Multnomah County misleads bar owners

As a follow-up to my article in yesterday’s Oregonian about the failed attempt to include e-cigarettes in the state’s smoking ban, today I’m posting a memo Multnomah County officials have sent to local bars and restaurants. In it, they mislead business owners about the dangers of e-cigarettes, telling them:

State law does not currently prevent the use of e-cigs; however business owners are encouraged to include e-cigs in no-smoking policies. E-cigs pose serious health risks and challenges to enforcement of the Smokefree Workplace Law as it appears people are smoking indoors.

The letter then recommends that businesses include e-cigarettes in their no-smoking policies, adopt completely smokefree outdoor dining areas, and adopt a completely tobacco-free policy for their entire properties. (Here’s a PDF of the memo.)

There are valid reasons why a bar or restaurants might ban the use of e-cigs, such as the fact that some guests find them annoying. But county officials’ claim that the devices pose “serious health risks” is completely unsubstantiated. There’s not even much evidence that e-cigarettes are dangerous for users, much less for bystanders exposed to vapor secondhand.

There have been two recent studies on exposure to e-cigarettes in realistic indoor conditions. They are summarized here and here. Conclusion of the first:

… the quality and quantity of chemicals released in the environment [by vaping] are by far less harmful for the human health compared to regular tobacco cigarettes. Evaporation instead of burning, absence of several harmful chemicals from the liquids and absence of sidestream smoking from the use of the e-CIG are probable reasons for the difference in results.

And the second:

The study showed that e-cigarettes are a source of secondhand exposure to nicotine but not to combustion toxicants… Using an e-cigarette in indoor environments may involuntarily expose nonusers to nicotine but not to toxic tobacco-specific combustion products.

Even in the case of nicotine, exposure from real cigarettes was ten times higher than that from e-cigarettes.

Those are studies of indoor use. Multnomah County’s advice is to ban them outdoors too. The idea that indoor e-cigarette use could be harmful to bystanders is at least worthy of investigation, although the evidence so far is that it’s nothing to worry about. The idea that outdoor use presents serious health risks is wildly implausible.

This is yet another example of how the crusade against e-cigarettes is driven by unscientific alarmism rather than any empirical evidence of danger. County officials have shown that they have no credibility on the issue by misleading local business owners about the alleged risks.

Oregon’s war on vaping

The Oregon legislature recently failed to pass completely sensible restrictions on selling e-cigarettes to minor, an effort undermined by more extreme anti-smokers who were more intent on banning vaping in workplaces, bars, and restaurants. In today’s Oregonian, I write about lawmakers’ misguided attempt to include e-cigarettes in the smoking ban and their next proposal to impose new taxes on them. An excerpt:

I never thought I’d say this, but I’m actually getting nostalgic for the original smoking ban debate. Advocates exaggerated the dangers of secondhand smoke, but at least they made an effort to ground their views in science and demonstrate that non-smokers were being harmed.

The same cannot be said for those seeking to extend current bans to cover vaping. They’ll be the first to tell you that more study of e-cigarettes is needed. But why wait for results? They’re ready to ban first and ask questions later.

Read the whole thing here.

How grilling meat really is like a smoking a cigar

In his “Explainer” column at Slate yesterday, Brian Palmer raised alarm about grilled and smoked meats, suggesting that by eating them we may be, as the headline puts it, “Cooking Up Cancer”:

A growing body of research suggests that cooking meats over a flame is linked to cancer. Combusting wood, gas, or charcoal emits chemicals known as polycyclic aromatic hydrocarbons. Exposure to these so-called PAHs is known to cause skin, liver, stomach, and several other types of cancer in lab animals. Epidemiological studies link occupational exposure to PAHs to cancer in humans. When PAHs from a flame mingle with nitrogen, say from a slab of meat, they can form nitrated PAHs, or NPAHs. NPAHs are even more carcinogenic than PAHs in laboratory experiments. The reasonable conclusion is that grilling meat may be hazardous to your health.

The evidence linking cancer to cooking meat over a combustion source has been accumulating for decades. Epidemiologists first noticed a connection between the consumption of smoked foods and stomach cancer in the 1960s. Japan, Russia, and Eastern Europe, where smoking is a popular way to preserve meat and fish, became laboratories for gastric cancer research. Newer studies suggest that eating smoked meats may lead to cancer even outside the gastrointestinal tract. A 2012 study, for example, linked smoked meat consumption with breast cancer.

Palmer then compares current attitudes toward grilled meats to outdated acceptance of tobacco use:

In the mid- to late-19th century, doctors determined that lip and tongue cancer rates were higher among smokers of pipes and cigars. Despite this link, major medical journals mocked those who opposed smoking. The Lancet, the leading journal of the time and still one of the most important medical journals in the world, wrote in 1879, “We have no sympathy with prejudices against … tobacco, used under proper restriction as to the time and amount of the consumption. … A cigar when the mood and the circumstances are propitious [is] not only to be tolerated, but approved.” Moderation, not abstinence, was the order of the day.

[...]

It wasn’t until 1964 that the Report of the Surgeon General finally and firmly declared that smoking was indisputably linked to the surge in lung cancer. By that time, epidemiologists had a complete picture of the long-term effects of the increase in cigarette smoking that began around the time of World War I. The conclusions practically drew themselves. Still, it took the public health community decades to agree that smoking in moderation is a terrible idea.

I learned of the article from my friend Jeff Woodhead on Twitter, who took Palmer to task for sensationalizing the dangers of grilling and noted that habitual cigarette use carries far greater risks than exposure to charred meat. I don’t disagree. However I want to defend Palmer on one point. He is actually correct to compare grilling meats to smoking tobacco, though not in the way he realizes.

That pack-a-day consumption of cigarettes greatly elevates one’s risk of lung cancer is no longer disputed by any sensible person. Moderate use of other forms of tobacco, in contrast, carries much less danger. The Lancet article that Palmer mocks for suggesting that moderation in tobacco use is nothing to worry about overstates the case but was not too far from the truth.

Just how dangerous is it to enjoy an occasional cigar “when the mood and the circumstances are propitious?” A study in Preventive Medicine compared rates of lung cancer among smokers of various kinds of tobacco to those of non-smokers. Cigarette smokers were 16 times more likely than never smokers to get lung cancer. Smokers of cigars only, pipes only, and cigars and pipes all fared much better. Further, lung cancer among pipe and cigar smokers was concentrated among those who were the heaviest consumers. “Among pipe and/or cigar smokers only, patients with lung cancer were more likely than controls to have been long-time smokers of 5 or more cigars or 5 or more pipefuls per day and to have inhaled. The odds ratio for those smoking 5 to 9 cigars or pipes per day was 3.2 and for those smoking 10 or more units 6.7. The odds ratio of those cigar or pipe smokers who inhaled was 12.3.”

A cohort study published in The New England Journal of Medicine followed about 17,000 men enrolled in Kaiser Permanente health plans who reported never smoking pipes or cigarettes. Over a course of more than 20 years, the study compared health outcomes for non-smokers and smokers of cigars. Cigar smokers carried a relative risk of cancer in the aerodigestive tract of 2.02 and in the lungs of 2.14.

A third study in BMJ examined the risks of dying from three smoking-related diseases among former cigarette smokers who had switched to smoking pipes or cigars. Their mortality risk relative to users of pipes and cigars who were never cigarette smokers was 1.51. To put that in perspective, their relative risk compared to people who had never smoked at all was 1.68. In other words, the study found that even former cigarette smokers who switch to pipes and cigars lowered their mortality risk to a level not much above that of never smokers.

Brad Rodu, an advocate of harm reduction approaches in tobacco control, summarizes many of these risks. What it basically comes do is this: Cigarettes are uniquely dangerous because they are inhaled directly into the lungs and are very addictive. Other forms of tobacco that are mainly enjoyed in the mouth and lend themselves less easily to habitual consumption are significantly less dangerous. The risks are real, but much, much lower than those associated with cigarettes.

How does all of this compare to eating meat? Palmer doesn’t cite many sources that specify the dangers, but one study he links to does associate consumption of smoked meat with breast cancer. It finds an adjusted odds ratio of 2.31-3.13. If that’s accurate (and it may be on the high side), then eating lots of grilled meat may actually be a lot like enjoying an occasional cigar — which is to say that it’s a reasonable choice many adults may decide to make.

(Note: Some of the studies cited in this post use relative risk while others use odds ratios. These are not identical measures but should be roughly comparable.)

It’s also interesting to ask how this compares to the dangers of exposure to secondhand tobacco smoke. Smoking bans have proliferated on the justification that workers should not be put at risk. Whatever one’s opinion of these policies, consider the findings from the landmark 2006 report from the Surgeon General. The report concludes without equivocation that environmental tobacco smoke increases the risk of lung cancer in non-smokers. By how much? The reports’ table of meta-analyses of studies estimates relative risks of exposure at home for non-smoking spouses or at work for non-smoking employees in a range of 1.12 at the low end to 1.43 on the high end. Those are low relative risks! If they are enough to justify comprehensive bans on indoor smoking — not to mention the outdooor bans that are now so popular — then one may well question the ethics of allowing restaurant cooks to expose themselves to grill smoke on our behalf.

One of the big problems with reporting on cancer is that it focuses on the wrong question. Journalists ask, “Does X increase the risk of cancer?” The answer is very often yes, but they don’t follow-up with, “By how much?” Lifestyle choices carry trade-offs and better reporting would help readers put them into perspective. Palmer, to his credit, does write that the “risk-reward equation for smoking differs from that of grilling or frying meat” and acknowledges that the epidemiology on the latter is not yet clearly established. His mistake is to carelessly lump all forms of tobacco use into one, ignoring the fact that different types and different use patterns carry substantially different levels of risk.

Of course, few yet advocate completely giving up grilled or smoked meat, much less passing legislation to restrict it. “Everything in moderation,” said one of the toxicologists quoted in the Slate article. One assumes that the toxicologist’s definition of “everything” doesn’t include tobacco, because who would say that these days? But Palmer’s comparison of grilling to smoking isn’t crazy. It just tells us a lot more about contemporary bias against tobacco use than it does about the dangers of meat.

DC wants to ban e-cigs in bars

People in DC bars are “vaping,” or using electronic cigarettes, indoors. A couple members of the DC city council — Yvette M. Alexander and David Grosso — have introduced a bill to include e-cigarettes in the city’s smoking ban:

In an interview, Alexander said e-cigarettes are being “used to usurp the smoking ban.”

“It is smoking, is an inhalant and it’s similar to smoking,” said Alexander, chairwoman of the Health Committee. “We don’t know what the ill effects of this are, and it’s still a bother to some people.”

“Similar to smoking” and “a bother.” Time was city officials at least made a show of finding evidence of harm before imposing bans. E-cigarettes may be annoying to other patrons, but there’s no evidence or reason to believe that secondhand vapor (is that a thing now?) is something to fear. And to point out the obvious, bar and restaurant owners are perfectly free to set their own policies if guests prefer to avoid it.

California brings smoking ban inside the home

It was only a matter of time:

Millions of Californians would not be able to smoke tobacco inside their own homes under new legislation that would raise the bar nationwide for fighting secondhand smoke.

No state ever has ventured into personal bedrooms and living rooms with its smoking restrictions, but California is going even further than that by targeting owner-occupied residences as well as rental units.

Specifically, the measure would prohibit lighting up a cigarette, cigar or pipe in condominiums, duplexes and apartment units. [...]

Levine’s bill would permit outdoor smoking near apartments or condos, but only in a clearly marked area that is at least 20 feet from any housing unit and 100 feet from a playground, school or pool.

Who could have predicted that ignoring property rights and letting bad science go unchallenged would lead to this?

Reform Oregon’s smoking ban

An Oregonian editorial last week was refreshingly libertarian, calling for same-sex marriage, tuition equity for some undocumented immigrants, restraint on gun control, and even opposition to the state’s smoking ban. I sent in a letter about the last item, which they published today:

The Jan. 12 libertarian-leaning editorial “Protect and expand personal freedom: Agenda 2013″ was a breath of fresh air, especially in regard to our state’s excessively stringent smoking ban.

Current law makes few exceptions for businesses that cater to smokers, making it essentially illegal for entrepreneurs to open new cigar bars or smoking lounges even in stand-alone tobacco shops. Regardless of whether one supports a broad smoking ban, it’s difficult to justify forbidding these businesses to open.

Sensible reform would replace the current exemptions, which apply only to venues that have been grandfathered in, with objective guidelines that would allow both existing and aspiring business owners to offer smokers an indoor refuge.

As I reported in the Oregonian in 2011, the promised decline in heart attacks that the smoking ban was supposed to usher in never developed.

Save the stogies

My forthcoming article that I’ve alluded to a couple times this week is now up at The Atlantic:

If a time traveler from the early 1990s were to arrive in the U.S. bars and restaurants of today, what would notice first? Perhaps that the food has become more interesting and varied, or that a perplexing number of diners are photographing it with their remarkable phones. The most obvious change, however, might register on the nose: the nearly complete absence of indoor smoking.

California implemented the United States’ first modern statewide smoking ban in 1998. Today twenty-nine states and 703 municipalities require bars and restaurants to be smoke-free, according to data maintained by the Americans for Nonsmokers’ Rights Foundation (North Dakota brought the tally to thirty states this month). Tobacco use has been banished from our culinary radar along with the question “smoking or non?” Most of us don’t miss it. Yet as a slew of new bans, taxes, and regulations drive smoking to the peripheries of society, it’s worth giving tobacco another look.

Read the whole thing. And for more context on some of the arguments, see my recent posts about the effects of new tobacco taxes and the failure of the FDA to establish an effective regulatory regime.

Quote of the day

Julien Guttman on the forthcoming outdoor smoking ban at George Washington University:

“We’re trying not to use the word ban,” says Julien Guttman, of the GW campus advocacy group Colonials for Clean Air. “We encourage people to talk about a smoke-free campus rather than a ban on smoking.”

This is the same Julien Guttman who lamented a couple weeks ago, “No matter how much science we have to back up what we are saying, there will always be individuals who see this as a restriction on their freedom.” Perhaps it’s a sign of progress that she feels the need to resort to such euphemism when defending the policy.

A bit more on the shaky science behind outdoor smoking bans here.

Where to smoke in Portland

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Today at Drink Portland, I’ve posted a guide to the city’s few remaining cigar bars. There are only eight of them, so click through if you’re looking for a place to escape the rain with a cigar and a drink. Since Oregon’s smoking ban only exempts bars that can demonstrate cigar sales from 2006, it’s essentially illegal to open a new cigar bar. These eight are all we have and all there will be. An update to the law a couple years later also capped the number of tobacco shops that can allow smoking.

Ban advocates predicted that Oregon’s law would drastically reduce the rate of heart attacks in the state. As I noted in the Oregonian, that never came to pass.

Pre-ban, my favorite place to have a cigar in Oregon was the Horse Brass Pub. My ode the Horse Brass is here. It’s still a great bar, but you can’t light up there anymore.

“No safe level,” continued…

The idea that there is “no safe level of exposure to secondhand smoke” has to be one of the most misleading statements in public health. I mentioned it in a story about campus smoking bans yesterday. It pops up again today in a blog post about airport smoking areas at The New York Times by Nicholas Bakalar:

Five large-hub airports in the United States have designated indoor smoking areas. According to a study from the Centers for Disease Control and Prevention, they all have unhealthy air — even in places where no one smokes. [...]

The researchers found that the pollution level in smoking areas of the five airports was 23 times as high as the level in nonsmoking airports, and the average in adjacent areas was five times as high.

The study, in the Nov. 20 issue of the Morbidity and Mortality Weekly Report, notes that no level of secondhand smoke exposure is safe, and even brief exposures can have adverse cardiovascular and respiratory effects.

Notice how much work the “no safe level” line is doing here. It allows the researchers to abdicate responsibility for showing that levels of particulate matter in the air surrounding smoking lounges are causing any actual harm. They have no need to relate this minuscule level of exposure to a level of risk — because, in fact, doing so is likely beyond epidemiology when the risks are this small, if they exist at all. As Jacob Sullum noted in 2006 when Richard Carmona’s Surgeon General’s report came out, the science in the report is much more modest than the “no safe level” hype that accompanied it:

Since it is difficult even to measure the health consequences of long-term, relatively intense exposure to secondhand smoke among people living with smokers for decades, how could one possibly demonstrate an effect from, say, a few molecules? It’s clear that the vast majority of people exposed to secondhand smoke suffer no noticeable injury, so in what sense is their exposure unsafe? “No safe level” is an article of faith, not a scientific statement.

And yet, unfortunately, the “no safe level” idea continues to be used as an easy shortcut by researchers — and then dutifully transcribed by health reporters.

Banned on campus

One of the quiet ways smoking bans have spread across the United States is via bans on college campuses:

Colleges and universities have become the latest target of anti-smoking groups. While schools have long banned smoking indoors, the new bans are addressing outdoor space.

So far, more than 800 schools have banned smoking on campus, according to the American Nonsmokers’ Rights Foundation. The list is dominated by medical schools and non-residential community colleges, although more and more residential colleges and universities are joining.

Encouraging schools to go smokefree is now official policy of the Department of Health and Human Services, which recently launched an initiative in collaboration with the University of Michigan to encourage campus bans on campus. The bans apply outdoors, which is a major inconvenience to smokers on sprawling campuses, potentially driving students to less safe perimeters. The measures are supposedly important for creating a healthy environment. Unfortunately, they seem to also create an environment of self-righteous attitudes and bad science:

“The CDC and surgeon general say there is no safe level of exposure to second-hand smoke,” said Julien Guttman, a GWU public health graduate student who is part of the advocacy group Colonials for Clean Air. “No matter how much science we have to back up what we are saying, there will always be individuals who see this as a restriction on their freedom.”

Those crazy individuals! The idea that there is “no safe level of exposure to second-hand smoke” is itself unscientific, a line of propaganda devoid of any measurement or relation of exposure to risk. If taken literally it would lead to absurdities like… well, like banning smoking in wide-open expanses of outdoor space.

Too hot for North Dakota

North Dakota, rugged North Dakota. Now home to one of the most restrictive smoking bans in the country:

Measure 4 bans smoking in places where North Dakota state law previously allowed for it, including bars, tobacco shops, taxis, motel rooms and private nursing home rooms.

The ban also requires smokers to be at least 20 feet away from buildings. Tobacco-less e-cigarettes are also included in the ban.

Violators could be fined $50, and bars that still allow smoking could be subject to having their liquor license revoked.

North Dakota will be the 30th state to implement a smoking ban in bars and restaurants, but few are this restrictive. The impact on cigar bars and tobacco shops could be devastating, as Stogie Guys reports.

This is speculative, but I imagine that the average North Dakota resident is not so intolerant as to object to smoking in these specialized businesses. However the anti-smoking groups who pushed this initiative didn’t give them the option to allow exceptions, forcing voters to choose between all or nothing.

Cigars for me but not for thee

The city of St. Louis implemented a smoking ban on January 1, 2011. There’s one place, however, where people still smoke with impunity:

The 109-year-old downtown Missouri Athletic Club may wriggle free from the city’s smoking ban.
City officials have prepared an agreement which exempts the private, invitation-only establishment — long frequented by judges, attorneys and politicians — from the municipal no-smoking ordinance.

The club, known as the MAC, has flouted the law since it was enacted Jan. 1, 2011, openly leaving ashtrays in the lounge, hosting hazy boxing matches and allowing men in suits to gather weekly at the bar with tumblers in one hand, cigars in the other.

The city cited and fined the club twice. The citations ended up in municipal court, where attorneys began working out a deal.

On Thursday, city Health Director Pam Walker presented a draft agreement to her advisory commission, the Joint Boards of Health and Hospitals, arguing that the nonprofit MAC is a unique entity, governed neither by rules for private clubs nor by those for businesses.

Hat tip to Michael Siegel, who inducts St. Louis health director Pam Walker into his Colonel Benjamin Church Hypocrisy Hall of Shame for carving out this exemption for local elites.

St. Louis isn’t the first city to engage in this kind of smoking ban favoritism. In Washington, DC, city councilman Jack Evans voted in favor of the District’s smoking ban, then took advantage of his position on the council to create special exemptions for organizations he likes:

The city’s smoke-free law provides an economic hardship waiver for struggling bars and restaurants, Evans said, but it leaves no wiggle room for a single event, like the St. Patrick’s Day gala or Fight Night at the Washington Hilton.

“Once a year, 1,000-plus people go there to drink Irish whiskey, smoke cigars and have dinner,” Evans said of the dinner. “Now they’re not allowed to do that. From my reading of the law there’s no other way to get an exemption but to legislate.”

Evans has continued to seek these one-time exemptions while leaving less connected charities who’d like to host cigar events out of luck.

As I wrote in 2009:

Evans has discovered the pain of having one’s treasured tradition banned by a bunch of meddling bureaucrats. I’d be sympathetic if not for the fact that Evans is one of those meddling bureaucrats. If he doesn’t like the law, he should introduce changes that open up smoking venues to everyone, not just to clubs that happen to have a city councilman in their membership.

Smoking: More than just a vice

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Something Not Unlike Research” is a health care blog I recently came across written by two university professors. One of them, Bill Gardner, wrote this week in defense of employers choosing not to hire smokers. He concluding by noting that “Smoking is a vice that benefits no one.” I took him to task for this last line on Twitter:

“Smoking is a vice that benefits no one.” — @Bill_Gardner Oh please. I like it. It benefits me! Arrogant assumption.

To my surprise, he responded in a new post:

My point is that I do not see a compelling argument against employers choosing not to hire them. By extension, we should have no public policies protecting access to employment for smokers (or bone lugers). This is, I believe, consistent with Mill’s view that

The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant.

I do want to see smoking go away, and I think social pressure is what makes that happen. (“Social pressure” is not, I think what Mill means by “exercising power”.) To that end, I think it is legitimate to ban smoking in public places, and for employers to refuse to hire smokers if they judge that to be in the interest of their firms.

Having conceded that smoking may benefit Jacob’s subjective well-being, can I still say that “smoking is a vice that benefits no one”? I certainly can, if it’s understood that benefit refers to the long-term well-being of smokers, and those who depend upon them, rather than immediate subjective well-being. In that sense of benefit, there is nothing to be said for smoking or binge drinking.

(NB: The binge drinking reference is about the bone luge, which happened to be the top post on my site when he visited. The photo definitely makes his post more awesome but I’ll stick to the smoking discussion!)

I’ll elaborate in more than the 140 characters allowed by Twitter. To start, I agree with Bill that smokers shouldn’t be a protected class of worker. I think refusing to hire smokers is generally a silly policy but that’s something the market can sort out. Where we disagree is in our assessment of smoking. He says that smoking is “a vice that benefits no one” in the long term, that “there is nothing to be said for smoking,” and that “I do want to see smoking go away.”

I know where he’s coming from because I used to make the same assumptions. I grew up believing everything bad about smoking and made it through high school and college without taking a single puff from a cigarette. My interest in tobacco began shortly after I started working as a barista. In conversation with a cigar-smoking friend, I realized that he talked about his stogies the same way I talked about coffee. The varietal of the plant and the origin of the leaf mattered, a Cameroon wrapper tasting differently than one from Nicaragua. Flavors ranged from light sun-grown tobacco to deep, dark maduro, much as coffee roasts came on a spectrum from light to dark. And he suggested that there was just as much difference between the hand-rolled cigars he was smoking and the mass produced cigarettes of Big Tobacco as there was between Folgers and the small batch beans I brewed.

Perhaps, I thought, there was more to tobacco than I realized. When I eventually tried a cigar for the first time I took to it at once. Doing that required getting over my own prejudices that had led to me viewing smoking as pure vice, an unhealthy and addictive habit without redeeming qualities.

I am not addicted to tobacco. I go weeks and months without it. Of the three mood-enhancing drugs I enjoy — caffeine, alcohol, and nicotine — the last would be by far the easiest to never again partake of. It’s unlikely that my occasional indulgence in a cigar will have any significant effects on my health, though there is a small chance that it will. In exchange cigars have given me wonderful experiences, both in taste and in the friendships that have deepened over contemplative, smoke-fueled conversations. I expect that cigars are a net benefit in my life on both the short and the long view. Perhaps additional evidence could persuade me otherwise, but it can’t simply be assumed that I’m mistaken.

Admittedly I don’t fit the median profile of a smoker. However the value that smokers get out of smoking is almost never acknowledged by anti-smoking activists, who treat smoking as inherently wrong. Unlike them, and perhaps unlike Bill, I don’t want to see a completely smoke-free America. I want to see smoking substantially reduced. I’d like for people to smoke less and smoke better, using products other than cigarettes, which seem to be the most dangerous form of tobacco. (It’s also worth noting that the employment policies that inspired these posts are enforced via urine tests for nicotine, which wouldn’t discriminate between pack-a-day smokers and those who smoke rarely or those who are trying to quit with the aid of nicotine patches or gums.)

Semantics aside, activists’ unwillingness to consider the benefits of smoking leads to excessively restrictive policies. Let’s take smoking bans for example. Consider two businesses:

Business 1 is a tobacco shop with an attached lounge that offers beer and wine. Customers are allowed to smoke there. It’s a freestanding building with no immediate neighbors, so no one except customers and employees is affected by the smoking. Four people are employed serving drinks in the lounge. A smoking ban passes that forces the business to eliminate drink service. The day the ban takes effect those four employees lose their jobs.

Business 2 is a restaurant that serves Dungeness crab caught in the Pacific Northwest. Commercial fishing has one of the highest fatality rates of any occupation and crabbing in this region is often the highest of all. For comparison, the average annual fatality rate for all occupations is 4 per 100,000 workers. For fishing as a whole the rate is 115/100,000. For Dungeness crab fishermen in the Pacific Northwest the rate is 463/100,000. (Source here.) There are no proposals to forbid restaurants from serving Dungeness crab.

The comparison might seem silly, but why? Dungeness crab is delicious but it’s hardly a staple in the food supply. Fishermen are literally dying to put it on our plates. Though the level of risk associated with secondhand smoke exposure is in dispute, it would be astonishing if the danger of pouring beer in a smoky room was at all comparable to crabbing on a stormy ocean. So again, why the disparity in how we treat these workers?

The number of actual deaths resulting from Dungeness crabbing is low since it’s a small industry, but it provides a model for how we normally regulate occupational risk. We don’t ban dangerous jobs, we try to discover reasonable rules to make them safer. Safety regulations have apparently been successful in reducing the fatality rate among Alaskan Dungeness fishermen.

Let’s accept for the sake of argument that banning smoking in some places to protect patrons and employees is justified under Mill’s proviso. It’s much harder to argue that smoke-friendly businesses should be banned entirely. Our normal approach to worker safety would allow people to work in smoking venues, subject to reasonable rules about ventilation to minimize risk.

Yet exceptions to smoking bans are often unreasonably narrow, preventing consenting adults from making free exchanges with each other. This is because policy makers view smoking as inherently without value. The thought process goes something like this:

1) Smoking has no value.

2) Protecting workers has value.

3) Therefore it’s OK to ban smoking everywhere without worrying about smokers’ preferences.

This is why I vehemently object to statements such as Bill’s. They create an environment in which the rights of smokers, business owners, and workers are too easily violated. I’ve seen too many of my favorite places completely altered by smoking bans, to the dismay of owners, patrons, and employees. See my ode to one of them, the Horse Brass, in DoubleThink magazine. Business 1 above is another example; it’s an actual establishment outside of Portland.

In sketch form, here are two other arguments for how ignoring the benefits of smoking skews our thinking and leads to bad policy.

Electronic cigarettes — The view of many in tobacco control is that tobacco is inherently bad and that quitting should be smokers’ only goal. It would undeniably be a good thing if more smokers quit, but the obvious truth is that quitting is difficult and relapse is frequent. A new study concludes that even with increased use of nicotine replacement therapy and quitlines, the rate of successful cessation has remained unchanged.

E-cigarettes are a promising alternative for smokers who find it difficult to quit. They are undoubtedly safer than actual cigarettes and offer a substantial opportunity for harm reduction, whether used to quit entirely or just to reduce use of real tobacco. Their popularity is likely due in part to their similarity to cigarettes: their appearance, the ritual of lighting them up, the ability to manage nicotine levels through their use. They deliver many of the same benefits smokers’ get from cigarettes at a fraction of the health cost. Yet precisely for this reason they are treated with outright hostility by many in tobacco control, who blind themselves to e-cigarettes’ potential because of their puritanical view of smoking — including acts that mimic smoking — as inherently bad.

Flavored cigarettes — The legislation giving the FDA regulatory authority over tobacco included a ban on all flavorings except for menthol. The reprieve for menthol may only be temporary. Flavors are treated as dangerous additives but they’re essentially being banned because they make smoking more appealing and enjoyable. This is pure paternalism. If a consenting adult wants to have a clove cigarette, he should be allowed to buy a clove cigarette.

The preferences of smokers were never given a voice in this debate. Because smoking was simply assumed to have no value, smokers were dismissed as addicts who could only benefit from this legislation. Perversely, those of us who support consumer choice on menthol are accused of racism since menthol cigarettes are popular among African-Americans. It’s unclear at this point how FDA regulation may affect more artisanal forms of tobacco, but the industry is understandably worried: If the agency views tobacco as inherently bad, it’s unlikely to pass regulations in the interest of pipe and cigar consumers.

The costs of smoking are undeniably high, yet smoking has persisted even in the face of penalties as harsh as death. The habit is here to stay. Unfortunately, smoking has become synonymous with Big Tobacco and the lowly, lethal cigarette. There is much more to it than that, and more to say on its half behalf. But that will have to wait for a future post.

Two more heart attack studies

As an addendum to the previous post, I should mention two more recent studies of smoking bans and heart attack rates. The first, from Brad Rodu, Nicholas Peiper and Philip Cole, published a couple months ago in Journal of Community Health, examines rates in six states and finds no effect:

The AMI mortality rate among persons age 45 + years (deaths per 100,000 persons, age-standardized to the 2000 US population) in the 3 years before adoption of the smoke-free ordinance (the expected rate) was compared with the rate observed in the first full year after the ban (the target year) in six US states. Target-year declines were also compared to those in states without smoking bans. Target-year declines in AMI mortality in California (2.0%), Utah (7.7%) and Delaware (8.1%) were not significantly different from the expected declines (P = 0.16, 0.43 and 0.89, respectively). In South Dakota AMI mortality increased 8.9% in the target year (P = 0.007). Both a 9% decline in Florida and a 12% decline in New York in the 2004 target year exceeded the expected declines (P = 0.04 and P < 0.0002, respectively) but were not significantly different (P = 0.55 and 0.08, respectively) from the 9.8% decline that year in the 44 states without bans. Smoke-free ordinances provide a healthy indoor environment, but their implementation in six states had little or no immediate measurable effect on AMI mortality.

The second unpublished study [pdf] looks at rates in 74 US cities that implemented smoking bans. It finds a decline of a mere 3% following implementation. Contrary to expectation, the effect disappears entirely when restricted to the 43 cities whose bans were meaningful. All things considered, it lends support to the idea that smoking bans have no short-term impact on heart attack rates.

[Thanks to Chris Snowdon and Michael McFadden for the links.]

Two years later, no heart miracle in Oregon

I have an op/ed up today at The Oregonian addressing the question, “Whatever happened to Oregon’s heart miracle?” Oregon’s statewide smoking ban took effect in 2009 and was predicted by many advocates to result in a steep decline in the rate of heart attacks of 17% or more. I contacted the Oregon Public Health Division to see if hospital data bore this out. Unsurprisingly, it didn’t.

For those who are curious, here is the age-adjusted rate of heart attack admissions for Oregon as provided to me by the state, with percentage change from the previous year in parenthesis:

2003 198.4
2004 181.2 (8.67)
2005 166.8 (7.95)
2006 166.6 (0.12)
2007 163.4 (1.92)
2008 152.5 (6.67)
2009 141.5 (7.21)
2010 137.1 (3.11)

And here is the same data in graph form:

oregonami

As I explain in the op/ed, the drop in 2009 is on trend with those in previous years and can’t be reasonably attributed to the smoking ban, and even under the rosiest interpretation it is still less than half of what ban advocates predicted.

The task of explaining this discrepancy fell to Ty Gluckman, director of clinical excellence for Providence Heart and Vascular Institute. It was Gluckman who wrote in 2009 that “[...] it’s highly likely that Oregon’s heart attack rates are already dropping as we near the law’s one-year anniversary. If we reduce the number of acute heart attacks by 17 percent, there will be at least 1,100 fewer hospital admissions in Oregon in just one year.” I said at the time that there was no way this was going to happen. You can read his entire response here.

Undaunted by contrary data, Gluckman suggests that Oregon’s less than stunning decline in heart attacks is due to two factors. One is that many bars were already banning smoking voluntarily before the ban. Another is that over this same period Oregonians were becoming more obese. However these confounding factors hold to some extent just about everywhere, which is why the only way to test the impact of bans is by 1) looking for increased rates of decline after implementation and 2) comparing these results with control populations that were not under a ban. This is essentially the method of the RAND study cited in my article, which found no impact.

The story in Oregon is consistent with that of other large populations that experienced no noticeable decline in heart attack rates following implementation of a smoking ban. See for example this New Zealand study, omitted from the meta-analysis Gluckman cites, or the publicly available data from many national governments.

Today’s article is my third Oregonian contribution on the subject of the state smoking ban. In 2008 I argued that the ban wasn’t actually about saving lives. In 2009 I argued that the its exemptions were unduly restrictive. Finally, also in 2009, I wrote for Doublethink about the last night of legal smoking at my favorite cigar hangout, the legendary Horse Brass pub.

No new smoking lounges in Oregon

Are you an entrepreneur wanting to open a new smoking lounge in Oregon? Too bad, that’s about to become illegal:

By the slenderest of margins, the Oregon House gave final legislative approval Wednesday to a bill aimed at preventing more hookah lounges from opening across the state.

The bill now heads to the desk of Gov. John Kitzhaber, who has said he will sign it.

The bill grandfathers in existing smoke shops and ones that apply for certification before the law takes effect. But after that, new smoke shops will face tight restrictions, including a ban on allowing customers to consume food or beverages, a maximum seating capacity of four people, and a requirement that at least 75% of sales be for off-premise consumption. On-premise smoking will be allowed strictly for the purpose of sampling.

Although the press and sponsors of the bill portrayed this law as anti-hookah, it makes no distinction between hookah lounges and cigar shops. Thus there will be no new cigar shops of the type that offer communal seating areas and lounges for their customers.

The smoking ban that took effect in 2009 restricts cigar bars as well; it allows exemptions only for businesses with tobacco sales records dating back to 2006, so it’s essentially impossible to open a new cigar bar either. The smoking lounges we have now or that will open very soon are all we’re going to get.

There is one silver lining to the bill: A couple senate amendments slightly weakened the final version of the law over the strong objections of sponsor and nanny statist Rep. Carolyn Tomei. It slightly lifts my spirits to know that she is unhappy.

Previously:
Save Oregon’s smoke shops
Oregon’s smoking ban creep
Where there’s smoke, there’s over-regulation