The Scottish smoking ban
The Scottish smoking ban has led to much healthier people and scenes of unconfined joy in the streets, apparently.
Ah ha! Maybe the ban was justified after all; maybe I was wrong about it making no difference other than that of aesthetics?
Er... Now, the smoking ban was introduced in March 2006 and it is now September 2007: so, they can only have been able to compare one year, right?
Is it only me that suspects that one year is not really long enough to construct a meaningful trend in public health? Especially since the ScottishExecutive Government has also been spending vast amounts of money on campaigns condemning unhealthy eating, lack of exercise and excessive salt intake—all of which are implicated in heart disease—during the same period?
I'm not saying that the downward trend in heart disease isn't down to the lack of smoke in public places: I'm just pointing out that a year probably isn't long enough to judge. Y'know?
Really? Is that outdoors in the middle of the fucking Highlands, or outdoors in the middle of Edinburgh's Tollcross at rush hour? A somewhat meaningless observation that one, wouldn't you say?
How exciting. I do wonder how they've measured that one too. I mean, 40% down amongst adults I can believe, but children? In what places were children exposed to smoke (especially given the paucity of pubs with a childrens' licence in Scotland)—except, of course, in the home? Or is this 40% a combined figure?
Yeah, as I say, it's a little bit too fucking early to tell.
Well, we expected that: we'd seen the data from Eire. I bet the off-licenses are happy though.
Ah, so a bunch of institutions—all of which are funded by the organisation which introduced the measure—have found that the smoking ban is absolutely the best thing since sliced bread, even though the time period is far too fucking tiny to have any statistical relevance whatso-fucking-ever.
Well, fuck me: I am surprised...
The Scottish smoking ban has led to a significant advance in public health, the most detailed scientific study of the measure so far has suggested.
Ah ha! Maybe the ban was justified after all; maybe I was wrong about it making no difference other than that of aesthetics?
Comparisons at nine hospitals revealed that there was a 17% year-on-year drop in heart attack admissions since the ban was introduced in March 2006.
...
Admissions to nine major Scottish hospitals were also compared in the year before and after the introduction of the ban.
Er... Now, the smoking ban was introduced in March 2006 and it is now September 2007: so, they can only have been able to compare one year, right?
Is it only me that suspects that one year is not really long enough to construct a meaningful trend in public health? Especially since the Scottish
I'm not saying that the downward trend in heart disease isn't down to the lack of smoke in public places: I'm just pointing out that a year probably isn't long enough to judge. Y'know?
It says the quality of air in pubs is now equivalent to that found outdoors.
Really? Is that outdoors in the middle of the fucking Highlands, or outdoors in the middle of Edinburgh's Tollcross at rush hour? A somewhat meaningless observation that one, wouldn't you say?
Exposure to second-hand smoke north of the border is down by 40% among adults and children, the study added.
How exciting. I do wonder how they've measured that one too. I mean, 40% down amongst adults I can believe, but children? In what places were children exposed to smoke (especially given the paucity of pubs with a childrens' licence in Scotland)—except, of course, in the home? Or is this 40% a combined figure?
Scotland's deputy chief medical officer said this was proof that the ban has produced major health gains.
Yeah, as I say, it's a little bit too fucking early to tell.
But Scottish publicans claim that many of the benefits could have been achieved without a ban and complain that bar sales have declined because of it.
Well, we expected that: we'd seen the data from Eire. I bet the off-licenses are happy though.
The findings will be presented to an international conference in Edinburgh on the ban organised by the Scottish Government.
They are based on scientific evidence collected from routine health data, as well as research projects undertaken by government scientists and Scottish universities.
Ah, so a bunch of institutions—all of which are funded by the organisation which introduced the measure—have found that the smoking ban is absolutely the best thing since sliced bread, even though the time period is far too fucking tiny to have any statistical relevance whatso-fucking-ever.
Well, fuck me: I am surprised...
Labels: culture, drugs, general hilarity, science, Scotland, totalitarianism
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11 Blogger Comments:
i dont have the stats to hand , but drinking in Eire has gone UP since the smoking ban - because folks are deciding to drink at home instead.
and yeah - one year is a ridiculous time frame when talking about long term trends in heart disease. this is nothing more than government propaganda dressed up as "news".
Ach, it's like the majority of studies of passive smoking and of global warming. How often are either conducted by those without a vested interest. See, colour me cynical, but respective studies by ASH and the IPCC are simply not worth a wank, just as any by any government-funded body. Out there, somewhere, is a study showing that children of smokers i.e. those raised in a smoky environment, have an increased resistance to lung cancer. Don't hear much from ASH about that one, do we?
It is a lies and spin, but one wonders if it has ever been any different. Maybe the difference now is access to such easy global communication, and the fact that dissenting voices can be heard.
Neal... The study that showed ETS to be slightly beneficial to children was actually performed by the World Health Organisation! It was buried pretty fucking quickly too - but not before "The Telegraph" got hold of it. :-)
Here's a bit about it: http://www.davehitt.com/facts/who.html
I already knew this, but it's worth pointing out that first the figures on passive smoking are not 'statistically significant' and that the margin of error is such that passive smoking may even be good for you. But even if you go with the work place passive smoking increasing your chances of getting lung cancer by 17%, I have to shout again: YOU HAVE TO KNOW WHAT YOUR CHANCES ARE OF GETTING IT WITHOUT PASSIVE SMOKE FOR THAT FIGURE TO MEAN ANYTHING AT ALL!!!
I have heard several theories as to why the Scots are particularly susceptible to cardiovascular disease [in the 70s they had the worst rates in Western Europe].
A Scottish GP, Dr Malcolm Kendrick offers some hiliarious, yet insightful observations - the obsession began for him some 20odd yrs ago when his countrymen seemed to be dropping like flies, while French gluttons experienced far lower rates of MI [over 50% less] when compared to Scotland.
You see it's all down to "stress" according to Kendrick, or more accurately dysfunction of the Hypothalmous, pituitary and adrenal gland axis. [HPA-axis].
HPA-axis dysfunction results in repeated endothelial injury [the innermost lining of arteries]followed by formation of atheroma plaques which increase in size after each "stress-related" event. Eventually total occlusion [say of a coronary artery] occurs, or [very often] a clot breaks off from a corotid artery travelling to the brain causing a stroke.
As an example, Kendrick cites the frantic conflict between catabolism and anabolism during [Scottish] meal times associated with a cultural void around preparing, cooking, and eating/digesting meals.
Indeed, how many delicious Scottish dishes can you name ?
This unhealthy relationship with food seems to activate HPA-axis dysfunction with subsequent and repetetive endothelial injury.
To the Scots eating is a bit like filling your car up [according to Kendrick], a waste of 10 minutes - but something that has to be done before going out on the pish.
A meal might consist of a boiled lump of beef, followed by a deep fied mars bars, all bolted down with a fag in one hand and perhaps a wee dram in the other.
Of course the situation is exacerbated by smoking [another stressor for HPA-dysfunction] which is known to affect blood clotting factors - and hence clot formation each time endothelial injury occurs.
We all know that passive smoking is more of a bogeyman than anything else, but I would have thought the Scots would be welcoming any measure that reduces their grim mortality rates [20% of the population in Glasgow will be dead before they reach 65]
http://news.bbc.co.uk/1/hi/scotland/4917730.stm
"We all know that passive smoking is more of a bogeyman than anything else..."
Ha ha! Well, Charge Nurse, I never thought to hear you say that! You are correct, of course.
As for the rest of it: are you essentially saying that their is a genetic link or is it purely cultural?
DK
Cultural [in this instance] - as well as Scotland Kendrick looked at three other groups with incredibly high rates of cardiovascular disease; *Aboriginals.
*Asian Indian Emigrants.
*Eastern Europeans.
His contention is that unhealthy stressors [resulting in HPA-axis dysfunction] triggers a neuro-hormonal response that leads to repeated endothelial damage and eventually heart attack or stroke.
These stressors may be chronic or acute.
Specifically, Kendrick mentions the displacement of some 1/2 million Glasweigens during the 50s & 60s to places like East Kilbride & Cumbernauld [the later described as a sprawling rabbit warren on stilts].
Unprecedented rates of cardiovascular disease were noted some 15-20yrs later.
Aboriginals have been subject to rapid social and lifestyle changes, severe socio-economic discrimination, unemployment and crap housing.
They are prone to obeisity, hypertension, type II diabetes and heart disease.
In one study Asian emigrees had x3 times the rate of heart disease when compared to a sample that had remained put.
Kendricks links this with culture clash, loss of control over family traditions and often lower socio-economic status in western countries.
Eatern Europeans are stressed too.
One study compared coronary heart disease between Lithuanian and Swedish men.
The result found mortality to be four times higher amongst the Lithuanians [way too high to be explained by standard risk factors] - the study found that the Lithuanians experienced unfavourale characteristics on a a cluster of "psychosocial risk factors" - the disolution of the Soviet Union, new market freedoms allied with population shifts may have contributed.
Bullshit, I hear you cry, well maybe, but have a look at Kendricks flow chart.
Unhealhy stressor, e.g. smoking, antagonism between catabolism/anabolism, increased autonomic nervous activity precipitated by psychological events, etc, results in HPA-axis dysfunction.
HPA-axis dysfunction results in abnormal hormonal activity [increased cortisol, insulin, etc].
Abnormal hormonal activity damages endothelium, and increases blood clotting.
Damaged endothelium/increased clotting favours atherosclerotic plaque growth [coronary and carotid arteries].
Atherosclerotic plaques lead to heart attacks and stokes [thrombus formation in a coronary artery or embolus travelling to the brain/lungs, etc].
If we accept this proposition it would appear that town planners are far more deadly than the comforting fug that occassionally enveloped the local boozer, at least in Glasgow.
ISTR that the reason the French seem to have a lower rate of death from heart disease is that French death certificates don't require a cause of death, just to certify that the deceased really is, well, dead. So cultural differences, in a sense, are key.
Quite right pete in dunbar, the French are far too laid back to be bothered by such trifles as filling in a death certificate properly.
Law & Wald [1999] looked at the "French Paradox" i.e. mortality from ischaemic heart disease is a quarter of that in Britain.
The study is available electronically via the BMJ.
These authors suggest that "poorly specified causes" while important does not explain such startling variation - we are then exposed to some rather daft hypothesis about onions and garlic [amongst other things].
Of course the good devil, and many of his acolytes are rather keen on the French insurers - but mon dieu if death certificates are an example of their ability to complete paper I think I'd rather stick with the good old NHS.
Perhaps the entire point is that the French are laid back.
Excellent point Neal, and one that would certainly sit well with HPA-axis dysfunction hypothesis.
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