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Frank Davis

Banging on about the Smoking Ban

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Correlation is Causation
In Sir Richard Doll's Times obituary, of his first paper - the London Hospitals study - it is reported that:

Doll thought that the increasing incidence of the disease might owe something to the hundreds of tonnes of tarmac being laid down across Britain at this time, but soon discovered that in 649 lung cancer cases there were only two non-smokers. Doll himself gave up the habit two thirds of the way through the research

Isn't that just the smoking gun? 647 out of 649 lung cancer patients were smokers! Pretty much an open-and-shut case of cause-and-effect.. No wonder Doll gave up smoking even before he'd completed the research.

At the weekend I was listening to an IPCC official insisting that there had been global warming over the past century. Of course, at the same time, carbon dioxide levels were steadily rising. Another open-and-shut case of cause-and-effect. No wonder the world is stampeding to shut down the carbon economy which has been creating our wealth killing us all for the past century.

A few days back Christopher Snowdon put up a chart showing that US oil production strongly correlated with rock music quality during the second half of the 20th century. Another great example of cause and effect. I guess that as more oil was produced, and America got wealthier, it produced more quality rock music celebrating that wealth. Something like that. It's obvious really. I'm surprised that I hadn't seen it myself.

And now today Letters From A Tory has - perhaps inadvertently - highlighted another one.

Even a basic Google search throws up evidence of impairments to visual functions, vigilance, reaction times, psychomotor skills, perception, drowsiness, attention and other cognitive tasks caused by alcohol, in addition to evidence of a clear relationship between blood alcohol levels and the probability of being involved in an accident. (my emphasis)

Clear relationship! That's shorthand for 'causal connection', of course. Clear relationship. Correlation. Causation. All the same thing.

That set me thinking about my own personal history of road accidents. The first one was when I came off my motorbike on the Thames Embankment in London about 35 years ago. I was annoyed at being sent on a futile, wasted journey across London. It rained while I was on my way back, and the roads became covered with a treacherous film of slime, and the bike skidded from under me when I angrily braked too hard. I didn't have a drink before. But I had one shortly afterwards.

Then there was the time, 10 years later, when I was driving a van, turning onto a road outside a pub car park, and the driver door swung open into the oncoming traffic, and as I reached out to close it, I forgot to take my foot off the gas pedal. The van continued turning, mounted the pavement and knocked down a lamp post. I must have drunk a whole half pint of beer just before that one.

And then there was the time I was driving my father back to hospital after a home visit. He'd had a stroke which had left him as strong as an ox, but mentally handicapped and unable to speak. Once he realised that he was going to be taken back to the hospital, he refused to get into the car. It took ages to induce him to get in. We'd hardly got a few hundred yards than he started to try to open the passenger door and get out. I went round a corner and clipped the front of a car emerging from a gate. I must've had a lunchtime glass of wine about an hour before that one.

The most bizarre one came after I'd been playing a Formula 1 Grand Prix computer game all day. This involved putting your foot down on the long curving straights, and then braking hard and turning sharply when you arrived at the next hairpin. After playing this all day, I jumped into my Mini to go buy something, and on the way back I found myself driving like I was in a F1 Grand Prix race. Arriving at a roundabout, I braked hard and turned the wheel over - and drove across the grass in the middle of roundabout. A few hundred yards later I spun the car through 90 degrees coming into another corner. And I hadn't touched a drop.

Of those four accidents, I put the first down to a combination of road conditions and being angry. And the second to a faulty door catch and my inexperience as a driver. And the third to the stress and distraction of my father in the car. And the last to having somehow had my driving brain temporarily rewired while playing a computer game. None were caused by alcohol. Alcohol was hardly a player at all.

And I've never had an accident driving while drunk. Not that I've ever driven while really totally plastered. But I'm sure I've been over the legal limit plenty of times. In my experience I drive perfectly well, technically, when I'm under the influence. I'm in control of the car. But I tend to get a bit headstrong. I'll take corners faster. I'll accelerate and brake harder. I'll throw the car around a bit. Driving seems too easy when I'm feeling a bit merry. And that seems to be the real danger: overconfidence.

When I drive I like to devote my whole attention to the road ahead. I hardly ever even play the radio. I don't like to even talk. And I like to be ice cool. Any distraction, and I drive worse. If anything is on my mind, and I'm worried or angry, I drive less well. Same if I'm tired or haven't slept well. Or if I'm driving an unfamiliar car whose handling I haven't figured out. It takes me months to get to know a new car.

In my personal experience, the real perils of driving arise when something takes my attention off the road ahead. It can be something that actually happens, like someone talking, or dropping something. Or it can just be something I'm thinking about, angrily or worriedly. If my attention is diverted for just a second or two, I can easily end up off the road.

But alcohol doesn't distract my attention. I think it slows up my reactions slightly. And it makes me a bit overconfident. But of itself that's not enough, in my view, to make me a menace as a drunk driver. There has to be something else to distract me if I'm going to end up wrapped around a tree.

But then, I've never driven a car with half of bottle of whisky inside me. So I don't actually know. Maybe I'll try it sometime.

I'm beginning to think tonight that maybe drink doesn't cause car accidents, but is simply a contributory factor. And maybe quite a small one. Far less than it's made out to be. And I already don't think that carbon dioxide causes global warming. It's just a contributory factor. And probably quite a small one. (I'm not even sure these days that the planet has been warming, given the poverty of the raw data, and the fact that it gets adjusted.) And I don't think smoking causes lung cancer. It looks more and more like a contributory factor. And maybe quite a small one.

It seems to be the besetting sin of our age to take small contributory factors and promote them to be prime causes. The strongest correlation points to the cause. Correlation is causation. The car crash happened because the driver was drunk. He got lung cancer because he smoked. The planet has been warming because CO2 levels have been rising. They are obvious candidates as causal agents, like prime suspects in a murder case. So much, in fact, that the police are so convinced that they will sometimes suppress counter-evidence in order to secure a conviction. Or climate scientists are so convinced that they will try to suppress sceptical points of view.

But I still reckon that US oil production was what made for all that great rock music of the 1960s. It's an open-and-shut case. It's obvious really.

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Well, Okay

So, I read this and thought to myself "Well, he might be just splitting hairs on this one."

Then I finished cooking my dinner and thought about it some more.

If I leave my front door unlocked, and my house is burgled, I might say "My house was burgled because I left the front door unlocked".

However, if leaving your front door unlocked makes it, let's say, ten times more likely that your house will be burgled, leaving your front door unlocked still does not "cause" burglary. Especially if 90% of homes with the front doors unlocked are never be burgled.

Regarding your point on causation and drunk driving, I just finished reading the book "Superfreakonomics", so I'll quote from it:

"A drunk driver is thirteen times more likely to cause an accident than a sober one. And yet a lot of people still drive drunk. In the United States, more than 30 percent of all fatal crashes involve at least one driver who has been drinking. During the late-night hours, when alcohol use is greatest, that proportion rises to nearly 60 percent.Overall, 1 of every 140 miles is driven drunk, or 21 billion miles each year.

"Why do so many people get behind the wheel after drinking? Maybe because—and this could be the most sobering statistic yet—drunk drivers are rarely caught. There is just one arrest for every 27,000 miles driven while drunk. That means you could expect to drive all the way across the country, and then back, and then back and forth three more times, chugging beers all the while, before you got pulled over."

So, if drunk drivers are only caught or get into an accident every 27,000 miles, it seems obvious that drinking and driving does not "cause" road accidents. However, it does make them 13 times more likely to occur. (The book goes on to also explain that you are also statistically more likely to die walking drunk than driving drunk.)

So, I guess I can't argue against your overall point. I think it's really the way we use language. We say "cause" rather "increases the likelihood" or "was the contributing factor" because it's the way we speak. And perhaps because it's the way we speak, it's also the way we think.

Re: Well, Okay

Sorry. It's WinstonSmith who wrote the above.

Well, it's obviously all much deeper than I may have suggested in this little essay. Playing at the back of my mind as I wrote were the philosopher David Hume's objections to the notion of causality, which were, I think, that just because one thing happens at the same time as another doesn't mean that the one caused the other. The idea of causality is controversial.

Another thing I didn't mention was all the other drugs that people can be high on. Cannabis, obviously. But all the others. Prescription drugs as well. How do they affect people's driving?

There are all sorts of things that affect how people drive. Alcohol is just one of them. And yet it's been picked out and promoted into a major cause of road accidents, rather like smoking has been picked out and promoted as more or less the sole cause of lung cancer. And at the same time all the other possible causes tend to get played down. So we end up with a highly over-simplified view of what's going on.

I think the issue of drink driving is also one of those issues where "everyone knows" that it's a bad idea to drink and drive. It's an unquestioned and unquestionable dogma. But these days it seems to me that we all walk around with far too many of these sorts of dogmas. And you can sort of recognise them because, if you question these dogmas, people often get rather angry. Perhaps because they've never questioned them themselves.

And there's much, much more to be said beyond that.

I think it's becoming increasingly clear that the next "biggie" for the ban-treatment (imposed by a thousand cuts, naturally, not in one fell swoop) is going to be alcohol. All the signs are there, and of course the drink-driving line is surely destined to be one of the flagship campaigns in this respect.

I, like you, I suspect, Frank, am of an age to recall the days before the mandatory one-year minimum ban and (effectively) random breath testing was brought in. As a result virtually everybody of driving age drank and drove – some to excess but most much less so, and probably all to an extent whereby they would have been classed these days as "over the limit." Now, I'm no spring chicken, so the timespan I'm talking about here is quite a long one, and I've racked my brains to try and think of just one person I know of who, when driving under the influence actually killed or harmed either themselves or someone else with their car. Do you know how many I've come up with? None. Zilch. Nada. So how does this square with all the horror-stories about the number of lives "lost to drink-driving?" Surely, I would know – or at least would have heard about – at least ONE person who caused injury to themselves or others whilst drink-driving?

Now, don't get me wrong all you people out there who are about to post hysterically saying: "My granny was run over by a drink-driver who I am 100% certain wouldn't have hit her if he'd been sober" – I'm not saying that there have never been accidents which might have been avoided if a driver had been sober rather than over the limit. What I'm saying here is that I suspect that a lot of the "statistics in waiting" which will no doubt be revealed to us over the next few years or so, have a very high chance of being massively – and I mean MASSIVELY – over-exaggerated. And, given the choice between believing my own personal experience, having lived through those much more hedonistic and enjoyable times, and believing a host of statistics put together largely by people who didn't, I think I know which of the conflicting two sources I will be trusting the most ………

I, like you, I suspect, Frank, am of an age to recall the days before the mandatory one-year minimum ban and (effectively) random breath testing was brought in.

I am of that age. Although I can't remember when those measures were brought in. And I probably wasn't driving at the time.

My parents were fond of a bit of a tipple now and then. And there plenty of occasions when they took us out in the evenings and knocked back beers and G&Ts galore (or so it seemed), and my father always drove back home perfectly adequately. I can only remember one occasion when he'd seriously had too many, and my mother didn't think he was up to the job of driving (through the centre of Rio de Janeiro) to get home. But he climbed in the car and did so. It was a bit hair-raising when he overtook a tram on the inside, but we got home safely.

I think it's becoming increasingly clear that the next "biggie" for the ban-treatment (imposed by a thousand cuts, naturally, not in one fell swoop) is going to be alcohol.

Well, this is what's at the back of my mind. How many lies are going to be told about alcohol? How many lies are already being told about it, which have come to be accepted as 'facts of life'? Why is it that it's always things like tobacco and alcohol that get singled out for these campaigns? As opposed to, say, eating ham sandwiches or reading paperbacks. I'm sure that doing those could be demonised and vilified as well, with a bit of imagination.

I've said before, and I'll say again, that the war on tobacco and alcohol is essentially a moral crusade. It's just that in the last 50 years or so the hell-fire preachers have been replaced by doctors and research scientists. The new puritans come with charts and statistics rather than with the Bible. But their message is exactly the same.

More dangerous waters

You may be right about overconfidence, but the main reason given for not mixing driving with alcohol is that it slows down the reactions. They can safely say this because it's a measurable effect. This means you can't get to the brake pedal as quickly as you might. It seems to me that this is a valid argument ONLY if you drive in a style which relies on quick reactions. There are other ways to drive - the best drivers NEVER have to take emergency action because they are experienced in predicting situations and can smoothly handle almost anything thrown at them, probably without passengers being aware. It's a good thing that experience teaches this because when you get towards and past middle age you can say goodbye to those razor sharp reactions that kept you safe when you were a youngster. My thesis is that older people still drive better than youngsters even when they've had a drink because they weren't relying on their reactions anyway. In almost any case they can confidently say "they've seen it all before" and know what to do to avoid difficult situations. Biggest problem is that huge numbers of younger people can't even drive properly when they're stone cold sober.The training just isn't up to it. None of what I've said should be taken to support the idea that anyone should drive after a complete skinful, but there's got to be some latitude in the law. And ain't that always the problem?

Re: More dangerous waters

Sorry, above written by George

Re: More dangerous waters

I'm sure you're right about reaction times being measurably slower. But you're right that it only matters if people are driving in ways that demand fast reactions. It's an interesting thought that older people's reaction times are slower anyway, because presumably that means that after they've had a drink their reactions are slower still. But then, they're experienced drivers. And experience is an invaluable aid to doing anything.

I don't regard myself as a particularly great driver, but I like to drive smoothly. I like to nurse the engine and the brakes, and not tax them too much. I don't like to do anything hurriedly. And most of the time I avoid that by driving well within my capabilities, and trying to predict what's happening ahead. The drivers I've admired most have been cool, calm drivers.

"Why is it that it's always things like tobacco and alcohol that get singled out for these campaigns?"

Well ……… I've always said, (and I know you're not 100% with me on this one, Frank, because you're much less of a conspiracy theorist than me), that the POLITICANS' reason for the smoking ban – and the reason why alcohol will probably fight off all its competitors (salt, trans-fats, junk food, obesity generally etc) for the position of the next "most demonised" substance, is because the large political parties really, really don't want little, local pubs. I think they realise that they may never be able to close each and every one, but they can certainly have a good go at clearing away a large chunk of them, and I think that this was the true motivation for the smoking ban. Hence their frequent boasting about how "successful" the ban has been – in terms of achieving its (deliberately unpublicised) objectives, it has been a roaring success! And now, this paranoia is, I believe, the main motivation for a similar campaign against alcohol.

It isn't that all politicians dislike pubs per se, in fact some of them probably like pubs very much, but I think many of the real big-wigs in power get very twitchy about the fact that Joe Public meets in them, exchanges views, gets along with other Joe Publics and (shock! horror!) might actually criticise THEM whilst they're there. It's one of the reasons why their response to the demands for further anti-smoking restrictions (parks, public gardens, open-air events, private homes etc) doesn't exactly have the same enthusiastic following that the original ban did – because those restrictions won't hit pubs at all, will they? For sure, there are still some loud voices from ASH and other loud voices from the medical establishment shrieking for even stricter regulations and even further demonisation of smokers. But loud POLITICAL voices? Very, very few. Even the political response to the proposed smoking display ban has, comparatively speaking, been muted, with some politicians muttering that they "think it's a good thing generally for the sake of young people;" others taking the middle line that it must be balanced against the concerns of the retail trade; and still others really not taking much notice of it at all.

It's about pubs. It always has been and it always will be. The only time they'll move onto something else is once virtually the only "pubs" left are those large, sterile, warehouse-like places where you arrive and leave with exactly the same group of people, having not exchanged a word with anyone else apart from the barman. Then, as is inevitable, when people begin to congregate and mix somewhere else, they'll move in on whatever they do there. Curfew, anyone?

the large political parties really, really don't want little, local pubs.

I don't see it quite that way. I think it's that they just don't care about them. They personally never go to them, preferring (if they prefer anything) wine bars or Starbucks or impersonal pubs that look more like airport terminals.

They don't like smoking. They don't like drinking (above a thimbleful of something). They don't like crisps and peanuts and pool tables and juke boxes. They don't like the whole culture of traditional pubs, which they regard as uncivilised. Perhaps some of them would actively like to close all pubs down.

When I was in Barcelona, and surveyed the area I was staying in, I found 3 or 4 non-smoking bars. They were hyper-modern, hyper-clean, spartan sorts of places with little or no decoration. They were also empty or not far off empty. Most of the smoking bars were older, quirkier, and decorated with all sorts knick-knacks. They were entirely different places, reflecting an entirely different set of values. There's a deep culture clash here.

the real big-wigs in power get very twitchy about the fact that Joe Public meets in them, exchanges views, gets along with other Joe Publics and (shock! horror!) might actually criticise THEM whilst they're there.

But smoky little pubs aren't the only places that people can meet up and Plot To Overthrow The Government. They can do it anywhere. If they really wanted to stop people talking to each other, they'd claim there was some sort of health threat in meeting people. Which, of course, there is: I might catch your cold/flu/name-your-disease. It would be very easy to start a health scare about meeting people, particularly strangers. But they haven't. Yet. Curfew indeed.

their response to the demands for further anti-smoking restrictions (parks, public gardens, open-air events, private homes etc) doesn't exactly have the same enthusiastic following that the original ban did – because those restrictions won't hit pubs at all, will they?

Well, no they won't. So why are they introducing them? Because they don't want to see people smoking anywhere.

My ultimate objection to conspiracy theories is that they usually rely on the protagonists being omniscient and omnipotent and possessed by an implacable determination. I don't think that anyone is that smart, or that powerful, or that determined. Nobody who is human, anyway. And the antis are human. Conspiracy theories always fail, in my view, because they are simply too implausible. It's much more likely that what happens is the result not of fiendishly Machiavellian conspiracy, but of uncertainty and ignorance and blunder. i.e. it's cock-up rather than conspiracy. Or it's much, much more likely to be.

I think a lot of the people, who turn correlation into causation without proof, do so because of their own bias. They want whatever 'bad thing' they are investigating to be caused by their own personal bugbear and, if they can find any correlation at all, then this is enough in their eyes to turn it into causation.

May I remind you about the cot death scenario. For many years the medical establishment said the majority of cot deaths were caused by parents smoking. Then it was suddenly discovered that laying a baby on its stomach to sleep caused cot death. Doctors had been advising parents to lay babies on their stomachs for decades and they suddenly had to reverse that advice. Once parents stopped laying babies on their stomachs, cot deaths reduced by around 50%.

However, instead of saying "Sorry, we got it wrong, cot deaths are caused by doctors' giving you bad advice and not by smoking.", they are still saying that smoking causes the majority of cot deaths.

They have no proof for this, but they don't know what causes the other 50% of cot deaths and they want it to be smoking, so they blame smoking due to their own bias.

I am getting very depressed about the scientific community. More and more of them seem to ignore scientific methodology and just promote the result they want.

However, instead of saying "Sorry, we got it wrong, cot deaths are caused by doctors' giving you bad advice and not by smoking.", they are still saying that smoking causes the majority of cot deaths.

It's the same with cervical cancer. That used to be blamed on smoking. It's now pretty well established that it's due to HPV infection.

The medically accepted paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop cervical cancer, and is hence viewed as a sexually transmitted disease, but most women infected with high risk HPV will not develop cervical cancer.

But Cancer Research UK, while giving HPV as the main cause of cervical cancer, goes on to say:

But most women infected with these viruses do NOT develop cervical cancer. So other factors must also be needed... Women who smoke are more likely to get cervical cancer than those who do not. Taking the pill could increase a woman’s risk of cervical cancer. It is not clear why this is.

So, while HPV is conceded as the main cause, the suggestion is that smoking is still causes one or two of the cervical cancers that weren't caused by HPV.

Harald zur Hausen, who discovered the HPV-cervical-cancer link,
insists the must be HPV present.

“People say that the papilloma virus is a necessary but not a sufficient factor. We here are deeply convinced that this statement is wrong; that the virus is necessary and in quite a number of instances is also sufficient... A few scientists still report cervical cancer without papilloma virus. zur Hausen will believe it when he sees it.".

Last month zur Hausen called for a vaccination programme to eradicate HPV infection:

"If we wish to achieve eradication within a reasonable period of time, we will need to vaccinate both sexes, and research has shown that boys respond to vaccination in the same way as girls. The main risk of developing cancer after HPV infection is with women and, because of the cost of vaccines, it has been decided to start with girls. But other cancers associated with HPV infection, such as anal and oral cancer, are more common in men, and genital warts occur in both sexes. So there is good reason to vaccinate boys before the onset of sexual activity as well," said Professor zur Hausen.

HPV infection has also been found in lung cancer patients.

The link with smoking was originally made because nuns didn't get cervical cancer much, while prostitutes did. Nuns didn't smoke much, and prostitutes smoke quite a lot. Prostitutes also use contraception rather more often than nuns.

It seems that once a disease is given some cause, the medical profession is unwilling to subsequently admit that it may not have been the true cause, and that it wasn't the sex and the smoking and the contraception that was killing off prostitutes, but the HPV virus.

I'm not sure about the oil production/rock music connection (yes, I know that was a tongue-in-cheek comment!), but I've always believed that it was the fact that back in the 1960's and 70's almost everyone smoked - freely, openly and, often, copiously, that helped to make those decades so outstanding for their creativity and innovation. In fact, when you look back at the real "groundbreakers" in any creative arena (i.e. those whose works have stood the test of time and, even after years have passed and fashion has changed, remain popular and admired even by contemporary artists), they were all without any exception - well, I can't think of one, and I've tried - smokers. Nicotine is, after all, a strong mental stimulant, and if a person is of a creative inclination it makes sense that they would be stimulated in that way by the effects of smoking. N'est ce pas?

It could go a long way towards explaining why once-outstanding creative people so often suddenly and unexpectedly "dry up" and vanish completely, or start producing work which is tacky and cheap (the "selling out" syndrome), or at the very least, uninspiring, in comparison to their previous glories. It might also explain why, compared to the 60's and 70's - when there seemed to a proliferation of outstandingly original creative people in all areas of the Arts - really, truly, outstandingly inspired artists in all creative fields are relatively few and far between today. And of those who are producing really innovative stuff these days, it's not uncommon for those to be the "celebs" spotted by the tabloids, having a crafty (or, sometimes, not so crafty) smoke somewhere. Coincidence? I don't think so. Maybe I'll do a little survey in my spare time one of these days. I'll let you know the results when I have them …….

Nicotine is, after all, a strong mental stimulant,

Well, I always reach for the tobacco when I'm thinking about things. And I'm not very interested in it when I'm not. It certainly seems to help the thinking process somehow. Is it entirely accidental that tobacco showed up just at the time when the Renaissance and Reformation were starting, and was well-established by the time of the Enlightenment? I'm always pleased to know that Isaac Newton and Albert Einstein were smokers. But was William Shakespeare? Apparently not.

"Shakespeare never mentions pipes, tobacco, or smoking anywhere in his poems or plays, in contrast with Edmund Spenser and other writers of the period. Alcohol is a much more likely stimulant for Shakespeare’s imagination, and even that is probably unimportant. The seventeenth-century gossip John Aubrey described Shakespeare as not much of a partygoer—when he was invited to a debauch, he’d beg off, saying he was in pain. More likely, he was working on another play."

And of course before tobacco arrived circa 1500, there can't have been any writers or artists or thinkers who smoked it. Which is the whole Roman and Greek period and before that. But who knows what they were on?

I think that anyone who is creative has to be someone who will experiment and take risks. In our risk-averse modern society, it's not surprising that the music is no good. And much else as well.

I've found myself wondering whether, if tobacco actually does aid thinking, the decline in smoking is a cause - or contributory cause - for the whole cultural process of 'dumbing down'. And that non-smokers are as a result generally stupider than smokers. Antismokers certainly produce a lot of really bad science.

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