P & T and Secondhand Smoke

[Euromutt]

Well, my libertarian principles tell me it should be all up to bar owners to permit smoking, or not. However..

This has been the case everywhere until a few years ago. How many non-smoking bars have you ever seen? I know that I haven't come across a single one. Ok, so we might then think that this is because the overwhelming majority prefers smoke in bars, so there's just no market for non-smoking bars.

That may apply in Sweden, but here in Washington state, at the time the smoking ban was imposed on bars and restaurants in December 2005, 85% of these establishments were already non-smoking, and their number was on the rise even before the imposition of the ban. Clearly, some mechanism exists whereby it is possible to get establishments to convert to non-smoking without resorting to a blanket ban.

So what happened, people stopped going to bars? Nope. There was a huge public outcry against the ban? Nope. Polls showed that 90% supported the law, after it was in place. There had been a lot of criticism before the law was passed, but very little of that was seen afterwards. The restaurant industry, who opposed the law beforehand, switched around when they saw the consequences.

Similar arguments are wielded ex post facto to justify bans in many places, and I'm unconvinced any of them are actually meaningful; they all smack of lessons in how to lie with statistics.

When you (general "you") impose a nationwide, or state-wide or province-wide, ban on smoking in bars, you eliminate the option for customers who want to smoke to take their custom elsewhere. Smoking is only one aspect of the equation here; at least as important, and probably more so, is the desire on customers' part to get out of the house and have a drink in a convivial atmosphere. The only thing that is shown by statistics that bar patronage didn't drop is that bar-going smokers would rather go to non-smoking bars than not go to bars at all.

It does, admittedly, demonstrate that the oft-wielded "it'll hurt the industry" argument against smoking bans is flawed. Flawed, but not invalid, depending on the situation. For example, here in Washington state, Pierce County imposed a smoking ban in January 2004. Because it only applied to the county, bar-frequenting smokers stopped going to bars in the Pierce County, and took their custom to neighboring King County or the Indian reservations instead, and that most certainly did hurt the hurt the industry locally. The lesson is that if you want to impose a smoking ban, make it cover as wide a geographical area as possible.

Polls showed that 90% supported the law, after it was in place.

Were the samples drawn from the population as a whole, or only from people who actually frequent bars? Why should the opinion of people who don't even go to bars carry any weight in deciding whether or not smoking should be allowed in such places? In fact, basing myself on the Millsian principle that the only limitation on one individual's freedom should be that it does not infringe upon another's, I'd go so far as to say that the decision whether smoking should be banned in a specific establishment should fall only to those who frequent it.

As a person with an allergy to tobaccy, I'm relieved I can now work, go to school, and patronize places without coming out wheezing, covered in a rash, and dealing with water blisters and itchy eyes, nose, ears, etc.

Look, I'm not unsympathetic. I just think there has to be a conceivable mechanism whereby you can go to a bar you like without being hampered by smoke, while at the same time I can go some other bar and have a ciggie with my pint. I acknowledge that not all places are like Washington state; in western Europe, non-smoking bars are rarer than hens' teeth. But why does a blanket ban have to be the only way to promote non-smoking establishments? Why couldn't government grant some kind of tax break to bars which adopt non-smoking policies? Or allow bars to purchase a license permitting smoking on the premises, the (sizeable) cost of which the bar owner could pass on to his customers?

Like seatbelt and helmet laws?

(The following is not specifically directed at anything you said, Linda, I'm just using that quote as a cue.)
I'll admit that, as one who subscribes to the aforementioned Millsian principle that the only limitation on one individual's freedom should be that it does not infringe upon another's, I've had to think hard about why I do support helmet and seatbelt laws, but I think I've found it. Smoking, like failure to wear a car seatbelt or a motorcycle helmet, imposes an avoidable burden on the health care system, thereby causing one's own freedom to affect that of others. Where smoking differs from not wearing a seatbelt is that, in the case of smoking, this burden can be (and is) compensated for by imposing an excise tax on tobacco and applying the revenue towards health care. By contrast, there is no practical way to tax people for not wearing a seatbelt or helmet, except by making it an offense not to wear one, subject to a fine which, for all practical purposes, takes the place of a tax.

So, let's try this out on a scenario based on a question I posted earlier (that nobody has yet answered) ~

Well, it took some thinking, but that doesn't mean the answer didn't exist. Patience must you learn.

Would you find it acceptable to scrap fire safety legislation in privately-owned businesses? Oh, this club doesn't have a fire escape but that's OK because the business owner doesn't want one. People don't have to go if they don't want to, right?

The parallel doesn't work for the following reason: very few members of the general public have the requisite skills to determine whether a building complies with fire safety codes. A customer or employee might ask the business owner whether the premises comply, but it's entirely possible for the business owner to lie and say they do (when in fact they don't), and the only way the customer or employee can find out that was a lie is the hard way, when the building catches fire.

By contrast, anyone can tell whether or not smoking takes place on the premises. Indeed, much of the argument for smoking bans is that the evidence to that effect is impossible to ignore.

There are dozens, if not hundreds, of individual items of legislation that businesses must comply with in the interests of health and safety.

Certainly, and all of them cover aspects which the layman cannot reasonably expected to be able to determine for himself. Restaurants can't operate if every customer has to be allowed to inspect the kitchen, and you can't reasonably expect every customer to know what he's looking for in the way of unhygienic practices. Laborers at a sawmill may have no way of knowing that a saw is inadequately guarded until it takes their arm off, at which point it's too late. Most importantly, it's possible for the management to lie (as it may be in their interest to do) and claim that the premises comply with safety standards when they don't. Freedom is based on the ability of individuals to make informed decisions; government has a right (indeed, a duty) to intervene and make decisions on behalf of its citizens when it rightly determines that those citizens do not have the means at their disposal to make an informed decision. But again, while the layman may be unable to determine whether he is being exposed to toxins or pathogens, the layman is perfectly capable of determining whether or not tobacco smoke is present in a room.

 

[fls]

Speaking of carcinogens. What are the workplace safety measures in place re: carcinogens? How does secondhand smoke measure up when compared to them?

The relevant comparison would be with long-term exposures. Other carcinogens have limits placed on daily exposure. The typical occupational exposures for a restaurant/bar-worker in an establishment that allows smoking are as harmful or more harmful than other carcinogens.

The National Toxicology Program provides a summary of this information plus references.

If this wasn't an issue of "personal freedom", nobody would think twice about eliminating this exposure.

Linda

 

[Blue Mountain]

Nominated for TLA

This means the restaurants wouldn't participate. They participate today because the government has access to police enforcement.

[several good paragraphs snipped]

I've been to ex-Soviet republics (I was born in Lithuania), and this is the attitude indeed: no regulation, so caveat emptor. What is the result? Commerce implodes. Nobody trusts the butcher, the baker, or the candlestick maker. If somebody started a testing organization, the butcher would bribe them, so nobody would trust *them* either. Result: there is no economic demand for vendor evaluation! Unemployment is high (who would invest in capital, when there's no justice if you were defrauded?) Counterfeitting is rampant (whenever I go, I am asked to bring medicines, because if I bring them, they know they're genuine).

I have seen laissez-faire economies: they're a total mess. People are *afraid to buy*.

The trick is to recognize a balance, and trust the republic. It fosters commerce, the health of the citizenry, and - most importantly - it responds to their directive. You can disagree with it, and rail against the system, but I propose that the reason this argument has received no traction is because the electorate knows better and sees this approach as in their best interest.

Nominated.

 

[Ivor the Engineer]

That same description, with some variation, would apply to many of our choices. Don't people choose to go skiing because it's exciting (i.e. conditioned release of adrenaline, endorphins, etc.)?

I choose to go skiing for pleasure, which no doubt results in adrenaline and endorphins being produced in my body. They are produced even if I don't go skiing. Nicotine is not produced in anyone's body as far as I know.

Casual smoking results in little harm (if any) while receiving the benefits of participating in a social activity, relaxation, etc.

Are you playing devil's advocate with this statement? Ok, I'll bite:

So how many casual smokers do you know?
What is "casual smoking"? 1 a day, 5 a day, more / less?
Would "casual smoker" describe the vast majority of the people who smoke?

Personally, I've only known 2 people in my life who I'd class as casual smokers. All the others (the number of which have smoked is in the 10's) have habits of 10 or more a day.

Nicotine isn't the point. People don't take up the activity to fill a need for nicotine.

Linda

Nicotine isn't the point of smoking? Huh?

What does it matter why people take up smoking? People continue the activity because of their addiction to nicotine and operant conditioning. You could make exactly the same argument for any physically addictive drug.

I think it is pretty obvious that a smoke filled room is going to be detrimental to a persons long term health if they have prolonged exposure. Some here want to argue the toss so I'm not going to get involved. With your expertise you are in a far better position to do that.

My argument is based on pragmatism. Since nicotine addiction is tolerated in our society, shouldn't it be made as safe as it reasonably can be? As a bonus, by making it safer, it would remove the effects smoking currently has on everyone else. Kind of like providing clean needles for heroin addicts but better.

The image of a group of nicotine junkies sat in a pub sucking up their dose from inhalers would probably remove much of the coolness that's been associated with smoking too.

 

[Deus Ex Machina]

So is that trying to equate the "choice" to smoke with, say, the choice to go skiing?

Smoking is a conditioned habit and physical drug addiction. So "choice" isn't quite the right word is it?

ah. nothing like a faith based statement of 'fact.'

I choose to smoke because I enjoy it. I also ride large motorcycles and (when not on the motorcycle) like to drink beer. I do all these things because I find they increase my enjoyment of my life at a cost acceptable to me.

 

[Ivor the Engineer]

ah. nothing like a faith based statement of 'fact.'

You'll have to explain that to me in more detail

I choose to smoke because I enjoy it. I also ride large motorcycles and (when not on the motorcycle) like to drink beer. I do all these things because I find they increase my enjoyment of my life at a cost acceptable to me.

So you could give up smoking anytime you wanted, right?

What's the cost of smoking that you're prepared to pay?

The expected cost for riding a motorcycle or moderate drinking of beer is very low in comparison to that of smoking regularly.

Or is that another faith based statement?

 

[Stitch]

Your right to swing your arms ends where my nose begins. Should be the same for the foul odour of cigarettes, too.

And perfume, Body Odor, halitosis etc...

 

[mumblethrax]

Certainly, and all of them cover aspects which the layman cannot reasonably expected to be able to determine for himself. Restaurants can't operate if every customer has to be allowed to inspect the kitchen, and you can't reasonably expect every customer to know what he's looking for in the way of unhygienic practices. Laborers at a sawmill may have no way of knowing that a saw is inadequately guarded until it takes their arm off, at which point it's too late. Most importantly, it's possible for the management to lie (as it may be in their interest to do) and claim that the premises comply with safety standards when they don't. Freedom is based on the ability of individuals to make informed decisions; government has a right (indeed, a duty) to intervene and make decisions on behalf of its citizens when it rightly determines that those citizens do not have the means at their disposal to make an informed decision. But again, while the layman may be unable to determine whether he is being exposed to toxins or pathogens, the layman is perfectly capable of determining whether or not tobacco smoke is present in a room.

But OSHA and restaurant inspectors don't simply post warnings in order to inform individuals, they outright ban practices that a hypothetical rational agent would reject. Nobody wants broken glass in his food, and so you can't serve food with with broken glass in it. Nobody wants to risk losing an arm to a saw at work, so you can't have unsafe work conditions except where they are necessary given the job you are performing.

I would also question the assumption that freedom rests upon the ability of individuals to make informed decisions in situ. We can view regulations from point of view of carefully negotiated offloading of this decision-making process from the individual to the appropriate authority, in order to maximize individual liberty (you inspect the restaurants and close them down if they aren't up to code, so I don't have to).

I'm confident that people can, in the appropriate context, come to well-reasoned conclusions about which processes will lead to desirable consequences. I am not confident that we can do this at the check-out or while operating a drill press. The notion of the rational agent making informed decisions in every aspect of her life is simply mythology; it is not consistent with any modern scientific treatment of human behavior. If this is freedom, we never had it to lose in the first place.

 

[baron]

The parallel doesn't work for the following reason: very few members of the general public have the requisite skills to determine whether a building complies with fire safety codes...

I agree with this and everything you posted afterwards except for the words " The parallel doesn't work for the following reason". Check what I was responding to: I was responding to the suggestion that health and safety - as a whole - should be voluntarily complied with, and managed by a private organisation. In other words, your argument is, by-and-large, my argument. For example, I made the same point in the very post you quoted from ~

So, a packer decides to look for a job in a factory. To do this, you are saying this person needs firstly to be fully conversant with all hundreds of potential safety risks in that factory and be able to evaluate them against the measures put in place by the company

I'm not advocating a blanket ban and have never said I would support it over more selective rulings (whatever they may be). I would be happy for 70% or 80% of bars to be non-smoking. In some places they are, although where I live, it's 0%. However, it looks like a blanket ban is what's coming. OK, so I have even more choice! I'm sure from a smokers' perspective it's not a good thing but, to put it bluntly, that's their lookout and I don't care. All I want is a choice of establishments that I can visit without gulping carcinogens and coming home coughing, nauseated and stinking like an ashtray.

 

[blutoski]

Which virus was that?

HIV.

We don't eliminate HIV in any case nor Hep C in all cases yet reducing viral loads has tremendous results in many cases.

I understood your point but he was talking about both evidence of benefit and evidence of causality.

And if a cancer treatment resulted in an average 90% reduction of the tumors, some of those people might have 100% reductions or at least have a bit more time on the planet. If you are dying of cancer, a month most certainly does have value.

It was just an example of the meaning of clinical significance. A patient with 1,000 viral load is indistinguishable from a patient with 10k viral load. They're both close do death.

The antiviral in question did not get past phase III trials, largely because it was ineffective in reducing viral loads below 1,000, regardless of starting point. They showed us the charts of the patients who started with large loads *implying* that a 90% reduction was normal. But patients with loads of 1,200 were reduced to 900, and patients with loads of 800 stayed the same.

This compares to other drugs which are effective in reducing load in all patients, and often are actually more effective with patients who have lower starting titres.

So, this drug piqued our interest from a "mechanism-curiosity" point of view, but was not of interest from a clinical perspective.

 

[luchog]

I
Since you asked specifically: I would be in favor of relaxing the governmental regulations on workplace safety. A person does not have to work in a factory whose conditions he deems unsafe any more than he does in a restaurant or bar that permits smoking.

Because safety is important to me, I would be totally in support of a private organization that judged workplace safety. Workers who value their safety (a group that I would hope includes all workers!) would be free to seek employment only with those firms who volunarily complied with this organization's policies and whose workplace environments were deemed safe.

The problem with this is that it simply doesn't work, which has been proven historically. Workplace safety costs money and impacts profits. Workplaces typically do only the minimum necessary to comply with safety regulations. Lower the standards, and safety will be correspondingly lowered.

Expecting a subset of employers to arbitrarily implement higher safety standards is a pipe-dream. To do so would raise their operating costs and make them non-competitive, at least in the long term. Furthermore, employment opportunity is non-elastic, so there would be a significant number of people desiring higher safety standards, but unable to find employment at a company that provided them, and thus would be forced to either work for an employer with lower standards, or remain unemployed.

This would be partially offset by the fact that employers with higher standards would be almost guaranteed to offer reduced monetary compensation (in order to make up for higher operating costs, as well as in reaction to a larger, more competitive labour pool); but would still result in a non-trivial number of people who would like better safety, but would be unable to obtain it.

Further, there would also be incentive for a workplace to claim higher safety standards, or create the appearance of higher standards, while still maintaining a lower level of workplace safety. This would enable them to reduce salaries in line with those businesses providing higher safety standards, while still maintaining lower operating costs. Private regulatory agencies can alleviate this problem somewhat, but there is the issue of funding and effective monitoring, as well as "under the table" collusion.

 

[luchog]

An evaluator who holds back due to litigation is not an effective evaluator. If indeed there is a demand for organized workplace-safety measures (as I believe there is), then this ineffective evaluator will find himself out of a job, supplanted through market forces by someone who is willing to do the job effectively--no need to have the government interfere here.

Except that any regulator that steps up is also subject to the threat of litigation; and not many are going to have the resources to operate in the face of such a threat. Remember, litigation does not have to be legitimate in order to be successful.

Consider the MPAA's movie ratings system for an analogous situation. A parent doesn't have to buy a magazine every time he wants to see if a particular movie is appropriate for his child. A movie's rating is prominently displayed in all advertising material, and an archive of ratings is freely available for perusal at the MPAA's web site. The movie studio, not the customer, foots the bill to have a film rated and to have that rating easily available for anyone who wishes to look it up.

But it is still possible for an unrated movie to be produced and distributed. The only reason that more unrated movies are not shown in theatres is simply because of the near-monopoly that the corporations have on theatre ownership -- nearly all theatre chains (and the vast majority of theatres are chains) are owned by the same corporations that own the production companies. So they can effectively block unrated movies, which includes a large percentage of foreign films, from being shown in the majority of theatres. Without that effective monopoly, the MPAA would be less important as a regulatory body.

You're also ignoring the fact that the MPAA is only quasi-private since it's power depends in large part on federal and state regulations regarding the viewing of "sexually oriented" or "inappropriate" subject matter by minors.

So the MPAA is not a strictly voluntary organization offering strictly voluntary regulation. They are a private organization enforcing government regulations; which was created to forestall the implementation of a government regulatory agency similar to the FCC and the passing of even more stringent government regulations. Various states had already passed regulatory legislation regarding motion picture content.

So what your proposal would do is allow the Federal government to create workplace safety laws at a fairly low level, encourage the creation of a quasi-private regulatory agency with higher safety standards, but allow for businesses to bypass the regulatory agency and operate at the much lower government-mandated safety standard.

 

[luchog]

The MPAA somehow implements a workable movie ratings system without government intervention. The ESRB somehow implements a workable video game ratings system without government intervention.

Actually, there is considerably controversy as to whether their systems are, in fact, workable; and the inconsistency of their ratings have become increasingly controversial. A documentary on the MPAA highlighting the flaws in the organization, This Film Is Not Yet Rated was released late last year. Interestingly, the film's creator has filed against the MPAA for illegally copying the film, which they admit to doing, though denied the specific illegality of their actions.

What makes them immune to the problems that you seem so sure would cripple a similar organization that monitors the health and safety practices of businesses?

They are supported by federal and local government regulation and enforcement.

If the only consideration is corruption, then I will choose the private sector over the government every time. Private organizations can be held accountable, too, you know. If you don't think their product or service is worth what they charge for it, then don't patronize them. They'll soon see the error of their ways, I assure you.

On the contrary, most private regulatory agencies do not have any accoutability. That is one of the key points in the aformentioned documentary. There is also the issue of academic accreditation agencies and their lack of accountability. The only accountability available for these agencies is through National Education Administration recognition of their validity through meeting specific government-mandated standards.

 

[George 152]

HOW MUCH second hand smoke do you need to be exposed to for it to be harmful?

Live with a smoker?

Work with smokers?

I'd like to see a study of the effects of vehicle exhaust gases on lung disease...
We're not going to because those emissions are carcogenic and in greater supply than cigarette smoke.
And every-one is a commuter

 

[Skeptic Ginger]

....It was just an example of the meaning of clinical significance. A patient with 1,000 viral load is indistinguishable from a patient with 10k viral load. They're both close do death.....

Bad example. You couldn't be more wrong about HIV. As long as viral loads are kept low, HIV does not progress to AIDS.

Sounds like your research drug just wasn't effective. The numbers you are citing on viral loads seem off by a couple factors so I can't make sense of your example. But otherwise, I get the point.

Public health guidelines state that treatment should be considered for asymptomatic HIV-infected people who have viral loads higher than 30,000 copies per milliliter of blood using a test known as a branched DNA test, or more than 55,000 copies using an RT-PCR test...A low viral load is usually between 200 to 500 copies, depending on the type of test used. This result indicates that HIV is not actively reproducing and that the risk of disease progression is low.

Uncontrolled HIV viral counts are typically in the 100,000s.

 

[BillyJoe]

I choose to smoke because I enjoy it. I also ride large motorcycles and (when not on the motorcycle) like to drink beer. I do all these things because I find they increase my enjoyment of my life at a cost acceptable to me.

I can relate to this.

But have you actually done the stats?

What's your risk of asthma, emphysema, chronic bronchitis, lung cancer, peripheral vascular disease, cardiovascular disease, and cerebrovascular disease above your background risk considering your level of smoking and how will this affect your future enjoyment of life? What's your risk of major and minor injury over and above those resulting from a car accident, considering the size of motorcycle and the speed and skill of riding your motorcycle, and the effect of these injuries on your enjoyment of life. What's your risk of liver disease, brain disease, heart disease, disease of nerves and muscles considering your level of drinking? Unless you've considered these risks you haven't made an informed choice.

You don't have to do the stats, of course. You can just say "stuff it, I'm just going to continue doing these things if I want to because I enjoy them". But then you can't say you continue to do these things "at a cost acceptable to me".

I once did this exercise for my high cholesterol - because I love full-cream milk, cream and cheese. I decided that my personal risk would not be significantly reduced by eliminating fats from my diet to justify my reduced enjoyment of food. It seems the health system benefited more than I did - because the number of heart attacks, for example, could be halved if everyone took these measures to reduce their cholesterol. But, for me personally, it didn't seem worthwhile.

 

[Skeptic Ginger]

...

I choose to smoke because I enjoy it. ....

You may choose to continue smoking because you enjoy it. But most people don't choose to start smoking because they enjoy it. Typically one has to get passed a period of nausea learning to smoke.

Most people start because of peer pressure. It's cool, you feel older, your parents don't tell you what to do. In fact, studies show if one doesn't start smoking by about the age of 20 very few people go on to start smoking later.

 

[blutoski]

Sounds like your research drug just wasn't effective. The numbers you are citing on viral loads seem off by a couple factors so I can't make sense of your example. But otherwise, I get the point.

Yes, I was just throwing out round numbers for illustrative purposes.

I should point out that this was 1991, and the prevailing attitude at the time was that patients needed to keep titres below 500 to be considered 'stable'.

 

[Skeptic Ginger]

Yes, I was just throwing out round numbers for illustrative purposes.

I should point out that this was 1991, and the prevailing attitude at the time was that patients needed to keep titres below 500 to be considered 'stable'.

This is confusing as well. We didn't test for viral loads in 91 that I'm aware of. I think you are mixing apples and oranges.

In 1991 one was considered to have AIDS if one's white blood cell count went BELOW 500. I think you have things mixed up. It's easy to do with those ol' memories.

 

[BillyJoe]

In 1991 one was considered to have AIDS if one's white blood cell count went BELOW 500.

What units?

http://www.mydr.com.au/default.asp?article=3011

The normal white cell count for adults is 4.0-10.0 x 10⁹/L.