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.

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Minimum pricing - still illegal

Scotland's dreadful health secretary Nicola Sturgeon has been banging the drum for minimum alcohol pricing policy at a SNP conference. As with plain packaging in Australia, the opportunity of attracting some media attention from an otherwise indiffernt world is the pathetic carrot being dangled.

The 1,300 gathering heard Ms Sturgeon say: "Delegates, I can tell you today that our minimum pricing bill will be reintroduced to parliament within the next month.

"When that bill is passed, Scotland will become the first country to introduce a minimum price per unit of alcohol. The world is watching us."

Not so much "when" as "if", since minimum pricing is almost certainly illegal under EU law. Rather than wasting time and money on this doomed policy, the Sturgeon General should listen to expert opinion, like this report from Rand Europe.

Minimum prices for alcoholic beverages, also sometimes called Social Reference Prices, are used in different ways in a number of areas outside the EU, including several Canadian provinces (Saskatchewan, Ontario, Newfoundland, New Brunswick, etc) where the regulation applies to licensed on-trade premises (Strang 2008).

But while a recent Scottish expert consultation concluded that minimum pricing is possible under EU competition law, ‘provided that minimum prices are imposed on licensees by law or at the sole instigation of a public authority’ (SHAAP 2007), minimum pricing practices have tended to be seen as trade-distorting by the European courts (as setting an artificial price floor amounts to resale price maintenance, limiting and distorting price competition), and therefore not typically put in place in the EU (Baumberg and Anderson 2008).

Minimum prices had also been considered, and even introduced through legislation in a few Member States such as Austria and Ireland, for cigarettes as a public health measure, but these moves were contested by the European Commission. This was in line with the jurisprudence of the European Court of Justice, which considers that minimum prices infringe Community law, distort competition and benefit manufacturers by safeguarding their profit margins.

Council Directive 95/59/EC states that manufacturers and importers of tobacco products have the right to determine the retail selling price of their products; according to ECJ jurisprudence minimum prices impair this right and are therefore not compatible with this Directive. The ECJ also stated that minimum prices are not necessary since their health objectives can be achieved through increases in taxation.

This report was commission by the European Commission and the sources given in this particular section include "personal communication from European Commission Directorate General Competition official."

When is Sturgeon going to take the hint?

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Who do you believe?

Further to Monday's post about the childhood asthma rate in Scotland, it is worth comparing the data presented by Jill Pell in her NEJM paper—which claimed there were 18% fewer hospital admissions after the smoking ban—with the actual hospital admissions data recorded by the Scottish NHS.

This is the "smoothed" graph presented by Pell in her study, which as noted in a previous post, does not even fit her own data. (The last 'year' shown is also not a full year.)

Pell's study produced the intended flood of media coverage, of which this Reuters report was typical.

Scottish smoking ban cuts childhood asthma attacks

A 2006 public smoking ban in Scotland reduced the number of serious childhood asthma attacks by 18 percent per year, researchers reported on Wednesday.

Before the ban imposed in March 2006, the number of hospital admissions for asthma was rising by 5 percent a year among children under 15. The after-ban benefits were seen in both pre-school and school-age children.

Critics had said the ban could force smokers who could not light up in the workplace or in enclosed public spaces to smoke more at home, increasing the risk to children.

Dr. Jill Pell of the University of Glasgow, who worked on the new study, said the findings in the New England Journal of Medicine show that did not happen.

"The evidence we have from Scotland is that it had the opposite effect. People are generally more accepting of the need to protect nonsmokers and vulnerable groups such as children," Pell said in a telephone interview.

"Children were being exposed to less secondhand smoke. We went into the study hoping we would see some health benefit coming out of that."

However...

NHS Scotland has since published the statistics showing how many children were admitted to hospital with asthma between 2005 and 2009. These figures can be viewed here. They do not support Pell's hypothesis in any way, shape or form.

The graph below shows the rate of hospital admissions for asthma for children aged 0-14 years in all Scottish hospitals (per 100,000). The years shown are financial years (April to March - the first year shown is 2005/06), which is useful since the smoking ban was introduced in Scotland at the end of March 2006. Each of the last four bars therefore represent a full post-ban year.

The next graph shows the total number of episodes of the same (ie. the absolute number of admissions). It naturally shows a very similar picture.

Although not discussed by Pell, it is interesting to note that the rate of asthma admissions amongst people of all ages has been higher in every year since the smoking ban was introduced.

And, for good measure, let's have a look at hospital admissions for all diseases of the respiratory system combined.

The data available online do not go back further than 2005/06 so we cannot see the long-term trend earlier in the decade. However, it is sufficient to see that there was no decline in hospital admissions for any of these diseases amongst any age group. If anything, there was an increase.

So, once again, you have a choice. You can choose to believe Jill Pell, a researcher who has, shall we say, "form" when it comes to producing studies like this.

Or you can believe the statistics produced by NHS Scotland which are based on the number of people who actually got admitted to hospital. These statistics, incidentally, support the claim made by Asthma UK that the rate of childhood asthma has remained essentially static for a decade.

It's your call.

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Somebody's lying

They say you're entitled to your own opinions, but not your own facts.

Wise words, but that's not how it works in tobacco control. Spot the difference between these two BBC news stories taken three months apart.

25 March 2011

Scotland's smoking ban hailed as anniversary approaches

Sally Haw, senior scientific adviser for the Scottish Collaboration for Public Health and Policy, said: "The ban really has been one of Scotland's big public health success stories.

"This bold step has really paid off."

Ms Haw cited a study by Glasgow University which showed a 15% reduction in the number of children with asthma being admitted to hospital in the three years after the ban came into force.

27 June 2011

Scottish health boards 'complacent' over asthma care

Research into the care of young people with asthma has exposed "shocking" complacency by some Scottish health boards, according to charity Asthma UK.

Asthma UK said the number of emergency admissions had remained unchanged for a decade - suggesting the asthma of many young people was still being badly managed.

Asthma UK Scotland's national director Gordon Brown said: "This report makes shocking reading - especially when you consider Scotland has one of the highest rates of childhood asthma in the world.

"Some health boards are doing some things very well - and this is down to the excellent staff within managed clinical networks.

"However, it seems that at a strategic level some complacency has crept in - that asthma has somehow been 'fixed' and priorities have now changed.

"This is borne out by the fact there has been no noticeable change in the unacceptably high emergency hospital admissions for children and young people with asthma in the last decade."

It is impossible for both these statements to be true. Either emergency hospital admissions for children with asthma fell by 15% after the smoking ban or they have remained unchanged for a decade. Someone's not telling the truth. Is is the "study by Glasgow University" or Asthma UK?

You can probably guess the answer. If I told you that the Glasgow study was penned by the infamous Jill Pell, you would be in no doubt at all.

Readers with a long memory will recall that Pell's study was the sheerest junk science. There was no effect from the smoking ban on asthma admissions. In fact, the first year of the Scottish smoking ban saw the largest number of childhood asthma admissions of the decade. Asthma UK is correct. Pell is wrong. Again.

Here we have two 'facts' which are totally at odds with each other appearing on the same news website in the same year. One fact is the number of children who actually went to hospital with asthma. The other is a piece of statistical jiggery-pokery created for political ends. And yet only one of them is true. The other is a fraud which has taken the place of the truth thanks to repetition and the appeal to authority (it was published in the prestigious, peer-reviewed New England Journal of Medicine). The real truth, meanwhile, appears almost by accident in a different context and no one at the BBC makes the connection.

This is the parallel universe created by the charlatans of the anti-smoking industry. They are entitled to their own facts. Whether or not they are true is of no consequence. They want them to be true and that is all that matters.

It is ridiculously easy to see through this garbage. The real hospital admissions data for asthma are available online, just as the heart attack data are. It takes a matter of minutes to distinguish fact from fiction and yet there is only silence and tumbleweed. If the mainstream media do not feel inclined to expose blatant policy-based evidence when it is in its crudest form, what hope is there of more subtle scientific abuses coming to light?

[Thanks to Ivan for spotting the two stories above.]

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Scotland prepares for failure

Tomorrow sees the start of new temperance laws in Scotland which will ban two-for-one offers and group discounts. The putative 'health' lobby has been blaming such offers for 'binge-drinking' for years. At midnight tonight, they will have a sudden change of heart and declare that these cheap deals were never the real problem and that much tougher action is needed to stem the mythical alcohol epidemic.

This is how it works. You might recall that selling alcohol below cost price was the Great Evil until the British government announced plans to stamp out the practice. At that point, the temperance lobby admitted that below cost sales were incredibly rare and demanded tougher action.

Prof Ian Gilmore, of the Royal College of Physicians, said in practice it was a "small step" with "no effect at all on the health of this nation". "If you go round the supermarket shops today, even where they're heavily discounted, they will not fall below this level."

Today, an editorial in The Scotsman accepts that Scotland's new laws will probably have no effect and opens the door to the inevitable tougher action.

It was a sound idea in theory, stopping an obvious economic incentive to over-indulge, but like so many ideas it appears it will not work in practice. As we report today, the supermarkets have already found a way around it by the devastatingly simple device of reducing the price of a bottle of wine, or packs of beer.

Public health professionals outwitted by the devastatingly simple? Say it ain't so!

Alas, it is so, and the BBC has noticed that Scotland borders a country that is marginally less of a nanny state.

Online deals are being used to get round new laws banning discounted promotions on alcohol in Scotland.

The legislation, which comes into force on Saturday, will stop deals such as two-for-the price-of one and group discounts on wine.

Tesco has emailed customers to say they can still get wine discounts because cases will be dispatched from a depot in England.

Damn you, open borders! Curse you, worldwide web! A plague of your house, free trade!

Those of you who have been dipping into my new book The Art of Suppression (reviewed by Dick Puddlecote here) might recognise the old 'cross border sales' problem from America's attempts to introduce statewide prohibition. In came the rum-runners and the mail order delivery companies.

Since it was not illegal for drinkers in dry regions to order alcohol by mail order from wet regions, local prohibition was primarily a problem for the poor who depended on the saloon. For the middle class, as Towne recalled, “it was mighty easy to give a dinner party with plenty of liquid refreshment. All one had to do, it seemed, was to lift the telephone receiver in Bangor, and ask that Boston send over a supply of whatever one desired.”

American politicians, under heavy pressure from the dry forces, responded to this 'loophole' by banning cross-border sales with the Webb-Kenyon Act in 1913. That Act ultimately pathed the way for national Prohibition seven years later. The Scots cannot do the same since it would certainly be viewed as a restraint of trade by the European Union.

And speaking of things the European Union won't allow...

The SNP will, of course, argue that the way to deal with this is for their flagship policy of a minimum price per unit of alcohol to be re-introduced, as it has promised to do in this session of Holyrood. In this the Nationalists are, again, right in theory - a minimum price, if set high enough, would probably reduce alcohol consumption.

"If set high enough" is the key phrase. The proposed 40p or 50p limit would make everyone a little poorer but it is very unlikely to lower overall consumption. The rich (doctors, politicians etc.) would not be affected at all and chronic alcoholics will never be put off by higher prices. Possibly a few moderate consumers might reduce their intake somewhat, but that would be a pyrrhic victory.

But there are two problems. The first, is the extra money goes to the retailers, mainly the big supermarkets...

When businessmen and politicians collude to screw the citizen, we should expect nothing less. But whilst it would be annoying to see supermarkets (or anyone) profit from an illiberal law, who makes the money is not the problem per se. The problem is that minimum pricing is a highly regressive policy that takes money from the poorest people in society.

Besides which, it won't work.

...and the second is that it is unlikely to stop those who crave alcohol from purchasing it.

Indeed. This is not a trifling flaw in a scheme that seeks to reduce alcohol-related harm. Why are we even talking about a policy that can't be introduced under EU law and, even it is could, won't bloody work?

The answer, I suppose, is that failure is the lifeblood of the neo-prohibitionists. They have to introduce laws that won't work. They'd be out of a job if the perceived crisis disappeared. Their motto is: "That didn't work, let's do it again." Same number of people smoking after the smoking ban as before it? Let's extend the ban. Graphic warnings had no effect? Try plain packaging. Higher prices lead to more smuggling? Make 'em even higher. Banning below-cost selling made no difference? Let's ban two-for-one deals. Banning discounts failed? Introduce minimum pricing.

This pattern is so familiar that The Scotsman can predict the response to the discount ban's failure before the law has even come into effect.

If these two measures, one coming into effect tomorrow, the other to be legisated for soon, do not succeed, the SNP might further its case for Scotland having powers over taxes levied on alcohol as a more logical, and fairer solution since the money raised would go to government

And so it continues.

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Strange, strange bedfellows

Via Dick Puddlecote, who got it via Freedom2Choose Scotland, I am left reeling in disbelief at the venality and rank stupidity of the Scottish Licensed Trade Association who have called for huge increases in the price of alcohol.

Supermarkets would be forced to charge a minimum of £10 for a bottle of wine under plans outlined by Scotland's pub bosses yesterday.

The Scottish Licensed Trade Association (SLTA) has urged ministers to dramatically hike alcohol in a bid to save bars from closure.

Its proposed £1 a unit 'minimum price' would send bills soaring for families. A can of standard lager would cost at least £1.76 and a bottle of whisky would rise to £28.

Now, I don't live in Scotland and, as things stand, it looks like I never will, but does the SLTA really believe that the way to draw drinkers into their boozers is to shaft them with extortionate drinks prices at the off-license? This bone-headed proposal has to be the most transparent attempt to co-opt temperance rhetoric for commercial profit since Coca-Cola came out in favour of Prohibition.

It's always been obvious that once a minimum price was set, it would rise ever upwards until alcohol was unaffordable to most people. Earlier in the year, I commented that:

With the principle now in place that the state has the right to decide how much a product should cost, there will now be a continuous campaign to create a minimum price per unit. Once that it done, every scare story about 'Booze Britain'—whether true or not—will be accompanied with a squeal from fake charities to increase that minimum price. Forever.

What I didn't expect was for the demands for a higher minimum price to arrive before the legislation has even been put before parliament, let alone that it would come from the a faction of the drinks industry.

Here we have yet another interest group that thinks it can save its own skin by throwing its customers under the prohibitionist steam-roller. It really is pathetic the way the pub industry is trying to portray their grog-shops as some sort health club these days. According to the SLTA...

"the only safe environment for the consumption of alcohol is within our licensed premises." 

Nothing cynical or self-serving about any of that, is there? And, actually, I take issue with the idea that it is safer to drink in a crowded room full of drunk strangers than it is to drink at home in front of the telly.

And you can save all this social responsibility clap-trap while you're about it. This is a scene repeated in every pub I go to...

"Vodka and tonic, please."

"Double?"

"Yeah, go on then."

I'm not complaining about this. You hardly need to twist my arm to get me to order a double and some of those drunk strangers are lovely people, but pubs are not community centres and they are not there to promote healthy living. Anyone who tries to portray them as such is heading for a fall when the temperance nuts point out the disparity between the myth and the reality. You're the pub industry, for God's sake. You sell a known "carcinogen" and "poison" as far as these people are concerned. Do you really think you can be friends with them?

And how about this sanctimonious twaddle from the SLTA website?

The cost of alcohol abuse to Scotland is simply unsustainable in economic and social terms and the newly appointed first Minister has already pledged to re-introduce legislation to bring in minimum pricing, as a priority...

Reports from Childline and other leading children’s charities have long highlighted the cost to our families when alcohol is widely abused in Scottish homes and the new parliament offers the chance to effect serious changes, and everyone involved has been invited to contact their MSP’s to demand this change. 

Look at the compassion! Can you see their furrows of worry? Won't somebody please think of the children? I can just picture these guys holding hands with Don Shenker as they frolic in a meadow. But wait, what's this? Don Shenker has turned around, stabbed them in the back and is running off laughing maniacally. Who could have seen that coming?

The SLTA even has a special website where they lobby to get their competition closed down display their deep concern about alcohol abuse. It's called Level the Playing Field. Does that phrase ring any bells? It should, because it's exactly the same phrase used when the anti-smoking lobby demanded that there could be no exemptions to the smoking ban. It is also the rallying cry of every self-interested protectionist lobby group in history.

As I have said before, there is no way of levelling the playing field between the off-trade and the on-trade because they provide two completely different services. The off-trade sells alcohol. The on-trade sells an experience and an environment. The public understands that the two are different which is why we have traditionally been happy to pay significantly more for a drink in a pub than for a can of lager in a shop.

Since 2006, however, the experience of being in a pub has become much less pleasant for a large minority—and frequently a majority—of Scottish pub-goers. It has, indeed, become so unpleasant and pointless to be in a place where a drink can't be combined with a smoke that many of these people have chosen to experience it much less often, if at all.

In fairness to the SLTA, they have never denied the devastating effect of the smoking ban. They opposed it at the time and they continue to call for it to be amended.

The Scottish Licensed Trade Association said the law change had resulted in the closure of hundreds of pubs and the loss of thousands of jobs.

Its chief executive, Paul Waterson, said the predicted upturn in new customers attracted by smoke-free pubs had "simply not materialised".

It goes without saying that the SLTA aren't saying this because they're keen defenders of civil liberties or property right. As with all industry lobbyists, they're worried about their bottom line and the smoking ban has—contrary to the routine lies of the tobacco control freaks—been very bad for business.

But even if we accept that opportunism goes with the territory for corporate lobbyists, the SLTA's attempts to punished drinkers—ie. their own customers—for exercising free choice is particularly loathsome. Do they really think we're going to reward them for treating us like this?

You cannot bully people into going where they don't want to go. Even if the price of a supermarket pint was the same as a pint from the pub, many people would still rather drink at home with a cigarette than go out and drink in the street—which, for them, is what the 'pub experience' now consists of.

As Belinda says, the prospects of minimum pricing working while Scotland shares a border with England are nil. Although the thought of rum-runners and bootleggers hurtling up the A1 is an amusing one, the sad truth is that the Scots will then appeal to the 'level playing field' and demand that the rest of the UK follows suit. Which, knowing the greed and cowardice of the political class, is exactly what will happen.

Is there any aspect of the pub debate that is not a cess-pool of cant and hypocrisy? If I see one more politician who voted for the smoking ban crying crocodile tears about the state of the pub industry, I may throw up. CAMRA are no better, climbing into bed with both the anti-smoking brigade and the temperance lobby in their crusade against any pleasure that doesn't appeal to overweight, middle-aged Jethro Tull fans. Alcohol Concern are, it goes without saying, paid shills and neo-prohibitionists whose world would fall apart if they told the truth for one day. The pub industry, almost to a man, switched sides on the smoking ban as soon as they realised that exemptions for private members' clubs would adversely affect their business. And the SLTA, one of the few groups to have taken a consistent stand against the ban, now wants to torment their customers until they take their rightful place standing outside empty pubs in the rain.

A plague on all their houses. It's got to the stage where I'm now officially on the side of Tesco's. How the hell did that happen?

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Very old rope

Various newspapers, including the The Scotsman, have been reporting this:

A doctor's letter written more than 400 years ago has revealed the medical profession were even then concerned about the risks of smoking to young people. The letter, by Dr Eleazar Duncon, was unearthed by librarians at the Royal College of Physicians of Edinburgh (RCPE) as they prepared for an exhibition.

Professor Sir Neil Douglas, the president of the RCPE, said it gave a "fascinating insight into historical concerns" about smoking and young people.

The amount of attention this little story has been receiving is rather puzzling. As readers of Velvet Glove, Iron Fist will know, various people warned about the health effects of tobacco, almost from the moment it arrived on European shores. 

More puzzling, though, is the suggestion that this particular example has only just been "unearthed". The letter has been on the National Library of Australia's database since 1999, and has long since been known by various academic institutions. 

One could argue that the RCPE has only just become aware of it, but that defence is undermined by the fact that the letter has been on the RCPE website for at least a year. I know, because that's where I first saw it. If you need proof that it's been there a while, see Michael Siegel's blog, where a reader mentioned it in this comment last December. 

In light of this, the idea of Scottish librarians happening upon this "fascinating" letter by chance whilst rifling through dusty old files lacks all credibility. Quite obviously, this was a well-prepared PR exercise directed at newspapers with column inches to fill. And it's been a successful one. The Sunday Express reported it with the headline 'Doctors wanted smoking ban in 1600s', which is not what the letter says at all.

So why has this fairly inconsequential snippet of history suddenly appeared now? The Scotsman provides the answer:

Its existence emerged just days before MSPs at Holyrood consider the principles behind a Scottish government plan to curb the sale of cigarettes and tobacco to youngsters. The matter is due for discussion on Thursday.

Truly, no stone goes unturned in the publicity drive for this campaign.

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