Smoking: More than just a vice

horsebrass 021

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:


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.

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


Writing at Blue Oregon

I have a post up today at Blue Oregon, a leading progressive site in Oregon that aims to foster “a wide range of voices – from urban sophisticates to gun-truck-and-dog Democrats; from radical vegetarian leftists to cranky government skeptics.” My post is about the previously mentioned proposal to ban smoking in tobacco shops and hookah lounges. Judging from the comments so far, the site’s readership loses tolerance when it comes to consenting adults enjoying tobacco together indoors. However I’m glad to for the opportunity to write there, and perhaps additional attempts at liberaltarian fusion will be more fruitful.


Smoking debate in Louisiana

I’m interviewed in a solid article in the Gambit about the effort to extend Louisiana’s smoking ban to bars and casinos. Of interest is this bit about how the market is providing the smoke-free venues consumers demand:

The campaign frequently partners with music venues to host a night of smoke-free music and events — and some of those venues, including d.b.a. and Tipitina’s, have made the switch to prohibit smoking in their clubs. Let’s Be Totally Clear now lists more than 30 New Orleans bars and venues in its smoke-free directory, from AllWays Lounge on St. Claude Avenue, to Chickie Wah Wah in Mid-City, to Maison on Frenchmen Street and Cure on Freret Street. This year, the directory added both d.b.a. and the bar at the Columns Hotel to its list of smoking-prohibited venues. Contreras says the number of smoke-free clubs in the city has doubled since 2009.

Republic made the switch in spring 2007, more than a year after it opened, and offers a smoking patio adjacent to the club’s main floor. Owner Robert LeBlanc’s other ventures like Capdeville, loa and LePhare also prohibit smoking. LeBlanc says the venues went smoke-free to protect employees, who LeBlanc says were formerly surrounded by “heavy, heavy smoke clouds,” though he admits he was “tepid” about the decision at the beginning.

“We have a pretty young workforce, so it’s not like we saw a lot of ill effects,” he says. “It’s just one of those things you just kind of see in the future — it’s not going to end well.” LeBlanc also works closely with TFL and says he is “very supportive in telling people the benefits in our experience, being candid and opening the books, for what we went through” making the switch.

But — surprise — LeBlanc wouldn’t support a ban.

“Bar owners and restaurant owners should have choices,” he says. “I’m not in favor of forcing people to do something against their will with blanket legislation.”

My only quibble with the article is that it doesn’t provide any rebuttal to overhyped claims of secondhand smoke’s dangers. Evidence to the contrary continues to go unreported. But overall, a really good piece.


Are smoking licenses the future?

These are bad times for smokers, but there is one bright spot. Bills in Washington would create new exceptions to the state’s smoking ban, arguably the strictest in the country:

Both of the introduced measures, Senate Bill 5542 and House Bill 1683, call for the establishment of a special state licensing program whereby businesses would apply to the State Liquor Control Board for endorsement as either a cigar lounge or retail tobacconist. These businesses would receive a license, which could be renewed each year, and in return, patrons could light up within these establishments.

No more than 100 lounges would be licensed as a cigar lounge at $15,000 per year. Up to 500 businesses, each paying a fee of $5,000 per year, could receive a retail tobacco license.

Business owners shouldn’t have to pay tribute to the state in order to allow smoking on their own property. But it’s better than nothing, and with cash-strapped legislatures looking for new ways to raise revenue this could be a good way to take back some of the ground lost to smoking bans.

Last year the Tacoma restaurant El Gaucho spent thousands of dollars building a 25 foot airlock to separate its cigar lounge from the rest of the property. The state ruled that even this was not sufficient to comply with Washington’s smoking ban.


Oregon’s smoking ban creep

I became aware today of a nasty new bill currently before the Oregon legislature. Since the state’s smoking took effect in 2009, only two types of businesses have been allowed to let their patrons smoke. The first is cigar bars, which can only allow patrons to smoke cigars, must have proof of tobacco sales from 2006, and must have a full on-premise liquor license, among other requirements. The second is smoke shops, which can allow their patrons to smoke various kinds of tobacco but can’t sell alcohol of any kind.

Predictably, a number of smoke shops have responded to the state’s comprehensive smoking ban by creating inviting spaces where smokers can light up. House Bill 2726 would drastically amend the rules for smoke shops, eliminating these lounges and possibly putting some of them out of business entirely. The bill would require smoke shops to generate 75% of gross revenue from sales of tobacco or smoking implements intended for off-premise consumption, would forbid shops to sell, offer, or allow the consumption of food and drink of any kind, would allow a maximum seating capacity of four people, and would permit smoking only for the purpose of sampling to make retail purchase decisions.

The primary target of this bill is hookah lounges, which activists are playing up as nefarious dens designed to hook kids on candy-flavored tobacco. However there’s no language in the bill that would prevent it from affecting regular smoke shops too; the word “hookah” doesn’t even appear in the text. If this passes it will be very damaging to a number of cigar shops.

There are two forces at work here. One is the class bias that favors cigars but forbids hookahs. Cigars are stereotypically enjoyed by the affluent. Hookahs are stereotypically for the young or Middle Eastern. Of course consenting adults of all types enjoy both products, but under this bill only the former would receive legal protection.

The second force is the paternalist desire to take all the pleasure out of smoking. The original smoking ban was supposedly implemented to protect against secondhand smoke and isolate smokers into a few enclaves all to themselves. With that accomplished, activists now turn to making smoking as unpleasant an activity as possible. Closing down smoking lounges is one example of this. You see it too in the ban on flavored cigarettes, in the call to ban menthol too, or in calls to ban flavored tobacco of all kinds, including pipe tobacco, which is not exactly the rage with kids these days. Or you see it in another Oregon bill that would classify nicotine as a prescription drug, a clear way to say that tobacco is only for addicts and not for responsible enjoyment.

The Oregonian supported the original smoking ban, but to its credit the editorial board has come out against this new proposal. They also published one of my columns in 2009 calling for smarter, more liberal regulation of smoke-friendly businesses:

The Legislature should revisit the smoking ban to make its bar exemptions more reasonable. For starters, the elitist exclusion of all forms of tobacco except cigars must go; there’s no justification for privileging cigars over other ways of smoking. Requiring cigar bars to have a hard liquor license instead of just serving beer and wine doesn’t make sense either. Nor is there any reason to limit seats to 40 or forbid lottery machines. Allowing lottery games and beer and wine sales would also help bring more revenue into the suffering state treasury.

Finally, the requirement that bars must provide sales receipts from 2006 should be eliminated. The law should apply equally to established business owners and new entrepreneurs.

The sponsor of this bill is Rep. Carolyn Tomei.

Update 3/3/10:
Here’s another article on the bill from The Lund Report.


In memory of Don Younger

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Last night Portland lost one of its legendary figures, Don Younger, owner of the Horse Brass Pub. If you enjoy Oregon beer, you should raise a pint to him tonight. As a relative newcomer here the story’s not mine to tell, but suffice to say that he and his bar did a great deal to nurture the brewing community that’s made Portland justifiably famous for beer. Imbibe wrote about that history in one of their first issues. John Foyston has more in the Oregonian, and Ezra is collecting memories of Don at the New School. Many more tributes will be rolling in.

I’d read about Don and the Horse Brass before I’d moved to Portland and made a point to visit the bar on my first trip out here several years ago. When I finally did move here the Horse Brass became one of the first local bars where I felt at home. I loved beer, but it was also one of the best places to enjoy a cigar. Knowing few people in the city, it was a place I could visit anytime and strike up a conversation with whomever else was there at the end of the bar where the cigar smokers gathered. On one of these early visits Don was holding court at his usual spot, and though I didn’t meet him then I still remember the night. There was a young guy a few spots down from me nursing a beer and reading a book alone. Don called him over: “What are you doing, you don’t come to a bar to read a book!” Just like that the guy was introduced to the group and welcomed into the pub community.

A few weeks later I tried to meet Don myself. The statewide smoking ban was about to go into effect and I wanted to talk to Don for some articles I was working on. Many bar owners privately opposed the ban, but he was one of the few who actively fought against it. I had no luck getting an interview though: The bartenders informed me that Don was sick of talking to people about it. I ended up writing about the ban in the Oregonian anyway, not expecting to hear from Don. Then I saw him at the Horse Brass a few days later and introduced myself. Amazingly, he knew exactly who I was, said he loved my article, and that if he’d known who was asking for him he would have gladly talked to me. I’ve never been more flattered to find out that someone had read something I wrote. As intimidating as he was by reputation, in person he was as friendly as could be, the perfect publican.

A few months later I noticed something that cracked me up: He’d posted a clipping of the article in the hallway of the Horse Brass, right by the bathrooms, with some patron adding a graffitied mustache to my headshot. It stayed there for about a year. I may never win a Pulitzer, but how many Pulitzer winners can say they’ve had their writing displayed outside the men’s room of the Horse Brass? I’ll take it.

Unfortunately I didn’t get to know Don well after that. I spent less time at the Horse Brass after the ban, and reportedly so did he. But I do have one more story. The final night of smoking at the Horse Brass was not, in fact, the last night one could do it legally. A few days after the ban took effect Don allowed his regulars one more chance to light up in defiance of the law. Though I hadn’t arrived for this part, I’m told by others that Don called for patrons’ attention a half hour before we lit up to let everyone know what was going on. He said he knew that smoking is illegal now, but that he’d promised his friends they’d have one last session together. Anyone could leave if they wanted to, and he gave them the phone number they could call to report him, but this was going to happen. The bar burst into applause. And, of course, nobody called the number.

What a man. What a bar. Long live the Horse Brass.


We’ll always have Helena

In 2004, physicians Richard Sargent and Robert Shepard published a study making the astounding claim that a six-month ban on indoor smoking in the town of Helena, Montana resulted in an immediate 40% drop in the city’s rate of heart attacks. Ever since then it’s become sport among anti-smoking researchers to search for similar “heart miracles” in other places that have implemented smoking bans. Curiously, the miracles tend to get smaller as the populations get larger. Big effects were found in Bowling Green, Ohio and Pueblo, Colorado, but they never carried over to state or national levels. A recent examination of England’s heart attack rates could claim at best a 2.4% reduction, and that with dubious manipulation of the data.

This has led many critics to allege that the heart miracles of Helena and elsewhere are statistical flukes that emerge from small sample sizes. There is new evidence to support this view: A comprehensive study led by the RAND Corporation used data from throughout the United States to see if there is a relationship between smoking bans and rates of heart attacks. It found no statistically significant effect. Further, it found that rates in populations comparable to those cited in previous studies are highly volatile and on average cancel each other out. This suggests that the many studies claiming large effects are the result of publication bias, not actual declines caused by smoking bans.

Tobacco researcher Michael Siegel, himself a supporter of smoking bans, sums up the significance of the study:

Without a doubt, this is the most definitive study yet conducted of the short-term effects of smoking bans on cardiovascular disease.

To give you an idea of the scope of this study compared to previous ones, the Helena study involved a total of 304 heart attack admissions in one community over a period of six months. This study examined a total of 673,631 heart attack admissions and more than 2 million heart attack deaths in 467 counties across all 50 states over an 16-year period.

The case for comprehensive smoking bans leading to immediate reductions in heart attacks has never been strong and now there is substantial evidence against it. Jurisdictions that have not yet imposed smoking bans have one fewer reason to do so; those that have should restore business owners’ rights to set their own policies, as the Dutch have recently done.

I would like to think that the anti-smoking movement and press would acknowledge these findings, but I’m not optimistic. As of now a Google News search for “smoking ban RAND Corporation” yields only one result, in contrast to the dozens or more that usually follow reports of sudden declines.

An Oregon heart miracle?


A toast to the Netherlands

Today is a good day for small bars in the Netherlands:

From today smokers in Holland will be allowed to light up in small owner-operated bars that are less than 753.5 square feet in size and have no other staff.

The 280 cases currently going through court for pubs allowing people to smoke inside will be dropped.

UKIP MEP for the North West Nuttall said he was “very pleased that the Netherlands authority has allowed common sense to prevail” and relax the ban.

“We know the smoking ban has had a serious detrimental effect on pubs,” he said. “It is absolutely bonkers.

“The way the ban came in was very underhand.

“I hope the Government will take what has happened in Holland on board. I hope it will happen here.

“We should have the option for smoking rooms in the UK, it should be down to the licensee.”

You know what to do.


Sweet 21

[Originally published at the American Spectator on the 75th anniversary of the repeal of Prohibition on December 5, 2008. Happy Repeal Day!]

Seventy-five years ago today Utah ratified the 21st Amendment and brought the United States’ dark age of Prohibition to a close. The very first Repeal Day was cause for raucous celebration, but since then the anniversary has mostly languished in obscurity. This year December 5 is finally getting the attention it deserves, thanks in large part to Oregon bartender and founder of Jeffrey Morgenthaler. Tonight drinkers throughout the nation will raise a glass to freedom.

As we toast, we should also reflect on how the spirit of the Anti-Saloon League lives on in the continued growth of the nanny state. Just as the teetotalers of the previous century held governments in thrall, so today do various do-gooders persuade city councils and state legislators to restrict our choices “for our own good.”

Yesterday’s demonization of drink is reflected most clearly in today’s anti-smoking crusade. The speakeasy has been replaced by the smoke-easy as bar owners hide ashtrays from sight from meddling health inspectors. Smoking bans have gone from California oddity to standard practice, creeping to ever more absurd extremes. Outdoor bans are increasingly common, extending to wide open beaches, parks, and golf courses. Dedicated cigar bars and tobacco shops are under fire. Even the home, the last refuge for many smokers, is no longer free from the government’s encroachment in some cities.

Though smoking remains legal, legislators are doing everything in their power to make it as expensive and unpleasant as possible. Smokers are an easy target for tax hikes and cigarette taxes now exceed any reasonable estimate of smoking’s social cost. Federal taxes on cigars may soon rise from five cents per stick to as high as three dollars and this year Congress came perilously close to explicitly forbidding certain types of cigarettes. Their only hangup was over whether to ban all tobacco flavorings or merely some of them. [Update: Since this was originally published, Congress has banned most types of flavored cigarettes.]

Politicians interfere with what we eat as well. Transfat bans are becoming the trendy new public health measure, led by Michael Bloomberg’s successful campaign in New York — the same city where chain restaurants must now make nutritional information not merely available, but prominent, regardless of whether customers really want to be reminded of how many calories lurk in their combo meals. American cheese lovers lament the restrictions on young raw milk cheeses, readily available in Europe but blocked domestically by risk-averse regulators who wouldn’t know Camembert from Kraft. Can restrictions on salt, caffeine, or high fructose corn syrup be far behind?

Then there’s the legacy of Prohibition itself. Though the 21st Amendment legalized alcohol sales, state regulations impede truly free markets. The ubiquitous three-tier system of producers, distributors, and retailers has spawned countless laws benefiting middlemen at the expense of consumers. Constraints on direct sales increase the cost of alcohol while bans on shipping make it impossible to order boutique spirits, wines, and beers. Even as the Internet has granted consumers access to the abundant long tail of countless goods, drink lovers remain trapped in a 1930s model of distribution.

Finally, we should acknowledge our contemporary struggle with prohibition. The war on drugs has led to gang violence, trampling of civil liberties, and military interventions abroad. Federalist principles are routinely ignored in medical marijuana raids, doctors face prosecution for prescribing painkillers, and ordinary adults must show their ID just to purchase effective cold medicine. The United States now has more than 300,000 people imprisoned for drug violations.

The ratification process of the 21st Amendment holds a lesson for today. All other amendments have been ratified by state legislatures, but this was different. Fearing that rural lawmakers would not bear the ire of the temperance movement, Congress sent the 21st directly to the people assembled in state conventions.

Bringing the modern nanny state to heel will depend on countless individuals standing up against those who would trade our liberties for their preferences. On this Repeal Day, raise a glass to freedom regained and to freedoms still to be won. Cheers to the 21st Amendment!


What really happened in Starkville, revisited

About a year ago I criticized a “study” from Mississippi State University alleging that implementation of a smoking ban in Starkville, MS caused a dramatic decline in heart attacks. The problem was that the study was in fact just a press release and the data from control groups hadn’t even been collected yet. Without control groups there was no justification for asserting that the decline in heart attacks was caused by the smoking ban rather than other factors. I challenged the authors, Dr. Robert McMillen and Dr. Robert Collins, on this point and they declined to respond, saying only that they would continue their research when more data arrived.

Now the data is in and they have released another study confirming their hypothesis. To their credit they have control groups this time. What they don’t have are tests of statistical significance. I’ll hand it over to Michael Siegel:

This study violates the most fundamental principal of epidemiology and biostatistics: you must evaluate any scientific hypothesis to see whether the results could be explained by chance. In other words, you must determine whether your results are statistically significant.

A persistent flaw in studies of this type is reliance on small population sizes to extrapolate an exaggerated effect. This one appears no different. Siegel again:

I did my own calculations based on the results reported in the study and based on a conservative estimate which maximizes the likelihood of finding a statistically significant difference, I found that the difference between the two rates of decline was not even close to being statistically significant. […]

For these findings, which are exquisitely sensitive to a simple shift in one heart attack here and one heart attack there, one must not put any confidence in their statistical meaning. Clearly, the role that these are just chance differences cannot be ruled out given the small sample size. Nevertheless, the study goes as far as telling us the exact cost savings from the heart attacks averted due to the smoking ban.

McMillen and Collins are getting closer to doing real science. Close, but still no cigar!


Bloomberg bans again!

Over at the Examiner I take a look at Michael Bloomberg’s latest attempt to make life worse for smokers, a ban in parks and beaches:

It’s no wonder that some non-smoking residents support the ban. They have nothing to lose and they’ve been hit with fear-mongering propaganda for years, such as Action on Smoking and Health’s dire warning that “If you can smell it, it could be killing you,”or even worse, uncritical reports about “thirdhand smoke,” the residue left behind on room surfaces when tobacco is lit. So firmly has the toxicity of tobacco smoke been in implanted in the public’s mind that activists no longer feel the need to demonstrate that it causes harm; the mere ability to detect its traces with fancy lab equipment is enough to raise a panic.

Whole thing here.


Smoking ban resistance in the UP!

Cheers to the veterans at American Legion Post 444 in Baraga, Michigan, in the Upper Peninsula, who are challenging the state’s smoking ban in court and refusing to comply:

During the next two months, several citizen complaints were filed about the post’s noncompliance, and local health department officials sent notices of violation. Geroux responded with a news release July 16 that described the new law as unconstitutional and un-American.

Further, the exemption for Detroit’s casinos (which was based on their need to compete with American Indian casinos not covered by the state law) is “wildly unfair” to the Baraga post, which lies within a mile, and competes for customers, with two alcohol-serving, smoking-acceptable tribal facilities, Geroux said.

After getting a cease-and-desist order from the health department July 20, the post decided to sue.

I wrote against the Michigan smoking ban for the Detroit Free-Press back in 2008.

[Thanks to Jan for the link.]


Thirdhand smoke is real and insignificant

This blog has previously chronicled attempts to scare people into persecuting smokers based on trumped up fears of “thirdhand smoke,” residue left on clothes and furniture after a smoker lights up. New research attempts to measure levels of this residue directly by artificially re-suspending particles left behind by a smoking device:

These quantitative data support the hypothesis of a resuspension from the cigarette smoke surface contamination. However, this airborne contamination through resuspension remains much lower (100 times) than that of secondhand smoke.

In other words, there’s nothing to worry about.


Beyond the pale

UK Deputy Prime Minister Nick Clegg made a lot of favorable headlines recently by launching the Your Freedom website, allowing citizens to suggest laws that should be repealed. In a new video he reveals that there are at least two suggestions that will “of course” not be taken seriously:

1) Reintroducing the death penalty; and

2) Allowing people to smoke in private businesses

Because clearly, these ideas are equally at odds with liberalism!

Dick Puddlecote has more, via Chris Snowdon.