Wednesday, 30 December 2009

Crime and punishment


Dick Puddlecote has written a superb post about the drop in crime seen in the Isle of Man since it opened Europe's first non-smoking prison. The crime rate fell by 14%, with burglaries dropping by 35% and assaults by 25%. Whether or not this represents a causal relationship is open to debate. It would be interesting to see whether those parts of America which have banned smoking in prisons have seen a similar decline. 

Whatever the truth, it is extraordinary that the media is happy to attribute a 14% drop in the crime rate to the smoking ban, just as they are happy to attribute a 2% fall in heart attacks to the smoking ban, but only mention the smoking ban as a footnote when reporting the  1,300% increase in pub closures (4 a week in 2006, 52 a week in 2009). 

And as Dick argues with impeccable logic, if criminals really do fear not being able to smoke more than they fear prison itself, what chance do publicans have of getting smokers to enter their premises of their free will?

If potential criminals are making life changing decisions to avoid being forced somewhere in which they can't smoke, is it so very difficult to accept that pubgoers can be easily discouraged from voluntarily entering premises, for the same reason?




Tuesday, 29 December 2009

The French resistance


"The French will never stand for it" they said when France brought in a smoking ban in 2007. This view echoed the "New Yorkers will never stand for it" and "the Irish will never stand for it" of previous years. It is a paradox often remarked upon that it was the very people who had the greatest reputation for being rebels, free spirits or plain stubborn who were also the first to embrace, or at least tolerate, total smoking bans.

If you'd have said the Croats, Germans or the Dutch wouldn't stand for it, you'd have been right. Smoking bans there were watered down or abandoned after public protests and lawsuits. Across most of the rest of Europe, smoking bans had enough exemptions to accommodate smokers in the first place. The comprehensive, zero exemption smoking ban is, as I have said before, almost uniquely associated with the English speaking world. The one notable exception is France.

I haven't been to France since they brought in their ban. I have witnessed at first hand the smoking ban being overtly flouted in England and America. I have heard that New York has many places where the ban is ignored. I believe many pubs in Ireland bring out the ash trays after hours. But I have heard that the French have complied willingly.

This compliance, it seems, is no more. The French may not have rebelled at first, but it was always in the post. Compare and contrast these reports from Time magazine. The first is from February 2007, the second from the current edition:

No (Revolutionary) Fire as France Curbs Smoke

Anyone expecting a great national rebellion bringing millions of irascible Gauloise-puffing Gauls to the barricades in defiance of authority and good sense will have been disappointed: France's nearly 15 million smokers meekly complied with the Feb. 1 law obliging them to haul their (cigarette) butts outside if they want to light up, or risk a hefty fine should they continue smoking in enclosed spaces. In fact, that relatively docile compliance with a liberty-restricting measure represented as significant a revolution in French cultural attitudes as does the state's health-driven campaign against tobacco.

"It's a pain, but that's the law, and the bosses are applying it," says a 34 year-old supermarket employee named Christophe who declined to give his last name as he paced the sidewalk for his smoke. Before the ban, Christophe says he and fellow inhalers were allowed to smoke in the large storage room in the central-Paris supermarket. "Now we can't and we're out here," he says, shrugging between drags. "That's life."



Smoking Ban? The French Light Up Again in Public

When France outlawed smoking in public places three years ago, residents took the news remarkably — almost shockingly — well. Almost overnight, cigarettes vanished from offices, restaurants, cafés and train stations as the French dutifully took their glowing butts outside — the only place where smoking was still permitted. But this being France, a backlash was almost certainly inevitable. According to a report released on Dec. 17 by an anti-smoking group, the initial obeisance of French smokers has now given way to people increasingly flaunting the law by lighting up indoors.

Anecdotal evidence abounds that French smokers are pushing back in ways that they previously didn't dare. On some French train lines — all of which are officially non-smoking — smokers frequently take over certain cars, thus far escaping punishment. Butts are also turning up in greater numbers in Paris' Metro. "I'm not bothering anyone, and if I am, they can go to another part of the platform," says a man who identified himself only as Adel as he smoked in the Etienne Marcel station recently. "If I see a Metro official, cop or someone who looks like they'll be a real pain, I won't light up. But otherwise, why shouldn't I smoke in the Metro when I want to and can get away with it? Especially because there are far worse smells in here than smoke!"

Down the street from the station, the manager of a plastic-enclosed caféterrace similarly rationalized bending the rules. "This is outside, and it's the only place where smokers are allowed, so it's all legal," says the man, who, perhaps aware that his enclosed smoking terrace is not actually kosher, requested that neither his name nor the name of his establishment be identified. "We have to live together, and this is one compromise to make that happen. Do you see anyone complaining?"




Thursday, 24 December 2009

Santa and public health - update


Last week I mentioned the British Medical Journal's 'Santa - a public health pariah' article, which I prayed was 'an elaborate hoax'. And - mercifully - it was. A look at the full text removes all doubt:

A quick perusal through the Victorian infectious diseases surveillance records shows no notifications of infectious disease outbreaks associated with kissing Santa. Although there were no cases of infectious mononucleosis ("kissing disease") associated with Santa, there have been numerous foodborne viral and salmonella outbreaks associated with Christmas parties. Santa was not named as a suspected point source.

All well and good. Any article that discusses Santa as if he actually exists is clearly taking the mickey (sorry kids). Unfortunately, there was none of the humourous stuff in the (free) abstract of the article available on the BMJ website. The tongue-in-cheek parts were in the full text hidden behind a pay-wall.

Worse still, the press release that the BMJ sent around the world was just about believable, in the context of the current hysteria over obesity:

Santa should share Rudolf's snack of carrots and celery sticks rather than brandy and mince pies and swap his reindeer for a bike or walk, says a public health expert in the Christmas issue published on bmj.com today.

Dr Nathan Grills, from Monash University in Australia, says the current image of Santa promotes obesity, drink-driving, speeding and a general unhealthy lifestyle. He argues that "Santa only needs to affect health by 0.1% to damage millions of lives" and that it would be better if his popularity was used to promote healthy living.

Since we are told that people smoking in movies makes kids smoke, and that spending time with fat people makes us fat, the idea that a fat Santa might 'normalise' obesity and drinking is perfectly credible in the wacky world of public health. Santa wouldn't be the first fictional character (sorry kids) to undergo a politically correct makeover. The Little Chef, for example, was slimmed down a few years ago:

The trademark tubby cook who has been the logo at restaurant chain Little Chef since 1972 is being put on a diet. Little Chef has come up with a slimmer version of the chef as part of a general sprucing-up operation to improve its image.

That didn't last, but they got rid of Isambard Kingdom Brunel's cigar and airbrushed Robert Johnson's cigarette, so anything's possible. Ultimately, the problem with the BMJ article was that it was parodying something that is beyond parody. It is simply not possible to make up anything more ludicrous than thirdhand smoke and passive obesity.

The only thing in the press release that might have set the alarm bells ringing was this bit:

Also, Santa has real potential to spread infectious diseases, says the paper. If Santa sneezes or coughs around 10 times a day, all the children who sit on his lap may end up with swine flu as well as their Christmas present, argues Grills.

But these fears aren't new either. Last month saw this:

Health chiefs in Hungary have clamped down on Father Christmas, suggesting the children's favourite should avoid kissing children and shaking their hands to prevent spreading flu this Winter.

They recommend that all people dressing up as Father Christmas should get vaccinated against the illness.

Some officials in the Eastern European country had argued for a complete ban on the traditional "Meet Santa" amusements which are available in many shopping centres at Christmas time.

Despite repeatedly clarifying that it was all a joke, the author of the BMJ article - Nathan Grills - has been getting a hard time, as Newsweek reports (thanks to Thomas for the link):

Around the world, Grills has been attacked as a mean-spirited Christmas killjoy. His e-mail inbox is filled with condemnations. He's so besieged by angry calls that he won't answer the telephone, so I couldn't talk to him for an interview. We had to correspond via e-mail.

Someone else who has corresponded with Grills by e-mail is Crampton at Offsetting Behaviour. In one of many e-mails the great satirist must have written this week, he explained:

Hi Eric,

Most of the 'Santa- A Public Health Pariah' article is meant to be tongue-in-cheek. It's a Christmas spoof. It's supposed to be spreading a bit of Christmas cheer, but with a tinge of seriousness to provoke a bit of healthy Christmas dinner table conversation. The BMJ Christmas edition is a special edition with much humour.

Fair enough, but when you have to explain a joke, it's probably not a very good one.

Unfortunately, the article has spread like wildfire but it has lost a bit of the Christmas cheer element.

Let's not be disingenuous here, Nathan. The article "spread like wildfire" because you sent out a worldwide press release to the media. You must have known that the media would have had no interest in covering it unless they believed that it was serious. As it was, you got considerable press attention and were interviewed on the radio. You can't have it both ways.

The media perhaps believed a little too much... probably because they had only read media release and not the article.

Well yes, because the BMJ put the article behind a pay-wall. Even if it was publicly available, most journalists still wouldn't have read it because - and I don't think this is a big secret - journalists rely almost exclusively on press releases and abstracts (sorry kids).

As an epidemiologist, Nathan, you should get on your knees and thank God that journalists don't read medical journals in full and don't understand how statistical sciences work. If they did, hardly any epidemiological studies would ever be reported on, unless it was to make fun of the poor methodology, weak associations and hysterical conclusions that are endemic to them.

Still, at least Nathan Grills has stepped up to the plate and admitted that his study was a hoax. If Stanton Glantz, Jill Pell, James Repace and Georg Matt now come forward and admit that their studies were jokes that got out of hand as well, we really can have a happy Christmas.




Bad Santa Cruz


These signs are currently being put up all over the Californian town of Santa Cruz. All of the above are now illegal in outdoor public areas there.

What next from the land of the free?


Thanks to Becky for the photo.



Friday, 18 December 2009

The Godber blueprint


In Velvet Glove, Iron Fist, I suggested that the 5th World Conference on Smoking and Health (1983) was a turning point for the anti-smoking movement. I said this for several reasons. It came in the wake of the first passive smoking studies and there was an unprecedented thirst for action. The language used there was unusually aggressive, particularly towards the tobacco industry. There was open talk of prohibition. The policies decided upon at this conference set the template for the next three decades. 

The list of who spoke at the 1983 conference reads like a who's who of the anti-tobacco movement, both then and now. John Banzhaf (ASH) and Stanton Glantz (Americans for Nonsmokers' Rights) both took to the stage, as did Takeshi Hirayama (author of the first epidemiological passive smoking study), Roy Shephard (author of 'The Risks of Passive Smoking') and James Repace (author of an early passive smoking study). Other familiar faces included Michael Pertschuk (of the Federal Trade Commission) and Paul Loveday (president of GASP).

Some of those who spoke at the conference would not make their mark for many years. Konrad Jamrozik, for example, was there. His mathematical howler would form the basis for claims about the death toll from secondhand smoke in the run-up to the English smoking ban. Nicholas Wald was also present. Wald's meta-analysis of passive smoking studies become a powerful weapon for pro-ban opponents in the UK and would heavily influence the SCOTH committee (of which he also happened to be a member). 

And so, I would contend, the 1983 conference represented the coming together of a distinct 'club' which would have tremendous influence in the years ahead and continues to do so today. Few people realise how small this club is, or that they are working from a plan devised decades ago.

While I see the 1983 conference as a turning-point, the wheels had of course been turning throughout the 1970s. Vincent-Riccardo Di Pierri has recently been going through the documents to show the particular influence of Sir George Godber - who was Britain's Chief Medical Officer from 1960 to 1973. Godber was a fervent anti-smoker at a time when such views were unfashionable and was regarded by his peers as one of the leading lights - arguably the leading light - of the global anti-tobacco community. 

In his thorough review of the various World Conferences on Smoking and Health, Di Pierri identifies what he calls the 'Godber blueprint' which anti-smoking activists have followed ever since. This involves the denormalisation of smoking and the criminalisation of smoking everywhere outside the home. Even today, most anti-smoking groups would not publicly call for such a draconian approach and yet, as Di Pierri shows, Godber was advocating these hard-line policies as far back as 1975 and his peers were agreeing with him.

I have written about the slippery slope before, most recently with reference to John Banzhaf. Indeed, Velvet Glove, Iron Fist is - as the title suggests - all about the slippery slope. Few outside the anti-tobacco circle would have agreed with the Godber blueprint in the 1970s. Many would have found it fanatical, excessive and illiberal, which is probably why we didn't hear much about it at the time. And yet we have moved much closer to Godber's final goal thanks to a gradual softening-up of the public accompanied by a little voodoo science. 

At every turn, the public is told that the evidence is leading the policy, but there is every reason to believe that the policies were set in stone many years ago and that these policies have been leading the evidence. It is clear from the documents that plans to deal with passive smoking, for example, were being drawn up long before there was any evidence of harm.

Pour yourself a drink and have a read of Di Pierris' article. It's a long one, but worth it.




Thursday, 17 December 2009

Merry Christmas from public health














In years gone by, the British Medical Journal would occasionally publish tongue-in-cheek articles and satires. Everyone was in on the joke and everyone knew they were only intended to provide a little light reading between the heavy stuff. At first, that's what I assumed this was:

Santa is a public health hazard - promoting obesity and drink-driving, experts have claimed.

Images of a fat, jolly and somewhat tipsy Father Christmas send out the wrong message and could damage millions of lives, they said.

Instead of sitting back in his sleigh and breaking the speed limit, Santa should get off and walk or jog.

Obese Santa also needs to swap the brandy and mince pies left out by hopeful children for carrots and celery sticks stolen from Rudolph the Red Nosed Reindeer.

Very funny, ho, ho, ho! Or perhaps not. Having looked at the original article, this doesn't look like a festive wind-up. It's written by an epidemiologist (naturally) and an illustrator (!), and it appears that they are deadly serious:

The authors conclude there is a need for Santa to undergo an image overhaul - one that promotes healthy living.

"We need to be aware that Santa has an ability to influence people, and especially children, towards unhealthy behaviour," they said. 

"Given Santa's universal appeal, and reasoning from a population health perspective, Santa needs to affect health by only 0.1% to damage millions of lives."

This little statistic reminds me of those overly optimistic entrepreneurs you see on Dragon's Den who say things like: "There are 3 billion women in the world. If only 0.1% of them buy our product, we will make £12 million." Yes, but what is your evidence for thinking that anyone will buy your product? 

And what is the BMJ's evidence for saying that a fat Santa damages anyone's health, let alone that it damages the health of the world by 0.1%?

"We propose a new image for Santa to ensure that his influence on public health is a positive one."

Of course you do. And this will begin, I imagine, with a campaign to have something banned. Quite unbelievable.

The full article is behind a pay wall at the moment. I'll read it all tomorrow and it had better turn out to be an elaborate hoax, because if this is meant to be taken seriously, there is no hope.



Tuesday, 15 December 2009

Game theory and cigarettes


Watching QI last night, I was reminded of John Nash and game theory. Nash was the troubled mathematical genius portrayed by Russell Crowe in the film A Beautiful Mind. He didn't invent game theory per se, but he did invent an off-shoot of it - the Nash equilibrium - which, to put it simply, is where both players in a game are aware of the other player's ability and motives, and therefore play in a predictable way to maximise their own advantage. 

In game theory, neither player will do better by changing their strategy - even if both would do better by collaborating - and, therefore, neither player will change their strategy even if it means losing out if the other player plays the same way

In popular culture, game theory can be seen in TV shows such as Goldenballs (or its earlier incarnation Shafted), where players can choose to take or share the winnings. If both players share, they share. If they both choose to take, neither gets anything. If one takes and the other shares, the taker gets it all.

The Cold War is the classic example of game theory in action, which brings me to Adam Curtis's fascinating documentary The Trap: What Happened to Our Dreams of Freedom. In it, Curtis describes a game Nash invented called Fuck You Buddy, which could only be won if the player betrayed his partner. The whole documentary is on Youtube. This is the most relevant part...




Nash believed that humans were inherently suspicious of each other, hardly surprising since he was a paranoid schizophrenic. His was a gloomy and pessimistic view of the world, but it did not apply to the mass of humanity. In reality, we are more likely to collaborate than Nash thought. We do not always act in naked self-interest.

So what's this got to do with tobacco? Well, as Stephen Fry pointed out on QI, game theory can be applied to advertising. If one company is advertising, all the rest must do the same. But if no companies advertise, they can save money. And in the case of tobacco advertising, the state intervened to remove the competition. In effect, the state forced the tobacco companies to collaborate. 

As Fry said, it should have been predictable who the real winners would be:

If neither of them advertised, they could keep the money and the market would remain the same. So what it resulted in is the bizarre situation where they banned tobacco advertising, and it was to the benefit of the tobacco firms because they were suddenly saved money which they were otherwise wasting.

It is almost heretical to say this, but the purpose of tobacco advertising is to make people switch brands (or to stick with the brand they are already smoking). Anti-smoking groups have long disputed this, saying that tobacco advertising exists to make people start smoking, but they have never produced any credible evidence to show that this is the case.

It is likely that the anti-smoking groups are wrong. The US has a lower smoking rate than the UK, for example, despite cigarette advertising (in print) being legal in the former but not the latter. Cigarette sales also happened to go up in both countries after cigarette commercials were banned on TV.

In truth, cigarette advertising does little more than give different brands a chance to compete. As I said in Velvet Glove, Iron Fist, the biggest winner from the clamp-down on cigarette advertising in the 1970s was Philip Morris, because they happened to be top dog at a time when competing brands were prevented from gaining market share. It is no coincidence that Marlboro has been the world's top-selling brand since the early 1970s. Other brands simply cannot compete on anything other than price (eg. Lambert & Butler). 

There are cigarette companies that would love to see tobacco advertising reintroduced, but not the big ones. As so often happens, the anti-smoking groups have inadvertently done Big Tobacco's work for them.



Saturday, 12 December 2009

Weasel words from Wales


Having tracked down the Welsh Chief Medical Officer's Annual Report - which inspired the Daily Post and the BBC to publish misleading and incorrect stories of a Welsh heart miracle - it's interesting to read what the man himself actually has to say.

On page 46, the report says (with my emphasis):

Hospital admissions for heart attacks were reduced in 2008 and although this decline cannot be wholly attributed to the smoking ban, some studies suggest that at least some of the reduction is due to the legislation.

It's hard to imagine a more feeble statement on which to base a major news story. Besides, the "studies" he refers to have ranged from the dubious to the outright fraudulent. The evidence from Wales certainly doesn't "suggest" any such phenomenon and that, you might think, would be what should concern the Welsh Chief Medical Officer. He might at least have looked at Scotland, England, Australia, New Zealand, Denmark, Connecticut and the many other places which saw no effect from smoking bans on the heart attack rate.

As with the New Zealand data recently unearthed by the eagle-eyed Michael Siegel, advocates are resorting to the trick of saying "we saw no evidence ourselves, but other studies have". No serious scientist would do such a thing, particularly in such a new field of research. 

It is abundantly clear that these people are clutching at straws.



Thursday, 10 December 2009

Of pipes and pipe men


Another review to mention, this time from Pipes and Tobaccos magazine, an international publication for the discerning smoker, and they're very nice about it...

Prohibition by increments 

Velvet Glove, Iron Fist: A History of Anti-Smoking reveals the anti-smoking movement's ultimate motive


“From the very outset, the people of the Old World were divided between those who swiftly became enamored of tobacco and those who found the smell unpleasant and the habit depraved,” writes Christopher Snowdon in his ground-breaking, well-researched and riveting Velvet Glove, Iron Fist: A History of Anti-Smoking.

You can read the whole review online and, if pipes are your thing, you might consider taking a trial issue of the mag. And if you haven't read Velvet Glove yet, Amazon are currently selling it a discount in the UK and the US.



"Is that so much to ask?"


From Santa Cruz, where the smoking ban just became a little bit more "comprehensive":




Click on the photo to make it larger. Amongst the places in which it is now illegal to smoke are "within 25 feet of any door or open window". So, in effect, pretty much everywhere, indoors and outdoors. The law was passed unanimously by the City Council. 


John Banzhaf, 1977: 

"Where you try to ban it entirely on a street or something like that, obviously you're going to have problems. But what we have found is if you have a law, if you provide separate smoking sections, if the restrictions are not onerous or whatever, if you don't have large fines or make it a major criminal problem it a then you have reasonable compliance."

John Banzhaf, 2003: 

"When we started to fight for nonsmokers, we started with airplanes. No one then thought we'd be successful at banning smoking in bars, banning smoking outdoors. We took the easier ones first. Each step builds on the one that comes before."



Thanks to Becky for the photo.



Wednesday, 9 December 2009

Smoking ban 'cuts suicide rate'


It didn't really, of course, but that headline wouldn't be any more silly than the one the BBC went with today:

Smoking ban 'cuts heart attacks'

The number of people suffering heart attacks has reduced since the smoking ban in Wales began, a report by the chief medical officer has found.

I can't argue with that. To two events undeniably coincided. Of course, the heart attack rate also fell consistently for six years before the smoking ban, but the BBC omits to mention that. 

So if the smoking ban was responsible for that, it must also be responsible for this:

Figures also showed fewer children were being injured by cars, with Wales three years ahead of a target reduction.

And this:

Suicide rates across all age groups have also fallen.

These things happened at the same time and, therefore, must have happened as a result. Post hoc ergo propter hoc - the source of all superstition. An old woman moved to the village and the crops failed, therefore she is a witch. I walked under a ladder and later lost my job. I took my lucky heather to the football and my team won.

Pathetic. And if the smoking ban 'cut heart attacks' in 2007/08, what sorcery is responsible for the rate rising in 2008/09?





Tuesday, 8 December 2009

The Welsh miracle is not dead. It just smells bad.


When it comes to heart attack miracles, it's difficult to pick the most preposterous. Heart miracles constitute a sub-genre of pseudo-science which is so comically ill-considered it almost makes other quackery seem reasonable. 

At the moment, only a relatively small number of people are in on the joke (including Dr Siegel, who has just exposed yet another), but we can console ourselves that many of these studies have appeared in print, thereby leaving a paper trail for future historians to follow when they rake over the coals of this decade's exodus from rational thought.

One of the silliest heart miracles was reported last year. It concerned the case of Wales, which saw a rise in heart attacks in the five months following the Welsh smoking ban and no significant fall in the post-ban year overall. This - you might think - would be enough for tobacco controllers to turn a blind eye to the green, green hills of Wales, but no. 

With a sneakiness that bordered on the heroic, a Welsh politician named Chris Franks spotted that the 4th quarter of the post-ban year saw fewer heart attacks than the same period of 2006. He used his influence to get the "story" into Wales' Daily Post, where he found a willing accomplice in the form of journalist Tom Bodden who wrote an article headlined: 'Fewer Heart Attacks in Wake Of Smoking Ban'.

This was all back in June 2008. It got a little coverage elsewhere but not very much. ASH and the Department of Health didn't want to touch it because they knew that it was all a scam. I explained why it was a scam on my website and at SpikedDr Siegel did likewise. So did Reason.

Now, via Jacob Grier, I see that this ancient corpse has been exhumed and Tom Bodden (for it is he again) is trying to breathe new life into it:

Smoking ban ‘sees fall in heart attacks’ in Wales

NEW figures this week are expected to reveal how the first full year of the public smoking ban in Wales heralded a steep decline in heart attacks.

The findings will be contained in the Chief Medical Officer for Wales’ annual report showing hospital admissions have fallen since the ban came into force.

I will be intrigued if the Chief Medical Officer does make such a claim, because it is completely untrue. Not only is it untrue, it has become even less true - if such a thing is possible - since I last wrote about it.

You see, reading all again this inspired me to return to the NHS Wales hospital admissions data (available at Health Solutions Wales). Since I last discussed the Welsh miracle, another year's data have become available. And - wouldn't you know it? - heart attacks increased last year. (Some readers may recall a similar phenomenon in Scotland).

As you can see from the graph below, there was no "steep decline" in the heart attack rate in Wales after the smoking ban. The rate of decline followed the exact same trend of the previous two years. But you will also notice a rise in heart attacks in the second year of the ban - the first rise for seven years. 



To put it in precise terms, the number of Welsh residents rushed to hospital with acute myocardial infarction rose from 3,999 (2007/08) to 4,126 (2008/09)*. Even if you add in emergency admissions for angina and subsequent acute myocardial infarction, there is a rise from 9,783 to 9,851. It doesn't matter whether you look at Welsh residents or Welsh hospitals (there are different statistics for both), the story is always the same. 

So what does Welsh Health Minister Edwina Hart have to say in the face of this unequivocal evidence that hospital admissions for heart attacks went up last year?

"The Chief Medical Officer’s annual report to be published later this week will show that hospital admissions for heart attacks were reduced last year."

This would appear to be from the horse's mouth, which is worrying. If the Health Minister is correct and the Chief Medical Officer does indeed announce that "hospital admissions for heart attacks were reduced last year" there will only be one explanation. 

The Chief Medical Officer must be a liar.


*Emergency admissions for acute myocardial infarction (Welsh residents):

2000/01: 4891
2001/02: 5398
2002/03: 5374
2003/04: 5263
2004/05: 4719
2005/06: 4425
2006/07: 4180
2007/08: 3999
2008/09: 4126

The Welsh smoking ban was enacted on April 2 2007. There were no exemptions.




Monday, 7 December 2009

A conscious act of cultural vandalism


After much searching, I have found one person who agrees with Richard Bacon's figure of one million fewer smokers since the ban. And it's another BBC man, Mark Easton:

Since the ban on smoking in public places swept across Britain in 2006 and 2007, the number of adults who smoke has fallen by about one million.

As I said in the last post, this is sheer wishful thinking. But since no one else is quoting this figure - not ASH, not the Daily Mail, not the Department of Health - perhaps the source of this figure is some BBC memo?

In any case, Mark Easton has form for viewing the smoking ban in a rather idiosyncratic fashion, not least in this mind-boggling piece of doublethink from July 2009:

Pubs aren't dying - they are evolving

The great British boozer, we are told, is dying. But the widely reported news that 52 pubs are closing every week is not what it seems. In fact, it is probable that there are more places to enjoy a drink now than a couple of years ago.

This is quite a statement in the face of overwhelming evidence from the British Beer and Pub Association (BBPA), which shows a massive increase in pub closures since 2007. To quote one of Easton's readers:

I agree they are evolving, they are evolving into blocks of flats and they are evolving into building sites. Some (few) evolve into restaurants and other family orientated places. When a pub closes it is becoming rare for it to reopen as a place where adults can meet and have a sociable drink.

So what is Easton's evidence for saying that pubs are not dying?

Last week's press release from the BBPA reveals that of the 52 weekly closures the CGA research identifies, 51 are "wet-led" establishments. It also notes that "branded pubs and café style bars are actually opening at a rate of two a week".

Feel free to check my maths here, but surely that amounts to a total of 50 fewer pubs/bars a week?

The pubs that are closing, overwhelmingly, are those that existed to serve customers who came to drink and to smoke.

Isn't that the very definition of pub? The kind of pub beloved of the Pub Curmudgeon? As opposed to licensed restaurants and 'fun pubs', or - to borrow a phrase from the Spiked - 'anti-pubs'. 

Of all the anti-pub chains, JD Wetherspoon is the most successful. Readers from outside the UK who are not familiar with this organisation should read Natalie Rothschild's wonderfully acerbic piece 'A place where nobody knows your name' which describes it with uncanny accuracy:

Here's a taster:

Wetherspoon is, in fact, not a chain of public houses at all - it is a chain of public control houses. It is the anti-pub, a health department official’s dream local, a place where you go not to get a break from your everyday worries but to be told we’re eating and drinking ourselves to death. Wetherspoon is careful to remind customers that they should eat and drink ‘responsibly’, not overstep the officially-recommended daily units of alcohol and calories, and be sure to consume at least five fruit and veg a day.

A Wetherspoon pub is not a place for drowning your sorrows, whiling away time or spending hard-earned cash on simple pleasures like a game of pool with your mates or choosing silly songs on the jukebox for you and your friends to sing along to. It’s not a place where anybody is likely to know your name, because, here, we are discouraged even from talking to one another.

The rise of the anti-pub is an undoubted consequence of the UK's smoking ban. As real pubs close down, the pub chains have taken market share. Perhaps that's why the big pub chains accepted the smoking ban with barely a whimper. JD Wetherspoon even lobbied for it.

Will politicians and public health professionals mourn the loss of the traditional boozer? I doubt it. More likely, they will view the emergence of "public control houses" as an unexpected bonus.

Or maybe not so unexpected. As Mark Easton suggested in his article, the assault on working-class culture by the metropolitan elite may have always been part of the plan.

You may disagree with the new licensing laws, the taxes on alcohol and the smoking ban. You may mourn the demise of old-fashioned tobacco-stained drinking dens. But you could equally argue that the legislation is doing exactly what it was intended to do.

Quite.



Thursday, 3 December 2009

Bullies and Banzhaf


I haven't yet mentioned Brian Monteith's book The Bully State, which is a rollicking good read. I reviewed it in the current Spiked Review of Books:

Readers who have not visited Britain for several years may be shocked by the lurch towards authoritarianism described in this book. Those who have witnessed the creep of the bully state first hand will be enraged, amused and informed in equal measure. Californian politicians can simply use it as an instruction manual.

Go have a look. And speaking of bullies...

Chubby ambulance-chaser John Banzhaf has called on e-cigarette users to sue e-cigarette makers. In a typically narcissistic press release, the ASH founder invites vapers to "possibly share in any damages awarded to users of this new product which the Food and Drug Administration (FDA) has declared 'illegal'."

Smokles provides an accurate character assessment of the litigious lard-ass:

I can think of no other example where the signatory of the letter refers to himself in the third person so many times and so magnificently. (In nine out of the thirteen paragraphs of his release, he refers to himself at least once, and even bestows upon himself a title: the Dean of Public Interest Lawyers).

You just have to wonder how this blowhard survived grade school.

Since nearly all e-cigarette users are very happy to be vaping rather than smoking, Banzhaf is once again displaying a certain detachment from reality with this press release. Judging by some of the comments at the e-cigarette forum, the ASH founder is going to struggle to find many takers:

Yeah, i'm sure we are going to turn on the hand that feeds us ... not.

That may be in his repetoire, being the disgusting turncoat sell-out pork belly that he obviously is, but it sure as diddly isn't in the most decent people's plans.

Similar sentiments are on display on the Tobacco Facts website which hosts the press release:

I wish these anti-smoking fanatics realized that by attacking e-cigarettes they’re actually supporting big tobacco.

They might be supporting big tobacco. They're certainly supporting the pharmaceutical industry, as Michael Siegel points out:

Interestingly, ASH is not promoting lawsuits against the pharmaceutical companies who market nicotine replacement products without informing their customers that these products contain detectable levels of carcinogens. Why this double standard?

Perhaps the answer lies in the fact that ASH is heavily funded by Big Pharma.

ASH is funded heavily by Big Pharma (specifically, by Pfizer - the maker of Chantix). If e-cigarettes really take off, they represent a huge threat to the profits of pharmaceutical companies, and in turn, they represent a threat to future funding of ASH. This conflict of interest is significant, but ASH has failed to disclose it in any of its statements about the dangers of electronic cigarettes, or in its propaganda designed to encourage vapers to sue e-cigarette companies.

Indeed ASH is funded by Pfizer (makers of Chantix, Nicorette etc.). It received $50,000 from the company in 2006 and is currently sharing the spoils of a $47 million grant made to various anti-smoking organisations. 

Banzhaf himself does very nicely as head of his charity, pocketing $226,000 in the last year their accounts were published. And although the FDA has concluded that Pfizer's stop-smoking drug Chantix is linked to suicide, Banzhaf is not involved in any of the lawsuits against Pfizer, nor will you find the word Chantix anywhere on ASH's website. 

Funny, that.




Tuesday, 1 December 2009

Where do these numbers come from?


The last time I commented on a Radio 5 show, the presenter read it and left a comment, so I shall be careful what I say about Richard Bacon's debate about outdoor smoking bans last night. I have no idea where Bacon stands on the smoking issue. Like most people, he probably has no strong view either way. Still, he makes quite the devil's advocate, generally making the opposing view rather more forcefully than the person invited to do it themselves.

You can listen to the show here for 7 days if you're in the UK. A few things struck me about it...

Firstly, of all the people who called in, only two supported banning smoking outdoors, and they were both tobacco control professionals. One worked for a charity which, I must confess, I have never heard of - Heart Research UK - and the second only owned up to working in tobacco control after he had been on the line for several minutes. 

Secondly, the passive smoking theory has been well and truly discarded in favour of overt paternalism and the tyranny of the majority. The Heart Research UK spokeswoman was openly prohibitionist in a way that no one would have dared before July 2007.

Thirdly, the BBC have titled this show 'Should smoking be banned in all public places?' How quickly definitions of 'public places' shift and slide.

Finally, and most importantly, I was amazed by the mangling of the basic facts. Perhaps those of us who follow these issues closely assume too much of the media but it was repeatedly said - by the presenter - that the smoking ban has made a million people give up smoking. I have never heard this figure even from ASH or the Department of Health. 

I read this in The Independent in June 2008:

The nationwide smoking ban has triggered the biggest fall in smoking ever seen in England, a report says today.

More than two billion fewer cigarettes were smoked and 400,000 people quit the habit since the ban was introduced a year ago, which researchers say will prevent 40,000 deaths over the next 10 years.

But then I read this in the Daily Mail earlier this year:

The ban on smoking in public has failed to increase the number of people quitting, a report revealed yesterday.

And then earlier this year:

The number of smokers giving up has barely increased since the ban, despite a hike in the amount spent by the NHS on quitting services.

Figures show that nearly a quarter fewer smokers gave up the habit between April and September last year compared to 2007 - the year the ban on smoking in public places was brought in.

I don't know how many people have stopped smoking since the ban but it certainly isn't anything like a million. The most reliable source is usually the Office of National Statistics, which said - in March 2009 - that adult smoking prevalence was 21%, down from 22% before the ban. Since there were 9.5 million smokers before the ban (although estimates differ) that reduction equates to around 432,000 successful quitters. 

A 1% drop in smoking prevalence over two years is very much in line with the long-term decline so it is tenuous to say that this drop was attributable to the smoking ban at all. In time, we may even see the Irish phenomenon happen here and have many more people smoking.

The other statistic cited was that smokers cost the NHS £10 billion. Again, I've never heard this figure before. I've remember the old £1.5 billion well. I'm aware that there is now a £2.7 billion figure being bandied around (which began circulating, strangely enough, after the anti-alcohol lobby started saying that booze was costing The Health £2.7 billion). But never £10 billion. Even a Google search failed to unearth a single internet crank giving that number, so where on earth did it come from?

I ask this as a serious question. The number of people who check their facts on government websites and medical journals is tiny compared to the listenership of the average radio show. Regular readers will know that I quibble with official statistics from time to time - and I realise that I'm whistling in the wind by doing so - but even the official sources must wonder why they bother when they hear numbers being plucked out of thin air on national radio.



Leeches


Via the Tobacco Harm Reduction blog, Smokles, I find an article of glorious common sense written by the editor of the irreplaceable STATS.org, Trevor Butterworth.

For two millennia, leeches were used to balance the humors--or to drain the patient of "excess" blood and other substances thought to be the cause of most of humanity's physical and mental ailments. 

In a similar vein, some doctors and public health advocates are turning to a modern equivalent of the leech--taxes--in order to draw "excess" money from going to "unhealthy" activities, thereby reducing disease and balancing health care spending.

Regular readers will greet the latest public health ruse with a familiar sigh:

Now the latest advice for "leeching" America comes from Dr. Lloyd I. Sederer, medical director for the New York State Office of Mental Health, and Dr. Eric Goplerud, director of the Center for Integrated Behavioral Health Policy at George Washington University. 

Writing in the Washington Post, they argue that imposing heavy taxes on alcohol would both reduce the harmful effects of heavy drinking and help pay for health reform. The logic is that if teens drink less, they'll have less unprotected sex, reducing their exposure to sexually transmitted diseases.

These people are deadly serious and - behold! - they come clutching research and a spurious statistic:

They claim that a tax increase of "3 cents per beer would cut youth gonorrhea by 9%"

So why not raise tax by 33 cents and reduce gonorrhea by 99%? Hell, why not go the extra cent and eradicate it entirely? Because, as Butterworth shows in delicious detail, this statistic is completely bogus. It comes from a 2000 paper published in the Journal of Law and Economics which noted that cases of gonorrhea fell between 1981 and 1991, at a time when beer tax had doubled.

What more evidence could anyone ask for?! Why, it's almost as compelling as the well known association between rock music and oil production:




Using the classic junk science tactic of cherry-picking, and making the classic mistake of confusing correlation with causation, the authors stated that this association is "consistent with the assertion that alcohol tax increases can reduce STD rates". 

Consistent, perhaps, but utterly wrong. Rates of STDs had been falling before the tax rise and they continued to fall afterwards. Between 1992 and 1996 - with no rise in beer tax - there was a decline in rates of STDs that was almost as sharp as that seen in the previous years.

So what really happened? A far more convincing reason for the fall in STD rates during the late 1980s and early 1990s is AIDS awareness and the corresponding upsurge in condom use. 

It is far from unreasonable to conclude that the steepest decline in gonorrhea rates between 1991 and 1993 had more to do with increased awareness of the dangers of unprotected sex than the sobering effects of an extra 2.7 cents on 12 ounces of beer.

This, surely, is the real reason. But this logical explanation offers no excuse for the forces of public health to tax, tax and tax. Consequently, it is ignored and replaced with junk science. The only wonder is that it has taken them nearly ten years to catch on to the potential for extortion that lay dormant in the 2000 study.

Will it ever end? And as Smokles says, wouldn't it be simpler if we just gave the state all our disposable income and let the politicians and health groups decide what it gets spent on? 


*Thanks to Dick Puddlecote for the graph.