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Monday
Sep102018

Points of view

God played a little joke on me last night.

I was at Magdalene College, Cambridge (above), to speak at a dinner ahead of the Global Tobacco and Nicotine Forum that takes place in London this week.

Following drinks outside, we were ushered in to the old candlelit hall (no gas, no electricity), first built in the early 16th century. And there, sitting directly opposite me, was a senior research analyst from the Foundation for a Smoke-Free World.

What are the chances?

I discovered she has a background in human rights and is also interested in gender issues. If I understood her correctly, smoking is a gender issue because, worldwide, the majority of smokers are men and by smoking they are imposing their habit (or worse) on the women around them.

Anyway, I had an enjoyable discussion with her and a chap who works for Juul Labs, and following my after dinner 'speech' – which emphasised the need to respect those who choose to smoke – things got even livelier with several other guests pitching in.

Summing up, our host Elise Rasmussen made the point that the pre-conference field trip tends to lend itself to more robust discussion because people are more relaxed and tend to open up more.

Sadly, such contrasting views are unlikely to feature on any of the panels at this week's conference which is dominated by those who want to see smoking eradicated from the planet. That's a pity because I think it would liven up some of the sessions.

We are however promised a MAJOR ANNOUNCEMENT.

Watch this space.

Sunday
Sep092018

Dinner date

I’m giving an after dinner speech at Magdalene College, Cambridge, this evening.

Among other things I'll be talking about Forest and the work we do supporting smokers.

The event, which starts with drinks on an outside terrace, is part of the field trip that precedes the Global Tobacco and Nicotine Forum (GTNF) that takes place in London this week.

The first GTNF (or Global Tobacco Network Forum as it was then called) was held in Rio de Janeiro in 2008. I missed it due to a misunderstanding (the invitation sounded too good to be true!) but I’ve attended every GTNF since - in Bangalore (2010), Antwerp (2012), Cape Town (2013), West Virginia (2014), Bologna (2015), Brussels (2016) and New York (2017).

I’d be hard pressed to choose my favourite because they were all memorable for different reasons, good and bad.

But if I was to judge it purely on our hotel, the memorable reception we received when we arrived at 6.00am following a nine-hour flight, and the fact that it was my first and only visit to India, Bangalore is the one that really sticks in my mind.

Cape Town would be up there too, although it didn't make quite the same impression. Nevertheless it’s somewhere I’d like to re-visit because even though I stayed on for a couple of days I saw very little of the actual city.

That’s the problem with conferences. During the event you rarely see much beyond the hotel grounds, even though you might be driven 20 or 30 miles to some ‘special’ location for a drinks reception or gala dinner.

Anyway, based on what I remember, I’d mark my experiences as follows:

Bangalore 9/10
New York 8/10
Cape Town 8/10
West Virginia 7/10
Bologna 6/10
Antwerp 5/10
Brussels 5/10

Inevitably perhaps the conferences that were easiest to get to were the least memorable, which is why I'm struggling to get excited about this week’s event in London (11-14 September).

In fact, until very recently - based on the programme and the list of speakers - I was in two minds whether to go at all.

But more about that next week.

In the meantime here are some posts from previous GNTF conferences:

Welcome to Bangalore
Postcard from India - parts 1, 2 and 3
GTNF 2012 – the highs and lows
Out of South Africa
Greetings from the Greenbrier
Pork chop at a bar mitzvah – reflections on GTNF 2015
Mandela, moon landings and JFK GTNF 2017

Sunday
Sep092018

More thoughts on smoking and the nanny state

Further to my previous post, here are more of my comments from last week’s interview on BBC Radio Guernsey.

On smoking in the open air

There is no research that says that smoking in the open-air poses any risk to any non-smoker. You would have to be in very close proximity to a smoker and be a very serious asthmatic for that to have any effect whatsoever and asthma is rather an interesting one because over the last 30, 40 years, while smoking rates have more than halved, cases of asthma have actually tripled. So clearly there is something else going on there, but in terms of cancer there is not a shred of evidence that exposure to somebody smoking outdoors is going to have any impact on you whatsoever. I don’t want to go over old arguments but even passive smoking indoors, there's been a lot of research over many many years, and even there the evidence of long-term harm is pretty insubstantial.

I do accept that smoking indoors can be unpleasant for a lot of people and I totally accept that smoking should be restricted in indoor public places. I would still argue very strongly that there should be indoor public smoking rooms in pubs. You were speaking to Peter Lee [a Guernsey publican]. I remember seeing Peter many years ago and I don't see there is any reason why we shouldn't have smoking rooms indoors. And of course this is one of the problems. Because smoking is now banned everywhere indoors it has forced people go outside and so you get people complaining [about] people hanging around outside pubs and clubs or somebody who wants to smoke outside the airport or outside the harbour and it does seem rather petty to ban smoking in designated smoking areas outside the harbour or even outside the airport.

We know that flying for example can be quite stressful for a lot of people. I have only been to Guernsey airport once. Obviously it is quite a small airport so you are probably not there for hours on end [like] you might be at larger airports like Heathrow and so on, but to say you can't smoke even in a designated smoking area takes the whole war on tobacco too far. It's nothing to do with public health because if you smoke it’s a private health matter. It’s not a public health matter if you're smoking outdoors and I just think that politicians and anti-smoking campaigners need to get a grip. There are far more important things in life than banning people from smoking in the open-air.

On the nanny state

I am reluctant to use that term these days because it’s been overused. I personally would use the term bully state because I think we've gone beyond nannyism. Nannyism is quite benign. It's trying to help people make the right choices but the point is, in recent years, particularly with tobacco and smoking, we have had the bully state because it is no longer [about] nudging people to change their habits, it’s about forcing them to quit smoking and I think often that's quite counterproductive because I think a lot of people don't like being told how to behave and what you're seeing increasingly now is some smokers reaching for their fags in defiance because we are now down to, if you like, the core smokers which is about 15 to 16 per cent of the population, and I think it’s going to be very difficult - without bringing in very authoritarian practices - to actually push the smoking rates down into single figures because there are, as I said before, a considerable number of people who smoke because they enjoy it. They may admit that they're addicted to it [but] we've done research which shows that, of what we call confirmed smokers, over half will say, yes, I'm addicted to smoking but I don't care because the pleasure outweighs the thought that they are addicted, and I say we have to respect people who choose to consume a legal product. If you want to go down the line of banning the product, like alcohol in United States, well that’s a different matter, but as I say that won't work. You will simply drive it underground and people will continue to smoke.

On smoking on hospital grounds

I understand that hospitals don't want to be seen to encourage it, but the reality is that people get comfort from smoking and if you are in hospital, particularly if you are elderly, you have gone in to hospital for a completely non-smoking related reason, you might be having a hip replacement, for example, you might be in hospital for six, seven, eight weeks. If you're told you can't go out and have a smoke then I think that’s actually quite cruel. We've seen situations where hospitals ban smoking on hospital grounds and elderly people, people who might be attached to a drip, [are] wheeled off site perhaps a quarter of a mile away where they sit or stand on a busy main road with all these diesel buses and cars going past them. This is inhumane. So while I understand why hospitals don't want to be seen to encourage smoking I think it’s a question again of being pragmatic and actually, you know, showing a bit of humanity to people who are in a stressful situation.

We’ve even had examples where staff are being threatened with disciplinary action, (a) if they're caught smoking in their uniform even though they might be off the premises, or (b) if they had the temerity to help a patient who wants to smoke, if they have the temerity to help a patient off site so they can light up. Those people might have worked for the NHS for 20, 30 years looking after people, caring for people, and they have been threatened with disciplinary action and potentially the sack for doing that and I think that’s utterly outrageous.

On countries that are getting it right

I think Germany is quite a good example of a nation, possibly for historical reasons, that does not want to appear to be too oppressive in it's lifestyle regulations. In Germany of course they actually have smoking lounges in airports. They are well ventilated, they are not smoky because they've got the latest state of the art ventilation, and that seems to be a very good compromise. Also in Germany, not in every state but in some states, and in Berlin for example, you'll still find some bars where you're allowed to smoke and again that seems to me a reasonable compromise. We are not asking for people to be able to light up whenever or wherever they want. Those days are gone and we wouldn’t expect a return to that, but we don't see why you should not be allowed to have smoking rooms in bars if the owner decided that it was a good thing for his business. What you will actually find is that very few bars and restaurants would allow smoking but at least there will be some element of choice. At the moment I think Germany is quite a good example of a country that gets the balance right.

To read the full interview click here.

Saturday
Sep082018

Thoughts on smoking, vaping and middle-class snobbery

I was planning to publish the full transcript of my midweek interview on BBC Radio Guernsey.

Unusually however it was 24-minutes long and I don’t want to impose the whole thing on readers. Instead, here are some edited ‘highlights’:

On smoking being banned on government property

It would be excessive and also rather hypocritical because governments benefit massively from the taxation from tobacco. I mean the taxation that’s raised from tobacco far outweighs the cost of treating smoking related diseases for example. Now I understand the government, like hospitals, don't want to be seen to encourage people to smoke but I do think they have got to be a bit more pragmatic about this and stop treating smokers not just as second class citizens but really as third class citizens.

Tobacco is a perfectly legal product. It is not an illegal drug. People are allowed to buy it and as I say the state benefits massively in terms of finance. We've already got a ban on smoking in all enclosed public places and when that was brought in it was brought in, we were told, to protect the health of bar workers. There was no mention at the time that some years later the smoking ban was going to be extended to outdoor public places as well and if we talk about smoking outdoors there's absolutely no threat to the health of any non-smoker so there really is no justifiable reason to ban it, whether on government property or any other outdoor public place.

On tobacco being made illegal

I think there are two things here, one is pragmatic and one is to do with the pleasure of smoking. In purely pragmatic terms we know that prohibition doesn't work. We all know what happened in the United States in the Twenties and Thirties when they tried to ban alcohol. All that happens is you drive the product underground and the people who benefit financially are the criminal gangs, and exactly the same thing would happen with tobacco. You wouldn't stub it out. People would continue to smoke. I mean we see [what’s happening] where smoking is largely banned in prisons in England, for example, and what's happening is that prisoners are turning to illegal drugs such as spice, which I am told is cheaper than tobacco, [so] people will always get around prohibition and, quite often, you will move people on to products that are potentially even more dangerous, but what basically happens is that you lose control of the market. So you are never going to stub it out completely.

Also, there is a fundamental thing here which a lot of people think is almost taboo to talk about these days. Yes, there are people who wish to quit smoking, yes there are people who wish they had never started smoking, but there are still a considerable number of people who take great pleasure from smoking, they enjoy it. They know the health risks, they know that they are potentially putting their health at risk, particularly in the long term, but they get so much pleasure out of smoking that they are prepared to put that to one side and I think we have to respect people's choices and if people choose to smoke a legal product then I think they have every right to do that as long as they are considerate to those people around them, and I think you will find these days that smokers are increasingly considerate to people around them. They have to be because they know if they are not considerate to other people then we are going to get more and more people demanding a complete ban on smoking in public places.

On vaping in public places

What people have to understand is that there are two different types of vaping. A lot of people can what they call ‘stealth vape’. You wouldn’t even be aware of it. You might be very close to them but you would have no idea because they are gently puffing away on a vape pen or something, but the pictures we see in the media tend to show people vaping these huge clouds of vapour. Now that is not the norm. Very few vapers do that and if they do that it in public places with a lot of people around them, frankly they are idiots and they are causing vaping to be banned in public places.

In pure health terms there is absolutely no reason to ban vaping in public places whatsoever. In fact if you're in the public health lobby or in government you would be absolutely mad to support a ban on vaping in public places because clearly at the moment vaping has been quite successful, it has been quite popular in the last few years. Smokers are switching to vaping. At the moment in the UK as a whole about there about three million vapers, about half of those are what we call dual users. So they are both vaping and smoking and but half have given up smoking completely.

The evidence at the moment suggests that vaping is massively less harmful, potentially less harmful, than smoking. So if you are in public health or government you really want to encourage people to switch from smoking to vaping. There’s absolutely no need, I mean it’s just ludicrous, to ban vaping in public places. If anything government should be encouraging smokers to switch and to vape instead.

On why a non-smoker defends smokers’ rights

I had the odd cigarette when I was 16 or 17 but I grew up in the Seventies when a lot of my friends smoked. I never took up smoking but I feel very strongly about this not just because I think smokers are under so much attack. I think it's quite wrong and unfair. I think it’s completely right that government educates people about the potential risks of smoking The government clearly has a role to play but when it comes to forcing, coercing people to give up through a whole raft of means, whether it's a comprehensive smoking ban, whether it’s punitive taxation, I think that's absolutely wrong.

I do think governments these days want to interfere in people's lives in a way that they wouldn’t have dreamt of doing 30 or 40 years ago and it's not just about smoking. It’s now alcohol, it’s now food and all the rest of it and in a civilised society we can't infantilise adults the way we are doing at the moment. People have to be allowed to make informed choices and if they choose to smoke that is a matter for them, it's not a matter for government.

On middle class snobbery towards smokers

There is a lot of snobbery, I have to say, around smoking. We get it all the time from cigar smokers. We defend people’s right to smoke cigars, smoke pipes, smoke cigarettes, we defend people’s right to vape, if that’s what they want to do. It all comes down to choice, but there is a huge amount of snobbery around smoking and you often find that cigars smokers will distance themselves from cigarette smokers and say, ‘Oh, we are a cut above them’, but I [also] think there is a lot of middle class snobbery here.

We know that, generally speaking, cigarette smokers tend to come from the C and D socio-economic categories. The majority of middle-class people have given up smoking and it tends to be people from perhaps poorer backgrounds who continue smoking. They are the majority of smokers these days. I think there is a huge amount of middle class snobbery that looks down their noses at people who smoke and I think it is quite outrageous actually.

For the full transcript, click here.

Incidentally, I’m glad to see that Chris Snowdon and I agree on middle-class snobbery. Here he is, speaking in Cambridge this afternoon:

Friday
Sep072018

PHE chief declares war on smokers

Further to yesterday’s post, The Sun has the story (above).

Nobody in England should be smoking within 12 years, a health chief has said.

The boss of Public Health England wants a “smoke-free society” by the year 2030.

Chief executive Duncan Selbie last night called for all smokers to be given help to quit.

He told the NHS England Expo in Manchester: “Smoking should no longer be seen as a lifestyle choice. It is an addiction that warrants medical treatment.

“Everyone who smokes must be offered the support they need to quit.”

The report includes a quote from me:

Simon Clark, of smokers’ lobby group Forest, said: “It’s laughable to think England will be smoke-free within 12 years.

“Some people will always want to smoke.

“It’s their choice and if you’re an adult you have every right to do so.

“Some smokers would like to quit but many smoke because they enjoy it and no amount of state-sponsored bullying will force them to stop.”

To read the full report click on the image above or click here.

Btw, we need to keep reminding people of the economic fallacy of Selbie's argument – that 'helping' smokers quit will 'free up almost £900 million a year, cash the NHS spends treating illnesses caused by tobacco'.

Where the hell does he think a sizeable chunk of smokers' hard-earned cash goes after the government gets its hands on all that tobacco duty (£10 billion plus VAT per year)?

It goes – ta da – to the NHS. What is the government/NHS going to do when that source of revenue dries up? They'll tax something else – e-cigarettes, certainly.

It would also help if the tobacco control lobby could be consistent in its relentless propaganda.

For years we've been told the cost of treating 'smoking-related' illnesses on the NHS is £2.7 billion a year. (Before that it was £1.5 billion.)

According to Selbie the cost of treating 'illnesses caused by tobacco' (note the difference) is £900 million a year.

Either way these are just estimates and calculations – unlike the sums we know are raised by the Treasury through punitive taxation on tobacco.

Anyway, Selbie has made PHE's position clear. Smoking, he insists, is not a lifestyle choice. It's an addiction that requires medical treatment.

Vapers, take note. Eventually, at some point in the future, PHE will come for you too.

Update: Mail Online has the story too, with my quote – England should have NO smokers by 2030: Health chief calls for millions of smokers to quit within 12 years to save lives and cut NHS bills.

Thursday
Sep062018

Public Health England chief vows to get "ruthless" on smoking

What do Philip Morris and Public Health England have in common?

They're both targeting 2030 as the year England will be 'smoke free' (sic).

Their definition of 'smoke free' is a strange one because it actually corresponds to a smoking prevalence of five per cent.

As the IEA's Mark Littlewood said at an event hosted by Philip Morris earlier this year (and I paraphrase), no-one would say Britain is 'heroin free' yet the number of people who use that drug is far less than five per cent of the population.

Moreover, five per cent of an adult population of 40 million is two million, so PHE (and Philip Morris) intend to declare England 'smoke free' when there are still two million people smoking. Really?

Anyway, PHE's chief executive Duncan Selbie has once again been making noises.

According to one report published today, Selbie says the NHS long term plan, which is due to be published in November, must have a “really big” prevention ambition'.

The same report notes that:

In a statement released today, PHE said prioritising smoking cessation, cardiovascular disease and obesity in the long term plan will have a huge impact.

It said this could lead to reducing smoking prevalence to less than five per cent by 2030, and halving childhood obesity and the number of avoidable deaths from cardiovascular disease.

If you want to know what that means, Selbie has posted an article – 'Prevention and the NHS long term plan: 3 ways we can save more lives' – on PHE's Public Health Matters blog:

Smoking [he writes] remains England’s biggest killer and ends the life of 200 people every day. Our prevalence rates are at an all-time low at just under 15% but this belies huge variation, such as in affluent Epsom and Ewell, where rates are at 4.9%, but just 60 miles away on the south coast in Hastings the rate is more than five times greater at 25.7%. We also see big variation particularly in people in manual work and those who suffer with mental health problems. Our prisons are now largely smokefree but it can be harder to smoke outside a railway station or pub than it can outside a hospital, and this is not okay.

Smoking is the single biggest modifiable risk factor that impacts on infant mortality and morbidity, causing up to 2,200 premature births, 5,000 miscarriages & 300 perinatal deaths per year. Almost 11% of women in England are still recorded as smoking at the time of delivery, which translates into over 65,000 infants born to smoking mothers each year. We need to take action and support women to increase the number having a smoke free pregnancy, including implementing the actions set out in the Government Tobacco Control Plan in respect of pregnant women and of the Maternity Transformation Programme.

Our ambition to remove smoking from England will only be achieved by the concerted efforts of everyone, but it can be done, and the NHS could be a more powerful driving force by actively nudging patients and its own staff onto cessation programmes, treating smoking addiction as a medical condition and taking an absolutely zero tolerant approach to smoking on the NHS estate.

All of this and more will play out through the long term plan and this time we must be more literal about the priority that we are giving to prevention. We need less rhetoric and more action. We need to be ruthless in our priority setting and ruthless in our implementation.

Interestingly, and despite PHE's declared support for e-cigarettes as a smoking cessation tool, vaping doesn't get a single mention.

Selbie's contempt for smokers is all too obvious however.

Of course, if he achieves his ambition to make England 'smoke free' by 2030 (he won't), expect to see a new NHS plan featuring a "zero tolerant approach to vaping on the NHS estate" allied to the "need to be ruthless in our priority setting and ruthless in our implementation" of anti-vaping policies.

We probably won't have to wait that long because I predict that public health campaigners – even those that are currently advocating e-cigarettes as a smoking cessation tool – will turn on vaping the moment there are more vapers than smokers.

I'd bet my house on it, if my wife would let me. (She won't.)

Update: Here is Forest's response to PHE's statement:

Prioritising smoking cessation is an "attack on choice and personal responsibility"

Wednesday
Sep052018

Listen to the "incredibly informative director of Forest"!

Got a minute?

Then listen to the "incredibly informative director of Forest" talking to Jenny Kendall-Tobias on BBC Radio Guernsey earlier today!!

Subjects included smoking (and vaping) in public places.

Click here. Transcript to follow.

Wednesday
Sep052018

Will the eradication of passive smoking be followed by the eradication of smokers?

Some anti-smokers, I am convinced, have a psychotic disorder.

Psychosis may involve delusional beliefs. Delusions are strong beliefs against the reality, or held despite contradictory evidence.

Fear of ‘passive’ smoking - including even the briefest exposure to tobacco smoke indoors or outside - is a good example of this ‘illness’.

Prior to the smoking ban I was interviewed in a busy London pub. Alongside me was a long-serving employee of ASH who I quite liked because she didn’t have that chip on the shoulder aggression that characterises some of her sterner colleagues.

Sat in that pub however she was a different person. She became agitated and started waving her hand in front of her face.

I wondered what the problem was. Then I realised. It was the smoky atmosphere. And, to be fair, it was a bit smoky. But her reaction was disproportionate and weird.

A friend of 40 years, who I met at university, is so smoker-phobic that he won't attend any event where people are guaranteed to be smoking – even if they are confined to an outdoor smoking area.

Unfortunately if you repeat something often enough (like ‘Passive smoking kills’) a lot of people will believe it even when the evidence of harm is insignificant or inconclusive.

I don’t deny, btw, that a smoky environment can be unpleasant. I know people who grew up in homes where one or both parents smoked up to 40 cigarettes a day and one or two of them still grumble about it when the subject comes up.

Far from encouraging them to smoke, it did the exact opposite.

Without exception they are also living long and apparently healthy lives – and will probably outlive me – which suggests that long-term exposure to smoke in the home may be unpleasant for some but it isn’t as bad as we’re led to believe.

As I've said many times before, no generation has been so exposed to tobacco smoke as the children who grew up in the Fifties and early Sixties when 80 per cent of men and 40 per cent of women were smokers, yet that generation is living longer, and is generally in better health, than any generation before them.

If ‘passive’ smoking is as harmful as they say it is, how is that possible?

Anyway, a new study – reported this week – has found that ‘passive’ smoking has been almost eradicated. According to The Times:

The amount of secondhand smoke inhaled by non-smokers has been almost eliminated over the past 20 years, according to research.

Scientists from the University of Stirling found “dramatic reductions” in exposure since 1998 and evidence of continuing improvements, particularly in the decade after the smoking ban in public places was introduced.

The study was published in the journal Tobacco Control and The Times reported:

Since 1998 the average amount of cotinine — a biomarker for exposure to tobacco smoke — measured in non-smokers’ saliva has reduced by more than 97 per cent.

Or, in tabloid terms: Exposure to second-hand ciggie smoke drops by 97% (Metro).

Inevitably these results have been presented as a great public health success story. According to the research team:

Our analysis showed Scotland has made even greater progress in protecting [my emphasis] non-smokers from secondhand smoke than previous reports had suggested."

Note that word, 'protecting'.

Truth is, the level of cotinine in non-smokers’ saliva may indicate exposure to environmental tobacco smoke but it is not an indicator of harm caused as a result of that exposure.

We went through the whole cotinine argument before the introduction of the smoking ban. Bar workers were tested for cotinine in their saliva and some had a higher level than people who were not exposed to tobacco smoke on a daily basis.

However, attempts to prove that 'passive' smoking was the reason for ill health among bar workers failed consistently through lack of evidence.

A handful of cases resulted in out of court settlements (probably because employers feared a huge legal bill, not to mention compensation, if they lost) but the few bar workers whose cases went to court lost every time.

That apart, the reaction to the 'news' that non-smokers' exposure to tobacco smoke has fallen by 97 per cent since 1998 was notable for two things:

According to the research team at Stirling University:

"The proportion of non-smokers who have no measurable evidence of cotinine in their saliva has increased at almost every survey year and now stands at more than four out of every five adults.

"However, that still means nearly one-fifth of non-smoking adults experience regular exposure to second-hand smoke.

"We now need to work even harder [my emphasis] on making sure that we protect the remaining 600,000 non-smokers in Scotland who continue to be exposed to second-hand smoke on a regular basis.’

In other words, non-smokers’ exposure to tobacco smoke has been reduced to almost zero and we’re still not happy! Cue campaigns to prohibit smoking in the home, beginning with social housing, and smoking outside (to prevent smoke 'drifting' in through open doors and windows.)

Also noteworthy was the reaction of ASH Scotland, a body that works hand-in-hand with the Scottish Government and relies on that same government (using taxpayers' money) for most of its funding.

According to CEO Sheila Duffy:

"This [delivering a healthier environment] has not happened by accident but is the result of work by successive Scottish administrations and is a clear example of the benefits of public health campaigns."

Apart from the underlying message ("Keep funding us!") do you see how Duffy chose to politicise the issue, praising ASH Scotland's benefactors for reducing non-smokers' exposure to "secondhand tobacco smoke" when the truth is that smoking, and non-smokers' exposure to tobacco smoke, was in decline long before devolution was a twinkle in Tony Blair's eye.

There is no significant evidence that the health of non-smokers has improved as a result of the smoking ban and other policies introduced by "successive Scottish administrations". The famous 'heart attack miracle' has been debunked so many times it's frankly embarrassing.

As for the display ban, the ban on tobacco vending machines and the ban on smoking in cars with children (which were introduced in Scotland independent of Westminster or Brussels), show me evidence that a single one of these policies has led to "huge reductions in secondhand smoke exposure in Scotland, delivering a healthier living environment."

Long before the Scottish, Welsh and Westminster governments banned smoking in all enclosed public places, shops, cinemas and public transport had gone ‘smoke free’. Many if not most offices were smoke free too.

As we entered the new millennium pubs and working mens' clubs were among the last remaining places where smoking was allowed with few if any restrictions and millions of non-smokers didn't go to pubs, nor were they members of private clubs that allowed smoking, so the smoking ban made almost no difference to them.

As for smoking in cars with children, that was restricted to a handful of smokers long before a law was introduced making it a criminal offence.

In other words, legislation has played very little part in "delivering a healthier environment" in Scotland or anywhere else.

Nothing, of course, will appease the zealots in the tobacco control industry and now that they have ‘achieved’ the ‘eradication of passive smoking’ what’s left - the eradication of smokers?

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