Wednesday 30 November 2011

A little taste of prohibition

Dec. 1920: Prohibition agents show off 89 confiscated stills.
(From here)

From The Morning Advertiser:

Five men who masterminded a major counterfeit vodka manufacturing and bottling plant in Leicestershire, were sentenced to a total of 17 years and ten months on Friday at Hull Crown Court.

The plot was uncovered in an industrial unit by HM Revenue & Customs (HMRC) when they carried out raids in September 2009. They seized 9,000 bottles of fake vodka, branded as Glen’s, manufacturing equipment, bottles and counterfeit packaging – labels and cardboard boxes, at the remote industrial unit at Moscow Farm near Great Dalby, Leicestershire.

The court heard there was a complete lack of any fire safety measures which posed a serious and life threatening hazard. The alcohol vapour alone could have triggered a major explosion if the lights had been switched on or a naked flame or cigarette had been lit.

It certainly could. You may recall what happened back in July...

Boston fire blast unit producing illegal vodka

An industrial unit in Lincolnshire, where five men were killed in an explosion, was being used to produce illegal vodka, police have confirmed.

This happened in Boston, England in 2011, by the way, not Boston, Massachusetts in 1921. Easy mistake to make.

This is part of a growing trend, as the UK's sky-high alcohol taxes combine with economic hardship to fuel demand for the black market. Half of all rolling tobacco is smuggled into the country. Counterfeit cigarettes are openly sold in the streets. We've got the smoke-easies (last week I was in a pub in central London where the landlord told people to light up and leave their cigarette stubs on the floor). Now we have criminal gangs producing poisonous moonshine and blowing themselves up with illegal stills. All we need now is Elliott Ness dancing the Charleston and we can have a full-blown 1920s revival.

The neo-prohibitionist fools believe they can avoid the consequences of prohibition so long as society falls short of a total ban. That's now how it works. It's a sliding scale. In The Art of Suppression I write about 'little prohibitions'—bans, price hikes, excessive regulations—which cause the same problems, only on a smaller scale. After all, as John Stuart Mill said: "Every increase of cost is a prohibition, to those whose means do not come up to the augmented price."

Still, at least people aren't getting literally blinded by moonshine like they did during Prohibition.

No, wait. They are.

25p vodka made me go blind

Christmas partygoers have been warned off bargain booze that can leave you blind. Eastern European gangs are flooding corner stores and even going door to door selling illicit drink in a £1billion- a-year trade.

Last night trainee accountant Dale Shaw, 27, told how he nearly lost his sight drinking the dodgy liquor. After being invited to a family party, Dale bought a bottle of Drop Vodka from an off-licence in Bradford, West Yorkshire.

He said: “I’d never heard of the brand before but it was £4 cheaper than the others. After downing a quarter of the bottle, Dale began to feel more drunk than usual and his vision began to blur.

But by the next morning he could not see at all and was suffering excruciating pains in the lower half of his body. “As soon as I woke I knew there was something wrong,” he said. “I was in agony and my sight was almost completely gone.”

Dale was taken by a relative to Bradford Royal Infirmary where a doctor immediately recognised he was being poisoned by the bootleg spirits. The cut-price vodka contained methanol – alcohol used in explosives, anti-freeze and racing car fuel – and not the safe ethanol found in legal booze.

Expect much more of this if Alcohol Concern and the BMA get their way.

Tuesday 29 November 2011

Velvet Glove, Iron Fist review

The journal Social History of Medicine has recently (well, two months ago) reviewed my first book Velvet Glove, Iron Fist: A History of Anti-Smoking. The review is behind a pay-wall, but as it is fairly short I trust they won't mind me reproducing it here.

Velvet Glove, Iron Fist is a fast-paced critique of the late twentieth- and early twenty-first-century public health focus on lifestyle behaviours. The book centres on smoking, which Snowdon, in common with anti-smoking activists, sees as the blueprint for increased regulation of individual health behaviour for the common good. Snowdon traces the history of anti-smoking campaigns from the early seventeenth century through to the present day, via campaigners such as Lucy Page Gaston in early twentieth-century USA and the National Socialist regime in 1930s and early 1940s Germany. Rather than making the simplistic argument that current regulations on smoking exceed anything the Nazis hoped to implement (although he makes this point), Snowdon's aim is to unveil the financial interests which have grown around the tobacco control movement and the spurious epidemiology used to back up some of its claims, particularly in relation to passive smoking and ‘third-hand smoke’ (that is, the residual nicotine that remains on surfaces after a cigarette has been smoked).

Much of the material in Snowdon's early chapters is re-worked from existing historical accounts of smoking, but he presents the material in an interesting and accessible manner. The more substantive part of Snowdon's argument comes in the later chapters, where he follows the development of the tobacco control movement from local initiatives to its global position today, a development which has gathered pace in the last decade and a half. In 1994, leaked documents acknowledging that the tobacco industry had been aware of the addictive nature of cigarettes and ‘had deliberately misled the public for decades’ (p. 191) undermined the notion of the smoker's right to choose. At the same time, concerns about passive smoking legitimated moving the debate beyond individual rights towards a raft of measures justified as within the public interest, such as increased taxation and restrictions on smoking in public places. These measures went beyond previous approaches, such as educating and informing the public about the dangers of smoking, to health and offering advice on how to quit.

This shift in the direction of anti-smoking campaigns has been chronicled elsewhere, most notably by historian Virginia Berridge (Marketing Health, Oxford University Press, 2007). However, Snowdon argues that the case against passive smoking was (and crucially for his argument, remains) scientifically unfounded, epidemiologically dubious and manifestly overstated. He seeks to call the tobacco control movement to account for unsubstantiated statements such as ‘[j]ust thirty seconds of exposure [to smoke] can make coronary heart function indistinguishable from smokers’ (Snowdon's emphasis; p. 332). He cites comments from Sir Richard Doll, one of the epidemiologists who established the causal connection between smoking and lung cancer, that ‘the effects of other people smoking in my presence is [sic] so small it doesn't worry me’. But such views went against the tide: Doll was obliged to later state he had been speaking in a personal capacity (p. 248).

While Snowdon is correct to highlight questionable tactics which go beyond sound public health, and to highlight the dangers to individual liberties which arise from those tactics being applied to other lifestyle behaviours, he undermines his case by downplaying the risks of smoking to individual health. He states that ‘some people might become addicted and some of those might then become ill and die’ (emphasis in original, p. 323), a statement which flies in the face of medical evidence.* ‘Will’ would surely be more appropriate. Similarly, to dismiss concerns about excessive alcohol consumption as ‘panic’ fails to take into account the very real social, as well as medical, harm caused by alcoholism.** Snowdon's attack on the health inequalities agenda (pp. 296–300) ignores the differences in longevity and mortality experienced in different social groups within the developed world. Further, although there is a detailed summary of the epidemiological evidence relating to passive smoking, there is a frustrating lack of referencing in other parts of the book. Regarding passive smoking, Snowdon by-passes the influence of Roy Castle in the UK context, a popular musician and television personality who died of lung cancer in the early 1990s despite being a non-smoker, and did much to bring the subject to public attention.

These criticisms notwithstanding, Velvet Fist, Iron Glove is an enjoyable read which surely proves that smoking has not lost its ability to provoke debate and reaction in over four centuries. It remains to be seen whether the pendulum will continue to swing towards prohibition, or whether smokers will enjoy a renaissance.

* 'Will' would probably have been a better choice of word, although in the context of the paragraph (which is about degrees of risk from cholera to gambling), it makes more sense. On the whole, I don't think the book downplays the risks of smoking at all.

** Alcoholism is always with us. Panics aren't. The hysteria about 24 hour drinking and 'binge-drinking' can fairly be described as a moral panic - see, for example, this study.

Almost half

I nearly missed this little story in the Daily Mail...

Tobacco firm gave thousands of pounds worth of hospitality to nine MPs who opposed smoking bill

MPs who received thousands of pounds worth of hospitality from one of the world’s largest tobacco companies opposed a new law banning smoking in cars.

The parliamentary register of members’ interests shows Japan Tobacco International, which produces Benson & Hedges, Silk Cut and Camel cigarettes, spent £23,000 entertaining 20 MPs in the past six months.

Almost half of them voted against a Private Member’s Bill banning smoking in cars carrying children.

"Almost half of them" means "less than half of them" — which doesn't sound like much of a return for sending 20 fat cat MPs to the Chelsea Flower Show (for that is what happened). So how does that compare to the MPs who were not treated to corporate hospitality?

The vote went in favour of the bill by 78 votes to 66. If we exclude the 20 votes of the MPs above, it leaves a vote of 67 to 57. Therefore 46% voted against the bill—or, if you are the Daily Mail, "almost half of them".

Amongst the MPs who accepted tickets to the flower show, 11 voted for and 9 voted against. Therefore 45% of them voted against the bill.

Behold the power of Big Tobacco!

Monday 28 November 2011

Malta gets mugged by reality

And so it comes full circle. Junk study after junk study claims a dramatic decline in the heart attack rate following a smoking ban. Each and every one of them is fatally, often comically, flawed. Whenever routine hospital data is available, it is obvious that smoking bans have no discernible effect on the number of people having heart attacks.

And yet the myth persists thanks to well-publicised, cherry-picked scam studies. So persistent is the myth than when a country makes an honest endeavour to replicate these fantastic results, they are genuinely baffled when the data show no change.

Malta bought the snake-oil in good faith and—guess what?—it didn't work. Alas, the Maltese health establishment is so far down the rabbit hole that this entirely predictable non-event is considered bizarre and mysterious.

Malta smoking ban fails to stub out heart disease
We are shocked over smoking ban results

The smoking ban may have led to a decrease in the heart disease death rate and hospital admissions in every country where it was introduced, but it has had absolutely no impact in Malta, a medical study has revealed [actually, the rate increased - CJS].

From Italy, where heart attacks dropped by 11 per cent after it banned smoking in public places, to Montana where the decline was a whopping 40 per cent, every country registered an improvement.

OK, one more time for the world...

'Italy' was in fact one region of Italy (Piedmont) and it didn't see an 11% decline in heart attacks. It saw a 2% increase.

'Montana' was one small town in Montana called Helena, hence the 'Helena miracle', and what more is there to be said about this piece of effluent?

“We were shocked and disappointed with Malta’s results, especially since the island was the second country in Europe to introduce the smoking ban,”cardiologist Robert Xuereb told The Sunday Times.

“Seeing that international studies all showed a reduction in heart attacks and smoking-related deaths, we assumed we’d find a drop in Malta too – to our surprise there was absolutely no change in the figures,” he added.

You don't say! I guess the Maltese forgot to employ a tobacco control charlatan to massage the figures, ignore inconvenient data and invent a phony computer model. How very remiss of them.

The findings were recently presented to the European Society of Cardiology Congress, which was held in Paris and attended by a record 32,946 participants from across the globe.

The paper, titled ‘The Smoking Ban: The Malta Paradox’...

Oh, for God's sake.

...looked at figures for cardiovascular deaths and hospital admissions due to a heart attack five years before Malta introduced the ban in April 2004, and compared these with five years later – there was no change in either the admission or mortality rates.

The inevitable excuses about the ban not being enforced properly follow. And then, in keeping with the conclusion of yesterday's post, there is the usual cry of "that didn't work, let's do more of it!"

“Maltese authorities were among the first to introduce the ban in Europe and they deserve a pat on the back for this, but unfortunately, we didn’t get the results,” Dr Xuereb said.

He is urging authorities to take bolder decisions that restrict smoking in places such as cars, in stadiums, public gardens and on beaches.

Of course he is. What else can a bone-headed prohibitionist do but call for more prohibitions?

People of Malta, please don't blame yourselves. You sound like the cripple who visits the faith healer and blames himself for his lack of belief when other people get cured but not him. Those other people didn't get cured, Malta, they were stooges. It was fixed.

If you insist on believing in miracles, you'd better brace yourself for disappointment. You were never going to see a dramatic fall in heart attacks. England didn't. Australia didn't. Denmark didn't. The USA didn't. Scotland didn't. Wales didn't. New Zealand didn't. Because they are impossible. Trust your own data, not the con artists of tobacco control.

Nothing to see here (part 94)
Heart attacks in Malta before and after the smoking ban

Sunday 27 November 2011

The failure of the Scottish smoking ban

A new study in PloS has found that Scotland's smoking ban had no effect on the country's smoking rate in the long term. Authored by the notorious Jill Pell and colleagues from Glasgow University, the study shows that there was an upswing in quit attempts in the months before and after the implementation of the ban (March 2006), but that these attempts had no lasting effect on smoking prevalence.

The graph below, which comes from the PloS study, shows 12 years of smoking prevalence data. The dotted line shows the predicted rate based on past performance. The vertical line shows the smoking ban.

If you look closely, you can see that smoking prevalence dropped below the anticipated level for a while around the time of the ban, but then rose back to the normal level where it has remained ever since.

... in October–December 2005 immediately prior to the introduction of the ban prevalence fell by 1.70% more than expected from the underlying trend. The magnitude of the decay parameter, −0.08, (95% CI −0.38, 0.22) indicates that this effect was short lived with prevalence returning to its long term trend by the last quarter of 2006.

The graph below shows the quantities of nicotine replacement therapy (NRT) being handed out by the Scottish NHS between 2003 and 2009. Again, the dotted line shows the predicted figures.

Assuming that NRT prescriptions are a marker for total quit attempts (a reasonable assumption), there was a rise in people trying to give up around the time of the ban. Quit attempts then fell below the average for the next two years. This suggests that many of the people who would have made a quit attempt in 2007 or 2008 brought their attempt forward to late 2005/early 2006. Having failed to quit at the time of the ban, these people did not try again in the next couple of years. Over the whole period, there was no increase in the number of people who tried to quit.

The rise in quit attempts was no doubt bolstered by the publicity about the ban and the expensive smoking cessation campaigns that accompanied the legislation. As the study's authors note:

In the six months leading up to implementation of the legislation there were two high profile television campaigns.

It was not the ban, but the fear of the ban, combined with increased advertising for smoking cessation services, that led to the increase in quit attempts—this is evident from the fact that the 1.7% drop in smoking prevalence pre-dated the ban by several months. Contrary to the expectations of anti-smoking lobbyists, the ban itself did not help people sustain their quit attempts, nor did it have any independent effect on the smoking rate. Given the choice of giving up smoking or giving up the pub, many of them gave up the pub.

Despite a large surge in the amount of NRT being distributed, there was no lasting effect on smoking prevalence. The short term blip was not sustained in the medium- or long-term. Ultimately, the ban failed to achieve what its advocates hoped and predicted. It also suggests that NRT products are not very good at helping people quit for more than a few weeks or months.

This should all be contrasted with the claims put forward before the ban. In 2005, NHS Scotland's 'evidence-based' review of the literature found that:

Prospective cohort studies reported reductions in smoking prevalence of 7–20% and population-based studies comparing workplaces with and without restrictions showed 15–20% lower prevalence. Partial restrictions had little or no effect. A recent meta-analysis reported a 3.8% reduction in absolute prevalence (pooled effect) associated with smoke-free workplaces.

Given the uncertainty around the precise estimate, the benefit of reduced smoking prevalence has been estimated using conservative estimates of the effect, with a range of 1–3%.

A more conservative estimate would have been 0%. It would have been right.

And let us cast our minds back to 2006 when the BBC reported this breathless forecast from Scotland's Chief Medical Officer...

Ban will 'eradicate lung cancer'

Lung cancer could be virtually wiped out in Scotland as a result of the smoking ban in public places, according to the chief medical officer.

Dr Harry Burns said lung cancer rates would be reduced to just a few hundred cases a year in the future.

Dr Burns said: "Imagining Scotland with no lung cancer is not trivial speculation. In the 1960s, one in 100 men died of lung cancer. Today, rates are falling all the time and thanks to the smoking ban, I expect the reduction in deaths to accelerate until dying from the disease becomes a rare occurrence.

"Anecdotal evidence shows that since the smoking ban, there has been a surge in the numbers of smokers seeking help to give up."

We now know that this "surge" was a temporary blip which was followed by two years of fewer people "seeking help to give up." It turns out that Imperial Tobacco was better at predicting the future than Harry Burns. This, also from 2006...

Imperial not worried by smoke ban

The world's fourth-largest tobacco group, Imperial Tobacco, has said it does not expect UK smoking bans to have a significant impact on business.

"We believe [UK] smokers will continue to choose to smoke regardless of regulations and our view is supported by experiences in other markets," said Imperial.

Can we expect a mea culpa from the anti-smoking campaigners who predicted a huge drop in the number of smokers, if not the elimination of lung cancer? Can we expect them to reassess their strategy in the light of yet another broken promise?

We cannot. As I have said many times, tobacco control is not a results-driven business. As in Ireland, where the smoking rate is now higher than before the ban, the anti-tobacco industry has only one response to failure—more of the same. Pell et al's conclusion epitomises this mindset.

Quit attempts increased in the three months leading up to Scotland's smoke-free legislation, resulting in a fall in smoking prevalence. However, neither has been sustained suggesting the need for additional tobacco control measures and ongoing support.

Heads, we win. Tails, you lose.

Saturday 26 November 2011

Snus prohibition

This week I wrote an article for the Swedish newspaper Espressen about the EU prohibition on snus—which most Swedes find baffling (and with good reason). The whole story is recounted in my book The Art of Suppression. This is a very brief overview. Prohibition still kills. Won't someone tell the FDA?

Here is the unedited article in English...

For most of us, the word ‘prohibition’ brings to mind images of Al Capone, Elliot Ness, speakeasies and moonshine gin being distilled in bath tubs. It is widely acknowledged that America’s attempt to use manmade laws to defeat the laws of fermentation was a fiasco. Russia, Finland and Iceland also experimented with bans on alcohol in the 1920s with equally dismal results. Sweden narrowly escaped the same fate in 1922 when a referendum for national prohibition was defeated by the tightest of margins - 49% voted for and 51% voted against.

The violence, crime, ill health and drunkenness that invariably accompanied alcohol prohibition meant that it was repealed in every country that tried it. Finland’s ban was so unsuccessful that by the time it ended in 1934, the Swedish government was complaining about the amount of drink being smuggled in from its supposedly dry-as-dust neighbour.

Bootlegging, gangsterism and poisonings were unintended consequences of prohibition that no government could ignore, but the harmful consequences of criminalising products are not always so obvious. In the case of the European Union’s ban on Swedish snus, the damage remains unseen precisely because the prohibition has ‘worked’. It has ‘worked’ in the sense that few people outside Scandinavia use – or are even aware of – the product. As a means of limiting snus use in Europe, the ban has been a roaring success, but as a public health measure it has failed as grievously as any prohibition in the last two hundred years.

My country, the United Kingdom, must take some of the blame. In the 1980s, a smokeless tobacco company set up a headquarters in Scotland where they produced an oral tobacco product similar to snus called Skoal Bandits. Low in nicotine, sweetly flavoured and with a masked cowboy emblazoned on each container, Skoal Bandits were accused of being aimed at teenagers. The British have no history of using snus and, as a result, there was a loophole in the law that allowed its sale to children. Alarmed by this news, anti-smoking groups and the tabloid press led a brief moral panic which resulted in oral tobacco being banned outright in the UK and Ireland. In 1992, the European Commission complained that unilateral bans by member states undermined market harmonization and so decided to enforce a total ban on “new tobacco products for oral use.”

Few noticed and fewer cared about this legislation because hardly anybody in the EEC used these products. It was not until Sweden prepared to join what had become the EU in 1995 that it became a live issue. Aware that Sweden was a nation of snus-users, the European Commission temporarily abandoned its insistence on market harmonization and allowed it an exemption from the ban. The rest of Europe remained indifferent to this little piece of diplomacy, but that was about to change.

The public health basis for the EU’s ban was based on the twin assumptions that snus increased the risk of oral cancer and was a gateway to smoking. The first of these beliefs was plausible since it was well known that some smokeless tobacco products, especially those used in Africa and Asia, contain high levels of carcinogens. What was less well understood, however, was that Swedish snus is a fundamentally different product. Whereas the hazardous ‘tobacco-specific nitrosamines’ can be found in excess of 1,000 parts per million in some chewing tobaccos, levels in Swedish snus are as low as 2 parts per million. Very little was known about the effect of snus use on health when the EU introduced its ban, but when scientists conducted studies in the 1990s, they found no difference in cancer rates between users and non-users. This evidence was so compelling that, in 1999, the EU went to the unprecedented step of removing the ‘Causes Cancer’ warning on snus packaging.

As for the ‘gateway to smoking’ hypothesis, it has become clear in the last twenty years that snus is a gateway from smoking. The revival of snus use in Sweden since the 1970s has been accompanied by an exceptional decline in smoking prevalence. Today, Sweden has the lowest male smoking rate and the lowest lung cancer rate of any developed country. In the North of the country, where snus consumption is at its highest, the smoking rate is lower still. Any lingering fears that snus causes cancer are dispelled by the fact that Sweden also has the third lowest rate of oral cancer (and the fourth lowest rate of pancreatic cancer) of any EU nation.

As public health researchers pieced this picture together, it became clear that European smokers had been deprived of a product that could help them quit cigarettes. One study estimated that 200,000 lives could be saved if the whole EU emulated the ‘Swedish experience’. Britain’s Royal College of Physicians, Action on Smoking and Health, the American Association of Public Health Physicians, the European Respiratory Society, the Norwegian Directorate of Health and the Swedish government have all called for the EU ban to be overturned, but they face resistance from hard-liners in the anti-smoking movement who are anxious to maintain one of the world’s few prohibitions of a tobacco product. The manufacturers of nicotine gums and patches are also keen to maintain their monopoly on the smoking cessation market and have lobbied hard for the ban to remain in place.

This leaves snus in a peculiar position. Despite being a near-harmless substitute for smoking, it is treated like an illegal drug in the EU while cigarettes remain freely available to any adult who wants to buy them. Few Swedes appreciate the role that snus has played in improving the nation’s health and few people outside Scandinavia have even heard of it.

There are no Al Capones or Pablo Escobars smuggling snus into other member states. No one is making counterfeit General in their basements or running illicit bars for snus users. The curious ban on snus has created no mayhem in the streets and yet, by helping to keep nicotine users consuming the most deadly tobacco products, this little known prohibition may be costing more lives than all the poisoned moonshine drunk in 1920s America.

Other recent articles related to The Art of Suppression:

'We should stop panicking about Boozy Britain' (Independent)

'Prohibition fuels firestorm of new dangerous drugs' (City AM)

Patrick Hayes' review of The Art of Suppression (Spiked)

Tom Miers' review of The Art of Suppression (The Free Society)

Saturday 19 November 2011

Big Alcohol = Big Tobacco

A bit more schadenfreude for the nonsmoking drinkers who applaud the anti-smoking campaign while expecting their own vice to be left alone. As I said yesterday in relation to quisling pub supremo Ted Tuppen...

Do you really think it is wise, as the head of a pub company, to equate alcohol with cigarettes? There are enough temperance nuts doing that already without you helping them out.

Five years ago this would have been outrageous hyperbole, but things move pretty quickly in 'public' health. Five years ago I don't recall anyone ever seriously using the term 'Big Alcohol'. Big Tobacco, sure. Big Oil, sometimes. But 'Big Alcohol'—not so much.

That's all changing.

How's that for guilt by association? Alcohol Concern Wales—for it is they—have created a document which contrasts statements from the tobacco industry with statements from the alcohol industry. They're both the same, doncha see?

The logic here is lame even by temperance standards. They take no account of whether the statements might be true, for a start. They have dredged the internet and found comments that are roughly similar and that is enough for them.

And when I say roughly similar, I mean similar as in they're both spoken in English and involve words. Take this, for example....

“The Lorillard Tobacco Company today announced the launch of a nationwide youth smoking prevention programme. in addition to the funds Lorillard and other companies have committed to the...youth smoking prevention and education programme.”
Lorillard Tobacco Company Press Release (1999)

“It is only through education, coupled with targeted interventions against misusers, that we can ultimately change the drinking culture...”
David Poley, Chief Executive of the Portman Group (2010)

Uncanny, eh? A tobacco company announces the launch of a youth smoking prevention programme (as it was required to do under the Master Settlement Agreement) and the Portman Group announces that, er, education and targeted interventions are essential to change the drinking culture. Both statements include the words "education" and "the". It's really quite spooky.

Or take this...

“[Increasing the price of cigarettes] discriminates against those who can least afford it. Increasing tobacco duty could cost the government billions of pounds...The Chancellor said the government’s policy on tobacco will reduce smoking. It’s not the government’s role to force people to quit.”
Simon Clark, Director of smokers’ lobby group Forest (2011)

“It is worrying that in the midst of a recession, when sales and consumption of alcohol are falling, that the Government should be talking about raising prices for all consumers, at a time when many are already struggling to make ends meet.”
Jeremy Beadles, Chief Exec. of the Wine and Spirit Trade Association (2009)

Let's take the first quote. Clark is saying that cigarette taxes are regressive (clearly true), that very high prices increase smuggling (also true) and that it is not the government's job to force people to stop smoking (a moral question, but a valid opinion).

Beadles, however, is simply saying that increasing the price of a product used by 90% of the population during a recession will make people worse off. He is not referring to the poor, to smuggling, nor to whether the government should be trying to stop people drinking.

These comments have very little in common except they refer to taxes. In the minds of Alcohol Concern, however, any industry that opposes tax hikes on its products is following the Big Tobacco template. As they say on their 'glancesheet' ('Glantz sheet'?):

This glancesheet shows how arguments previously put forward by tobacco companies and lobbyists, to delay or prevent tighter regulation of the industry, have now been adopted by the alcohol industry to protect its own interests.

There should be a version of Godwin's Law for anyone who resorts to comparing an industry with the tobacco industry for rhetorical purposes, with extra marks for using the word 'Big' (capitalised, natch). To the neo-prohibitionists, any industry that dares to challenge them is "recycling Big Tobacco arguments" and, therefore, can be ignored.

The irony is that there is a template being copied here and it is being copied very precisely. The temperance lobby is demonising industry, demanding higher taxes, calling for a total ban on advertising, playing the 'think of the children' card, using junk statistics and talking about 'passive drinking'.

Now who did they get from, I wonder?

Friday 18 November 2011

Unfree Enterprise

Ted Tuppen:
Plenty to look miserable about
Few things are less edifying than an industry conspiring with the government to screw over its competition. The Coca-Cola company's support for Prohibition was driven by a transparent pursuit of profit. The makers of Nicorette and Champix not only support the EU's snus ban but are lobbying for the prohibition to be extended to all smokeless tobacco products. It's cynical and it's opportunistic. It's rent-seeking.

Britain's pub industry is going down the same dismal road. Yes, the pubs have been victims of punitive legislation themselves. Yes, they could have done more to oppose the smoking ban. And yes, we have some of the highest alcohol taxes in the world, but that it is no excuse for this...

Tuppen: Supermarkets may need to be "bullied"

Supermarkets may need to be “bullied” into adopting a responsible pricing strategy on alcohol according to Enterprise Inns chief executive Ted Tuppen.

First the Scottish Licensed Trade Association, then Greene King, and now Enterprise Inns. All lining up to demand a new bad law to make up for another bad law. They all share the delusion that minimum pricing will drag back the customers that the smoking ban drove away. Ted Tuppen is the guy who, in 2007, predicted that "the ban will lead to a number of pub closures across the industry, particularly amongst lower quality wet-led outlets." But, he said, Enterprise Inns would be just dandy:

"However, we are confident of a positive outcome as the smoking ban becomes an accepted part of pub-going and licensees and customers alike enjoy the benefits of the more pleasant, healthier, smoke free regime."

Since then, Enterprise has sold hundreds of its pubs and its share price has collapsed from £7.00 in July 2007 to 29p today. Winning!

The Enterprise boss also launched an attack on the government’s “punitive” beer duty escalator, saying it is time to “level the duty playing field so cynically distorted” by George Osborne and “put right the duty wrong perpetrated by Gordon Brown”.

Ah, the fabled "level playing field", destroyer of jobs, killer of businesses. Funny how the playing field is always levelled down but never up, isn't it? I recall Enterprise Inns pleading for a level playing field back in 2006...

Hubert Reid, Enterprise chairman, said: "If a total ban is inevitable, then it should be imposed across the board, including 20,000 private members clubs, in order to create a level playing field for all those employed or operating within the hospitality and leisure industry."

To be clear, the exemption for private members' clubs would have distorted the market and been unfair to public houses. It would have been better for the consumer, but it was still a rotten law.

Back in 2006, it may have seemed good business to demand the government shaft all licensed premise with equal vigour. With hindsight, a united front against the whole illiberal law would have been better. The pubco's must now regret getting into bed with the anti-smoking lobby in 2006, just as they will live to regret getting into bed with the temperance lobby on the minimum pricing issue.

“Pubs don’t want to be treated as a special case but we do need to see an end to the discrimination which will lead to more pub closures and more job losses,” said Tuppen.

No, Mr Tuppen. Being treated as a special case is exactly what you want. The on-license and off-license trade are completely different industries selling completely different services. Off-licenses sell alcohol. Pubs sell an experience. There can be no level playing field. The pub experience is necessarily more expensive. It involves washing glasses, larger premises and—above all—extortionate rents to greedy pubcos so that their CEOs can pocket £1.2 million a year.

“I am uncomfortable with the imposition of minimum pricing, no matter how attractive it might seem. I believe that we need a society which suffers from less regulation and not more.

Well, that's more like it, sir. So, no more silly talk of minimum pricing then?

“However, a minimum pricing level may well be necessary if we are to have a ban on below-cost selling." 


It is plainly nonsense to say that minimum pricing is needed to ban below-cost selling. However, if Mr Tuppen thinks that selling alcohol below is such a great way to get ahead in the licensed trade, why doesn't he try doing it for a few weeks and see how it goes? He will soon find out why—as even the temperance lobby now admits—below-cost selling is as rare as hen's-teeth.

"Can we ask the supermarkets to be responsible? This is really where the industry, the Association of Licensed Multiple Retailers, the British Beer & Pub Association are all in loud agreement."

The pub industry are united in wanting the state to shaft their competitors? Well, stone me.

"Like cigarettes, why shouldn’t alcohol be sold behind the counter rather than picked up by anyone from the shelves?"

Because cigarettes are small, high value items which makes them a perfect target for shop-lifters. Are you seriously suggesting that people would go to pubs more if they had to buy alcohol from a supermarket counter? And do you really think it is wise, as the head of a pub company, to equate alcohol with cigarettes? There are enough temperance nuts doing that already without you helping them out.

"There should be a clear restriction on irresponsible advertising and multipack sizes could be reduced to say a pack size of four, rather than 20."

What on earth is this fellow babbling about? Is this meant to be "nudging"? Give me gospel temperance over the doctrine of piddling inconvenience.

"There should be a ban on external advertising of price, something I think which would equally apply to pubs."

Does the phrase "cutting off your nose to spite your face" mean anything to you, Ted?

"These are simple solutions which the supermarkets should be encouraged, or perhaps bullied to follow, perhaps through a voluntary code of practice."

There's nothing like bullying people to make them do things voluntarily, is there? And that's what this is all about: bullying. Ted Tuppen is the mouthy little oik standing behind the big kid, goading him on. Too stupid and cowardly to do anything himself, he relies on the bully to beat up his enemies. Utterly pathetic. Boycott Enterprise Inns while you still can. There aren't many left.

Thursday 17 November 2011

BMA retracts claim about smoking in cars

The British Medical Association has now retracted its claim that secondhand smoke is 23 times more concentrated in a car with all the windows open than in a smoky bar.

The original claim—press released around the world this week—stated that:

There is evidence to suggest that the levels of SHS present in vehicles can contribute to a serious health hazard for adults and children. Further studies demonstrate that the concentration of toxins in a smoke-filled vehicle is 23 times greater than that of a smoky bar, even under realistic ventilation conditions.

In the studies a number of ventilation conditions were assessed, where airflow parameters included average driving speed, presence of air conditioning and open windows. Realistic ventilation is described as driving at average roads speeds with all four windows completely open.

The BMA has now rewritten their briefing paper (the previous version has now disappeared) so that it now reads:

There is evidence to suggest that the levels of SHS present in vehicles can contribute to a serious health hazard for adults and children. Further studies demonstrate that the concentration of toxins in a smoke-filled vehicle could be up to 11 times greater than that of a smoky bar.

In the studies a number of ventilation conditions were assessed, where airflow parameters included average driving speed, presence of air conditioning and open windows.

Aside from removing the now-notoriously fictitious "23 times" claim, it is significant that the BMA has removed all reference to "realistic conditions". As I have said before, when experiments have been conducted in realistic conditions (ie. with one or more windows at least partially open), the amount of secondhand smoke in a moving vehicle is much lower than in a smoky bar. When all windows are closed and the ventilation is turned off, however, concentrations are higher than in a smoky bar. Of course they are. Cars are smaller than bars. That's why people who smoke in a car open the window.

The BMA's half-correction is welcome. I wonder if they will use their formidable PR machine to make sure the media get the message? (Rhetorical question). The fact remains that millions of people have now been informed that secondhand smoke in a car under realistic conditions "is 23 times" more concentrated than secondhand smoke in a bar.

Now, with the world's media having moved on, the BMA has little to lose by quietly announcing that what they meant to say was that secondhand smoke in a car under unrealistic conditions "could be up to 11 times" more concentrated than secondhand smoke in a smoky bar.

Perhaps the BMA should launch a campaign to make people smoke under realistic conditions?


I'm grateful to Ivan who has left a comment leading me to this interview from the Today programme with Dr Vivienne Nathanson, the head of science and ethics at the BMA. The fact that she wants it to be illegal for people to smoke in their own car demonstrates her weak grasp of ethics. This interview demonstrates her weak grasp of science.

Bear in mind that this immediately followed an interview with Simon Clark who mentioned the debunking of the "23 times" claim in the Canadian Medical Association Journal.

Interviewer: What is the evidence?

Nathanson: Well, the evidence is, in fact, that the levels of toxins that can build up in a car do reach 23 times the levels in a smoky bar...

Interviewer: And that is—sorry to interrupt you—but that is peer-reviewed?

Nathanson: Yes, absolutely.

Interviewer: Everyone in the scientific community accepts that it's true?

Nathanson: Absolutely.

Pretty emphatic stuff, there. Of course, what the peer-reviewed study actually says is...

We recommend that researchers and organizations stop using the 23 times more toxic factoid because there appears to be no evidence for it in the scientific literature.

It's also worth reading this blog post which casts a critical eye on some of the other claims in the BMA's latest report.

The BMA's tactical victory

The BMA appeared to put their foot in it yesterday with their 'ban smoking in cars' media blitz. Firstly, they used a thoroughly discredited junk statistic. Secondly, they demanded that it be illegal for a person to smoke in a car by his or herself—a policy that most people rightly regard as the nanny state gone berserk.

All of this made it easier for those of us who discussed the proposed ban on television and radio. At the very least, we were able to make the public aware that the BMA's grasp of the science is weaker than is generally assumed. Readers of the Telegraph, the Independent, Spiked and Full Fact can consider themselves better informed than most.

But if relying on the absurd "23 times more toxic" canard was a blunder, I'm not so sure than calling for a total ban was also a cock-up. I tend to share the view of Simon Clark that it was a deliberate strategy.

My view, for what it’s worth, is that it’s tactical. The BMA’s declaration coincides with the second reading of Labour MP Alex Cunningham’s Private Members’ Bill which calls for a ban on smoking in private vehicles when children are present. It’s listed to be debated on Friday 25 November.

The BMA has possibly worked out that by calling for more extreme action, the coalition government may see a ban on smoking in cars with children as a reasonable compromise.

I may be right because, unknown to me (I have only just read it), the Huffington Post this morning published a piece by Dame Helena Shovelton, chief executive of the British Lung Foundation, entitled Calls for a Ban on Smoking in Cars Are Welcome, but Action on Children Is Needed Now. (I assume that my article is intended to be a companion piece.)

As we know (and I respect them for it), the tobacco control industry is very well coordinated. Alex Cunningham, the BMA and the BLF are not working in splendid isolation. They will be working together, I'm sure, and privately they will all be singing from the same hymnsheet. First, a ban on smoking in cars with children, then a ban on smoking in all private vehicles.

By calling for the latter now the BMA is trying to make a ban on smoking in cars with children appear more liberal. They will be delighted with that, believe me, because they know that, after that, a ban on smoking in all vehicles is only a matter of time.

There are two routes to prohibition. One is to move incrementally—the salami slice approach—as is happening with alcohol advertising. The other is to appeal to the public's sense of compromise by making extreme demands. Back in 2003, The Lancet called on the government to ban the sale of tobacco completely in an editorial titled 'How do you sleep at night Mr Blair?' Although widely derided, this editorial opened an Overton window which made a total ban on smoking in 'public' places—which had previously been seen as the most extreme measure available—seem almost moderate.

Let there be no doubt. The BMA believes it is perfectly appropriate for the police to stop and fine adults for smoking a cigarette in their own car, even when no one else is in it. They have the ethics of a rattlesnake and will undoubtedly campaign for a total ban in the future, just as The Lancet will one day renew its call for tobacco prohibition. Compromise in anathema to them, but expect them to suddenly present themselves as compromisers in the next days and weeks.

Wednesday 16 November 2011

The British Medical Association spices up an old myth with a new lie

I predicted last night that...

The chances are [the British Medical Association] will claim that a cigarette smoked in a car exposes passengers to either 23 or 27 times more secondhand smoke than they would get from a whole night in a smoky bar. Both of these statistics are obviously absurd.

In the end they plumped for the "23 times" figure despite it being thoroughly debunked in the Canadian Medical Association Journal, which offered this advice to advocates:

We recommend that researchers and organizations stop using the 23 times more toxic factoid because there appears to be no evidence for it in the scientific literature.

Did that stop the BMA resurrecting this zombie statistic?

It did not. Not only are the BMA bandying around a figure for which there is "no evidence in the scientific literature", but they have added a fresh layer of nonsense to it.

There is evidence to suggest that the levels of SHS present in vehicles can contribute to a serious health hazard for adults and children.

Further studies demonstrate that the concentration of toxins in a smoke-filled vehicle is 23 times greater than that of a smoky bar, even under realistic ventilation conditions.

In the studies a number of ventilation conditions were assessed, where airflow parameters included average driving speed, presence of air conditioning and open windows. Realistic ventilation is described as driving at average roads speeds with all four windows completely open.

The BMA seem to be suffering from undiagnosed pseudologia fantastica. Their new briefing paper supplies three references for their bizarre claim about "realistic ventilation". Only one of the named studies experimented with a scenario in which all the windows were open. The researchers called it 'Condition 3' (PM is particulate matter)...

At the other extreme, in Condition 3 (all windows open all the way while driving), the PM2.5 level was the lowest (M = 60.4 μg/m3, range = 15.7 to 220.5 μg/m3).

And how does that compare to a "smoky pub"?

To provide some context about the PM2.5 levels recorded in this study, in a recent report of PM2.5 levels in Irish pubs throughout the world, the average level of PM2.5 in 48 Irish pubs that allowed smoking was 340 μg/m3.

Pedants and sceptics would say that there is a bit of a difference between "23 times higher" and "82% lower" but what the hell, eh? If the BMA says it, it must be true.

Tuesday 15 November 2011

Smoking in cars: groundhog day

Word has it that the British Medical Association is going to have another stab at campaigning for a smoking ban in cars today. This is turning into an biannual crusade and I don't have any more to say about it than I did in all these previous posts.

The chances are they will claim that a cigarette smoked in a car exposes passengers to either 23 or 27 times more secondhand smoke than they would get from a whole night in a smoky bar. Both of these statistics are obviously absurd. The "27 times" canard comes from an unpublished, non-peer-reviewed study presented at a conference nine years ago. It was heavily rigged towards getting the "right" result and finally concluded...

The calculated exposure for a five hour automobile trip with the windows closed/ventilation off and with a smoking rate of 2 cigarettes per hour is 25 times higher than the same exposure scenario in a residence.

"Residence" is not quite a "smoky bar" and "windows closed/ventilation off" is not exactly a realistic scenario for a smoker on a five hour car journey, but nevermind. And no, I don't know why 25 got changed to 27, but this is the reference ASH use for the claim.

The "23 times" claim is even more fun, because it involves a rare mea culpa from tobacco control. In a study in the Canadian Medical Association Journal entitled 'Second-hand smoke in cars: How did the “23 times more toxic” myth turn into fact?', MacKenzie and Freeman showed that the "fact" was entirely without scientific evidence and stemmed from a, obscure quote in a local newspaper in 1998 (as I had revealed on this blog two months earlier).

They concluded with the following unheeded recommendation:

We recommend that researchers and organizations stop using the 23 times more toxic factoid because there appears to be no evidence for it in the scientific literature.

I'll be talking about this on BBC Sussex at around 9.40 am.

Don't panic

I've got an article over at The Independent today covering many of the facts about alcohol of which readers of this blog will be familiar, but politicians seemingly are not.

Yes, we are drinking more than we did in the immediate post-war years. An economic depression sandwiched by two world wars reduced alcohol consumption to the lowest in our history, but austerity Britain can hardly be considered a typical reference point. Using more relevant benchmarks, we are drinking less than we did in 1914 and very much less than we did in previous centuries. We are drinking only marginally more than we did thirty years ago and—here is a seldom spoken truth—we are drinking less than we did in 2002.

Yes, there are millions of us who exceed our ‘daily limits’ (they’re actually weekly guidelines). How could we not? These guidelines were not based on any real evidence when they were set in 1987 and methodological changes have since dragged several million more of us over the line of ‘hazardous drinking’. Limits that do not allow for tipsiness, let alone drunkenness, deserve to be ignored and yet the percentage of men and women drinking above the ‘limits’ has still been falling for a decade, with the largest decline seen amongst young men.

By comparison with our European neighbours, we are firmly mid-table in the alcohol consumption stakes, behind France, Germany and Spain and far behind the Czech Republic and Luxembourg. In terms of alcohol taxation, however, we are Champions League contenders. The UK has the second highest excise duty on wine, the third highest excise duty on beer and the fourth highest excise duty on spirits. ‘Rip-off Britain’, perhaps, but hardly ‘Boozy Britain’.

The comments are generally positive. Do go have a read.

Heart miracles are impossible

King-size cigarette,
pint-size intellect
It's good to see Dr. Carl V. Philips back and blogging over at Ep-ology. In his last two posts he has been discussing the North Carolina heart miracle 'study', which is as bad a piece of advocacy-driven junk science as you will ever see.

In particular, he makes a point which I have tried to made before, which is absolutely fundamental to all the heart miracle studies. The results they report—of heart attacks falling by 17%, 21%, 40% or whatever—are simply impossible.

Let's go along with the "consensus" view that long-term secondhand smoke exposure increases the lifetime risk of heart disease by around 20-30%. Nevermind whether that is a realistic estimate. For good or ill, it is the figure used by the Surgeon General and other authorities, and it is accepted by those who conduct the heart miracle studies.

That being the case, is it plausible that the elimination of secondhand smoke from restaurants, offices and bars could reduce the heart attack rate by 21% (as reported in North Carolina) or 40% (as reported in Helena, Montana)?

It is not.

For one thing, most restaurants, some bars and nearly all offices were non-smoking before the ban. In addition, many non-smokers avoided the few remaining smoky venues before the ban. The vast majority of heart attack cases are elderly and not the kind of people to be out partying in bars, nor indeed working in pubs or waiting tables in restaurants. Furthermore, the amount of secondhand smoke inhaled by this subsection of non-smokers before the ban is minimal compared to the long-term exposure that the 20-30% figure is based on.

As Carl explains...

How many people go from being exposed to restaurant/bar smoke to unexposed as a result of the ban? It is a bit fuzzy to define this since there will be a lot of people whose exposure is reduced, and a spectrum of how much it is reduced. But we can start with the observation that roughly half of everyone had approximately zero such exposure before the ban, never or almost never going out to eat and drink, or avoiding smoking-allowed venues when they did...

Thus, even if you believed that exposure at the level of visiting restaurants and bars causes somewhat more than 20% increase in risk, which is an absurd belief in itself, there is no possible way the effect of the smoking ban could be more than about half of the claimed 21%.

Even if we assume that secondhand smoke does cause heart attacks, smoking bans have so little effect on so few non-smokers (and have no effect at all on the smokers, unless it compels them to quit), that the kind of reductions in the heart attack rate reported by these studies defy both science and common sense. If there is an effect, it is too small to measure and would never show up in population-level statistics. Once that is understood, it is obvious that any studies which claim a dramatic effect on the heart attack rate must be flawed, cherry-picked or distorted. Sure enough, when such studies are examined, they prove to be flawed, cherry-picked and distorted.

We can figure that half of the population was not exposed in the first place, that easily a third of those exposed were smokers, that many of those exposed had very minor and occasional exposure, and that many others that were exposed had only a minor reduction in exposure since most of their exposure was elsewhere. So it seems unlikely that even one-fifth of the population experienced a substantial reduction in exposure, getting the effect down below 1% of the total.

If, to take North Carolina as an example, the smoking ban caused the heart attack rate to drop by 21%—which it unequivocally did not—it follows that smoking in bars, restaurants and offices must have been responsible for a fifth of all heart attacks before the ban.

It is quite possible that thirty years of induced panic about passive smoking has persuaded many people that such diluted tobacco smoke is capable of wreaking such havoc, but the empirical evidence shows that it cannot be so. If it were, the relative risk from secondhand smoke exposure would be far higher than 20-30%. Indeed, secondhand smoke would be responsible for more heart attacks than smoking. It would mean that passive smoking (at work and at home) was the single biggest risk factor for heart attacks. Even the most tobaccophobic hypochondriac surely cannot believe such a thing.

In the case of Stanton Glantz's bar-lowering Helena study (2004), the smoking ban effect was even greater—an astonishing 40%. Again, this implies that smoking in a subsection of private venues was responsible for two-fifths of all heart attacks before the ban—a manifestly risible idea.

Interestingly, Glantz must have known that his findings were inherently implausible because he addressed them in the text of the study itself. His comments tell you much about the man's mathematical illiteracy and, sadly, tell us much about the decline of the peer-review process (the study was published in the prestigious British Medical Journal). He wrote:

The effect associated with the smoke-free law may seem large but is consistent with the observed effects of secondhand smoke on cardiac disease. Secondhand smoke increases the risk of a myocardial infarction by about 30%; if all this effect were to occur immediately, we would expect a fall of - 0.30 x 40.5 = - 12.2 in admissions during the six months the law was in effect, which is within the 95% confidence interval for the estimate of the effect (a drop of - 32.2 to - 0.8 admissions).

His argument here is that secondhand smoke exposure increases the risk of heart disease by 30% and so, "if all this effect were to occur immediately", a smoking ban should reduce the heart attack rate by around 30%. 40% is, he concedes, a little higher than might be expected but it is within the margin of error.

This piece of reasoning is so patently flawed that I still cannot believe it was allowed to be published. Let's leave aside the fanciful idea that the effect of a lifetime's exposure would suddenly be nullified by a smoking ban in non-domestic settings. The key point is that Glantz ignores the fact that secondhand smoke is one of dozens, if not hundreds, of risk factors for heart attacks (or heart disease—he treats them as if they were the same thing). He seems not to comprehend the difference between relative risk and absolute risk. He does not acknowledge that a relative risk which affects a subsample of the nonsmoking population is not going to have a commensurate effect on the entire population. And he implicitly treats secondhand smoke as if it were the sole cause of heart disease. These are staggering schoolboy errors for a man with pretensions of being an epidemiologist (which just goes to show that a degree in mechanical engineering is not always the best grounding for a career in cardiology).

Look at it this way. If using a mobile phone while driving increases your risk of having an accident by 90%, what will be the effect on the number of car crashes in a country that bans the practice?

The answer is that we do not know. There are countless other risk factors for car crashes and so, even if using a mobile phone has a substantial effect on individual risk, the effect at the population level will be too small to measure.

By Glantz's logic, however, the effect of a mobile phone ban will be to reduce the number of car crashes by 90%—because he doesn't understand the basic difference between individual relative risk and absolute risk to the population. How can he be so ignorant? There are, as Carl says, only two possibilities.

Interestingly, it is not entirely clear whether he spouts junk because he has not acquired a modicum of understanding about the science in the field where he has worked for decades, or because he is a sociopath-level liar; I am not entirely sure which is the more charitable interpretation.

Do go read both of Carl's pieces about the North Carolina nonsense:

Unhealthful News 189 - Absurd claims about the effects of smoking place restrictions, North Carolina edition (Part 1)

Unhealthful News 190 - Absurd claims about the effects of smoking place restrictions, North Carolina edition (Part 2)

Friday 11 November 2011

Better the devil you know

The Guardian has some unsurprising news about mephedrone (AKA meow meow, m-cat, bubble, etc.)

Mephedrone was classified in the UK as a Class B substance in April last year. Prior to the ban it was a "legal high", with users buying it primarily from websites that advertised it as "plant food". Since then prices have approximately doubled to £20 per gram and the trade has been taken over by street dealers.

UK Home Office figures published in July found mephedrone ranks joint second with cocaine behind cannabis in popularity among 16- to 24-year-olds, with 4.4% having taken it in the previous 12 months.

Yes, it's another triumph for prohibition. Mephedrone is one of dozens of drugs to have surfaced as legal highs in recent years. Most legal highs have little going for them apart from their legality. Mephedrone's staying power suggests that it has qualities which allow it to compete as a controlled substance. Whether it is truly dangerous—let alone addictive, as The Guardian's report claims—remains to be seen. All the mephedrone-related deaths reported in the media before it was banned turned out not to be mephedrone-related at all (as readers of The Art of Suppression will know). Since it was banned, there has been talk of 200 deaths, but, if so, specific incidents have been uncharacteristically absent from the newspapers.

All of which leads me to mention the article I wrote for City AM yesterday, the theme of which is the futility of this war on chemistry.

Despite immense efforts by police, customs officers and legislators, there has been no decline in the nation’s consumption of illicit chemicals since the ecstasy panic peaked fifteen years ago. What we have instead is an ever-widening menu of narcotics about which users and authorities know little.

One proposed solution is to introduce a law similar to the USA’s Analog Act which automatically bans drugs which are “substantially similar” to banned substances. The idea is tempting in its simplicity, but this Nixon-era legislation is too vague to be legally useful and has rarely been invoked. The grey market continues to be one step ahead of legislation.

An alternative solution was proposed last week by Dr James Bell, of the South London and Maudsley NHS Foundation Trust, who suggested abandoning the unwinnable war against chemistry in favour of legalisation. All calls for drug liberalisation fall on stony political ground and Bell’s was no different, but there would be no better way of stopping the flood of dubious chemicals than a regulated free market. These drugs are nobody’s first choice. BZP was originally a worming tablet for cattle. Ketamine was a veterinary anaesthetic. GBL was a superglue remover. In all likelihood, that is what they would have remained had ecstasy not been banned.

Nobody made 80 per cent proof gin in their bathtubs after prohibition was repealed in 1933. Instead, Americans turned from distilled spirits to beer, the number of alcohol poisonings fell and the murder rate subsided. There is a lesson there for those fighting against narcotic moonshine today.

Do go read it all.

Thursday 10 November 2011

The gathering storm of prohibitionism

Reason magazine's Nick Gillepsie interviews the great Joe Jackson about music, smoking and the "gathering storm of prohibitionism."

Jackson's antipathy for the creeping nanny state in his native England and his longtime home of New York City led him to write a meticulously researched essay called "Smoking, Lies and The Nanny State." It also led him to finally flee New York and London, setting up residence in Berlin because there he at least feels like he is relatively "free" and "treated like an adult."

Well worth watching.

Wednesday 9 November 2011

The North Carolina smoking ban/heart attack hoax

Stop me if you think you've heard this one before.

From the University of San Francisco (note the byline)...

Heart attacks down 21 percent in the first year after the North Carolina smokefree restuarant and bar law took effect

Submitted by sglantz on Wed, 2011-11-09 11:54

The evidence that strong smokefree laws provide large and immediate health benefits just keeps piling up.

The latest study, released today, found a 21 percent drop in emergency room admission for heart attacks during the first year of the law, saving an estimated $3.4 to $4.3 million in heath care costs. This is serious money, particularly as both government and the private sector struggle to keep health costs down.

These real documented and rapid benefits not just in terms of health, but the economy, show that the economic argument on smokefree policies has clearly shifted away from the tobacco industry and its allies to the health side.

Real and documented, you say? So we can assume, at the very least, that there were 21% fewer heart attacks after the smoking ban?

Not even that, I'm afraid. Not even close. As the study shows, there were 9,066 heart attacks in 2008. This fell by 10.5% to 8,113 in 2009. The smoking ban came in at the start of 2010. In that year, there were 7,669 heart attacks—a decline of 5.5%.

The researchers have even helpfully included a graph in which you can clearly see the heart attack rate falling before the ban and then leveling off somewhat after the ban.

As if to rub our noses in it, the researchers spell out exactly what the trend was.

Interestingly, the rates appear to have consistently declined between the year 2008 and 2009; after that period the rates leveled off at a consistently lower level in the year 2010.

Er, yeah. So where on earth does this claim that there was "a 21 percent drop in emergency room admission for heart attacks during the first year of the law" come from?

The answer is that they did a Gilmore. They made a computer model. You may recall Anna Gilmore and her band of merry women reinterpreting the no-change-there-then English heart attack data and declaring that 2.4% of the 4.2% drop was attributable to the smoking ban. Unprovable (she made no attempt to prove it) but also unfalsifiable.

This new study takes that approach to absurd new depths. Whereas Gilmore claimed that a portion of the drop in heart attacks was due to the smoking ban, this model says that the smoking ban reduced the heart attack rate by 21%, despite the actual heart attack rate only falling by 5.5%.

You almost have to admire the sheer audacity of these people. Every time I think there is no way they can keep flogging this dead horse, they come up with another ruse.

Here is a study which unequivocally shows that the smoking ban had absolutely no effect on the heart attack rate. If anything, the year after the smoking ban saw rather more heart attacks that would be predicted based on the preceding years. The study provides all the data you need to see that the heart attack rate fell by 5.5% after the smoking ban and yet it concludes—based on a demonstrably ludicrous computer model—that the smoking ban reduced the heart attack rate by 21%. When your computer gives you information like that it's time to turn it off and turn it on again.

And yet you can be sure that when this study is inevitably reported, the facts will not be allowed to stand in the way. The number of people who actually went to hospital with a heart attack will become irrelevant (although it's fitting that bans based on imaginary deaths are saving imaginary lives). The fiction has become the reality. The model has spoken. "There were 21% fewer heart attacks after the smoking ban. Here's Tom with the weather..."

Tuesday 8 November 2011

Review time again

Patrick Hayes has written a thorough and generous review of The Art of Suppression for Spiked.
In masterfully charting the history of the prohibitionists’ war on pleasurable substances, in highlighting their endless failures to impose restrictions on the public, in exposing their dodgy use of statistics and ‘evidence bases’ to disguise moral arguments, and in emphasising the ability of us as individuals to exercise our capacity for self-restraint and personal responsibility, Snowdon does all of us determined to challenge the contemporary prohibitionist movement a great service.

Do read the whole thing.

The Art of Suppression is available from Amazon UK, or direct from me. Why not treat a loved one to a dozen copies this yuletide?

Friday 4 November 2011

Season of hate

I generally have zero interest in what random people choose to type beneath the line of news stories on the internet, but a couple of articles this week made me think that the intellectual climate is darkening at a worrying rate.

Take this item from the Winnipeg Free Press about an unfortunate woman who nearly froze to death after being locked outside a hospital.

It was a bitter winter night, -30 C, in December 2000, when a 54-year-old hospital patient slipped outside Seven Oaks Hospital in her hospital gown, pulling her intravenous pole behind her.

She wanted a smoke.

An hour later, she was found comatose in a snowbank. The woman had suffered hypothermia and frostbite to her hands and feet. Four fingers on her right hand had to be amputated. She was left with limited mobility in her left hand.

The door had locked automatically behind the patient and she couldn't find a way back in. 

It's hard not to feel sorry for a lady who had a near-death experience and suffered multiple amputations.

Or so you might think. In fact, the mental image of a woman having a cigarette alone in arctic temperatures unleashed a river of bile in the comments section.

Shouldn't be smoking in the first place. Maybe a little cold made the lady realize that smoking is not healthy for you and neither is hanging out in the cold in a hospital gown.

This is a disgusting, filthy habit, and for people who are already in the hospital for a smoking-related illness wanting to go outside and smoke some more is just sickening. It's one thing not to be concerned for your own health - that's your perogative, but don't put the other patients & children with weakened immune systems in the way of second hand smoke. There are hundreds of other places to smoke, and a hospital or the hospital grounds definetely should not be one. Take a walk down the street, across from the hospital to inhale your death stick. If you can drag yourself out of bed, with your IV pole and grown, down the elevators outside, then you can take a few extra steps to move away from the building. Yes, even if it's -40. It won't kill you. Or maybe it will.

It's a dirty blue collar habit. And as for the stereotype - it need only be confirmed by the appearance of them in mass aroud the door of a building in the winter.

Absolutely zero sympathy for anyone who defies a doctor's caution to stop smoking and gets lung cancer. In fact, they should be refused any treatment whatsoever.


And how about this light-hearted little item in The Economist, in which a journalist notices that many airports around the world manage to accommodate smokers in some small way without inconveniencing other passengers.

Yes, smoking is bad for you. But if you are a smoker, a civilised cigarette makes all the difference between being an irritable passenger itching to burst out of the terminal doors and a calm, considerate sort who makes room for his fellow travellers.

... Smokers don’t ask much. Put a designated smoking zone in the shoddiest corner of the terminal and they will trek to it, thanking the authorities with every carcinogenic breath. It would make economic sense too: Heathrow worries about losing its place as Europe’s foremost hub for international air traffic now that plans for the airport’s expansion have been shelved. But why waste money on a third runway when you can build a little smoking room and watch travellers flood in?

This is very moderate and unassuming stuff. The risks of smoking are acknowledged and all that is being asked for is "the shoddiest corner". Will the readers of this article respond with similar  bonhomie and tolerance? They will not.

Smoking is a filthy habit that should be discouraged, not encouraged. "Kissing a smoker is like licking a full ashtray". I don't want to sit next to a passenger who has been chain smoking, whose head and arm hair and clothes stink of stale smoke, whose yellowed teeth exhale nicotine air in my ambiance as s/he coughs his lungs up. Not to mention the cost to clean up smoking lounge draperies, fabric chairs, carpet. Because smoking kills the olfactories, smokers have no idea how badly they smell and they cannot taste food. Get a life, save money, and quit!

Having someone who has recently been smoking sit next to you on a flight is almost as bad as having them smoking there. The stench of cigarette smoke hangs in that persons hair, clothing and (if you are close enough) breath for a very long time. Let's keep it as far away as possible. Those demeaning goldfish-bowl smoking rooms are one of the saddest sights I've ever seen at an airport. Do these people know just how ridiculous they look?

If I am going to sit next to someone on a nine hour flight I don't want them stinking of fag ash. I don't mind if people smoke in special smoking rooms as long as they are required to shower and change into fresh clothes immediately afterwards.

Why not facilities for other drug addicts whilst one is about it? Of course the rest of us do not wish to be in the plane with smelly smokers, let alone drug-addicted pilots, so we are looking at complete segregation here....

Remember how in the very recent past, tobaccophobes insisted that they were not against people smoking per se, they just didn't want people to do it around them. Now, it seems, their sensitive noses need protecting to such an extent that the mere presence of someone who smoked several hours ago is enough to stir their righteous indignation. In the first story, we see a woman who has done everything that is demanded of her by braving sub-zero temperatures so that not a wisp of smoke goes up the delicate nostrils of fellow Canadians and yet all that can be said of her is that it is a shame she survived.

Finding anonymous half-mad obsessives spouting drivel on the internet is the easiest task in the galaxy, of course. It is always possible that a handful of loons scour the search engines for any mention of their bête noire to make sure their peculiar voices are heard. And yet, there is something in the sheer hatefulness—and quantity—of these comments that suggests that the policy of 'denormalisation' is producing fruit.

This is the inevitable result of the state-sanctioned stigmatisation that the anti-smoking movement has been working towards for twenty years. The public health establishment might distance itself from such sentiments but when even the NHS produces adverts like the one below, they must take some responsibility for lighting the blue touch paper.

Governments have a responsibility to quell tensions and defuse conflict in society. In no other area of life does government deliberately create and inflame hostility. Like so many other failed tobacco control policies, the doctrine of denormalisation is counter-productive and damaging because it is the brain-child of a small group of emotional zealots, some of whom are operating at a sub-optimal level of mental health themselves. It's time for the government to put the tobacco control freaks behind them and chart a new course before things get really nasty.

Thursday 3 November 2011

No miracle in Oregon

Jacob Grier has written an article in The Oregonian looking at the state's heart attack rate following its smoking ban of 2009. It will no come as no surprise to regular readers that the dramatic fall in heart attacks predicted by ban supporters has failed to materialise.

Two years ago, Ty Gluckman cited research from Americans for Nonsmokers' Rights founder Stanton Glantz showing that smoking bans led to a 17% fall in hospital admissions for acute myocardial infarction and concluded that "it's highly likely that Oregon's heart attack rates are already dropping as we near the law's one-year anniversary." He said:

If we reduce the number of acute heart attacks by 17 percent, there will be at least 1,100 fewer hospital admissions in Oregon in just one year. At a cost of more than $35,500 per admission, the savings will be substantial: $40 million.

"Highly likely" is right. Oregon's heart attack rate has been dropping for years. In the year before the ban, it fell by 6.67%. As Grier shows in his article, in the years since the ban, it has fallen by 7.21% and 3.11%—very much in line with the long-term trend.

Taken from

Once again, routine hospital admissions data provide no evidence of a heart miracle. This is not surprising since the 17% figure comes from a meta-analysis of  studies which are riddled with data-dredging, retrospective cherry-picking and blatant researcher bias. That the myth of the smoking ban heart miracle has travelled the world and informed policy for the best part of a decade is a scandal that would be front page news in any other field of science.

As Grier notes, the Oregon non-event adds to the weight of evidence taken from countries around the world—including three peer-reviewed studies focusing on the USA—showing no positive effect from smoking bans on the heart attack rate.

Critics have dubbed these fantastical results "heart miracles," and, like most miracles, they proved too good to be true. When larger populations are examined, the effect diminishes or disappears entirely. The most extensive study to date was recently conducted by the RAND Corp., with a data set of more than 670,000 heart attack admissions from 26 states over a period of 11 years. It concludes that "smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions" for heart attacks.

The RAND study also explains how publication bias in favor of results and the large variations in smaller samples have combined to produce the illusion that bans are effective.

Gluckman has responded in the same newspaper, acknowledging that the figures Grier presents are correct while downplaying their significance. His defence is that many venues were smoke-free before the 2009 ban and so the effect of the state-wide legislation was less pronounced that it might have been. (This is the same excuse given by Anna Gilmore and colleagues (without evidence) when they failed to replicate the 17% drop claimed in the notorious Scotland heart miracle study.) It is strange that Gluckman did not mention this limitation when he was raving about the $40 million saving the state would make when it reduced heart attacks by 17%.

Now, at the eleventh hour, Gluckman concedes that heart disease is multi-factorial. He notes that major causes such as obesity may cloud the results. Indeed they could. It was always massively implausible that one minor variable—secondhand smoke exposure in bars—could have a large enough effect to show up in aggregate data, but this is the lemon that has been sold to the public around the world. We were told unequivocally that smoking bans produced declines in the heart attack rate of 17%, 40%, 50% and higher. Hospital admissions data have consistently shown this to be a fantasy.

Smoking ban campaigners have little choice but to back-track and make excuses in the face of reality, but there are two important things to remember.

The first is that this scam has only been exposed because it relied on data that are accessible to the public. The public will never be allowed to see the raw data behind the vast majority of what passes for science in journals like Tobacco Control. Light is the best disinfectant, but the bulk of the anti-smoking movement's policy-based evidence remains hidden in dark corners.

The second is that, although the fiction of the heart miracle is now virtually impossible to maintain, studies making impossible claims were published in peer-reviewed journals, including respected organs such as the NEJM and the BMJ for several years. Several meta-analyses (including two written by Stanton Glantz) have uncritically perpetuated the myth. And yet, whenever hospital admissions data are publicly available, they strongly indicate absolutely no impact on heart attacks from smoking bans.

There are lessons here about the perils of publication bias, advocacy-led science and the limitations of ecological studies. But in the end, it comes down to one simple fact — we have been lied to.