British American Tobacco admits funding newsagents' campaign against display ban

It has emerged at the AGM of British American Tobacco that this tobacco company provided funding and input to the campaign of newsagents to resist the tobacco display ban.

An earlier story by the same Guardian writer quotes Parminder Singh, President of the National Federation of Retail Newsagents:

There is no way that the NFRN could afford the resources and expertise to mount such a high profile campaign to fight on its members' behalf to oppose the tobacco ban without some help towards funding. We are grateful, therefore, to have some help from the tobacco manufacturers to do this.

At stake is the tobacco display ban, legislation enacted already in the Republic of Ireland (a tobacco smuggling hotspot) and voted into law in both Westminster and Holyrood, but not yet implemented. To say the law is controversial understates the case. There is no conclusive evidence that putting tobacco out of sight will make the prospect of smoking any less attractive to young people.

The retail trades, including newsagents and convenience stores, have to put their case against the combined wisdom of the Department of Health and all the health charities, with added lobbying from pharmaceutical interests. The government will not give tobacco interests a hearing. This seems a marriage made in heaven: the  newsagents have access to government but no money, the tobacco interests have pots of money but no access.

I have no idea, nor do I really care, how much of the campaign was paid for by British American Tobacco. The reason Health Secretary Lansley will not speak with tobacco interests is that the WHO Framework Convention on Tobacco Control forbids it. Then the health lobby loses itself in moral indignation when the tobacco industry behaves like businesses all over the world, and uses its funds (which it is forbidden by law to use for its own advertising or to sponsor kids to play football) to help business partners.  As far as I'm concerned placing obstacles in the way of tobacco interests attempting to buy influence simply diverts their direction of travel. Tobacco interests have every right to a voice in decisions affecting their product, especially considering the level of taxes levied on their products. Stifling the voice of the tobacco industry and taking the huff when it refuses to lie down and die is just being childish. Here's illustrating:

"For any major company to seek to covertly lobby MPs through the back door is disgraceful, but particularly when it comes to tobacco. The Government has legal obligations to protect public health policy from the vested interests of the tobacco industry and it can only do this if the tobacco industry is transparent about its lobbying activities", said Deborah Arnott, the chief executive of Action on Smoking and Health (ASH).

Since the WHO forbids tobacco companies from lobbying openly, the inference is clearly that they're not allowed any voice.

"Lobbying by the NFRN was effective in significantly delaying the implementation of the legislation in small shops and it has already admitted that it received support from tobacco manufacturers for this campaign. The question is which tobacco manufacturers. If BAT was involved it needs to come clean."

The inference here is that NFRN's delaying tactics were successful only with tobacco industry funding. Does that mean the newsagents should have been silenced by lack of funding? The alliance with tobacco was enough to discredit the NFRN's campaign completely?

Behind the scenes are the extraordinary demands of the Framework Convention on Tobacco Control, not least its dictates about who may influence public policy: as if this needs to be decided by a non-elected global body.

Interestingly, outside the doors of the British American Tobacco AGM, was gathered a group of young people demonstrating against child labour in the tobacco plantations. They were photographed with Deborah Arnott, CEO of Action on Smoking and Health and Kevin Barron, the Labour MP who questioned BAT. I hope, but don't expect, that Deborah Arnott and Kevin Barron will be sure to remind these young people that exploitation of children isn't limited to tobacco companies.

World Health Organisation honours Greek PM for unenforceable smoking ban

This is a popular story today. Greek PM Papandreou has picked up the World No Tobacco Day prize for his determination to implement a smoking ban.

The report linked above describes the smoking ban as 'politically unpopular'. The Associated Press report refers to Greece as 'a country where the new smoking ban is largely ignored'.

Mr Papandreou is accredited with 'political courage' for his insistence that the smoking ban will be a comprehensive law in spite of other austerity measures the government is taking, and in spite of opposition from Greek people. I am not sure that 'political courage' are words that describe the actions of a leader who follows a global health agenda at the expense of his people's livelihoods and against their wishes.

Tobacco harm reduction: NICE makes a silk purse of a sow's ear

The National Institute for Clinical Excellence has reinvented tobacco harm reduction.

It's a poorly guarded secret that smoking cessation treatments don't work. The tobacco control professionals know this very well. Their strategy is therefore changing.

NICE has a section dedicated to harm reduction in tobacco. It even has its own email address, and a list of registered stakeholders. In seeking to promote harm reduction, they have published a draft  consultation paper, aimed at professionals in smoking cessation and public health managers, with a view to publishing guidance about harm reduction.

The consultation begins with a preamble making emphasising: 1) the health toll from smoking; 2) health inequalities reflected in smoking rates; 3) the dangers and recorded damage caused by passive smoking in the home; 4) people's wish to quit and low rates of success. (They still insist that NHS help is more effective than cold turkey.) It also explains the methods that it includes and those it specifically excludes (including hypnotherapy and all other alternative therapies).

Excluding therapies with a known track record from an approach that calls itself harm reduction seems odd, but not unexpected in the field of smoking cessation.  In fact the consultation paper includes e-cigarettes in its methods. But the overall point seems to be that although smoking cessation meds don't work they still have their place for people who want to cut down smoking, whether for their own health or other people's. Is this the answer to Tim Coleman's prayer – a passport to keep people on smoking cessation meds for longer periods, especially people on low incomes?

Were it not for the fact that they are playing another guilt trip on smokers for damaging their loved ones and putting themselves at risk, this could almost be taken for benevolence. It appears that the pharmaceutical apron strings are still pulling tight.

The authors of the questionnaire seem a little confused about the ethics of promoting smoking harm reduction rather than complete withdrawal:

Question 8: Are there any unintended consequences from adopting a harm-reduction approach, for example, does it deter people from trying to stop smoking?

Question 9: How can practitioners deliver the complex messages about harm reduction without weakening advice about the benefits of stopping smoking?

But they do ask:

Question 10: Does long-term use of pharmacotherapies or ‘nicotine-containing products’ to reduce smoking have any ill-effects on health?

... surely another opportunity to complain about Champix at the highest level!

Organisations can become stakeholders by registering (details here). The list of stakeholders is dominated by 'public health interests', but both the Vapers' Network and Tobaccoharmreduction.org have also joined up. Organisations that represent patients are eligible to register: that means any smokers or users of any kinds of tobacco, since they seem so keen to treat smokers as patients. (It doesn't appear to cover Scotland, however.)

Australian plan for plain packaging upsets olive farmers

Calling a colour 'ugly' will always upset someone. The Australian Olive Association doesn't like the term 'ugly olive green', used to describe the background colour on the plain packaging designed for Australian cigarettes, and wants the Federal Health Minister to find a new colour.

It seems the Olive Association doesn't want olives to be associated with cigarettes.

Start Champix earlier in quit attempt and it might work, says Pfizer study!

Pfizer's new study claiming that starting earlier on Champix would improve its effectiveness couldn't come at a better time. This drug has maimed countless lives, and is the subject of a black box warning. Peter Hajek of the UK Centre for Tobacco Control Studies (no competing interests of course) and colleagues 'compare the effect to making food look unappealing. "The level of hunger pangs may be the same, but it is easier to resist a food that has become less tempting," they note.'

This is a poor comparison. Messing with someone's brain doesn't resemble disfiguring somebody's dinner. 

The people at the UK Centre for Tobacco Control Studies know how ineffective many quit attempts are.  Another member, Tim Coleman expressed this view in November:

Currently stop smoking services are evaluated on the percentage of 4-week quitters, but around three-quarters relapse after this date. 

His solution was to attempt to get funding for people to take smoking cessation drugs (NRT) in the longer term as a kind of damage limitation exercise. A similar assessment comes from the Tobacco Control blog, discussing Turkey's new anti-smoking facilities:

It’s worth remembering that, if the Turkish experience mirrors international evidence, every hotline call represents several other smokers who have decided to quit on their own. Even in countries with excellent, and often free, quit resources, more than 80% of smokers quit cold turkey (pun intended!) on their own.

An editorial discussing this study comments: 

One in five Americans smokes [...] and only between 4 and 7 percent of those who try to stop succeed. 

 These people know what a poor success rate smoking cessation drugs have. Yet huge amounts of money are spent promoting them, even on solutions like Champix which occasionally spell disaster for those taking it and their families.  

ASH Scotland is on a crusade to persuade the managers of Scottish mental health facilities to remove smoking rooms. Their next event will 'explore the new implementation guidelines' published by the Scottish government. No doubt they will be urged to ensure that smoking cessation meds are always available to patients who are forced into a no-smoking regime at a catastrophic time in their lives. Stopping people from smoking trumps every other consideration.

Scottish Champix widow sues Pfizer

Champix was approved for use by the Scottish Medicines Consortium in January 2007. By 2008 BBC Scotland was reporting alleged bizarre, threatening and suicidal behaviour on the part of people who took the drug, and lawsuits were beginning in the US.

Brian McLinden died just over a year ago and it's been reported that his wife Patricia will also sue Pfizer.

It's odd that stories of sudden and traumatic death, and distressing behaviour, are considered to be a price worth paying for a lower smoking rate.

It didn't take public pressure to get rid of smoking in bars. It took a government-funded pressure group. But years of documented agony (and a non-too-impressive success rate) requires hundreds of people to take legal action before this drug is properly investigated and taken off the prescription lists. People stopped smoking before this drug came on the market and they will continue to give up after it's been dumped.

Regular reviews on Tobacco Harm Reduction

Tobacco harm reduction is a controversial area. I can't comment on the science but I can give an outline. The premise of tobacco harm reduction is that smoke, rather than nicotine, is what makes smoking dangerous. Consequently smokers who want to give up can use smokeless tobacco or e-cigarettes more safely than smoking tobacco.

The emerging tobacco harm reduction market has benefited from scares about the dangers of smoking to by-standers. Urging people to give up smoking has always been easier if you can persuade them that smoke is killing their loved ones. In fact ASH Scotland uses the term 'harm reduction' here (a section from Sheila Duffy's epic 'Beyond Smoke Free' document), to mean that using nicotine replacement therapy beats smoking in front of your children. She seems to feel that smokers should be content with a 'sticking plaster', rather than a satisfying experience.

Users of e-cigarettes and other smokeless tobacco have found themselves faced with the threat of prohibition far more quickly than smokers. The market for e-cigarettes has clearly competed for the same customers that might otherwise have bought nicotine patches and gum from global pharmaceutical companies. Pharmaceutical companies want to develop drugs based on natural substances like tobacco, and the entire anti-smoking establishment has sought to make e-cigarettes unavailable to consumers, in the hope that it will create a captive market for pharmaceutical cessation products (see forum discussion here).

Users of e-cigarettes know that banning their product is not to do with health (even though spurious claims are made about uncertain health risks). They can see cigarettes still on the market, while the product they resorted to in order to stop smoking has been banned – leaving them with the options of stopping smoking without any help or buying the products of pharmaceutical interests.

Smokers have lived with their chosen product being taxed to the heavens: e-cig users live with the threat of their product of choice being made unavailable (for much the same reasons as the rest of us will no longer be able to buy calendula lotion or other common herbal products after 1 May). For most people an e-cigarette ban remains a threat rather than actuality (New York State being closest to an outright ban in the US, and full bans operating in Brazil, Singapore and in Canada except where the e-cigarette is free of nicotine – see here for details).

This guide to essential reading on tobacco harm reduction offers further links and insights. Stories include a possible workplace ban on e-cigarettes in Georgia (together with suggestions for local action) and the opposition of students at the University of Massachusetts to a smoking ban that included e-cigarettes and smokeless tobacco in its reach. There's much more where this came from, and the list will be regularly updated.

Greenock Telegraph's sketchy reporting of smoking ban problem

On learning from an outraged employee that Inverclyde Royal Hospital regularly sees smokers in its grounds, Greenock Telegraph reporters went 'straight to the health board chiefs'. There they learned more of what hospital trusts have been discovering up and down the country – that bans are not enforceable. Staff can be forced by contractual obligations to comply with rules (although how many of them will have been issued with new contracts outlining a complete ban on smoking on the premises – perhaps the threat of disciplinary action has been enough). But visitors and patients cannot be policed in the same way.

End of investigation. The story is that people are breaking the rules, and this version doesn't so much as attempt to understand these people's point of view. It's an old story, and has been a running sore on hospital premises for years now.

The absurd situation of people hanging about smoking in hospital doorways, obstructing entrances and upsetting people who have been frightened by passive smoking myths, has persisted for too long. The public has demonstrated its contempt for outdoor bans in hospitals everywhere. Health boards should insist on allowing the creation of proper, weather-proof shelters for people who need to smoke during their visit to hospital, whether as patients or visitors.  They should complain for a change in the law. Staff should not be prevented from smoking in their break times either.

And the Greenock Telegraph should also get its act together. Since people have not stopped smoking in hospital grounds since the ruling came in, it shouldn't be difficult to find one offender who is prepared to give his or her view of the issue. No smokers were interviewed. No staff who have been successfully restricted from smoking were interviewed (have they been banned from speaking to the press?)

Nul points.

Stop the Traditional Herbal Medicinal Products Directive

This is the second time within a week that I've presented a petition on the Traditional Herbal Medicinal Products Directive that will come into force on 1 May. This directive will make it illegal to sell any herbal medicine without registering it. The official version assures the strongest players on the market:

competitive advantages exist for manufacturers with established high-quality products: in the registration process itself and also in obtaining a substantial market share.

Very few herbal remedies have been approved so far. A list of remedies approved up till 22 April can be found here. 

This directive is not about protecting us. It allows the government to prosecute people for the possession of simple remedies that can be exploited for gain by pharmaceutical companies that can afford the registration, approved R&D procedures and produce drugs that are more expensive and less effective than the herbs on which they are based. As Heidi Stevenson points out here, using marijuana to illustrate, the only way to sell pharmaceutical derivatives is to criminalise citizens for using marijuana itself. This model will be replicated other herbs, with THMPD easing the way.

This directive is about concentrating access to remedies of choice in the hands of those already financially powerful enough to push others out of the market. It's about denying people the benefits of natural remedies at source and offering expensive and adulterated versions of these remedies developed for a commercial market.

Please sign, and encourage your friends to sign and circulate this petition.This is an audacious assault on the freedom of everyone in Europe to use natural remedies: it has nothing to do with the protection of health and everything to do with protecting global pharmaceutical interests. 

Glass half empty?

Half of all states permit smoking in worksites, restaurants and bars – the Center for Disease Control reckons this situation will end by 2020, leaving no public smoking at all in the 'land of the free'.

Let's see, shall we?

Anti-ban protest reported in Palma

Hotel, bar and gaming industries forget their differences and protest the smoking ban in Palma, demanding modifications to the comprehensive smoking ban which they claim has cost some establishments up to 40 per cent of their takings and caused lay-offs and closures.

Has anyone been telling them that smoking bans don't cause a 40 per cent drop in trade – those that have witnessed it happening to them over the course of a few weeks – or that supermarket prices are to blame?

Bans are reversible if the will is there: don't let anyone tell you otherwise.

More on ASH Scotland's alliances

As if the Scottish Coalition on Tobacco were not enough, ASH Scotland also coordinates the Scottish Tobacco Control Alliance.

They also support what they call local alliances. The thoroughness of their briefings must be considered in light of their 27 staff (just take a look at their media briefing for the Lothians).

The resources put into attempting to reorder everybody's priorities so as to blame smoking for all ills, deaths and inequalities (who wants to live forever?) are significant. However, page 3 of SCTA's 2010 annual report shows that of the 119 or so member organisations involved with it, the largest groups are involved with NHS smoking cessation and NHS health promotion. It's a career move, rather than a popular cause.

SCTA holds events, has members and topics groups, produces a bulletin and annual report (all accessible from here), and has gained a grant from Cancer Research UK towards the formulation of what has become Scotland's tobacco control strategy. Their output includes a discussion of the new mental health guidelines, Smoke-free mental health services in Scotland – Implementation guidance at a meeting for mental health professionals in Glasgow in June (you get Learning Outcomes for attending too – all free of charge). Never mind that the then Scottish Government specifically exempted mental health services from the smoking ban when it was passed in 2005, and no reason has been offered for any change from this position, nor has any such change been endorsed by the public.

Sheila Duffy's latest (comments-free) blog post urges all parties to support a new tobacco control strategy (while announcing that most of the parties have promised this already). She had a column in today's Scotsman (20 April) that appeared as 'Platform' beside the editorials, claiming that tobacco control still had to eradicate the differences in mortality rates between Scotland's rich and Scotland's poor, and that continued support for Scotland's tobacco control was essential.

Impressive although all this networking is on one level, it's hard to see how it helps resolves any of the difficulties that face most Scots these days. Sheila Duffy's conclusion to her opinion piece in the Scotsman today concludes:

The challenge for our politicians is to reduce the health inequalities gap caused by smoking ...

An interesting economic analysis, that such inequalities are caused by smoking. Duffy is right to point out that higher mortality exists in more deprived areas. But this is not simply because people smoke: even if smoking is a factor, so is chronic unemployment, homelessness, anxiety and all the other consequences of being at the bottom of the economic heap. It's as if the powers that be are saying to the deprived: societal problems are too complicated to work out. But your problems will be marginally less severe if you don't smoke. So don't do it. You know it makes sense.

It's a top-down analysis. It's taken committed smokers out of 'polite society' too: they can no longer relax with peers and be seen to enjoy themselves in public places. It's made it harder for many smokers to assume positions of leadership, because the act of smoking has been so deliberately stigmatised. In the end it distorts all experience to the single plane of whether or not people smoke (see the discussion of the young mother on page 4 of the annual report).

It does all this very largely on government funding and with the blessing of all the main political parties in Scotland.

Work together, says Scottish Coalition on Tobacco

Work together to improve tobacco control in Scotland. This is the message of Sheila Duffy, speaking as Chair of the Scottish Coalition On Tobacco, which includes the following organisations:

ASH Scotland, British Heart Foundation Scotland, British Lung Foundation Scotland, British Medical Association, Cancer Research UK, Chest Heart & Stroke Scotland, Macmillan Cancer Support, Royal College of Nursing, The Roy Castle Lung Cancer Foundation, Royal College of Physicians of Edinburgh, Royal College of Psychiatrists, The Stroke Association, and the Royal Environmental Health Institute of Scotland.

And furthermore:

The coalition provides a platform to share view with other organisations and with policy makers as it works closely with the Scottish Government, NHS Health Scotland, and the Scottish Parliament's Cross Party Group on Tobacco Control. Its collective approach means that SCOT has become an influential and respected voice in public health, with the secretariat being provided by ASH Scotland, the leading charity campaigning for effective tobacco control in Scotland.

 These people have got cooperation off to a fine art. On the issue of tobacco control they have succeeded in pushing legislation through Holyrood with eye-watering majorities (both the tobacco display ban and the smoking ban itself were opposed by fewer than twenty MSPs each).

Perhaps they have succeeded in convincing enough of the public that something must be done about Scottish health, whether under-age smoking, drinking, anti-social behaviour. But it doesn't stop at something, either with tobacco or alcohol. Australia has graduated to a general state of threatening to stop people from smoking in their own homes. Meanwhile Alcohol Focus Scotland, following the strategy of ASH Scotland, excludes the drinks industry from alcohol policy discussions.

It's disappointing that the licensed trade can't find its way to cooperating as effectively as the alliance that's fighting it. Disappointing but not surprising, because the alliance of professional associations and well-heeled charities is naturally in a far stronger bargaining position than those in the market place whose survival depends on sympathetic policies.

The picture illustrating 'Level the playing field' aptly shows the slope in the playing field sloping sideways and not offering advantage to pubs, clubs or supermarkets. Yet the Scottish Licensed Trade Association's campaign of the same name seeks to remove any advantages of clubs in relation to licensing laws, and the ability of supermarkets to sell cheap booze.
The difficulties faced by licensed premises of all kinds relate to official attitudes and policies relating to drink, the beer tie, drink and driving and all manner of other issues. The smoking ban, however, has allowed official policy to dictate the pub's customer base, and interfered terribly with what happens in private clubs. It's hard to see anything more fundamental to the success and confidence of the pubs and clubs as autonomous institutions welcoming whoever came through the door.

Pubs, supermarkets and clubs used to serve different markets. The smoking ban has done much to increase direct competition between pubs and supermarkets for the same market – most pubs can't offer nearly the same advantages in terms of social experience to their erstwhile customer base, the smokers, nor can they compete with supermarkets on price. This has made pubs feel more keenly any apparent preferential treatment that clubs get in their licensing arrangements.

Unlike those worthies (above) who find it relatively easy to cooperate with each other to further the honourable agenda of denormalising smoking, drinking and who knows what next, the traders in the market place are still treating each other (publicly at any rate) as their biggest threat. Of course there are issues but surely if nothing else they could unite to fight the powers that unite to stop them trading effectively.

They're doing it in Spain.

Counting the costs of tobacco control

Let's go back to last October, and a reported entitled 'Government lobbying government', reported here. It gave the Scottish Government's grant to ASH Scotland as over £921,000 in 2008–2009.

This is a tabloid trick perhaps but one might ask how this situation arises, when ASH Scotland is guaranteed an income that would pay for the treatment discussed here for four people.

In the real world, of course, this is about rationing treatment. I have no idea what factors are built into decisions that allow some people funding for this kind of condition and not others. It is quite clear that the pot paying for drugs is not bottomless and hard decisions have to be made. The drug in question has not been approved by the Scottish Medical Council, but arrangements have been made successfully for at least one patient in Scotland to receive it.

SMC refused to approve eculizumab for use on the NHS last November. Professor Peter Hillmen is a consultant haematologist and expert on PNH, who leads the only Scottish clinic for patients with the condition as well as heading up a key treatment base for the illness in Leeds. He said: “I have two to three patients in Glasgow who are not funded. They are the only patients in the UK who do not have treatment.”

Negotiations are ongoing.

In the face of such stories it is hard to see how ASH Scotland's income is guaranteed, at a considerably higher rate than the London-based Action on Smoking and Health (see first link above), even though the population is only one-tenth the size of England's population. It has 27 staff to push its agenda (as I've pointed out before, when I was on a casual contract with the Scottish Government in a division of the Health Department dealing with illegal drug use there were just half a dozen of us plus secretarial backup shared with other divisions). 

Here's another waste of money: 620 delegates at c. £350 a pop (conference fee) plus accommodation expenses, attending a two-day conference on pushing smoking cessation drugs. Even the BMJ's Tobacco Control blog acknowledges that most people giving up successfully don't need the drugs, so why does so much money need to be thrown at this national obsession?

Incidentally I heard that the SNP have overtaken Labour in the polls –  perhaps the popularity of this story helps to account for it. Having discovered that enforcing a smoking ban in the grounds of several hundred hospitals is next to impossible they now want to try it in the grounds of a few million motor cars

Many more hospitals build shelters ...

Five years after the smoking ban came in, this report says that it's not enforceable in the grounds of hospitals and many are rebuilding shelters.

Let's hope they have the sense to make the shelters comfortable enough to tempt people away from the doorways. This will save the security people a job. Four walls and a roof would be nice, although it's still against the law to treat smokers like civilised human beings.

The Daily Express does not specify which hospital trusts are involved. This is not limited to Scotland. Attempts to introduce no-smoking policies into the NHS have been attempted before and failed. Back in 2005, hospitals expressed doubts about being able to introduce no-smoking policies by the end of 2006.

... the results of its random survey of 80 hospital trusts showed that although 90% of them had brought in a partial no smoking policy, the 10% which had gone one step further and tried to introduce a total ban had failed.

Not that it stopped them trying, of course. Some people can't help trying to change human nature – they even keep referring to smoking as a 'preventable cause of death',* while also themselves calling it an addiction, and finding it quite impossible to prevent it from occurring.

* Still an interesting topic for debate.

BMA urges conference to distance itself from pharmaceutical interests: whistling in the wind?

A startling cautionary note has come from the World Health Organisation, urging smoking prevention activists to bite off the hand that feeds their activities. If not that, to get a respectable distance from other relevant commercial interests in the field. Delivered at a pharmaceutical-industry sponsored conference, it remains to be seen how much difference the acknowledgement of a competing interest in the field will make.

Chris Snowdon has covered this issue, with some background.

Our own resident smoking cessation medication trade-fare cum training school, the UK National Smoking Cessation Conference, similarly relies on pharmaceutical sponsorship. Looking at the list of delegates am I the only one to be amazed how much money changes hands in the effort to stop people from smoking? Most if not all these people are salaried, many of them specialising in smoking cessation or 'health improvement'. By the time the conference takes place in June there will probably be over 600 of them on the delegate list, and of course many more who won't make it.

What gives government such a kick out of employing people to stop people from smoking ... from buying a product which gives them so much money. Tell me it's conscience, and I won't buy it.

It gets harder to believe that one can view pharmaceutical corporations as primarily interested in the good of our health. They will be the main beneficiaries of the Traditional Herbal Medicinal Products Directive, which aims to outlaw the sale of herbs as medicines (due to be implemented on 30 April this year), thus removing access to herbal remedies by people all over Europe – including remedies originating outside Europe. (You can sign a petition here.*) Europe also wants to remove access to smokeless tobacco and e-cigarettes, also on the grounds of their supposed risks to the public. This will leave the smoking cessation business to the pharmaceutical corporations.

What makes Europe step into line with the commercial imperatives of these hugely powerful pharmaceutical corporations? Is it credible that pharmaceutical interests will be acknowledged to be as commercially powerful as that of the tobacco interests, and therefore just as suspect?

Those who make a virtue of a level playing field when it comes to applying smoking bans don't apply a level playing field in the economic and political arenas. Pharmaceutical companies and tobacco companies are clearly rivals in the market for nicotine, but tobacco companies face a ban on advertising and sponsorship. This means that no one depends on them for income, including the media. Pharmaceutical companies on the other hand make drugs, and government needs their cooperation. Pharmaceutical companies are seen as a source of good health and high quality, prestigious employment. They tick all the right boxes.

CorporateWatch quotes The Guardian in its general overview of pharmaceuticals.

There were times not long ago that drug companies were merely the size of nations. Now, after a frenzied two-year period of pharmaceutical mega-mergers, they are behemoths, which outweigh entire continents. The combined worth of the world’s top five drug companies is twice the combined GNP of all sub-Saharan Africa and their influence on the rules of world trade is many times stronger because they can bring their wealth to bear directly on the levers of western power.

With so much influence (employing two lobbyists for every member of the US Congress), it isn't surprising that commercial interests outweigh those of public health:

The US government has shown many times how it backs up its pharmaceutical industry at the cost of ordinary people the world over, including its own citizens. In September 1999 the US government decided to grant US pharmaceutical corporations the patent rights over drugs invented with public funds – six HIV/Aids drugs, as well as anti-malarial treatments and other medicines of vital interest to developing countries. The government had the right to use the drugs in public health initiatives, but chose to protect the commercial interests of its industry instead. 

I think I won't hold my breath for smoking cessation specialists to stop depending on pharmaceutical influence.

Defend traditional medicines and prevent pharmaceutical monopoly on remedies.

Late in the day (this directive comes into force on 30 April), another dimension of the Freedom to Choose is under threat, but there is still time to remonstrate:



This video tells us that it is already illegal in Canada to grow aromatic herbs in your garden (Bill C-51). It speaks of the loss of thousands of remedies.

It tells us that pharmaceutical companies are under the spotlight because of a number of drugs scandals (among which we can include Champix). This directive will give such companies a monopoly and render illegal across Europe thousands of remedies collected over thousands of years from countries all over the world.

The Alliance for Natural Health has raised funds to bring action to court, to convict the European Union of abuse of authority. This initiative needs evidence of support from the public.

Sign against THMPD (Traditional Herbal Medicines Products Directive) (Directive 2004/24/EC) here.

Nicotine receptors in the brain: Of Champix and vaccines

As the scale of the radiation disaster in Japan becomes clear we learn that a nicotine vaccine is on the way. Just what the doctor ordered.

Comparisons with Champix should raise alarm bells (see link from Dick Puddlecote's post). Champix works by attaching itself to and blocking nicotine receptors in the brain. As a side effect, it can also block serotonin receptors in the brain, as described here by lawyers involved in Champix litigation. Champix has been banned for use by pilots for many years now. The risk of adverse consequences is very well known.

Much as I distrust antis, I can't go along with the idea that they have produced a drug that would block smokers from experiencing any pleasure at all. Even although some people find it hard to believe it, parts of the brain do respond to nicotine specifically, and it is these receptors that the manufacturers of Champix have attempted to block.

Smokers are, however, expected to accept a fair risk that they will react badly to Champix. And that doesn't just mean a sore head. If you're unlucky, the Champix blocks your seratonin receptors too:

Varenicline, the active ingredient of Chantix, has only one significant side effect: it also has an affinity for the 5-HT3 serotonin receptor. If the varenicline binds to this serotonin receptor, the serotonin response, like the nicotine response, is inhibited. Serotonin regulates several stress hormones, so an inhibition of serotonin reception can lead to side effects like nausea, headaches, anxiety disorders, and changes in libido and appetite, similar to side effects seen for SSRI antidepressants.

There is no shortage of warnings and stories on the internet on this drug.

ASH Scotland, perhaps uniquely, tells us 'there is emerging evidence that varenicline is safe and effective for people with mental health problems'. Not by my definition of the word 'safe', there isn't.

Hobson's choice at the Scottish polls

For a minority government, the scale of the vote in favour of the Tobacco and Primary Medical Services Bill on its final reading on 27 January last year was impressive (108 members voted in favour and 15 against). A similar landslide vote brought in the smoking ban itself on 30 June 2005 (97 in favour, 17 against). In both cases the Scottish Conservatives provided the only opposition. 

It's no secret that the Westminster Conservatives have been disappointing on the issue of the smoking ban (and related issues) since gaining power with the Liberal Democrats in Westminster last year. It is hard to imagine the Scottish Conservatives having the upper hand in any coalition emerging from the Scottish elections (not that being the stronger partner at Westminster has helped any!) 

Scotland's elected representatives are voted using the party list system (additional member system). This means that each person votes for a constituency MSP and for a regional MSP. Although meant to favour minority parties, the plan here shows that Holyrood is as dominated by major parties as Westminster. Since the Scottish media views the election as a two-horse race, major parties naturally respond by urging their supporters to vote for them on both lists. The result is dismally predictable. 

Further: I have never been sure what the list members are meant to represent. Constituency MSPs represent their constituents – in theory anyway. Are you meant to vote for the policies that they represent, rather than for their personal effectiveness as political representatives? Do they feel any sense of responsibility for their voters, or does most of their loyalty go to whatever party selected them to fight regional seats on its behalf?

Both Labour and the SNP want further powers for the Scottish Parliament. One wants Scotland to be its own country and the other doesn't. Personally I feel that Scotland has too many people trying to run it in too many different places (Edinburgh, London and Strasbourg) and that matters should be made simpler by chopping the devolved assemblies and allowing their function to be filled by regional Westminster MPs, who would meet in the regions (including London of course: no more West Lothian question!). (For reserved issues they could all meet together at Westminster. Much less travelling would be needed.) It would bring legislators closer to the voters on certain issues, whether in Cardiff, Edinburgh or Stormont. 

What of smoking issues in the election manifestos of the two front horses? Well, here is what the Scottish National Party had to offer in 2009 (current manifesto not yet released), under the heading 'Creating a smoke free Europe':

Preventing smoking in public places is an important step to creating a smoke free, healthier Scotland and the SNP is working in partnership with our European neighbours in the fight against tobacco. In addition to the Scottish Government’s smoking prevention action plan, a number of initiatives have been taken at a European-wide level and the SNP will continue to work with the EU to make sure that future initiatives are powerful tools in creating a smoke free Europe.

At least it's clear. Labour's message isn't quite so blunt, but the direction of travel is similar.

Scottish Labour led the UK in banning smoking in enclosed public spaces. We remain determined to do even more to tackle Scotland’s high smoking rates. We will introduce a revised Tobacco Control Strategy that will tighten up the loopholes in legislation to prevent tobacco advertising on merchandise. We will consult on the desirability of a ban on smoking in cars that are carrying child-passengers.

That's your choice.

Scottish Libdems 2011: learning the differences between active and passive smoking

You can read the Scottish Liberal Democrats' manifesto here. For a party that is likely to win only a sprinkling of seats, there's certainly a lot of reading material. There's very little on tobacco and smoking, except a promise to make 'progress' on smoking cessation measures. There's quite a bit on alcohol and (without mentioning the words 'minimum pricing') a commitment to approaching this issue on a UK-wide basis.

The Scottish Liberal Democrats' chief manifesto pledge is to create 100,000 jobs by selling off Scottish Water. A policy taken from the Scottish Tories (Severin Carroll of The Guardian) may not be a vote winner in Scotland.

How well do Scottish Liberal Democrats understand the smoking issue? Party leader Tavish Scott distinguished himself even in the early stages of the parliamentary discussion that culminated in the Smoking, Health and Social Care Act 2005. In April 2005 Tavish sounded off as follows:

We are tackling two of the biggest health-related factors in our society – smoking and alcohol. They are time bombs that have long-term impacts that we must address now. Smoking is the single largest cause of preventable premature death in Scotland. Some 13,000 families a year in Scotland lose a loved one through smoking-related death and 1,000 of those are associated with passive smoking. Some 35,000 Scots are treated every year for smoking-related diseases. Each and every year we see among lifelong non-smokers 865 deaths from lung cancer, heart disease, stroke and respiratory conditions that are related to passive smoking. Statistics show that non-smokers who work in a pub where smoking is allowed are at least 20 times more likely to develop lung cancer than other non-smokers. 

We cannot accept such statistics in modern Scotland; we have to act now and for the long term, which is why this devolved Government has committed itself to introducing a comprehensive ban on smoking in enclosed public spaces in order to reduce smoking, save lives and help to transform Scotland's national health. [emphasis added] 

Do we know how many members were sitting in the Chamber that day ... however many it was, no voice pointed out to Tavish Scott that his statistics were bull. No one has ever presented the idea that exposure to secondary smoke elevated the risk of lung cancer to bar staff by a factor of twenty. The risk elevations given for passive smoke exposure in regard to lung cancer are typically up to 25 per cent, i.e. a factor of 1.25.

Risk elevations for active smoking in regard to lung cancer might approach 20, but this is very different from secondary smoking. Also the dizzy heights of 1.25 as a risk factor from passive smoking relates to a lifetime's exposure, not a summer job in a smoky bar (Tavish Scott does not specify any length of tenure for his hypothetical bar workers), and many epidemiologists would not consider risks of this order to be significant.

Tavish Scott shows lamentable ignorance, but also the failure of anyone else in the Chamber to put the real situation on public record demonstrates how much the Scottish Parliament has allowed the truth to become a casualty of the war on tobacco.

Park committee won't ban smoking

A children's park in the vicinity of Great Ormond Street Hospital has become the subject of a row following a campaign to get smoking banned.

The park extends over seven acres, and is for children only (i.e. children must accompany adults). The park's executive director made the following point.

“As you are aware Coram’s Fields serves some of the most disadvantaged people in the area and making it a non-smoking zone could mean their children, many of whom don’t have gardens, would not come to the park and therefore miss out.”

She was accused by the campaigner of belittling the intelligence of poor people. But she argued that a ban on smoking might lead to children being prevented from coming to the park. Further, the park was not an indoor environment.

As you might expect I don't have much sympathy with the campaign. A park is public property and everybody's rates maintain it. An outdoor smoking ban is punitive in a park, and the impact is felt by children as well as adults, if the ban prevents the adults from enjoying the park. Disadvantage can mean many things, not least that home life can be more stressful than many of us would like to imagine. Even if it isn't particularly stressful it is more than likely to be small, offering limited space for letting off steam. Restricting people who smoke from doing so in public areas (in seven-acre parks!) is simply inconsiderate. It has nothing to do with anybody's intelligence.

The park is there to maximise children's access to fresh air, exercise, space to run around, all of which improves their own quality of life and that of their parents and carers. It would be tragic if this amenity were disrupted for the sake of banning smoking. Well spoken, the executive committee of Coram's Fields!

Non-communicable diseases and harm reduction threaten the world?

Well, do they?

Guardian health blogger Sarah Bosely thinks the name non-communicable diseases isn't quite sexy enough to get people concerned and motivated as they were about HIV and AIDS. Quoting a Professor Beaglehole in The Lancet:

The spread of non-communicable diseases (NCDs) presents a global crisis; in almost all countries and in all income groups, men, women and children are at risk of these diseases. Worldwide, substantial gains have been achieved in economic growth, health, and living standards in the past century. This progress is now threatened by crises of our own creation–climate change, finance and food insecurities, and the crisis in NCDs, principally heart disease, stroke, diabetes, cancers, and chronic respiratory disease.

Do I think this is alarmist? Yes, to the extent that non-communicable diseases can't be considered by anyone's standards as threatening to human life as diseases that spread through populations by contagion or infection.

We are told that 'two-thirds of all deaths globally are from NCDs every year - and four out of five of those deaths are in low and middle-income countries. One third are in people aged less than 60.' I have a table in front of me with UK mortality from 2003, a year when the total mortality was 610,871, of which 397,609 were over 75. Before I saw the table I never imagined that living to 75 was normal! In early 2000s UK, two-thirds were living more than 75 years, compared with two-thirds globally surviving 60, as in the Lancet report. I am not sure why it should come as a shock that one-third should die before the age of 60, and I don't see why it should be surprising that heart failure or failures in the respiratory system should cause fatal collapses in people of all ages, since these are the vital systems that keep our bodies going.

I'n not quite sure what's driving the non-communicable diseases campaign. They want to advance tobacco control (are people in low and middle income countries aware what vicious proportions anti-smoking campaigns can assume?), and tackle salt consumption as well as going for more specific campaigns, such as improving HPV protection in young women.

The cynic in me says they want to distribute more drugs and push for more restrictive tobacco and alcohol laws. It says that the figures tell us nothing about quality of life but treat longevity as a goal for good or ill, and that anti-smoking campaigns of the kind seen in this country are not likely to increase the sum of human happiness. How do they propose to cut down people's consumption of salt?

We know how to tackle the tobacco companies and fast-food chains. We have the pills to protect people from cardiovascular disease. Our teenage daughters are being protected from cervical cancer - and the same jab ought to be available in countries where the death toll is far higher than it is here.

Nothing to be cynical about at all really, is there?

Note the confidence in being able to 'tackle the tobacco companies'. Has it occurred to these worthies from the global health community that a less doctrinaire approach to their pet projects might save more lives? A European Commission public consultation on revising the 2001 tobacco directive included the suggestion of banning snus throughout Europe. Snus, chewable tobacco, is considered to be far less injurious to health than smoked tobacco, but the logic of anti-smokers dictates banning because it carries unknown risks.

Hat tip to Dick Puddlecote for this part of the story: a link to former director of Action on Smoking and Health Clive Bates, discussing a position paper on snus from 2007 in a blog post entitled Saying stupid things with fake sophistication:

So the main ASH Scotland policy idea is that other countries should be prevented by law from reaching a position where more of the tobacco use is through far less harmful forms of tobacco consumption and that addicted individuals should be prevented by law from having access to lower risk products. What next? A ban on anti-lock brakes? Cycle helmets? Ropes while rock climbing? Any risk reduction measures at all while engaging in inherently risky behaviour? There's the warped logic of the overweening health planner behind all this ... if you make a risky activity much safer, then people might not stop doing it altogether.

Can you imagine Clive Bates getting a job with ASH or ASH Scotland today? He opines, 'No less than 266 references are used to support the truly stupid idea that smokeless tobacco, which can substitute for cigarettes and is far less hazardous, should be banned. He says, 'Even tobacco companies provide better and more balanced analysis than this effort by ASH Scotland' [emphasis added]: stop right there!

Clive Bates defends the idea of harm reduction: people can choose vastly less harmful products than smoked tobacco, and it is perverse to obstruct the public from choosing safer alternatives.

Tobacco control, the whole community, will favour outlawing snus. This makes them the worst possible candidates for advocating global tobacco control because they will 'encourage' countries to ban these products, which are safer than tobacco, in their attempts to reduce cancer rates, heart attacks and respiratory problems. Does this increase our confidence that they can effectively tackle non-communicable diseases? Not really.

Welsh schoolchildren's anti-smoking animation

I wonder what lessons they are missing out on in order to create the time for this 'animation'?

http://www.itv.com/wales/anti-smoking-animation26279/?

For a start, they could try learning what an animation actually is: I suspect this would be a far more enlightening exercise than getting children to chant 'We have a right to be healthy'.

Devolution, the smoking ban and the Scottish elections

Scottish UKIP's manifesto (p. 5), published on Monday 4 April, declares against the smoking ban. It is the only Scottish party that has made this commitment. (That surprised you!)

UKIP's central plank of policy is of course independence from Europe, which they base both on cost grounds and on the number of laws and directives that come from Europe, effectively limiting the ability of governments to listen to their electorates. They also remind us that the European Commission, which writes the European laws that are then voted on by MEPs, is a non-elected body. A policy document on tobacco and smoking from 2009 gives an idea of the scope of its ambition: no member country can expect to be entitled to a contrary view.

The Scottish establishment currently doesn't have a contrary view: Labour, the SNP and the LibDems vie to convince the electorate that they care about it by letting doctors and health lobbyists dictate health policy, and the Westminster Coalition has also presented a dismal lack of contrast to what came before it.  The major parties across the UK, and the nationalist parties in Wales and Scotland, all essentially support the smoking ban and associated laws such as the tobacco display ban – whatever they said when in opposition. Whether nannies or nudgers, they speak and the population is expected to improve its behaviour. But from left, right and centre come dissident voices.

Personally I feel that the smoking ban is anathema to anyone with an ounce of political principle, regardless of their political position. To Conservatives, priding themselves on a sense of responsibility and respect for business integrity, the ban makes no sense: it deprives both businesses and customers of any sense of responsibility for their actions. To liberals, who used to stand for tolerance and a mixed economy, it makes no sense either as it ties the hands of business behind its back and is profoundly illiberal. To Labour, whose mission is to protect the 'working man', the smoking ban has been a complete disaster as it has deprived communities of their social centres and of much of the sense of civic pride remaining to them after the industrial losses of the Thatcher era. Scottish and Welsh nationalist parties have risked alienating large swathes of their passionate and loyal supporters by following the anti-smoking agenda.

From the Left (does this have anything to do with Labour any more?) we have a refreshingly libertarian perspective that condemns the enormous taxes imposed on tobacco (with links to further posts at the foot). The same blog attacked last summer's proposal to ban tobacco from all NHS Grampian sites and punish any staff carrying it about their person while at work or at any time if in uniform (a proposal that has since been scrapped as unworkable):

Excuse me, but when did these skilled employees become human billboards? Clearly the board do not think it sufficient for these public servants to merely offer up their time and their hard work to help care for the sick. No, they must submit their personal lifestyle choices to the cause of Grampian’s latest health drive.

Indeed NHS Grampian appears not be particularly au fait with contemporary employment practices. Since serfdom went out of fashion, the basic premise has been that while workers sell their labour power, they do not hand ownership of themselves and their bodies to their superiors. Nonetheless the Grampian board appears to want sovereignty over what their employees breath (sic) in, regardless of whether they are at work.

Prior to last May there was no shortage of Labour-knockers claiming that the smoking ban was a communist/Stalinist plot, so finding voices on the left who rejected authoritarianism and Nannying was cheering.

Less surprising is sites such as Liberal Vision, which offer a better view of liberalism, or ConservativeHome (tobacco-related posts picked by way of illustration), which allows Conservative supporters to wonder what the hell happened since last May. I'm not aware of many rebels to the tobacco orthodoxy within the ranks of Scottish or Welsh Nationalists but perhaps the political establishments here and in Wales are too small to allow loud dissenters to be comfortable?

All parties include people who resent the extremes of anti-tobacco policy. UKIP has brought the smoking ban issue to the table and made a manifesto issue out of it, also reported here and in the BBC link at the top of the story.

UKIP also addresses devolution: they want to use the Scottish Parliament building to accommodate Scottish Westminster MPs and do away with MSPs, and assembly members in the other devolved regions. My understanding is that Members of Parliament would deal with specific ('devolved') policy areas in their respective regions, and with 'reserved' matters as a single group in Westminster. Whether you like this idea or not, my feeling is that the present devolved government is a dog's dinner, with too many government departments in too many places.

Why in a tiny country like Scotland is domestic policy decided by one legislative body and foreign and defence policy (and other reserved matters) decided by a completely different legislative body? UKIP's proposals also mean that Scottish MPs would no longer have any vote on 'uniquely' English issues, avoiding the anomaly known as the 'West Lothian Question', so they won't be able to blame the Scots when things go wrong!

I'm trying to be politically non-partisan (I have two votes, after all). I tried to push the devolution issue on UKIP's story today in the Scotsman but no one has really tried to argue the merits of the devolved system as it currently runs. One or two people have made clear their suspicion of UKIP, but not helped to convince me there is a merit to devolution as we know it. My question when voting would be, do you want want to resolve this mess that is devolution? If anyone from any party wants to convince me that there is merit in devolution they are welcome to have a go. (They're not going to persuade me that there is merit in the smoking ban.)

The Spanish miracle: reporting before the event

There will be a drop in heart attack admissions this year in Spain, as yet unquantified, as 400,000 Spaniards stop smoking following the introduction of the smoking ban.

The Spanish National Committee for the Prevention of Smoking has said that a yet to be quantified fall in the number of people suffering heart attacks or serious breathing illnesses can be put down directly to the new regulations on smoking introduced on January 2. 

They have forecast that 400,000 Spaniards will give up smoking this year, considering that many early deaths will be avoided, especially in the hostelry sector. They say they will have definitive numbers at the end of the year, but already estimate a 10% fall in heart attacks.

Less than three months in they are already jumping on the bandwagon. Forecasting a drop in smoking rates and a drop in smoking-related diseases (why didn't Jill Pell try it in Scotland?) in their view 'shows that the legislation was "urgently needed and necessary"'. A forecast justifies policy? they're having a laugh.

(Just as well Jill Pell didn't predict a further drop in heart attack admissions after 2007, because it hasn't been sustained – not that it ever reached anywhere near 17 per cent anyway.)

Fresh air in Ashton Lane

Congratulations on this insightful review on the smoking ban by Joe McGuire at the Glaswegian. Not only does he refer to absurdities like heart attack and child asthma admissions falling like a stone as fact rather than hotly contested hypothesis, he also finds six supporters of the ban in Ashton Lane and cites them  as some kind of demonstration that the smoking ban has won side support among Glaswegians and Scots in general.

Ashton Lane

An easier place to stop passers by than this, no more than ten minutes away:

Maryhill Road

Or perhaps Sighthill, a bit further off – one might have actually had to knock on doors: 

Sighthill

Joe might have still been told that people support the ban (who knows) but at least he would have made some effort to get to places that people find harder to get out of.

Sydney apartment block goes non-smoking

From Forest, the story of making an apartment block smoke-free in Syndey, Australia. Even the balconies will be out of bounds for the purpose of smoking.

The report does not specify that the blocks are public or subsidised housing, but this clearly leaves detached housing dwellers far better off in terms of freedom from personal constraints. Yet again the less well off pull the short straw. And all for the good of their health?

The idea that smoke can get from one apartment to another invites scepticism, to say the least. There is no reason to believe that direct passive smoke exposure elevates risk significantly after a lifetime. Causing harm to people in another apartment is a degree or two less likely. And any apartment reckoned to leak smoke from one apartment to another should be investigated by building control.

Discriminating against smokers at work

Hard not to agree with Michael Siegel that policy makers at Michigan hospitals (where applicants who test positive for nicotine are refused employment) are engaging in discriminatory behaviour. They are rejecting applicants who show even the traces of nicotine detectable in someone who is trying to give up smoking using nicotine substitutes. As if this were not sufficiently absurd, they deny that what they are doing is discrimination because people don't have a constitutional right to smoke ... a non-sequitur if ever I saw one.

The point about discrimination is not whether it is affronting somebody's constitutional right to do something, it's whether applicants to a job are being evaluated according to their suitability to do the job or on irrelevant factors to do with any other agenda, be it racism, gender discrimination, healthism, or whatever. It is deciding that someone thought able to do the job on interview is not given the opportunity to prove themselves because nicotine has been traced in their system.  'In two instances, Crittenton had to revoke job offers because the applicants tested positive for nicotine during a screening, Kapuscinski said.' The applicants had already been preferred over other applicants before being ditched.

Aiming to 'foster a healthier work force, as well as to demonstrate to our patients and the community our strong commitment to health and wellness' may be laudable, but it doesn't rule out the possibility of discrimination. Most discrimination is probably defended by those that practise it on the grounds that it upholds some kind of cultural/asthetic/moral value.

Not only does this policy pick on smokers (as opposed to the obese or sexually active), as being unsuitable employees for a health establishment, it also makes it difficult for those who are trying to quit smoking using nicotine to get employment in the health field. It is hard to see a more blatant example of discrimination against smokers in respect not only of non-smokers but also in relation to almost anyone else who does not tick all the boxes.

This policy is expected to spread, we are told by 'experts' (John Banzaf leading the field: this is the organisation of which he is chief executive, you can see him give his tuppence worth about a council's anti-smoking policy in Scotland here). We can see how smokers get the short straw: it reflects the power of the enemies of tobacco in the market place. A workers' representative protests,

"It's not right for employers to tell employees what to do when they're off-duty," said Lewis Maltby, president of the National Workrights Institute.

In my view Mr Maltby has not made the critical point that smoking workers are being discriminated against, meaning that regardless of their abilities they cannot gain employment in a profession even if they have invested in training for it. Being off-duty is a luxury to those who can't even get work:

'The idea has caught on outside Michigan. Some police forces in Ohio have adopted similar policies to control health care costs, and Ohio-based Scotts Miracle-Gro Co. has a nicotine-free hiring policy ...

Already it has gone beyond health-related employment. The time will come when smokers will be able to claim discrimination, and it will be long overdue.