Health and Sport Committee concealed evidence in petition hearing

Last Tuesday, 22 January, the Health and Sport committee took less than six minutes (180:45 minutes in) to dismiss a petition that took months to research and several exchanges of emails with helpful Petitions Committee admin staff in order to get the wording to maximum effect.

It is quite clear that the committee staff were reading off the Scottish Government script (the briefing written by the Scottish Parliament Information Centre, which includes the best tobacco control fairy tales in its summary of the facts), including such beauties as the heart attack drops and similar miracles brought about excusively by smoking bans. This is what appears to have swayed them – the conviction that reducing the passive smoke exposure of workers has led to clear improvements in general public health, and the equally hard-to-believe scenario presented by Richard Simpson MSP that the argument as to whether air cleaning technology could ever be able to clean smoke from a room had been settled for all eternity in 2001.

Gil Paterson's position is patently ridiculous – admitting that ventilation improves 'every day', and yet it will never be safe to expose anyone to smoke. He also explains the government's position on passive smoke in terms of pointing out to the public that freedom doesn't mean being able to damage other people: a conclusion that is neither relevant nor illuminating in the circumstances. Claiming that smoke 'must pass by you before it gets out' is another indicator that Paterson has not noticed how far air cleaning technology has moved.

The fact is that second-hand smoke is a red herring in the air quality issue. No ventilation equipment can operate unless it meets criteria set out by OSHA and its member organisations in Europe. The criteria are based on the presence of measurable chemical compounds during eight-hour shifts, regardless of whether secondary smoke is present.

Such indoor air quality standards feature in studies by Professor Andrew Geens, who refers to recognised occupational exposure limits throughout his work. This work was submitted as evidence to the petition along with substantial additional material. This evidence was introduced at the meeting itself by Aileen McLeod MSP on behalf of F2C (Scotland) member Bill Gibson, but none of the committee wanted the opportunity to scrutinise this evidence.

They voted instead to close the petition, effectively burying the evidence.

Euroscepticism from the left

This is a departure from the normal area covered by this blog. The other day I bought the Morning Star, feeling that the Guardian is a fairly pro-establisment paper that would not reflect the kind of left wing that was betrayed by Blair and Brown. This is what its leader says about Europe (following David Cameron's promise of a referendum):

We cannot hope for a Miliband government which stands up to the European Union. Not on EU-enforced austerity. Not on EU-enforced privatisation. Not on EU-enforced attacks on workers' rights. Not on the EU transformation into a NATO-style military force.

And certainly not on the EU democratic deficit. The bloc has steadily tightened the noose on the governments' power to conduct their own affairs. It has grabbed more and more power for its unelected officials to dictate national policy.

Its war on democracy has gone as far as imposing unelected 'technocratic' leaders on Italy and Greece with orders to enforce austerity by any means necessary.

And neither the Tories nor Labour nor the hapless Lib Dems are willing to give us a chance to say what we think about British membership of this warmongering, undemocratic big-business superstate.

EU membership is too important to abandon to Ukip (sic) and the Tory right, who are on the right side of the debate for all the wrong reasons.

***
Socialists and trade unionists should be bold in pushing for withdrawal from the EU. We must not be chased off the battleground by critics trying to smear all Eurosceptics as racists and frothing Ukip extremists.

We can make and win the case for EU withdrawal based on hope, not fear. ... If Miliband's Labout won't offer that vision then it's up to us to apply the pressure from below. The People's Pledge campaign has already registered a series of overwhelming votes in favour of a referendum and momentum will only grow throughout 2013. [Link added]

...The three main parties want a capitalist Britain to be run by the global elite. The Tory right and Ukip want a capitalist Britain to be run by the British elite.

We want Britain to be run by the British people. We want a socialist Britain – and we can't have that until we escape from the grasp of the Brussels brokers.

Morning Star, 24 January 2013

 

I was quite surprised by this editorial, because I thought the left had bought into the European deal. Europe seems to be in the grip of corporate lobbyists (at least that's how it looks from this country): and more power for corporate bodies almost invariably means less for the people they employ.

A referendum would be good, without waiting for the electoral convenience of the Prime Minister.

PE 01451 closed after very brief hearing, Scottish Parliament

It looks as if I'll need another attempt to upload the video of the Health and Sport Committee meeting on Tuesday this week. In the meantime the link is here. The meeting lasts over three hours. Our petition comes in at about 180.35 minutes in.

Calling it a hearing is something of an exaggeration. One member, Aileen McLeod MSP, introduces a letter with some supplementary evidence presented to her in person by her constituent Bill Gibson, and sent to other committee members subsequently.

Gil Paterson MSP talks of his experience with the automotive industry, comparing workers in a car workshop where he describes a sealed environment and gas masks. He then opines that there will never come a time, regardless of the advances made in air cleaning technology, when the smoking ban can be repealed safely.

Richard Simpson MSP says that the ventilation issue was settled way back in 2001, recommends closing the petition and abruptly leaves the committee room leaving the convenor, Duncan McNeil MSP, to wind up in his absence.

Glancing at the sheet in front of him (no doubt the Spice briefing) regaling tales of improvements in heart attack and asthma admission rates, he concludes that the smoking ban has been of great benefit and, no one dissenting, declares the petition closed.

No scrutiny of the evidence has taken place, nor suggestions made to call expert evidence on smoking and air cleaning technology. Mr McNeil declares that the smoking ban works according to Health and Safety Executive guidelines by removing the source of the pollution rather than providing ventilation, showing that he has chosen not to consider the possibility raised in the petition – namely, that removing smoking gets rid of a single source of indoor air pollution, leaving the remainder, and making very limited difference to any toxicity in the air.

 

On access to politicians

According to certain people this article should not be circulated as it comes from the pen of tobacco industry executive Ronan Barry, but his point is too important to leave at the mercy of the Framework Convention on Tobacco Control.

He welcomes a proposal within the EU for a committee to investigate tobacco lobbying, because of the issue of whether tobacco companies should be allowed access to political figures in order to put their case and fight their corner, according to article 5.3 of the Framework Convention on Tobacco Control.

He proceeds:

European companies are comprised of European citizens. To say that any class or category of citizens should be barred or restrained from communicating to or trying to persuade politicians to their points of view is, I would suggest, to challenge some of the EU’s fundamental democratic principles.

However, this is what some anti-tobacco NGOs want to do. Why? Is it because they realise that the arguments of the tobacco lobby are strong and credible? Or is it because they have a profound mistrust in the ability of democratically elected politicians to do their job, ie to listen to the views of society, choose between competing arguments and then make policy. The people of Europe expect politicians to judge between opposing arguments and viewpoints. They do not expect that NGOs should attempt to control or supervise who may present politicians with arguments in the first place. [Emphasis added.]

Barry makes the reasonable case that access to politicians is a general principle accountability that must not be over-ridden by interest groups demanding the exclusion of others from the democratic process. He is not opposed to a committee finding that greater transparency is needed in the lobbying efforts of tobacco companies provided the same standards of transparency are applied across the board.

Television advertising of electronic cigarettes

This evening cigarette advertising on television begins again: electronic cigarettes, that is.

In this interview, Sheila Duffy, CEO of ASH Scotland and Michael Ryan, director of E-lites, the brand of electronic cigarette that is being advertised, go head to head. I don't envy Duffy, who is caught between a rock and hard place, and her position is hard to rationalise. Her loyalty is to tobacco control, which has a mission to reduce the smoking rate. Although e-cigarettes allow smokers to use nicotine without smoking, avoiding some of the alleged health effects of smoking, she is cautious about celebrating the advertising of e-cigarettes because using them mimics the act of smoking.

She also comments on the fact that e-cigarettes contain nicotine: however the ASH Scotland position on smoking cessation is: ASH Scotland believes all proven treatments which help smokers to quit should be freely available on the NHS in Scotland. One major treatment is nicotine replacement therapy, which the NHS supplies in Scotland as elsewhere, yet Duffy does not appear to object to the use of nicotine in NRT. Does she believe e-cigarettes should be free on the NHS?

Duffy is caught between the need to appear to respect people's choices and her dislike of what they choose. Countless people worldwide have stopped smoking – good – but done it using e-cigarettes. Perhaps not so good. She cannot come out and condemn e-cigarettes because they do provide an alternative for smokers and are supported by enthusiasts everywhere who have helped them to give up smoking. Her suspicion of e-cigarettes remains.

Michael Ryan, defending the advertisement of e-cigarettes, argues cogently against Sheila Duffy, rejecting out of hand that people will smoke because they see someone using an e-cigarette. He uses public health concerns about smoking to promote e-cigarettes, an entirely logical choice of marketing strategy in modern Scotland – it is a shame he has to repeat the '4000 carcinogens' story used by tobacco control to describe the content of tobacco smoke. No carcinogen found in tobacco smoke is unique to tobacco smoke and I believe the number of toxins in tobacco smoke that can be harmful to humans (if ingested in sufficient quantity) is fewer than ten.

I am not sold on the idea that mass smoking cessation would have a miraculous effect on public health, even if it could be enforced. What is true however is that millions of people have taken up e-cigarette use, either permanently as a means of quitting or for relief in environments that are hostile to smoking. E-cigarettes seem to be a growing market.

Unfortunately for Sheila Duffy, her methods of promoting smoking cessation have failed: twelve years of escalating smoking cessation and tobacco control expenditure have done nothing to hasten smoking cessation, which has actually slowed down.

Figures on tobacco control and smoking cessation expenditure obtained from FOI request from the Scottish Government, December 2012

Number of smokers taken from Scottish Household Survey reports

It is hard to see what tobacco control has to lose from the advent of e-cigarettes if their goal is truly to give smokers an alternative – their record in bringing down the smoking rate is abysmal. It is hard to escape the conclusion that their goal an endless number of attempts to stop smoking, rather than actual successes.

Helping smokers to quit is a highly cost effective public health measure. ASH Scotland believes all proven treatments which help smokers to quit should be freely available on the NHS in Scotland.

NHS Tayside responds to complaints about smoking shelters

Late last year Smokers Justice presented a complaint to NHS Tayside about their smoking policy following this story.

Phil Johnson of Smokers Justice sent me this reply from NHS Tayside.

NHS Tayside, along with other Health Boards in Scotland, considers smoking to be the most serious threat to the health of the people of Tayside. In accordance with this view we believe that, as a public health organisation, it should contribute, in every way possible, to continuing the de-normalisation of smoking. A key component of this is NHS Tayside's policy which bans smoking in its grounds. Our own staff, visitors, other Health Boards and the Scottish Government has strongly supported our Smoking Policy.
[Links added]

In line with any other Policy, the smoking ban has to be enforced and our experience since 2006, (when the Policy was launched), has indicated that the employment of a Liaison Officer, along with support from NHS managers, is the most effective approach. The Courier and Advertiser is trained to persuade those NHS staff and visitors who smoke in our groundsto put out their cigarettes and signpost them to support services to help them quit smoking permanently. In the case of staff, he can also report smokers to their line managers for potential disciplinary action. Given the fact that our staff are viewed by the public as exemplars for health, then their behaviour can have a significant impact on the beliefs and attitudes of others. This is particularly important in the case of smoking.

I should stress that NHS Tayside staff who smoke are offered, and receive, considerable support from smoking cessation experts to quit smoking. Many of our staff have actually sought support to quit smoking as a result of our Policy.

We do have one smoking shelter in each hospital for in-patients to smoke. We decided not to have any others because our experience showed that this would dilute the message of our Policy. Also, when we tried to have more shelters pre-2006, staff and visitors saw this as an excuse to smoke anywhere they liked.

Therefore it is essential that we maintain the strength of our message within the Smoking Policy, which, along with other tobacco control initiatives, will eventually lead to a smoke-free Scotland. [Emphasis added]

Good luck with that one, NHS Tayside. The direction of travel has changed since anti-smoking rhetoric became an international government obsession, reflected in the smoking rate seen against anti-smoking government expenditure in Scotland:

Figures on tobacco control and smoking cessation expenditure obtained from FOI request from the Scottish Government, December 2012

Number of smokers taken from Scottish Household Survey reports

It is hard to find a way to say how unproductive tobacco control spending is on actual outcomes regarding smoking levels. And since we know so little about that, the figures on heart attacks and other health indicators are fairly meaningless as it remains as impossible as it ever was to measure either smoking levels or passive smoke exposure.

On the issue of smoking in hospitals, the casus belli in this case, read Smoking Scot, whose research and detailed accounts are worth pursuing.

I am very familiar with General Hospitals and their smoking shelters and I've had ample time to observe the dynamics of several shelters. During daylight hours the main users are hospital staff, able bodied patients and outpatients. During visiting hours those patients who need help with drips, catheters and such frequently enlist the help of family and friends - and they park themselves close to the entrance. There's nothing rebellious about this, the simple fact is the entrances to the shelters are not wide enough for a standard wheelchair and - in almost all cases I witnessed - we're talking about the aged or severely infirm, some with a terminal condition and all with something medical attached to them. Exposing them to rain, snow or extreme cold in a flimsy hospital gown is simply not an option for those who really care about them. Reality is so very far removed from the idealistic little vacuum of Simpson and McMahon.

After dark was a time of great poignancy when those without family had to make it to the entrance on their own. I spent a couple of evenings chatting to an aged widow (close to the entrance; even a hospital gets quiet after 21.00 hrs), who was remarkably candid about her condition and immediate future, despite having to wheel her drip which had her catheter reservoir dangling precariously on a hook. However they all had one thing in common, considerable personal dignity. None of us wanted to be in hospital yet those places, the entrance (after everyone had naffed off), or the shelters were great levelers. Met many very interesting people, got lots of tips and advice, even made a friend, and was delighted for him when he finally got what he wanted and passed over. And not one of them had any smoking related illness. Guts, bowels, breasts and brain cancers mainly.

Continue reading

Smoking Scot continues, discussing the perils of developing a culture of covert smoking, questioning who is demanding smoke-free health services, despairs at the myopic medical establishment view of smoking itself. The piece stands by itself but raises points that have been touched on this blog many times.

The main point is that actions enforcing the denormalisation agenda have no effect whatever on smoking rates, except perhaps to retard their decline. Like Sheila Duffy, NHS Tayside is living in a dream world if it believes the present trajectory will lead to a smoke-free Scotland.

Fifteen-fold rise in tobacco control spending since 1999 but decline in smoking rate slows right down

On Friday 14 December Sheila Duffy of ASH Scotland speculated in an opinion piece on the possibility of a smoke-free future – one where smokers make up less than five per cent of the population.

Aiming for an adult smoking rate of five per cent or less in roughly a generation is an ambitious but an achievable target. It depends on effectively helping the 69% of adult smokers who say they want to be smoke-free to achieve their ambitions, and preventing children from becoming hooked on tobacco.[1]

She announces a tobacco control strategy to be launched by the Scottish Government in early 2013. It will show the way to reduce the smoking rate within twenty years to levels that might allow them to describe Scotland as ‘smoke-free’.

This effectively involves Scottish Government making policy decisions that will dissuade adults from making the decision to smoke. The graph below shows UK-wide smoking rates over around 60 years from 1948 (the solid lines), with the sharpest declines between the mid 1960s and 1990, most of it before tobacco control was a major government policy issue:



Smoking prevalence and lung cancer incidence, by sex, Great Britain, 1948–2007[2]
Click to enlarge

It is immediately evident that the rate of decline has slowed in both genders since the middle of the 2000s. Scottish statistics on the smoking rate since 1999 are shown below:

Whether respondent smokes by year, 1999–2011 data, Adults (2011 base: 12,866)[3]
Click to enlarge

A slight and slowing decline in the smoking rate is clear. In November I submitted a Freedom of Information request to the Scottish Government in order to get a picture of how much money had been spent on tobacco control generally and smoking cessation specifically. The results are shown below:

Figures obtained from FOI request from the Scottish Government, December 2012
Click to enlarge

Viewed against the smoking cessation rate we have this:

Figures on tobacco control and smoking cessation expenditure obtained from FOI request from the Scottish Government, December 2012

Number of smokers taken from Scottish Household Survey reports

We can see that the decline in the smoking rate has slowed in spite of a sharp escalation of tobacco control spending in Scotland (spurting in the middle of the decade in preparation for the smoking ban). We must stress that the total smoking cessation expenditure on this graph is included in the total tobacco control expenditure and not additional to it. However Scottish Government total expenditure on tobacco control has increased by some 1500 per cent – and this figure does not even include expenditure by other bodies such as Cancer Research UK[4] and Big Lottery funding.

Two conclusions: (1) this represents an atrocious waste of public money, particularly in an age of austerity: the prescriptions of tobacco control have resulted in an attack on the hospitality sector and forthcoming restrictions will also inconvenience both smaller and larger shops, when the tobacco display ban is fully enforced. Tobacco control policies have also resulted in higher taxes on tobacco products, all of which favours illegal rather than legal tobacco suppliers.

And (2), if such a huge increase in expenditure has failed to persuade people not to smoke, it is hard to see what new initiatives could possibly make an impact. Certainly Sheila Duffy’s dream of driving the smoking rate down from 25 to 5 per cent of the population in the next twenty years is pure fantasy. She should be recommending an immediate cessation of all tobacco control expenditure.

---

[1] http://www.politics.co.uk/comment-analysis/2012/12/14/the-wisdom-of-scotland-s-smoke-free-gamble

[2] http://www.cancerresearchuk.org/cancer-info/cancerstats/types/lung/smoking/lung-cancer-and-smoking-statistics

[3] http://www.scotland.gov.uk/Publications/2012/08/5277/10#figure10.1

[4] http://www.cancerresearchuk.org/science/research/who-and-what-we-fund/browse-by-location/edinburgh/ash-scotland/grants/13466-a-tobacco-free-scotland-delivering-%60beyond

UK tobacco control and smoking cessation expenditure (from Westminster) are set out in 'ASH Briefing: UK Tobacco Control Policy and Expenditure' (updated October 2012) available here.
Press release link

No one is seriously talking about a complete ban in smoking in pubs and restaurants

So said Clive Bates (formerly a director of Action on Smoking and Health) in 1998 – a different generation of tobacco control that could still respect choice and recognise that smokers should have access to public recreational space. Just six years before a comprehensive smoking ban was implemented in the Republic of Ireland, and nine years before such bans covered the whole of the United Kingdom.

If nothing else this shows how money thrown at a situation changes the tone of public discussion. A policy that was declared to be unthinkable in 1998 turns into superstrong smoking legislation in four separate legislatures in the United Kingdom less than a decade later.

Clive Bates was moderate by today's standards and has joined the debate in recent months.

Adding anti-depressant drug to smoking cessation therapy fails to help prisoners stop smoking

Who is surprised? What struck me about this story was that the drug in question, Nortryptiline, 'is not FDA-approved for smoking cessation but often is used for that purpose'. That it does not work for smoking cessation is not terribly surprising, as no interventions seem to have a long term success rate of more than about 5 per cent.

We know that the prison population is given drugs for smoking cessation that are not approved for this purpose. Are the prisoners informed that the drugs they are on are not licensed for this purpose?

Cautionary notes on Nortriptyline are as follows:

Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant such as nortriptyline, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. 

This is shocking – a non-approved drug being used for behaviour modification purposes in a captive population.

In fact the leader of the research reported in this article, which concluded that the drug did not help smoking cessation in the long term, seems to think that the prison population is not captive enough: 'One thinks that you have a captive audience" in prison studies, she said. "However, half of the prisoners were either transferred to another prison within the study or released into the community.' Fluidity in the prison makes follow-up harder – surely this is hazardous for a drug which might induce suicidal tendencies.

Bear in mind that Glaxosmithklein received record fines recently for (among other things) improper marketing of drugs – selling them for non-approved uses. Why is it legal to do this in New York prisons? Looks like, as far as smoking cessation goes, anything goes – especially when a population already has limited choices.