No drink ban on under 21s: SNP loses another vote on alcohol bill

A Scottish Government plan to allow local councils to raise the off-licence purchasing age to 21 has failed to gain the support of the Health & Sport Committee at the Scottish Parliament.

The proposal is itself extraordinary, as it would have the result of having different purchasing ages in different parts of the country. This carries the clear danger that young people who want to buy off-licence will travel to another district. Importantly, the presumption behind the under 21s ban is that people below 21 are more likely to be irresponsible than their elders. Also, according to Liam Burns of the National Union of Students (reported here) the local measures would not require local consultation prior to decisions and implementation.

A further compelling bonus of this decision is that it simplifies (or halts further complication of) the age of majority. Purchasing alcohol on or off-licence is allowed at 18, when people legally become adults. Making the legal age for off-licence purchasing of alcohol higher than the age of majority blurs the impact of reaching 18, which should be the age when people are considered autonomous, and able to make legal and other significant decisions about their lives. Making people aged 18 to 20 dependent upon their elders for off-sales makes nonsense of this autonomy, and discriminates against the 18–20 year age group.

Dutch ban for small pubs lifted again (what happened to Scotland?)

Dutch small bars are celebrating the lifting of a smoking ban that was first imposed in 2008. The ban still applies to any outlet that employs staff, but any enterprise in the hospitality sector without staff is free to allow smoking.

Since the ban was ostensibly imposed on the grounds of protecting staff, one-man operators fought it on the grounds that they had no staff needing protection. Partial success in the courts last year led to a temporary lifting of the ban on such operations, but these judgements were overturned and the ban became general once again, but it has never been effectively enforced. This week's change has come from a new Dutch government – only just formed several weeks after the general election on 9 June.

Dutch bar owners, apart from not enforcing the ban, have also made their feelings known in other ways. They are well organised, and in a sensible way: i.e. the small bars have banded together as they have had a specific campaign regarding the smoking ban.

What has happened in Scotland and the UK? Dominated by chains and breweries, the fight for licensees since the ban struck their pockets has focussed on tied licences and (happily for the government) supermarket prices. It is never easy to get the powers that be to admit that the licensed trade, rendered unfit for purpose to up to half its customers by the smoking ban, has suffered thereby. And since some venues have stood to gain at the expense of their smaller neighbours, the trade has itself been divided.

In reports on the recent study that demonstrated the damage done by the smoking ban (in Scotland as well as the rest of the UK) the response from Paul Waterson of the Scottish Licensed Trade Association is lukewarm if not downright disappointing. Here, he says that pubs have been hit by the smoking ban, but not what an absolute travesty the ban is, and he does not recommend a review.

Even before the ban became law, the SLTA's stance was conciliatory rather than defiant. They declared they had compromise proposals on the table. Regrettably this proves to have been too genteel an approach to the enemies that were pushing at the door. What kind of bargaining counter is a 'compromise proposal'? Now that the Scottish Government's anti-smoking agenda has proved anything but genteel, bodies like the Scottish Licensed Trade Association must grow teeth and defend their members' choice of customers be respected. How is it to any licensee's advantage to be forced to put customers outside?

Weil Maessen, who represents the Dutch small bar umbrella organisation KHO, reminds us that the fight is not over until the whole hospitality sector regains choice. Brilliant: not just defiant but intelligent and prepared to deploy strategy and keep fighting!

Are you listening, NHS Grampian?

This could be you in three years' time. Or less.

Bournemouth
Derby, Leicester
Swindon (and here)
Romford
Scarborough
East Lancashire
Kent Medway Maritime

And counting.

Philippines: 'role model' physicians barred from smoking

Press reports say that the Philippine Medical Association has banned its doctors from smoking in order to set a good example to the public.

The reasoning that doctors must be a good example to society doesn't really hold up, as doctors are valued for their competence and listening skills, rather than for the exemplary behavioural models they provide to the rest of society. One could make this demand of anyone, as it has already been made of footballers and film stars. This is, rather, an example of the herd mentality: if you don't behave like us, watch your step. The general public is expected to inform on doctors who smoke.

A critical observer points out the open-ended nature of the threat. No sanction is specified for deviant doctors: 'we'll cross that bridge when we come to it'. This looks like: 'we'll get rid of you if we can afford to'. Who knows: they have not said. It's not a recipe for even-handed justice/sanction setting, and not a good example to set to the rest of society either.

Adult venues recognised in Galveston, Texas: smoking ban revised

Galveston, island city in Texas, has revised its smoking ban, which has been in force since only January this year. Amendments to relax the ban will be implemented after just over a week, allowing 'adult-only' venues to admit smoking, and considerably reducing the non-smoking zone around doorways in venues that will remain non-smoking.

The smoking ban was the subject of court action by a number of businesses including a party that had already implemented an indoor smoking ban and built a patio. Their fight defends the principle that proprietors choose their market and regulate smoking behaviour on their premises and complains the council made no investigation of how the ban would affect their premises.

It seems that Thursday's council decision has pre-empted any decision from the courts.

Tobacco advertising!

Smoking related stories are usually accompanied by smoking-cessation related advertising (see the sponsored links under this story).

But see this from the foot of Sheila Duffy's latest blog piece.

I don't suppose ASH Scotland is making any money out of this one: maybe they just don't get enough traffic to persuade Google to include more prohibition-friendly sponsorship links?

A Scottish suicide: campaign against Champix

Champix is a smoking cessation drug with a dubious reputation. I will leave you to google it (it is known as Chantix in the USA), but anecdotal accounts of bad effects and lawsuits make taking it not such a good idea if you wish to quit smoking. Its manufacturers declare that the benefits outweigh the disadvantages, but the problem is the that disadvantages can kill. This story appeared in the Paisley Daily Express before Brian McLinden's family had understood that Champix might have contributed to his death. His wife Patricia asked hypnotherapist and Champix campaigner Chris Holmes to tell her story, which he does here.

Chris rightly points out that the advantages of this drug include a spectacularly low success rate and, given the horrific stories attached to it, wonders how it remains legal. Please make this story as widely available as you can.

Lodging motions on Pell in the Scottish Parliament

Actually some of them really believe what she came out with: 

*S3M-7054 Kenneth Gibson: A Reduction in Smoking Means Fewer Asthma Attacks—That the Parliament welcomes the findings of recent research by the University of Glasgow concluding that the admission of children with asthma-related problems to hospital has dropped by more than 18% since the introduction of the ban on smoking in public places in 2006, a reduction equivalent to three fewer children being admitted each day; recognises that, prior to the ban, the admission of children with asthma was increasing at a rate of over 5% per year; notes that the researchers also discovered that, since the ban, there had been a 17% year-on-year drop in hospital admissions from heart attacks and a significant decline in respiratory problems among bar staff; considers that the smoking ban has resulted in a massive step being taken toward shedding Scotland’s image of being the sick man of Europe, and believes that this legislation has greatly improved the health and wellbeing of the Scottish people.

Chris Snowdon crunches the numbers on this by helpfully breaking down the figures supplied on Pell's graph for each year under study and breaking them down into daily averages: 


2000: 2391/366 = 6.53 per day

2001: 2142/365 = 5.87 per day (drop)

2002: 2034/365 = 5.57 per day (another drop)

2003: 1803/365 = 4.94 per day (another drop!)

2004: 2621/366 = 7.16 per day (rise)

2005: 2103/365 = 5.76 per day (drop)

2006: 2633/365 = 7.21 per day (rise)

2007: 2056/365 = 5.63 per day (drop)

2008: 2235/366 = 6.11 per day (rise)

2009: 1397/304 = 4.59 per day (drop) (ten months only of this year counted)


(I added the 'rise' and 'drop' indicators for additional clarity!) Kenneth Gibson also applauds the 17 per cent figure that Pell came out with in 2007 with respect to heart attacks. I didn't know anyone took that figure seriously any more, especially since the drop in England was 'found' to be only 2.4 per cent: a figure that was also not corroborated by routine statistics.


Isn't it reassuring that Scottish leaders believe what they want to believe, rather than looking squarely at the evidence in front of them? 

LA through the eyes of a resident smoker

We've all read about how badly smokers are treated in California. Here is an eye witness account from a smoker, Juliette, in a guest blog post.

Juliette's own blog is here.

ASH Scotland, illicit tobacco and an international forum against cancer

Sheila Duffy's main extravaganza of the week was an 'illicit tobacco summit' in Perth (Scotland), which brought together a range of players, including a representative from the Scottish Grocers' Federation, Trading Standards, the Police, Gerard Hastings and Mary Cuthbert from the Tobacco Control division in the Scottish Government.

If nothing else, it is odd to see such people join forces in a bid to overcome illicit tobacco traders: some wish to protect legitimate traders in tobacco, while others seem to be doing everything in their power to denormalise the position of tobacco in the marketplace. It may be little time before there is division in the ranks.

Sheila's latest blog post (here if you would like to comment) reminds us that 'illicit tobacco is not a victimless crime'  (quoting Detective Sargent Allan Orr). Just in case we feel like getting involved. It winds up by pointing out that border controls next year are expected to weaken because of funding schemes drying up. Then, just as we are thinking of buying some tobacco from the corner shop, she chimes in by reminding us that it kills us anyway, even if legit.

No doubt enforcement authorities do face a headache, but it might be of smaller scale if such a large share of the purchase price of tobacco weren't made up of tax. I've suggested diverting ASH Scotland funding towards border controls, as Sheila does paint such a colourful picture of gun-runners throwing tobacco and hard drugs into the mix in small Scottish communities. (Yes, I know those particular controls aren't a devolved issue.)

Sheila adds a blog to her blogroll, from the American Cancer Society. I've yet to look in detail but it seems overly concerned with tobacco control, and prioritising non-communicable diseases. Wouldn't more emphasis on treating communicable diseases save more lives? Of course they can promote their activity, that's natural, but their priorities don't seem to promote maximum societal welfare.

Health Secretary to persevere with minimum pricing policy

The Health Secretary has not given up on minimum pricing. Not that I've got anything against a fighter, but it's hard to see the merits of a system where alcohol in Scotland is priced higher than its larger neighbour over the border: a border, moreover, that has no border controls. BBC reporter Brian Taylor's summary of the arguments and counter-arguments says that the main argument in favour is the support expressed by health service leaders and the police: not very persuasive against the arguments put forward by opponents to minimum pricing (it's really not enough to say that important people agree with you).

For me the Achilles heel was the claim that:

In the first year of such a policy, there would be 50 fewer deaths, 1,200 fewer hospital admissions, 400 fewer violent crimes and millions of pounds saved in healthcare ... 

Their claims are much less extravagant than they were prior to the smoking ban when it was claimed that 1,000 lives would be saved in Glasgow alone: in England an estimate in 2007 came in at 11,000 lives a year. Later that year back in Scotland we had Jill Pell announcing 17 per cent fewer heart attack admissions in the first year of the ban (never repeated, which is possibly why she had had to move on to another condition). Mortality statistics for Scotland reveal a steady decline in total mortality since 1999 and earlier (peaking in 1989 at nearly 34,000), steepest at 2003/4, rising slightly at 2007, and declining since.* Figures for the Glasgow area show nothing to support a claim that 1,000 fewer people have died every year since the smoking ban came in, hovering at 6.5 to 7.5K per year for both men and women.**

Saving fifty lives by comparison is quite a modest prediction, if hard to verify, but 400 fewer violent crimes and 1,200 fewer hospitalisations is hard to believe. How they come up with these figures is anybody's guess.
Whatever the legislation is meant to tackle, whether chronic drinking or anti-social behaviour, it won't help the situation if it turns out that the people causing the trouble are not mostly at the bottom of the economic heap, but it will hurt them just the same.

Tables from General Register Office for Scotland
*Deaths, by sex and age groups, Scotland, 1901 to 2009
**Deaths by sex, year and (post-April 2006) NHS Board area, 1991 to 2009

Scottish Government defeated on minimum pricing

In a vote that attracted UK-wide attention, the Scottish Government has been defeated on the key issue of the Alcohol Bill, the much-discussed issue of minimum pricing. As seems to be the pattern in such highly charged issues, the votes went along party lines, with the Greens supporting the Scottish National Party in voting for minimum pricing and the Labour and Tories voting against, with only former health minister Malcolm Chisholm MSP breaking ranks.

Labour appointed a commission that reported on the issue, saying that the issue was a UK-wide one, should be based on taxation rather than minimum pricing and a ban on selling below cost. To that extent it makes sense but the Alcohol Commission has also suggested banning alcohol sponsorship and a banning alcohol at official functions. In the middle of a public financial crisis banning sponsorship is lunacy: allegations abound that sponsorship deals include cheap drink that encourages binge drinking, and there may be some truth in this but it is a moot point whether it outweighs the health benefits brought by more participation in sports.

We're not doing very well then. Neither a Scotland-only policy that sets a minimum price per 'unit' (whatever that is), nor blanket ban on alcohol companies sponsoring functions and sporting events, is likely to go very far in stopping people from drinking. As Richard Simpson MSP pointed out in the Chamber, a separate minimum pricing policy in Scotland would provide business for cross-border informal alcohol sales. And as this blogger points out, such a policy would exert the most pressure on the lowest earners, leading in some circles to a deepening spiral of crime, debt and family breakdown.

Almost more dangerous than this possibility is the one of attempting to stop sponsorship by the alcohol trade in the same way that tobacco companies have already experienced. Apart from taking money out of the economy away from areas that need investment (sport, for example), this option marginalises the whole industry. The government should instead demand input from the alcohol industry into policy recommendations: who understands the alcohol trade like them that produce it? This is the approach suggested by The International Coalition Against Prohibition in their reply to last year's consultation on the issue. (TICAP also promotes the Brussels Declaration on Scientific Integrity, which points out that moderate consumption of alcohol has health benefits and prohibition thus not a sensible health policy option.)

In broad terms, although I haven't absorbed enough detail so far, it seems much better to allow the alcohol industry full participation in drink damage limitation exercises, than to allow government health departments full authority in this area. Sure, the Health and Sport Committee can run about managing the tobacco and alcohol industries but is that its job? Input is one thing, but it is surely not appropriate that the Health and Sport Committee leads on the detailed regulation of a trade issue.

The Scottish Government's report in 2007, Better Care, Better Health (a jumbled sandwich with direct discussion of public health priorities in the middle) seems 90 per cent concerned with health service management and targets. The page featuring the Health and Sport Committee on the Scottish Parliament website reflects a similar preoccupation with Health Service management, and its recent reports, listed at the bottom of the page, don't cover sport at all. Wouldn't it be better for alcohol and tobacco to be regulated by industry and trade department officials (admittedly a problem in post-devolutionary Scotland) than by a health department with too much on its plate already? (and is there any commitment to youth sport?)

Minimum pricing is off the agenda at any rate: it remains to be seen what will replace it, as May 2011 is just a few months away.

Freedom2Choose meeting in Northampton hoped to be the first of many

This meeting of the UK organisation Freedom2Choose with pub trade representatives and two MPs is reported here. One of the MPs refers to a ten minute motion due to be lodged at Westminster on 13 October: details here.

 Ten minute Rule Motion: Mr David Nuttall: Public Houses and Private Members’ Clubs (Smoking): That leave be given to bring in a Bill to exempt public houses and private members’ clubs from the requirements of Part 1 of the Health Act 2006 relating to smoke-free premises; and for connected purposes.

This is the first opportunity since the Bill was passed in February 2006 to bring pressure on MPs. Readers in Scotland will have their own feelings about whether lobbying their MPs on this subject is ethical! But remember that the lobby groups working to maintain the ban will be hard at work throughout the UK. Your MP still represents your interests and is accountable to you, wherever you live.

Please take every opportunity to open a dialogue with your MP on this subject and make him/her understand that there is a genuine case for a relaxation of the smoking ban.

'Falls' in the asthma rate kept under spotlight

Local MEP Catherine Stihler has weighed in to the asthma 'debate'. In a letter to The Scotsman she savages a subscription-only article criticising the latest Jill Pell study by Brian Monteith (former MSP) in yesterday's edition.      

Ms Stihler (with whom I corresponded briefly in the past) wants to see smoking bans in workplaces throughout Europe. Her defence of Jill Pell is peculiarly irrelevant to the shortcomings in Pell's study ('40 per cent of children in Scotland live with an adult smoker'). Her website shows a handful of references to smoking, showing that she is a champion of smoking cessation and graphic images. Nothing very remarkable really. The asthma report has gone round the world, and this is the quality of letter writing that supports it.

Freedom to Choose (Scotland) press release, tobacco strategy, Sheila Duffy and the voluntary sector

Sheila Duffy is never out of the news these days. Today it's the Evening News (again), and another 'call' for the Scottish Government to pull the strings to stop everyone from smoking. Free will doesn't come into this it all ('no, of course, it doesn't', I hear the cry, 'you're all addicts'!). The 'right' policies will create the 'right' results, and people's thoughts, feelings, hopes and desires are quite irrelevant.

None of this has worked, as the latest press release from Freedom to Choose (Scotland) points out. The number of smokers has not fallen below one million where it was in 2005. But still the demands from ASH Scotland come thick and fast: what is the Scottish Government doing about the smoking rate?

Sheila appears to be in the middle of a plan funded by Cancer Research UK, due to wind up in February 2011. Calling itself an 'ambitious strategy' it demands an ambitious strategy on tobacco control from government, to be implemented by the voluntary sector (in what sense voluntary? need to look into this!). Someone had the bright idea of calling non-governmental organisations (i.e. charities, the third sector) para-governmental organisations. I wish I could remember who it was and it seems that they had a very good point. No doubt some of them do very good work but they are clearly in danger of undermining democratic processes.

That's it really. If Scottish people don't want money spent on this, they really must shout about it, because Cancer Research UK appears to be paying the client groups hovering around ASH Scotland to shout about it : money that could be spent on clinical research.

Tobacco control blogs on how to fund global tobacco control

Read here. Graced with a comment from the wonderful James Repace warning of the dangers of secondhand smoke infiltration in multi-family dwellings' endangering 'tens of millions of people in the US alone'. (Only secondhand, James? Keep up!)

Speculation about how to raise enough money to cover the spiralling costs of tobacco control include more taxation mandated through the World Health Organisation's Framework Convention on Tobacco Control (FCTC).

Apart from James Repace two other contributors have given ideas so far: one says don't go just for the big tobacco companies: go for the users too. The other says the costs of global tobacco control are too high: ban the whole thing from farmers to end users (possibly under the illusion that illegal drug control comes cheap).

These are people who find nothing undemocratic in global bodies setting policy or mandating the raising of taxes on people including consumers who are found more in the least prosperous sectors in society. And they taxes will deter smoking. High taxes are thought to be a big factor in increased smuggling.

Further constructive ideas are invited.  Comments are moderated (unless you comment here instead).

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

Talking about outdoor smoking bans

Since everyone else is talking about the smoking ban that Mayor Bloomberg wants to impose on the parks and beaches of New York, we should talk about it on this blog too. Let's start here.

Don't forget to view this video.

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?)

More junk from Jill?

Jill Pell stormed the world in 2007 by announcing a 17 per cent fall heart attack admissions to Scottish hospitals which she attributed to Scotland's smoking ban in enclosed public places, implemented in 2006. The story got global coverage and hasn't stopped being talked about since ... although I do wonder if it might be muted since they claimed that heart attack admissions dropped in England by only 2.4 per cent (this story was not taken seriously either because the figures didn't fit routine statistics).

Now Jill Pell, backed by a team at Glasgow University, is telling us that childhood asthma hospitalisations have fallen away since the smoking ban too.

This is nonsensical to many, simply because the only public enclosed places that children attend with any regularity never encouraged smoking in the first place. Pell's explanation of a stupendous drop in child asthma cases of nearly one-fifth, that parents 'smoked less' or banned smoking in the home is not believable. For this to make any difference we would have to see residential streets lined with smokers during every commercial break. And we just learned yesterday that smoking cessation targets are not being met.

In any case, there is an inverse correlation between smoking and asthma. Asthma increased in a period over the last generation when the popularity of smoking was unquestionably declining.

As with the heart attacks, we find the startling drop in hospitalisations never took place. Chris Snowdon on Velvet Glove Iron Fist takes  up the story (comments are worth reading too); Simon Clark at Taking Liberties  also comments.

Of Scotland, Jamaica and health inequalities

Scotland saw a rash of stories today following this press release from ASH Scotland. The Courier warns starkly that 'anti-smoking targets will not be met'. The Scotsman says, Fear of Scots health divide as war on smoking fails poorest. (Did anyone really think a smoking ban would close the health inequalities gap? If there are more smokers at the bottom of the income scale, there will be more people suffering social disruption from those sections of society. The wealthy, even those who smoke, are relatively little inconvenienced by smoking bans if they have room to entertain at home. Being effectively marginalised from mainstream society does affect health: physical, mental and emotional.)

I enjoyed the take of Planet Politics on this situation. It confirmed my suspicion that all the smoking ban has managed to do was to 'rearrange the smoking deckchairs' (i.e. get people smoking at home instead of persuade them to stop smoking), rather than make any difference in anyone's health.

Indeed the ASH Scotland press release speaks of an 'increasing health inequalities gap'. That wasn't meant to happen, was it? Oh dear, the anti-smoking groups have been going on about health inequalities for years, but they just seem to be making things worse. Health inequalities are getting wider, not narrowing. I have to say that the idea that smoking causes health inequalities is somewhat blinkered, but that is what professional tobacco control advocates believe.

Meanwhile, Jamaica does not have a smoking ban yet and does not seem to have even announced one. But the Director of the Heart Foundation of Jamaica is clearly gunning for one. No apprehensions whatever about any adverse consequences. These words express plenty about the importance of narrowing health inequalities in the minds of ban advocates:

Those who continue smoking because of their addiction to the drug nicotine, an ingredient in cigarettes, will continue to do so in their homes, to the possible detriment of the health of those who live with them. But for non-smokers who enjoy the freedom of clean air and the health benefits of unpolluted lungs, smoking bans reduce exposure to second-hand smoke.  [my emphasis]

The bans effectively divide the interests of one section of the population from the rest. Non-smokers are more equal than everyone else.

Almost thinking outside the box on smoking

Well done the Telegraph for stating the obvious on smoking – that any arrangement resulting in patients smoking in beds and adjacent to oxygen tents is a thoroughly bad one and needs to be changed urgently. 'Let the patients puff away in their shelters,' it says. Well, that would be a marked improvement on having to go out on to the street. There was never any excuse for implementing comprehensive site bans in the first place – nobody can say they weren't warned.

But it didn't go far enough. Shelters are not the answer if you are confined to bed and have mobility problems. If on the other hand you are with a relative who is seriously unwell and you want to go for a quick smoke while they are undergoing treatment, the last place you want to be is in a shelter round the back of the hospital where you cannot be found if needed. I appreciate that the Telegraph might not want to condone breaking the law, but in this case they should have gone further.

The only solution to the problem of hospital smoking is large comfortable smoking rooms (preferably with coffee facilities) that will attract patients and visitors out of doorways and other places where they feel driven to smoke. Instead of treating smokers as culprits and driving them to situations where their smoke will inconvenience or endanger others, how about allowing them some dignity – or is that now considered to be against the national interest?

And well done Duncan Barkes of Talksport for making this very point on this morning's show (about 3.45 am)!

Radio controlled vending machines

The National Association of Cigarette Machine Operators has been hit by bans on its vending machines both by Westminster and Holyrood and the machines are expected to go out of commission in October 2011. This means that in future years youngsters will be unable to obtain 16 tabs for the price of 23, but the powers that be clearly feel that they will be thereby less tempted to buy cigarettes.


NACMO has created a vending machine that works by radio control, following age verification. Once the machine is turned on, it allows only one sale before it turns itself off again and must be reactivated from behind the bar before any further use.


I witnessed the final debate at Holyrood when the Scottish Parliaments passed the display ban and vending machine legislation (to a round of applause!) as part of the Tobacco and Primary Medical Services Bill (quite how the display of tobacco was connected with primary medical services was not made clear). A Labour MSP Rhoda Grant proposed an amendment to allow a trial of radio controlled vending machines in Scotland. None of her party supported it, and when the Conservatives pushed it to a vote, she voted against it. Michael Matheson SNP's statement was telling: 'we have no robust evidence to demonstrate that remote-controlled vending machines are a much more secure way of ensuring that young people cannot access cigarettes'. 


Even the fact that these machines are standard in many European countries and the premium rates charged on top of the UK's rather atrocious retail prices for tobacco would not convince him that stinging operations on vending machines did not reflect where youngsters actually buy their baccy. If the machines are removed it only means that the most expensive choice of cigarettes will be taken off the market.


As for 'no robust evidence'? How about this quotation taken directly from the Stage 1 report by Mary Scanlon (Conservative): 

The Committee notes that strong views were advanced on both sides of the debate. The Committee also recognises that the evidence base for this proposal is at an early stage and that the international evidence to date is inconclusive.

Ms Scanlon points out that there is no evidence base to support the entire Bill (that part relating to tobacco). Yet Mr Matheson quibbles about knowing whether a machine works, even when being asked to consider running a trial. Little difference between this and 'no robust evidence'. 


Isn't that always the answer: any technology that offers a solution that might prevent a ban 'won't work'. Not ventilation. Not radio-controlled vending machines.


The Scottish Government and many of the parliamentarians seem quite myopic on this issue. The present initiative described in the Morning Advertiser is directed at Westminster, and time will only tell whether they will come to the conclusion that there is no need to ban vending machines.