Asthma and the smoking ban - facts, or propaganda?

The BBC has today reported a sharp fall in the number of children admitted to hospital with severe asthma in recent years, with some attributing this directly to the smoking ban introduced in July 2007. But does this claim really withstand scrutiny, or is it yet more propaganda from the anti-smoking lobby?

Reading the headline, you would be forgiven for believing that there was a proven causal link between smoking - actively or passively - and childhood asthma. Whilst research suggests this may be the case, it's not quite so straight forward.

A rich source of asthma-related information, the website www.asthma.org.uk states "It's difficult to know for sure what causes asthma". It continues:

"What we do know is that you're more likely to develop asthma if you have a family history of asthma, eczema or allergies. It's likely that this family history, combined with certain environmental factors, influences whether or not someone develops asthma.

"Many aspects of modern lifestyles - such as changes in housing and diet and a more hygienic environment - may have contributed to the rise in asthma over the past few decades. Environmental pollution can make asthma symptoms worse and may play a part in causing some asthma."

Whist the statistics demonstrate children whose parents smoke are more likely to develop asthma - particularly for those children whose mothers smoked whilst pregnant - there is little evidence to suggest passive smoking is a major contributory factor. (You will doubtless have noticed the quote above fails to mention smoking at all.)

The prevelance of asthma increased in the majority of countries across the world (including the UK) since the 1970s, although levels appear to have plateaued in some developed countries. Indeed, self-reported symptoms of asthma in children 13–14 years of age decreased by about 20% in the UK between 1995 and 2002 [Anderson, 2005] (before the smoking ban!).

Nor can the increased prevelance of asthma be explained by any links with passive smoking.  Throughout the last four decades, the number of smokers (and children living in households where there is at least one parent who smokes) has steadily and consistently fallen. Furthermore, the level of harmful substances per cigarette has also fallen steadily in recent years, with levels of tar and nicotine, for example, less than one third of what they were half a century ago.

Even if we accept, for the sake of argument, that passive smoking is the primary contributory factor in severe childhood asthma, it is difficult to see how the smoking ban could have led to the fall in admissions as has been claimed.

The smoking ban was introduced primarily to protect staff in the workplace; mainly in pubs and restaurants, but not exclusively so.  Whilst it may be different in your place of work or local pub, these aren't places where I have ever seen large numbers of children hanging out.

The argument as reported on the BBC website, that the smoking ban has lead to a fall in severe childhood asthma, appears to amount to little more than post hoc, ergo propter hoc - after it, therefore because of it (as any latin scholar or fan of the West Wing can tell you). As often proves to be the case, this is likely to prove a nonsense.

Whilst it is obviously in the interests of those nannying fussbuckets responsible for the introduction of the smoking ban to try and further 'evidence' of the benefits of the ban (other than the 1,000s of pubs forced to close since 2007), this is a pretty lazy effort by any standards.

As H Ross Anderson, professor of epidemiology and public health, stated in his 2005 article:

"Any advance in our understanding of trends is likely to depend on the development of new theories of causation together with better methods of measuring and classifying asthma in population studies."

Until such time as we have not just developed new theories but have proven the causations of asthma, you will forgive me if I treat any such claims by the anti-smoking lobby with a healthy pinch of cynicism.

In the meantime, I'm sure the BBC will continue to do what the BBC does, and not let the facts or balance get in the way of a 'story'...

Highly recommended further reading from Simon Cooke's blog: http://theviewfromcullingworth.blogspot.co.uk/2013/01/how-to-lie-with-statistics-asthma.html

Please, nanny, ban fruit

The ongoing race by Labour MPs to come-up with the most ridiculous gimmick for inclusion in their manifesto for 2015 has a new front runner. Take a bow Andy Burnham, Labour’s nanny-in-chief the shadow health secretary.

 

According to Burnham, the government should ban high-sugar cereals and other foods which, he claims, are contributing to an obesity epidemic among British children.

 

Whilst it is reassuring that Labour seem to have finally woken up to the problem of childhood obesity, instead of a meaningful and considered policy proposal we are forced to endure yet another knee-jerk piece of headline grabbing.

 

It is reported that Burnham is considering proposing a 30% cap on sugar in cereals and other foods, despite even a cursory examination of the facts illustrating that the effect of this would be minimal.

 

A recent report by Which identified those cereals with the highest sugar contents to be Frosties (37g of sugar per 100g of cereal), Coco Pops (35g) and Sugar Puffs (35g). Put another way, the sugar content of a single 30g serving of each of these three cereals is 11.1g, 10.5g and 10.5g respectively.

 

Now let’s imagine that each of these cereals contained just 30g of sugar per 100g as Burnham is considering proposing. The sugar content of a single 30g serving of each would fall to 9g.

 

In other words, Burnham’s nannying fussbucketry would see little Andy eating between 1.5g to 2g of sugar a day less than he is now. Assuming that he doesn’t sprinkle a spoonful of sugar over the top to compensate (that wicked Mary Poppins has a lot to answer for).

 

Now, of course, reducing the sugar intake of children would help to tackle obesity. But to suggest legislating to force Kelloggs et al to marginally reduce the sugar content of their cereals would help in any meaningful way is nonsensical.

 

Now I must confess, I’ve never been a lover of Frosties, and I don’t think I have ever tried Coco Pops or Sugar Puffs. I’ve always been more of a fruit person.

 

For my breakfast this morning, I indulged in a packet of ready-to-eat apricots. No unhealthy cereals for me, nosiree. Just natural, healthy fruit. Or so I thought.

 

A cursory glance of the packet tells me that my healthy breakfast choice contained a whopping 60g of sugar per 100g. So now I’m in a quandary – should I put a handful of apricots in my son’s lunchbox tomorrow morning, or two handfuls of Sugar Puffs?

 

So please, Nanny Burnham, if you are serious about helping parents and protecting children, leave Kelloggs alone. Let’s ban fruit instead.

Minimum pricing, on chips?

We read in the Telegraph today (here) that the Prime Minister has instigated plans to introduce minimum pricing on the sale of alcohol.

Whilst such a move will undoubtedly be welcomed by some health professionals, and warmly so by the patronising, preaching nanny statists, it is difficult to see this as little more than an eye-catching gimmick which will achieve little in the way of public health improvements or a curtailing of problem drinking.

Whilst ‘problem drinking’ and ‘preventable deaths’ are easy and emotive phrases to bandy about, I fear we are trying to come up with solutions before we have fully understood the root causes of the problem.

Whilst there have been well publicised and extreme cases of nightclubs retailing alcohol at ridiculously low prices, inviting partygoers to‘drink all you can’ for a fixed price, these are very much the exception rather than the rule.

Minimum pricing will have no impact at all on those individuals that believe their alcohol intake on a Saturday night to be directly proportional to their masculinity, who in the main already pay way above the likely level of any minimum price in their quest to prove their manliness.

We also seem to fall in to the trap of assuming that those who abuse alcohol only buy the cheapest alcohol available to them, and then only because it’s cheap; that we can price alcoholism out of peoples’ reach. The notion that we can tax addicts into kicking their habit is breathtakingly misconceived.

Any solution to ‘problem drinking’ must be centred on the tried and tested approach of education, education, education. No, it won’t give you a sexy headline; it won’t give you overnight results; but it will work.

The Telegraph also reports today that of the quarter of the population which is clinically obese, over 40% thought they were a “healthy” weight. It also reports that even a substantial number of health professionals cannot tell the difference between a healthy weight and an unhealthy one.

As the National Obesity Forum calls for the better education of pupils about the dangers of obesity, I await next year’s inevitable plans for the minimum pricing of fatty foods with baited breath…