Minimum pricing: what to expect

The ChaMPs Public Health Network—founded in 2003, entirely state-funded and involved in the dodgy minimumpricing.info website—is one of several arms of government working to impose minimum pricing on the public.

You will be hearing a lot of cant and nonsense about this scheme in the next few months as the Department of Health/British Medical Association PR machine turns up the throttle. The tone of the discussion can be gauged from a meeting hosted by ChaMPs in 2010 when the usual lies were presented as facts. For example, they said that the price of alcohol has fallen in real terms since 1980. In fact, alcohol has risen by 20% in real terms. Either they don't know what 'real terms' means, or they are willfully misleading the public.

No, it's not.

The interesting thing about this meeting is that the attendees were quite aware of all the drawbacks of minimum pricing. They worried that the policy...

Could stimulate adverse publicity. Alcohol is still socially acceptable.

Yes, "still". But not if they get their way, because the anti-smoking blueprint of denormalisation remains their template...

Help culture change and cover the whole population (like the tobacco agenda)

Need to find ways of making alcohol less socially acceptable and seen as a public problem. (Lessons learned from Smoke Free).

It's interesting to note that, in contrast to absurd claims that minimum pricing will "save nearly 10,000 lives a year", this meeting found that...

Evidence of a positive impact would be hard to find as alcohol has such a long term impact on health.

Several of the criticisms of minimum pricing made on this blog and elsewhere over the last two years also feature...

Would there be a risk that harmful drinkers move on to replacement risky behaviours? They many neglect buying healthy food in preference to alcohol for example. Could increase the gap in health inequalities

Is there risk it will encourage more people to experiment with home brewing?

Legislation in itself will not impact on attitudes of high level drinkers and doesn’t tackle the reasons why people drink.

They were also worried that their cost estimates, though vastly inflated, did not appear big enough.

Cost benefits quoted don’t sound very impressive (12.9 billion over 10 years saved against 20 billion per year cost). 

Their answer to this problem acts as a golden rule for the whole campaign.

We need to be careful which statistics and messages we are using if we are to convince and not undermine.

And I'm sure you will.

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Goodbye, you lizard scum

I have a post about the 'toxic sugar' canard over at the Adam Smith Institute. Before you go any further, please click over there and have a read.

I would like to leave it there, but there really is so much more to say. Seriously, has the whole world gone insane? I can understand why the media would pick up on a story like this and I can almost understand why a popular science magazine like Nature would publish the wacky article in the first place. It sells. What I don't get is why a bunch of nodding-dog journalists would respond with half-witted opinion pieces such as 'Evil is among us. And it’s called sugar'.

It's not that I didn't see it coming. I've been saying for years that the anti-tobacco blueprint would be rolled out to alcohol, food and fizzy drinks. It's just that I didn't think it would happen this quickly and when it did happen, I expected gales of laughter and an anti-nanny state backlash. This is manifestly not happening. That is a problem, but it isn't the biggest problem. The truly terrifying thing is that the intellectual climate is so retarded that Nature can publish such an article without feeling any shame.

Look at the people in the video below. Look at their self-satisfied little faces. These are the authors of the toxic sugar article. They are idiots. I do not say that to be insulting, but as a statement of fact. The woman on the right, in particular, should not be trusted with a pair of scissors. She calls herself a "medical sociologist" and works at UCSF. This should disqualify her from going anywhere near a scientific journal. She thinks that sugar is a poison because it is fermented to make alcohol. If you read the Daily Mail, alcohol is made by "distilling sugar". This is what we're up against: cretinous arguments made still more ludicrous by a woefully uneducated media.







The asshole on the left begins by saying "We are in the midst of the biggest public health crisis in the history of the world." He's not talking about the Black Death, cholera, influenza, malaria or even cigarette smoking. He's talking about people drinking fizzy drinks in North America. The guy is either ignorant or insane or a liar. This one statement is enough to discredit him and yet he has made another video in which he says: "Fructose is ethanol without the buzz ... fructose is poison." That video has had nearly two million hits on Youtube. It's over. The morons have won.

He's another UCSF chump and it's no surprise to find that he's friendly with the anti-smoking loons of that quasi-university. In that same video, he refers to "the UCSF Legacy Tobacco Documents Library that Stan Glantz runs right across the street. Stan's a good guy. I like Stan a lot." Right there we have another disagreement because Stan is not a good guy. On the contrary, he is a charlatan and a crank and he should be investigated, prosecuted and imprisoned. He is another obsessive fruitcake who has found a pulpit from which to preach his warped, scientifically illiterate ideas thanks to the lax admissions standards of UCSF.

As you may know, Glantz regularly appears on television claiming that half of all teenage smokers picked up the habit solely as a result of seeing smoking in movies. This is a man who should, as Christopher Hitchens might have said, be out in the street, shouting and hollering with a cardboard sign around his neck and selling pencils from a cup. Do interviewers call him on his bampot theories? They do not. Instead he is perched up in San Francisco with millions of dollars of grants and a professorship in a subject which he has not studied at degree level and of which he apparently knows nothing.

Glantz also invented the heart miracle scam. What better illustration of the Western world's plunge into unreason can there be than this? Here we see the perils of the campaigner-researcher, the corruption of peer-review and the pitiful credulity of the media in perfect alignment.

To take just one example, last year Michael Siegel wrote about a heart miracle in one Minnesota county. It was so pathetic I don't think I even mentioned it at the time. In summary, some devious anti-smoking lobbyists cherry-picked a county and claimed that heart attacks had fallen by 45% after the smoking ban. Siegel listed some of the news stories that unquestioningly covered it.

For example, the headline of an ABC News article reads: "Smoking ban cuts cardiac events 45%, Mayo Clinic says."

A Procor headline reads: "Smoking ban cuts heart attacks in half."

A Thirdage.com article headline reads: "Smoking Ban Cuts Heart Attack Risk In Half."

The UPI headline about the research reads: "Smoking ban cut heart attacks risk in half."

The Minneapolis Star-Tribune headline reads: "Smoking bans cut cardiac events 45%."

The EMax Health headline is: "Smoking bans reduce heart attack rates by half, finds study."

The Business Insider headline reads: "Heart Attacks Decreased By 50% After These Workplaces Launched Smoking Bans."

The trick was a simple one. They didn't look at the year of the ban (2007). Instead they compared heart attack rates in 2001 with those of 2008. Sure enough, they fell by 45%, but this was not out of line with the general decline in heart attacks across the USA. The heart attack rate is falling everywhere. You may recall from last week that the UK saw a halving of heart attacks in the same decade. The longer the timeframe the bigger the fall. Cherry-pick one small county (population 150,000) and the effect can be exaggerated further.

This is routine deception on the part of tobacco control, but that is not the point. My point is that you don't need to be privy to this information to work out that "Smoking ban cut heart attacks risk in half" is a bullshit headline. You do not need to be well versed in statistics to work out that, if this were true, half of all heart attacks before the ban were caused by wafts of tobacco smoke in bars and restaurants. And you don't need to be cognisant of medical science to realise that this is simply preposterous.

Similarly, you do you need to understand biology to know that you are not going to get cancer from smelling tobacco on someone's shirt and yet the concept of thirdhand smoke has been widely talked about, not least by the Daily Mail, as if it was anything other than the ramblings of the insane.

Who came up with the idea of thirdhand smoke? Georg Matt. Who's Georg Matt? He's a wacky psychologist based in San Diego. There is a running theme here, is there not?

Where does every crackpot idea come from?

Where does every hysteria-driven, junk science-based ban begin?

Which is the home to the world's worst university?

Which state is dragging the world into an intellectual dark age?

California.

Lex Luther had the right idea. Bill Hicks had the right idea.

California has to go.

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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.

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Liam Donaldson up to his old tricks

Liam Donaldson on the way to the bank

Remember Britain's former Chief Medical Officer Liam Donaldson? Under the last Labour government, this flabby old fear-mongerer epitomised everything that is wrong with the public health crusade. Evidence-free policy making, perpetual scare stories, junk statistics, sucking up to the pharmaceutical industry—Donaldson brought it all to a new level.

In addition to lying through his teeth in his attempts to bring in the smoking ban and minimum pricing of alcohol, Donaldson was consumed with the desire to do battle with a viral pandemic. In the search for his very own Moby Dick, the sweaty surgeon hyped up fears of first SARS, then bird flu and finally swine flu. Thanks to Donaldson, no country overreacted to this scare more than Britain and no country helped the pharmaceutical industry make more money, as I said in a post last year:

Donaldson described swine flu as the "biggest challenge [to the NHS] in a generation" and predicted that a third of the UK population would come down with the virus in the winter. In an act of near-insanity, the British government ordered 110 million doses of the swine flu vaccine Tamiflu, 50 million more than would be needed to treat every man, woman and child in the country. The Department of Health ordered 32 million face masks. The Home Office made plans to dig mass graves.

In the event—despite the coldest winter for 30 years—there were fewer deaths than in the average flu season. The final death toll was 450—0.7% of the 65,000 predicted in Donaldson's worst-case scenario. Of these 450 deaths, only 70 could be solely attributed to swine flu.

The big winners from the swine flu panic were the pharmaceutical companies who managed to offload vast quantities of anti-viral drugs that were not needed and will never be used. There is now a hefty body of evidence that shows that Big Pharma had a disproportionate and malign influence on the World Health Organisation while the 'crisis' unfolded.

Our investigation has identified key scientists involved in WHO pandemic planning who had declarable interests, some of whom are or have been funded by pharmaceutical firms that stood to gain from the guidance they were drafting. Yet these interests have never been publicly disclosed by WHO and, despite repeated requests from the BMJ/The Bureau, WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them.

"There was no scientific basis for the WHO’s estimate of 2 billion for likely H1N1 cases, and we knew little about the benefits and harms of the vaccination. The WHO maintained this 2 billion estimate even after the winter season in Australia and New Zealand showed that only about one to two out of 1000 people were infected. Last but not least, it changed the very definition of a pandemic.”

The world was suckered by the WHO and the WHO was—to put it most charitably—suckered by Big Pharma. No country was conned more than Britain and at the heart of the British scare was Liam Donaldson. Having coaxed the government into wasting millions of pounds on unnecessary drugs, Donaldson retired last year, with the risible promise to come back to the job if swine flu re-emerged as the plague he always claimed it would be. It hasn't, of course, so has the discredited quack drifted into ignoble retirement?

Of course not...

Liam Donaldson Takes Up Role With Lobbying Firm APCO

The former chief medical officer for England has agreed to advise a global lobbying firm with a string of UK healthcare clients.

In the new role, Donaldson will provide strategic advice for clients such as the British Association of Pharmaceutical Wholesalers, Johnson & Johnson and Pfizer.

As Paul Flynn says, "the wages of error are bounteous". But, as if that wasn't enough, he's also got himself a job at the WHO.

WHO Director-General names Sir Liam Donaldson envoy for patient safety

WHO Director-General Margaret Chan has named Professor Sir Liam Donaldson as WHO Envoy for Patient Safety. In this role, Sir Liam, who served as England's Chief Medical Officer between 1998 and 2010, will help the Organization promote patient safety as a global public health priority.

What a cosy little club the WHO is. And Donaldson is showing no sign of toning down the scare-mongering in his new role.

"If you were admitted to hospital tomorrow in any country... your chances of being subjected to an error in your care would be something like 1 in 10. Your chances of dying due to an error in health care would be 1 in 300," Liam Donaldson, the WHO's newly appointed envoy for patient safety, told a news briefing.

This little statistic is a classic Donaldsonism, as Emergency Physicians Monthly has pointed out:

This guy was formerly England’s Chief Medical Officer for twelve years. England’s own parliament put out a report of England’s Health Committee in 2009 – while Donaldson was the CMO - showing that “around 3,500″ medical errors in the NHS each year involve the death of the patient.

Between 2009 and 2010, there were 14.5 million hospital admissions in England – at least according to the NHS’s “Hospital Episode Statistics” online. With one in 300 dying from an “error in health care” (according to Dr. Donaldson), then a total of roughly 48,300 patients in England would have died at the hands of us careless, lackadaisical, downright dangerous medical providers.

Same calendar year, but there is a big discrepancy between 3,500 patient deaths cited in the House of Commons report and 48,300 deaths cited by Professor Sir Liam Donaldson.

That discrepancy leaves me with three possible explanations.

First possibility: Those who created the statistics used in the Sixth Report of the Health Committee for the House of Commons were a bunch of incompetents and should all be beheaded. Remember, the report was created during Sir Liam Donaldson’s tenure as England’s Chief Medical Officer, so he is not without blame if this scenario holds true.

Second possibility: There was a MI5 cover up of nearly 45,000 deaths due to medical errors in England in 2009. Someone call Scotland Yard … and Geraldo Rivera.

Third possibility: Sir Liam Donaldson is blowing bubbles out his bum when citing statistics on behalf of the World Health Organization.

Liam Donaldson scaring the wits out of people with made-up statistics to enhance his own power and prestige? Nothing changes.

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Think of the (very small) children!

What age-group do you think of when someone says the word 'children'? 16 years or younger? Under-18 perhaps?

And what about 'young children'? Ten year olds? Eight year olds? Maybe younger?

So what about 'very young children'? That would have to be toddlers and pre-school children, right? Six or seven at the most.

So what can we make of Diane Abbott saying this?

"It is wrong that very young children can get out of their skulls for less money than it takes to buy a bottle of Coca-Cola."

Leaving aside the fact that a bottle of Coke costs 70p, which is far too little for anyone to get 'out of their skulls' on, Abbott's twist on the old 'think of the children' canard means one of the following:

a) she have a unique definition of what a 'very young child' is

b) she honestly believes that very young children are getting 'out of their skulls' on alcohol for 70p

c) she is one of the stupidest people to ever become an MP in British history

d) she is deliberately using misleading language to scare people into supporting minimum pricing

It could very easily be a combination of (c) and (d). Incredibly (or not), this serial incompetent and self-confessed hypocrite in on Labour's shadow cabinet. Still more incredibly, she is the spokesperson for health, which should be interesting when she has to tackle obesity (something she has clearly never attempted before).

Still, it gives me an excuse to show this again:

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A resolution

This is an annual event, isn't it? After twelve months of riffing endlessly on the themes of obesity epidemics, tobacco pandemics and alcohol panics, there is always one slow news day after Christmas—usually coinciding with the new life expectancy figures coming out—when the truth shows its face. And the truth is that the real threat to the NHS is that the nation will soon look like the cast of Cocoon.

From the BBC:

Leaving aside the very speculative nature of the figures—and leaving aside the Beeb's innumeracy (17% is much closer to 1 in 6 than 1 in 5)—the basic premise is, of course, solid. We are the longest living people in history and I hereby make it my 2011 resolution to use the graphic above every time some idiot scurrilously claims that "this generation will die before their parents".

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"It's very scientific"

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

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

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

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

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

RB: Thank you for having me.

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

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

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

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

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

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

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

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

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

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

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John Banzhaf is a liar

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

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

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

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

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

Action on Smoking and Health was formed in 1968.


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

Sue me, fatso.



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

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Tobacco control caught fibbing again

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

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

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

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

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

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

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

SNIPH backs off on snus and potency

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

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

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

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Lie through your teeth

I've occasionally wondered why dentists have never shown the same  enthusiasm for lifestyle regulation as doctors. You never hear the dental equivalent of the British Medical Association calling for tax rises on sugary drinks and a ban on gobstoppers.

Cynical minds would say this is because dentists usually work in the private sector. While it often seems that doctors view patients as an unnecessary obstacle keeping them from the gold course, dentists could be forgiven for wanting the government to subsidise pork scratchings and boiled sweets.

Whatever the motives, dental patients have learnt not expect to expect the Spanish Inquisition (no one expects the Spanish Inquisition, etc.). But then along comes this idiot, and now Alex Deane at Big Brother Watch has told his tale of unit-counting at his dental surgery.

From Big Brother Watch:

Dentist: we haven’t got details of your alcohol intake.

Me: no, you haven’t.

Dentist: well, there’s a health form - we’ve got to have it!

Me: no, you don’t.

Dentist: well, what am I supposed to put in this space, then?

Me: you can put that I said it’s none of your business.

Dentist: Alex, you don’t seem to understand – this is to guard against oral cancer.

Nought to cancer in four questions!! Talk about bringing out the big guns. Needless to say, the exchange ended:

Me: I’ll take my chances

Dentist: (total disbelief) So I’ve got to put that you won’t tell me?

Me: Yup.

As it happens, my own dentist is a good friend of mine so I have been spared all of this. He knows exactly how much I've been drinking most weekends and any lectures from him would, in any case, be laughably hypocritical. He also tells me that in 12 years in practice, he has only ever diagnosed one case of oral cancer. (It is a fairly rare disease, claiming fewer than 2,000 lives in England and Wales last year.)

But Dick Puddlecote confirms that this line of questioning is now not only standard, but compulsory.

I had a similar experience a couple of months ago when moving to a different dental practice and signing in for a check up. In this case, I was given the form to fill in myself. I completed it but left the question on 'alcohol units per week' blank, assuming that it was optional. Having handed it to the receptionist and reseated myself to continue reading a riveting copy of OK magazine (yes, it was the only *cough* literature available, and yes, I was being sarcy), she called me back to point out that I had not answered all the questions.

"Oh, I didn't think that one was compulsory", said I, politely, to which she countered that she couldn't register me at the practice unless it was filled in. I just took the pen, placed a big fat zero in the box, handed it to her with a smile, and sat down again. The look I received was a mixture of disdain and anger. She knew the answer was untrue but - short of accusing me of being a liar in public - there was nothing she could do about it.

Unless you actually like being lectured, what better way to deal with intrusive questions from the state?

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For those born yesterday

As a coda to the previous two posts...

From Katherine Huntly of the British Lung Foundation, in a letter in today's Guardian:

Smoking just one cigarette, even with the car window open, creates a greater concentration of second hand smoke than a whole evening smoking in a pub or a bar.

And from ASH's latest smoking-in-cars 'fact sheet':

Opening a window does not reduce the levels of secondhand smoke in a car to a safe level as the smoke simply blows back into the vehicle, often lingering for hours.

As Frank Zappa once said, it's not getting any smarter out there.

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Just open the window!

I was interviewed on BBC Scotland radio this morning on the subject of banning smoking in cars (listen here for 7 days, 2.17 hours in). Sleepy though I was—and coming off the back of a hilariously one-sided vox pop—I tried to make the point that the simple act of opening a window in a moving vehicle provides ample ventilation to disperse secondhand smoke.

Prof John Britton had earlier told the BBC that levels of secondhand smoke in cars are twenty times higher than in smoky bars. As a medical man, his opinion naturally trumped mine as far as the presenter was concerned. Nevertheless, it's worth finding out this '20 times higher' claim comes from.

A good place to start is a heavily referenced report from ASH (UK). It claims that:

According to a report by the Ontario Medical Association, secondhand smoke levels in cars can be 23 times greater than in a house.

ASH give a citation of this report from the Ontario Medical Association, which says:

Based on the evidence that exposure to SHS in a vehicle is 23-times more toxic than in a house due to the smaller enclosed space, the state of Colorado drafted a bill that would impose fines on adults caught smoking in cars when a child is present.

But what evidence is this? Their only reference turns out to be a news story from the Rocky Mountain News, not exactly a reliable scientific source.

ASH do, however, have another source:

A study comparing secondhand smoke particle concentrations in a vehicle with those in a bar which allowed smoking, found in-vehicle concentrations 20-times greater than inside the bar.

Again there is a citation, this time to an actual scientific journal, but the article in question does not measure secondhand smoke in cars, nor does it attempt to. It certainly doesn't give any estimate of how much more secondhand smoke is in cars than other locations, and it doesn't cite any references that might lead us to find an article that does.

And there the trail ends. Such is the game of Chinese whispers that passes for evidence-based medicine these days.

If you want to find some real science on this issue, you have to turn to an American Journal of Preventive Medicine study from 2006, which measured particulate matter (PM2.5) in vehicles.

Bearing in mind that the EPA's 'hazardous' level for 24 hour exposure is 250 ng/m3, this study found average peak concentrations of 271 ng/m3. But they did so by keeping the windows closed. When a window was opened, the level was only 51 ng/m3. This is a fraction of what would be found in a smoky bar (200-500 ng/m3) and is well within the EPA's limit (which, remember, is for 24 hour exposures, not the occasional car journey). And after smoking, levels quickly fell to the same found in a nonsmokers' car.

The study also measured carbon monoxide levels, with even less impressive results. When the window was opened, levels barely changed at all.

Another study sometimes cited carried out a similar experiment but only opened the window by 3 inches. Even with this restricted ventilation, average levels of PM2.5 were 119 ng/m3—well below the EPA's hazardous level.

All of which suggests that—if smoking in cars is a problem at all—it is one that can be simply solved by opening the window. And that, of course, is what everyone already does. 

Would I agree with a law forcing people to open the window whilst smoking? I probably would, if I thought that would be the end of the matter, but we all know that it won't be because protecting people from secondhand smoke is not the purpose of the Royal College of Physicians' latest 'demands'. By calling for a total ban on smoking in cars, even when no one else is present, they have finally given the game away. This issue isn't about science and it's not about 'protecting' nonsmokers. It never has been.

UPDATE

While I was on BBC Scotland, Tony Blows was on Radio 5, making his point rather more forcefully. He called Deborah Arnott a liar which, considering she brought up the Scottish heart scam, I suppose is fair comment. F2C have the audio. 

Incidentally, I was told that the producers wanted me to debate with a spokesman from an anti-smoking group but the spokesman refused! I bet Arnott now wishes she'd ducked out as well.

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Deborah Arnott: lying about Ireland

Deborah Arnott, Chief Executive of ASH, is interviewed in The Guardian today and comes up with a novel explanation for the smoking rate rising in Ireland since the smoking ban:

To pause is to run the risk of the numbers once again increasing: in Ireland, she tells me, the government successfully brought in smoke-free legislation, but "they didn't do anything else, and smoking started to creep back up again".

As reported previously, the smoking rate did rather more than "creep back up again". It has risen to an astonishing 33%. As for the idea that the Irish "didn't do anything else", where to begin? 

Ireland has constantly increased the price of tobacco and now has the highest rate of cigarette tax of any EU country; it has graphic warnings on cigarette packs; it has banned all forms of tobacco advertising; it has raised the age of purchase to 18 and it was the first country in the world to ban tobacco displays in shops.

It is completely untrue to say that Ireland has done nothing else since the ban. It has, in fact, done even more than the UK. And yet it is fast becoming one of Europe's heaviest smoking nations.

I don't recall ASH predicting that the smoking ban would make more people start smoking unless it was followed by an endless stream of legislation. I seem to recall them saying the smoking ban would be the nearest thing to a magic bullet. I also recall smoking rates falling for decades when ASH did very little and rising when they started doing a lot.

It looks like Arnott is rehearsing her excuses for when the smoking rate is shown to have risen in England. It's a convenient line to take: "what we wanted then didn't work because it needed to be accompanied by what we want now." It's not true, of course, and it doesn't make any sense, but that has seldom been a handicap.

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