has managed to set up an anti-smoking conference offering Learning Outcomes in (for want of a better expression) anti-smoking propaganda, I wonder how long before Scottish National Certificate qualifications are issued in Junk Science for being able to describe the damage to children from third hand smoke? What an outcome that would be for a small country with a proud educational record.

Or perhaps we will start to take science seriously again instead!

Sunday, 6 February 2011

How attending free anti-smoking conference will get you points

Source, Learning outcomes link at this page.

Learning Outcomes for Smokefree Homes and Cars
With NHS Knowledge and Skills Framework below

Participants will:
1. develop their knowledge base around the harm caused by second-hand tobacco smoke inhalation
2. understand the part that smokefree homes initiatives play in Scotland’s tobacco control strategy
3. appreciate the progress made to date in changing public attitudes towards smoking in the presence of children
4. be able to describe several initiatives underway outside their own health board area to address second-hand  smoking in homes and cars
5. be able to describe some of the most recent findings regarding the harm caused by second-hand smoke exposure
6. be able to articulate the benefits of working in a multi-agency partnership to address passive smoke exposure in the home
7. recognise the challenges associated with addressing resistance to implementing smokefree homes, both within organisations which could provide support and within the community
8. feel more confident in advocating within their organisation or community for support for smokefree homes initiatives
9. be aware of training available to address smoking in the home
10. Additionally, those participants who undertake brief advice training on the day of the event will: feel more confident about giving brief advice to those considering making their home smokefree.

Knowledge Skills Framework (KSF) outlines:  Learning Outcomes for Smokefree Homes and Cars Conference
Learning outcomes 1 – 9 have the potential to provide evidence for application of the following KSF
Core C1 Communication                         Level 2
Core C2 Personal & People Development Level 2
Core C3 Health, Safety & Security
Core C4 Service Improvement                 Level 2
Core C5 Quality
Core C6 Equality & Diversity
Health & Wellbeing 1                                 Level 2

Learning Outcome 10 adds in the following HWB3 level 2 
Health & Wellbeing 3                                 Level 2
For the competencies for public health practice:
Area 1: Professional and ethical practice 
4: Continually develop and improve own and others’ practice in public health
Area 2: Technical competencies in public health practice
8. Identify risks to health, wellbeing and safety, providing advice on how to prevent, ameliorate or control them – demonstrating:
  • knowledge of the risks to health, wellbeing and safety relevant to own area of work and of the varying scale of risk
  • knowledge of the different approaches to preventing risks and how to communicate risk to different audiences.
Area 3: Application of technical competencies to public health work
9. Work collaboratively to plan and/or deliver programmes to improve health and wellbeing outcomes for populations/communities/groups/families/individuals

This work was funded £500,000 by the Big Lottery: a grant over half the value of ASH Scotland's core government grant last year. The project is called Refresh. NHS Scotland funding has ensured that attendance at the conference can be free

Fifteen years ago I worked in a key government department on drug misuse based in St Andrews Square. I was employed for a single year as casual Administrative Assistant. There were two Administrative Officers, an Executive Officer and two Administrative Assistants with a typing pool of three shared with other divisions, and the division heads totalling no more than nine or ten. ASH Scotland has approaching 30 staff on its payroll (another Word document sets them out from 'about us' (ASH Scotland organisation chart). I have no idea of the size of the drug misuse division now but it is extraordinary to find a government-funded charity fighting tobacco use with over three times as many staff as a government division on drug misuse.

New York Times urges caution on prohibition and Whoopi says no

Changes to the law that will put parks, beaches and plazas off limits for smokers have brought a welcome editorial from the New York Times, which concludes:
Meanwhile, there is talk that the mayor and the City Council want even more, like banning smoking near doors of office buildings and apartments. They need to take a deep breath and remember that we tried prohibition 90 years ago. They called it a noble experiment. It turned into a civic disaster.
 Note the use of the word 'smokers':
Already smokers are forced to huddle outside, these days perched on the city’s gray, leftover snowdrifts. Starting in early summer, after the mayor signs the bill into law, they will not be able to stray onto the 14 miles of city beaches or into the city’s 1,700 parks, not even Central Park or windswept Battery Park. Instead of smoking on Brighton Beach, what does a smoker do — take a boat out 12 nautical miles into international waters?
No pretence about 'this is not about smokers, just about smoking'. The real-life implication is that blanket no-smoking policies marginalise smokers.

The paper welcomes the early stages of anti-smoking activities, but finds the outdoor ban has gone too far. But the anti-tobacco lobby has a puritanical streak. The words 'there is no safe level of secondary smoke' should have warned us.

Whoopi Goldberg is another notable critic of the New York plan.

Saturday, 5 February 2011

Learning Outcomes to be awarded at anti-smoking conference

The Scottish Tobacco Control Alliance (ASH Scotland) announces a conference on smokefree homes and cars, to be held in March in Dundee.

Two things stand out: one is that the problem of secondary smoke in the home seems to be the preserve of people from 'poorer backgrounds'. Does this mean that the list of alleged ill effects are also related with being poor?
More than half of babies and young children from poorer backgrounds are regularly exposed to SHS in the home, compared with less than a fifth of UK children from families with a professional background.  Exposure to SHS in childhood is associated with reduced lung function, middle ear disease, an increased risk of respiratory symptoms and a higher incidence of respiratory tract infections.  SHS exposure has also been shown to be a cause of cot death.
The second is that this event seems to have been set up to 'qualify' relevant personnel in talking people out of smoking at home, by the award of Learning Outcomes in the National Health Service 'Knowledge and Skills Framework'.  The link 'Learning Outcomes' on the page linked above sets out the details in a Word document.

This conference (thanks to NHS Scotland funding) is free of charge. Magnificent: Scottish national certificates in attempting to convert stubborn smokers in deprived areas ... whatever will they think of next?

Royal Edinburgh Hospital now a no-go area for smokers

In fulfilment of the ambitions of smoking ban advocates everywhere, the Royal Edinburgh Hospital (Edinburgh's psychiatric hospital) banned smoking everywhere on the site at the beginning of 2011, with the exception of two smoking shelters. This involved closing the smoking rooms that marked psychiatric hospitals as exempt premises when the smoking ban was introduced.

The outrage expressed in the article can be understood against the Scottish Government's determination to challenge the exempt status of psychiatric units in respect of the ban, in spite of all the consultation results (read here, and here). Eighty-one per cent of patient groups voted against the ban, and only one-third of respondents voted in favour of the exemption accorded to psychiatric units being removed. This must be weighed against the conviction of health board directors that smoking doesn't relieve stress for patients in psychiatric hospitals.

Apart from the danger of people lighting up covertly, and the inconvenience to staff of having such limited smoking facilities on the hospital premises, there is also the issue (reflected in this report) of a blanket smoking ban resulting in more involuntary admissions and/or people avoiding psychiatric treatment.

Freedom to Choose (Scotland)'s effort to challenge the Scottish Government on this issue was brushed firmly under the carpet. Throughout, the government's intention has been to avoid parliamentary scrutiny of the results of its consultation on smoke-free mental health services and its findings.

Thursday, 3 February 2011

Pennine Acute Trust seeks change in law to support non-smoking policy

Yesterday I reported how NHS Grampian has moved from resolving to ban smoking everywhere on its sites and impose sanctions on staff carrying tobacco (their plans from the summer) to settling for encouraging people not to smoke, rather than banning them.

The solution found by the Pennine Acute Trust is less imaginative. It calls for a change in the law (as planned by Wales), so that smoking in hospital grounds becomes a crime.
The trust is now urging local MPs and councillors to support a campaign for a change in the law to make all hospitals and grounds fully no-smoking areas. 
In the midst of staffing crises, the trust is actually lobbying for a law to dictate how to treat smokers on its own premises. It has already dispensed with plans for shelters.
Chief executive John Saxby said it was incredibly difficult to enforce no smoking on hospital grounds.
He said: "We certainly do not wish to place our staff at risk of potential abuse or injury when tackling the very emotive issue of people smoking at hospital entrances or in hospital grounds."
Splendid pass-buckery. Bans are fantastic as long as 'our staff' don't have to enforce them.

Such a ban would mean that anyone attending Pennine Acute Trust property, whether in the capacity of patient, visitor, staff, contractor of any kind, will be breaking the law by smoking on the premises, even outdoors – all for the sake proving how hot the Trust is on health issues. This Trust has no scruples about making patients 'take their drip and stand at the bus station'.

Breaking the law for smoking outdoors – regardless of circumstances concerning personal mobility, state of mind or anything else: was that in anyone's manifesto last May? Leaving Pennine Acute Trust powerless to exercise discretion or compassion under any circumstances?

Pennine Acute Trust should be careful what it wishes for. So should anyone lobbying in support of its aims.

Wednesday, 2 February 2011

NHS Grampian: full retreat from hospital smoking ban

An unexpected pleasure to read NHS Grampian's new view of the smoking restrictions proposed last summer. Not to put too fine a point on it, the smoking ban 'would cause huge problems', according to medical director Dr Roelf Dijkhuisen. In a revolutionary statement that health boards up and down the country should note, Dr Dijkhuisen said, 'patients addicted to smoking could not be expected to “take their drip and go and stand at the bus station” to have a cigarette'.

Quite obviously this is an absurd requirement in an institution designed to improve people's health.

Nor does Dr Dijkhuisen approve of the solution reported in the Press and Journal just days ago.
"I’m not a fan of shelters. They are ugly bus stops and extremely expensive. Maybe we will designate an area where we will have to do no building work. Rather than spending £150,000, we should look at alternative ways of providing designated areas without forcing people to stand in the rain."
It remains to be seen what the Trust will propose as a solution, but it would seem that Dr Dijkhuisen's recommendations are intended to be a permanent solution, rather than a sticking-plaster job pending a total ban in a few years' time.  He is not the only board member who doesn't see the need for a complete ban in the foreseeable future:
Yesterday members welcomed the medical director’s recommendations – which included improving employees’ knowledge of the locations of smoking areas and clearer signs – but chief executive Richard Carey said it was important to remember this was not ideal and that a ban should still be a target.
Chairman Dr David Cameron disagreed, saying while the “aspiration” was for premises to be smoke-free, the board’s role was to “encourage people not to smoke rather than ban them”.
Does this sensible qualification from Dr Cameron mean that we have started to retreat from the ideal of a smoke-free Scotland? Surely no Scottish government would now legislate to make smoking on NHS premises a crime, as they seem to want to do in Wales? Some of ASH Scotland's ambitions as laid out in their recent (Cancer Research UK-funded) report Beyond Smoke-free also seem unrealisable.
We must ensure that all Scottish health and education services have smoke-free grounds.
A permanent solution, accommodating smokers in comfortable indoor accommodation that will entice them away from the doorways, will only be possible when the law is changed.

Biting the hand that feeds them?

Partick Thistle urges its supporters to 'quit smoking' by promoting Smokeline.

We find the usual assurances from smoking cessation experts:
Fiona Dunlop, Health Improvement Lead for Tobacco with NHS Greater Glasgow and Clyde, said: “Even if you’ve tried to stop smoking in the past, there are many ways to help you quit in a way to suit every lifestyle. So whether you’ve tried quitting before, or are giving it a go for the first time, Smokeline and Stop Smoking Services in Glasgow and Clyde are here to help.  The Stop Smoking services are very easy to access and sessions are informal and supportive.  Advisors will discuss using products such as Nicotine Replacement Therapy (patches or gum), Champix or Zyban and help you get the product of your choice. In this way your quit attempt can start as soon as you are motivated.” 
We don't find this: "Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date." Is Partick Thistle being used as a front for pushing drugs that fail to work far more often than not? No therapy that doesn't involve smoking cessation drugs finds space here.

Partick Thistle is less likely to take up this issue with its sponsors Ignis, whose corporate bond managers' report reveals that Imperial Tobacco is included in its top ten holdings. However, the current sponsorship arrangement is due to expire this year, so perhaps Partick Thistle will take this opportunity to rid itself of such an unhealthy investment.

Imperial Tobacco, like other tobacco companies, cannot directly invest in sports or any other endeavour, but investment via bonds is less easy to ban (and perhaps such investment is still feeding MSPs' and other official pension funds).

Tuesday, 1 February 2011

We're all waiting for you ...

The Framework Convention on Tobacco Control indulges in public tut-tutting in respect of countries that have failed to file their phase 2 reports on implementing the Convention to its Secretariat.

If you want to read how the naughty boys and girls are following their obligations under the Framework Convention, follow the link Monitoring Performance on the Global Treaty.

An unexpected finding in the report, which is causing particular concern among tobacco control advocates, is that of the 49 Parties targeted for the report – representing the first countries to ratify the FCTC – only seven submitted their official implementation reports to the Treaty Secretariat on time (deadlines ranged from February 27 to March 31, 2010). By the time Tobacco Watch went to print at the end of September, 20 Parties had still failed to turn in reports. 
Imagine any country having any priority higher than tobacco control. Unthinkable. And this year they actually name and shame some of the wayward countries that have failed to submit reports:
Sri Lanka
San Marino
Solomon Islands
Democratic People’s Republic of Korea
The links will take you to random health reports from respective countries. Only the report for Spain contained any reference to tobacco: many of these mentioned inadequate access to basic healthcare (because of transport infrastructures) and access to clean water as health issues. Some have life expectancies 20 or 30 years less than ours. As for this story:
Madagascar had a serious malaria epidemic in 1990 causing the death of tens of thousands; efforts are underway for annual antimalarial campaigns, especially in the Hauts Plateaux. [emphasis added]
it's hard to imagine an international health agency insisting that tobacco control is an urgent issue in any country with this kind of tragedy in its recent history. Can you imagine it happening in the developed world? But there you have it: the first international multilateral treaty devised by the World Health Organisation concerned tobacco control. This piece (even though produced by extreme evangelists!) also refers to the Madagascar malaria disaster: it also mentions overcrowding, natural disasters and political instability as further regular health threats.

Another piece here discusses the irrelevance of the World Health Organisation's priorities, with particular reference to malaria.

Further news stories from the Framework Convention on Tobacco Control (probably mostly about new kids on the block that haven't understood the FCTC's message yet) are available here.

It does seem clear that an emphasis on tobacco control is well off the mark.

NHS Grampian smoking ban hits rocks

It's a great pleasure to share this story, not least because Freedom to Choose (Scotland) helped to publicise the issues back in the summer. You can review older blog reports on this story here. It seems to have been clear to everyone involved that a complete ban would have been ineffective and resented (see this story, for example).
A hospital spokesman said: “We are still proceeding with the aims and objectives of our existing tobacco policy. The aim is to ensure that all NHS Grampian premises become smoke-free within a very few years but, in moving towards this objective, a limited number of designated smoking areas will be permitted as an interim measure.
“NHS Grampian also remains committed to promoting healthy living and non-smoking as its normal culture. It will do this by establishing a smoke-free environment for all who wish it, while being sensitive to the needs of those who smoke, and offering support to those who wish to give up.”
I wonder how long this interim will be and what the bill for dismantling the smoking shelters will amount to? To an extent I can sympathise with Margaret Watt, of the [non-smoking] Patients' Association at the sheer lunacy of putting up smoking shelters to the tune of £150,000, only to tear them down again (one presumes) when the madness returns 'within a very few years': when they decide again that 'being sensitive to the needs of those who smoke' is against Trust policy.

It may be facile to say it, but none of this expenditure would have been proposed if the smoking ban had not created a huge problem (not to speak of extra costs: read about a PFI contractor charging an extra £2,600 a year for cleaning after removing smoking shelters from a hospital site). I would be interested to know whether a £150,000 shelter will be sufficiently attractive to lure people from doorways. If it's not made attractive enough I would sack the Trustees for wasting money.

The better way would be not to have made the whole hospital a no-smoking zone in the first place. A smoking room here and there, comfortable and inviting (non-smoking lounges also of course) would resolve the problem permanently and much more cheaply. Air can be cleaned.