How to resolve a smoking problem: ban e-cigarettes in pubs?

Just a quickie: a headline article in the Evening News claims that Edinburgh Royal Infirmary has 'blown' £600,000 on clearing smoking-related litter since the smoking ban. Clearly this is another attempt to attempt to outlaw smoking on hospital grounds, but to my mind the real question is why anyone has tried to extrapolate smoking-related cleaning costs from total cleaning costs at the hospital. More observations that smoke has been seen curling its way into hospital windows. The way to prevent generalised hostility against smokers on hospital sites is to provide appropriate spaces for people to smoke where they can be comfortable, reasonably safe and won't get in the way of others, but such common sense would be interpreted as an attempt to 'normalise' smoking and cried off the agenda.

Anyone would think that an electronic gadget that produces no obvious waste problems and emits no tar would be a welcome addition to the anti-smoker's apparatus. But the e-cigarette has been widely attacked for not having been proven to be safe: not only concerning their direct use, but there have  been stories abound about e-cigs exploding while being charged, children swallowing cartridges, and doubtless others. Now, incredibly, Borders Council Licensing Board has tabled a motion to ban e-cigarette use in licensed premises. (Stop press: the licensing board has requested more information before agreeing to ban e-cigarettes. I hope they find it's more trouble than it's worth.)

These days there is not even the excuse that most e-cigs resemble real cigarettes and their use presents staff with potential difficulties in enforcing the smoking ban. It's a case of 'they may not be safe', and for some reason this is a reason to ban them. Is it really about normalising smoking? or the idea that people cannot assess safety, even with the help of widely available data?

Official objections to e-cigs versus Forest in debate two months ago here.

'Further indoor smoking restrictions', aka ban on smoking at home

I had a call from the BBC this morning inviting me on to the Radio Scotland Morning Call phone-in with Louise White. The subject was the study blogged by Forest here, by someone at Heriot Watt University here in Edinburgh. It claimed that passive smoke exposure 'in particular in more than two places of exposure was significantly associated with risks of stroke, angina, heart attack, abnormal heart rhythms ... impacted on sleep problems, self-recognition, making decisions, self-confidence, under strain constantly, depressed and happiness in never smokers' (this from the abstract).

Ouch. And to wind up, 'elimination of indoor passive smoking from different sources should still be a focus in future health programs'.

This is surely a case of torturing the figures till their pips squeak. None of the issues in question, including depression and lack of self-esteem, can be attributed to causes as vague as secondary smoke exposure (especially if you experience it in two friends homes in the space of what, a day? a week?)

I wasn't called on to the show until very nearly the end of the discussion, just before 9.30 a.m.. Professor Linda Bauld was on and a medic arguing for further restrictions, and Dr Stuart Waiton from Taking Liberties against it. Stuart pointed out that the new research that comes out all the time always tends to suggest that people's liberties should be further restricted for their own good. Professor Bauld didn't think that legislation would be the answer, but she did want to use what I can only describe as pester power. (It's not enough to open the window or even to go out of the door, you have to go right outside, close the door, etc. I am only surprised that third-hand smoke wasn't mentioned). The medic acknowledged that he would not want to use extra powers to interfere if he thought people were smoking at home in front of kids, but somehow did want something to be done. Callers had varying viewpoints, I think most felt that further powers would not be enforceable (by which I think was meant teachers, health visitors and social workers being able to take action of sorts if they suspect kids are exposed to passive smoke).

My objections to all these restrictions are that the other factors in these conditions they talk of are all vague, nothing is being measured, everything is approximate, nothing is ruled out, and we are expected to accept more or less as a matter of faith that tobacco smoke has the same effect as bad air and damp housing.When I did finally get on air I responded to the point made about this 'new research' recommending more restrictions, by commenting on the neverending flow of anti-smoking studies and by pointing to my favourite page on the Cancer Research UK website. It's the one that says that they fund studies that support existing tobacco policy. (Or to be blunt, they are unlikely to fund studies that don't find a significant risk to health from secondary smoke, or any other excuse to tighten restrictions further.)

Then I had the producer on the line thanking me for my time. By the time I remembered to put up the volume again a minute or so later, they had moved on to a discussion about doggie-bags. Seriously I hope that the national broadcasting station in an independent Scotland will offer something a little more heavyweight!

My views were offered as a non-smoker. I did dabble in smoking a little bit in the early days following the smoking ban. But I didn't miss it when I wasn't smoking.

I was also invited on to the show as a campaigner. Campaigning is not one of my strengths, I am more of a desktop warrior, and it's superficial and non-engaging. Other priorities have taken over (work, mostly) and the group on which this blog bases its name has not really functioned effectively for over two years. I now see the whole issue as one caused by too much centralisation of power generally, and certainly not one that can be resolved by people like me taking on tobacco control directly.

Double standards on child health and smoking in cars ban

Following the decision that smoking in cars could now be outlawed south of the border it was refreshing to see from Zoe Williams in the Guardian some criticism of double standards on smoking. This is the highlight:

Almost all the Tories so fervently against smoking in cars are simultaneously pretty sanguine about foodbanks. Six weeks ago nearly 300 MPs voted against a motion calling on the government to reduce dependency on emergency food aid. It is difficult to observe, without the option of yelling and swearing, how disingenuous this is, how slimy and mawkish for a government happy to live with the idea of people living in squalor, in fuel poverty, going hungry, suddenly to find itself unable to bear the idea of a child in a smoky car.

Williams gets flak from readers about this. It's clearly aimed at all benefiting all kids, not just poor ones and the poor shouldn't be spending their money on cars anyway (or tobacco). But here and elsewhere she points out that Westminster MPs are highly selective in their view of what damages children's prospects and interests.

In perspective: secondhand smoke is implicated in one in five cases of sudden infant death. Since smoke is more intense in a small, enclosed space, it is logical to assume that babies are more endangered by smoking in cars than by smoking elsewhere.

However, the smoking figures are almost always in constellation with other factors – factors surrounding or inherent to the child, from poor housing to low birth weight. Birth weight is of course related to smoking in pregnancy, but again other factors, such as maternal education, age and class, have an impact. A study in Ohio found mould spores in the lungs of sudden infant death victims; and midwives regularly say that mould is dangerous. Kia Stone, a young mother profiled in the Guardian's Breadline Britain series 18 months ago, lost her daughter shortly afterwards. A large mushroom was still growing out of the damp plaster in the bedroom when she got home from the autopsy.

Nobody even collects figures for mould as a risk factor – separate from damp and leaks. Bedrooms that are too hot are also a factor, as is frequent house moving, and living in overcrowded conditions, B&Bs or hostel accommodation. The connection isn't made – presumably through sheer lack of interest – that buildings in which people can't control the heating are often too hot or too cold.

Never take your ability to adjust the central heating for granted! This points to an area of public health (cot death) in which there is no interest in pursuing certain lines of research. When I grew up in the 1970s we were taught that bad housing contributed to poor health, but now the agenda is all about blaming the impoverished for bad choices.

More crudely, is it sensible to assume that what Westminster votes for is aimed to benefit anyone's health? (this question refers not to the general UK population but to its rulers).

Health, safety, toxicology and hypotheses

Hat tip Junican, see comments. In reply to Linda Bauld.

You can't go far wrong if, whenever you see the word 'may' in science, you dismiss the supposition. Science does not do supposition or superstition. It does hypothesis. Scientific investigations MUST depend upon an initial hypothesis. It would be extremely silly to assume that the hypothesis is true, and act upon it, without confirmation of its truth.

The propositions of Public Health are, at the moment, concerning ecigs, ambivalent, and this is a serious matter. There ought to be no such ambivalence.

The mechanical safety of the machine is not a 'health' matter. It is a 'safety' matter, just as electric kettles are a 'safety' matter. The liquids are also not a 'health' matter. They are a 'toxicology' matter. That is, the danger of trace elements in ecig liquid is a matter for scientists in toxicology to decide, and not the Public Health advocates.

Welsh Health Minister wants to restrict e-cigarettes because they resemble a legal product

Because they 'renormalise' and 'reglamorise' smoking, says Mark Drakeford, more restrictions should be imposed on e-cigarettes. In almost the same breath, he mentions New Zealand where these things 'are viewed as health products'. Muddle, muddle, muddle.

Mr Drakeford mentions the addictive nature of nicotine, which the Welsh health authorities don't seem to object to prescribing for pregnant women, only recommending caution. See 'Using nicotine replacement therapy for smoking cessation in pregnancy'. It's not quite clear what their objection to nicotine is, but in any case e-cigarettes are not the first products to offer alternative delivery systems for nicotine.

As it happens I don't object to e-cigarettes being restricted to young people, but the health authorities would be far better advised to let people use them from age 16. That way, they will be able to obtain e-cigarettes legally at an earlier age than they can obtain cigarettes. Given the dastardly character in which tobacco has been painted in the last few years, it's hard to understand what the fuss is about when a product that is thought to be significantly less harmful becomes available.

Do we know that it's significantly less harmful? No? If not, why not?