07/02/09 Correspondence with Department of Health

To my letter to the Prime Minister I received a response from the Department of Health.  Very underwhelming to say the least.  Their second letter explains their refusal to comment further, or in other words avoidance of answering my questions. Clearly they know their reports are not as bullet-proof as they claim and their silence speaks volumes.  I will post the next reply if and when I receive it.  This page includes the correspondence between myself and the DofH as it stands.

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Dear Mr. White,

Thank you for your letter of 17 December to Gordon Brown about smokefree legislation.  As I am sure you will appreciate, Mr Brown receives a large amount of correspondence and it is not always possible for him to answer all of his letters personally.  As the issues you raise are health related, your letter has been forwarded to the Department of Health.  I have been asked to reply.

Firstly, as any statistics that the Government publishes are put under close scrutiny, they are the most accurate and up to date available and provided by sources that are appropriate, reliable and independent.

Some of the statistics you quoted were from the Local Government Analysis and Research organisation’s data which was collected from local authorities on their smokefree compliance inspections.  However, all sources of data relating to smokefree legislation can be found in the report on the impact of the legislation during the first year following its implementation at: www.smokefreeengland.co.uk.

Smoking is the largest single cause of preventable illness and premature death in the UK.  It kills 106,000 people every year and costs the British taxpayer more than £1.7billion a year in treatment bills alone.  It causes 84% of deaths from lung cancer and 83 per cent of deaths from chronic obstructive lung disease, including bronchitis.  Faced with this terrible toll of disease and disability, the Government is taking action to support smokers who want to give up and to help people not to start.

England’s smokefree law was introducted to create a healthier environment for everyone to work, socialise, relax, travel and shop in, free from secondhand smoke.  The legislation was introducted following the Government’s extensive consultation with the public about the legislation.  The fact that a large majority of the public favoured smokefree legislation was showin in a number of published independent opinion surveys and in the responses to the wider public consultation which the Department of Health carried out in 2005, when 49,000 of the 57,000 responses favoured comprehensive smokefree legislation.

The Department ran a full 12-week consultation on draft smokeree regulations.  The consultation was well publicised and around 550 responses were received from a range of stakeholders from the NHS, local government, trade and industry bodies, as well as responses from companies and individualss.  The Department published an analysis of the consultation responses together with the final regulatory impact assessment for smokefree regulations.

Throughout this process there was extensive private, public and political debate and consultation on the most appropriate policy response.  As a result of taking account of peoples views the Government put forward proposals to a free vote of the House of Commons on 14 February 2006.  The Commons voted by a very large majority across parties to end smoking in virtually all enclosed public places and workplaces.

This decision on the principle of smokefree pubs and restaurants was endorsed by a similarly large majority of after extensive debate at the various stages of scrutiny in the House of Lords.

The smokefree provisions in the Health Act 2006 were carried on free votes across parties by large majorities in both Houses of Parliament.  This Parliamentary support for smokefree legislaton reflected the very widespread public support.

With regard to the impact of smokefree legislation on the hospitality industry,  it is too soon to make any definitive statements.

However, we can say that since implementation on 1 July 2008 the smokefree law in England has been very effective and has received wide popular support.  It has been welcomed by the vast majority of people and businessses.  Importantly, it protects people from the harm done to health by secondhand smoke.  It has been described by medical experts as the single most important public health initiative for a generation.

In preparing the smokefree legislation,  Ministers considered the possible economic impact of taking action on second hand smoke.  A Regulatory Impact Assessment (RIA) was published alongside the Health Bill.  The RIA contains estimates of cost and benefits of legislation to end smoking in enclosed public places and workplaces.  A copy is available on the Department of Health website at www.dh.gov.uk.

Closures in the pub industry and general hospitality sector were covered at the time of Parliament’s consideration of the legislation in 2005/2006 and the RIA includes the following statement (paragraph 323 on page 10, final sentence):

Given the evidence from other countries, as well as in England, the Department of Health understands that it is likely to be prevailing economic, structural and cultural issues, rather than the introduction of smoke-free legislation, which will be the primary causes of any significant decline in the sector.

Data indicate there has been a smooth transition to smokefree public places and workplaces in England, with high levels of support from the geeral public and businesses.

Survey data, anecdotal evidence and reports in the media seem to indicate that the impact on the hospitality trade as a whole has been at worst neutral and in many cases positive.  The Department has seen no significant evidence to date that implies that smokefree legislation, either in this country or in others where it has been in place for some years, will create any long-term economic problems for pubs or the hospitality trade in general.

The Department of Health has commissioned independent research to evaluate the impact and this will be peer reviewed and published in due course.  The Department will continue to monitor the impact of the smokefree law which is due to be reviewed in 2010.

You also raise doubts about the dangers of secondhand smoke.

The evidene base that secondhand smoke harms health is substantial, and has been reviewed extensively, both in this country by the Government’s independent Scientific Committee on Tobacco and Health (SCOTH) and overseas.

In 2004, SCOTH concluded that exposure to secondhand smoke contributes to a range o serious medical conditions, including:

  • lung cancer;
  • heart disease;
  • asthma attacks;
  • childhood respiratory disease;
  • sudden infant death syndrome; and
  • reduced lung function.

In June 2006, the US Surgeon General published a report that examined a great deal of evidence and found that even brief secondhand smoke exposure can cause immediate harm.  The report says that the only way to protect non-smokers from the dangerous chemicals in secondhand smoke is to eliminate smoking indoors and that exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.

The US Surgeon General concluded that:

  • secondhand smoke causes premature death and disease in children and adults who do not smoke;
  • children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, ear problems and more severe asthma.  Smoking by parents causes respiratory symptoms and slows lung growth in children;
  • exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer; and
  • the scientific evidence indicates that there is no risk-free level of exposure to secondhand smoke.

The Surgeon General said on the publication of the report that

The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance.  It is a serious health hazard that can lead to disease and premature death.

In 2005, research published in the British Medical Journal estimated that over 600 deaths each year in the UK are due to exposure to secondhand smoke in the workplace.

The World Health Organisation (WHO) has classified tobacco smoke as a known human carcinogen.  The US Environmental Protection Agency classified secondhand smoke as a “class A” human carcinogen, along with asbestos, arsenic, benzene and radon gas.

In 2004, the WHO’s International Agency for Research on Cancer’s report Tobacco Smoke and Involuntary Smoking reviewed the evidence of the health risks associated with smoking and secondhand smoke.

I realise that this is not the reply you were hoping for, but I hope it clarifies that Governments position on this matter.

Yours sincerely,

Cameron Gordon.

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  Dear Mr Gordon,

Firstly, thank you for acknowledgement of my letter and taking the time to respond.  However, whilst I appreciate the response I am not satisfied with the content of your letter for multiple reasons.

It would appear that many of the points in my original letter were entirely ignored.  For instance, I purposefully included independent studied on secondhand smoke to highlight that not all findings are supportive of the notion it is harmful – something that makes it absolutely impossible to say the evidence is conclusive that passive smoke is harmful, as in order for something to be ‘conclusive’ it must be demonstrated time and time again positively – but this is not the case.

You mention the SCOTH report, which is not particularly scientifically viable and I personally find it insulting that such a report is used as evidence to convince the public at large that passive smoke is a killer.  First and foremost, the report was not a new study, it merely reviewed existing studies – and cherry picked ones at that, something you are certainly aware of.  Secondly, the report focuses mainly on active smoking and the effects this has on smokers, not non-smokers.

A further problem with the SCOTH report is its categorisation, as middle age is defined as being between 35 and 69 years old.  Bearing in mind the life expectancy is less than 80 for both men and women, how exactly is 69 still middle age?  In keeping with this theme, the report also ignored the fact that almost 40% of the 120,000 deaths attributed to smoking occur in males and females who are above the life expectancy.  How can something so deadly as tobacco smoke kill people above the life expectancy?

In addition to the above, point 2.7 of the ETS section makes a reference to a report by the Australian National Health & Medical Research Council (NHMRC) from November 1997.  This report was blocked from release by an Australian court because the NHMRC had failed in discharging its statutory duty of public consultation.  In April 1997 Simon Chapman, of the working party on the report, stated that the calculations of risk to non-smokers who were exposed to secondhand smoke were so low that journalists “will be hard pressed to write anything other than ‘Official: passive smoking cleared-no lung cancer”.

My final point on the SCOTH report is that the majority of scientists named in it are well known within the anti-smoking movement.  How can this be called objective research?  It is blatantly evident that the report was produced solely as a means to determine and dictate future government legislation, rather than a genuine piece of scientific work.

In view of this, why is the SCOTH report so highly regarded?  I would like to know why the WHO study, and indeed the Enstrom and Kabat study, are hushed and pushed aside.  Is it because the results are too embarrassing to the cause?  The Enstrom and Kabat study is most probably the single largest study ever conducted on passive smoking, and so we would expect it to be the most valid.  Yet the results show no harm to non-smokers from secondhand smoke – so why are these results not making the news?  Why is the government not using these figures to determine laws on smoking?

Similarly, the results from the WHO study were widely anticipated, with members of ASH expressing their eagerness to receive them as it was believed the study would give unequivocal evidence that secondhand smoke killed.  When the results came in, though, they showed the opposite – no statistical increase to non-smokers, with a 22% decrease of lung cancer in children with smoking parents.  The latter point is very important – if one of the biggest studies ever conducted finds that smoking may offer a protective effect, why is this not being studied further?  And, equally important, why are these studies ignored?  How can these studies come back with these results and the government simultaneously state that the evidence is ‘conclusive’ and there is no safe level of secondhand smoke?  This is a clear and evident lie.

You mention the 2006 Surgeon General’s Report – yet notably omitted the fact that he was thereafter out of office for being bias.  You also neglect to mention some of the other points mentioned in the report (perhaps because they directly conflict with the SCOTH report?), which are written in Chapter 1, pages 13-16:

The evidence is inadequate to infer the presence of a causal relationship between maternal exposure to secondhand smoke during pregnancy

The evidence is not sufficient to infer a causal relationship between secondhand smoke exposure from parental smoking and the onset of childhood asthma.

The evidence is not sufficient to infer a causal relationship between exposure to secondhand smoke and an increased risk of stroke.

Studies of secondhand smoke and subclinical vascular disease, particularly carotid arterial wall thickening, are not sufficient to infer a causal relationship between exposure to secondhand smoke and atherosclerosis.

The evidence is not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among persons with asthma.

The evidence is not sufficient to infer a causal relationship between secondhand smoke exposure and acute respiratory symptoms including cough, wheeze, chest tightness, and difficulty breathing among healthy persons.

The evidence is inadequate to infer the presence of a causal relationship between chronic secondhand smoke exposure and an accelerated decline in lung function.

The evidence is not sufficient to infer a causal relationship between secondhand smoke exposure and a worsening of asthma control.

You also raise the point that the 2006 Surgeon General’s Report claims SIDS can be caused by second hand smoke.  There is, in truth, no evidence of this.  In fact, it is still unknown what actually causes SIDS. In fact, in June 2001, Wake Forest University researchers reported SIDS may be related to a genetic deficiency, citing new research as showing that the absence of a particular muscle enzyme allows fatty acid products to accumulate, producing a toxic effect causing heart arrhythmias and respiratory arrest

There are also other theories of what causes SIDS. One such theory is that babies who die from the syndrome may have brain abnormalities that prevent them from when waking up when they don’t get enough oxygen during sleep, which suggests that an ‘immaturity’ of the central nervous system is a likely cause of SIDS.

A 2002 study published in Acta Neuropathologica[1] found that inadequate nutrition left some babies without all their bran neurons, thus leaving them at risk of SIDS by not being able to develop appropriate heart and lung control, with the researchers stating:

“we hypothesized that infants without the full complement of neurons and neuropil (ARCn hypoplasia) are at risk for SIDS because they are unable to develop appropriate cardioventilatory control during this crucial developmental period.”

If we look at the smoking rates and SIDS rates we see it does not make sense to claim secondhand smoke is a causative agent, as smoking rates have been declining for decades.

In your letter you also claim that 84% of deaths from lung cancer are a result of smoking, and 83% of deaths from COPD are from smoking.  This, again, is not true.  At best all that can be said is 84% and 83%, respectively, were smokers and contracted the disease.  However, this does not indicate a causal relation, and it also does not take into account the fact that any smoker – or, fraudulently, ex-smoker – who contracts the disease goes down as another smoking-related death.  Well, this is junk science.  Unless it can be proven that they would not have contracted the disease(s) were they non-smokers then the claim cannot be made.  In fact, in the court case Mrs Margaret McTear vs Imperial Tobacco Lord Nimmo concluded:

It is not within judicial knowledge that cigarette smoking can cause lung cancer: this is an issue which I am duty-bound to approach with an open mind and to decide on the basis of the evidence led before me; and the burden of proving it is on the pursuer… Epidemiology cannot be used to establish causation in any individual case, and the use of statistics applicable to the general population to determine the likelihood of causation in an individual is fallacious. Given that there are possible causes of lung cancer other than cigarette smoking, and given that lung cancer can occur in a non-smoker, it is not possible to determine in any individual case whether but for an individual’s cigarette smoking he probably would not have contracted lung cancer

Regarding COPD, emphysema rates have been increasing all the while smoking rates have been decreasing.  There is also scientific proof that emphysema is caused by a genetic gene deficiency.  Howard Buechner, M.D., explains that a significant number of the people with the disease lack a gene that controls the liver’s production of a protein called alpha-1 antitrypsin (AAT), and it is this protein which controls or degrades as enzymes known as neutrophilelastase, produced by the white blood cells.  When this enzyme is left unchecked, it destroys alveolar tissue.  The fact that this is caused by a missing gene proves that no amount of cigarette smoking is to blame.  In fact, a 2004 book entitled α1-antitrypsin deficiency 3: Clinical Manifestations and Natural History states that the deficiency of A1AT causes emphysema or COPD in adult life of virtually every person with the condition.  There is also the proteinase/antiproteinase hypothesis, which says that normally the locally synthesised proteinase inhibitors, especially the aforementioned AAT, permeate the lung tissue, thus preventing proteolytic enzymes from digesting structural proteins of the lungs.  Accordingly, lung destruction results from either an excess of proteinase release in the lungs, a reduction in the antiproteinase defence within the lung, or both.

There is not a shred of evidence that smoking causes COPD, and while saying 83% of COPD sufferers are smokers this is a misleading number.  In America emphysema alone has increased from 2.3 million cases in 1982 to 3.1 million in 2002 – all the time smoking rates have been dropping.  In 2007, approximately 75,250,000 people smoked, including cigars and pipes, yet only 3 million suffer from emphysema, with the annual death rate from lung disease, excluding lung cancer, being just 120,000.  How can tobacco smoking be labelled a ‘cause’ for a disease which affects not even a quarter of smokers?

Another point raised in your letter is that many businesses support the ban.  This is a result produced by asking surviving businesses, the result would be very different if all the businesses that had to shut down were asked.  I am certain that of the five pubs closing daily, not one proprietor would claim to be pro-ban.  You also mention how smokers cost £1.7 billion annually, however you fail to acknowledge firstly how many billions drinking alcohol costs (which is far more than smoking) and also how much smokers pay into society – over £9 billion a year, which far outweighs anything smokers take out in healthcare costs.

Finally, regarding the votes you speak of, I mentioned in my original letter how the votes used were closed-ended questions, whereby people could only answer ‘yes’ or ‘no’.  In these votes the majority of people did indeed say they would like a ban.  However, in the open-ended questions the clear majority wanted restrictions on smoking, not a blanket ban.  Yet this was ignored and no other opportunities were explored, such as ventilation, smoking and non-smoking pubs or any other possibility.  You say the smokefree legislation would end smoking in ‘virtually’ all enclosed public places and workplaces, yet in reality it has resulted in all enclosed public places, to the point that smoking on an open railway platform is not permitted.  In fact, the only exemption seems to be the House of Commons, which serves as a clear divide between the public and the law-makers.

I look forward to your response.

Yours Sincerely,

Richard White

[1] http://www.ncbi.nlm.nih.gov/pubmed/12070659?dopt=Abstract


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Dear Mr White,

Thank you for your further letter of 20 January about secondhand smoke.

There is nothing that I can add to the Department’s previous replies.

The scientific and medical evidence that you have decided not to accept is accepted by the World Health Organization and governments and medical experts all over the world.

I am afraid that, as you have raised no new issue, the Department can add nothing further to the matter.  Any further correspondence you wish to send will be treated as for information only and a response cannot be guaranteed.

I hope tihs clarifies the Government’s position on this matter.

Yours sincerely,

Cameron Gordon

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Dear Mr Gordon,

I am more than a little perplexed at your last letter.  I am afraid I neither agree nor accept that there is nothing more to be said from you regarding SCOTH, given that I asked specific questions to which I expected relevant answers.  Your silence on these questions does, in all honesty, speak more than your response ever could and for that reason I feel it is undoubtedly in the best interests of the Department of Health to respond to them – if for no other reason than as a matter of integrity.  As I stated in my previous letter, many of my first points and questions were ignored in your response, my reply to you asked for answers to the original questions and so this matter has by no means reached a conclusion or a point where you can legitimately say there is nothing else to add. I believe if the SCOTH report is as convincing and conclusive as you claim then there is no reason to dodge my questions.

Following on from my previous letters I have more to add.  Of the 16 person panel of SCOTH four are members of the Labour Party, two work for ASH, one for the WHO, one employed by a pharmaceutical company and three have enjoyed grants or hospitality at the hands of pharmaceutical companies.  Given this, objectivity was clearly not central.  Furthermore, the report also stated that “In most studies considered individually the observed odds ratios failed to reach statistical significance.”  So despite your claims the report actually found that the majority of studies looked at found second hand smoke to not be a health concern.

In addition to this, you also claimed that the conclusions were accepted around the world.  This may well be true, but it does not mean that each and every researcher and scientist agrees.  Indeed, Dr. Ken Denson studied smoking studies for over a decade and found that smokers who exercised moderately outlived non-smokers, and that what we are really seeing is smoker-related diseases rather than smoking-related diseases.  In other words, as cigarette smokers typically come from a poorer background and have generally unhealthy lifestyles compared to non-smokers what the data really shows is the consequences of these unhealthy lifestyles rather than the smoking itself.

I would greatly appreciate a proper response to my letters so that this matter can reach an end.  As the Department of Health is responsible for the information on public health matters I assume you have the relevant data and information to provide me with the answers I request.  I see no reason for you to continually dodge or ignore my questions, and feel that as I am taking the time to contact you to ask for the information the least you can do is provide it.  The information is such that it should be made available to the public and there is no reason for it not to be provided.

Yours sincerely,

Richard White

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