About alcohol packaging, and putting economic needs first

On Thursday ASH Scotland's daily news bulletin featured more stories on alcohol than on tobacco: one story on gum disease and alcohol (you are more likely to get gum disease if you are alcohol dependent) and another discussing plain packaging for alcohol products.

This is more interesting, and is now being considered by the Health Select Committee, which also wishes to consider raising the legal age of drinking. As things stand at present, UK legislation in this area would be binding on Scotland, and clearly the Scottish whisky industry is less than pleased at the prospect of not being able to distinguish Laphraoig from Buckfast.

In a manner typical of the licensed trade, the whisky industry seems to hold the view that it's okay for other sectors to fall foul of clumsy and ill thought out government legislation,  but not their good selves:

Campbell Evans from the Scotch Whisky Association told The Scotsman that while a plain packaging measure might be workable for tobacco products, it would be far harder to implement for alcohol.

The Scottish National Party in the person of its Westminster leader Angus Robertson is quoted saying that the whisky industry must be promoted, and the SNP has warned against plain packaging for alcohol. One wonders if they ran this policy before colleagues at Holyrood (a few of their number signed a motion on plain packaging for tobacco: Willie Rennie, S4M-01640).

Will the SNP base any of its independence campaign on defending the whisky label, even while it goes along with the plain packaging policy for tobacco? Time will tell. This is an instance where the economic interest at stake has asserted itself more readily than in the case of tobacco. Will ASH Scotland back off from the alcohol debate if it cannot accept the SNP's support for the alcohol industry?

It seems likely that even tobacco control has had to give way to economic pressure in Wales, where the Welsh Assembly government are considering relaxing the smoking ban on TV sets to allow smoking under certain conditions. The idea is not to lose out to studios operating under English smoking laws, which exempt filming and TV studios. When completing the consultation on this proposal I suggested that relaxing the ban would enable Welsh TV production companies to gain business from Scotland. (I couldn't help myself. The guidelines included ensuring that no children or other members of the public were present during filming smoking scenes, and the questions asked whether respondents felt this would give sufficient protection from smoke to children and the public.)

So this watertight smoking ban that is so good for the economy is seen to harm TV production companies as it prevents them from showing things authentically, in their true likeness – and the Welsh Assembly looks prepared to act to change this situation. The idea of allowing thousands of bars and customers to live more authentically by allowing smoking in adult recreational establishments is clearly in a parallel universe. But the chink has been made in the armour. Smoking bans ultimately hurt business.

HoReCa claims damages

The launch of HoReCa is described in this press release. Damages will be sought from governments, and also possibly from other agencies that have sought to promote smoking bans.

HoReCa Belgium describes some background to the claim, declaring the smoking ban to be unlawful.

Resistance from the trade in the UK to the smoking ban has been risible. But when the authorities went so far as to imprison Nick Hogan for not paying the stupendous fines he was meant to pay for smoking ban infringements, the general public had organised a whip-round to release him within days, to the tune of nearly £9,000. Fortunately trading associations on the continent are relatively robust: perhaps they can inspire our hospitality trade with their success.

Frank Davis has described this very well. Please go over and look.

Smoking cessation will be under local authority control

The introduction to this year's UK National Smoking Cessation Conference is brief. It refers to a change of management in the field of smoking cessation:

As well as research updates and clinical innovations we will consider the implications of the shift of responsibility for the delivery of tobacco control and the commissioning of stop smoking services from the NHS to Local Authorities.

I am not too clear on the implications of this. Why are so many public health-related areas being taken out of the NHS remit and being given to local authorities? They are listed here and include mental health and dental services. Some observers fear the new system will mean that these services fall under normal local authority funding arrangements, i.e. means tested.

Although it empowers local authorities to commission public health services, this change doesn't seem to be anything to do with decentralising power. The government has employed MHP as a consultant in public health. Their report on the process can be seen here. Its introduction talks about holding the new public health service (local authorities) to account in meeting objectives that are created centrally, of course with the help of MHP. Its summary of key objectives starts by recommending all local authorities define public health in the same way. If this is decentralisation, it is very much from the top down.

Since smoking cessation is included in the package of services to be handed over to the local authorities, MHP's paragraph on the subject is instructive. It includes the information that 'NHS Walsall currently commissions the Walsall Stop Smoking Service which is achieving quit rates for participants in the scheme of 47.9%'. Information as to how long these people need to have stopped smoking before they are counted as successful is, if anywhere, buried in amongst pages of the Joint Strategic Needs Assessment for Walsall. I would hazard a guess at four weeks, especially as smoking cessation specialist Timothy Coleman has so recently told the world that patches don't work – but however long it is, it's remiss of them not to include this information in their report. However, since MHP's business is public relations, a dearth of vital detail is perhaps not surprising.

Nicotine patches: change of tune from the UK Centre for Tobacco Control Studies

From this:

The prevalence of smoking is higher among Pakistani and Bangladeshi males than among the general population. Smokers who receive behavioural support and medication quadruple their chances of stopping smoking, but evidence suggests that these populations do not use National Health Service run stop smoking clinics as frequently as would be expected given their high prevalence of smoking. [emphasis added] 

To this:

FREE nicotine patches or intensive counselling via an NHS helpline do nothing to help smokers quit, says a Government- funded study.

This latter study is led by Tim Coleman, and the earlier study was co-authored by Rachna A. Begh, both of the UK Centre for Tobacco Control Studies. Three years elapsed between the two pieces.

What are the policy implications? The concluding paragraph of Tim Coleman's study is non-committal:

In England, where support for smoking cessation is available to all smokers either free or at relatively low cost, adding additional proactive telephone counselling or an offer of free nicotine replacement therapy to usual quitline care did not affect smoking cessation rates. On the basis of this study, providing these through a quitline is not recommended.

and:

What is already known on this topic

• Quitlines can support large numbers of smokers in achieving smoking cessation.
  
  
• The most effective and cost effective methods of support through quitlines need to be determined.

What this study adds

• Among callers who sought help to stop smoking through the English quitline, offering free nicotine replacement therapy was no more effective than standard support by the quitline.
  
  
• Cessation rates were not improved by offering additional telephone contacts with advisors providing proactive counselling.
  
  
• Offering free nicotine replacement therapy or proactive support were no more effective than standard reactive quitline support

It is tempting to ask what nonsense we have been fed for the last few years about NHS being four times more likely to quit. Freedom2Choose has raised this question more than once in the past (also here).  Three years ago the mantra 'four times more likely to quit with NHS help' was received wisdom.

The Department of Health page making this claim is now archived.  However, new Department of Health guidance, dated 2011/2012, lists Nicotine Replacement Therapy with an A evidence rating ('the recommendation is supported by good (strong) evidence').  Make of this what you will. (The same document gives Champix an A evidence rating, and states there is 'no clear evidence' of a link between taking Champix and increased depression or suicidal thoughts.)

This is an extremely messy picture. The notion that NRT doesn't work is backed by other evidence besides Tim Coleman's study, but it is not supported by the Department of Health guidance linked above. Nor is it reflected in the Scottish 'Give it up for baby' campaigns, which routinely supply free patches, and pay expectant mothers to make use of the quitting service. The  body promoting 'Give it up for baby' is, rather sinisterly, named NMSC (National Social Marketing Centre), with the slogan 'leading behaviour change'. Instead of evidence-based persuasion, we have psychological manipulation of people's behaviour to suit the whims of policy makers and planners. Behaviour change could well take priority over the supporting evidence, with planners claiming that 'the ends justify the means'.  (Incidentally Tim Coleman has also recently 'discovered' that patches don't help pregnant women stop smoking either.)

Prediction: the UK Centre for Tobacco Control Studies will call for 'more research' to solve the problem of quitting; the Department of Health and National Social Marketing Centre will continue to promote the use of nicotine patches.

More David v Goliath rhetoric from the WHO at Singapore Conference

Bloomberg has pledged $220 million to fight tobacco in poor countries (how would you spend so much money?).

Judith Mackay is quoted:

Dr Judith Mackay, one of the authors of the World Lung Foundation Tobacco Atlas and a well-known anti-tobacco campaigner, said it showed "the whole drive from the high income to the low-income countries", adding that the tobacco companies "are now challenging legislation from Scotland to Australia to Iran to Latin America. This is one of the biggest developments we have seen and one of the most sinister. The WHO has said it has got lawyers and will help. This is a form of harassment and intimidation of other countries that might face challenges."  [emphasis added] 

Legal challenges to disadvantageous legislation are intimidation? Yes, there are situations where a company can intimidate a country by using legal action. But the fact of legal action is not in itself an act of intimidation. Mackay is attempting to pre-judge the issue (tobacco = wrong, civil society = right). The whole point of legal action is to have the justice system adjudicate on a case, not to confirm the prejudice of one side.

A press release gives us this:

SINGAPORE, 21 MARCH 2012 - Full implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC) – particularly provisions on countering tobacco industry influence – is necessary to protect people from the harms of tobacco use.

What happened to all the other global issues? Why is the WHO stuck on tobacco? My opinion is that it is the result of corporate pressure mounting to avoid action on industry for environmental contamination, by blaming people for their own ill health. This is the kind of intimidation by big companies that I believe is happening (see paragraph on 'Silent Science' here).

The Tobacco Control Blog carries an upbeat coverage of the Conference claiming:

 I got the real sense that tobacco industry legal threats are no longer as intimidating to governments – this will surely have a knock on effect to other countries once these court challenges are successfully resolved.

The Framework Convention Alliance might not be so sanguine, unless they have been jollied along by proceedings at the Conference.

Fairy tale from the World Health Organisation

I found it hard to believe that this was written by the Director-General of the World Health Organisation. How can a leader of the global health organisation write such emotive claptrap from her position of eminence?

Margaret Chan introduces the Fifteenth World Conference on Tobacco and Health.

This conference is being held at a time when we are at a crossroads in our efforts to rid the world of a killing addiction. In principle, the balance is entirely in our favour. In a perfectly sane, reasonable, and rational world, with a level playing field, the anti-tobacco community would surely speak with the loudest voice and carry the biggest stick.

In her world the only thing that holds back a victory of civil society over tobacco, which has unique killing properties, is the persuasiveness, power and wealth of evil tobacco companies. Nowhere does she mention that some of what she terms 'civil society' does not support the global anti-tobacco project. Perhaps most disingenuous is her 'David and Goliath' depiction of civil society, representing the poor people against the filthy rich tobacco companies. Her humble tobacco fighters are in Singapore for a four-day conference at a very humble venue, with the option of a pre-conference preparation period and includes the option of a Bloomberg award for promoting tobacco control through the arts. Scholarships are available for this heroic yet humble effort, from the Bill and Melinda Foundation, Bloomberg Philanthropies, and three other bodies (these are available for the youth sections too).

Chan says:

Big Tobacco can afford to hire the best lawyers and PR firms that money can buy. Big Money can speak louder than any moral, ethical, or public health argument, and can trample even the most damning scientific evidence ... 

So if her side won it would be because of integrity and sound scientific reasoning, but if the other side won it would be down to the depth of their pockets.

Her mission is to persuade people everywhere that tobacco companies provide products so injurious to people's health that they should not be encouraged anywhere, and where they exist they should be marginalised to the utmost extent possible – regardless of any benefits they bring to struggling economies, in any way. In the UK, for example, in spite of much reported youth inactivity and anti-social behaviour, it would still be considered unproductive to allow tobacco companies to sponsor  sports activities.  

And doesn't this just make you want to weep:

Members of civil society, 

We need you, now more than ever. 

Experience has shown that, when government political resolve falters or weakens under industry pressure, coalitions of civil society can take up the slack and carry the day. We need this kind of outcry, this kind of rage.

This organisation wishes to elevate the threats of tobacco above any other priorities of national governments. She wants an army of activists orchestrated by the Framework Convention Alliance to raise objections if governments get it wrong. Her closing comments are also instructive:

I sincerely hope that this conference, including the high-level ministerial panel on countering tobacco industry interference, will again tip the balance entirely in our favour.

This conference is our watershed event. I sincerely hope that this event further damages the health of an industry that aggressively sells a health-destroying addiction. 

We can, and must, stop this industry’s massive contribution to sickness and death, dead in its tracks.

Even if she kills off an industry with a 'massive contribution to sickness and death', she will not do away with sickness and death, and seems quite unconcerned with the complex pattern of events that make the poor particularly vulnerable. The anti-tobacco project is run by fanatics who think in terms of black and white ('civil society' good, tobacco bad), even though conditions on the ground are rarely so straightforward.

The latest report from the Framework Convention Alliance admits the movement is in trouble, but does not acknowledge that its simplistic outlook and goals might be responsible. For example it criticises those Parties to the Framework Convention Alliance that have partnerships with tobacco companies, without being at all concerned with the terms of such partnerships. Such countries are Breaking the Rules and get a Bad Mark, regardless. It is the kind of non-negotiable approach you expect from tyrants.

Press complaints commission with more on Berwickshire News

I heard again from the Press Complaints Commission officer about the Berwickshire News item Health board step up efforts to help both staff and patients stub out their smoking habit.  The complaint featured this passage:

The new policy prohibits smoking in the grounds of all the health board’s hospitals and surgeries, with only a few execeptions and harsh penalties for those who don’t comply. 

Under the Public Health Scotland Regulations 2006, failure to comply with the policy is a criminal offence. Individuals may be fined a fixed penalty of £50 for smoking in any no-smoking premises. 

Their correction runs as follows:

In an article published on January 12 about a new NHS Borders smoking policy we incorrectly stated  that "failure to comply with the policy is a criminal offence". The sentence should have stated that "failure to comply with the law is a criminal offence". 

We also stated that there would be "harsh penalties" for those who don't comply. We accept that this is also misleading and apologise for the error.

I haven't yet ascertained that this correction will appear online.

Blatant theft of an idea

Plane packaging

Too good not to share. Follow the link to discover how to make your own!

Transparency and the lobbying process

This eminently reasonable view emerged from response to a result consultation from the Irish government about the regulation of lobbyists, reported here.

The principles of good governance are compatible neither with calls for exclusion of any relevant stakeholders, nor with the existence, de facto, of a privileged status of any stakeholder in the debate. Where public policy is made having regard to only one side of any debate can sometimes lead to unintended consequences. Fair and equitable access to all stakeholders, who wish their views to be considered, can guard against this and allow Government/Regulators to make a truly informed decision. 

The response comes from John Player. Unsurprisingly it refers to the Framework Convention on Tobacco Control's Article 5.3, which seeks to exclude tobacco industry involvement with any policy decision. It is hard to see such an exclusion as fair. Not only is it short-sighted in policy terms, but it complicates needlessly the relationship of employees of the tobacco and related industries with their elected representatives.

I haven't reached a view about the need for regulating lobbyists, except if it must be done it should be even-handed. In particular the special pleading that the purpose of some lobbying is 'self-evident' and there is no need for regulation in such cases seems quite wide of the mark. Regulation need not be onerous, but if it is required of any lobbyists it should be required of all of them. It appears that many people fail to understand the importance of transparency in relation to lobbying. The ingredients of tobacco are a very small part of the tobacco lobbying issue, even though they are frequently treated as the only important issue (more on this here).

In relation to tobacco, a further point has been made in a Montreal Court where Imperial Tobacco and two other companies are facing liability trials for allegedly causing disease in smokers. The point is that all ingredients in tobacco are regulated (UK version here), and government must logically share any liability for damage, as the tobacco companies are simply playing within the rules. The more tobacco companies are excluded from policy discussions, the more persuasive such an argument becomes. (It may not win. Did you know this: 'A recent Supreme Court of Canada decision ruled that the federal government cannot be a third-party defendant in a British Columbia department of health lawsuit against the tobacco companies because its actions were policy decisions, which are immune from liability.' [emphasis added] Immune from liability? Nice work if you can get it.)


It is an unusual step for a newspaper to feature a tobacco company's submission in full. There is a link to further submissions to the consultation, but it appears to lead you to another story about lobbying instead. 

Smokefree New Zealand

New Zealand by 2025: a country where only a handful of the population will be smokers.

In a parallel universe, this won't happen till 2040.

New Statesman and Pete Robinson on pubs

The New Statesman discusses the plight of pubs. It discusses pubcos and then 'other challenges':

Demand is falling. Competition is increasing. Supermarkets are serving a new generation more interested in intoxication than conversation. With beer duty set to go up 10p a pint in the budget on top of VAT rises, there are worries that another wave of pubs will be pushed over edge, and free holders like the Railway are also at risk.

The smoking ban does not even merit mention as a minor contributing factor. Another article referred to in the text of this story does not mention the smoking ban either.

I leave it to Pete Robinson to explain that the smoking ban did enter the equation at some point. From his position with The Publican he was able to see the direction of travel very clearly. The trade was doing very well until mid-2007.

If the Publican was guilty of anything it was blind, unbridled optimism. It's as if there'd been so much good news to report over the previous few years it was unwilling to dwell on the bad.

And bad it was, arse-wipingly bad.

Towards the end of 2007 the industry was clearly in deep trouble. The 'New Breed' of non-smoking drinker had failed to materialise and the long exodus of the pub trade's life blood, its rank-and-file customers, was already underway. Pub insolvencies were already up 600%, a number that would TREBLE in the following year to EIGHTEEN TIMES former rates, while those prized industry shares were nosediving into the cellar. 

Yet at the time you'd never have guessed any of this by reading The Publican. The main consensus was how smoothly and successfully the ban had been implemented. Every 'industry ‘spokesman’ and his dog queued up to insist their business had been totally unaffected by the ban and each was reported in equal, laborious measure.

And The Publican failed to learn from history:

By 2008 the post-ban carnage could no longer be ignored. But as the rapidly plummeting trade stats settled into a terminal spiral of descent the Publican's editorial opinion switched to naively blaming 'bad' pubs which had been unable to evolve.

'Embrace' the smoking ban we were told. Just do food and everything will be okay. Up your game, open a library/post office/cinema in your pub. Set aside a lunchtime for expectant mothers or an evening for transvestite grandads.

Just offer 'excellence' then watch the customers come running.

How do you 'evolve' to a 33% to 80% drop in takings? Even if it were possible for the country to sustain 40-odd-thousand foodie pub-restaurants, for many it was madness to invest a fortune in pricey catering equipment when local competitors were offering £2.99 two-for-one deals.

In truth the customers we've lost don't want excellence. Most pubgoers couldn't give a toss about fine dining, health emporiums, creches, drop-in centres or gymnasiums. They simply want to be treated like adults. They want their old pubs back, warts an' all. 

The Publican magazine has now folded.  

Press complaints commission finds breach of code in NHS Borders tobacco policy story

I learned today that our complaint to the Press Complaints Commission regarding this piece from the Berwickshire News was resolved when the editor agreed that their story contained a material inaccuracy and agreed to correct it.

The complaint was essentially:

Among other things it discusses a new tobacco policy drawn up by NHS Borders that bans smoking throughout its premises including the grounds of hospitals. This policy is reported in the article to go 'beyond the legal requirements'. It then states, 'Under the Public Health Scotland Regulations 2006, failure to comply with the policy is a criminal offence.' There is nothing in the regulations that allows outdoor smoking to be restricted or gives NHS Borders the power to amend the law. 

i.e by printing something that was inaccurate the newspaper contravened clause 1 of the editors' code of practice. Happily Berwickshire News accepts its mistake:

The answer, essentially:

The newspaper accepts that the word “policy” was inaccurate and could be misleading to readers. It offered to change the word to “law” in a printed correction so that the sentence would read, “Under the Public Health Scotland regulations 2006, failure to comply with the law is a criminal offence”. The newspaper stated that it had not made a deliberate attempt to mislead the public and would happy to make a clarification.

So to be clear: if you are a visitor in the grounds of NHS Borders you will not be breaking the law by smoking. There is a policy against it, but a policy does not carry the force of law.

It is essential that people should not be misled into believing their choices are constrained by laws when this is not actually the case.

I am still waiting for the PCC to confirm that there will be an official record of this case on their website. This happened last time I made a complaint to the PCC.

It looks as though I was just in time. The Press Complaints Commission is to be axed. I wonder what will take its place?

Not so critical of Stacey Solomon

It's worth pointing out that some press stories on Stacey Solomon on her issue of smoking while pregnant don't condemn her and indeed regard public censure of her as abusive.

This is from a writer who appears to believe Jill Pell's quite incredible conclusions about the smoking ban and premature births. Yet she feels like the witch hunt is tasteless:

The anti-smoking lobby, which has attacked her with such venom, certainly has the stats to back up its claim for moral legitimacy. But I balk at the mass condemnation of the one-time nation's sweetheart. 

It has the whiff of the witch hunt. There are glints of glee in the eyeballs of those rushing to crucify this otherwise likable and soft-natured woman. [...]

That a good mum should be rounded on and metaphorically spat at by those who imagine that not smoking makes them angels of propriety is so painfully ironic it's almost funny. 

As for the publicity-seeking vultures behind Celebrity Mum of the Year stripping her of her previous title, that's the biggest joke of all. 

With this year's short list featuring Natasha Giggs and the still to give birth, Peaches Geldof, Stacey can rest assured that being a decent mum has sod all to do with that prize.

Hooray for this writer from the Belfast Telegraph for acknowledging that good motherhood is a not defined by being risk averse, and for condemning this needless public outcry.


Hat tip to Pat Nurse who undertook some hefty radio work on the story this week.

Understanding 10 per cent

Who knows how to explain a drop in rates in laymen's terms?

Following Jill Pell's study, headlines (and Richard Simpson MSP) advised us that the rate of premature birth dropped 10 per cent because of the smoking ban.

How do the papers come up with a 10 per cent drop? On the face of it you could say that between 65 and 55 the difference is 10, but we are not talking percentages. The figures look at rates per thousand. If the rate had been measured in hundred thousands, the difference between 55 and 65 would mean something different again. With thousands, it appears to me as a lay person that the range is no larger than 1 per cent of the sample, and I can't understand what the fuss is about.

Support for Pell from certain quarters (less from others)

Less than wholehearted support from this quarter.

Support from the great and the good in the Scottish Parliament:

*S4M-02252 Richard Simpson: Smoking Ban Reduces Premature Birth Rate— That the Parliament welcomes the report by the Centre for Population and Health Sciences suggesting that there has been a 10% reduction in the country’s premature birth rate; notes that the report has associated this with the introduction of Scotland’s ban on smoking in public places, which was introduced in 2006; understands that the study was based on data collected over 14 years from more than 700,000 women; notes that the report comes at the same time as information claiming that, since the successful introduction of the smoking ban in public places, there has also been a reduction in hospital admissions arising from acute heart attacks; looks forward to the implementation of the further tobacco control measures that the Parliament has passed to discourage smoking, and believes that significant inequalities remain in the distribution of those still smoking, which it believes to be a major public health challenge for Scotland.

Supported by: Hugh Henry*, Patricia Ferguson*, James Kelly*, Sarah Boyack*, Jackson Carlaw*, Jean Urquhart*, Helen Eadie*, Stewart Maxwell*, John Park*, Malcolm Chisholm*, Anne McTaggart*, Paul Martin*, David Torrance*, Patrick Harvie*, John Mason*

It is surely inaccurate to describe the difference between 55 and 65 premature births per thousand live births as 10 per cent. A decline from 65 to 55 births may have taken place in the period Pell examined but they don't support her case – partly because the drop is already under way before the ban is introduced. This represents a decline in the numbers affected by about one-tenth but Dr Simpson categorically states that the premature birth rate has declined by 10 per cent. (This of course might help to explain how Pell achieved her 17 per cent drop in heart attack admissions.)

Source

This piece from BBC Scotland in 2009 is also relevant because it states that the premature birth rate was increasing up to 2005: a change associated with a growing number of expectant mothers with diabetes. It does not deal with the post-2006 period. It also records the rates in the 1980s as around 54 per 1000, which means that the peak of 62/3 was not typical of the pre-smoking ban premature birth rate. In any case the variation between 54 and 62 per thousand is very small in percentage terms.

Pell's front-cover-of-the BBC premature birth speculation

h/tip Chris Snowdon, Pell now claims a 10 per cent drop in premature births since the smoking ban was implemented in Scotland.

There is no evidence for this (Chris takes apart the figures). Considering that as I write the BBC has given it a home page splash there is surprisingly little in the article to justify all the fuss,

But while their work suggests a link, it is not proof that one thing necessarily causes another. As with all retrospective studies like this, it is impossible to rule out entirely all other factors that might have influenced the finding. 

However, Dr Daniel Mackay and colleagues from the University of Glasgow say their findings "add to the growing evidence of the wide-ranging health benefits of smoke-free legislation" and "lend support" to the adoption of such legislation in countries where it does not currently exist.

Not only do the figures give a nil result, but the reporter acknowledges that even if there had been a result it might not have been explained by the smoking ban. (But the figures show that there was no significant result to corroborate the stated finding.) The report nevertheless reports the researchers claiming this non-result is evidence of a health benefit that should encourage the spread of smoke-free policies. And of course we get this:

[The British Heart Foundation] says the focus should now shift to the effect of smoking in the home and confined spaces, such as cars, especially where children are present.

Well, fancy this research appearing just as another anti-smoking offensive appears to be under way.

FCTC centre stage in the Netherlands

FCTC cannot be ignored any longer in the Netherlands.

In your dreams.

Dutch chastised again for neglecting tobacco control

Let this be a lesson. Countries that don't fulfil their obligations under the Framework Convention on Tobacco Control will be repeatedly admonished by the Framework Convention Alliance and its supporters.

Stigmatising smokers different from stigmatising tobacco companies?

Professor Hilary Graham this week criticised the use of stigma against smokers. It's kind of her but I am not sure how much it advances any argument. It was covered by a few publications: this one reports:

She has now called for a rethink on how smoking is portrayed and for the focus to be on education rather than vilification.

So what exactly does this change? The health establishment sees too many smokers among the population and especially among its disadvantaged. Beginning with the smoking ban, it has created an excessive fear of secondary smoke. It has sought to portray smokers as vulnerable and mainly poor. It has always been part of their mission to reduce what they call 'health inequalities', which (unbelievably) it actually believes smoking causes. The general public has taken its cue and come to the conclusion that smokers are smelly and pathetic as well as being murderers. At least, a vocal minority has taken this line.

The glitterati of the tobacco control movement don't have to enforce ridiculous laws like the smoking ban. (They can leave that to juniors in the environmental health departments.) They feel responsible for social inequalities – how can they fail to feel responsible, having trumped scholars through the ages by discovering what causes disparities in health in the community?

They have successfully split the left wing, which used to be friendly to working-class and community solidarity, by invoking the demon 'tobacco company' as a typical 'big business'. Tobacco funding has become dirty and is not even allowed to sponsor football matches, while, in the course of business, corporations can buy votes and ensure the success of their projects.

Professor Graham's idea of education rather than vilification doesn't fundamentally challenge anything, as the language of anti-tobacco has always been paternalistic rather than adversarial. Highly educated tobacco control professionals are taking it on themselves to explain the problems of the poor through a tobacco-soaked lens, and trying to persuade them of the errors of their ways. They encourage the community to see them as helpless addicts and have even campaigned successfully for legislation that will take them out of social circulation, to prevent them being role models for the rest of us. Hysteria about tobacco has encouraged people to think that those who have lost loved ones to heart, lung, or other 'smoking-related' complaints can justly blame tobacco, because nothing else makes people ill, right?

We are in other words in a situation where the powerful class has managed to influence social relations profoundly, and where the less powerful are told by the powerful how to behave in polite society. They are denied public space and the powerful are seeking ways to invade their private space. (They have already substantially invaded it by defining pubs, which are business enterprises as 'public places'.) There is no way that smokers can easily engage in any form of social protest, without accepting their subordination as a group. Those that cannot adapt to this requirement will see social protest as not concerning them – they will be marginalised.

And they will be the most marginalised, and perhaps in the most need of direct political action, of coming together to discuss, make plans, support each other.

No Professor Graham – you may be well intentioned, but you don't really understand that it is the purpose of tobacco control to disenfranchise and marginalise smokers, and the hateful expression of the most virulent anti-smokers is inevitable collateral damage.

Nicotine replacement could be made stronger for expectant mothers

Nicotine replacement therapy is not only distributed free on prescription in Scotland, but in areas that have taken up the 'give it up for baby' programme pregnant women are paid to use it.

A report from the University of Nottingham now 'discovers' that NRT doesn't work for pregnant women, concluding that changes in the mother's metabolism resulting from pregnancy suggest that patches with a stronger dose of nicotine could be the answer. Now they will need to find an optimum level of nicotine that is strong enough to 'work' but not strong enough to harm the foetus.

Tim Coleman, author of the study, is a leading figure in UK Centre for Tobacco Control Studies, with acknowledged personal interests in the development of smoking cessation drugs. True to form he has identified a research opportunity in the unreliability of the nicotine replacement cessation regime. That's his living I suppose but these days it's not hard to think of many better ways to use resources.

EU seeks again to harmonise policy on tobacco

EC Commissioner John Dalli announced yesterday his desire for plain packaging and for tobacco to be made to look unappealing. He refers again to the revision of the tobacco products directive, upon which there was an EU public consultation last year, showing most citizens to be opposed to Europe-wide regulation on tobacco. The section on Consumer Information (section 6) included discussion of plain packaging. In the section recording responses of government representatives, it read:

While most Member States were in favour of all proposed policy options for improving consumer information, plain packaging proved to be the most controversial. Almost half of respondents supported the introduction of plain packaging alongside the other recommended changes, but several indicated that the solutions to these problems should be more carefully analysed. 

The other categories of respondent are NGOs, industry and citizens. Let us hope those 50 per cent of government representatives who oppose the plain packaging dig in their heels when it comes time to revise the tobacco products directive as John Dalli intends to do by the end of this year:

Besides attractiveness, there are two other key issues that I consider essential for the revision of the Tobacco Products Directive. First, I am reflecting on possible ways of regulating access to tobacco in a more stringent manner to limit the exposure of minors to tobacco products. Second, I am considering how to address new types of nicotine products on the market, such as electronic cigarettes. This is the general framework in which I plan to propose a revision of the Tobacco Products Directive by the end of this year.

It is not clear that he intends to take into account the results of last year's consultation. In fact he tells us that 'consultations are ongoing', although he does not specify who has been consulted since the report was published:

Over the past ten years or so, the EU has consistently shown strong leadership in global tobacco control. We should be proud of our achievements in the international arena, and seek to build on them. The revision of the Tobacco Products Directive needs to demonstrate the EU's continuing momentum to keep up this level of leadership and to take it further. I know that many Member States are keen to live up to their commitments under the WHO Framework Convention on Tobacco Control. However, Member States cannot make progress in areas such as labelling and ingredients without further harmonisation at EU level.

Leadership in tobacco control takes priority over democratic accountability.