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Thursday, February 16, 2006

Smoking ban revisited

There has been much discussion on other Liberal Democrat blogs about the vote to ban smoking in public places and I have largely abused my position by posting lengthy comments to them. It seemed right therefore to place my latest missive here so that it can be debated.

The caveat here is that what is being proposed for Wales is far better defined and, in my view, more defensible than what was passed in Westminster for England. That is because here we have been very specific that we are intending to pass health and safety legislation that will protect workers and that as such the debate about private clubs, bars etc does not come into it.

Some have argued that lots of people do risky jobs. The Health and Safety Executive they say, seeks to minimise workplace risks, but some are inevitable. And in many cases the risk in a job may be compensated for by differential wages. Surely a better, more liberal approach would be to seek to create a more level playing field where employees have the collective teeth to demand such premiums. If 80% of the potential market wants smoke-free bars and restaurants, this should be incentive enough to provide them, plus a premium wage for people who work in smokey ones to further level the playing field and you've got a properly liberal solution.

I would reply that the difference between us is that I do not believe in applying the employment methods of a 19th century mill-owner to the 21st Century. Yes, a lot of people do risky jobs but the whole point of employment law. health and safety, measures and good practice is to reduce the risk. A work-place smoking ban falls into that category. That is why it is a liberal measure because it has regards to the rights of those least able to resist harm.

At the end of the day you cannot use market forces to either compensate for risk in this field or to mitigate against it. The market reacts completely different in the entertainment and hospitality industry than it does in a north sea oil field. In the latter you have a limited, highly skilled workforce, in the former you have a plentiful supply of largely unskilled people who can quickly be trained up. The only outcome of applying a risk-based minimum wage to bar staff will be to bankrupt businesses. If you expect them to do it voluntarily they will not because they will lose money. The other outcome is that many people who struggle to find other jobs will find that they have to choose between compromising their health or not working. That is not a liberal choice.

Where smoke-free bars have set up they have struggled to compete because non-smokers have chosen to accompany their smoking friends, even though they would prefer to go elsewhere. That is why there is no level playing field. This legislation will enable all businesses to operate on an equal basis.The point is that this is about balance.

I would not propose a total ban because that would outlaw a legal activity that can be carried out in a way that it does not cause a detriment to others. I do however support a workplace ban because I believe that the rights and health of workers who have no real alternative choice need to be protected. I am backing my convictions.

Let us also be clear, this is not about the smell of cigarette smoke, it is about the very harmful carcinogens and toxins that cannot be removed from an atmosphere by ventilation. Do not think that just because the smell of smoke has been minmimised that it is now safe, it is not.As for the claims that there is no proven causal relationship between second hand smoke and ill-health/death, only the tobacco industry is saying this now.

This is (a rather lengthy) extract from the report of the Welsh Assembly Committee set up to look at this issue:

"The Health Risks of Environmental Tobacco Smoke (ETS)

3.2 Most of the evidence cited to show that ETS is detrimental to health centred on six key documents. The authors of the documents have used evidence from numerous studies that have been peer reviewed and have carried out empirical analyses to show causal evidence of the health impacts. These five studies were produced over a period of six years and their findings each replicate those of the other reports.

3.3 The 1997 report of the California Environmental Protection Agency concluded that there was sufficient weight of evidence of a causal relationship between ETS exposure and developmental problems in babies; sudden infant death syndrome; some respiratory illnesses; lung and nasal sinus cancer; and cardiovascular disease. The report also found suggestive evidence of a causal link with spontaneous abortion, cervical cancer and further respiratory related problems.

3.4 In 1998 the Scientific Committee on Tobacco and Health (SCOTH) published a report commissioned by the four UK Health Departments. This concluded that ETS exposure:• is a cause of lung cancer and, in those with long term exposure, the increased risk is in the order of 20-30%;• is a cause of ischaemic heart diseases, and if current published estimates of magnitude of relative risk were validated, such exposure would represent a substantial public health hazard;• is a cause of serious respiratory illness and asthmatic attacks in infants and children when parents smoke in their presence;• is associated with sudden infant death syndrome, the main cause of post-neonatal death in the first year of life. The association is judged to be one of cause and effect; is likely to be a causal association with middle ear disease in children, linked with parental smoking.

3.5 SCOTH issued an update report on 16 November 2004 reviewing evidence since its report of 1998.5 It concluded that knowledge of the hazardous nature of second-hand smoke has consolidated over the previous five years, and that this evidence confirms that second-hand smoke is a serious public health risk.

3.6 In 1999 the World Health Organisation published its conclusions following consultation on environmental tobacco smoke and child health. It found that:ETS is a real and substantial threat to child health, causing death and suffering throughout the world. ETS exposure causes a wide variety of adverse health effects in children, including lower respiratory tract infections such as pneumonia and bronchitis, coughing and wheezing, worsening of asthma, and middle ear disease. Children’s exposure to environmental tobacco smoke may also contribute to cardiovascular disease in adulthood and to neurobehavioural impairment.

3.7 The report also concluded that maternal smoking during pregnancy is a major cause of sudden infant death syndrome (SIDS) and other well-documented health effects, including reduced birth weight and decreased lung function. In addition, the consultation noted that ETS exposure among non-smoking pregnant women can cause a decrease in birth weight and that infant exposure to ETS may contribute to the risk of SIDS.

3.8 In his report for 2002 the Chief Medical Officer for England included a section on ETS. His introduction to the section stated:

Exposure to other people's cigarette smoke (second-hand smoke, passive smoking, environmental tobacco smoke) can: increase the risk of contracting smoking related diseases such as cancer and heart disease; place extra stress on the heart and affect the body's ability to take in and use oxygen; trigger asthma attacks; increase the chances of sudden infant death syndrome (SIDS); and harm children and babies even more than adults.

3.9 In 2002 the British Medical Association’s (BMA) Board of Science and Education published a report in collaboration with the Tobacco Control Resource Centre. The report summarised the scientific and medical knowledge on the nature and scale of the health effects of passive smoking: in adults, second-hand smoke increases the risk of lung cancer by some 20-30 per cent and the risk of coronary heart disease by 25-35 per cent. In children, exposure to second-hand smoke increases the risk of lower respiratory tract illnesses, asthma, middle-ear infection and sudden infant death syndrome.

Certain population groups are particularly vulnerable: children, pregnant women, people with existing cardiovascular or cerebrovascular disease, and those with asthma and other respiratory disorders. Moreover, those in lower socioeconomic groups are at greater risk of exposure than those in better-off groups. There is no safe level of exposure to tobacco smoke, and adverse effects can be seen at low levels of exposure.

3.10 Ash Wales and the paper from the University of Aberdeen referred to the report of the International Agency for Research on Cancer, produced in 2002 and published in 2004 by the World Health Organisation, which reviewed links between passive smoking and cancer and concluded that tobacco smoke is carcinogenic to humans. This report presents international scientific concensus.

3.11 The following studies are also significant.

3.12 A study in Helena, Montana USA, looked at whether there was change in hospital admissions for myocardial infarction (heart attack) while a local law banning smoking in public and in workplaces was in effect. This found that during the six months in which the ban was in place the number of admissions of people from Helena fell significantly, while those admitted to the same hospital from outside Helena rose. When the ban was removed, the number of admissions from Helena increased. A commentary on the study suggested that although the study was small it focussed attention on a subset of literature on secondhand smoke and its consequences. The literature seems to indicate that relatively small exposures to toxins in tobacco smoke seem to cause unexpectedly large increases in the risk of acute cardiovascular disease.

3.13 The Scottish MONICA study showed the effects of non-smokers exposed to ETS mainly at work having a significant reduction in pulmonary function.

3.14 A study showing that workers in premises permitting customer smoking reported a higher prevalence of respiratory and irritation symptoms than workers in smoke-free workplaces. Concentrations of salivary cotinine found in exposed workers in this study have been associated with substantial involuntary risks for cancer and heart disease.

3.15 Professor David Cohen of the University of Glamorgan, has undertaken a study modelling the economic and health impact of a ban on smoking in public places. The model predicts: The estimated effect of eliminating exposure to environmental tobacco smoke (ETS) in public places in Wales is an annual reduction in deaths from lung cancer and coronary heart disease of 253 with a possible additional reduction in deaths from stroke and respiratory diseases of 153.There may be an additional annual reduction in deaths of between 60 and 180 if active smoking is reduced as a result of the smoking ban.

3.16 The report of the Office of Tobacco Control, Ireland, on the first year of smoke-free workplaces says:• that in a study of pubs in Dublin where exposure levels in 24 pubs before and after the ban have been analysed, there has been a significant reduction in particulate levels – Ave PM10 by 53 per cent and Ave PM2.5 by 87.6 per cent; a study of 81 bar workers before the introduction of the smoke-free law and a year later indicates a reduction in breath carbon monoxide levels. The results show that for the 56 workers whose tests have been completed and analysed there has been a 45 per cent reduction in non-smokers and a 36 per cent reduction in ex-smokers.

3.17 A study undertaken for Smokefree London, published in the British Medical Journal estimated deaths from passive smoking in the UK. It found that passive smoking at work was likely to be responsible for 617 deaths a year, including 54 in the hospitality industry. This would equate to one-fifth of all deaths from passive smoking in the general population aged between 20 and 64 years and up to half of such deaths of employees in the hospitality industry.16

3.18 Of those organisations which gave evidence to the Committee, only FOREST, the Tobacco Manufacturers’ Association,18 and the National Association of Cigarette Machine Operators contended that there is no evidence that ETS could be significantly detrimental to the health of non-smokers.

3.19 Four scientific studies were cited in support of this view. The Committee noted that three of these were produced in the early 1990s before much of the evidence of harm had been established. However, one longitudinal study which followed a large cohort was published in 2003 by the British Medical Journal. The cohort comprised over 188,000 adults who were followed from late 1959 until 1998, with particular focus on 35,500 who had never smoked but had spouses with smoking habits. The report concluded that:

The results [of the study] do not support a causal relation between environmental tobacco smoke and tobacco related mortality, although they do not rule out a small effect. The association between exposure to environmental tobacco smoke and coronary heart disease and lung cancer may be considerably weaker than generally believed."

Finally, on the issue of ventilation the Committee reported:

"The British Medical Association (BMA) claimed that ventilation cannot protect against the health risk of passive smoking. They advised the Committee that ventilation does not remove the fine particulate matter that is breathed most deeply into the lungs and into the thorax and that filtered tobacco smoke has the same potential to ncause cancer in a cell system as unfiltered tobacco smoke. Their view was supported by, among others, the Chartered Institute of Environmental Health, the Public HealthAssociation Cymru and Ash Wales. Ash Wales and Professor Gerard Hastings contended that it would take an air flow comparable to a wind tunnel or tornado to be in any way effective."
Does this mean that I have to come up with a long, yet piffy, retort to make up for the one you posted to my comments yesterday?

Although I see the carciogens are present in both you posting to my blog and your argument here. And their absence in the workplace it the reason why I think we both come down in favour of a workplace ban, even if that workplace happens to be somebody elses place of leisure.
I have just added you to my favourites and will come back again soon. Superb work on this personal blog. Perhaps you will really enjoy looking at my blog. good things about stop smoking
Antismoking Lies
I believe that anti-smoking authorities have been lying to us about the dangers of secondhand smoke. I have formed a group to fight smoking bans called KEEP ST. LOUIS FREE! We defeated a smoking ban in St. Louis by challenging the notion that secondhand smoke kills people. Check out the real science of secondhand smoke and see how NYC hates its ban: www.nycclash.com If you want help fighting a smoking ban in your city, contact me at hanneganlounge@safeplace.net

Read this estimate of ETS danger by researcher David Kuneman taken from a STLtoday.com blog "No Smoking in Illinois?" and decide for yourself if anyone's liberty needs to be taken away.

Ok, lets go to all the so-called studies which “prove” ETS is a hazard. There are two kinds of ETS studies… sloppy ones and well executed ones. The sloppy ones are those which are case-controlled. This means, the researcher asks a nonsmoking lung cancer patient what airborne carcinogens he/she was exposed to. If 30% more patients respond to being exposed to lots of smoke, the researcher concludes ETS increases Lung Cancer risk 30%. These studies usually involve a few hundred patients. This is where you get your data from. Trouble is, patients are not experts and do not know if they were exposed to asbestos, lived in a home with a radon problem, etc. The patients have all heard ETS causes LC, so they blame that. Please go to http://kuneman.smokersclub.com/ for a more complete explanation.

The well executed studies are called cohort studies. These rarely conclude ETS causes Lung cancer and Heart Disease. In cohort studies, thousands of persons are enrolled and all are healthy. They are divided among those exposed to smoke..or not. After about 30 years, the researcher contacts as many as he can locate, and determines the health of the study subjects. These are more expensive to run. The most well known of the cohort studies is the UCLA study which found no risk. These kinds of studies are less subject to bias.

The EPA report combined the results of 13 studies, and all but one were case controlled. They could Have used all 58 studies completed at the time, but did not simply becasue if they had, they would have been forced to conclude ETS is safe. According to the EPA report, even using those 13 studies, without the Frontham study, they would have concluded ETS is not dangerous. Trouble with the Frontham study is she refuses to let anyone see her raw data. I have a copy of the complete EPA report—that’s what it says.

In summary, we have the EPA claiming ETS is dangerous, and the Dept of Health and Human Services which only cites studies conducted by antismoking groups, and has never actually done a study of thier own claims ETS is dangerous. We have OSHA, the Congressional research service of the Library of Congress, and OakRidge Nat Labs claiming ETS is not dangerous.

Now, lets move on to population studies. All good epidemiology text books teach than when a weak risk such as a 30% excess risk is determined from epidemiology studies, then the researcher has to conduct population studies to either confirm, or reject the 30% result. If the researcher checks the prevalence of the disease indentified, as being more common in populations, more exposed, then the risk is confirmed. The trouble is, Europeans only get about half as much Lung Cancer as we do, and they are exposed to more ETS and always were. This according to WHO. And euros smoke about 1/3 more than us, and always did and euros live about 2 years longer than we do. Another population study is that in the US, age-adjusted rates of heart disease, nonsmoker’s lung cancer, asthma, COPD, and days missed from work are higher now than than in the 1970s when we were exposed to about 9 times more smoke. There is also a higher rate of childhood cancer, birth defects, middle ear infections, asthma, and most other diseases blamed on smoke today, than in the 1970s. early cases of smoking related cancer among young adults are increasing.. Again see http://kuneman.smokersclub.com/ for more detailed info. Population studies fail to confirm the 30% increased risk these case-controlled studies claim exist. And it’s more than just a litle odd no matter which disease you’re referring to, the elevated risk caused by ETS is always claimed to be the same- 30%- not double, as Dean claims.

I think the fact that we have removed 90% of all ETS, and nothing good happened, speaks volumes as to what we can expect if we remove the last 10% of ETS exposure. Dave Kuneman
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