Hypothermia: the wrong message

The Lothians have seen a rise in hypothermia cases, says the Scotsman. 


This could be only the 'tip of the iceberg', as this article discusses winter deaths in general: many are not defined as hypothermia, as they take the form of respiratory or cardiovascular events but their incidence increases in cold weather. The jump seen this winter undoubtedly results from record cold temperatures in December. And yet countries with colder climates than the UK have better records than we do.


I've always been a little surprised at the silence of charities for the elderly on the subject of the smoking ban. Or did I miss something? 


Under the smoking law it is illegal to stand and smoke in a doorway. A smoker, regardless of his/her age or condition, is required (even in the absence of law enforcement agents) to expose him/herself to the elements rather than seek shelter in a doorway. A smoker, to fulfil the requirements of the law, must ignore his/her own most basic instincts to seek shelter, to the peril of his/her life.

Of course we have all seen smokers in doorways of an evening smoking. Enforcement officers issue warnings, then toddle off home at 5 pm, leaving smokers at the mercy of their fellow drinkers. There is much moaning about doorway smoking, but who would force a smoker out of a doorway? I have no idea, I've never seen it happening and can only hope that most anti-smoking vigilantes would draw the line at forcing a person bodily to stand in the rain/wind/snow.

Extreme changes of temperature and alcohol are both bad for maintaining body heat. Requiring people to leave drinking establishments to smoke in the open air (especially in winter) seems counter indicative. Surely, protection from hypothermia requires the maintenance of a regular temperature, and this is more important the older one gets, especially after a drink.

So much for pub-goers. What about those who stay at home? A recent study has emphasised people's need for social interaction, showing that isolation can have bigger health indicators than smoking itself:

Data across 308,849 individuals, followed for an average of 7.5 years, indicate that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity). 

Those who don't wish to subject themselves to the indignities of the smoking ban (and others housebound for any reason) will fall all the more readily into the habits accompanying isolation, such as sitting still for long periods and failing to keep warm.

The recent struggles of acute hospital trusts to bar smoking from hospital premises spring from a fear that offering any shelter to smokers will 'send the wrong message'. Those trusts are entirely wrong about this. It is not the wrong message that people should  have access to 100 per cent shelter (when smoking), especially when they are ill or in distress, and especially when they have to emerge from warm hospital to the chill outdoor air of a British winter. It is the wrong message that the advice given for decades to elderly and vulnerable people for avoiding hypothermia (and indeed isolation) are suddenly dispensable when it comes to advising smokers. The risks of exposure to cold air are clear and present; of subjecting anyone to risk from passive smoke are distant and hypothetical. How are we to take official advice to keep warm seriously when we are ordered into the cold for the sake of using a (legal) tab?

No doubt Cameron's cronies in Downing Street aim to teach us our civic duty of caring for our elderly neighbours re the new social relationships of the Big Society. But do they appreciate how much harder the task is, now that the nation's social institutions have been snatched and remodelled so as to leave so many out in the cold?

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.

Safe levels of secondary smoke confirmed

Remember this piece from the Staffordshire Sentinal where a West Midlands environmental health officer was quoted describing a study that a study 'found a child [in a car] inhales three times the amount of smoke that would be considered safe to inhale over the course of a day'?

The study referred to is not online, but a powerpoint presentation that shows the results of a similar study can be seen here. The lead author of this presentation is Hilary Wareing, Co-director of the Tobacco Control Collaborating Centre, Warwick, who also authored the study featured in the newspaper article.

The authors compare the exposure of children to smoke in a car with the EU allowable daily exposure of 25ug/m^3. Conveying a sense of shock, they say that children absorb three times more smoke in a ten-minute (or an eighty-minute) journey than is permitted by the European Union in 24 hours.

The maximum length of journey undertaken in either study was 83 minutes. This is roughly one-seventeenth of day. Giving the exposure of smoke during a journey as three times the EU permitted level would be accurate only if the journey was 24 hours long and the smoke exposure was constant throughout.

The authors don't seem at all concerned by the length of exposure to smoke: the powerpoint graphs don't include the length of time exposed. They find that 'concentrations of PM2.5 found in all journeys, even when a single cigarette was smoked, were three and a half times higher than the recommended daily exposure'. In other words regardless of the number of cigarettes smoked (and the length of the journey undertaken), exposure was constant. They also find that 'open windows or an active ventilation system resulted in lower concentrations but levels remained above the EU daily exposure limit'. This acknowledgement that managing the air makes a difference is a significant one. (The quotations are taken from the paper version of the single-author version of the study, hard copy only.)

Concentrations of fine particulate matter, which is measured by PM2.5, provide a limited indication of the dangers presented by aerial pollutants. Actual toxicity matters, as well as particle size. As Michael McFadden observes:

[the environmental officer quoted by the Staffordshire Sentinal] is equating the FPM 2.5 produced by cars, commercial high temperature incineration, and general industrial and chemical processes with the FPM 2.5 produced by the quiet low-temperature combustion of tobacco and pretending they are the same thing just because the particles are the same size. That's actually not much different than comparing a teaspoon of arsenic crystals with a teaspoon of sugar crystals and concluding they are equally dangerous to eat because the crystals are the same size ....

Finally, as noted above: FPM 2.5 is VERY disproportionately produced by tobacco burning at smoking temperatures. That's why the Antis have turned it into their holy grail for talking about "smoking pollution." It actually has nothing to do, all by itself, with any determination of the "danger" of the pollution involved except that such small particles, just like vapors, can go deep into the lungs.

All that said, the admissions that one can measure smoke exposure, and also reduce its concentration by air management systems, are important, especially coming from a tobacco control organisation.