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What hope is there for liberty if truth becomes a plaything of militant lobbyists?

November 29th, 2011 Posted in Government, health, Spin by

Tobacco was unfortunately very much in the news again recently with the BMA launching a campaign to ban smoking in cars probably as a prelude to what will then seem a more reasonable move to get it banned when children are present. I want to focus here not on the ban but on the methods being used by its advocates.

On Radio 4s Today programme Vivienne Nathanson of the BMA was questioned about her evidence:

Nathanson: Well, the evidence is, in fact, that the levels of toxins that can build up in a car do reach 23 times the levels in a smoky bar…

Interviewer: And that is—sorry to interrupt you—but that is peer-reviewed?

Nathanson: Yes, absolutely.

Interviewer: Everyone in the scientific community accepts that it’s true?

Nathanson: Absolutely.

The BMA has since issued a major correction and apology with the explanation that the mistake was caused by human error.  These things happen but as Head of Science and Ethics, Nathanson has a duty to check. I find her glib assertions regarding peer review and scientific consensus indefensible. It is hard to see how they could be made in error.

The same day over on Radio 5, a phone in caller queried the general evidence base for passive smoke harm and Deborah Arnott of ASH countered by emphasizing claims that heart attacks have been reduced by smoking bans:

“There’s very good evidence supported by the BMA, the Royal College of Physicians, the World Health Organisation, the Standing Committee on Tobacco & Health which reported to the Department of Health. The Coalition Government very recently conducted a review of smokefree legislation, and what we’ve seen is a significant decline in heart attacks following the implementation of the legislation. The evidence is incontrovertible.”

In response to criticism that a fall in heart attacks in England post the 2006 Health Act was part of an existing trend, she said:

“Yes, but the decline is greater than trend. And that’s in a peer-reviewed article published in a very reputable journal, and it’s been found not just in England, Scotland, but everywhere that smokefree legislation in public places has been brought in.”

The statistics on heart attack hospital admissions in the UK are freely available to all on line. Here is a link to the NHS data for Scotland.

Using the measure preferred by the tobacco control industry and the hospital admissions data from NHS statisticians (table AC5) we can calculate emergency admissions for heart attacks as follows:

12 months pre ban:             7905
0-12 months post ban:        7250        (-8.29%)
12-24 months post ban:      8913        (+12.75%)
24-36 months post ban:      7707        (-2.50%)

() = % change from pre ban baseline

The word Arnott used was incontrovertible, the claim is a 17% reduction and the intervention was presented by some supporters as certain to have an immediate major impact on public health. Taking all that into account we should see a consistent, trend independent effect in the public record but whichever table or measure we use it is impossible to objectively claim that such an effect exists.

I value sober analysis of NHS statistics more than I do articles authored by tobacco control activists, peer reviewed or otherwise. I am not alone in this view and it is unlikely that Arnott is unaware of the serious credibility issues facing all the studies that support her claim or indeed of the existence of other work that contradicts it. The evidence is very far from incontrovertible.

Arnott is a skilled professional propagandist who is all too aware that, whatever the actual truth; provided that she sounds convincing her version will be believed by enough otherwise ill-informed people to achieve her objective. An article here gives some insight into her personality and the nature of her campaign.

Arnott is correct in saying that there has been a peer reviewed publication in the BMJ that supports her claim.  It claims a 2.4% decrease in heart attacks due to the ban but fails to adequately explain how the result was arrived at. This approach is sadly increasingly common in medical journals. Bearing in mind Arnott’s comment on trends, it is notable that, according to the NHS, the overall decline in heart attacks for the 12 months post ban was 4.26% compared to a 5.19% decline 2 years before the ban. The post ban decline was in fact neither large nor significant. The BMJ paper was produced by a team led by Anna Gilmore.

Arnott is also correct in saying that there has been a review of the 2006 Health Act. It was written by Linda Bauld.

The authorship of both these papers throws up some very searching questions about ethics at the Department of Health. Surely in a society that allegedly values honesty and transparency we have a right to expect government to review policy and measure its efficacy using the most qualified, objective and unimpeachable resources available. Why then did the DH directly commission two not especially qualified people both of whom have a notable history of anti-tobacco activism? The results were hardly likely to be seen as either credible or objective.

ASH is largely funded by the Department of Health and appears to be in firm control of the government’s agenda.

How can we possibly have a free and liberal society if we allow the truth to become the property of pressure groups directly funded by government departments?  The principles at stake here radiate way beyond tobacco. We urgently need to reform the charity sector and I would suggest also the Department of Health.

Thanks to Chris Snowdon and Frank Davis for giving their time to transcribe the radio interviews.

Written by Chris Oakley.

4 Responses to “What hope is there for liberty if truth becomes a plaything of militant lobbyists?”

  1. BrianB Says:

    Chris, do you mind if I correct your statistics on Scottish heart attacks?

    The numbers that you quoted are in fact those for Acute Coronary Syndrome (ACS). ‘Heart attack’ is, by convention, described as Acute Myocaridal Infarction (AMI). ACS, by the Scottish NHS (ISD) definition striclty means just Unstable Angina – which may, or may not ultimately lead to an AMI.

    Whilst Jill Pell, in the egregious study that led to the claim of a “17% fall in heart attacks”, rather muddied the water when she too referred to ACS rather than AMI (despite the recurrent lurid headlines since), her definition of ACS was based upon results from on a rather less conventional laboratory test (troponin) and so has no absolute comparison either with conventional AMI counts, nor those of unstable angina. How convenient!

    Anyway, the actual – and official – annual heart attack emergency admission numbers pre and post ban are:

    2005/06: 8,310 (the year before the ban)
    2006/07: 7,767 (6.53% decline from 2005/06)
    2007/08: 7,339 (5.51% decline from 2006/07)
    2008/09: 8,239 (12.26% increase from 2007/08)
    2009/10: 8,147 (1.12% decline from 2008/09)

    Overall, 4 years after the Scottish smoking ban, the annual emergency admissions for AMI are just under 2% down on the year before the ban.

    Comparing this with the equivalent period before the ban (and this data is only available in Table AC3 – now apparently defunct) there was an 18% fall in AMI from 2001/02 to 2005/06. So, not only was the claim of a 17% reduction in heart attacks complete hooey, it appears that the introduction of the smoking ban has actually dramatically slowed the pre-existing and steady rate of decline in heart attacks, year-on-year.

    So, how does that grab you, Arnott?

  2. BrianB Says:

    Sorry for the typos:

    “Myocardial” not “Myocaridal”

    “strictly”, not “striclty”

    A preview/edit facility would be useful.

  3. Angela Harbutt Says:

    Hey thanks for the input Brian. On behalf of LV I apologise if the comments section isn’t as great as it could be – I’ll look in to it (I dont think we ever anticipated such detailed comments when we created the site).

    I think Chris’ post and your comment only goes to show that almost everywhere we look now we see phoney science , hidden methodologies, lazy research and down right abuse of data being deployed to win vested interest cases.

    It is immensely annoying – I have no doubt the listeners to radio 4 or radio 4 will have gone away thinking (again!) that the “science” has proven the case. I have forwarded this link to the BBC asking that they make necessary corrections in a suitably high profile slot on both of the programmes. I can only hope that they recognise their duty to “inform” and not just be the mouthpiece for these vested interest groups (some of which WE pay for with our taxes).

    This type of abuse (I can find no other word for it) will anger many of the genuine medical (and other scientific) researchers out their who see their work being undermined. I feel for them – because science and data could do so much to inform.

    I think what it does tell us is that we can no longer trust vested interest groups to conduct research that can be relied on for legislative purposes. And, of course hope that the government realises what damage this does to their reputations and seek more independent sources here on in.

    As for the rest of us… we must inevitably return to our instincts and what my mum calls “good old-fashioned common sense” on such matters.

    Thanks for the input.

  4. Dave Atherton Says:

    The fox has seen the rabbit, I’ll be back.