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.


Ann W. said...

Chris, do the following statements mean the same thing?

“Of all smokers who die prematurely, half will die before age 70 and lose an average of 23 years of life. The half who die after age 70 lose an average of 8 years of life.”

“The chance of dying from smoking for long-time smokers is 1 in 2. Deaths from smoking result in 15 years loss of expected life, on average. About half the deaths from smoking happen before the smoker reaches 70 years of age. These smokers lose an average of 22 years of life. Older persons (70 and over) who die because of smoking lose an average of 8 years of life expectancy.”

Christopher Snowdon said...

Pretty much.

Angry Exile said...

Roy Castle isn't the first non-smoker to get lung cancer and he won't be the last. Is secondary smoking on his death certificate? I doubt it. Besides, I seem to recall some anecdotal evidence that he smoked cigars. Either way bringing up Roy Castle isn't the instant debate winner the antis wish it was.

Anonymous said...

I'm waiting until after all smoking has been banned everywhere and made illegal to the point of prison sentences so that nobody dares smoke - and then who will be blamed for all the lung cancer, heart disease and other illnesses that are currently blamed on smoking. In fact, if the rates go up and people begin dying younger or at the same rates, with no more smoking, then the whole charade will need rewritten and the current anti-smoking pabulum disappeared down the memory hole, erased from history, so that the generation of that time will not realize it was all just a big scam from Richard Doll to Roy Castle to the likes of ASH, CRUK, BMA, Glantz, Banzhaf, Arnott, etc. But by then the lying bastards will be rich and retired and all that immorally gained payola firmly held in their family coffers for generations of inheritance to come.

Anonymous said...

From Dave Atherton

The Roy Castle Lung Foundation headed up by Dr. Rosemary Gillespie. I wrote to her this year and she was unable to confirm that Roy Castle was an occasional cigar smoker or that which genetic malfunction, EGFR or p53 he died of.

In conclusion The Foundation cannot confirm, nor claim that Roy Castle contracted lung cancer from second hand smoke.


Ann W. said...

Chris, sorry for going on about this but hopefully you can help me understand why the two statements are as you say "Pretty much" the same.

Here's my problem. The first sentence states that “Of all smokers who die prematurely" where as the other sentence states “The chance of dying from smoking for long-time smokers is 1 in 2."

A couple of years ago, I proved to the authors of a Health Canada study that there was a discrepancy between their projected smoking-attributable deaths and the total deaths from all causes. So large was their discrepancy that we would have had to bring back the non smoking dead to balance their calculations.

The current information states just under 5 million Canadians smoke and that 37,000 of them die from smoking related illness each year.

I can understand that there would be some people who smoke that would die prematurely because of their smoking and I can understand that half of those deaths could occur before the age of 70 (first statement) but how does one qualify “long term smokers” and relate it to the total number of smokers and the 37,000 smoking-attributable deaths each year? (second statement)


Christopher Snowdon said...

The only difference between the two statements is that the first tells you how many smokers die as a result of smoking (1 in 2). So half don't die as a result, a quarter die before 70 and another quarter die after 70.

The second statement says exactly the same but without giving the percentage of smokers who die from smoking-related diseases at the start.

Does this answer your question? (I don't see a reference to 37,000 deaths)

Ann W. said...

Thanks Chris, the 37,000 number is just the current death toll stated now and had nothing to do with the two statements. I was trying to come up with an equation that I could use to see how many years it would take to kill all the smokers who die from smoking related deaths if no one else started to smoke but without now what the definition of "long term smoker", I don't think I can do that.

Anonymous said...

Ann W and Chris.

I do not know whether this matters or not, but the first statement says:
"Of all the smokers who die prematurely....... Thus, by the use of the word 'prematurely', the statement is already suffering from bias. It is impossible to know whether or not a person has died 'prematurely' since there is no specific moment when a person is destined to die. Any use of the phrase 'premature death' is a fraud. There cannot possibly be such thing other than in a loose, conversational sense. Words such as 'premature' should not figure at all in a scientific document. Such words are emotional and not intellectual.

Anonymous said...

Further, we note that in the second statement, the phrase 'die from smoking occurs four times in the space of a few lines. Again, the phrase 'from smoking' is emotional.

I would say that neither of the statements are worthy of serious consideration.

I notice that you are from Canada. Are Canadians particularly stupid? (Not you personally!)

Ann W. said...

@ Junican
"Are Canadians particularly stupid?"

When it comes to smoking related information....I have to say "YES, yes we are"

Anonymous said...

“Of all smokers who die prematurely, half will die before age 70 and lose an average of 23 years of life.

This is a propaganda stat. Consider the fact that you could also say something along the lines of "Half of all nonsmokers who die before age 77 will have died prematurely and will lose an average of 15 years of life" or somesuch. Obviously anyone who dies before the average age (therefore, half the deaths more or less) will have "lost" some portion of their life, regardless of whether they smoked or had sex with vegetables or enjoyed licking stamps.


Ann W. said...

“Of all smokers who die prematurely, half will die before age 70 and lose an average of 23 years of life.”

I have to confess that when I read that statement I thought that it meant something different than the usual 1 out 2 smokers will die from their habit.

In fact, I thought it meant that “some smokers will die prematurely from their habit and of those that do die, half will die before age 70” and that over time that statement had been perverted to today’s “ 1 out of 2 smokers will die from their habit, half before the age 70”.

But then, I don’t think like most people, which is why I have to ask these silly questions to make sure.....

Anonymous said...

Ann W, To me those quotes are both imprecise and implausible. The most credible attempt I've found, to estimate decrease in life expectancy through smoking, is on the web site of Prof David Spiegelhalter of Cambridge Universty. Smoking is put on a par with each of: poor diet, heavy drinking and lack of exercise; each knock off about three years. These estimates of ten or fifteen years are either made up nonsense or arise from ignoring the fact that smoking is correlated with the other three bahaviours. I would suggest that being an otherwise fairly healthy living smoker, as I am, is ideal; but the harm is generally exaggerated. See this link scroll down:
Here is an interesting aricle about risk:
Jonathan Bagley

Anonymous said...

Sorry, "behaviours" and "wouldn't suggest". JB

Anonymous said...

Lung Cancer a Different Disease in Smokers and Nonsmokers

PHILADELPHIA — Lung cancer that develops in smokers is not the same disease as lung cancer that develops in people who've never touched a cigarette, a new study finds.

There are nearly twice as many DNA changes in the tumors of people who have never smoked than in the tumors of people who smoke, which suggests the cancer of "never-smokers" is different from smokers' cancer, said Kelsie Thu, a Ph.D. candidate at the BC Cancer Research Center in Canada.

"We think this finding provides evidence that never-smoker and smoker lung cancers are different, and suggests they arise through different molecular pathways," Thu told MyHealthNewsDaily. "Never-smokers might be exposed to a carcinogen, not from cigarettes, that causes their tumors to have more DNA alterations and promotes lung cancer development."


Anonymous said...

" Lung cancer that develops in smokers is not the same disease as lung cancer that develops in people who've never touched a cigarette, a new study finds."

Can that be taken to mean as well that lung cancer that develops in non-smokers who have been heavily exposed to secondhand smoke over many years can be identified as being caused –– or not caused –– by the exposure to secondhand smoke?

Anonymous said...

It would mean that since what they find in a smoker isnt the same as a non smokers LC that shs didnt cause their LC.......Now go find you some LC non-smoker victims whove been in shs for over 40 years and lets see. Since the RR is so low at 40 years or more you know its not gonna be found!

Anonymous said...

Below is a link to another aspect of smoking and life expectancy. Smokers can get bigger pension annuities. And the size perfectly reflects mortality statistics. This is big business, not public health lies and bull shit.


The 3% escalation table is probably a better guide to life expectancy. For a 55 year old man, the enhancement is 15%, which means he is expected to live only100/115=0.86 as long. Assuming a future life expectancy of 25 years, we are talking about a loss of a little under 4 years.

Antipholus Papps said...

Roy Castle spent his life sucking on brass pipes and polishing tap-shoes.