Anna Gilmore returns

Anna Gilmore's new study doesn't seemed to have generated much media attention, perhaps because any editor looking at the headline of the press release is likely to think "well, duh":

Smoke free legislation linked to drop in second-hand smoke exposure among adults

Levels of second-hand smoke exposure among non-smoking adults fell by almost 30 per cent after smoke free legislation was introduced in England in 2007, researchers in the Department for Health have found.

...Professor Anna Gilmore, who directed the study, said: “The importance of this study is that it examines the impacts of smoke free policies on adults’ exposure using a specific biological-marker of smoke exposure (rather than self-reported exposure) while simultaneously controlling for underlying declines in exposure.

“To our knowledge it is the first study to do this. The fact it shows marked declines in adult exposure provides further evidence of the important public health benefits of smoke-free policies.”

What, if any, are these "public health benefits"? The study looked at cotinine readings in nonsmokers before and after the English smoking ban and found that they fell by 27%. Cotinine itself is perfectly harmless, but it is a bio-marker for nicotine which is, in turn, is a proxy for "secondhand smoke exposure". Nothing wrong with that, nor is there anything surprising about cotinine readings falling as a result of a total smoking ban in 'public' places.*

The graph below (which comes from the study) shows saliva cotinine levels in nonsmokers before and after the ban (click, as ever, to enlarge).

'SFL' indicates the start of the 'SmokeFree Legislation'. What is most striking about this graph is how much cotinine and, it must be assumed, secondhand smoke exposure declined before the smoking ban. After the ban, cotinine levels did not change for people living in smoking households and Gilmore found that people in social classes IV and V experienced no reduction in secondhand smoke exposure at all (inevitably, this leads to her calling for "further efforts to reduce SHS exposure to benefit those who remain most exposed.")

Only nonsmokers from social classes I to III who live in nonsmoking households saw a decline in their saliva cotinine levels. Gilmore claims that this decline was greater than would be expected from the long-term trend, although none of her graphs appear to support this.

Gilmore's track record gives us no particular reason to trust her assertion that the smoking ban accelerated the existing trend towards less secondhand smoke exposure. However, it is obviously very plausible that a smoking ban would have this effect so, for the sake of argument, let us agree that there was a 27% drop in saliva cotinine readings as a result of the ban.

Her data show that before the ban (1998 to 2007), average cotinine levels in nonsmokers' saliva fell from 0.36 ng/ml to 0.14 ng/ml. After the ban, this declined continued and, by the end of 2008, cotinine levels were at 0.071 ng/ml.

The question is: so what? Is this decline—which sounds impressive when described as a 30% fall in secondhand smoke exposure—of any practical significance? How do these levels compare with actually smoking?

A systematic review of cotinine readings found that the average smoker has a saliva cotinine reading of 318 ng/ml. This is more than 2,250 times greater than levels found in nonsmokers before the ban.

This difference is so vast that it is difficult to show it visually. The graph below shows cotinine levels of nonsmokers in 1998, 2007 (pre-ban) and 2008 (post-ban) compared with a typical cotinine reading from a smoker. If you click to enlarge, you may just be able to see the nonsmokers' data.

While smokers have average cotinine readings of 318 ng/ml, the smoking ban reduced the average nonsmokers' levels by 0.0019 ng/ml. This is beyond negligible. Whether before or after the ban, we are talking about truly homeopathic levels of exposure. It takes a leap of faith to believe that reducing 'exposure' levels from 0.03% of a smoker's level to 0.02% of a smoker's level really constitutes "the most significant and beneficial public health intervention for a generation". Far from showing us how effective the smokefree legislation has been in tackling the passive smoking peril, this study reminds us how overhyped the peril was in the first place.



* However, it is wrong of the press release to describe a 27% fall in nonsmokers' cotinine levels as meaning that "second-hand smoke exposure among non-smoking adults fell by almost 30 per cent". This suggests that if all secondhand smoke was eliminated, cotinine levels would fall to zero. This would never happen because nicotine, and therefore cotinine, exists at low levels in various nightshade vegetables.

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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..."

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Anti-tobacco and anti-alcohol swap notes again

The day might come when I get tired of reminding drinkers of how foolish they were to doubt the slippery slope, but that day is not today, so let's have look at the next ASH (Wales)/Alcohol Concen conference, shall we?

That seems fairly unambiguous and it's a nice sequel to the recent 'alcohol and tobacco summit' in Scotland. Being an ASH event, it is of course sponsored by the pharmaceutical companies Novartis and Pfizer, and some of the country's top anti-smoking fantasists will be sharing their tips with the temperance lobby, including Gerard Hastings, a man who thinks the Ferrari logo looks like a Marlboro packet.

Temperance campaigners will be particularly excited to hear that Linda "the smoking ban didn't hurt pubs" Bauld and Anna "but it did reduce the number of heart attacks" Gilmore will be attending. Alcohol Concern are not slouches when it comes to bending the truth themselves, but these two have the know-how to go nuclear with the junk science. Let's remind ourselves of some of their greatest hits.

According to Linda Bauld, the smoking ban had "no clear adverse impact on the hospitality industry". And here, using pub closure figures from the British Beer and Pub Association, we can see what "no clear adverse impact" looks like:

And in her study of heart attacks in England, Anna Gilmore said: "We conclude that the implementation of smoke-free public places is associated with significant reductions in hospital admissions for myocardial infarction." Hmm, quite. And here's that significant reduction in full (the figures come from her own study):

Considering that the world and his wife has swallowed the idea that the smoking ban didn't damage the pub trade but did reduce the heart attack rate, you can see why any lobbyist would want to kneel at the feet of these two conjurors. Well done Alcohol Concern, you wanted the best. You got the best.

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Bashing Diageo

From the Beeb:

Drinks company Diageo is to pay for 10,000 midwives in England and Wales to be trained to offer advice on the dangers of alcohol during pregnancy.

The Department of Health hopes the training initiative will in turn help more than one million expectant mothers over three years.

This sounds like pretty good news. I imagine that nearly all women are aware they should drink little or nothing during pregnancy already—indeed, only 4% do not reduce their drinking when they get pregnant—but no doubt there is more that could be done. So this sounds like a sensible scheme to prevent damage to unborn children, based on solid evidence that heavy drinking can cause Foetal Alcohol Syndrome.

The National Organisation for Foetal Alcohol Syndrome is very happy about it...

Susan Fleisher, from the charity, said the scheme would have have huge benefits.

"The thing that's so fantastic is that they're helping us with prevention, we can actually prevent children being born with foetal alcohol brain damage," she said.

"But it costs money, and thanks to Diageo we expect we will be educating in the next three years 10,000 midwives. Ultimately, if it all goes well, they will reach at least a million women."

Hurrah! Everyone's a winner and no need for bans, taxes or coercion. What kind of misery-guts could possibly find reason for gripe about this?

Vivienne Nathanson from British Medical Association said there were concerns over the scheme.

"They certainly have a conflict of interest because it's in the interest of the drinks industry for people to continue to drink and it's in the interest of health for people to drink much less, and certainly not to drink during pregnancy or to drink really minimally."

Only someone whose income has always comes from the state could interpret the role of business in such a simple-minded and misanthropic manner. As far as Nathanson is concerned, if it wasn't for the angels of government, the drinks industry would be telling pregnant women that drinking makes babies big and strong while selling whisky doped with heroin outside schools.

Because businesses only cares about profit, don'cha know? It's not as if they're run by men of flesh and blood who want the world to be a better place like the rest of us do. No, they want babies to be born retarded and adults to die of liver disease. And if this kills their customers and ruins their company's reputation, then so be it, because not only are business-owners fiendishly clever, they are—by a strange paradox—also incredibly stupid.

At least, that's how it is if your understanding of business started and ended when you read a book by Naomi Klein, as seems to be the case with most 'public health professionals'.

There is an element of sour grapes here because, as I mentioned in March, a bunch of fake charities and temperance groups—including the BMA—spat their dummy out and "walked away from the table" in protest at the government including industry in these discussions. And a good thing too. The policy announced today is the kind of reasonable, effective and efficient use of money they would have dismissed out of hand.

Over at The Guardian—where naysayers dominate the news story—none other than Anna Gilmore, professor of no fixed ability, tries to join in the industry-bashing...

But Prof Anna Gilmore, a public health expert from Bath University, said there was a fundamental conflict of interest in the "responsibility deal". She said: "These large corporations, whether they sell tobacco, food or alcohol, are legally obliged to maximise shareholder returns. They therefore have to oppose any policies that could reduce sales and profitability – in other words, the most effective policies."

Sorry? Corporations are "legally obliged" to maximise shareholder returns? I know Labour made a lot of laws when they were in power but I hadn't heard of this one. Have there been many prosecutions? Do business get raided by police if they launch a duff product? Are there advertising executives languishing in jail for making poor use of the marketing budget?

Or is this just more proof of Anna Gilmore's estrangement from reality? It's almost as if she's being sponsored to go around getting things wrong on as many different subjects as she can. No wonder Uncle Stan looks so proud.

UPDATE: Leggy has more on this, including a gem of a quote from that massive hypocrite Don Shenker.

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You can't rip people off, that's our job!

Blackadder: How would you like to earn some money?

Comte de Frou-Frou: I would not like to earn it. I would like other people to earn it and give it to me. Just like in France in the good old days!

On a few occasions over the last decade, Action on Smoking Health have got upset about (alleged) price-fixing between tobacco companies. It happened in 2003:

"We ... hope that the OFT carry out a thorough probe and are not fobbed off by industry spin," said Amanda Sandford, of anti-smoking group Action on Smoking and Health. If the consumer is being ripped off then this should be exposed."

And again in 2008:

“The hypocrisy of the industry knows no bounds,” said Deborah Arnott, the director of Action on Smoking and Health. “While complaining bitterly about tax increases, these companies have been raising the price of cigarettes to fill their own coffers while hiding behind the screen of tax rises.”

Coming from people who call for higher cigarette prices at every opportunity—and who barely conceal their contempt for the consumer—this righteous anger might seem baffling. If raising the price of cigarettes reduces smoking, what does it matter whether it is the government or the industry that does it?

But that is to disregard two of the key components of the modern anti-smoking movement: fanatical hatred of the tobacco industry and an unquenchable thirst for money.

Readers will be no doubt be thrilled to hear that Prof. Anna Gilmore, the world's greatest scientific mind and a woman of unimpeachable integrity, has now started dabbling in economics. In an article published the impeccably peer-reviewed Tobacco Control magazine, Gilmore uses the concepts of market failure and barriers to entry as an excuse to curtail tobacco industry profits. The only problem is that she doesn't understand what market failure is and the barriers to entry are entirely the result of tobacco control's own policies (ie. banning advertising).

Like ASH, Gilmore wants higher cigarette prices, but not unless the state (and state-funded researchers in the anti-tobacco industry) get to keep the spoils. Here's a sample paragraph...

This situation benefits the tobacco industry while disadvantaging the consumer, and reducing potential benefits to population health and the public purse. The extreme profitability of cigarettes gives tobacco companies both the incentive and the resources to fight public health measures designed to reduce tobacco consumption, and an enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market. The pricing power of these companies also creates significant economic rents for the tobacco companies which ought to be captured by the state and used for wider social benefits.

Where to begin with such guff? We could start by asking when tobacco control suddenly started worrying about smokers being "disadvantaged" by higher cigarette prices or anything else? We could ask exactly which "public health measure" has been successfully fought by the tobacco industry in recent years? And does not the industry have a right to defend itself, and its customers, against Gilmore and her ilk in any case? Who really has an "enormous interest in opposing anything that could disrupt the current cigarette-dominated nicotine market"? Was it the industry that banned snus in the EU? Is it the industry that is banning the e-cigarette around the world? Or is it the puritan wing of tobacco control aided and abetted by the pharmaceutical industry? And in what kind of society do profits from a legal industry get "captured by the state" for no reason other than that its opponents resent its wealth and wish to have it for themselves?

Carl V. Philips has written an excellent post about Gilmore's latest train-wreck of a study over at ep-ology ('Anna Gilmore adds junk economics to her junk epidemiology portfolio') so there's no need for me to say any more. Here's a sample...

So this is their “radical” idea? Putting a new label on basically what is already being done, perhaps with a bit of nationalization of the companies, and making the absurd claim that this has something to do with the economic theory of market failures?

The most charitable interpretation is that this is just an attempt to use junk science as an excuse for a preferred policy, to transfer corporate profits to the government (something that can be done any number of ways that would work better if that is what government decides to do).

Well, I suppose given Gilmore’s demonstrated abuse of epidemiology there was no reason to expect anything else.

Incidentally, Gilmore's is the second article to be published recently in Tobacco Control which discusses ways of forcing the tobacco industry to hand its money over to public health 'professionals'. The other wants a 'polluter pays' principle and is discussed on the seldom updated TC blog (check out the swivel-eyed contribution from James Repace in the comments)

Is the anti-smoking lobby getting worried about where the next billion dollars is coming from? In these difficult economic times, it's always possible that someone in government might find better things to spend money on than a clique of unaccountable zealots whose policies don't deliver what they promise and whose research methods fall somewhere between charlatan and comedian.

One alternative way of raising money never seems to occur to them, but I will throw it out there. As downwiththatsortofthing notes, support for anti-smoking policies is always 80%. So why not ask all those hundreds of millions of people who support the movement to chip in a few dollars each? Y'know, like legitimate grass-roots organisations and charities do. No? It wouldn't work, you say?

Coercion and extortion and it is then.

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