Safe levels of secondary smoke found in smoker's home

An article misleadingly entitled 'Danger in every breath' claims that an Evening Times trainee editor was told that her smoking did not produce hazardous levels of smoke.

Admittedly one person smoking twice a day in the house produces far less smoke than a 20- or 40-a-day smoker. The current wisdom of the medical establishment is that there is no safe level of secondary smoke. But two cigarettes produce a level of smoke that is not lethal.

The early part of the article refers tests on smokers homes reading up to a concentration per cubic metre of '3000 micrograms – 120 times higher than safe levels' (defined as 25 micrograms per cubic metre, according to the Evening Times article: I am still looking for support on this from WHO). The specific reading for the editor's home featured in the second part of the article is not recorded, but the editor expresses her 'relief' that the air in her home was 'at a safe level'. We are not told how far below 25 micrograms per cubic metre the editor's house was measured at.

Not only was the editor's house measured below the 'safe level': we are also informed that there is a safe level: this admission occurs rarely but I have seen it before in this story, which reported that children in cars inhaled 'three times times the amount of smoke that would be considered safe to inhale over the course of a day'.

Environmental tobacco smoke is not listed in the 2005 document Workplace exposure limits (EH40). Other readers will be more familiar with some of the chemicals listed here than I am, but I did note that flour dust is recorded with a value of 30 mcg per cubic metre (long-term exposure limit) or 10 mcg per cubic metre (short-term exposure limit).

It seems curious in the light of so much publicity and pressure for legislation surrounding secondary smoke that smoke is not listed in the WEL document (which was updated in 2011). The word 'smoking' is used only once, as a 'complicating factor' in considering workplace exposure. (Nicotine is listed with a lower limit of 0.5 mcg/m³ , far lower than the limit given for smoke.) The words 'smoke' and 'tobacco' don't appear.

Many unresolved issues remain: if every other substance under the sun, including those with exposure limits that are less than 1 microgram per cubic metre can be listed in a document called 'Workplace exposure limits', why not smoke? And (of course) why is smoke the only substance commonly described of having 'no safe level of exposure'?

Liberal Vision revisited, again

This time, a discussion of the relevance of libertarianism to the smoking ban, for the benefit of people who think of themselves as libertarian but still believe that the issue is about dirty air caused by smoking ('The right to swing my fist ends where the other man’s nose begins'), rather than an invasion of personal autonomy, and the right of individuals and businesses to decide their own rules of engagement.

I haven't considered the issue of libertarianism enough to know whether I am a libertarian. But you don' t have to be a libertarian to realise that the only way the health authorities have got away with the smoking ban so far has been by convincing enough people that secondary smoke is a killer (even though there is no evidence to support the hypothesis that isn't distorted by compounding factors). And to convince people of something so unlikely, they must have been distorting the truth for some ulterior motive – which is not acceptable to me and many readers of blogs like this one. Government needs to be reliable, truthful and keep things in proportion. It fails on all counts with this legislation.

Too little too late: Duffy answers Waterson

The response, when it came, was barely audible. Sheila Duffy's retaliation to Paul Waterson's suggestion that perhaps we should review the smoking ban came five days later, and somewhat tepidly reiterating the same tired points that we have been hearing for years now.

The smoking ban reduced heart attack admissions by 17 per cent in the year following implementation. Except they didn't, as was blindingly obvious from the moment Jill Pell's study was announced to the world (nine months before the actual study was published).

Asthma attacks in children declined by 18 per cent (the smoking ban did not affect child venues) – this was not true either.

Duffy also remarks on the state of the hospitality sector, remarking that it has not suffered overall. However, certain sections have suffered, namely pubs, clubs and bingo halls. The licensed trade association would not be calling for a review if its members were not suffering.

Duffy finally asks 'who would compromise or roll back on these health gains'? The problem has been that she and her like have lost much credibility over these supposed health gains. Consider ASH Scotland's next project: extending the smoking ban to prisons and mental institutions and intervening to stop people from smoking with children at home. It's the issue of children that exposes the poverty of the secondary smoking claims. It is an article of faith among anti-smoking activists that smoking bans do not increase children's exposure to secondary smoke. But the smoking ban inevitably involved at least the risk to children of considerably more exposure to secondary smoke. Since the strategy was denormalising smoking, the politically acceptable route was to prohibit smoking in public places and then conduct a very thorough 're-education' to persuade parents not to smoke at home. (Coming soon to a town near you.) It might have been more credible simply to have made some very strong statements about secondary smoke to encourage parents to smoke away from home, but left adult venues alone, with perhaps some encouragement to use extraction systems. That would have both reinforced smoking as an adult activity and protected children further from exposure to smoke – but of course would not have 'denormalised' smoking or made smokers an object of public vilification.

As a rebuttal of Paul Waterson's piece, Sheila Duffy's fails: Mr Waterson's is better researched and more reasonable. I would not agree with his recommendation of separate smoking rooms, unless he wants bars hit with rules from licensing boards about when staff may enter specific rooms in pub premises. An indoor air quality standard and extraction systems could do the job, clear the air of  all the stale air as well as the smoke, and open up pubs for business to their core punters again.

SLTA invites Dutch and Croats to reconsider smoking ban

The Scottish Licensed Trade Association has invited licensees from countries where the smoking rules are more relaxed – the Netherlands, Croatia and Hungary – to a meeting with Scottish licensees in order to explore possibilities of relaxing the ban.

At a time when the world awaits an avalanche of outdoor smoking bans (following New York) and apartment bans (following Australia), perhaps the last thing anyone expected was for the Scottish licensed trade to announce that smoking bans in pubs are not needed! This is not in fact what the SLTA is saying to the press – they are looking for 'some accommodation', not a return to the old days.

Good luck to them. Bringing Scottish licensees face-to-face with their counterparts who have fought successfully against restrictions in other countries is an inspired move, and we hope it will restore some confidence to our licensed trade.

In the mean time, the Scottish licensed trade and all hospital managers should know that there is a European Air Quality Standard, EN 13779, that deals with non-residential human occupancy and discusses tobacco smoke as just one of a range of conditions in buildings that must be dealt with. This documented is dated 2007, so it has been known for some time that tobacco smoke is reckoned to be a problem capable of resolution. There never has been a need for a smoking ban, and the whole of Europe should know it by now.

ASH Scotland considers second-hand smoke in the home

Today saw ASH Scotland's conference entitled Smokefree Homes and Cars, at the Dundee Hilton. Its agenda speaks pretty much for itself (but more below). ASH Scotland's work on smokefree homes has been assisted by  a National Lottery grant of £500,000, awarded in 2009 which was more than half its government grant for 2009/2010 (most recent information on ASH Scotland's finances here).

Yesterday (the 2nd) ASH Scotland released a press release on the event, which referred only to the 'smokefree homes' element. Sheila Duffy summarises future requirements as follows:

• 'setting a national target for reducing second-hand smoke exposure in the home;
• ensure continued funding to develop and evaluate new smoke-free home programmes at local level;
• develop a robust monitoring and evaluation system to measure and compare effectiveness of the range of projects that are ongoing and share best practice;
• develop further training in second-hand smoke issues amongst health professionals and others who work with families;
• support partnership working to meet targets and pool resources; and consider implementing a public health campaign to raise the awareness of second-hand smoke in the home.'

None of these involves any change in smoking legislation, but intensive 'partnership working' with people who deliver services about smoking. And of course a funding commitment (they will need a renewal of this revenue stream) – but with lottery funding and occasional injections of cash from Cancer Research UK topping this up.

Ever wanted to know what the Big Society means? Forgive my cynicism, but it means just this: 'voluntary sector' groups can set a policy agenda, attract funding enough to pay nearly thirty salaries and organise and pay for policy implementation with limited parliamentary scrutiny. Within a few short years, our fear of secondary smoke has allowed us to abrogate responsibility for controlling the stuff, to the extent that we are now supposed to welcome 'experts' who wish to advise us about making our children and grandchildren and their friends ill from the effects of fourth hand smoke. No law is needed, we are just expected to do what the experts tell us is right. Our rights to privacy have been trumped by a perceived right to 'smokefree' air.

Just as ASH Scotland succeeded in creating smoke-free psychiatric services without resorting to changing the law, and not  unlike Honduras, where the police can be called for dealing with family smoking even though smoking is not itself a crime, government is bypassed and partnership working does the rest.

A top-down policy agenda (in the case of smoking, one that we know comes from the Framework Convention on Tobacco Control) is fulfilled, to all appearances, by 'the community' with popular support from the grassroots. I don't buy it: nothing suggests that the smoke-free agenda is anything but doctrinaire and intolerant scaremongering.

Banning smoking in cars

The Northern Ireland Assembly and Westminster are both under pressure to extend the smoking ban to include cars that carry children as passengers.

Deborah Arnott, of Action on Smoking and Health (unlike her pal Sheila Duffy at ASH Scotland) definitely wants legislation: 'While we can't pass legislation to prohibit smoking in the home, smoking in cars can and should be prohibited by law.'

Reports on Northern Ireland (link above) say that nine out of ten households want a smoking ban in cars. This suggests that most people are likely to consider the perceived sensitivities of children to smoke, and that legislation is not needed.

I adopt the general view that respiratory problems in children have increased while smoking has decreased and see no reason to attribute breathing problems in children to smoking. I don't have children, nor do I drive and only smoke on a very irregular basis so don't have any personal slant on the issue.

My big question is, if they suspect that secondary smoke is dangerous, why have they left protecting children so late in the day? They have been campaigning on secondary smoke since the 1970s:

... the last 40 years have seen an incredible amount of expenditure on studies, press releases, TV ads and such things all designed to play up the fear of wisps of smoke in pursuit of the strategy laid out at the 1975 World Conference on Smoking and Health chaired by Sir George Godber.  The consensus of that conference was that to achieve the public support needed to eventually eliminate smoking it would first be necessary 'to foster an atmosphere where it was perceived that active smokers would injure those around them.'

Since they had all this ammunition at their disposal, the simplest thing would have been to protect the children by first of all campaigning about them. They didn't do that: they decided to protect adults instead, and run the risk of further exposing children in the process. Now their strategy is to come back and say: 'the adults are protected: it's only right that now we protect the children', yet bydoing things in this order they have left children 'exposed' for years.

Their objective is and always has been opposing smoking, not protecting health. Had children's health been a factor they would not even have run the risk that parents would smoke more at home. Given the number of pub closures over the past four years it is very hard to believe stories like this: but even if they are true, the possibility of displacing parental smoking to the home, given the dangers now posited, should have made the smoking ban untenable.

I really doubt whether home smoking has done very much damage. I was brought up in a 'smoking household', in that my father smoked until I was ten. But we lived in a big draughty house. I have lived in houses where the smoke was more noticeable. One was a converted flat, where condensation on colder mornings would gather in puddles on the window sills and drip on to the floor. Someone did smoke there, but the problem was not smoke, it was over-tight windows, no chimney, etc.

We were brought up learning that damp housing hurt people's health. Substandard housing and bad air will hurt children's health. The debate on cars must be left to people with more experience of children's health and car interiors, but really the call to ban smoking in cars has come far too late in the day to take seriously as a major health risk. Dame Helena Shovelton of the British Lung Foundation declared: 'Smoking just one cigarette, even with the car window open, creates a greater concentration of second-hand smoke than a whole evening’s smoking in a pub or a bar.' By not tackling this stupendous problem before tackling smoking in pubs, they have ruined their own case.

Late reminder for Hallowe'en: use it for Bonfire Night

When I tell you that this reminder comes from the executive director and chief counsel of ASH.org (US), you might have an idea what to expect. Never mind the car accidents and the poisonous candy (he says). Don't be too concerned about fires either (let's add). The death toll from secondary smoke tops the lot.

Thus, suggests Prof. John Banzhaf of Action on Smoking and Health (ASH), adults should warn their children this Halloween, and also on other days, against visiting, going to parties, or playing in homes where adults smoke, especially in their presence. 

Adults puffing around the bonfire are clearly to be avoided like poison.

Stay safe. Avoid smoking adults on bonfire night.

Bad science in a good cause is bad science: social marketing under a spotlight

John Davies, a professor with scruples, explains why bad science in a good cause is still bad science.

The object of his attack is social marketing, which is manipulating/influencing people to achieve societal goals, as opposed to marketing in a commercial context, which clearly aims to influence people for commercial gain. Social marketing prides itself on manipulating people for their own benefit. However I don't know a huge amount about this area so have included this link from the Open University, which introduces some of the ideas behind social marketing. It says that social marketing relies on voluntary compliance rather than coercion. My thoughts: velvet glove, iron fist (h/tap Chris Snowdon).

Social marketing appears critical of commercial marketing, however the book Social Marketing carries the subtitle 'Why should the devil have all the best tunes?' Proponents such as Gerard Hastings, the book's author, clearly have much to learn from commercial marketing about the techniques of persuasion, but will they be any more honest than their commercial counterparts? 

The Open University link above explains social marketing as 'marketing to achieve social goals'. But whose social goals? Is there a social consensus about the matters that social marketing is involved with, namely health and the environment? Certainly not, I would suggest, these days.

Social marketing is mentioned frequently in anti-smoking initiatives, indeed John Davies refers to the passive smoking concept as an example in his video. ASH Scotland's recent report Beyond Smoking refers to it in both section 2 (Cessation) and section 3 (reducing exposure to second-hand smoke). In both these sections social marketing is employed to influence people into behavioural changes. The end is clearly felt to justify the means (John Davies tells how it is also employed in education about cocaine use). 

Social marketing also popped its head up at the 2010 UK National Smoking Cessation Conference in Glasgow, in the shape of at least one session featuring the use of social marketing: it featured telling the stories of real life quitters and was presented by Andy Lloyd and Martyn Willmore of Fresh Smoke Free North East (their group is also featured in the recent Forest report, from page 10). Lloyd, interestingly, is Media, Communications and Social Marketing Manager for their organisation, which gives some idea how central social marketing is to the tobacco war. 

We are grateful to John Davies for putting the question: once you start telling lies, or disguising the truth in a good cause, where does it stop? I think he did not quite ask, Who decides what the truth should be? Where's the accountability? All good questions, and ones that the public increasingly begin to ask.

Canadian blog tells how smoking bans damage elderly people in their homes

The Old Rambler is one of many blogs to cover the story of 88-year-old Philipina Schergevitch today. He lives in Canada where there is no exemption for elderly residential homes (although some have been able, against many odds, to construct special facilities) in a country with regular sub-zero daytime temperatures in the winter.

A link in this story shows a care worker facing court action for alleged criminal negligence following the death of resident Myles Patterson after being left smoking outside. The worker was acquitted in a short trial (read the second and subsequent accounts here). The Crown was no doubt anxious to absolve itself from any responsibility (without legislation there would have been no need for outdoor smoking) and the defence that a care worker with 15 years' experience on the job could 'forget' that an elderly person was smoking outdoors in a wheelchair in sub-zero temperatures as night was approaching is a little hard to believe. But the defendant was found not guilty, and the home took measures to prevent a recurrence of the tragedy by imposing a ban on anyone smoking outdoors in temperatures below 5 degrees.

Secondary smoke is really that scary to the Canadians.

The eviction notice against Philipina Schergevitch reaches another level because no one can show that smoking in one apartment causes contamination in another. They are struggling enough to show that the effects of secondary smoke cause more than mild irritation in the great majority of people. It's mostly air. The consequences of being stupidly scared of secondary smoke are bad enough, but this takes paranoia to a new level by claiming that smoke can creep along beside electricity cables into the house next door.

The government, which subsidises her rent should be thinking very, very hard about this.

Please don't delay in taking action and spreading the word.

Letters to the Department of Health

This is a long post but the correspondence is informative on the real-life implications of smoke-free mental health services. The correspondence is real but the name given of the letter-writer is fictitious (Mr Gordon at the Department of Health is not fictitious and will be known to anyone who has ever written to the Department of Health in London on matters related to the smoking ban!)

1st letter, August 2010

Dear Mr Gordon

Please register a formal complaint about my treatment by the Department of Health regarding denial of access to healthcare.  I believe my rights are being breached with no justification and in a way that is disproportionate to an argument of protection of public health.  I am being harmed by inhumane treatment and removal of my rights to make my own lifestyle choices.

It appears that healthcare is not a human right when smokers are concerned but rather a privilege for good boys and girls who have only fashionable vices or can be forced to comply with lifestyle engineering from people who don't even know them or have their best interests in mind.

You have been unable to provide evidence to support your claims that second hand smoke presents a health risk to workers and the general public.  Nor am I aware of any reason why I would be forced to stay in a place that would subject bystanders to potential harm when twenty first century technology is quite capable of creating comfortable, non-offensive and segregated (if necessary) environments for all.  The marginalisation of smokers is particularly harmful when incarceration without relief and involving forced withdrawal leads to suicidal thoughts.

It seems unlikely that independent scientific evidence can support such forced treatment when air quality standards for workplaces are not breached by levels of smoke in a particular environment, when expert opinion   [English translation] considers there to be no risk and when all evidence is assessed as a whole rather than cherry picked from marketing reports for the cessation industry.

As you know, I use electronic cigarettes and you are also considering closing the harm reduction market so there will be no options left for me other than to smoke (there is evidence that NRT is ineffective and a scandalous drain on health services and potential quitters).  When I am experiencing a psychotic episode I smoke to feel normal and more stable, I do not know yet if electronic cigarettes will have the same benefits so it's important for me to know that I will not be forced to withdraw from smoking if I'm in a psychiatric hospital.

The smokefree scam is clearer now that outdoor bans are planned, the harm reduction market is up for closure and government grants fund dodgy lobbyists for social engineering projects.  It's clearly not about health and not justifiable under the European Social Charter.  If anyone bothered to do real research they'd discover that quit rates declined as the cessation industry grew.

Apart from incidental conflicting interests, AstraZeneca have a presence on the DH Scientific Committee on Tobacco and Health - serving to prove that this is about vested interests and brand wars, not public interest.

I look forward to hearing from you

H Johnson

*****

Later in August

Our ref: DE***********

Dear Ms Johnson, 

Thank you for your recent emails about secondhand smoke, smokefree legislation and human rights.

I realise that you disagree with the Government’s position on the dangers of secondhand smoke, but medical and scientific evidence shows that exposure to secondhand smoke increases the risk of serious medical conditions such as lung cancer, heart disease, asthma attacks, childhood respiratory disease, sudden infant death syndrome and reduced lung function.

The evidence base that secondhand smoke harms health is substantial and indisputable.   It has been reviewed extensively over many years, both in this country by the Government’s independent Scientific Committee on Tobacco and Health (SCOTH) and overseas. 

In June 2006, the US Surgeon General published a report that examined a great deal of evidence and found that even brief secondhand smoke exposure can cause immediate harm.  The report says the only way to protect non-smokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors and that exposure of adults to secondhand smoke has immediate adverse effectson the cardiovascular system and causes coronary heart disease and lung cancer.

The US Surgeon General concluded that: 

•                                  secondhand smoke causes premature death and disease in children and adults who do not smoke;
•                                  children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma.  Smoking by parents causes respiratory symptoms and slows lung growth in children;
•                                  exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer; and
•                                  the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

 The Surgeon General said on the publication of the report that:

The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance.  It is a serious health hazard that can lead to disease and premature death.

The World Health Organization (WHO) has classified tobacco smoke as a known human carcinogen.  The US Environmental Protection Agency classified secondhand smoke as a “class A” human carcinogen, along with asbestos, arsenic, benzene and radon gas.

In 2004, the WHO’s International Agency for Research on Cancer’s report Tobacco Smoke and Involuntary Smoking reviewed the evidence of the health risks associated with smoking and secondhand smoke.

In March 2005, the BMJ published research that gave an estimate of 617 workplace deaths a year in the UK caused by secondhand smoke, which equates to two worker deaths each working day of the year.  This research is available on the web at Smokefree England.

In July 2005, the Royal College of Physicians also published a comprehensive report on secondhand smoke (pages 43-49 look at deaths from exposure to secondhand smoke).  This report is available on the web at Smokefree England. 

You also suggest that the Department of Health is infringing your human rights through smokefree legislation in mental health settings.

In July 2006, the Department of Health published a consultation on the smokefree regulations to be made under the Health Act 2006, including proposals for residential mental health settings.  The majority view from respondents to the consultation who addressed the issue of smoking in residential mental health settings was that there should either not be any exemption to permit smoking within residential mental health units, or that any exemption should be time-limited.  This view was shared by stakeholders including the Royal College of Psychiatrists, Cancer Research UK, the Royal College of Physicians, the British Medical Association and many NHS organisations that responded to the consultation.

For this reason, the regulations laid before Parliament provided a time-limited exemption from smokefree legislation for 12 months only.  Therefore, since 1 July 2008, it has been against the law to smoke in any enclosed or substantially enclosed part of any mental health establishment.  This includes smoking by patients, visitors or members of staff, and includes all residential mental health units, regardless of whether they provide acute or long-term services. 

The 12-month time-limited exemption for residential mental health units provided them with the opportunity to develop appropriate outdoor space for smokers if they needed to, and to implement smokefree policies in their units, given that the initial proposals for residential mental health units were different.

Smokefree mental health settings ensures that mental health patients receive  treatment in an environment that is equal, in health terms, with other patients in the NHS (the NHS has been smokefree since 31 December 2007), as well as tackling the institutional use of tobacco and the clear health inequality that mental health patients suffer because of smoking.

More generally, with regard to human rights, the Government believes that people should have the choice to smoke, but believes it is also right that people are both made aware of the major health risks of smoking and also provided with support to quit.

Importantly, the Government believes that at the same time, it is right that others should be protected from exposure to hazardous secondhand tobacco smoke.  This is what is being achieved through this legislation, where smoking is eliminated in virtually every enclosed public place and workplace in this country.

The smokefree provisions of the Health Act 2006 are consistent with what many other Governments are doing to protect people from the harmful effects of secondhand smoke.  Smokefree legislation is not only very effective in protecting health, but is also very popular. 

You suggest that the Government is planning to introduce outdoor smoking bans.  I can assure you that the Government has no current plans to introduce a ban on smoking in outdoor and/or non-enclosed public areas.

You also suggest that smokefree legislation is denying you access to healthcare.  The Government is not denying you access to healthcare, as the NHS offers support and treatment of smoking cessation through its Stop Smoking Services.  I am afraid that it is not the Department of Health’s responsibility if you choose not to use these services and/or treatments.  

Any complaints you have relating to breaches of your human rights should be directed to the Human Rights Commission as you have already done. 

As there is nothing further I can add on these matters, I am afraid that any further correspondence you send on these issues will be logged, but you may not receive a reply.

Yours sincerely, 

Cameron Gordon 

Customer Service Centre 

Department of Health

****

Even later in August

Dear Mr Gordon

I've had some time to think a bit more about your response to my complaint:

Please register a formal complaint about my treatment by the Department of Health regarding denial of access to healthcare.  I believe my rights are being breached with no justification and in a way that is disproportionate to an argument of protection of public health.  I am being harmed by inhumane treatment and removal of my rights to make my own lifestyle choices.

Here are some thoughts:

Your appeal to authority

The World Health Organisation has evidence that people are more likely to get cancer from mobile phones than second hand smoke:

A tale of two studies   

The International Agency for Research on Cancer (IARC) is a well-respected body set up by the World Health Organisation. It has conducted many large epidemiological studies into possible carcinogens. Let's take two of them. We'll call them Product X and Product Y.

There were two major findings for Product X. They were:

    Odds ratio: 1.40 (1.03-1.89)

    Odds ratio: 1.15 (0.81-1.62)

There were also two major findings for Product Y. They were:

    Odds ratio: 0.78 (0.64-0.96)

    Odds ratio: 1.16 (0.93-1.44)

You will notice that each study found one small but significant finding and one small but non-significant finding. In the case of Product Y, however, that significant finding suggested a protective effect. 

None of these findings are particularly strong, but – if you had to pick – you would say that Product X was the most likely to be the real carcinogen, right? After all, both findings for Product X show a potential increased risk, and the largest of them is not only statistically significant but is more than twice as large as Product Y's.

But that's not how these findings were reported at all. The WHO issued a press release saying that there was no conclusive evidence that Product X caused cancer and blamed "biases and errors" for the study's findings. The WHO also issued a press release for Product Y, saying that it definitely did cause cancer and blamed weaknesses in the study for its failure to show this more clearly. 

Consequently, the BBC reported that Product X "does not appear to increase the risk" of getting cancer, but reported that Product Y represented "a definite, although small, risk" of getting cancer.

So why would the weakest associations be hyped up while the stronger associations were downplayed?

Product Y is passive smoking. Product X is a mobile phone. 

Why is the Department of Health not protecting us from mobile phones by banning their use?  Maybe it's something to do with bribes from the pharmaceutical industry?  

The report from Royal College of Physicians is a marketing report for the cessation/pharmaceutical industry.  Does not assess all evidence, cherry picks and ignores scale, perspective and harms caused by removal of self determination and informed choices.

Death estimate - assumptions and guesses.  No death certificates here.

Stakeholders

Royal College of Psychiatrists, Cancer Research UK, the Royal College of Physicians, the British Medical Association and many NHS organisations  ... I don't remember voting for them and they all work closely with pharmaceutical interests who coincidentally produce cessation products - conflicting interests.  'Stakeholders' can determine how I'm allowed to live my life, what I'm allowed to do if I want to stay alive in your society and who is allowed to profit.  Can [I] set up an organisation and call myself an authority so I can be a stakeholder in their healthcare and citizen rights?  The point would seem to be that pharmaceutical company interests are stakeholders and cessation industry interests are stakeholders and I'm a commodity to be rented out to stakeholders, not an individual to be allowed free will.

Smokefree mental health settings ensures that mental health patients receive  treatment in an environment that is equal, in health terms, with other patients in the NHS (the NHS has been smokefree since 31 December 2007), as well as tackling the institutional use of tobacco and the clear health inequality that mental health patients suffer because of smoking.

I wouldn't be in that situation if I wasn't sectioned to be detained, that doesn't correspond equally to the liberty of other patients to remove themselves from the smoke free environment.  I'm not an institution and it's my choice to smoke if I want to, you are an institution with clear institutional blindness and prejudice towards certain groups of people, including smokers but not mobile phone users.  Your totalitarian behaviour such as the control of smokers makes smoking a desirable behaviour for some of us.  The world is a pretty shit place when we have to share it with intolerant busybodies and smoking offers respite.  I  was already sick of the idea of being restricted to smoking in the rain if I was lucky enough to get a member of staff to take me walkies, the next time you lock me up you'd better make sure I'm sedated the whole time because this dog intends will bite [sic] without home comforts – like smoke and a comfy spot.

The Government believes that people should have the choice to smoke

Where?  Where can I smoke if you override private property rights and exclude me from municipal property?

You suggest that the Government is planning to introduce outdoor smoking bans.  I can assure you that the Government has no current plans to introduce a ban on smoking in outdoor and/or non-enclosed public areas.

Actions speak louder than words:

And a call from your 'stakeholders' 

The Government is not denying you access to healthcare

I wouldn't choose to use NHS services but the government has incarcerated me twice without consent.  Your 'places of safety' force withdrawal from smoking so are not somewhere I would choose to stay.  I do not want to stop smoking when I am ill, I smoke partly to improve mental stability, therefore you will not allow me to access healthcare without harming my mental state.  You imply that it's a simple matter of submitting to use of cessation products.  I do not want to stop smoking when I am ill, cessation products do not work most of the time and treatment for mental health issues should not be reliant on acceptance of  compulsory addiction treatment.

Apparently ex smokers are three times more likely to get lung cancer too so that may also be an outcome of forced withdrawal.  Quitters are more likely to get diabetes and become fat (and fat people are next in line after smokers and drinkers as the new 'niggers').  Do you have pills to offset these problems caused deliberately by your removal of choices?

Even if you could prove to a court that second hand smoke has measurable health risks, higher than mobile phones which you allow, can you prove that the only answer is to remove my freedom to make my own informed choices?  Is it proportionate to exile smokers from indoor areas or treat them like dogs when you lock them up or remove the rights of property owners to decide who they wish to cater for?

As you have decided what choices I'm allowed without consultation or consideration and you've determined how I must live in order to be able to qualify for human rights I'm seeking legal advice.

H Johnson

Letters to the Editor and the British Lung Foundation

I am delighted to see the link I included yesterday from Planet Politics reproduced as a letter in the Herald. Stuart Winton refers to 'another unintended - or perhaps ignored - consequence of the smoking ban': there can be few allegedly 'unforeseen consequences' of the smoking that were not actually easily foreseeable. 


Above Stuart Winton's letter appears a letter from a Dr James Cant from the British Lung Foundation. Below is a reply, reproduced with his permission from Dave Atherton of Freedom2Choose. 

Dear Doctor Cant,

I trust you are well

Let me get my conflicts of interest out of the way first of all. I am an Executive of Freedom2Choose a pro choice smoking organisation and my apologies for this strongly worded email. I read your letter in The Herald and are appalled at the levels of science and argument employed. While I accept the high risk of active smoking, 7 years early mortality, 86% of lung cancer and 90% of emphysema cases are smokers, the "science" on second hand smoke (SHS) presented by people like yourself insults the intelligence. It is not noble to mislead on the science to get more legislation passed.

Firstly on SIDS can you explain between 1970 and 1988 the incidence of SIDS rose 500% but smoking rates tumbled from 45% to 30% of the adult population?

Also can you explain why in 1950 when 66% of the adult population smoked asthma has tripled when not even 25% of the population smokes?

This paper from 2008 not only concludes that nicotine and hence active and passive smoking actually leads to less incidence of asthma and atopy, but gives you the aetiology too.

"The results unequivocally show that, even after multiple allergen sensitizations, nicotine dramatically suppresses inflammatory/allergic parameters in the lung including the following: eosinophilic/lymphocytic emigration; mRNA and/or protein expression of the Th2 cytokines/chemokines IL-4, IL-5, IL-13, IL-25, and eotaxin; leukotriene C4; and total as well as allergen-specific IgE."

These are the results of a Swedish paper and they are statistically significant.

"Children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7). CONCLUSIONS: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children.”

I have also reviewed the Royal College of Physicians report into childhood diseases and conclude "This level of publication bias in my opinion brings the RCP and its scientists into serious disrepute."

With respect Dr. Cant whether your position is more clerical and takes you away from the science may be a moot point, but I fear that the anti smoking lobby have returned science to a new Dark Age of alchemy and we the population will pay the price.

I look forward to your reply.

Regards

David Atherton

I hope that Dr Cant is able to respond to this. His letter is a thinly disguised bid for smoking restrictions in cars and homes (declaring that even moving to the next room to smoke won't protect your child, etc.) 


Incidentally I am pleased to see that Jill Pell is getting short shrift from many readers in the Scotsman following her unbelievable study findings that adults smoking outside pubs and workplaces has reduced the numbers of children being hospitalised for asthma by nearly one-fifth. (Would it really have taken a study to tell us that?)

Barbados: anticipate the opposition!

Barbados will see a smoking ban from 1 October, and the local branch of the World Health Organisation, the Pan American Health Organisation, wants to ensure we are not under any misunderstanding about the necessity for comprehensive bans as opposed to any other form of solution. Their new publication Anticipate the Opposition is as predictable as the arguments it tries to refute, not least in its characterisation of all those who oppose the smoking bans as fronts for the tobacco industry:

Myth 1. Environmental tobacco smoke is just a nuisance.
Wrong. It is not just a nuisance, it is a health hazard. It causes at least 200,000 deaths a year in workplaces alone ... [calculated from guesswork about the amounts of exposure involved, and more guesswork about other confounding factors].

Myth 2. Voluntary agreements offer 'courtesy of choice': it is possible to accommodate smokers and non-smokers.
Wrong. This ignores the serious health consequences of SHS ... [the consequences that are only guessed at].

Myth 3. Ventilation systems protect non-smokers from the effects of SHS ...
Wrong. The tobacco industry has promoted the installation and use of expensive ventilation systems and equipment in an attempt to accommodate smokers and non-smokers in the same indoor enclosed spaces. [The reason that this is a better health alternative than a smoking ban is that modern equipment cleans air very effectively, not only of smoke but of other airborne pollutants. Getting rid of smoking only gets rid of the smoke but as many people will testify the air in pubs can still be very stale. Not surprisingly this paragraph refers to particles being 'deposited on furniture' before it can be ventilated.]

Myth 4. Smoke-free environments will never work.
Wrong. SFEs are widely supported by smokers and non-smokers, and if rightly enforced they work by protecting people from exposure to SHS. [They don't protect people from any other airborne pollution. On enforcement the levels of fine against landlords 'allowing' smoking are 50 times the fine for breaking the ban. In Barbados the ratio will be smaller, but still a significant deterrent to landlords who wish to accommodate their existing customers.]

Myth 5. SFEs result in lost businesses to restaurants and pubs.
Wrong. [followed by claims that all the 'good' studies find the overall economic situation unchanged for the hospitality sector and the economy. See opposite view from Michael Marlow, who claims not only that overall economic and hospitality trade figures mask large drops in specific sections of the hospitality industry, but also that bars are more likely to survive by flouting the ban, because it is in their interests to flout it.]

Myth 6. Smoking bans infringe smokers' rights and freedom of choice.
Wrong. Smoke free laws do not infringe anyone's rights. [Actually, they infringe everyone's rights. Even if their (declared) intention is about health, rights can be infringed as an unintended consequence. Smoking is legal, it is a recreational social pastime, smokers contribute plentifully to the public coffers and it is wrong to declare a public moratorium on a social activity, declare it's for the benefit of another group in society and deny that any wrong has been done to the smokers. This is infringement on the rights of hospitality traders and of the community in general (just as white civil liberties were oppressed by apartheid since it prevented them marrying black people ... they may not have cared about it in the main but their liberties were significantly curtailed by the doctrine of separate development).]

Safe levels of secondary smoke possible?

As a non-scientist I'm not particularly keen on reading technical pieces about chemistry or air quality but I was intrigued by this piece on an experiment in Staffordshire, where an environmental officer said 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'?: previously discussed here.


It is part of the faith of anti-smoking authorities the world over that there is no safe level of secondary smoke. Google the phrase and read about it being quoted everywhere in the world. But inevitably the protest arose that 'no safe level' was scientifically nonsensical and represents only a value judgement on the act of smoking itself.  


A measurable level of toxicity in the air can be dealt with. Air cleaning systems improve all the time: they are more sophisticated than creaking fans in the ceiling. But the anti-smokers have never wanted the problem to be dealt with rationally. Even though smoke is not as hazardous as other substances in the working environment it is not an industrial by-product, so can be excluded by means of prohibition and really because there is no safe level, only a ban will eradicate exposure. Any other toxin can be dealt with by calm efficiency, but ETS (secondary smoke) has magic qualities that allow it to evade effective control.


This piece provides an account of an OSHA measure of secondary smoke achieved by measuring nicotine only, rather than compounding it with measurements of formaldehyde and benzene, which form part of background pollution. Unfortunately the piece, though entitled 'OSHA sets safe level of second hand smoke', fails to link to OSHA itself, which is rather odd.  Yes, it's from a pipe smoking web site but I found it informative.


This famous table ('The Dose Makes The Poison') gives a breakdown of toxins found in smoke, and their toxicity.


Surely it is essential to uphold the notion that all risks are measurable, and that only by establishing a safe level of any risk is it possible to deal with it. 'No safe level' implies that something kills on impact. Deadly substances have to be contained and isolated if contact with them presents a clear danger to human life. Secondary smoke has formed the backdrop of life in the licensed trade and informal social life and many workplaces for generations and clearly doesn't fall into this category, since our elderly people are living longer than ever. 


Anyone who wants people to fear the impact of secondary smoke, when there are so many airborne chemicals resulting from the industrial-scale incineration of minerals, is guilty of shameless scaremongering, and enormous social and economic damage.  

THE ANTI

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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.