Tuesday 30 August 2011

Passive smoke 'danger' exposes Scottish Government to legal action

A prisoner has effectively called the bluff of the Scottish Government by suing it for passive smoke exposure – paving the way for many more cases against the government if the prisoner wins.

Reading through the worst claims about secondary smoke, one can see why a prisoner (still exposed to secondary smoke because of exemptions built into the 2005 law) might be worried. The fact that not a single fatality has been identified should offer some reassurance, but a prisoner who lives in dread of smoking-related conditions (which all affect vital body organs) might still seek compensation – why not? (Madame Labate's case might give a reason why not – see most recent link above).

Which way will the Scottish courts fall on this one? Admit no harm, or expose the Scottish public to a bill for compensation?

Will this be a push towards banning smoking in prisons – effectively removing the smoking ban exemption in prisons (as ASH Scotland aims to do)?

Will this be a political decision or one based on the evidence?

Michigan licensees ban lawmakers from premises (follows Belgian legal action)

H/tip Juliette. Bar owners ban the legislators from patronising their premises. As in Belgium, where they have reportedly sued the government for economic losses. More news when available.

Greeks struggle to enforce smoking ban

The story is here. High numbers of complaints fail to produce smoke-free Greece. Does that mean that the numbers breaching the ban far outweigh the numbers of complaints? I'd love to know.

Friday 26 August 2011

Breached the ban?: trade in half your fine for a course on secondary smoke!

Great Yarmouth Borough Council has offered a course to people fined for breaching the smoking ban. If they attend, they are let off half the fine.

I wonder who designed the course, who it was designed for (not only for people who breach the ban, surely? I thought everyone loved the ban!), how long it goes on and how much nonsense is peddled in it. It's almost bound to say that there is no safe level of secondary smoke and that ventilation never works. (Although it seems that ASH is retreating from this impossible position in the context of outdoor smoking bans.)

Nice to know that someone can make money out of the ban being breached, and all in the name of 're-education' too. When I was at school people used to think that kind of education was a sinister form of brainwashing.

British American Tobacco and Corporate Social Responsibility: damned if they do ...

Big news: companies use corporate social responsibility programmes to gain influence in political services and disguise the harm they do to society as a whole. In this study that is supported by Cancer Research UK and others the history of this industry's corporate responsibility programme is described in some detail.

I don't have any quarrel with the idea that companies undertake Corporate Responsibility for the purpose of gaining influence with powerful people. It seems the obvious thing for companies to do. Depending on who you listen to, all companies probably do damage at some level, whether to the environment, sea life, wildlife, the air, whatever. Companies also provide employment (in theory anyway) and seek to persuade that their activity does the economy and people more good than harm.

It takes a particularly vivid stretch of the imagination to conclude that only British American Tobacco has any ulterior motive behind its corporate social responsibility activities. The conclusion should be that this is normal corporate behaviour. Instead we get this:
In a detailed case study that involved searching BAT documents made publicly available as a result of litigation in the US (for the period, 1998-2000), the authors illustrate how the company used its corporate social responsibility programme in its dialogue with policymakers to influence the priorities of public and elected officials in the UK, encourage them to take notice of proposals that best suited the company (for example, to make regulation voluntary), and to revise the Government's concerns about whether the industry could be trusted to work in partnership. 
As usual, tobacco interests are endowed with all the evils of the market capitalism and every other industry in the world is ignored. The only corporate interest whose influence this study seeks to curb is the tobacco industry ... that is to say, apart from the other big bogeymen, alcohol and food. From the study itself:
This last point may help to explain why companies from other industrial sectors—specifically food and alcohol—are currently enjoying greater success in influencing public health policy in the UK through the government's Public Health Responsibility Deal [126].
This is really nothing to do with companies getting undue influence. It's about Cameron's love of playing with big business guys (but let's ignore all the other rich boys' games except for alcohol, food and tobacco). And it's about the implementation of the Framework Convention on Tobacco Control.
Finally, in highlighting the political dimensions of CSR, this paper underlines the importance of parties to the FCTC acting on the Guidelines for implementation of Article 5.3 [134]. Article 5.3 was specifically introduced to protect health policies from tobacco industry influence [135]. Its impact depends on governments implementing the Guidelines that comprise a number of Guiding Principles and Recommendations [135]. ... [etc]
If this study were really about corporate influence getting out of hand I would have some sympathy, but it's not: relying on industry papers made public during court action, it presents British American Tobacco manipulating government opinion with successful CSR campaigns, as though to suggest that only the tobacco industry were capable of such underhanded dealing.  No other industry is studied by way of comparison.

It does this in an attempt to justify further the aims of the Framework Convention on Tobacco Control as well as to criticise the UK's Public Health Responsibility Deal. It is policy-driven research, as usual. (Conflicts of interest are noted.)

Sunday 21 August 2011

Can an air quality standard resolve secondary smoke issues?

Earlier this year we discovered an air quality standard that had been published by the European Commission in 2007. Shortly after we used it in this story it disappeared from its website, but we had saved it, and subsequently published it on the Freedom2Choose website.

This link again. A discussion has developed in the comments between supporters and opponents of air-cleaning equipment in pubs. Much of it has to do with the very idea that technology could render a smoking ban quite unnecessary: nothing, say opponents, beats elimination of a contamination source.

The notions that 'there is no safe level of secondary smoke' and 'ventilation doesn't work' run throughout anti-smoking campaigns. Both are nonsensical and they conspire to ensure that eliminating tobacco smoke remains the recommended option.

As far as I can see  technology has moved a long way since noisy and ancient fans offered the best ventilation available to pubs. The situation is different now, as companies have to deal with many air quality problems with a degree of urgency. Air quality in aviation is a case in point. The equipment is sophisticated and designed to remove contaminants for a sustained period (throughout long flights for example). But it already has other uses, and possible further applications are many.

The equipment under discussion is described in the video:



Taking the video entirely at face value (which states that tests are going well and orders are being placed for the system), it would seem that all contaminants within a given air space can be removed. I would expect that systems can be purpose-built for specific buildings (businesses, operating theatres, workshops) according to their size and the kind of activity going on, and that a range of off-the-shelf models will be available to suit a range of needs. I see no reason why it should not work to clear pubs of smoke.

I've supported an air quality standard for as long as I have been aware there was such a thing. It has always made sense to me that people should not be exposed to bad air when they are working – especially when doing hard physical work, when more of it would be inhaled. I simply haven't accepted that smoke does pose a significant risk – the dose makes the poison, and toxins in smoke are extremely weak. But in principle there should be a standard for air, just as there are basic safety standards of other kinds.

So much for the standard. As for the equipment, I really can't see how it is possible to conclude that ventilation engineers will look at the issue of secondary smoke extraction, shake their heads and say, 'No can do'. Can they?

Saturday 20 August 2011

Driving smoking down yet further in Scotland

First a graphic illustration (from Cancer Research UK):

Figure 6.2: Prevalence of cigarette smoking by age, Great Britain, 1974-2005

And an interview with Michael Matheson (Scottish Health Minister) (available 6 more days from today). Sheila Duffy also participates. The Minister is questioned about the failure of the Scottish Government to meet its smoking targets. Both the Minister and Sheila Duffy point out in the interview the dramatic fall in smoking rates that has occurred since 1999. The graph (UK-wide) shows that there has actually been very little change in smoking rates since 2005.

Unusually for a BBC Scotland interview presenter Colin Kelly (sitting in for Kaye Adamson on Call Kaye) challenged the Minister and a couple of callers on their approach to smoking. Colin's fear is that if the Minister pushes too hard there will be a backlash against the smoking ban, which he likes. He is concerned about  individual liberty – to an extent – as well as costs. At 24.50 minutes into the clip he asks the Minister whether the only people who now smoke are in deprived pockets of Scotland who require help in many different areas of their lives – Matheson replies that they have a 'range of measures in place to try and help people who do wish to give up smoking'! The only problem he recognises in smokers is that they smoke.

The next stages of Scottish smoking cessation strategy seems to aim at the smokers in Scotland's most deprived communities. If Matheson is anything to go by, they won't get much of his personal attention because he already knows that all their health problems are smoking-related.

A recent initiative to persuade people not to smoke got off to a quiet start in Arbroath last weekend, where just 30 people signed up. The Courier reports the failure rates of smoking cessation programmes in the area, and state that NHS Tayside had the lowest success rate at 33 per cent (not mentioning that this figure was likely to have been a success rate at four weeks – very far from being a confirmed success story).  Professionals know that cold turkey is a very common quit method. Professional intervention seems quite over-rated, especially by those that provide it. Even if the reporters on the Courier are not reporting the full story it's good that they point out some of the failures of the smoking cessation service.

More here: again this relates to the UK, but is relevant. Of the whole NHS smoking cessation activity Chris Holmes points out that the 'real' smoking cessation rate has been about 6 per cent over the last few years. He says this:

Ladies and gentlemen, this programme was started by the Blair government in 2001.  It has been running for a decade, and boasting roundabout 50% success rates all along, with hundreds of thousands of smokers being duped into taking part with scandalous misinformation about actual outcomes, and yet the number of smokers in the UK today is: “similar to previous years”!
It's hard to resist the conclusion that the smoking rate has flattened out, and that no amount of NHS service delivery will make any difference in the future.

Edit, 21 August: You can access a permanent link to the Matheson discussion here.

Thursday 18 August 2011

Scotsman: World is adopting the smoking ban: denying the wisdom of ages

Surely the message from this piece by Scotsman consumer affairs correspondent Jane Bradley is that the rest of the world isn't adopting the smoking ban – at least not with the 'zero tolerance' approach adopted throughout the United Kingdom.

Bradley claims that the smoking ban has halved children's exposure to smoke (this seems a bit unlikely to me but no doubt she has studied the 'correct' sources) and that the smoking ban was 'likely' to be here to stay. She speaks of other 'countries' going further than the UK (referring to individual US states and possibly states in Australia), but also refers to countries, like the Netherlands, where the ban has not gained popular support.

Simon Clark of Forest is quoted as having pretty much given up on Scotland as a lost cause ('I think we are resigned to the fact that we are unlikely to make much headway in getting the ban reverted in Scotland'). Never say die, Simon. Bradley does however acknowledge the unpopularity of the ban with publicans:
Limited opposition to the ban in Scotland, makes this option unlikely, though it would be a welcome move for disgruntled publicans who say people are staying at home to drink while smoking. It is estimated that more than 450 pubs have shut down in Scotland since the ban was introduced five years ago.
The ever present Sheila Duffy of ASH Scotland deplores the suggestion of amending the ban declaring that 'only a blanket ban offers complete protection from second-hand smoke'. She then urges people to ban smoking in their own cars in order to achieve even more protection from second-hand smoke – she's nothing if not thorough.

The article finishes with the nonsense that smoking while driving is not safe – typical of the tunnel vision adopted by people from every walk of life who wish to discourage smoking. The number of journeys completed safely on a daily basis is testament to the nonsense of this statement. The only things that make driving unsafe are inattention, faulty mechanics, alcohol and certain other medications, and bad luck/other drivers. (You can see road casualties from this link here: Table ras:10001 for numbers of accidents and Table ras:30002 for numbers of casualties. Clearly it would be better if we didn't have so many, but I don't see how you can come out with smoking as a factor on the basis of anything better than supposition.)

Bradley claims that the smoking ban is likely to stay, and even Forest despairs of removing it. But no smoking ban is needed. And while the ban hasn't brought demonstrators to the streets in Scotland as it has in the Netherlands or Spain, there is no doubt that smokers would increase their attendance in public venues if there were no ban. It is simply normal behaviour to congregate, whether over tea and coffee or over a drink.

No smoking ban is needed, because smoke is only one of a number of pollutants that were discussed in an air quality standard that was drawn up in 2007 for the whole of Europe. Table A1 shows levels of pollutants in indoor air (four levels, of which smoking takes place in levels 2, 3 and 4), and there are detailed descriptions of how to dispel the pollutants. Technically beyond my comprehension, but it certainly doesn't say: 'Don't even try and get rid of tobacco smoke. Can't be done – but here's how to deal with kitchen and garage exhausts, paints and solvents.'

All this technology exists because somebody has identified a need to extract pollutants from air. The need is there, followed by the application of science to meet the need. The wisdom of 'anti-smoking' seeks to overturn the wisdom of centuries in the words of Rollo Tommasi (comment 15). 'No air management system can protect people in a room from smoke produced in that room.' We can make aeroplanes, rockets, perform surgery, make bridges that can carry formidable amounts of traffic – design all manner of hardware, software, learn languages, apply computer languages to make virtual reality. But we can't move smoke? ever?

Try this, Rollo.

Wednesday 17 August 2011

Ring-fenced funding, smoking cessation, social marketing and slave labour

Further to this post, a planning document has come to light (h/tip Eddie) entitled The Application of Social Marketing to Behaviour Change in Tayside – A Progress Report. It gives a budget for two items regarding smoking cessation totalling £540,000 and two items on social marketing totalling £162,000.

I am struggling to get hold of what social marketing is really about. Here is a very quick explanation using the smoking example:


Gerard Hastings is an international pioneer on this issue, and loves working with authority at the highest level on interventions supporting the official view of desirable behaviour change. An anonymous commenter on this blog assures me that social marketing is about behaviour change according to people's aspirations, rather than according to the grandiose notions of public health. Perhaps I should have attended this conference?

For the time being, Hastings is the only authority I have consulted, and I've yet to be convinced that there is anything politically radical or right on, or democratic, about 'top down' programmes of behaviour change. Democracy is about being represented – not being managed.*

Social marketing as developed by NHS Tayside is about top-down management. It's about NHS Tayside deciding on a desirable behaviour change, be it handwashing or smoking cessation. I would be the last to claim that the budget here was very high, but still would contend that a handwashing policy in a health service doesn't require a social marketing toolkit. It's basic hygiene.

The smoking cessation programme, with a target of 360,000, has got 800 into its fold of which around half abstain for up to three months. Its target is 1,800 quitters, or 2 per cent, over two years. Nothing startling there in marketing terms, especially if the targets are for a three-month quit. But do we really need to ring-fence that money for a very small number of people to quit smoking? Over half a million pounds?

Reading on we discover that the supermarket vouchers paid out to people passing their carbon monoxide tests probably come from Asda, since Asda is listed among the  'partnerships'.

Asda – now where did that name come up recently? Another initiative to reduce health inequalities? Oh no, it was this:
Unemployed people ‘bullied’ into unpaid work at Tesco, Primark and other multinationals 
Unemployed people are being sent to work without pay in multinational corporations, including Tesco, Asda, Primark and Hilton Hotels, by Jobcentres and companies administering the government's welfare reforms. Some are working for up to six months while receiving unemployment benefit of £67.50 a week or less.
On another page, another company participates in the no-work-no-benefit charade – a registered charity this time:
March 2009 was my first claim. The placement was seven months after. [Before that] I was going to college [to learn English]. I paid £50 for it. Then when I went to the job centre they told me: “Now it's the New Deal. You're going to a placement”. I told them my English was not good but they said: “It doesn’t matter, you have to go. If you're not going, we’ll stop your money.” They told me they would stop my JSA [Job Seekers Allowance] so I stopped my English course.
The first [placement] was with the British Heart Foundation. I worked from 9 or 9.30am to 4.30pm with a half hour break. I did everything. I went for one week and the manager was so rude. One day she ate something and left so much mess in the kitchen. Then she says to me: “Karina, you wash up.” The first time I didn’t say anything. I was scared they would stop my money.

My point isn't to 'get at' Asda or the British Heart Foundation. It's to show how companies that participate in top-down initiatives supposedly to improve our health are capable of profiteering from government initiatives to get people off benefits. Again: 'Instead of being represented, we are now being managed. The governments in all the western countries manage us on behalf of the international system.'*

*with thanks to Tony Benn (reply to second question)

Tuesday 16 August 2011

Swiss Federal Health Office: nicotine addiction is a disease

The Swiss Federal Health Office has determined that basic insurance should cover the cost of treating of nicotine addiction, which is to be treated officially as a disease – 'under certain conditions', yet to be decided. The story is here.

Pfizer has successfully put the case that Champix, among other smoking cessation medications, should be on a list of medications funded under basic insurance. (Not only does this drug have an extensive history of adverse effects – it has also allegedly attempted to conceal these effects from the general public.)

Health care free at the point of delivery is a miracle that our ancestors might only have dreamt of but like any other dream it has a downside. Defining what is 'essential', basic, becomes a matter of political lobbying according to the priorities of the day and is no longer a matter of common sense.

Treating something that is not a disease as if it were a disease and getting the treatment paid for whether by the health department or an insurance company is removing control of the situation from the individual with the affliction. It is also giving easy money to the person supplying the treatment. They don't have to sell it to the public – they have to sell it to the authorities.

Ironically even those who support the reimbursement of smoking cessation costs by insurance schemes are aware of the shortcomings of the medication:
CIPRET says Champix can double the chances of heavy smokers giving up in three months. But Gianfranco Domenighetti, professor of health economics at Lugano University, warns that the controversial medication needs to be well tolerated. “According to a Canadian study, this medicine increases cardiovascular risk by 73 per cent,” he said. Tolerance and effectiveness issues have also been raised for other treatments such as nicotine substitutes or Zyban, an antidepressant used against addiction. But most of all, according to de Haller, “their effectiveness is not 100 per cent guaranteed”. [...]
Some voices, notably in parliament, have suggested that anti-smoking drugs should only be reimbursed if the treatment is successful. De Haller is sceptical about “making people pay in relation to the therapy’s success, when the effectiveness is not 100 per cent guaranteed”.
'Not a hundred per cent guaranteed' is euphemism in style. We learned just the other day that when people  get shopping vouchers to take smoking cessation medication in Scotland they achieve a rate of only 50 per cent at four weeks. The rate drops further in the following weeks.

Health risks and hit-and-miss success rates acknowledged, the court ruling requires that smoking cessation medications can be paid by insurance schemes in the right conditions. The qualifier itself indicates that this medication is not 'basic'. Even if limited in application, the ruling will still provide drug companies with a guaranteed market for a drug that treats a state of mind.

I wonder what Simon Chapman would make of it all?

Imperial Tobacco threatens appeal to Supreme Court

The story is here. The writer speculates that an appeal to the Supreme Court could cause trouble, if the Supreme Court ruled against the Scottish Government.

However the Supreme Court has already rejected an appeal from Sinclair Collis (vending machine company owned by Imperial Tobacco) on the legislation that will ban vending machines this year.

Much as I would like to see the courts overturning the legislation, I fear that they have already been lent on by legislators, and they are not providing the impartial service that they should be providing.

Legislators are not minded to heed appeals from what they perceive as tobacco interests – even though the results of a recently published European consultation on tobacco regulations revealed that ordinary citizens argued against the display ban in the same terms as the tobacco industry (para 6.6.4).

Such prejudice should not even register with the courts.

Monday 15 August 2011

Scotland bribes smokers to quit: the efficacy of medication

NHS Tayside is extending its programme that offers money to people who use NHS services in order to attempt to stop smoking, on a postcode lottery basis. It targets its efforts towards those in deprived areas whose postcode indicates that they are probably heavy smokers, in order to try and close the 'health inequality' gap. 


The Courier explains. The scheme (which pays £12.50 a week in supermarket vouchers) has allegedly reached a quit rate of 50 per cent after four weeks. (Only five readers have left comments on this story, and they don't seem very happy about the outlay on the scheme.) This stupendously high quit rate (compared with what is normally achieved – see Michael Siegel's review of a recent study) apparently justifies the roll-out of the scheme, known as quit4u, from Dundee into neighbouring towns. 


Interesting that arch anti-smoker (and plain packaging advocate) Simon Chapman doesn't buy the line that NRT works, or that expenditure on it is justified.
The pharmaceutical industry has a clear commercial interest in eroding public and professional confidence in unassisted smoking cessation, yet easily implemented ideas, such as graphic health warnings, are more effective than nicotine replacement therapy. 
Is Chapman biting the hand that feeds him? It is not hard to find pharmaceutical links with the anti-smoking industry. Indeed health professionals were cautioned about this close relationship only a few weeks ago, by the World Health Organisation. Some of Chapman's anti-smoking colleagues are puzzled by his line of argument. Many have taken issue with him.  Not only does he not believe in smoking cessation treatments, he believes that pharmaceutical interests exaggerate the difficulties of smoking cessation, and that anti-smoking campaigning should not attempt to make out that people can't quit without help. Two years ago he published a major study that made the following points:

  • - Research shows that two-thirds to three-quarters of ex-smokers stop unaided. In contrast, the increasing medicalisation of smoking cessation implies that cessation need be pharmacologically or professionally mediated.
  • - Most published papers of smoking cessation interventions are studies or reviews of assisted cessation; very few describe the cessation impact of policies or campaigns in which cessation is not assisted at the individual level.
  • - Many assisted cessation studies, but few if any unassisted cessation studies, are funded by pharmaceutical companies manufacturing cessation products.
  • - Health authorities should emphasise the positive message that the most successful method used by most ex-smokers is unassisted cessation.
The message still hasn't got through to Tayside. 


I would love to know how Chapman expects the anti-smoking bandwagon to get pharmaceutical industry support if he goes about dissing the effects of nicotine replacement therapy. Does he expect to extort the money from the tobacco industry? Only time will tell.

Friday 12 August 2011

Selecting studies to scare smokers

Here's another one. Your risk of AF (atrial fibrillation) increases when you smoke.

Regardless of the fact that most people, probably correctly, perceive smoking as a health threat, new stories about how bad tobacco is come out daily.

But we know that. Stories about smoking roll off a production line, because there is a ready market for them. We also know that the mass market exists for stories that at least appear to give a result that makes tobacco appear more dangerous. We know that studies are censored at birth.

The same goes for secondary smoke. The diagram below comes from this story on heart attacks – the heart attack miracle that occurred in the year following the implementation of smoking bans everywhere from Scotland to Montana. Except (1) there is no evidence of any follow-up studies to show a sustained effect, (2) the figures frequently disagreed with routine statistics and (3) only the localities that did show a drop in heart attacks featured in published studies. The figure shows the range of results from all localities with comprehensive smoking bans, and the results clearly fail to show that smoking bans always result in a drop in heart attacks.

Chris's post shows more detail. We can be sure that for every study showing us the dangers of smoking and secondary smoking, there are studies or potential studies with results that anti-smokers would prefer us not to know.

This does not mean that there is no risk attached to smoking, of course – just that we are not told of any benefits (although nicotine has been appropriated by the pharmaceutical industry and so is regarded as having benefits), and we may be misled as to the scale of the risk. The study of AF linked above, for example, shows risk doubling, i.e. a risk factor of 2 – still a low risk.

Thursday 11 August 2011

Bumpy ride for UN conference on non-communicative diseases

It should surprise nobody that a global conference on non-communicative diseases fails to get to the top of most people's priorities. Former editor of the British Medical Journal Richard Smith discusses the forthcoming UN summit on non-communicable diseases (September in New York) – admits to no little surprise that there seems to be limited enthusiasm for it and contemplates the merits of a global resolution on this issue that is unsupported by any funding.

The summit focuses on four risk factors: tobacco use, alcohol misuse, physical inactivity and inadequate diet. These are leading factors in cancers, cardiovascular disease, COPD and diabetes.

Lancet editor Richard Horton observed earlier this year that the non-communicable disease agenda lacks the urgency of other issues.
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.
Richard Smith still seems to feel it is worth while keeping on the table as an issue for the NCD Alliance. But the NCD Alliance seems to be losing patience with the rest of the world:
A particular problem for the NCD Alliance, a quickly formed global body of organisations concerned about NCDs, is that the outcome document lacks clear targets, meaning that member states can easily slide away from doing anything. There are also disagreements over follow up and the need for partnerships. The alliance says that its time to “stop being polite.” They want outrage.
The issues that concern the NCD Alliance seem far too important to leave at the table of a hastily formed group of non-governmental organisations, that appears to think it should be an authority on global health issues ... an authority with teeth, that can enforce its will on member states. What can such an alliance actually do? Adequate food cannot be guaranteed by a non-governmental body without the willing cooperation of many other actors. Such a body can recommend good diet, but where malnutrition is a recognised issue it won't necessarily help matters to have yet another body declare that everyone needs a balanced diet.

All an international body can do is demand policy changes. Any other kind of intervention costs money.

What kind of policy changes will be advocated? Is this kind of scenario in less developed countries really going to be helpful or relevant?

Mr Smith seems a little surprised that NCDs don't get the attention from the general public that was given to AIDS. The global health agenda seems to have turned upside down since then.

Tuesday 9 August 2011

Smoking ban e-petition, Westminster

The Government doesn't intend doing anything about the smoking ban, any more than the Scottish Government does. Still, it's opened up the e-petition site, and two petitions on the smoking ban have been accepted.

Amendment of the smoking ban allowing proprietors of businesses to decide whether or not to allow smoking on their premises.
(directed to the Department of Health) and
 The smoking ban has lead to economic misery for many thousands of businesses. Pubs are closing at an unprecedented rate. Even non-smokers admit that the atmosphere in pubs has been adversely affected. The streets in our towns and cities are now being blighted by crowds of smokers gathering outside pubs, causing noise and litter pollution. Give landlords of public houses the choice - smoking or non-smoking! At the moment there are enough pubs for people to be given this choice - but for how much longer?
(directed to the Department of Environment, Food and Rural Affairs).

Both (quite preposterously of course) recommend the owner be able to choice whether to allow smoking on his own premises, and the World Health Organisation will be very unhappy with the Coalition if they allow such a proposal. Even though a European standard for air quality was published in 2007, rendering the ban unnecessary in the eyes of any reasonable person, the European Commission would also be horrified if anyone actually got a say in the matter on this issue.

A tally of 100,000 votes guarantees a debate on the issue. The petition is open for a year.

I have featured two petitions because they are directed towards different government departments. I have never been quite sure why it is the Department of Health's business to plan legislation affecting businesses. Anybody would think the health service had no problems of its own to sort out. This applies to Scotland as well. Scottish legislation on smoking, starting from the Department for Health & Social Care/Sport (or whatever) has been aimed at the hospitality industry and now threatens shops and vending machine operators.

It is fairly galling to feel one has to petition for the right to treat smokers with some dignity and consideration – no government should require its citizens to enforce such laws against one another.

Monday 8 August 2011

Gerard Hastings: Mandela points out dangers of smoking to prisoners on Robben Island

In this lecture on social marketing (discussed earlier here), Hastings describes how Nelson Mandela made his fellow prisoners aware that getting cigarettes in prison would involve making deals or exchanging favours with prison guards. I think Hastings is pushing the issue by presenting this as a simple attempt by Mandela to stop prisoners from smoking in the interests of their health. He was – I would expect – far more concerned with the vulnerability of prisoners and how this could be exploited by prison guards, than with the issue of smoking as a health concern. The Mandela clip is right at the start of this:



Actually I find his whole message hard to swallow. 'Doing things with, not to, people'? It takes an entire new academic discipline – social marketing – to encourage people towards behaviour change, and simultaneously to encourage them to believe that the changes in behaviour came of their own volition? It may make a kind of sense to some people – but it assumes that a common core of 'health-oriented' goals will motivate everyone, and this is far from being the case. To quote from our banner,
When health is equated with freedom, liberty as a political concept vanishes.
I find it hard to believe that Mandela, as a freedom fighter, would have espoused denormalisation as a strategy, as it is practised against smokers today. One of Mandela's followers, Steve Biko wrote extensively about what he termed 'Black Consciousness' – the necessity for blacks to think 'Black is beautiful', to take pride in black identity, way of life, economy and political cause. Under a pen name Biko wrote through the years after his banning at the age of 26, until his imprisonment and death in incarceration in 1977 aged 30. For example:
What of the white man's religion – Christianity? It seems the people involved in imparting Christianity to the black people steadfastly refuse to get rid of the rotten foundation which many of the missionaries created when they came. To this date black people find no message for them in the Bible simply because our ministers are still too busy with moral trivialities. They blow these up as the most important things that Jesus had to say to people. They constantly urge the people to find fault in themselves and by so doing detract from the struggle in which the people are involved. Deprived of spiritual content, the Black people read the Bible with a gullibility that is shocking. While they sing in a chorus of 'mea culpa' they are joined by white groups who sing a different version – 'tua culpa'. The anachronism of a well-meaning God who allows people to suffer under an obviously immoral system is not lost to young blacks, who continue to drop out of Church by the hundreds. Too many people are involved in religion for the blacks to ignore. Obviously the only path open for us now is to redefine the message in the Bible and to make it relevant to the struggling masses. The Bible must not be seen to preach that all authority is divinely instituted. It must rather preach that it is a sin to allow oneself to be oppressed. ... Black Theology seeks to depict Jesus as a fighting God who saw the exchange of Roman money – the oppressor's coinage – in His father's temple as so sacrilegious that it merited a violent reaction from Him – the Son of Man. (p. 45)
The abuse of power by whites under Apartheid was extreme and decades-old. Denormalisation of smokers and other groups, in its latest manifestation, is a relatively recent phenomenon. It is hard to imagine Biko or Mandela agreeing that health issues, as defined by senior civil servants and professors in social marketing, should define the aspirations of working people or the unemployed. It is particularly hard to imagine them being taken in by the rhetoric of social marketing – manipulating behaviour change of the powerless by the influential. It smacks too much of saying that the powerless want to be just like the influential (70 per cent of them anyway!). Starting with the missionaries long, long ago, says Biko:
Children were taught, under the pretext of hygiene, good manners and other such vague concepts, to despise their mode of upbringing at home and to question the values and customs of their society. The result was the expected one – children and parents saw life differently and the former lost respect for the latter. ...Yet how can one prevent the loss of respect between child and parent when a child is taught by his know-all white tutors to disregard his family's teachings? (p. 110)
 Hastings is correct to credit Nelson Mandela with leadership skills – but not to imagine that Mandela's heart was won over by an anti-smoking campaign that wasn't in progress when Mandela went to prison and was barely perceptible when he came out.

Excerpts from Steve Biko, I Write What I Like, Penguin, 1988 edition.

Sunday 7 August 2011

Mecca gains concession to extend gambling into smoking area

Bingo players are to be allowed hand-held devices to enable them to play bingo while 'out for a smoke', after a bid to extend the gambling area of bingo was granted by Edinburgh City's licensing board. Not all councillors approved the measure, one (Cllr Eric Barry) being quoted as saying:  "This actually goes against public health by allowing people to spend longer in a smoking area while playing this game." 

Although the Bingo Association was under no illusions about the impact of the smoking ban for bingo, a petition they ran in 2007 requested only a review of the tax levied on bingo, not a review of the ban – and even this, directed against the Scottish Parliament, could only plea for the Scottish Government to put the case to the Westminster Government. One can only guess why the Bingo Association did not protest the smoking ban itself – the Scottish Government had the power to change the smoking ban, but not to resolve the taxation issue. The petitions committee did not permit Mike Lowe of Premier Bingo, called as a witness to his petition, to expand on the issue of the smoking ban. All Sir Peter Fry could say was:
The third whammy is the effect of the smoking ban. We want to be in business when society accepts the smoking ban, as it has accepted the smoking ban in cinemas. Cinemas used to be full of smoke, but now people cannot smoke in them and we do not find the public marching out saying that they will never go again because they cannot smoke there. That process takes time so, for that time, my members want to stay in business.
For whatever reason, the ban was seen as set in stone, and not something that the industry should challenge. Instead of this, bingo pleads with the licensing board to extend its gambling operation from one part of the property to another. You can drink and gamble inside but not smoke, you can smoke and gamble in the smoking area (can you drink?) – and Cllr Barry would have prevented the extension of gambling to the smoking area, as people should not be 'allowed' to be exposed to tobacco smoke while gambling! One player commented to the Daily Record"It will give people the opportunity to smoke, which is what people use (sic) to do at bingo halls. But it will also separate the smokers from nonsmokers, and people go to bingo halls to socialise." The smoking ban broke up this sociability in the first place. 


Cllr Barry's view demonstrates the hysteria that exists today about secondary smoke, described here in a comment on a recent story about smoking bans in mental health settings:
Then you claim that there should be a “right to a smokefree environment”. Where did this “right” come from – the wishing well at the Castle of Fantasy? The bulk of what is in tobacco smoke is already in the air generally. It is also the same in other forms of smoke, e.g., cooking, heating, candle. And there is no evidence that these constitute any physical harm as they are typically encountered, particularly outdoors. There is evidence, however, that there are now some that are suffering neurotic tendencies, e.g., anxiety reactions, hypochondria, somatization. Antismoking propaganda has manufactured secondhand smoke (SHS) into a bio-weapon-like phenomenon, extraordinarily different to anything else on earth. Those that have lapped up this propaganda are now in irrational belief and fear concerning SHS, hyper-reacting to it as if it was sarin gas. They are the hand-wavers and hand-to-mouthers at the prospect of a whiff of SHS, utterly convinced that a whiff of SHS will drop them dead on the spot. Unfortunately, their neurosis has been promoted by the medical establishment. These neurotics act like a cult whose primary belief is to avoid any SHS exposure and a “right” to a smokefree environment. And officialdom accommodates and reinforces their delusion because this is the primary means to the eugenics smokefree “utopia”.
More on bingo in Scotland here.

Friday 5 August 2011

The wolf in sheep's clothing: the 'Overworld' of Tobacco Control

Some illuminating insights from Frank Davis's blog yesterday:
'I wrote last night that the antismoking zealots seem to regard themselves as good, but that I see them as evil. I’d like to kick that thought around a bit more.
The reason I think that they’re evil is because they’re destroying communities and friendships with their smoking bans. I’ve got personal experience of it, and I’ve seen it happening to other smokers, and I’ve had people commenting on my blog saying as much. I think the smoking ban is tearing at the whole fabric of society, right down at its foundations. It’s pulling it apart. The pub closures that have followed in the wake of the smoking ban are just the tip of the iceberg. 
The social damage is almost completely hidden because it happens at an individual and personal level. It isn’t ‘news’. But it ought to be, because it’s happening to millions and millions of people, and adding it all up the damage is colossal. But the politicians and the pundits and the news media can’t see it. So they don’t think anything untoward is happening. But I think something terrible is happening to hundreds of millions of smokers all over the world, with hardly anybody noticing.
That’s my perception of events, anyway. And I don’t see that there’s any upside to smoking bans. There’s no genuine health threat from secondhand smoke, and in fact some of the antismokers admit that the threat is a bit nebulous. But for them the real point of the ban isn’t to save any non-smokers’ lives, but to make smokers quit smoking. It’s a social engineering project. And it’s one that doesn’t seem to be going too well, if reports that more people are smoking since the smoking ban are true. And I can well imagine they are, now that smoking tobacco is now an act of rebellion much like smoking cannabis was 40 or 50 years ago. 
So what’s the upside? The only upside I can see is that a bunch of professional antismokers are making a very good living, thanks to all the government taxes and Big Pharma money they get. Tobacco Control is a multi-million dollar industry. For thousands of people, it’s become a career.
So there’s this Tobacco Control industry, which destroys communities, and which bankrupts businesses, and which does nothing of any positive value at all. What do we usually call that sort of outfit?
We call them crime syndicates. Like the Mafia or Cosa Nostra.
Criminal enterprises of that sort work by extorting protection money from people. They don’t contribute anything of value to the community. They just parasitically live off society. They take, and they give nothing back. 
In fact, a lot of criminal enterprises not only take, but they also give back. It’s just that they give back things which are illegal. Like drugs. Or prostitution. They’re often simply conducting businesses which happen to sell things which are illegal. If they were made legal, they’d become legitimate businesses overnight.
But the Tobacco Control crime syndicate doesn’t give anything back at all, unless you want to count the Nicotine Replacement patches which Big Pharma are pushing as the only legal alternative to smoking tobacco or vaping e-cigs or sucking snus. 
Because Tobacco Control doesn’t work quite like most crime syndicates do. It works by conjuring up an imaginary threat (from firsthand smoking, secondhand smoking, thirdhand smoking, etc, etc ) to public health, and demanding political action and, of course, public funding. And unlike the Mafia or Cosa Nostra, it hides behind the pretence that it’s doing something good. Al Capone never pretended to be doing good. Neither did “Baby Face” Nelson. Or “Legs” Diamond. 
The Tobacco Control crime syndicate works by presenting itself as whiter than white, and as Doing Good, and furthermore as Doing Good that urgently needs to be done if Lives Are To Be Saved. The trick is to find a threat of some sort, pump it up to the max, and laugh all the way to the bank with the research grants and publicity funding that you extract from big stupid government.' 
[...] read more
Or, in Ian Rankin's words, "We spend most of our time chasing something called 'the underworld,' but it's the overworld we should really be keeping an eye on."

Thursday 4 August 2011

Air quality quandary

A study has been published that sets out to measure the impact of providing air cleaning equipment and a health coach to families with a smoker, on secondary smoke exposure in the home. The results are shown here and discussed here.

Dividing the participants three ways, they discovered points of note. The groups included two (out of three) that were provided with air cleaners and professional coaching on smoke exposure. The third group had neither equipment nor coaching provided. Concerning symptoms experienced by the children involved, who were asthmatic, the difference between the two groups provided with air-cleaning equipment was negligible. Provision of a health coach, whose advice was confined to the issue of secondary smoke exposure, did not make any difference to the children's symptoms.

Only smoking households were included and so no comparison was made between smoking and non-smoking households using air-cleaning equipment.

The authors still felt they could conclude: 'Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.' Their reasoning was that they could still detect nicotine in the children even though the air cleaning equipment was in use.

This is where my understanding of the issues is somewhat patchy. I am struggling a little to see what damage is being done in the context of this study if the symptoms of subjects are being relieved. So what, if there is trace cotinine in the urine of those children?

The study itself was set up by a body known as PREACH (yes, PREACH): Particulate Reduction Education in City Homes. In terms of a study it is deliberately vague, for example it says that people are given HEPA air cleaners, but this isn't very useful information as even a brief search will show quite a few different models. Since the study seems designed to show, not that air cleaning systems work but that they are of limited use against secondary smoke, it is interesting that they don't specify which model they are using – they would surely have indicated if they had used a top-of-the-range model. In fact they are not interested in the technicalities, only in the goal of reducing parental smoking.

Perhaps they were irked by the results, especially that providing a health coach didn't improve the children's symptoms! Their focus on smoke as the only relevant pollutant is quite marked as we see in the press release linked above. For example:
Parents should be counseled to implement a total ban on indoor smoking and use air cleaners only as a temporary tool on the way to achieving a smoke-free household, the Hopkins team concludes in the Aug. 1 issue of the Archives of Pediatrics & Adolescent Medicine. [emphasis added]
and: 
Because smoking is a main driver of indoor air pollution, the researchers recommend the use of air cleaners even in smoke-free homes if they are part of multi-family dwellings in which second-hand smoke can easily seep in from surrounding units.
This even though the single greatest difference made to symptoms in the study was made by the provision of air-cleaning equipment. It is quite extraordinary to advise parents to dump the air cleaning equipment once they have managed to stop smoking, and shows pretty near tunnel vision and misunderstanding of the purpose of the equipment. They only use they perceive for this equipment in non-smoking households is to protect against smoke entering the apartment from other flats ... this eventuality in itself probably a fantasy. 


It is excellent that at least they have started looking into the use of these machines to help relieve air quality problems in people's homes. It would be even more productive to abandon attempts to re-educate parents into reducing the time they spend with their offspring if such education, as in this study, makes no clear difference to the outcome.

Everybody but everybody has got a part to play. Sometimes.

H/tip to Dick Puddlecote who picked up an opportunity missed on the recent Panorama documentary about drink. The investigator berated UK Health Secretary Anne Milton for the presence of alcohol industry representatives in policy discussions on alcohol. He neglected to remind her that her own policy document on tobacco directly contradicted this sentiment.
10.1 The government takes very seriously its obligations as a party to the World Health organization’s framework convention on Tobacco control (FCTC). The FCTC places obligations on parties to protect the development of public health policy from the vested interests of the tobacco industry. As a result, the tobacco industry has not been involved in the development of this Tobacco control plan.
The Framework Convention on Tobacco Control recommends preventing tobacco industry interests from influencing health policy. Earlier this year, the policy was applied to alcohol at a summit in Scotland hosted by Alcohol Focus Scotland and ASH Scotland. Meanwhile south of the border, according to Panorama, health bodies withdrew from the consultation discussions on alcohol policy because they felt the alcohol industry had too much influence. Said Anne Milton to the investigator:
"We have to talk to people that we disagree with, but it's really important because, actually, when you look at public health - and alcohol as a public health issue - what we need to do is employ every tool in the box. And everybody, but everybody, has got a part to play."
The expectation among health bodies now appears to be that industry should get pushed out, and that the correct answers on alcohol involve price, marketing and availability. While Anne Milton is correct that all parties have legitimate interests, the logical conclusion of her position is that the demands of the Framework Convention on Tobacco Control makes inclusive decision making impossible. However Panorama's reporter clearly shares the health lobby's view that the alcohol industry's presence in policy discussions gives it too much influence. The way to modify this influence however is for 'health' groups to stay involved, and not walk out of discussions just because they don't get their own way.

Chris Snowdon provides some historical perspective on drinking rates

Wednesday 3 August 2011

Smoking bans threaten mental health: Opinion, Australia

This writer asks why comprehensive smoking bans are imposed on mentally ill people, when at least at this point in our history nobody would think it right to impose such a comprehensive ban on the rest of the community. Both the circumstances of a person's incarceration in mental health facilities and the fact that they may not get home for a period of days, weeks or months, to say nothing of their existing mental anguish and the effects of any medication, make somebody's stay in a mental health facility possibly one of the least suitable times to deprive them suddenly of nicotine and expect them to get by on patches at best.


There do seem to be people out there in the caring profession who find the opposite and who knows but they may be most sincere in their views. But bringing in a comprehensive ban that will force psychologically disturbed people to withdraw suddenly from nicotine would be controversial even if implemented in a single unit. The current trend is for health departments to encourage if not legislate for the provision of comprehensive smoke-free mental health service, affecting all units everywhere.  People who run these departments are not medics, they are officials, who seem to be motivated by targets and ideologies dressed up as care for patients.


The comments on this story are instructive too, especially the one that points out that 'nicotine replacement is not an alternative to smoking, it's an aid to give up smoking'. In the eyes of tobacco control, nicotine replacement is a form of 'harm reduction': i.e. anything is better than smoking (as long as it's not made in China with cartridges of course) and we'll give you nicotine patches because you really want to give up smoking, don't you – most smokers do, after all! One reader says:
We should not be allowing or encouraging people to utilise pathological coping mechanism when they are facing a crisis. When alcoholics and heroin addicts are admitted we provide healthier alternative and encourage them to reduce their dependence. 
But this is a false parallel. No one is admitted to psychiatric care because he or she is a smoker. Drug and alcohol abuse signify addictions of a completely different order from a nicotine habit. There is no reason that any patient should be compelled to give up smoking. Allowing smoking areas need not undermine the ward experience for everyone else. It's just a matter of will.


To finish let's have another story about Champix (comments disabled). Sorry it's from the Daily Mail. The MHRA (medicines regulators) are convinced that people who react to Champix have underlying problems (even though most reports I have read concerned people without any history of psychological problems I can't pretend to have read enough to be certain of this). This will account for ASH Scotland's keenness to recommend Champix to those in mental health facilities.

Tuesday 2 August 2011

Tobacco pharming

When is a tobacco company not a tobacco company?

The WHO, FCTC, EU, national governments and the anti-smoking lobby, as per article 5.3 of the Framework Convention on Tobacco Control, refuse to sit round the table with tobacco companies yet quite happily accept representation from Pharmaceutical Companies. The question that must be asked is "What is the difference when Big Tobacco and Big Pharma are working together?"

The company annual report for 2010 shows that Japan Tobacco International has an R&D section which has worked on producing drugs to combat osteoporosis and HIV and that licences have been agreed with Pharmaceutical Companies both inside and outside the USA. Companies include GlaxoSmithKlein, Roche, Merck, Torii, giving a global reach.

Clearly tobacco companies will not be chastised if they get involved in pharmaceuticals, because pharmaceuticals are an approved activity. (Nor will the pharmaceutical companies which collude with companies that are engaged in pharmaceutical research – even though the likes of Japan Tobacco is still involved mostly in tobacco.) 

Article 5.3 seeks to 'protect health policy with respect to tobacco control from commercial and other vested interests of the tobacco industry'. This means in the ideal world of tobacco control, the tobacco companies don't get a look in, and despite their products being very highly taxed are expected to be listened to politely and dismissively without any hope of being able to influence the outcome in tobacco or health policy. The same applies to anyone who sells or distributes tobacco (those involved in tobacco vending machines are endangered and soon to be extinct).

So if the tobacco companies turn their attention to medicinal drugs will they be invited back to the table? because they won't have an axe to grind in the pharmaceutical area of their operations. To paraphrase the British Medical Journal, 'an obvious escape from this negativity is to quit the tobacco market'. 

Personally I think it's highly questionable whether overloading the pharmaceutical market is necessarily beneficial to health, and in general I would prefer a business environment where investment decisions were not guided by government-sponsored vilification/denormalisation/negativity campaigns ... whatever you choose to call them (and Simon Chapman and Becky Freeman, writing in the British Medical Journal, couldn't have described the process better if they were trying to slander themselves). 

Consultation report shows opposition to Europe-wide tobacco restrictions

After two weeks away from blogging, I'm just getting used to the idea again. This story has been covered by prominent bloggers opposed to tobacco control including Simon Clark, Chris Snowdon and Frank Davis but it bears repeating.

It's an important story as the consultation report shows the scale of the general public's opposition to the proposals made by the EC in the consultation (they made up nearly 97 per cent of the respondents, most of the remainder being government and industry responses). The general idea of revising the directive was to increase restrictions and to bring them within the scope of European legislation, leaving member states with less or no authority in the area of tobacco control.  Removing a vital area of policy from the scope of member states' national governments does not figure as a concern in the consultation report, but this issue was important in motivating me to respond to the consultation as it may have been to many others.

Now that they know that many European citizens are against them (as well as some non-governmental organisations, which include smokers' rights groups as well as the likes of ASH Scotland), one wonders what they will do with their Directive. Don't let them convince you that the public wanted Europe-wide restrictions on tobacco.

It doesn't.

Monday 1 August 2011

Supreme Court refuses to hear appeal on vending machine ban

Isn't it nice that the Supreme Court will avoid wasting court time by refusing to hear a manifestly unjust case, thus avoiding the clear obligation to vote against the government?

There is clearly an alternative option to a vending machine ban: mandating effective age-verification, and using equipment that allows only one sale each time a machine is activated following age verification. Yet the Supreme Court will not allow this case to be made.

I suspect it may be for the same kind of reason that the Scottish Parliament refused to allow a trial of radio-controlled vending machines – that it would put them behind in the tobacco control league tables. Juvenile or what?