Crap predictions

As any pedant will tell you, we are now in the last month of the first decade of the century. And so, on that tenuous note, let's revisit some of worst predictions for what would happen by 2010. In Britain.

Over at Spiked, Rob Lyons rightly lays into the myth of the obesity time-bomb, which was only ever the result of taking existing trends and making the bone-headed assumption that they will continue at the same pace forever. Some readers will recall Caroline "window dressing" Flint predicting that there would be 13 million obese adults in the UK by 2010.

The report warns that, based on current trends, 33% of men and 28% of women will be obese by 2010. The government says it is the "most accurate estimate so far" of future obesity rates.

The data is published just days after a "minister for fitness" was appointed.

Unless a lot of people hit the turkey and mince pies in a big way over the next two weeks, this prediction looks to be what it has always been: a scare story based on junk statistics. As Rob points out:

According to the lastest results from the Health Survey for England, regarded as the best source of information on the topic, obesity rates have fallen. Yet you could have been forgiven for failing to notice: it’s barely been reported. After all the sensationalist headlines over the past few years about an ‘obesity timebomb’, would it be too much to expect some balanced reporting over the fact that the aforementioned explosive might not be going off after all?

Of course, the powers that be can always say that they prevented the obesity time-bomb by taking action, to which Brian of Nazareth might cry "well, what sort of chance does that give me?" In fact, the decline in obesity began before Jamie Oliver got involved and before the middle-class media started sneering at parents in Rotherham. The obesity time-bomb didn't happen because it was never going to.

And what has happened to the binge-drinking epidemic that was supposed to follow the introduction of the wildly misnamed "24 hour drinking"? As Monsieur Puddlecote and myself never tire of saying, it never happened. Whether one looks at alcohol sales, per capita alcohol consumption or self-reported drinking levels, the story of the decade has been one of falling consumption. And as Dick has recently noted, police arrests for drunk and disorderly have also fallen throughout the decade. But who cares about these silly things called 'facts' when the media can show some ropey bird in high heels lying on a bench with a bottle of WKD beside her?

The tabloid version of "Binge Britain" (another classic panic phrase) is not, and never has been, the truth. And as our present recedes into the past, the hysteria is already being documented by sociologists. Rather marvellously, for those who vividly remember the prophecies of doom when the Licensing Act was passed in 2003, the whole thing is already going down in history as a great British moral panic. A study by Henry Yeomans in Sociological Research provides an academic discussion of the frenzy and reminds us of the drivel that was spouted at the time:

The Licensing Act 2003 was speculatively linked to a projected explosion of violence, sexual assault and general disorder. On the eve of the Act coming into effect, The Sun reported in battle-ready terms the creation of a ‘field hospital’ in Newcastle-upon-Tyne to handle the imminent ‘casualties of 24-hour drinking’ (Perrie, 2005). Of course the press may be prone to sensationalism, but it was not just the Daily Mail who believed that ‘the binge is about to become an uncontrolled riot of drunkenness’ (Daily Mail, 2005). David Blunkett MP described the Act as ‘a leap in the dark’ that risked worsening crime problems (Daily Mail, 2005) and Mark Oaten MP claimed that ‘when the problem is running out of control in our town centres, extending drinking hours to twenty four hours a day is madness’ (Plant & Plant, 2006: 100).

It all seems like yesterday, doesn't it? All those predictions of "urban savages", mayhem and an epidemic of drunkenness, alcoholism and disorder. In some sections of the press, the panic endures, even as alcohol consumption falls year after year (with the steepest fall in 62 years coming in 2009). Perpetuating the fear is an easy job since—as Tom Papworth wrote at Liberal Vision —"it is these days very easy to send a film crew down to a town centre and film a few dozen people behaving badly, and extrapolate this to the wider country."

Yeomans paper (which is worth reading in full) explains the panic in terms of Protestant asceticism and the 'Iron Cage of Temperance'.

This paper views the reaction to the implementation of licensing reforms in 2005 as a moral panic for two reasons. Firstly, it was an intensified period of concern about alcohol use in Britain within longer term processes that have constructed alcohol as a social problem.

Secondly, the reaction appears irrational and disproportionate to the level of threat actually posed. This is partly because of the diminutive number and length of licence extensions granted and also due to the negligible effect on crime and disorder. The Department of Culture, Media and Sport’s evaluation of the Licensing Act 2003 found no uniform detrimental effects (DCMS, 2008) and Home Office statistics show that crime levels continued to fall from 2005 to 2008 (Kershaw et al, 2008).

Although it is easier to appreciate in retrospect, the mayhem widely predicted clearly did not materialise. In the absence of any rational support for the public outrage, this paper thus seeks a moral and ideological explanation for the events of 2005.

And finally, as Britain endures its coldest December for a century—and its third "unusually cold" winter in a row—this gem from The Independent in 2000 has become rather popular on Twitter. You need to read the whole thing to fully appreciate the hubris, but this gives a flavour:

According to Dr David Viner, a senior research scientist at the climatic research unit (CRU) of the University of East Anglia,within a few years winter snowfall will become "a very rare and exciting event".

"Children just aren't going to know what snow is," he said...

The chances are certainly now stacked against the sortof heavy snowfall in cities that inspired Impressionist painters, such as Sisley, and the 19th century poet laureate Robert Bridges, who wrote in "London Snow" of it, "stealthily and perpetually settling and loosely lying".

Not any more, it seems.

Merry Christmas to all readers. I'll be back in a few days with the worst junk science of 2010.

Vast study finds no heart miracle but lots of publication bias

In light of my recent posts about post-smoking ban 'heart miracles', it is timely that a new study of heart attacks rates in the United States has just been published. This study—by far the biggest ever conducted— confirms that smoking bans have no significant effect on either the incidence of, and mortality from, acute myocardial infarction.

Published in Journal of Policy Analysis and Management, the study looked at more than two million heart attack deaths over the course of 16 years, making it by far the largest exercise of its kind ever conducted. The researchers found a great deal of fluctuation in heart attack rates but concluded that:

...large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature.

The crucial four little words here are 'in the published literature'. The large increases get ignored while the large decreases get studied, written up, published and press released. The widely-reported studies that have found drops in heart attacks after smoking bans are—as regular readers already know—the result of straightforward cherry-picking and publication bias. We know that in most Western countries there is a long-term trend of declining heart attack rates. We also know that there is substantial variation in heart attack rates and that smaller communities (like the Isle of Man or Helena) are more likely to see bigger fluctuations because the average number of cases is already very small (single digits per month, in those instances).

As such, it is child's play to mine the hospital data and find places which have seen large drops in heart attack admissions following a smoking ban. It's not a coincidence that such studies usually rely on obscure towns in Montana or Ohio, and not the huge populations of Wales, Australia or New Zealand, where we know smoking bans have had zero effect on the number of heart attacks. And on the odd occasion when researchers get carried away and agree to do a heart miracle study for an entire nation before they've had a chance to look at the data, they can always ignore the actual hospital records and cook the books to create the illusion of a large drop in heart attacks, even though the real data show nothing of the sort.

What this latest study shows is that if you look at vast populations, there is far less chance of a fluke result and, if the findings are honestly reported, there can only be one conclusion:

"In contrast with smaller regional studies, we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases."

For more comment on this, see Michael Siegel, Jacob Sullum and Mr Puddlecote. The latter also has the news about regular commenter Junican winning a year's subscription to Tobacco Control after entering a competition to come up with new terminology for the anti-smoking movement to employ. His spoof suggestion turned out to be less risible than the real submissions. Junican is currently buying pornographic magazines to wrap around his issues of the world's foremost anti-smoking journal so he can read them in public without embarrassment.

Something for the weekend

A few blog-posts of interest for the weekend...

Find A Voice really, really hates smoking, but he hates junk science and intolerance more. He gives an account of his conversion here:

You may argue that the medical evidence provides an overwhelming case to introduce such bans but I don't accept this. Having had my eyes opened to all the pseudo-science that currently is awash throughout 'the case for banning / the case for introducing more powers' industry, I have revisited the purported science over the period and much to my surprise (as I thought the smoking science to be irrefutable) the damage to others by second-hand (and the dubious third-hand and extremely dubious fourth-hand) smoking is statistically insignificant.

There might be the tiniest evidence that in certain extreme circumstances (i.e. lock someone in a room for a smoker for a number of years without a supply of 'fresh' air) that second hand smoke may have a very small effect - but would be less than exposure to harmful emissions than one would get through regularly using a car. So that only leaves the smokers themselves and whether or not smoking causes the smoker terrible harm or none at all is entirely the smoker's problem. Nothing to do with me or anyone else.

Likewise, the nurses at Hypercryptical are not happy about the heart miracle hoax or the plan to deny smokers routine surgery.

You might think that I am a rabid smoker demanding my place back in the world, but I am not - I am just an ordinary person, saddened that research has been manipulated to give a false impression of health gains to suit a particular agenda.

The reason for this post is this article in Pulse. It appears that smokers will be denied routine surgery unless they quit or complete an NHS Stop Smoking course. NHS Surrey has take the lead here. Read it all, including the comments.

Smokers will contribute (as tax revenue) £10.5 billion into the coffers this year. Source: HM Revenue & Customs. This equates to 11.55% of the NHS budget for England (£11) billion).

Who will next become society's dog to beat - alcoholics, the obese, the elderly or you?

At tfa.net, the Freedom Association has posted its response to the EU's latest consultation on tobacco control. The disproportionate influence of state-funded groups like ASH is mentioned, as is the ineffectiveness of the proposals. Have a read.

Also, Freedom in A Puritan Age is a new one to me and looks like a website worth keeping an eye on.

Finally, on an entirely different note, the best album I've heard all year is the self-titled debut and swan-song of Dan Haywood's New Hawks. It is a record of extraordinary breadth and ambition and has been getting the thumbs up from Uncut, The Independent and—somewhat incongruously—Clubber's Guide 24/7. I've been listening to little else for the last few weeks. Here's a sample:




Spate River from Kevin Cameron on Vimeo.

How's that Scottish heart miracle going?

Being in the mood to look back on the effectiveness of tobacco control efforts (see Ireland's Abject Failure below), let's see how that Scottish heart attack miracle has been coming along. You'll recall the professorship-winning study by Jill Pell which claimed that hospital admissions for acute coronary syndrome  fell by 17% in the first year of the ban.

Pell didn't go down the traditional route of finding out how many cases were admitted to Scottish hospitals and comparing rates before and after the ban (the data are readily available). That would be far too obvious and accurate. Instead, she went to the elaborate effort of limiting her sample to a selection of hospitals and then extrapolated the results across the whole of Scotland. After all, why use the actual data when you can create your own?

The answer, of course, is that there wasn't a 17%, or anything like it. And now, with three years post-ban data in the can, let's see how that heart miracle looks using the real NHS admissions data.

And, just to be sure, let's look at the rates of acute myocardial infarction (heart attacks).

Is any further comment really required?

Ireland's abject failure

Anyone remember when Ireland was tobacco control's jewel in the crown? The Irish smoking ban of 2004 was reported around the world and was supposed to lead to a "cultural change" that would see smoking gradually fizzle out. Keen to 'lead the way', Ireland has since followed the tobacco control blueprint to the letter. It's banned packs of 10, banned tobacco displays in shops and put more tax on cigarettes than any other country in the world.

The result, as previously reported here, is now official...

More smokers now than before 2004 ban

More people are smoking now than before the ban on smoking in public places was introduced six years ago, the Dáil has heard.

Minister of State for Health Áine Brady pointed to figures showing that 29 per cent of the population smoked despite the ban, the abolition of packs of fewer than 20 cigarettes, the ending of in-store displays and advertising, and the cost of cigarettes, which at €8.55 a pack “are the highest in the world”.

Although, to be fair, Ireland's slavish devotion to tobacco control policies has had some effect:

Sinn Féin health spokesman Caoimhghín Ó Caoláin described tobacco smuggling as a “huge and growing problem”

And let's not forget all those pub closures. All in all, a colossal disaster for all concerned except, perhaps, for the tobacco industry. I've said it before and I'll say it again. It's a damn good job it's not a results-driven business.

E-cigarettes banned because they are 'confusing'

Kings County, in Washington State, has banned the use of the e-cigarette in public places because it "threatens to undermine the social norming impact [of smoking bans]" and because e-cigarettes "cause confusion". This is an intriguing and dangerous development in 'tobacco control' since there is no evidence that e-cigarettes pose a health risk to the user, let alone to those around them.

I put the words 'tobacco control' in scare quotes because while this is undoubtedly a matter of control, it is no longer a genuine tobacco issue, let alone a smoking issue. Just as the anti-smoking movement became an anti-tobacco movement, so the anti-tobacco movement has become an anti-nicotine movement. When you have people campaigning against a product because it looks like a cigarette, it is difficult to sustain the delusion that we are not in the grips of scientifically illiterate, hysterical and—above all—moral crusade.

The Board of Health states that because e-cigarettes resemble cigarettes, they might cause "confusion and concern [to] the owners of those establishments who seek to comply with the Smoking in Public Places Regulations." Apparently, the possibility of causing confusion is now a legitimate reason for making an activity illegal in the United States of America.

The Health Board overstates the similarities between e-cigarettes and their combustible cousins. E-cigarette vapour dissipates within seconds. They leave no smell. Many of them are multi-coloured and look about as much like a cigarette as a pencil does. Above all, they don't cause cancer, but that doesn't deter those who want to ban e-cigarettes entirely from promoting a campaign that will lead to e-cig users returning to the real health hazard they had successfully given up.

Like all new products, e-cigarettes are bound to attract curious glances at first but this will disappear once people are familiar with them. Maybe some people will react with confusion and concern, but—and this is the real point—so what?

Ladyboys cause confusion and concern. Kerry Katona causes confusion and concern. My tax returns cause confusion and concern. It's not the government's business to protect sentient beings from confusion and concern. If the state must take a role in the e-cigarette issue it should be to quell the confusion through honest information and alleviate the concern with facts. And the facts are that e-cigarettes are, at worst, 99% safer than cigarettes, they create no secondhand smoke and they seem to be a damn fine substitute for smoking.

The idea that the government has to act to uphold "social norms" is particularly sinister. Quite simply, it is not for the government to decide what is normal and what is abnormal. Civil society decides what is normal and the concept of normality varies from person to person and community to community. And so it should.

A system that allows different people to plough their own furrow has been working just fine for years, thanks. And even if we did require a one-size-fits-all benchmark for normality, it is unlikely that we would turn to the inherently freakish collection of politicians and single-issue campaigners to provide it. You uphold your social norms and I'll uphold mine. K?


(For you early risers, I'll be making a similar point but less well and with more hesitation on BBC Radio 4's Today programme tomorrow. Or not, depending on what hits the cutting room floor.)

Is this the love child of Glantz and Gilmore?

The other day I was thinking of running a worst-junk-science-of-the-year poll. Thank God I bided my time otherwise I would have missed the chance to nominate this beauty.

Isle of Man smoking ban 'cuts heart attacks'

A ban on smoking in public places has reduced heart attack admissions, according to research commissioned by the Isle of Man's Department of Health.

The department has compared admissions in the two years prior to introduction of the ban on 30 March 2008 and the two years since.

It discovered that the number of men over 55 admitted for heart attacks had dropped since the ban.

But if we take a look at the 'study' (unpublished and not peer-reviewed, not that that makes a lot of difference these days), a very different picture emerges:

Do my eyes deceive me or does this graph show that there significantly more heart attacks after the smoking ban?

They don't and there were. In the 23 months before the smoking ban, there were 109 heart attack admissions, or 4.7 per month. In the 23 months after the smoking ban, there were 153 heart attacks, or 6.65 per month.In what universe does this count as a drop in heart attacks?

In the crazy world of tobacco control, that's where. Note the regression lines, designed to take your eye off what is actually happening. Note how the second half of the graph has a line that is driven down by the lowish figure for the last month shown (since the next month needed to make it a full two years has mysteriously gone missing).

This is a method taken straight out of the Anna Gilmore's box of tricks, with a dash of Glantz's Helena magic thrown in for good measure (small community, inaccessible hospital records, data mining etc.). If there isn't a drop in heart attacks, you simply 'predict' how many would have occurred if the smoking ban hadn't come in and make sure your prediction is higher than the real number. And before you know it the BBC will be falling over itself to report that "a ban on smoking in public places has reduced heart attack admissions" and the New England Journal of Medicine will be beating a path to your door.

And the feeble effort shown above is the best this researcher—a maths student at Rutherford Polytechnic the University of Northumbria—could conjure up. The graph that shows all heart attack admissions, (ie. the relevant, non-cherry-picked data set) is even less compelling.

Notice that before the ban, there were usually fewer than ten heart attack admissions. Notice, too, that after the ban the rate was usually well above ten. And, of course, there were more heart attacks in total after the ban than before it. And, as the flat black line shows, the monthly rate of admissions did not go down one bit in the nigh-on two years after the ban.

But you're not supposed to look at any of that. Instead, you are invited to look at the upwards line in the pre-ban period and assume that the rate would have continued rising, even though that line only goes up because of a big jump (by Isle of Man standards) to 14 cases shortly before the ban. Nor are you supposed to notice that any responsible statistician would identify that unusual leap as a statistical artifact. The fact that more than two-thirds of the data points are below the regression shows that it's being contorted by an outlier.

It's truly unbelievable that this sort of stuff gets taken seriously. Or it would be if it didn't happen every few months. This is a world where a flat line equals a decline, and a 50% increase in heart attacks equals a reduction in heart attacks.

In a year that has seen fierce competition for the title, Ms Howda Jwad of Northumbria University—for it is she—may just have clinched the inaugural World's Worst Junk Science Award in the dying days of the year. Glantz, Pell, Gilmore, Winickoff—it's time to up your game.


Thanks to Brian Bond for the tip

The ban and the Beeb

A very busy day of smoking ban-related items at the BBC yesterday, evidently inspired by the Dutch rolling back its smoking ban. Belinda has the run-down and sound clips at F2C Scotland.

Nicky Campbell had a spirit-sapping phone-in on Radio 5 (all phone-ins are spirit-sapping). The usual suspects called up: people who gave up smoking and think everyone else should too, people who believe that bar-workers have no choice but to work in pubs, people asking why we don't ban drinking as well, etc. etc.

Points of interest included Rosemary Gillespie from the Roy Castle Lung Cancer Foundation twice refusing to answer the question of whether Roy Castle smoked. Since the whole organisation is built on the idea that he got lung cancer despite not smoking, this is hardly a intrusive line of enquiry and her silence does make me wonder.

And a call from a gentleman who is happy that he can now enjoy a smokefree pint of real ale (CAMRA member?) crystallised the inherent snobbery and contemptuousness of the whole public health movement:

"Can I just say, quite a lot of the pubs that have closed down, to be honest I'm quite grateful they have. I think they were the most awful places which were actually just big smoking dens and had the most dubious clientele in them and they were just asking to be closed down."

I also find it very hypocritical for Cecilia Farren to talk (on Radio 4) about the "vested interests of the tobacco industry" when she is the director of GASP (UK). Aside from the fact that the tobacco industry had no hand in the grass-roots Dutch campaign, GASP is not just any ordinary anti-smoking group. It's not a volunteers' group, of course—hardly any of them are—but it is more explicitly commercial than most. It is a limited company that sells no-smoking paraphernalia and is therefore dependent on smoking bans for much of its business. Aren't conflicts of interests like that worth mentioning?

Smoking 'n' apple sauce

An interesting period piece, this.

Death in the West was the 1976 British TV documentary which used the Marlboro cowboy as the starting point for a discussion on smoking and health. The film became controversial when Americans for Nonsmokers' Rights started showing it in America in spite of the industry's legal protests.

Someone has now put it up on Youtube and it's still worth watching, especially for those of you who have been following the debate round at Frank's. Of particular historical interest are the interviews with the still defiantly doubtful executives from Philip Morris. Some of this dialogue is quoted in Velvet Glove, Iron Fist.

Who pays for these studies?

I'm not in the habit of fisking studies based on the abstract alone, but I'll make an exception in this instance.

Overestimation of Peer Smoking Prevalence Predicts Smoking Initiation among Primary School Students in Hong Kong

Purpose:

To investigate the relationship between perceived prevalence of smoking and smoking initiation among Hong Kong primary second- to fourth-grade-students.

Methods:

A cohort of 2,171 students was surveyed in 2006 and again in 2008. Students who perceived ever-smoking prevalence in peers as “none” or “some” were considered as correct (reference group), whereas those who perceived it as “half” (overestimation) or “most/all” (gross overestimation) were considered as incorrect.

Hmm. So if they perceived that none of their peers smoked, they were assumed to be correct. That may be true in the sheltered world of tobacco control, but for the rest of us that should be classified as an 'underestimate'. Except there isn't an 'underestimate' option available in this study, which leads me to think that it isn't very well designed.

Results:

At baseline, overestimation was found to be cross-sectionally associated with ever-smoking. At follow-up, 7.2% of never-smoking students with incorrect estimation at baseline had started smoking, which was 79% (95% confidence interval: 3%–213%), greater than that of 3.7% for those with correct estimation. Among the never-smoking students with incorrect estimation, subsequent correct estimation was associated with 70% (95% confidence interval: 47%–83%) lower risk of smoking initiation compared with persistent incorrect estimation.

Regardless of whether these kids' estimates are right, it's fair to assume that those who said 'most' had more friends who smoked than the ones who said 'some' or 'none'. And since having friends who smoke is a major predictor of smoking initiation, that—not the overestimating—is the reason they start smoking. The ones who said 'all' would, of course, be liars having a laugh at the researchers' expense. Given that the subjects are schoolchildren I believe, and hope, that there were many of them.

Conclusion:

Overestimation of the prevalence of peer smoking predicted smoking initiation among children. Interventions should be carried out to evaluate whether correcting children's overestimation of peer smoking could reduce smoking initiation.

Rubbish. The conclusion is that if your friends smoke, you're more likely to smoke yourself. But I think we knew that already, didn't we?

Catch up

The debate returns at Frank Davis's...

"It's very scientific"

It was a mark of the crankiness of Victorian-era anti-cigarette campaigners that they claimed cigarettes caused instantaneous death (see Chapter 2, Velvet Glove, Iron Fist). And it was partly because the public became weary of such obvious scare stories that they found it difficult to believe the real truth—several decades later—that chronic smoking could cause fatal diseases in middle- and old-age.

But everything comes full circle and the latest comments from the new Surgeon General, Regina Benjamin, seem designed to take us back at least 100 years. Her predecessor was a tough act to follow. Scientifically illiterate statements like "There is no significant scientific evidence that suggests smokeless tobacco is a safer alternative to cigarettes" and "There is no safe level of secondhand smoke" set new standards of quackery at the Surgeon General's office. But the new incumbent looks up to the job, and when you have an obese Surgeon General serving a president who smokes, all bets are off.

The latest headline claim—breathing a puff of secondhand smoke can kill you instantly—is really just a variation of Carmona's "no safe level" rhetoric. It takes the theoretical possibility that someone at death's door who is critically, terminally ill with heart disease could be finished off by smoking a cigarette, and then extends it to suggest that healthy people are being killed in the street from breathing secondhand smoke.

Benjamin has done nothing to distinguish between these very different situations. Indeed, she has gone out of her way to add to the confusion. This is very clear from her recent interview with Ed Baxter on KGO Radio. Baxter gives her every opportunity to clear up any misunderstanding but Benjamin just keeps piling it up. The transcript is below, and requires little further comment, but I recommend listening to the audio to get a measure of the woman. She doesn't exactly ooze authority. (Listen here - starts at 17.00). My thanks to Becky Johnson for helping with the transcript.

EB: Well, this may be, there have been a lot of warnings about cigarette smoking, but this may be the scariest I've seen. So we really wanted to get it straight from the person who did the study and the survey so we went straight to the top. Surgeon General, Regina Benjamin is on the KGO live line. Thank you for joining us.

RB: Thank you for having me.

EB: If I'm reading this correctly, you're saying your next cigarette could be your last. That's a dramatic way of putting it: "The next cigarette could be your last." This  is a report coming straight out of the Surgeon General's office. Cigarette smoking can cause instantaneous shut down of systems, is that true?

RB: It can certainly cause a heart attack and death, that's true. This report is the 30th Surgeon General's report on tobacco. The previous reports have focused on what diseases are caused by tobacco. But this particular report focuses on how tobacco smoke really damages every organ in your body. One of the things we know is that if you inhale cigarette smoke or inhale passive, second-hand smoke you might have an underlying cardiac disease like heart disease and didn't even know it. When you inhale it, those chemicals, they can irritate the blood vessels, irritate that lining, causing immediate damage. And also cause your blood to be thicker and clot quicker so that can cause an immediate heart attack. So just that one cigarette can cause a heart attack.

JLJ: So even just second hand smoke? Just a whiff of the smoke?

RB: That's correct. We know that cigarettes today have over 7,000 chemicals and chemical compounds. And inhaling those chemicals causes immediate damage to your blood vessels.

EB: And this, of course, would be more severe or traumatic to somebody who has a chronic condition, who has been smoking for a while....

RB: No, it's anyone! Most people who have heart disease, for example, don't even know they have heart disease because they never had any symptoms.

EB: So anyone just walking on a street, a first cigarette or just second hand smoke?
This could be caused by hypertension or any underlining disease, correct?

RB: Any underlying disease or people who may appear to be very healthy and just didn't know it! And also people who are healthy, it affects them as well. It affects your blood vessels and can damage your DNA. We find that people who, particularly women who have reproductive problems, because the DNA is affected by the chemicals in the tobacco. We didn't even know these chemicals existed. We didn't even know that there were 7,000 different chemicals and chemical compounds so these things are new. It's very scientific, but how these chemicals affect your body. Every organ in your body.

EB: We know it causes cancer. It may lead to heart disease. People are talking about chronic diseases. We're talking about instantaneous—and I just want to make sure we're understanding this correctly—instantaneous... your next cigarette or breathing someone's secondhand smoke could cause, basically, an acute episode that could lead to instant death.

RB: That's correct. The other thing is that these cigarettes today are more addicting. The nicotine, the chemical compounds that we now have the science behind—and this report tries to explain how it becomes much more addicting.

On e-cigs, snus and harm reduction

I've got an article up at Spiked today on the subject of the possible prohibition of e-cigarettes. With the exception of The Independent, the British media have ignored today's study in Tobacco Control which recommends taking e-cigarettes off the market while their safety is tested (and if you think they'll ever come back on the market, I have some magic beans you might be interested in). This being Tobacco Control, the study isn't available online, but I describe the main findings—which are few—in the article. Michael Siegel also discussed it on his blog yesterday.

The simple truth is that not one death has been attributed to the use or misuse of e-cigarettes since they appeared in 2004. Niche product though it may be, this is a sufficient length of time for any action against it now to be viewed as reactionary rather than precautionary. In the same six years, some stop-smoking drugs have been shown to have killed many people, and of course several million more have had their lives cut short as a result of cigarette smoking. And yet it is the e-cigarette that faces the chop.

Do have a read...

John Banzhaf is a liar

I've just been over to John Banzhaf's ASH website to see if he's said anything particuarly insane since the last time I visited and I see he is now claiming that ASH is 'America's first antismoking and nonsmokers' rights organization'.

This happens to be something I know a bit about. So let's see...

The Anti-Tobacco League was formed in Massachusetts in 1850.

The Anti-Cigarette League was formed in Chicago in 1899.

The Nonsmokers Protective League was formed in New York in 1911.

Action on Smoking and Health was formed in 1968.


Now, I pick my words carefully when dealing with this notoriously litigious individual, but let me say loud and clear that John Banzhaf is a liar.

Sue me, fatso.



[PS. New CATCH up now at Frank's gaff]

No. Inception.

I'd hate to think that some of you may have missed the fact there are new Alan Partridge episodes available online. Now scratching a living presenting Mid Morning Matters on North Norfolk Digital, it's so funny you'll want to drink a weak Australian lager.

Fill yer boots...

Tobacco and Allergies: Is There a Connection?

[This is a guest post from An Apple a Day, who contacted me a while back offering to write something. At the time they had a post on their site about allergies so I asked them if they would give us an answer to the question of whether people can really be—as some claim—allergic to tobacco.] 

Edward Stern is a guest blogger for An Apple a Day and a writer on earning your online nursing degree for the Guide to Health Education.


We’re all well-versed in the fact that smoking is bad for you [I wouldn't be too sure about that - CJS]. But can you really be allergic to tobacco? By definition, an allergic reaction is the result of your body fighting off something it believes to be harmful such as a disease. Allergies manifest themselves in hives, itching, irritation, redness, more mucus produced, etc. Therefore, if there are people allergic to tobacco, it would mean their bodies find tobacco harmful and are reacting to it.

Whether this actually happens, and why, is still up to much debate. A U.S. Environmental Protection Agency study claims that individuals may be allergic to tobacco smoke. These allergies demonstrate themselves through nasal symptoms like runny nose and congestion. Tobacco smoke allergies may also cause headaches and nausea. Children with such allergies are susceptible to ear infection and lung deficiencies, such as a greater risk for asthma. Most of these symptoms are easily treated with over-the-counter medicines.

This begs the question: what ingredient is actually responsible for the “allergic reaction”? Is tobacco itself the culprit? Cigarettes are filled with all kinds of chemicals and carcinogens that are far more likely to act as irritants to our system and create allergy-like symptoms. How do these “allergies” manifest across different brands of cigarettes? The EPA study asserts that people can be allergic to smoke, yet failed to indicate what types of cigarettes were smoked in the studies conducted and what ingredients were present in the cigarettes. Other studies shedding light on these questions are scarce. Before any hard claims are made that tobacco causes allergies, more research needs to be conducted.

Regardless, claims of “tobacco allergy” seem to be sufficient for anti-smoking advocates who want to ban smoking from public places, or in places like Los Angeles, where the city wants to ban smoking outside of homes. People are allergic, that's enough, and no one really dares to question the veracity of such statements or what they really mean.

I'm not trying to say that cigarettes aren’t harmful. They are. But in making a case for legislation that bans personal habits from public places, I would argue that lawmakers need to know their facts and steer clear of studies that are speculative at best. Until someone knows why these supposed “allergic” reactions occur (and can definitively pinpoint tobacco as the active trigger), the topic should be avoided in anti-smoking legislation discussions.

What's the catch?

A quick reminder that the debate at Frank's is continuing with three more posts since I last mentioned it:

CATCH-3: Frank Davis adds his 2 cents to the discussion
CATCH-4: Chris Snowdon responds to Rich White and Frank Davis
CATCH-5: Frank Davis continues the discussion

To all those who have been commenting, I have been reading and I will try to reply to all your questions. Unfortunately, time has not been on my side recently, not least thanks to the inability of Britain's train operators, coach companies and taxi drivers to handle a dusting of snow in December.

Tobacco control caught fibbing again

The Swedish National Institute of Public Health (SNIPH) has got itself into hot water after lying accidentally giving the wrong impression to journalists about the health effects of snus.

SNIPH has been waging a vendetta against snus for many years. As you may be aware (if you recall Skoal Bandits), a massively ill-informed burst of prohibitionist fervour in the early 1990s resulted in snus being made illegal in the EU. The reasoning was that it caused oral cancer and was a gateway to smoking. Sweden wisely negotiated an opt-out when it joined the EU in 1995 and since then a mountain of evidence has amassed to show that snus categorically does not cause oral cancer and that is a very effective gateway away from smoking.

The SNIPH would have us believe that the Swedes' incredibly low rate of smoking (just 12%) and correspondingly low rate of lung cancer are in no way way related to the enormous quantities of (basically harmless) snus they consume instead. Nor are they prepared to consider the possibility that if the EU removes its completely arbitrary ban on the world's least hazardous tobacco product, the Swedish experience could be replicated elsewhere.

For motives that are—I'm sure—as pure as the Scandinavian driven snow, various people in and around the EU don't seem all that keen on legalising a product which is about as safe as Nicorette and considerably more effective as a smoking cessation aid. I really can't think why the tobacco control movement would be against such a product.

Having grudgingly accepted that snus doesn't cause mouth cancer (which is intuitively the most likely outcome from a tobacco product used in the mouth), the SNIPH has been on a ten-year fishing expedition to find a 'link' with various other cancers and heart disease.

Last week came a shock new claim. At their conference in Stockholm, the SNIPH announced the results of a new study which showed that snus affects fertility and causes impotency. DN, one of Sweden's biggest newspapers, announced that "nicotine in snus affects potency and also inhibits women's ability to become pregnant." (Article here; translation here.)

This claim came directly from the SNIPH's tobacco control project manager, Asa Lundquist, and generated considerable discussion in Sweden, where over 20% of men are regular snus users. Swedes are used to hearing scare stories about snus (invariably from the SNIPH) and this was no exception. But what makes this scare particularly risible is the fact that the "finding" is a figment of Lundquist's imagination. Although she went on the record to talk about the study, and even approved the DN's article before publication, no such study has ever been conducted and the DN has since printed a correction:

SNIPH backs off on snus and potency

In Wednesday's DN we referred to a new study from the Public Health Institute showing that snus causes erectiledysfunction. No such study exists.

"I nearly fell off my chair when I saw this article," said Stefan Arver, associate professor of endocrinology at the Karolinska Institute. "There is no such study. We have a hypothesis and plan to conduct a study among snus users after the new year."

It's bad enough that researchers announce what they expect to find from a commissioned study (eg. Jill Pell, Manuela Martins-Green). But pretending to have completed the study and making up the result has to be a new low. So please, in the interests of whatever tiny degree of scientific integrity that remains, at least have the decency to begin the research before you start lying to us.

All back to Frank's

Frank Davis is currently hosting a debate on the subject of 'Does smoking cause lung cancer?'

Why? Well, why not? It seems that not everyone is convinced by the evidence. So untrustworthy have anti-smoking campaigners been in their handling of science in recent years that it is not surprising that some people find it difficult to believe anything they say.

This, to me, is going too far. The evidence that primary smoking is a major risk factor for lung cancer and several other serious diseases is wholly different in terms of quality and quantity from the junk science we cover on this blog every day. That doesn't mean the claim should be taken on trust, however. Instead, we can look at the evidence and make our own minds up.

I've kicked things off with the case for the prosecution and Rich White (author of Smoke Screens) has replied with the case for the defence. Feel free to leave your comments on Frank's site.

Overkill

The big news today is that secondhand smoke causes 600,000 deaths a year worldwide. Anyone tempted to take this figure remotely seriously should bear in mind that the authors of the associated study also believe that "smoke-free laws banning smoking in indoor workplaces rapidly reduce numbers of acute coronary events" and "fully smoke-free policies have a net positive effect on businesses." And, interestingly in the light of the Moral Maze the other night, they consider the main aim of smoking bans to be denormalisation:

Above all, [smoke-free] policies contribute decisively to denormalise smoking, and help with the approval and implementation of other policies that reduce tobacco demand, such as increased tobacco taxes and a comprehensive ban of tobacco advertising, promotion, and sponsorship.

Still, you can't fault their impeccable methodology:

To identify national data for second-hand smoke, the keywords “second hand smoke”, “environmental tobacco smoke”, and “passive smoking” were combined with names of countries or regions, by searching Google and the PubMed database

The spirit of Newton and Darwin lives on, does it not?

What can be said of the 600,000 estimate? Obviously if you extrapolate a relative risk over a larger population, you will get a larger number. That doesn't make the study or studies you are extrapolating from any better, but I won't risk waking this blog's resident troll by going into all that again.

It's interesting that this study appeared in the Lancet because back in the 1990s, Lancet columnist Petr Skrabanek* remarked on the tendency of public health campaigners to use larger and larger populations to get scarier and scarier death counts. He called them "jumbo-jet numbers" because talking about the equivalent number of jumbo-jets that would have to crash for the same death toll sounds more dramatic than explaining that you have to die of something and that most of the people being "killed" were very old. This, from a collection his articles [PDF]:

The intoxication with numbers is another characteristic of the modern crusaders against smoking. They typically use big population blocks as denominators to obtain bigger and bigger numbers. Richard Peto, a leading anti-smoking exponent and a statistician, announced that 'of all children alive today in China under the age of 20 years, 50 million will eventually be killed by tobacco.' This would put the hecatombs of the Second World War in the shade. The British Medical Journal referring to another such statistic, 'typical of the Oxford epidemiologist Richard Peto', quoted that 'about 20 million children now living in Europe will be killed by tobacco in their middle age.' And The Times reported on January 1, 1988, that according to Mrs Risk-factor Epidemiology: Science or Non-science?

Edwina Currie, 'more than a million schoolchildren and 60,000 babies born this year will die of smoking-related diseases such as lung cancer.' Surprisingly, no-one has yet used the population of the whole world as a denominator: this would produce numbers of babies, toddlers, schoolchildren, and other children, killed by tobacco in truly phenomenal ranges. Perhaps the reason for this reticence is the fear of overkill.

Well, now they have. In fact, they've missed a trick by not using the other PR tool of multiplying by years (eg. here). So, to save someone the trouble, here's my study:

'A quantitative, longitudinal assessment of worldwide mortality from environmental tobacco smoke'

Christopher J. Snowdon

Methodology: Google and PubMed of course. I'm a professional.

Results: 600,000 x 10 = 6,000,000

Conclusion: Secondhand smoke will kill 6 million people over the next ten years. Where's my cheque?

[*nb. Petr Skrabanek was a skeptic about—amongst many other things—secondhand smoke. You can probably guess what the anti-smokers' response was. That's right, they accused him of working for the tobacco industry. Which was a lie. He died of a non-smoking related disease in 1994.]

Final thoughts on Nudge

The subject of Wednesday's Moral Maze was Nudge by Thaler and Sunstein. They argue (compellingly) that it would be nice if we could set society up so the things that 99% of people want to do were the default setting, but if you don't want to do them, it would be a piece of cake to opt out. For example, companies in the US (the authors are from America—this is important) might offer free health insurance but you have to opt in to claim it. Thaler and Sunstein suggest changing things round so you're automatically given the insurance but can opt out if you want.

Who could complain? Pretty much nobody, right? And who could complain at the idea of having sunbeds switch themselves off after 10 minutes in case you fall asleep under them, or driving license renewal forms that ask you if you would like to give your organs to someone who needs them should you perish prematurely?

I consider myself to be basically a libertarian and I can't muster up any arguments against these things, and this really is as far as Nudge (the book) goes. The authors spend several page fretting over whether governments have the right to force motorcyclists to wear crash helmets, for God's sake. These people would be considered virtually anarchists in Britain.

All this seems to have passed a lot of people by. It nearly passed me by. As I mentioned in my review of it in August, the very fact that 'nudging' has been adopted by the likes of Julian Le Grand was sufficient to put me off it for several years. I'm very pleased I finally relented since it's a good addition to the library of behavioural economics. It's also 95% libertarian and only 5% paternalism.

Whilst I would never be so indelicate as to suggest that not everybody involved with the Moral Maze on Wednesday night had read the book, the whole format did rather hinge on its co-author Richard Thaler being an authoritarian wolf in libertarian sheep's clothing.

This was apparent from the choice of guests. With the panel broadly splitting in half, with Portillo and Phillips roughly in the libertarian camp (yes, very roughly - don't write in) and Taylor and Longley roughly in the paternalism camp. Since Delingpole and I are fairly obviously with the libs, and the lady from the Roy Castle Foundation with the paternalists, to even up the numbers the other witness would have to be a paternalist.

The trouble was that the other guest was Thaler himself and—as very quickly became apparent—he is anything but. Accused of trying to change people's goals, he said:

"I don't think we could have possibly been any more clear that that's completely wrong." 

Lest that still not be clear enough, the sublimely incredulous Thaler responded to further insinuations of social engineering by saying:

"Absolutely not. There is nothing that could be wronger than that." 

Listening in the green room, I said to James Delingpole that I didn't think they were quite going to get the argument they wanted out of this discussion. (Towards the end of the show, Michael Portillo drily noted that Thaler "didn't stand for some of the things we thought he stood for.") Thaler went on to strongly deny wanting presumed consent for organ donation, and when asked about plain-packaging, explained once more that he didn't approve of bans at all.

There may be tea-partying parts of America where this sort of talk is considered paternalistic, but then Americans take their liberties a bit more seriously than we do. By the standards of British politics, let alone European politics, Thaler would be classed a loony libertarian. Nevertheless, the format of the show assumed that Delingpole and I would violently disagree with him and his supposedly authoritarian-by-the-back-door ways. This we could not do. Delingpole praised Thaler's sensible book and lamented the way it had been perverted by politicians. He also quite rightly picked Matthew Taylor up on his elitist assumption that the world is divided up into "sophisticated and intelligent" people who are capable of making informed decisions and a lumpen mass of imbeciles who are constantly manipulated by malign institutions for profit.

When it was my turn to be interrogated, Longley wondered with exasperation why I was so opposed to Nudge. I wasn't, I said, although by this time I was tempted to add "... but I can pretend to be if it would help things." Some readers of this blog noticed that I was interrupted quite a bit by Longley and Taylor (the latter chaired The Spirit Level debate at the RSA), something which is more apparent to me listening back than it was at the time. I can't say that I thought the questioning was any more aggressive than in the average Moral Maze. The whole point is to have a bit of an argument and for all three of us, this was more than a rhetorical contest.

Longley believed that the government had decided that smoking was abnormal and anti-social and was going to do something about it. Essentially, he espoused absolute democracy, in which once a government had been elected, it had a mandate to do whatever it wants. Obviously I disagree, since I believe in liberal democracy, which accepts that since democracy is imperfect, elected governments should work within limits (eg. unwritten limits in Britain, written limits in the USA). In any case, using the absolute democracy argument is particularly weak when talking about contemporary Britain where you have a government nobody voted for, made up of two parties which promised less regulation and the overturn of the tobacco display ban.

Anyway, you don't need me to explain what was said as you can listen here, but I hope that the message came over on Wednesday night that Nudge does not in any way justify the kind of lifestyle policies that all the main British political parties have been going along with in recent decades. The Nudge philosophy is totally at odds with every public health initiative that goes beyond giving accurate advice and information to people who want it.

'Nudging' is not a cute name for 'do what we say'. As Thaler and Sunstein consistently stress, any nudging must have a cost to liberty that is close to zero and a financial cost that is close to zero. In other words, goodbye smoking ban, farewell minimum pricing and adios fat tax.

If the coalition is serious about cutting regulation, adopting Nudge would be a sound textbook to work from. But as we have already seen from plain-packaging and the farce of the YourFreedom website, they have no intention whatsoever of doing that. So, if anyone in politics ever gets round to actually reading the bloody book, it much more likely to be farewell Nudge.

Hire me

Thanks to all who listened to and commented on last night's show, which can be listened to here for 7 days. I'll have some final thoughts on libertarian paternalism later today but first I have a broken boiler to attend to.

As a quick aside, however, I see the BBC has described me on its website as:

Chris Snowdon: Smoker and author of 'Velvet Glove Iron Fist; A History of Anti-Smoking'

Does this suggest that smoking is now so rare and exotic that it's worth calling attention to? (There are only 1.2 billion of us after all.)

Or is smoking now classed as an occupation? If so, I'd just like to say that I'm available for work, I have my own lighter and I'm prepared to travel.

Nudge and the Moral Maze

Tomorrow evening I'll be appearing on BBC Radio 4's Moral Maze programme which will be discussing 'libertarian paternalism' and the so-called 'Nudge agenda'. Details are here:

How far should we go to stop people doing something that's bad for them?

We know cigarettes are very likely to cause you serious illness and could even kill you. The tricky thing is many people find them extremely enjoyable and they're perfectly legal. The government, frustrated that some people still persist in choosing to exercise their right to pursue a perfectly legal activity, despite decades of health education, bans on advertising and smoking in public places, are looking at forcing tobacco manufacturers to sell cigarettes in plain packaging.

The problem is that all those people exercising their freedom to smoke are then clogging up the NHS demanding that the rest of us pay for the treatment of their self inflicted illnesses. It's a question not just for smokers. How do you feel about a fat tax, or a minimum price for alcohol?

Tax is a bit of a blunt instrument and unpopular with voters, so it's not surprising that politicians have latched on to "nudge economics". Behind the doors of Number 10 there's a unit called The Behavioural Insight Team that talks about finding intelligent ways to encourage people to make better choices for themselves.

Is this an example of paternalist libertarianism - preserving people's freedoms while at the same time minimising their impact on the wider society? Or a worrying Orwellian development where politicians have given up trying to win the political argument and have instead just resorted to employing teams of psychologists and marketing executives to manipulate our behaviour?

If we're too stupid for our own good, why should we worry if politics becomes the equivalent of potty training? How far should we go to stop people doing something that's bad for them?

Expect plain packaging, smoking bans, temperance crusaders and other frequent offenders from this blog to get a mention.

I discussed libertarian paternalism in Chapter 14 of Velvet Glove, Iron Fist and also in the review of Nudge I wrote back in August. From the latter:

If politicians stuck to both the spirit and the letter of Thaler and Sunstein's philosophy, the nudge agenda would be largely benign and almost certainly beneficial. Far from supporting the kind of policies being pursued by the UK Faculty of Health, any British government that was genuinely committed to the Nudge agenda would have no choice but to repeal whole swaths of legislation that already cross the line between libertarianism and paternalism.

Undone by the facts once more

In yesterday's post I quoted the say-anything anti-tobacco shill Martin Dockrell (of ASH, natch) saying:

"By helping smokers who want to quit and protecting our children from the tobacco ad men this will be an enormous leap forward for public health, perhaps even bigger than the smoking ban," he said.

He was talking about the crazy plain-packaging ruse, but he would have said the same thing whatever the policy was. Fair enough, that's his job. If he weighed up the pro's and con's of each policy and then gave a reasoned and intelligent assessment, he'd soon find himself in a smokefree Jobcentre.

But by saying that plain-packaging could be an "even bigger" leap forward for public health than the smoking ban, he is clearly suggesting that the smoking ban was itself a leap forward. This is frequently stated by all sorts of people, and it is often assumed that the smoking ban led to a surge in people giving up smoking. But has it?

"Encouraging" smokers to give up was, of course, the true (and barely concealed) motive for bringing in the ban in the first place and woe betide anyone who cast doubt on whether this would really happen back in July 2007. In ASH's hilariously premature and ill-founded Myths and Realities of a Smokefree England document (which I wrote about at t'old place) they said that the idea that mass abstinence wouldn't happen was a "myth".

We haven't heard much about smoking prevalence since (the statistics for such thing are always slow in coming forth), so I'm grateful to regular reader Dave Atherton for sending me the Office of National Statistics' Life Style Survey 2008 (published 2010), which concludes:

The overall prevalence of smoking among the adult population was the same in 2008 as it was in 2007 at 21 per cent.

A similar phenomenon was found by the EU's Eurobarometer which found the UK's total proportion of smokers (all forms of tobacco) to be 28% in 2009, which is—again—exactly the same as it was in 2008.

And all after the biggest, most controversial, most costly and most socially divisive piece of tobacco regulation in British history. Good work guys. Have the rest of the day off.

The other thing the ONS's report shows is something that Dick Puddlecote and I often point out—drinking is not on the increase in the UK:

Following an increase between 1998 and 2000, there has been a decline since 2002 in the proportion of men drinking more than 21 units a week, on average, and in the proportion of women drinking more than 14 units 

That's yer "hazardous" consumption. This is overall consumption:

The average number of units of alcohol consumed in a week rose steadily in the 1990s and achieved a peak of around 17 units for men and 7.5 units for women in the period 2000 to 2002. These levels fell to 14.8 units for men and 6.2 units for women in 2006. The revised methodology shows that the average number of units consumed is continuing to fall from 18.7 for men and 9.0 for women in 2006 to 16.7 and 8.4 respectively in 2008.

So, to summarise:

• Rates of drinking are falling and have been for years

• The smoking ban had no impact on the number of people who smoked, unless by "impact" you mean "put an end to a ten-year decline"

I mention this just in case any journalists or single-issue activists accidentally give you completely the opposite impression.


(Coming up in your soaraway British Medical Journal next week: '"The smoking rate plummetted after the smoking ban and our computer can prove it", says Professor Anna Gilmore and Professor Jill Pell'.)

The children! The children!

Readers will recall that in May this year, a new British government was elected that promised to cut unnecessary regulation and put an end to Labour's nanny state. How do you think they're getting on?

From the Beeb:

Make cigarette packaging plain, government urges

I think it was Roger Daltry who sang something about meeting the new boss. Other people have said that patriotism is the last refuge of a scoundrel. I'm not so sure. I think scoundrels can sink much lower than that when they need to. See if you can see a theme running through the feeble claims for this latest piece of Sovietisation...

The government is currently planning to ask retailers to cover up their displays of cigarettes from next year to protect children. But now cigarette packets could also be made a standard colour like grey, rather than the existing bright colours.

Campaign group ASH says this is "an enormous leap forward". The Department of Health is considering the idea of asking ['asking' as in "we'll fine, bankrupt and imprison you if you don't agree" - CS] tobacco firms to put only basic information and health or picture warnings on their packets.

Making the cigarette packets a plain colour would protect children from taking up smoking in the first place, it suggests. It would also help support people who are trying to give up smoking, the department said.

Health Secretary Andrew Lansley, said it was time to try a new approach. "The evidence is clear that packaging helps to recruit smokers, so it makes sense to consider having less attractive packaging. It's wrong that children are being attracted to smoke by glitzy designs on packets.

"We would prefer it if people did not smoke and adults will still be able to buy cigarettes, but children should be protected from the start. The levels of poor health and deaths from smoking are still far too high, and the cost to the NHS and the economy is vast. That money could be used to educate our children and treat cancer," Mr Lansley said.

"We will shortly set out a radical new approach to public health in a White Paper."

Martin Dockrell, director of policy and research at ASH, (Action on Smoking and Health), said the industry calls packaging "the silent salesman".

"They use it to seduce our kids and mislead smokers into the false belief that a cigarette in a blue pack is somehow less deadly than a cigarette in a red one.

"By helping smokers who want to quit and protecting our children from the tobacco ad men this will be an enormous leap forward for public health, perhaps even bigger than the smoking ban," he said.

I am so tired of this unceasing nonsense that I can barely summon up the energy to mention that children have not been allowed to buy cigarettes since 1906. It seems barely worthwhile to point out that 40% of cigarette packs are already made up of warnings which say 'Smoking Kills'. There is no use in saying that colours and logos alone cannot "seduce" anyone. And it is futile to note that any government that forms policy on the back of hysterical yelps about protecting children treats all its citizens as children.

The wish-list of anti-smoking extremists is long and publicly available. It should be no more a surprise that they want plain packaging of cigarettes than it is that Los Angeles is calling for a total ban on smoking outside the home. These policies have been discussed in hushed tones at tobacco control conferences for several years, and it is, of course, their job to come up with wild, new directions for tobacco control.

It is also—so we thought—the job of elected politicians to tell fanatics and nut-jobs where to get off. But that is no longer the case, and the anti-smoking fraternity must be pinching themselves when they hear their fruitiest schemes being discussed by a nation's Minster for Health.

In truth, the coalition of the unwilling, like every government in recent memory, will use "tough" (but ultimately pointless and counter-productive) measures on smoking as a distraction from its failure to do anything about real issues. It's pathetic and predictable, but that's how it is. Evidence, logic and ethics don't come into it. It's simple politics and those of us who didn't vote Conservative at the election should feel vindicated today.

UPDATE: A tweet from Leeds University's Faculty of Medicine of Health rather gives the game away:

That's first step, you will notice. Not even 'next logical step'. Truly, they haven't even begun.

(PS. You can follow me on Twitter at cjsnowdon.)

Detoxifying the brand

The BMJ's Tobacco Control blog provides a good example of why top-down prohibitionist campaigns struggle on the internet. No doubt they've all seen the memo telling them about the importance of engaging with the online audience, but when your movement is fundamentally elitist, engaging with the wider world has its problems.

There is the issue of not having very much to say, even though—unlike 99.9% of bloggers—that is your job. To be fair, this is also true of corporations which decide it would be a swell idea to start a blog. More serious, perhaps, is the problem that you and your colleagues are less-than-typical members of society. This can be ignored whilst chatting over the salad bowl at a public health conference, where views differ by only small degrees, but when thrust into the wider world, the chasm between you and civil society suddenly becomes visible. If you start blogging, not only will people see you in your less guarded moments, but they will also be able to talk back at you.

A recent feature on the Tobacco Control blog highlighted these problems. 'Word wars and tobacco control: choose the winner' (the first entry for six weeks, natch) invited readers to suggest words to describe tobacco controllers and their opponents. This led to problems. Firstly, a number of smokers and libertarians offered up less-than-flattering words to describe the, er, tireless champions of public health, and, secondly, a number of supporters responded with such enthusiasm that they almost seemed to be doing a parody of the stereotypical swivel-eyed anti-smoking zealot.

The comments system were swiftly deleted, but the zealotry remains online (at the time of writing). And perhaps it is a parody. How else can we explain gems like this?

Tobacco company - Suicide facilitation organization.

Growth (noun) - A measurement of suffering and death achievement as well as mortal collateral damage

Passive smoking - Collateral human and animal carbon life form lethal damage

Tobacco executive - Government Licensed murderer

Or this...

Change tobacco industry financial reports to 'disease reports'

Or how about something from an ultra-PC feminist dissertation?

Lezak Shallat: In my experience, there is a real clash of discourses between the language we use in tobacco control and the language we should be using to reach out to potential (and much needed) allies in the women’s movement. This raises a linguistic and ideological barrier that impedes greater collaboration. A case in point is the concept of tobacco “control”. For the TC movement, the word “control” encompasses a strategy to focus on a product and not its users (smokers) by setting limits that protect the rights of non-users. Within the TC movement, there is little talk of “anti-tobacco” measures or policies. This abbreviated terminology is reserved for headlines and journalists. Among feminists, however, the word “control” raises hives. It is located at the opposite end of the spectrum from autonomy over one’s body and the right to decide for oneself about work, education, reproductive life and more. This idea is central to feminism, and has been successfully exploited by the tobacco industry as a concept to sell cigarettes. The discourses clash. Control vs. protection; freedom to chose vs. informed choice; promoting vs. exploiting aspirations of “autonomy.” These words carry ideological subtexts that hinder greater dialogue with the feminists about how to address smoking as a women’s health issue.

Keen to find out more about the author of this riveting prose, I did a quick Google search which turned up this page, which happened to be hosting a particularly unfortunate, but possibly apt, banner campaign.

I also turned up this page which—if you'll excuse another cheap giggle—explained that:

Although she was named Leza K. at birth, she dropped the space and changed her byline to Lezak Shallat after discovering that, in Spanish, the word "lesa," roughly translated, means "idiotic."

A wise move since she "writes about social justice issues from Latin America" and lives in Chile. Of course, if she lived in the English-speaking world, the name Leza wouldn't be funny at all, would it?

And how about this from the real-life prohibitionist "Terence A. Gerace, Ed.M., M.A., Ph.D." (Who feels the need to put that many letters after his name on a blog comment?)

The terms Big Tobacco, tobacco industry, and major tobacco companies should be eliminated in favor of “toxic-tobacco companies” or “toxic-tobacco industry”. None of the former terms provides the true negative denotation that “toxic-tobacco companies” and “toxic-tobacco industry” do. Placing “Big” in front of Tobacco blunts tobacco’s negative associations. “Big” has a positive connotation as evidenced by McDonalds Corporation’s using “Big” in front of “Mac” and Frito-Lay placing “Big” before “Grab” to designate its large bag of snacks for individuals.

The idea that calling tobacco industries 'Big Tobacco' "blunts tobacco's negative associations" is plainly nonsense. The whole reason why the term Big Tobacco was coined by anti-smokers in the first place was to (a) perpetuate the David vs Goliath myth which portrays the anti-tobacco industry as brave pygmies against a behemoth, and (b) to rally those who instinctively dislike big business.

Getting rid of the 'Big' in Big Tobacco is fine with me. I've never understood why cigarettes from large companies should be worse than any others. But let's not pretend this is anything other than rebranding for the sake of it, and rebranding is always a sign of failure. Whether it's the post office changing its name to Consignia or socialists calling themselves liberals, the purpose of rebranding is to move away from a toxic brand.

The desire to rebrand is particularly urgent amongst tobacco controllers, since they are gripped by the delusion that the tobacco industry invented the very terms they are forced to use. This is sheer paranoia. I have heard it said that the industry invented the word 'anti-smoking' as a pejorative term. Apart from the fact that it is an entirely neutral word for people who are against smoking, the enemies of tobacco called themselves 'anti-smoking leagues' a hundred years ago. Lennox Johnson called himself an anti-smoker in the 1940s (see Chapter 4 of Velvet Glove, Iron Fist). If anti-smoking has a pejorative context today, it is because the public have seen what anti-smokers say and do, and they don't like it.

The anti-smoking movement (sorry—'tobacco control movement') would prefer it if everyone called smokeless tobacco 'spit tobacco' because it sounds more disgusting. They would no doubt prefer the tobacco industry to be known as 'the swine' and cigarettes to be known as 'Satan's death truncheons'. Alas for them, 'tobacco industry' is a more informative, balanced and descriptive term for an industry that makes tobacco, 'cigarettes' are small cigars that gained popularity in Revolutionary France and most smokeless tobacco products don't involve spitting. And since language is there to describe rather than propagandise, that'll just have to do.

UPDATE: As Leg-Iron reported last week, Junican submitted a spoof suggestion which succeeded in being slightly less deranged than the genuine offerings and now seems set to win him the "prize" of a one year online subscription to Tobacco Control (God knows what the second prize is).

The last anti-smoking volunteer walks on

Two weeks ago Smokles told us the tragi-comic story of Errol Povah (above). Povah is a very rare breed— a genuine unpaid anti-smoking activist. The 57-year old Canadian set off on a coast-to-coast run/jog/walk intending to raise $47,000 for his nutty pressure group and "put the entire smoking industry out of business."

Povah's ambitious plan involves arriving at Philip Morris's New York headquarters later this month where he no doubt intends to carry out some sort of protest (yes, he's one of those who dresses up as the grim reaper). As Carl Phillips pointed out, the choice of route holds certain problems since Philip Morris moved to Richmond (400 miles away) several years ago. And his problems don't end there...

Originally, he said, he wanted to raise $540,000 - a dime for each of the world's 5.4 million people who die from tobacco annually. But money has been tight.

This is so true. As of today, Povah has raised a little over ten percent of his reduced target, and when we last heard from him, the dearth of donations was becoming a burden.

“It’s a huge struggle,” Povah said from Ottawa Tuesday, adding the lack of support crew or sponsors is a major disappointment.

Forced to travel alone, Povah has had to conduct his marathan journey in a highly unsatisfactory, half-arsed manner:

Because he has to bring his van along, and has no one helping him, he has to walk forward a certain distance, then go back for his van. At the end of the day, having advanced 26.2 miles but having walked twice that, he drives the van another 26.2 miles forward to account for the miles he had to walk in the wrong direction.

Alas, things have only got worse in the last three weeks...

"I literally can't afford to buy new shoes," he said, after finishing a 26.2-mile walk on Tuesday from Warrensburg to Glens Falls. "I'm flat broke at the moment. I have to get some money organized."

This pitiful tale provides a stark reminder—especially to him—that the anti-smoking "movement" has not been funded by voluntary donations for a very long time. Aside from one or two sugar daddies (Povah hopes to rope in Mike Bloomberg when he gets to NY), it is funded by the state and Big Pharma while the public looks on in apathy.

Far from bringing down the tobacco industry, Povah's quixotic expedition is an embarrassment for anti-tobacco because it highlights the lack of support it has from civil society. If the public was supportive, they'd get their hands in their pockets and not let this man have to go back and forth to his van every day. You'd think the billion dollar anti-tobacco industry would throw him a few thousand dollars just to spare their blushes.

Instead this chump jogs his way towards an early grave to raise the kind of money that professional anti-smokers wouldn't bother to pick up if it fell in the street, while quack researchers pick up millions of dollars to sit around conjuring up voodoo science in California.

You'd need a heart of stone not to laugh.