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.

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.

 

Health Minister's written answers on smoking in hospitals

SOURCE
 
Written answers on hospital smoke-free policies
Richard Simpson (Mid Scotland and Fife) (Scottish Labour): To ask the Scottish Government what steps it has taken in the last three years to ensure that there is no smoking in the grounds of all hospitals other than psychiatric hospitals. (S4W-11310)

Michael Matheson: Smoking is prohibited by law only in wholly or substantially enclosed public places. Areas in the open air, such as hospital grounds and car parks, are not covered by this legislation. The Scottish Government issued guidance on smoking policies for the NHS, local authorities, and care providers in December 2005 to support the implementation of the smoking ban.

This encouraged NHS boards and other service providers, to demonstrate leadership in implementing smoking policies and promoting smoke-free lifestyles. It also highlighted the benefits of going further than the strict parameters of the law and working towards completely smoke-free policies to maximise health gain. This was subsequently reinforced in the chief executive letter Health Promoting Health Service: HPHS CEL (01) 2012.

While the decision to move to smoke-free hospital grounds is currently a matter for individual boards to determine the Scottish Government is currently developing a new tobacco control strategy, which we intend to publish early next year, and we will consider smoking within NHS grounds as part of that work.

Richard Simpson (Mid Scotland and Fife) (Scottish Labour): To ask the Scottish Government what steps it has taken in the last three years to introduce a ban on smoking in psychiatric hospitals. (S4W-11311)

Michael Matheson: Smoking has been banned in public places in Scotland since 2006 by virtue of the Smoking, Health and Social Care (Scotland) Act 2005. However, the law includes an exemption for residential mental health institutions and permits smoking in designated indoor rooms in such settings. During 2009 the Scottish Government consulted with stakeholders, service users and the public on the best way to achieve smoke-free mental health services in Scotland. The smoke-free mental health services in Scotland implementation guidance was issued by NHS Health Scotland on behalf of the Scottish Government in March 2011.

The guidance clearly articulates the benefits behind the drive for a change to smoke-free and the expectation that NHS boards will implement smoke-free policies in mental health services at a pace which suits the services’ particular needs and circumstances. For example, with the support of the guidance, the state hospital, Carstairs has managed a successful transition to its current smoke-free status.

The Scottish Government is committed to developing a new tobacco control strategy for publication early next year. As part of that work we will consider whether there is a need to review progress in this area.

Written answers on second-hand smoke exposure in prisons
Richard Simpson (Mid Scotland and Fife) (Scottish Labour): To ask the Scottish Government what steps it has taken since 2006 to ensure that non-smoking prisoners are not exposed to second-hand smoke in (a) their cells, (b) communal areas and (c) workshops. (S4W-11312)

Kenny MacAskill: I have asked Colin McConnell, chief executive of the Scottish prison service, to respond. His response is as follows:

“Since 26 March 2006 prisoners have not been permitted to smoke in communal areas and workshops within Scottish prison service establishments. Prisoners are allowed to smoke in cells as long as the governor has not designated the cell as a non-smoking cell in accordance with the prison rules. On admission to custody and when moving cells prisoners are asked for their smoking preference to minimise, wherever practicable non-smokers sharing cells with smokers.”

Richard Simpson (Mid Scotland and Fife) (Scottish Labour): To ask the Scottish Government how many complaints the Scottish prison service has received from prisoners regarding passive smoking since 2006.(S4W-11313)

Kenny MacAskill: I have asked Colin McConnell, chief executive of the Scottish prison service, to respond. His response is as follows: “The Scottish prison service does not centrally classify or record complaints specifically regarding passive smoking.”

You have to admire their priorities.

Shadow Minister for Health: lack of progress in smoking cessation in pregnant women

The Shadow Minister's motion appears to challenge the closure of training facilities for midwives in Scotland. The wording is as follows:

*S4M-03281 Richard Simpson: Birth Rates in Scotland 

That the Parliament notes that the number of births reported by the Registrar General in the most recent midyear population statistics was 52,687 (2001), 51,239 (2002), 51,792 (2003), 53,576 (2004), 54,259 (2005), 54,961 (2006), 56,726 (2007), 59,240 (2008), 59,331 (2009), 58,937 (2010) and 58,766 (2011); notes that, following the low point in 2002, an increase of over 7,000 births annually is being sustained; understands that there are growing concerns regarding births where there are complex needs, such as multiple births or where drugs and alcohol issues are involved; believes that there has been a lack of any substantial progress in reducing the number of pregnant women who smoke or, after having successfully given up in pregnancy, resume smoking; notes what it considers to be the continuing low levels of initial or sustained breastfeeding; understands that there are demographic workforce pressures and these might be exacerbated by new pension arrangements; calls into question the whole basis of what it understands is the decision of the Scottish Government to cut the intake of midwifery students by 40%, with the closure of midwifery training at three university nursing and midwifery departments, and considers that this increasingly appears to be a misguided decision. 

Supported by: Mark McDonald*, Lewis Macdonald*, Iain Gray*, James Kelly*

No doubt this is a party political challenge along the lines of  'we would do better by pregnant women by not closing midwife training facilities'. But he is asking the Chamber to agree that £40 million of public expenditure is failing to persuade a critical target population to stop smoking. It's hard to imagine that £40 million (or more) spent under a different administration will stop people smoking.

I had thought with Give it Up for Baby (the scheme paying expectant mothers £12.50 a week to enrol in smoking cessation and keep off cigarettes for the duration) that they had found the magic bullet. The scheme, started in Dundee, has recently been declared a rip-roaring success and it has been announced that the government wishes to launch it across Scotland. I guess it is a little reassuring that not all the Parliamentarians are fooled by this hype. The facts are:

1. Scottish health boards have other priorities, many of which are far more urgent than smoking cessation;
2. Even if they didn't and the money available to be spent on this was limitless there is no proof that this expenditure would bring down the smoking rate further.

News:  1. There has been a reduced nicotine inhaler on my local supermarket shelf for nearly a month.
2. We are in the middle of the 2012 UK National Smoking Cessation Conference. Tomorrow's programme (i.e. for Tuesday) is here.

Stirling is proud to present ...

... The 'independent' academic review on plain packaging. The Department of Health has so described this document in this statement: last paragraph on the first page.

The Stirling Observer finds its local university at the centre of the plain packaging campaign, and is justifiably proud. It quotes Professor Linda Bauld:

Professor Bauld added: “This systematic review forms the basis for the UK wide consultation on whether plain packaging should be introduced. The studies we identified and describe in the review were remarkably consistent in their findings

(well, there's a surprise)

and clearly set out what effect plain packaging could have. 

“The public consultation will take place from April to July and will help the government to decide whether the UK will follow Australia’s lead, where plain packaging will be introduced by 2013. 

“I’d encourage people to have a look at the evidence set out in our review, make up their own minds about the issue and respond to the consultation.”

Thanks for that, Linda. (In case anyone wishes to take up this invitation, this is worth reading, from Dick Puddlecote.)

Equally proud is the adorable Richard Simpson MSP:

*S4M-02667 Richard Simpson (Mid Scotland and Fife) (Scottish Labour Party): Plain Packaging of Tobacco Review of Evidence—That the Parliament congratulates the academics from the University of Stirling Management School, who have conducted a systematic review of plain tobacco packaging, which it believes has led to the UK Government’s consultation on whether tobacco should be sold in standardised, or plain, packaging; notes that the study team included Professor Gerard Hastings and Professor Linda Bauld, both of whom are members of the UK Centre for Tobacco Control Studies; notes that the review of evidence focuses on whether cigarettes should be sold in plain packs to reduce the attractiveness of the brand packaging and making the health warnings clear; further notes that the study claims that, in over three dozen other studies, it was shown that plain packaging can help smokers in three ways, by increasing the prominence and effectiveness of health warnings, by making the pack, and thereby smoking, less appealing and by removing the confusion about the relative harm that pack design can cause, and calls on all those who have concerns about the substantial number of new smokers each year in Scotland, who it understands are predominately young people, to respond to this consultation.

(Richard Simpson MSP is to be remembered for denying there was any need for a watertight case that the display ban would work. No doubt he feels the same about plain packaging.)

The 'independent' academic review in question is 'independent' only insofar as it is not officially part of the Department of Health. At least four of its six authors and at least two of their four institutions are set up to fight tobacco use and are funded for that purpose: to 'discover' (ad nauseum) the harms of tobacco and recommend restrictions on its use. Hardly objective or even a study, this is an attempt to assemble a brief in support of what government plans to do. Calling it an independent academic review is disgraceful and dishonest, and sadly what we have come to expect from the government in relation to tobacco control.

Just wouldn't it have been nice to have included the views of Ukraine, the US Chamber of Commerce, TransAtlantic Business Dialogue and other US business organisations that have protested, the International Chamber of Commerce, Brand Republic or even British American Tobacco? Perhaps an 'independent' academic review could have ensured representation of these views in the report, and even academics from relevant disciplines for assistance in compiling it.

But the wisdom of the health lobby trumps all of them.

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.

Scotland's spending on tobacco control, 2010-2011

Tobacco Control Activities, 2007–2008 to 2010–2011

	2007-08	2008-09	2009-10	2010-11
	£	£	£	£
Overall Budget Available	13,545,000	19,996,230	20,358,046	20,295,596
1. Smoking Cessation-Related Activity	9,160,500	12,711,230	13,128,096	13,013,096
2. Voluntary Sector Activity	1,005,112	983,950	983,950	971,500
3. Smoke-Free Laws	2,596,000	2,550,000	2,550,000	2,500,000
4. Smoking Prevention	148,125	3,165,000	3,098,000	3,065,000
5. Tobacco Communications	550,000	521,000	550,000	300,000
6. Surveys	70,000	62,000	33,000	18,000
7. Miscellaneous/Contingency	15,263	3,050	15,000	3,000
8. Tobacco and Primary Medical Services (Scotland) Act 2010 - Implementation				425,000

Notes:
1. Smoking cessation figures do not include the £2 million per annum contained within NHS boards’ unified budgets.
2. The above figures do include the budget for enforcing the smoke-free legislation and is provided by means of a block grant.


ASH Scotland ('Voluntary sector activity') earnings for the coming year don't seem to have reduced much.

The biggest section of the budget is smoking cessation related-activity. If local authority money is included, this gives over £15 million to smoking cessation this year. The Scottish Daily Mail today declared on page 32 (no url), 'Scots smokers failing to heed £20m health drive', and tells us that the Scottish Government has failed to achieve a 22 per cent smoking rate by the end of this year. Dr Richard Simpson MSP appears to experience a moment of clarity in this article when he says: 'I also have concerns about the amount paid to pharmacies. We need to be sure this is not the same people who keep coming back when the first lot of patches has not worked.' Appearing not to hear him, Public Health Minister Shona Robison says, 'It's good news that we've seen a significant increase in the number of people using NHS services to quit the habit': didn't anyone tell her what the headline of the story was? Since the number of smokers has remained constant, Dr Simpson could be right that they have created a revolving door syndrome


Smoking prevention is a big issue in budgetary terms. A survey of young people carried out by Young Scot (remember this picture?) was completed in 2007. Interestingly, it doesn't  refer to brightly coloured packaging or the visibility of tobacco in shops as contributing factors to young people smoking. The three most popular options chosen by participants were peer pressure, 'looking good' and curiosity. The range of options offered to young people in the survey did not include either option (the survey questions are listed at the back of the document). Clearly nobody read this report before drafting the law that would ban tobacco displays. 


All in all, disappointing that most of this money isn't used elsewhere in the Scottish health service or Scottish society generally.  

The Beauly–Denny pylons: more about relative risk

h/tip to Kate

Scottish Government plans to build a power line between Beauly (Cromarty) and Denny (Stirlingshire) have given rise to protest on health grounds. The line will carry 400 kilo volts and cross 137 miles at a height of 53 metres. Parts of an existing line will be dismantled and parts will go underground, but no underground work is expected at Stirling, the major centre of population on the route.

A Daily Record report earlier this year mentions leukaemia as a known risk of living under electricity pylons.  It claims that childhood leukaemia rates under high voltage lines are twice what they are away from such lines, and also mentions depression and suicide as further risks associated with high voltage lines. Dr Richard Simpson MSP criticises the absence of any proper discussion of these health issues.

A doubling of risk is fairly low. To compare with the risks from secondary smoke: the risks (of lung cancer or heart attack) commonly said to result from exposure to secondary smoke are around 24 per cent, or a relative risk of 1.24, which is considerably less than 2 (indicated by a doubling of risk). Many risks have to be at least 3 before they are taken seriously enough to merit investigation as to whether they can constitute a cause of an outcome.

Dr Richard Simpson does himself some credit in this instance. He is clearly a man who believes in the precautionary principle: he favours smoking restrictions on health grounds – even though a risk of 1.24 does not constitute a meaningful risk in any sense of the word. A doubling of risk (an increase by a factor of 2) is perhaps another matter, especially when discussing childhood cancers, rather than the alleged ill effects of secondary smoke, which are generally diseases of old age. As Dr Simpson says: we may decide after an investigation about the likely health impact that we still want to have the project, but we are not even having the discussion about health. Stirling residents see the government burying the power lines in areas of scenic significance but not in areas where large populations live.

This link discusses some of the issues around electro magnetic fields (EMFs) that surround pylons. Paragraph 12 helpfully gives the exposure risk rates and compares pylons with both active and passive smoking. It says that secondary smoke exposure increases risk of heart attack from 10 in 100,000 non-smokers to 12 in 100,000 exposed non-smokers. Leukaemia rates increase from 3 in 100,000 to about 11 in 100,000 following exposure to EMFs. This is much more than double but the rate varies according to the strength of exposure, generally with results between 2 and 4.

Officially the verdict goes like this: 'the evidence does not establish that exposure to EMFs is a cause of cancer although it does provide some evidence to suggest the possibility exists'. That's probably fair, for a relative risk reaching 4. So the Scottish Government should recognise the fears of the Stirling residents and acknowledge that there is at least some ground for their fears, rather than ignoring the issue altogether.

As for the Scottish Government's view of secondary smoke, if it can make light of a relative risk of up to 4 on childhood leukaemia so far as to expose whole communities to such a risk, it is hard to understand how a risk of 1.24 (alleged risk from secondary smoke) is so serious that it can deprive every pub, club, bingo club, bowling alley (ad infinitum) in the land of any discretion in how this problem should be managed.

Understanding the business of selling tobacco

Who knows more about selling tobacco. These people?

Or these people?

My vote goes to the former crowd. They sell tobacco, alongside other consumer commodities. They buy it every few days and sell it every day. The survival of their livelihoods depends on understanding the market environment, in tobacco and whatever else they sell.

They also believe in upholding the law around purchasing age. They make use of No ID No Sale (devised by the Tobacco Manufacturers' Association), a campaign designed to encourage age verification at the point of sale.

What about the British Heart Foundation? On the face of it they are an organisation designed to make the public aware of heart health. Nothing wrong with that. In this instance however they are using charitable donations to promote the tobacco display ban, which is a real waste of money when their expertise is not in the tobacco trade. Considering that many people who are in the tobacco trade consider that the display ban will make bootleggers stronger and sales to young people harder to control, they are using public funds to back a loser. And they claim (either in naive ignorance or untruthfully) that only the tobacco industry disagrees with their approach to the tobacco trade. In an era where universal benefits are about to be sacrificed on the altar of cost efficiency, just how stupid is this?

No doubt the British Heart Foundation works very hard to maintain its revenue stream, which is substantial (its Annual report is downloadable here). Their survival depends on successful fundraising (and significantly, legacy fundraising), running profitable second-hand shops and canny investments.

But it relies on naive arguments for its tobacco policies. There is no evidence that the display ban will work (I know I linked to this piece already but really, what are these people doing passing laws without knowing they will make any difference?)

Imperial Tobacco loses court bid to stop display ban

The full judgement is here. It's too complex to digest quickly, but the judge Lord Bracadale did not agree with the petitioners' case that the provisions of the tobacco display ban crossed the line defining reserved legislation.

In the eyes of the court, the transaction between the customer and the patron remains fundamentally unaltered by the display ban. (The Scottish Government on the other hand recognised that it could not, for example, ban the sale of ten-packs, as this would materially restrict the way in which tobacco could be supplied.) Imperial also failed to establish that the measures of the Act, outlawing the display of tobacco and the banning of vending machines, concerned the regulation of the supply of tobacco for the sake of general consumer protection: the judge held that the regulation was minimal and for the specific purpose of public health promotion by way of persuading young people not to smoke, which is a devolved issue.

In his summing up the judge quoted at some length material prepared in support of the legislation, in order to show that the legislation sought to influence young people rather than dissuade adults from purchasing tobacco: i.e. to show that the legislation had a specific public health objective, rather than a consumer protection objective.

There was also discussion of whether the Tobacco and Primary Medical Services Act interfered with free trade agreements between dating back to the Union – too much to absorb in one morning!

Unfortunately, the terms of the tobacco display ban do substantially interfere with transactions between shoppers and suppliers as indeed they are meant to, by forcing both parties into whispers that might have accompanied the sale of 'two packs of three' forty years ago. If the judge is correct in his conclusion, there remains the fact that the customer is confronted at best with a list of products in order to make his choice instead of being able to see what is in stock. If not meant to inconvenience or even stigmatise, the whole procedure is designed to convey the idea that cigarette smoking is discouraged. Even if this doesn't alter the character of the transaction in a way that defines it as reserved legislative territory, it certainly merits challenges from all quarters. Perhaps counsel for the tobacco companies, brighter than I am in such matters, will find grounds for appeal.

As people of all ages regularly access illegal substances, it is not guaranteed that subversive sales are likely to dampen the popularity of smoking. Indeed the lack of available evidence that the legislation will have the effect of stopping young people from smoking is well known: during passage of the Bill, Richard Simpson MSP said: 'The fact that we do not have all the evidence is not a reason not to have the ban.' U-huh. (Comment, with language alert.)  Problems with implementation and enforcement have also been expressed in an article published in The Grocer, which calls for the legislation to be scrapped. Imperial Tobacco is not the only body working for such an outcome.