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Anti-Smoking Laws – The Proof of the Pudding

One consistent theme of SBM is that the application of science to medicine is not easy. We are often dealing with a complex set of conflicting information about a complex system that is difficult to predict. That is precisely why we need to take a thorough and rigorous approach to information in order to make reliable decisions.

The same is true when applied to an individual patient. Often times we cannot make a single confident diagnosis based upon objective information. We have to be content with a diagnosis that is based partly on probability or on ruling out other possibilities. Sometimes we rely upon a so-called “therapeutic trial” to help confirm a diagnosis. If, for example, it is my clinical impression that a patient is probably having seizures, but I have no objective information to verify that (EEG and MRI scans are normal, which is often the case) I can help confirm the diagnosis by giving the patient an anti-seizure medication to see if that makes the episodes stop, or at least become less frequent. Placebo effects make therapeutic trials problematic, but if you have an objective outcome measure and a fairly dramatic response to treatment, that at least raises your confidence in the diagnosis.

We can apply the same basic principle on the population level. If a public health intervention is addressing the actual cause of one or more diseases, then we should see some objective markers of disease frequency or severity decrease over time. Putting fluoride in the public water supply decreased the incidence of tooth decay. Adding iodine to salt decreased the incidence of goiter. Fortifying milk with vitamin D decreased the incidence of rickets.  However, removing thimerosal from the childhood vaccine schedule did not reduce the incidence of autism (or the rate of increase in autism diagnosis). That is because calcium deficiency causes rickets, but thimerosal (or the mercury it contains) does not cause autism.

In public health there is also the equivalent of placebo effects – confounding factors in epidemiological studies. So studies need to be interpreted with caution. But if we see a consistent signal – a consistent association between a treatment and a decrease in disease incidence or severity, then our conclusion becomes more and more confident.

We are beginning to see this consistent signal with anti-smoking laws and a decrease in diseases that previous evidence suggests is increased by smoking or exposure to second-hand smoke. A recent study published in PLOS Medicine looked at the incidence of preterm birth and low birth weight in Scotland following legislation that came into effect on March 26, 2006 banning smoking in public places. Prior to the legislation preterm and low birth weight were trending up. The study found a statistically significant drop of about 10% beginning January 1, 2006, with a slight reversal two years later. They interpret these results as an anticipatory effect – smokers trying to quit in anticipation of the legislation, with some smokers failing and going back to smoking over the next two years. This conclusion is supported by the spike in nicotine patch prescriptions in January of 2006.

Further, the reduction in preterm birth and low birth weight was found among current smokers as well as never smokers. The decrease among never smokers suggests a second-hand smoke effect.

Epidemiological studies are always difficult to interpret, as I stated above, and this study is no exception. The strength of this study is that it was very thorough, looking at all pregnancies in Scotland over the study period. But there are many confounding factors, one of which pointed out by the researchers is the fact that smoking status was self-reported, and the introduction of legislation may have affected willingness to self-report smoking. Since all pregnancies were looked at, however, this would not have affected the overall decrease in these outcomes reported.

The significance of this one study is enhanced by the fact that it is part of a trend in studies showing a decrease in diseases that prior evidence suggests are worsened by smoking, following smoking bans. A study of acute myocardial infarction (AMI) in Massachusetts found a decrease of 7.4% following a statewide ban on smoking in public places. It is also significant that the decrease occurred in towns that did not have a prior local smoking ban, but not in towns that did. The effect was therefore also likely attenuated by the prior existence of local smoking bans.

A 2009 review and meta-analysis concluded:

Using 11 reports from 10 study locations, AMI risk decreased by 17% overall (IRR: 0.83, 95% CI: 0.75 to 0.92), with the greatest effect among younger individuals and nonsmokers. The IRR incrementally decreased 26% for each year of observation after ban implementation.

Using the same Scotland cohort following the 2006 ban, a study has also found a decrease in hospital admissions for asthma:

After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children.

Overall the data show that smoking bans reduce second hand smoke exposure, smoking, and  adverse health outcomes associated with smoking. There is a fair degree of consistency in the data, and this consistency is growing as more studies are being published. We have appeared to cross the fuzzy threshold where we can conclude with a fair degree of confidence that banning smoking in public places works. In the interest of public health, reducing health care costs, and child safety, the totality of evidence strongly suggests that we should strengthen bans on smoking in public places and apply them universally.

Meanwhile, concerns that such bans would economically harm bar and restaurant owners have not been born out in the evidence. A Minnesota study, for example, found a slight increase in revenue following smoking ban laws. It seems more people are willing to go to bars if the experience does not necessarily involve being exposed to intense levels of second-hand smoke.

Smoking ban laws have passed the test of the “therapeutic trial”. Combined with the totality of evidence for the risks of smoking and second-hand smoke, this strongly supports such bans as effective public health measures.

 

Posted in: Public Health

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53 thoughts on “Anti-Smoking Laws – The Proof of the Pudding

  1. chaos4zap says:

    Dr. Novella wrote a similar article a while back and I had the same issue with it then. The response of the average smoker to a smoking ban is quite simply, not to quite. It usually just leads to anger and frustration. I would make the argument that the very nature of addiction, does not really line up with the hypothesis that people quit in anticipation of bans and that a large number of people quit as a result of smoking bans. People that smoked before bans did so with the knowledge that it’s bad for their health and would surely lead to an increased chance of cancer, other severe health issues and untimely death. People can’t smoke at bars and restaurants and all of the sudden…these people decide that is it? That’s what is going to get them to quit? Not the 6 dollar a pack sticker price or adverse health effects? There may be a case for second hand smoke exposure, but that could have been improved by more stringent requirements for smoking/non-smoking areas and ventilation requirements for smoking areas. Smoking bans have always seemed to me to be more self-righteous than effective. If they wanted to actually make a difference in smoking rates, why wouldn’t money be poured into offering free, or reduced cost interventions with demonstrable success rates like the patch or some of the prescriptions on the market now? Putting pictures on a pack and smoking bans in public areas seems like an effort to make it look like things are actually being done, but they are not very effective. Isn’t it possible that these statistics are artifacts and have little, or nothing to do with the smoking bans? Aren’t the smoking bans too new to really know if they are working? Since the health effects of exposure to smoking are more chronic than acute…..won’t it take some time before we would expect to see any meaningful results? For the statistics referenced above, what was done to rule out other contributing factors to the data, other than the smoking bans?

  2. thatguybil81 says:

    There is a growing body of epidemiological evidence that show that these public smoke bans result in clinical significant improvement in the general public’s health.

    That does not end the discussion on if these bans are a good thing from a societal and liberty perspective. It is indeed a very short slippery slope to banning other unhealthy behaviors based on “promoting the general welfare”.

    The debate on the those grounds needs to be vibrant and robust. It should not be foisted upon a reluctant public.

  3. PJH says:

    ” A recent study published in PLOS Medicine looked at the incidence of preterm birth and low birth weight in Scotland following legislation that came into effect on March 26, 2006 banning smoking in public places”

    Sadly it appears that the numbers might have been massaged somewhat.

    While the following link is to an admittedly pro-smoking blog, it does address some of the claims made by the study: http://velvetgloveironfist.blogspot.com/2012/03/scottish-smoking-ban-miracle-touches-to.html

    For example they cite “Looking at the ISD figures, it is difficult to see any effect on expectant mothers” with a graphic showing that while there’s been a decline in preterm/low weight births, the decline started (at least 1997) well before the smoking ban (in 2006) and has continued since shown in the graph

  4. cervantes says:

    Chaos – smoking bans in workplaces and public places have multiple effects. They do motivate some people to quit; they definitely cause people to cut down, even involuntarily; they make it easier to quit because you aren’t constantly exposed to other smokers; and they reduce smoking initiation because smoking is de-normalized and young people don’t see it modeled as much. So they are a very useful adjunct to other measures to reduce smoking rates. Finally, of course, they greatly reduce exposure to second hand smoke.

  5. nybgrus says:

    @choas:

    asthma and pre-term birth are immediate figures, not chronic.

    AMI is a combination of both long and short term effects of smoking.

    And yes, many people find the cost and long term health negatives to be extraordinarily minor issues. It is well known that humans have a tendency to over-value immediate pleasure and undervalue long term costs. Creating a ban, which makes an immediate cost/hurdle can easily tip the scale.

    Part of behavioral change in patients is to get them to decide what is more worth it – to stop or continue. We list the health aspects, but then ask the patient to list what they think are the positives and negatives. And if, in the patient’s assessment, the positives outweigh the negatives, then they won’t quit. We try and demonstrate why the negatives are really bigger than they think, but that is extremely difficult. And there are many people who don’t stop simply because they have no motivation to, even though the recognize that they should… and claim that they absolutely will… you know, sometime later on.

    For those sorts of people, having a ban that makes it very inconvenient to smoke, or forces them to smoke in their homes and cars and ruin their own furniture/clothing/etc can indeed be a very potent motivator to make “later on” be “right now.”

    I can understand your incredulousness that an inconvenience would be a more potent motivator than $$$ and health concerns. But it is very much the case that it often is.

  6. WilliamLawrenceUtridge says:

    I’m a member of the non-reluctant public that was very, very happy smoking is being restricted more and more by both laws and social pressure. Anything that makes smoking less accessible, more difficult and increasingly onerous is a good thing because it means less stink, less cancer, fewer cigarette butts on the sidewalk.

    Banning smoking from bars and restaurants isn’t the same thing as an iron-fisted government taking away your precious freedoms. In fact, if the governments of North America were smart they’d institute a similar degree of control over all drugs – making crystal meth, cocaine, heroin and especially marijuana legal with the same restrictions as alcohol and cigarettes. A realistic analysis of risks, benefits, harms and costs should inform policy, not ideology. That analysis resulted in smoking being restricted but not forbidden, it’s a shame the same hasn’t happened for other addictive substances.

  7. chaos4zap says:

    Some good points from many of you, thank you. I really don’t mean to cross anywhere near conspiracy-ville, but the amount of revenue that states make from taxing tobacco is fairly large. I know that some will say that the reduced, long-term health care costs would far outweigh what they make in taxing, which is fair…but a little unrealistic. States need money now and they are just like anyone else, often failing to go for the long term benefit. That is why it seems to me like it is in their best interest to go for things that give the illusion of addressing the issue, but they really aren’t. I’m a smoker and I will flat out admit the potential bias, but I’m trying my best to account for that in the concerns I’m bringing up. I do agree that it is a slippery slope. To me, there really is no justifiable reason for anyone to tell a business owner what they simply cannot allow smoking in their establishment. If people don’t want to be around smoke, then they won’t go there. If the establishment owner wants to allow smoking, then maybe he/she is saying that they don’t care if they lose the non-smoking customers, but that should be their choice. Why not strict guidelines on segregation and ventilation rates of smoking/non-smoking areas? I certainly respect the right of people not to be exposed to smoke, but that can be accomplished by engineering means and the business owner would at least have an option. I’ll concede on this point and just agree that the political and “freedom” implications are more complicated than the health issues. I’m also very aware that immediate inconveniences can be more of a motivator than more sever long-term consequences…..but we are talking about an addiction here. Sure, those people that can quit with relative ease may quit, but the majority of people have tried and failed many times to quit. While wanting to quit is an important first step, for many people it simply isn’t enough to want to break the addiction…even if they want to. I’m going into anecdote land now and as such, you can take it for what it’s worth. 3 out of 3 places that I have moved too and lived in the past 6 years have transitioned to smoking bans after I moved there. Sure I smoke outside now, but so does everyone else. There is no significant decline in people smoking before/after and not once have I heard a single person hint-at or flat out say that they were quitting or had quite because of the inconvenience. My personal observations are far from science, and I’m certainly willing to listen to new evidence, I just find the evidence cited above as very tenuous at best and it seems like much more weight is being put on the conclusions being drawn or inferred than would be if this same evidence was being used to support something like Homeopathy. At the end of the day, I’m a smoker (but I won’t always be) and it doesn’t really matter to me rather the bans work or they don’t. If they work, then great! It will make things easier when I finally decide to quit and smoking outside allows me a chance to stretch my legs and often times start up a good conversation with someone else. If they are not very effective, let’s get the attention shifted to interventions that have a real chance to making an impact.

  8. Scott says:

    Segregation and ventilation cannot effectively prevent smokers from harming nonsmokers – unless the segregation is to a hermetically sealed room accessed via airlock. And there really isn’t a credible slippery slope argument – the extent to which smoking harms nonsmokers is reasonably unique.

    The next big issue, IMO, is the harm to children of smokers from smoking in the home.

  9. Scott says:

    BTW, the “if you don’t want second-hand smoke, don’t go to establishments which allow it” also doesn’t fly. Smokers do not have the right to harm others, regardless of on whose property the harm takes place and what the property owner thinks about said harm.

  10. BobbyG says:

    Clinic Monkey EHR stands ready to serve.

    http://clinicmonkey.blogspot.com/

    /s

  11. “Fortifying milk with calcium decreased the incidence of rickets. However, removing thimerosal from the childhood vaccine schedule did not reduce the incidence of autism (or the rate of increase in autism diagnosis). That is because calcium deficiency causes rickets, but thimerosal (or the mercury it contains) does not cause autism.”

    Fortifying milk with Vitamin D decreased the incidence of rickets. That is because Vitamin D deficiency causes rickets.

    Milk is not routinely fortified with calcium.

    There are children in sunny countries — Bangladesh, Nigeria — who develop rickets anyway. Not only do they not consume milk, their diet consists almost entirely of cereals which are low in calcium. So yes, calcium deficiency can cause rickets but it isn’t usually the cause. As long as Vitamin D is adequate, not much calcium is required to prevent rickets. Increasing milk consumption from “none” to “some” should do it. Adding calcium to the milk is not necessary.

  12. LMAO says:

    Fortifying milk with calcium decreased the incidence of rickets…because calcium deficiency causes rickets

    I think you meant to say we began fortifying milk with vitamin D to decrease the incidence of rickets because vitamin D deficiency is the most common cause of rickets.

    Milk is naturally high in calcium. Although calcium-fortified milk is available, it’s not typical.

    (I wanted to make sure I wasn’t misremembering, so I took a look at the label on my jug of whole milk… it says 240ml provides 30% of the RDA of calcium; ingredients are milk and vitamin D3, that’s all.)

  13. LMAO says:

    hahaha… ooops… cross-post…

  14. mousethatroared says:

    chaos4zap “If people don’t want to be around smoke, then they won’t go there. If the establishment owner wants to allow smoking, then maybe he/she is saying that they don’t care if they lose the non-smoking customers, but that should be their choice.”

    You don’t seem to be considering the employees of the establishment, the waiterstaff, cooks, etc who work eight or more hours a day around the smoke. Or do you believe that the establishment owner should have the right to expose their employees to any environmental hazard, as long as it makes their product more marketable to the consumer?

  15. Chris says:

    WLU:

    I’m a member of the non-reluctant public that was very, very happy smoking is being restricted more and more by both laws and social pressure. Anything that makes smoking less accessible, more difficult and increasingly onerous is a good thing because it means less stink, less cancer, fewer cigarette butts on the sidewalk.

    I was very happy when my workplace banned smoking about twenty-five years ago. This was back in the days when there were no partitions, just rows of desks and an occasional drafting desk (which some facilities idiot thought would be a good place to put computer terminals, we got that fixed very fast). One guy who had asthma would actually take to wearing a gas mask to avoid the smoke due to the smokers, especially the one who would burn the cigarette down to the filter filling the room with an acrid burning plastic smell.

    One time a group of leads and supervisors stood by my desk discussing some design review matter, with two of them puffing away. I picked up a computer printout (those big ones that were folded 17″ wide rolls) and started to fan the smoke away from my desk. They got the hint.

    I remember one guy walking down the hallway trying to hide a lit cigarette in his hand behind his back. I actually had to ask him if he was so daft to think we could not smell it, and see the trail of gray smoke. He apparently had no clue.

    At last count we have had at least half a dozen family members die from smoking related diseases. The youngest being about forty two years old from mouth cancer, about year after half his jaw was replaced. I am very glad my father quit smoking in the mid-1960s, he is the only sibling surviving from his family.

  16. David Gorski says:

    While the following link is to an admittedly pro-smoking blog

    That is an understatement, to put it mildly, akin to saying that black holes are rather dense.

  17. sarah007 says:

    There is a lot of milk nonsense here. Milk may contain calcium but the absorbable calcium is questionalble due to the pasteurisation. There are much better sources of calcium like sesame seeds, some 30x better.

    Love the opportunity to ‘casually mention’ the myth of ‘thermiosil safety’, did you see that the co author of the MMR paper with Wakefield has had all charges and striking off the medical register overturned so maybe soon you will have to do a u turn boys, look forward to that party.

    Love the flouride mythology too, how about the associated increase in hypothyroidism, they used to use flouride to ‘treat’ hyperthyroidism this as it is a halogen and blocks the action. Flouride makes teeth brittle, not stronger.

    Funny how there is increases in duff thyroid in areas that add flouride/poison to drinking water, good job we have clever doctors to prescribe the ‘cure’.

  18. Angora Rabbit says:

    Ditto what Alison and LMAO said – rickets is a vitamin D deficiency and the milk fortification was discovered here by Harry Steenbock so many years ago. We call calcium deficiency just that although it can manifest as osteomalacia. A typo easily fixed.

    Regarding the troll, if she were my nutrition student she’d get an F. Ignore her.

  19. Thanks for the correction – I changed it to vitamin D. Milk is also often fortified with calcium, which increases bioavailability, but vitamin D is the main thing.

  20. Regarding smoking ban laws and quitting – the evidence overwhelming shows that scaring people into making good decisions like quitting smoking has a small impact. Using social pressure is more effective (but still modest), and smoking ban laws tend to increase the social stigma of smoking, which has a consistently measurable effect.

  21. Chris says:

    The trick is to make sure a person does not start smoking in the first place. Of course, that was accomplished in our family by watching our step-mother’s struggles to stop smoking, which included my father forbidding her from smoking in the car, and then later in the house.

  22. EricG says:

    @ thatguybil81

    judging by the content of your position, prior to a robust discussion, I should be allowed to carry around a rod of decaying uranium. I wasn’t invited to that discussion and the regulation of radioactive minerals has been imposed upon me by an iron fisted government. it is, after all, *my* health and who is to tell me that I can’t establish a restaurant where we all get together and share how wonderful our rods of uranium are? We’ll call it, “235 Freedoms” and if you aren’t interested, just stay several hundred meters from me at all times.

    When someone sponsors a bill to “regulate cheese puffs in order prevent 2nd hand orange, greasy fingers” then we will have approached the edge of this short and slipperly slope.

    @WLU ditto^2. legalize, tax, fund education (my personal pref for the fund distribution). meth though…you’d have to present a pretty incredible argument. I have seen/read/heard/witnessed nothing exept how it burns lives to the ground. Quickly.

    Excellent article Dr. Novella; always like reports of progress. As amusing as they are, sometimes I (personally) tire of CAM discussion.

  23. ConspicuousCarl says:

    sarah007 on 07 Mar 2012 at 1:05 pm

    Love the opportunity to ‘casually mention’ the myth of ‘thermiosil safety’, did you see that the co author of the MMR paper with Wakefield has had all charges and striking off the medical register overturned so maybe soon you will have to do a u turn boys, look forward to that party.

    Your argument is that thimerosal must be bad because a government body decided that one of Wakefield’s co-authors does not share his guilt? Even if Wakefield’s guilt or innocence were the factor which determined the reality of vaccine safety (which it isn’t), that would be an absolutely pathetic attempt to argue on the subject. You might want to sharpen your crayons a bit, if indeed they let you do that on your own yet.

  24. cervantes says:

    Also, tobacco is addictive — it’s philosophically vexed, but there’s a legitimate question about whether smoking is really a “choice” or a voluntary activity. We interfere, by law, in many addictions, e.g. heroin and cocaine are illegal and tobacco sales are heavily regulated plus in most jurisdictions you aren’t allowed to consume on the street. Why should tobacco be any different — unless you’re for legalizing cocaine and meth.

  25. DugganSC says:

    Honestly, since I started seeing increasing bans on smoking on work campuses, I’ve long wondered how the rates of pneumonia in smokers has fared. Smokers are already prone to lung issues and suddenly you’re routing them out to spend 3-5 minutes in the rain and the cold to get their fix, or to their car, where the smoke will build up, just poisoning them. Sure, some will quit for the inconvenience, but how many are we just encouraging to die more quickly? That said, that’s all speculation on my part, as I have no idea whether anyone has done statistics on that.

    On a side note, regarding looking at the effects of a national medication change, I’ve heard a number of times that the connection between Reye’s Syndrome and childhood aspirin usage is somewhat tenuous. The link is based on tying a decrease of occurrence Reye’s Syndrome to several countries issuing warnings about aspirin use in children, but the articles point out that the increasing rarity of Reye’s happened pretty uniformly across the world, including nations that hadn’t indicated such a warning. My understanding (admittedly, based off of scanning articles online since I’m not in the medical field myself) is that the justification more or less came down to one doctor deciding there was a link and recommending ceasing use of aspirin without really deciding why there would be a link. As someone who frequently reads articles on this site, I’ll admit that that hits all kinds of alarms similar to a chiropractor claiming that eggs cause cancer and pointing out that egg usage has decreased in the US and so has cancer.

  26. papertrail says:

    “…did you see that the co author of the MMR paper with Wakefield has had all charges and striking off the medical register overturned so maybe soon you will have to do a u turn boys.”

    Let me quote from a BBC article: “As Mr Justice Mitting observed in his judgement, ‘There is now no respectable body of opinion which supports (Dr Wakefield’s) hypothesis, that MMR vaccine and autism/enterocolitis are causally linked’.

  27. Lytrigian says:

    @DugganSC: Since rain and cold do not cause pneumonia, I would think it surprising indeed to see an increased incidence due to forcing smokers outside for their fix.

  28. Carl Bartecchi says:

    Pueblo, Colorado had one of the highest smoking populations in the state. In 2003, Pueblo voters passed the Smoke-Free Indoor Air Act prohibiting smoking in workplaces, public buildings restaurants, bars, bowling alleys, etc., and the law was enforced. Eighteen months later, heart attack admissions to our hospitals declined by 19%. We reported that finding in Circulation, 2006;114:1490-1496. We decided to continue the study another 18 months and found that the admissions for heart attacks dropped 41% compared to the 18 months prior to the smoke-free ordinance. We reported that finding in MMWR, Jan. 2, 2009. We compared our results with neighboring El Paso County which had no smoke-free ordinance and had no decline in heart attack admissions during the same period. Our population loves the smoke-free act and would never go back. Our bars and restaurants are prospering and we have seen a significant decline in the number of smokers in our community.

  29. Steven,

    The calcium already present in milk is very bioavailable.

    Fortification of milk with Vitamin A (skim milk) and Vitamin D (all milk) is required by law in many (most?) industrialized countries as a public health measure.

    This is different from calcium-fortification of milk, which has more to do with marketing. In the US, milk and orange juice may be fortified with calcium and marketed to people concerned about preventing osteoporosis. These vehicles for calcium are chosen because calcium added to them will be particularly bioavailable. Lactose and particular proteins in milk, and acid in juice, favour calcium absorption whether naturally present, added or from other components of a meal. In addition, neither contain oxalate, commonly found in leaves, which inhibits calcium absorption.

  30. barbyrabaker says:

    I believe that smoking bans make it easier to quit. As a former smoker, I know that it is never easy because there are so many triggers that can remind you of how much pleasure smoking brings. Some of those triggers–seeing people light up after a good meal, smelling the smoke as you walk by a table–are removed by smoking bans. I quit two years ago, and now I am surprised when I see a smoker, and less likely to want to light up in companionship.
    I also think it would be helpful if nicotine substitutes were cheaper than cigarettes.

  31. DugganSC says:

    @Lytrigian:
    I think everyone and their mother knows that wet and cold do not directly cause colds or pneumonia. However, it is fairly well documented that they can make you more likely to get infected due to the combinations of a) reduced immune response from your body having to work to warm itself, b) changes in the respiratory system, c) the sneeze droplets carrying the virus traveling better in humid air than in dry air, and d) the tendency for people to subconsciously move closer to each other to conserve warmth.

    *wry grin* Of course, if you go all rational about that, you lose the chance to dismiss the question by making a snarky comment.

  32. sarah007 says:

    Crinkly carl said “Your argument is that thimerosal must be bad because a government body decided that one of Wakefield’s co-authors does not share his guilt? Even if Wakefield’s guilt or innocence were the factor which determined the reality of vaccine safety (which it isn’t), that would be an absolutely pathetic attempt to argue on the subject. ”

    So when Wakefield wins his case in Texas against the BMJ what are you going to do about that then?

    Alison said “Fortification of milk with Vitamin A (skim milk) and Vitamin D (all milk) is required by law in many (most?) industrialized countries as a public health measure.”

    So soon milk will be really nutitrious when they add all those vitamins that are so dangerous on the other thread about the danger of vitamins!

    Which one is it then?

    What Pasteurization Kills

    The enzyme phosphatase is completely destroyed. The final test for pasteurization after heating to 165 degrees Fahrenheit is the negative Alpha Phosphatase test. This is the enzyme that is critical to the absorption of minerals and calcium! The dairy industry’s adding of vitamin D is useless with this arrangement.

    So instead of building bone density, lots of calcium winds up getting into blood vessels calcifying the inner walls to promote cardiovascular problems, or entering joints to create arthritis.

    Who said pasteurised milk was nutritious then?

    Maybe we should add statins to milk, protein, carbs in fact why not add all the vitamins. You can even get lactose free milk now, how about milk free milk, all scientific and clean?

    Duggan said “the sneeze droplets carrying the virus traveling better in humid air than in dry air,”

    Sorry that idea has not been proven, it’s a myth.

    Is this scientology based medicine?

  33. sarah007 says:

    paperpants said “Let me quote from a BBC article: “As Mr Justice Mitting observed in his judgement,‘no respectable body of opinion’ supporting the supposed risks of the jab.

    I like your insertion of your view of this!

    Respectable body is a view open to scrutiny, this comment doesn’t mean much really.

  34. Calli Arcale says:

    The enzyme phosphatase is completely destroyed. The final test for pasteurization after heating to 165 degrees Fahrenheit is the negative Alpha Phosphatase test. This is the enzyme that is critical to the absorption of minerals and calcium! The dairy industry’s adding of vitamin D is useless with this arrangement.

    So instead of building bone density, lots of calcium winds up getting into blood vessels calcifying the inner walls to promote cardiovascular problems, or entering joints to create arthritis.

    Sarah007, if phosphatase is critical to absorption of calcium, and phosphatase is destroyed in pasteurization, how does milk cause calcium to get into the blood vessels and calcify the inner walls? This seems like a rather serious contradiction.

    About viruses traveling better in some kinds of air than others…..

    I think dampness has very little to do with the aerodynamic properties of snot; thus, sneeze particles will travel just as well in dry as damp air. (Dampness does affect aerodynamics, but I don’t think this will be significant for an irregular semiliquid blob. An aerospace engineer is free to correct me.) Dampness *might* influence the water content of the blob, which *might* affect survivability for any viruses inside, but I don’t know how significant this is. (Dry air does, after all, provoke increased mucus production to compensate; the blobs may be plenty moist.) I have read, however, that influenza viruses in particular are often (not always) cold adapted — they actually come packaged with insulation to help them survive the transfer to another host. This might make them less adapted to warm weather, or perhaps in the summer they just have more competition. (Maybe it’s harder for influenza to infect a person who already has a rhinovirus; I wouldn’t be surprised if some viruses have developed means to fend off infection by another virus, since they want the cell’s machinery all to themselves.)

  35. WilliamLawrenceUtridge says:

    So when Wakefield wins his case in Texas against the BMJ what are you going to do about that then?

    When Wakefield loses his case in Texas, I’m quite sure you won’t mention it at all because of your consistent practice of ignoring anything you don’t already agree with.

    The enzyme phosphatase is completely destroyed. The final test for pasteurization after heating to 165 degrees Fahrenheit is the negative Alpha Phosphatase test. This is the enzyme that is critical to the absorption of minerals and calcium! The dairy industry’s adding of vitamin D is useless with this arrangement.

    Correct me if I’m wrong, but don’t humans manufacture their own enzymes to absorb vitamins and minerals? I mean, it’s the milk that’s heated, not the human, right? So whether the milk is heated to 160 or not doesn’t matter since the absorbtion takes place in the gut. The gut that’s not heated to 160 degrees. Because your claim essentially says we can’t absorb any calcium unless we drink unpasteurized milk. And I don’t drink unpasteurized milk, but somehow I’ve still got rigid bones that hold up the rest of me.

    Respectable body is a view open to scrutiny, this comment doesn’t mean much really.

    The thing is, if the “respectable body” disagreed with your opinion, it wouldn’t be respectable anymore. This is known as the “no true Scotsman” argument – you make up your mind and define your terms and evidence such that you don’t have to ever change it, or even look at anything that disagrees with your statement. It’s an extremely effective way of intellectually lazily dismissing anything you don’t already agree with. For instance, if the Texas court dismisses Wakefield’s case against BMJ, you’ll either ignore this result or claim the court was too biased by Big Pharma to ever give a fair hearing – despite your certainty now that Wakefield will be victorious.

  36. Zetetic says:

    The latest CAM/Woo I saw about smoking is the deleterious effects of smoking are all caused by toxic chemicals in fertilizers and weed abatement products that tobacco farmers utilize. Smoking is just fine if it’s “Natural”, they say!

  37. thatguybil81 says:

    @#EricG

    Carring around U-236 has not historically been legal.

    Smoking has been historially been a socially accepted norm.

    Changing social norms should not be routinely done via laws.

    Btw I am a non smoker, who enjoys the fact that I can work in a smoke free enviroment and have a drink after work with out smelling like nasty smoke.

  38. mousethatroared says:

    Hmmm, It has been my understanding that the reason people got more colds and respiratory infections in winter was due to lower humidity drying out nasal passages, causing small cracks in the protective layers which guard against viruses, bacteria, etc. Also more time indoors with more people touching stuff, that we then touch, following by touching our face, zap, two weeks of a miserable cold, curtesy of the person who left their germs on that doorknob.

    But I can’t offer sources on that, it’s just what I have gathered through reading various public health “wash your hands often” announcements.

    I’ve always thought of the idea that getting cold and wet gives you pneumonia as the victorian melodramatic novel theory of disease transmission.

  39. WilliamLawrenceUtridge says:

    You know what’s natural? Dying of lung cancer. And lung cancer for that matter.

    thatguybil81, why shouldn’t we try changing social norms via laws? What’s wrong with building a better society through the judicious use of motivation, particularly when there is essentially no benefit and significant detriment for something like smoking, the law isn’t very intrusive and benefits the majority? Most people don’t smoke, why should the wants of a few people engaging in an act that is harmful to those around them be supported? Drunk driving impinges on the rights of a drunk to drive home intoxicated, should it be legalized? And conversely why should public smoking be legal when it’s merely a slower and less attributable way of killing people?

    There’s a difference between a proscriptive, totalitarian society and a reasonable degree of restriction over harmful behaviour. A balance should be sought rather than two extremes shouting at each other about unrealistic slippery slopes.

    /end soapbox

  40. Chris says:

    Zetetic:

    The latest CAM/Woo I saw about smoking is the deleterious effects of smoking are all caused by toxic chemicals in fertilizers and weed abatement products that tobacco farmers utilize.

    All well and good, except for the fact that nicotine is good for killing insects. There are organic gardening formulas for making nicotine insecticide (though I think I’d just buy a can of tobacco, and not scrounge for butts).

    I have reminded more than one smoker that the stuff they suck into their lungs is effective for killing plants (and reading the article I linked to: veggies in the nightshade family).

  41. nybgrus says:

    I had interpreted Zetetic’s comment as sarcasm/satire…. was it not?

  42. Chris says:

    I don’t think so, because I had heard of it before. It is kind of a cross between cognitive dissonance and delusional thinking. Without much googling I found this and information about a tobacco company, American Spirit, that tried to use organic as a selling point.

  43. EricG says:

    @ thatguybil81

    seriously?

    Since when does the historic legality or social acceptance of something have any bearing on what we now know? Social norms, in many cases, *ought* to be changed by laws, unless you think racial segregation and corporal punishment in public schools should be given a fair shake as a former civil normality?

    I can think of a list none too short of things that used to be legal that are no longer, and with good reason. Have to agree with WLU again on this one, unless you can provide an ever growing list that shows us sliding down this slope as “liberties” are being stripped where the consequences don’t significantly outweight the benefits.

    This is self-limting as I’d wager that a society will generally only tolerate restriction if it applies to a small group of people and does significant harm – hence drunk driving laws, smoking and so on.

    try and ban reality television or butter, you’d have a murderous revolt. smoking? society shrugs as most people don’t smoke and appear to be rather bothered by its consequences. In fact, im in favor of legalizing more things, not less. Just a reasonable discussion of pros and cons as to the impact of society. i think smoking has lost this battle by lack of public outcry…

  44. mousethatroared says:

    By my reading, Zetetic wasn’t promoting the idea that “natural” cigarettes are healthy, they were just relaying a “woo/CAM” belief they had heard.

    It’s not a recent belief, though, I remember a friend saying the same thing at a party twenty years ago (apparently it stuck in my head because it was just so silly).

    Love the nicotine as an insecticide link.

  45. Zetetic says:

    I’m definitely NOT promoting “Natural” or any other type of cigarettes!

  46. Chris says:

    I did not think so, Zetetic. I knew you were reporting one of the more outlandish woo claims. It is up there with burying a cow horn with manure for biodynamic gardening woo or “pyramid power.”

  47. Lytrigian says:

    The truth is, we don’t know exactly why some diseases seem more prevalent in colder weather, only that they are. There are a number of plausible guesses which have been mentioned here, but some of them have nothing to do with the weather per se.

    One guess is that people stay indoors more in colder weather, and so come in to closer contact more frequently and for longer duration, and this promotes transmission. If true, then sending smokers outside is actually good for them.

    Another possibility, besides those already mentioned, is that the cold season is also when the kids happen to be in school, busy exchanging all sorts of interesting pathogens among themselves to bring home as presents to the rest of us. If true, then sending smokers outside doesn’t affect things one way or the other.

    There appears to be (at least according to Wikipedia) some experimental support for enhanced transmission in cold, dry air, but NOT for reduced immune response.

    And then there’s the months of the year when it *isn’t* cold outside, so it’s just not an issue.

  48. nybgrus says:

    lol. I guess that one was so out there for me that I thought he was just making a joke.

  49. Chris says:

    nybgrus, you have learned that no idea is so “out there” to be a joke. Consider it a cautionary tale.

  50. nybgrus says:

    I know… I guess just this once I was hoping…

  51. DugganSC says:

    *facepalm* Yes, it’s dry air that supposedly transmits it better. (c.f. http://books.google.ca/books?id=rRIdiGE42IEC) Mea culpa.

  52. William B'Livion says:

    Almost everyone accepts that even pure organic untreated tobacco is pretty much bad for your health, whether you smoke it, chew it, or snort (snuff) it.

    What American Spirit claims, and what others have claimed that falls into “reasonably possible” is that certain pesticides that (purportedly) large scale tobacco farmers are required by law to use are ALSO carcinogenic, and that smoking THAT tobacco is worse than untreated tobacco.

    Kinda like acetaminophen in large doses isn’t great for your liver or stomach. Drinking alcohol in large doses isn’t good for your liver, but drinking alcohol AND taking acetaminophen in large doses is REALLY not good for your liver.

    http://www.consumeraffairs.com/news04/2006/04/cigarettes_pesticides.html
    And
    http://pubs.acs.org/doi/abs/10.1021/ac060328w

    (the first article references the study in the second link)

  53. trrll says:

    sara007 wrote, “The enzyme phosphatase is completely destroyed. The final test for pasteurization after heating to 165 degrees Fahrenheit is the negative Alpha Phosphatase test. This is the enzyme that is critical to the absorption of minerals and calcium! The dairy industry’s adding of vitamin D is useless with this arrangement.”

    Wow, you’ll believe just about anything that fits your prejudices, won’t you? And clearly, you see no need to trouble yourself to learn even the most basic information about biology and physiology.

    Here’s some basic info:
    a) Our bodies make their own enzymes. We do not need or get enzymes from the food we eat, because
    b) The acidic environment of our stomach is specifically evolved to destroy proteins, including enzymes.
    c) This is a good thing, because foreign enzymes can be dangerous, and even deadly (an example of a foreign enzyme that does occasionally manage to get into the body is botulism toxin). Even if a foreign enzyme is not specifically harmful on the basis of its enzymatic activity, it could cause an allergic reaction.
    d) Fortunately, large molecules like enzymes are not normally absorbed from the digestive tract if they are not broken down. By breaking them down into their constituent the amino acids, the body is able to use the raw materials to create its own enzymes.

    In other words, if bovine phosphatase were getting into your system, it would almost certainly be a Bad Thing. Which would be yet another argument for the benefits of pasteurization, were it not almost certainly the case that the stomach destroys it, anyway.

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