Where smoking ban increases immediate risks to personnel

More light blogging. This one concerns the approaching smoking ban in New Zealand prisons, due on 1 July. More than one opinion piece has suggested that prisons are poorly staffed for managing tense situations. Changing the law to prevent prisoners from smoking, while protecting prison guards from whatever ailments smoking might give them, is likely, according to the union (which officially supports the principle of a smoke-free workplace), to make their work increasingly difficult especially in the first 24 hours of incarceration, the period when most prisoners are at risk from self-harm. Officers frequently find supervising prisoners during this period traumatic. Another association has asked for riot police to be on standby.

Is it really worth it?

Champix covering up

Another light blogging day. What Chris said.

Test your knowledge of the Framework Convention

Light blogging day today. I decided to do this test on tobacco control issues and the Framework Convention. Scoring 3/10 on the first attempt, I took the test again and persevered until I reached no right answers at all. It's the only sane response. The first question asks whether it is 'ok' to have smoking rooms in bars and restaurants. The answer, taken from Article 8 of the Framework Convention on Tobacco Control, concludes 'there is no safe level of secondary smoke and notions such as a threshold value of toxicity from second-hand smoke should be rejected'. No reason is given for this command to leave common sense at the door. Anything that doesn't kill on impact has a safe level, and people can be exposed to secondary smoke for decades without ill effects. Another question asks if tobacco advertising is acceptable if it doesn't glamourise tobacco. Answer no: advertising is an attempt to normalise tobacco use. Actually, it's an attempt to sell specific brands of tobacco. The product is legal. Normalisation is a given. Any advertising wishes to make its product a household name, like fairy liquid or After Eights.

The test goes on to check the participants' knowledge of the Framework Convention's version of tobacco control wisdom, using a 'true or false' model. Expect a high score if you see the world through the same lens as the Framework Convention – driven by ideology and impervious to common sense.

Pressure grows for a federal smoking ban in Germany

A cross-party parliamentary group in Germany is pushing for a federal law to supersede state laws on public smoking in Germany. State laws have provided a number of different bans that are poorly enforced. An attempt to impose a nation-wide ban in 2007 failed.

The report, using a Yougov poll, remarks that 'the tide may be turning against smokers'. But Yougov's director Peter Kellner doesn't pretend to impartiality on this issue. The Yougov poll declares 65 per cent of smokers in favour of an outright ban on smoking in enclosed public places throughout Germany.

It doesn't help to explain why the smokers in many states have not complied with the ban, nor does the report offer any reason to suggest that they will change their minds, just because a parliamentary group is embarrassed about Germany's failure to go non-smoking in pubs and restaurants. The best they can offer is that 'public opinion' will force smokers (and the licensed trade and the courts that have supported them in the past) to concede.

Germany has another reason not to like anti-smoking campaigns.

Retailers unite against European tobacco restrictions

Retail representatives of eleven European nations including the UK's National Federation of Retail Newsagents have met in Brussels to demonstrate joint opposition to restrictions on tobacco.

The revisions follow 'an EC "consultation"' that took place in 2010: the questions offered the possibility that EU member states should be allowed to legislate for themselves on tobacco control issues. The Commission's decision to pursue policies and restrictions throughout Europe gives its opponents a strong motivation to join forces.

Arguments will be dismissed as the work of tobacco company propaganda – just as licensees up and down the country who watched their takings plummet following the smoking ban were told that 'the recession' was to blame for their struggling trade.

"These measures will mean huge costs for retailers along with an explosion of the black market, presenting a threat to more than half a million small retail businesses in the EU," said Giovanni Risso, chairman of the European Confederation of Tobacco Retailers which hosted the Brussels meeting.

The retailers say existing legislation has already forced business closures, thanks to the rise in the smuggling of cheaper illegal cigarettes. Now they say standardised packaging would make products even easier to counterfeit - and banning the more addictive ingredients in tobacco would trigger an illicit market in stronger cigarettes.

They are persuaded that this approach to tobacco will make legitimate sales harder without reducing the demand for the product, and that illegal traders will reap the benefits. It is hard to see how further restrictions in the legal trade in tobacco can fail to benefit rogue traders.

The proposals mimic the Australian unbranded packaging model. A popular argument claims that the branding must be worth sales to tobacco companies, since the threat of its removal has provoked them into a reaction. But it's not that simple: brand identity is important in the marketplace to protect against cheap imitation, and on health grounds alone you would think that distinctive brand-packaging would win the support of the so-called 'health lobby'. Even an Australian anti-smoker has been won over on the argument that government has no right to tamper with the brands of legally traded products.

This legislation will see the potential destruction of brands that have been legally built up over many years. Quite simply, this puts the spotlight squarely where it should be. This is a debate about the freedom of the marketplace, and the boundaries of government restrictions to legal trade. The government, in my opinion, has no right whatsoever to actively seek the destruction of brands that are legally traded in the marketplace. Yes, it has every right to persuade people to choose not to smoke. And it has a duty to publicise the health risks of smoking, if for no other reason than relieving the pressure on the public purse of the exorbitant costs of treatment ... 

I wish the traders from these eleven European countries a productive association. Their case is compelling.

Where New York goes ...

... well, that didn't take long:



Whatever the Chest, Heart and Stroke Association says, those on the street don't appear to endorse the idea quite yet.

Tobacco funds Australian Coalition government

You would think the tobacco companies were the only companies to apply pressure to politicians by offering money, or that they did it in a uniquely evil way. No matter what else happens, tobacco companies remain the only source of unethical funding, and accepting tobacco money should be enough to destroy any party's credibility. Fortunately some of those commenting on this article seem aware that condemning corporate donations to political parties doesn't wash if you turn a blind eye to all but tobacco companies. That doesn't make you anti-corruption, it just makes you anti-tobacco.

In fact other people do bad things with their influence too.

In spite of opposition taunts, donations from the tobacco companies will probably not prevent a law being passed  to mandate plain packaging. Just like tobacco displays in shops and brand packaging, the effects of tobacco company donations are not always as predictable as anti-tobacco campaigners make out.

Richard Horton talks up NCD agenda, Moscow, April 2011

Richard Horton winds up discussion of a disorganised and frustrating event by describing the unexpected charisma of Vladimir Putin, who addressed the first global ministerial conference on healthy lifestyles and non-communicable disease (NCD) control. He then makes an intriguing case for resources to be given to non-communicable disease control:

Although 80% of NCD deaths take place in low and middle-income countries, the fact is that for the 50 or so poorest countries in the world an unfinished litany of problems remains—infectious diseases, maternal and childhood illnesses, and unchecked population growth. NCDs come bottom of this list.

Quite rightly so. Diseases that can't pass from one person to another, whose cause is usually multi-factorial and can't be isolated and analysed, come a long way down the pecking order of complaints that a world health authority should turn its hand to – especially when people are dying in ways that should be cheap and easy to prevent.

If we are to make any progress at all in getting NCDs noticed, we’ll have to show how their prevention and treatment can easily be integrated into existing health programmes that are already struggling in health systems starved of cash and capacity.

How can you prevent something when you don't know what causes it? How, also, can you do it at no cost?

Another big vertical initiative is not what countries want or need. This points to an uncomfortable truth—we in the health community have not made an effective business case for NCDs. Deaths alone are not enough. We need to show why NCDs matter—and they do—for economic stability as well as poverty reduction. The macroeconomic case for action is lacking: an urgent gap to fill between now and September.

 So what is the 'business case' for emphasising NCDs, when Horton himself admits they are at the bottom of the heap as far as poor people's priorities go?

My cynicism knows no bounds perhaps, but the Framework Convention Alliance's interest in this conference indicates that tobacco control can be found lurking. I just hope that their keenness to promote the cause of NCDs doesn't lead to people being pressurised to sack employees who smoke, or otherwise make their lives difficult. I'm also intrigued about exactly what the conferences imagine they can do cheaply and easily to prevent non-communicable diseases ... but since they wish to discuss them at inter-government level this September, perhaps it won't be long before we find out.

SLTA invites Dutch and Croats to reconsider smoking ban

The Scottish Licensed Trade Association has invited licensees from countries where the smoking rules are more relaxed – the Netherlands, Croatia and Hungary – to a meeting with Scottish licensees in order to explore possibilities of relaxing the ban.

At a time when the world awaits an avalanche of outdoor smoking bans (following New York) and apartment bans (following Australia), perhaps the last thing anyone expected was for the Scottish licensed trade to announce that smoking bans in pubs are not needed! This is not in fact what the SLTA is saying to the press – they are looking for 'some accommodation', not a return to the old days.

Good luck to them. Bringing Scottish licensees face-to-face with their counterparts who have fought successfully against restrictions in other countries is an inspired move, and we hope it will restore some confidence to our licensed trade.

In the mean time, the Scottish licensed trade and all hospital managers should know that there is a European Air Quality Standard, EN 13779, that deals with non-residential human occupancy and discusses tobacco smoke as just one of a range of conditions in buildings that must be dealt with. This documented is dated 2007, so it has been known for some time that tobacco smoke is reckoned to be a problem capable of resolution. There never has been a need for a smoking ban, and the whole of Europe should know it by now.

Calls for e-cigarettes to be banned while Champix remains on sale

Michael Siegel asks quite fairly why Champix, known to have links with psychotic, suicidal episodes and worse, is freely available, when certain anti-smoking groups have called for the banning of e-cigarettes, which have no documented safety record or pending lawsuits on behalf of users.

He shows links between the US anti-smoker groups and pharmaceutical giants including Pfizer, which manufactures Champix. He also addresses the ideology of anti-smokers (popularly tagged 'quit or die'). Your quitting aid mustn't even look like a cigarette or it doesn't count:

The ideology is simply this: nothing that looks like cigarette smoking can possibly be a good thing, even if it saves lives. People need to quit smoking the way we say they should quit smoking. There is a right way and a wrong way to quit smoking. The right way is our way and the wrong way is any other way. If it looks like smoking, it's still smoking, even if there are no adverse health effects and the individual has achieved smoking cessation. 

 His logic is persuasive:

If anti-smoking groups want to argue that any smoking cessation product on the market has to first be unequivocally proven safe, then fine. They can argue that e-cigarettes should be removed from the market but they must also call for Chantix to be pulled from the market for the same reason.

Alternatively, if they believe that the burden of proof is on others to demonstrate that Chantix is unsafe before pulling it from the market, then that's fine too. But then they must apply the same reasoning to electronic cigarettes and ask that these products remain on the market until such time as they are demonstrated to be unreasonably unsafe.

More on Champix here.

New York outdoor ban gets mixed reception

See video for a range of reactions. Not all good news for the ban-istas.

Edited to add: more reaction on the BBC report, which cheerfully discusses when the world will follow the lead of New York City.

Policy by public opinion poll according to ASH Scotland

The lull in anti-smoking legislation will soon be over, and Sheila Duffy will soon stop reminding the incoming government of its obligations to children and get down to some serious work. Her latest effort claims:

Our polling shows that the public are aware that there are risks to children’s health from exposure to tobacco smoke with a huge 88% saying that they think second hand smoke increases the risk to a child’s health ...

The agenda has clearly moved to children (adults are no longer exposed in the workplace), meaning we can expect restrictions on smoking in homes and cars. The reasoning is superbly executed ... most people think smoke endangers children, therefore policy must be 'x'. (Are most people right? We should be told, but not only by Sheila Duffy.) More:

This is not necessarily about getting smokers who look after children to quit. Rather it is about informing people about the harms caused by tobacco smoke and showing parents and carers that the best way of protecting their children from the harm caused by second hand smoke is to not smoke around them.

So they are not even bothered about getting adults to quit any more. They are after 'harm reduction', which means nicotine replacement therapy in ASH Scotland's language. This means that they may have absorbed the wisdom imparted by the likes of Tim Coleman that NRT doesn't work for most people once they have left the clinic. That is, it doesn't work as a quit smoking tool, but it can still be used to relieve temporary discomfort.

Ms Duffy then goes on to recommend a 'social marketing campaign' covering the dangers of passive smoke exposure to children. What happened to public information campaigns? The term 'social marketing' is itself instructive, as marketing is a form of deliberate persuasion. The messenger is quite uncritical of the message: it has been taken for granted as fact, removed from the realm of objectivity, and given to the marketers to deliver to the public.

ASH Scotland has yet to start pushing for third-hand smoke awareness, but it's only a matter of time. Third-hand smoke is discussed clearly by Chris Snowdon here; he quotes author Winickoff from a private email regarding his study on third-hand smoke:

Basically, the study found that IF you believe that thirdhand smoke is harmful to infants and children, then you were much more likely to have a home smoking ban.

Not much science there either really, is there? More logic, really, and certainly doesn't address the issue whether third-hand smoke is a danger to children, or an issue that would make it advisable to wear a face mask when changing bed linen. The line of argument is identical to Sheila Duffy's. If enough people believe it's dangerous, there is no need to prove it any more.

Durham University accepts tobacco money for scholarship fund

The story can be found here and here. The donation from British American Tobacco seems to have upset academics and some of the student body, and is predictably described by Action on Smoking and Health as 'cynical'.

The funds will pay for scholarships for Afghan women, probably explaining the reaction of Action on Smoking and Health, who will see the donation as an attempt by British American Tobacco to win favour and sales in Afghanistan. The University claims that most of its staff and students feel that the benefits of funding women scholars from Afghanistan outweigh other considerations. The donation is one of 2,000 others received following the appeal.

It's unfortunate for anti-smoking authorities that tobacco companies have money to burn, but since tobacco companies are forbidden by law from advertising, thanks to anti-tobacco campaigns, it is hardly surprising when they employ more subtle forms of marketing (not that BAT describe their donation in such terms: they describe their corporate social responsibility fund as 'an end in itself').

Action on Smoking and Health concerns itself only with the evils of tobacco. No one else is accused of cynicism for donating to the scholarship fund, although with so many donors it would be hard to imagine that none of the others was a corporate donor with a potential market in Afghanistan.

It could be that there are insufficient 'ethical' funds in the pot to support all our philanthropic instincts. I support the University for attracting and employing a broad base of donations, without specific prejudice against accepting money from tobacco.

More on stakeholders: how corporations influence and profit from public policy

This paper has been lodged with legislators in Ohio. It concludes:

Ohio's Constitution is much more protective of property rights than the U.S. Constitution.  We can't wait to have our properties returned to their rightful owners!  We want you, our state legislators, to know that you've supported these special interest groups over us mom and pop business owners.  You've forgotten to protect the minority.  You've forgotten that our properties are to be held forever inviolate.  That's "forever", not ignored when it suits special interests.  No one is forced to work for us and no one is forced to enter our properties.  We want to be profitable once again.  And we want you to know that we know who's behind controlling our behaviors for profit.  Now...do you want to side with them?  Or us, the people who vote? 

Whether you agree or not that private property should be inviolate, it can't be right for wealthy corporations to be able to lobby for policies that are ostensibly in the public interest, in a way that sidelines public participation, and from which they gain clear commercial advantages.

For the particular attention of Sheila Duffy, who clearly feels that tobacco companies are the only companies that attempt to influence public policy.

Stakeholders

Hat tip to Simon Clark for this, which includes the Secretary of State for Health Anne Milton's answer to a Parliamentary Question from Philip Davies MP. The question concerned whether lobbyists should be required to disclose any links with pharmaceutical industry or any public funding. The answer:

The Government are under obligation to protect tobacco control from the vested interests of the tobacco industry, under The World Health Organisation’s Framework Convention on Tobacco Control.

Our policy on this is set out in Chapter 10 of 'Healthy Lives, Healthy People: A Tobacco Control Plan for England'. This does not extend beyond the tobacco industry and the Department, as with all other policy areas, engages with a wide range of stakeholders including the pharmaceutical industry, organisations in receipt of funding from the pharmaceutical industry and organisations in receipt of funding from the public purse.

We can therefore take it for granted that acceptable stakeholders in tobacco policy might include pharmaceutical interests and publicly funded bodies.

The government may not count the tobacco industry as a legitimate stakeholder in tobacco policy because of the demands of the Framework Convention, specifically Article 5.3. Pharmaceutical companies, on the evidence, are meant to 'represent health interests', and are thereby 'good guys' who would never abuse their enormous financial clout by applying improper pressure?

They are effectively the tobacco companies' chief competitors in the market for recreational nicotine. Thanks to the stipulations of the Framework Convention on Tobacco Control, they don't even need to apply any improper pressure, as the rules exclude the tobacco companies from proper participation. The bad guys have been chucked out of the club so only the good guys are left?

These stipulations can also encourage the public to believe that all the 'bad guys' are being sidelined, when they are actually very much in the game. Governments and their agencies agencies can attempt to chase a big player out of  the market only with the help of an even more powerful player – and the big and powerful inevitably involve interests that can clash with those of the general public.

Demands such as those made by the Framework Convention damage the political negotiation process in EU member countries with their one-size-fits-all approach. They make certain elements of policy non-negotiable, even though the essence of politics is negotiation. The Secretary of State actually claims to have no power to include tobacco interests in tobacco policy discussions. In the Mother of all democracies this is a sad state of affairs, and one that badly needs correcting.

Legal challenge to vending machine ban in Scotland fails

The report is here.

I can't say what part of the European Convention on Human Rights is supposedly contravened by a ban on tobacco vending machines. I would just say that such a ban is unnecessary, and taking the most highly priced cigarettes out of the market in order to deter kids from using them is a waste of time as well as damaging to industry.

Radio-controlled vending machines have been developed specifically to deal with age verification. An amendment by Rhona Brankin MSP (Labour) asking for time to trial these machines was rejected out of hand by all three major parties in the final stage debate, because it 'would not work' (Ms Brankin attempted to withdraw the amemdment but it still went to the vote). And because it would involve existing machines remaining in service while the trials proceeded.

But probably most of all because in the words of Shona Robison, then Minister for Public Health and Sport: .

I am sure that no one in the Parliament would want Scotland to lag behind England on a tobacco control measure. [Official Report, col 23102]

 Reassuring?

Anti-smokers struggle to keep up

For the second time this week, anti-smokers have made an unseemly fuss about dreadfully old news. The first was when the BBC was criticised for this. Written in 2001, clearly headed with a disclaimer, it raises the wrath of doctors in 2011, as reported here.

Now the British Medical Journal (keeping its mind on serious medical issues as usual) has a go at tobacco companies because they have taken to selling cigarettes in packs of 14. Yes, packs that have been in circulation since pre-historic (i.e. pre-smoking ban) days have just reached the attention of those doctors insane enough to complain about such trivia.

Campaigners are outraged that smokers can buy cigarettes in packs of 14 'instead of the usual 20'. Should I add to their consternation by reminding these worthy campaigners that smokers can still buy ten-packs, as they didn't get round to banning them yet?

The vested interests of (ahem) tobacco companies, and private meetings

This month Ms Duffy blogs on the Guardian's revelations that tobacco industry funding had assisted newsagents in their campaign against the display ban, covered in a story here just over a week ago.

ASH Scotland's concern with tobacco industry 'vested interests' is natural. Any industry has 'vested interests' in public policy debates that affect its products. Less wholesome are 'competing interests', especially in the field of tobacco control: this is where a lobbying group claims they are acting in the public interest, even though private interests benefit from their lobbying activities. Even the British Medical Journal published a note of concern about this issue.

Ms Duffy also refers to a meeting that was 'publicised' by the Scottish Licensed Trade Association, where 'retrograde moves' and 'backwards looking, expensive and unworkable' proposals were discussed – the whole thing financed by tobacco companies. Simon Clark has quite rightly pointed out that not only was the meeting private, but also funding it was a matter of necessity. Publicly funded Ms Duffy with no anxieties about her next meal (cool salary offered here, and it's not even the top job)  huffs about tobacco money going to fund private trade meetings on topics vital to their commercial survival.

Interesting that with this kind of track record, pharmaceutical companies – the ones who feed the tobacco control industry – are regulated with such a light touch in Scotland. Incoming MSPs take note.

Filtration aided by nanomaterials will make smoking safer

This is real harm reduction. The Royal Society of Chemists reports a recent study finding that nanomaterials can be used in filtering to reduce significantly the toxins inhaled by smokers.

Isn't it fantastic how scientists can put their minds to solving a health problem? Or a social problem?

We can guess what the response of the tobacco control community will be. The same as it has been to the ventilation/air management issue, and radio-controlled tobacco vending machines. 'We are not wholly persuaded that the proposed mechanism is entirely foolproof' (col. 23117), said Ross Finnie MSP of radio-controlled vending machines. (Most of us don't believe that the proposed tobacco display ban is entirely foolproof either.)

Sheila Duffy, paragon of scientific objectivity, mentions the 'discredited and expensive solution of ventilation'. The word 'ventilation' is hyperlinked to a web page of the Department of Health in Colorado, effectively an opinion piece on myths about secondary smoke, and it includes the efficacy of 'ventilation' as one of the myths.

Presenting a health service information sheet as any kind of evidence to support her cause, as if it  demonstrates scientifically the eternal and complete ineffectiveness of any kind of air cleaning system, shows only contempt for her readers.

The only right answer for people like Ms Duffy is compliance with the wishes of ASH Scotland. This applies to the whole anti-tobacco movement. Scientific methods to make smoking less dangerous are a dangerous distraction from the prohibitionists' goal of cessation.

Belated h/tip to Juliette Tworsey.

Prisoners in private mental health facility may bring legal challenge to smoking ban

Inmates at a privately run secure hospital have been given permission to challenge a smoking ban, which covers the buildings and grounds of Chadwick Lodge Hospital in Milton Keynes.

A smoking ban covers indoor psychiatric facilities in England. In common with other inmates of secure units patients at Chadwick House may not get outdoors without an escort. Even if they do get out, they may not smoke. In granting permission to the patients for a judicial review, Lord Justice Silber acknowledged the importance of this issue.

A spokesperson for Chadwick Lodge referred to the Rampton Judgement, a similar judicial review of a smoking ban at Rampton Hospital, passed in 2009.  One judge in this case, Mr Justice Keene, dissented from the view held by the court and his views are laid out in the judgement from paragraph 92. At para 108, he says:

I readily acknowledge that, in assessing proportionality in a matter like this, weight has to be attached to the position endorsed by the democratically-elected body.  However, nothing put before this court demonstrates that Parliament ever appreciated that in reality the consequence of Regulation 10(3), the time-limit on exemption for mental health units, was likely to be a complete or virtually complete ban on smoking for those detained in secure mental hospitals.  There was no debate on the merits of such an outcome, which means that there has been no democratic endorsement of it.  

He continues (referring to Regulation 10, the exemption of psychiatric units from the smoking ban that expired one year after the smoking ban was introduced in 2007):

it seems to me that the prohibition in England on smoking in institutions like Rampton, a prohibition which results from the cessation of the exemption in Regulation 10 plus the security considerations applicable there, is more than is necessary to accomplish the public health objective of protecting people against second-hand smoke.  It is therefore disproportionate, and there is a breach of Article 8.

He is quite correct that blanket bans on smoking have been forced, on people who have no freedom of movement,  without any democratic endorsement, and that this was not necessary in achieving the public health objectives of the smoking ban.  There are of course many more arguments on both sides, but this seems fundamental.  Smoking bans have failed among the wider public too. It seems distasteful to force a smoking ban on someone just because you can: just because the courts have awarded you custody over this person for treatment purposes – even though the treatment s/he is receiving is not smoking-related. (The same argument applies to those people who want to criminalise smoking in apartment blocks, when they wouldn't attempt it on someone with a large house and private garden. It actually looks like victimisation.)

Since Mr Justice Keane wrote these words we know more about the difficulties in enforcing bans. We reported recently how many hospitals, having failed in their attempt to outlaw smoking on NHS premises, are rebuilding smoking shelters. People who smoke at hospitals may be visitors, patients or staff. Patients may be temporarily immobilised by being hospitalised but in general most of these people have much more freedom of movement than someone who has been held in a secure unit for any length of time.

It is also possible that smoking bans can adversely affect treatments of other kinds. People undergoing drug rehabilitation are another group of people that have more freedom of movement than people in secure units. This article reports that they are voting with their feet and not completing their programmes following the introduction of no-smoking policies.

Health authorities should consider not whether they want everyone to stop smoking but whether it is feasible to stop people from smoking, and especially whether it is fair to deprive people of nicotine in situations where, for their safety or that of the public, they can't just walk away.

WHO demands general smoking ban in Germany

It is harder now for European authorities to claim that smoking bans are universally popular. Germany has failed to enforce its ban, Spain has protested vigorously, and Belgian café proprietors and customers have also protested about a ban due for implementation in food establishments on 1 July, three years earlier than planned. The Netherlands has also thrown off its ban for bars without employees.  


Demands not just for a full implementation of the ban in Germany but for the law to be enforced centrally instead of in its federal states have appeared, of all places, in the British Medical Journal.  I only have access to the abstract but already the Heidelberg branch of the World Health Organisation gets its say, claiming that the German people are exposed to dangerously high levels of smoke in their restaurants and pubs.


(Clearly he seems to be under a misapprehension that people are forced to allow smoking in pubs and that unwilling customers are forced to go into them.) 


People seem happy to tell priests to keep out of politics and stick to religion: not a view I would necessarily agree with – everybody should have a say in politics. I would only agree to limiting religious interference in politics if religion wanted to keep secular interests out of politics. Why don't people realise that health is the new religion? Why do people tolerate health officials who are so steeped in politics that they happily recommend interfering with German legislation in order to achieve their smoke-free agenda? 


The study is entitled 'Full smoking ban is needed in Germany as four out of five pubs flout regulations'. What size of budget is needed to report what is common knowledge: that people can smoke in German public houses? 


The Netherlands didn't get off scott-free either. Tobacco control has no respect for national boundaries. 

One for the Civil Aviation Authority: Smoking keeps pilots alert!

Under the title Is the smoking ban to blame for tired pilots? KrausKBlog reports on research claiming that active smokers can sustain their concentration for longer than non-smokers, and the poorest performers are nicotine-deprived smokers.

Similar research is reported here. Nicotine increases work capacity. Remember that next time you have to clock out for a smoke break.

The study on which this good news is based? You can see the abstract here.

The conclusion (from a tobacco harm reduction blog):

It’s time to be honest with the 50 million Americans, and hundreds of millions around the world, who use tobacco. The benefits they get from tobacco are very real, not imaginary or just the periodic elimination of withdrawal. It’s time to abandon the myth that tobacco is devoid of benefits, and to focus on how we can help smokers continue to derive those benefits with a safer delivery system.

Whether or not you want to switch to a safer delivery system is a personal decision. Any smoker who does claim to derive benefits from smoking (in spite of official assurances that they are all in the smoker's imagination) will welcome this research.

Pubs counter denormalisation

This is right. Reuben encourages the competition for best smoking area. (Although he has his reasons for not nominating any pubs.)

Pubs that have managed to carry on creating a hospitable environment for smokers are, in a certain sense, accomodating to the ban, but they are also resisting it. This is because the ban was not really about passive smoking but, rather about making smoking a more uncomfortable experience so as to push people into stopping.

Of course, the ban was about denormalisation, and furthering a script about secondary smoke that has spread round the world. This writer is right to appreciate any effort made to undermine this effort to demonise and marginalise smokers.

I can't really disagree with any of it:

One thing you will find these days is that politicians of all stripes will profess their desire to support pubs. Doing so is good politics. It’s a nod to British tradition, and to (understandable) nostalgia for a more communitarian epoch. But we are entitled to ask what kinds of pubs they wish to support. Judged by their policy, the political class seem to approve of pubs only insofar as they don’t let anyone smoke, don’t get too noisy and don’t encourage too much drinking. In other words, pubs transmogrified into beer serving starbucks outlets are what they are willing to support. And this is hardly the kind of environnent that will induce people to pay a premium over the prices in ASDA – and so its no surprise that for all the verbal publoving from our politicians, the industry is still in decline. If we want to save our pubs and clubs then we cannot simultaneously dragoon them into being part of the public health set up.

Here is a recent contribution to the pub debate from the Green Party in Scotland entitled Local pubs and small producers are the order of the day:

Politicians certainly like sounding tough on booze culture, but that doesn't offer the solution we need. Scotland does have a problem, but we think the solution lies in small businesses taking back some control. [... ] 

However, local pubs and craft brewers, whose interest lies in quality not quantity, have a great contribution to make to our communities, our economy and to a better relationship with alcohol. We don't need to let the multinationals and the big chains keep the upper hand. It's time to celebrate the alcohol culture we should have, and return the industry to a healthy state. 

We should be keeping the pub economy rooted in communities [...]

 All this stuff about community and local control is all very well, but doesn't allow publicans any control over their own smoking policy. Because smoking, say the Greens, isn't normal. I prefer Reuben's view.

Mapping mortality and health care priorities

Thanks to Paul L. Bergen for this.

Worldmapper tells us much, as Paul indicates, but I think we can take it further still.

The World Health Organisation increasingly talks about non-communicable disease control (such as here), as a major new public health priority ... indeed an epidemic that threatens to derail countries from their development goals.

A first glance at Worldmapper's page on causes of death supports this view to an extent, as it shows (using figures from 2002) that non-communicable diseases killed over 33,500,000, as opposed to nearly 18,500,000 deaths in the 'often preventable illness' category.

If you click on Deaths from non-communicable illnesses, the map will show the distribution of mortality from these diseases using land area to reflect populations affected. You can scroll through these conditions one by one by clicking on the 'next map' link to the right. They are concentrated in Europe and North America, i.e. developed countries but also noticeably featuring India. If you go to the Other preventable illnesses page and scroll through the following maps, you see a much larger concentration in Africa. (India is badly affected by these too.)  The exception is polio, which affects USA and Europe more than Africa.

The one crucial piece of information not supplied by this group of maps is the age of death. The maps giving this information list by gender as well as aggregate figures, from infancy to 100+. It is quite clear that if you start here and click on the 'next map' link till you get to age 100, Europe is starting to outstrip Africa by the time you reach the 45-to-49 age group, and by 64-to-69, Africa is skimpy.

It should be clear from this that non-communicable diseases are diseases of older people more than the other group of diseases. This is of course a very broad brush, and India seems to get the worst of both worlds. But there is certainly a pattern.

In Paul L. Bergen's words:

When the FCTC targets regions like Africa and asks (demands) that health resources be used for tobacco control operations, the money that would make a difference if applied toward malaria (or countless other endemic diseases …see more maps on the site), that would save many lives, is funnelled off into satisfying political aims with little effect on mortality.

 I would have thought it was obvious in any case that communicable diseases present a far bigger general health threat than non-communicable diseases. These maps show that communicable diseases kill the young and economically active, and this should be what concerns the World Health Organisation – not non-communicable diseases.

It would be nice to get more up-to-date figures on these maps!

Education, Education, Education: the global reach of tobacco control training

Increasingly you can get good training in tobacco control in different parts of the world: today we feature India and Romania.

The Public Health Foundation of India, in cooperation with the John Hopkins Bloomberg School of Public Health and the Keck School of Medicine at the University of Southern California offers three-month courses tailored to professionals in health, journalism, law enforcement, the legal profession and administration.

Just in case you wondered about the course content for journalists (I did), it's here. After completing course no. SCJR 2011 for journalists, participants will be able to:

• Understand the basic concepts of tobacco control
• Understand different media approaches to deal with the issue of tobacco control
• Describe the impact of globalization on the civil society intervention in the area of tobacco control
• Examine the effectiveness of media activism in tobacco control
• Understand specific role of Journalists in augmenting tobacco control efforts in India

Doesn't this speak volumes about the autonomy and independence journalists are meant to have these days? Isn't this just a little bit designed to prejudice one's understanding of the issues? There is a lecture on 'the role of journalists in tobacco control'. The courses are for the benefit of those 'full time working professionals who want to make a difference in the communities through tobacco control and enhance their career development'. 

If on the other hand you are based in south eastern Europe, the Smoke Free Partnership is your training provider. Your TobTaxy training takes place in Romania in September, aimed at picking teams of three people to work in each of Romania, Bulgaria, Malta, Turkey, Greece and Cyprus. TobTaxy, believe it or not, means 'Making tobacco tax trendy'. This particular project is funded by the EU till 2013, and is designed to  by improve (ahem) people's understanding of tobacco and taxation issues. They expect an 'increased number of visits and interaction between the public health community and the Ministries of Finance'. That's where to go if you want an all-expenses-paid boost on the tobacco control career ladder.

It may be that many people attempting these courses, whether in India or south eastern Europe, are sincere in wishing to relieve their compatriots of their dependence on the weed. Unfortunately the entire set-up is funded with an agenda that's not about learning: at least, not as I grew up to understand learning. An outcome of TobTaxy is expected to be 'formulation of rebuttal arguments through skilled debate and strategic action'. We used to learn to write essays in order to present an argument, but modern-day learners in tobacco control learn arguments for the sake of putting the other side down.

Carl V. Phillips runs a useful discussion on Conflicts of Interest, showing that 'adamance' (an unyielding attitude) can constitute a conflict of interest, depending on one's stated claims. The stated claims of the entire public health shebang are of course public health improvement. The subtext states that the tobacco industry and its associates must not be allowed to influence health policy, according to article 5.3 of the Framework Convention on Tobacco Control. Carl Phillips:  '... a good test of a position is whether its proponents can make a plausible case for it when the opponent's views are not even considered'; the plain fact is that tobacco control's strategy has relied on stamping out opposition. The whole movement's engine is a conflict of interest, because it seeks to block tobacco and associated interests from access to public policy debates (while the movement itself profits from pharmaceutical funding), all the time claiming an over-riding concern for public health.

China and Wales attempt the impossible

It is widely agreed that the smoking ban in China, implemented yesterday, will not be enforceable, and according to the Telegraph, no penalties are payable for breaches. In this vast country, smoking still features in cultural exchanges and economic deals, and smoking is not widely understood to be a health risk.

China has failed to live up to its treaty obligations under the Framework Convention on Tobacco Control. This is an attempt to comply – the outcome remains to be seen.

Wales has banned smoking in the grounds of some of its hospitals. Actually it intends to outlaw smoking in the grounds of hospitals:

The ban at hospitals run by Cardiff and Vale University Health Board is the first step in a move to outlaw smoking in all hospital grounds in the region.

This is a move that the Welsh section of BMA has wanted for many years. The rationale, according to Dr Andrew Dearden, chair of the BMA's Welsh Council, is that 'smoke was putting people's health at risk in the very place they visit to get better.'

"The BMA in Wales has campaigned for smoking to be banned on all hospital grounds. In fact, we called on the assembly government to change the law to ensure hospitals were included in the smoking ban legislation, which came into effect two years ago today,"

 he said, even going so far as to declare that:

"This wasn't done, and now, more than ever, it seems absurd to have smoking outlawed in places such as pubs and restaurants. But in hospital grounds, where people go to be cured of illnesses, it isn't."

Hospitals throughout the UK have been rebuilding smoking shelters after failing to realise their dream of smoke-free medical facilities. Apparently oblivious to this widespread failure, Cardiff and Vale University Health Board insists that a diplomatic approach is the answer: 

Dr Sharon Hopkins, Cardiff and Vale University Health Board’s director of public health, said: “We want to do this through cultural change, not through finger-wagging and fines."

Bringing outdoor smoking in hospital grounds within the scope of a public places smoking ban will not stop people wanting to light up. If it is enforced (what a waste of resources that would be!) it could deter people from turning up for treatment.

China and Wales will both discover that smoking bans leave you with as many problems as you started with and them some. Counting the cost of enforcement will be one of the first disadvantages.