Deborah Arnott Aims to “Get Rid of Smoking”

H/T Tony in the comments yesterday for this BBC Radio 5 audio, in which Deborah Arnott said her aim was to get rid of smoking (highlighted in red below), and then denied saying so. I set out to transcribe that bit. And then the subsequent bit where a consultant oncologist mentions HPV as a factor in lung cancer. And then I ended up transcribing most of the rest as well, partly because of what Deborah Arnott said about heart attack reductions, and the supposed popularity of the current smoking ban, but also because two of the callers who phoned in (Stephen and Simon) were clearly very, very angry.

I think I’ve got Deborah Arnott pretty much word for word. The other callers I’ve pretty much got right. I skipped the lady from BLF, and a lot of what Theresa had to say.

5 live Breakfast: Should we leave smokers alone?
9 am 16 November 2011

Nicky Campbell: The BMA have said that smoking in cars should be banned whether you’re on your own or not. Is it time to leave smokers alone? That’s what we’re asking today.
Caller Stephen: Is this April Fools’ day? I’ve now been asleep for nine hours. Let’s not ban smoking in cars, let’s just ban cars. That would be far better. First of all, nobody, but nobody, has ever died from secondhand smoke. Anybody who disputes that please phone through to the health and safety executive.
NC: Stop right there. Let’s put this immediately to Deborah Arnott.
Deborah Arnott: Well, 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.
Stephen: Mrs Arnott, that is incorrect. You have actually stated that heart attacks have been reduced since the smoking ban came in. Heart attacks were being reduced before the smoking ban came in.
DA: 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.
Stephen: My argument about all this is, and I’ll tell you. Who makes money out of a smoking ban? The pharmaceutical companies make money out of the smoking ban. The pharmaceutical companies have funded every antismoking group for the last god knows how many years. The smoking ban came in from America, then came into Europe – it was a European directive – and this pathetic government…
NC: Would you smoke in a car with children?
Stephen: No, I would not smoke in a car with children.
NC: Why not?
Stephen: Simply because I think it’s unfair on children.
NC: Why is it unfair on children if they’re not harmed by passive smoking?
Stephen: Because it’s a matter of responsibility. There are many things I wouldn’t do in a car with children.

I think that all the supposed heart attack gains have been pretty thoroughly debunked. As Stephen said, heart attack numbers were falling prior to the ban, and contrary to what Arnott said, the bans made no difference to the rate at which the numbers fell.

It’s also noteworthy that Arnott always seems to argue from authority. She cites all the various authoritative bodies, ‘peer-reviewed’ studies, and ‘reputable journals’, as if that was all that mattered. She speaks in sweeping generalisations. She never cites a single actual study.

NC: Graham in Bradford
Caller Graham: Hello Nicky. If you give me the time to tell my story I’ll try to get it all in. When I grew up in the late sixties and early seventies, we were very fortunate on our street, we were the only people with a car, and my parents used to take us out a lot on long drives on a sunday away from home. They always had the windows shut in winter. Both my parents were chainsmokers. My father smoked 60 a day, and my mother smoked 40 a day. And unfortunately I picked up the habit very early. I started pinching cigarettes out the packets around about 10, and I took the habit up when I was 13. And I’m 48 now, and I’ve got a lung age of 87. I’ve got COPD, so I’m very disabled so I wish I’d never started. I’ve tried to give up 6 times. I’m what you call a chronic smoker. The NRT just doesn’t work for me. I smoke very heavily now, but it’s rolling tobacco not cigarettes.
NC: Do you think it would have been any difference if smoking had been banned in cars?
Graham: I hate to blame my parents for it. I’ve made the choice myself in a way, but you don’t make a choice when you’re a 10-year-old, and they smoked in the house as well. I think with children there is sensible reasons for legislation. I don’t want to ban people from being able to smoke in their own space if they’re alone or whatever, but where there’s children concerned I think there should be some legislation, Nicky.
NC: Stephen’s back.
Stephen: Sorry.This is not about smoking in cars with children. What the BMA have come out with, what they’ve actually stated that they’re trying to ban smoking in your own car. That’s.. it’s absolutely disgusting.
Caller Paul in West Drayton: I do agree. At the end of the day, number one, how are they going to police this? Number two, what’s the next step? Stop smoking in your house? We’ve got to be able to use common sense, and this really does smack to me of 1940s Germany…
NC: (giggles).
Paul: We are starting… We are… They’re going to start coming into our house. That’s where we’re going.
NC: With the Nuremberg laws, yeah.
Paul: We’ve got to really understand what’s happening. I’ve got a small child. I do not smoke in the car with him. I do not smoke in the house. Let us as people have our freedom to be able to do what we want, and bring up our children how we want.
NC: Deborah Arnott, Have people a right to smoke in their own house? Yes or no?
DA: Yes, they do. But they need to also understand the risk. Cars aren’t the same as homes. There are lots of laws that pertain to how you use your car, because the car is not considered to be the same as the home. You have mobile home laws, seat belt laws, road traffic acts about speeding. The car is not considered to be the same as the home.
Simon Clark: Well, I think there are two issues here. One is smoking in cars with children present. And then there’s this BMA suggestion that smoking should be banned in all cars. I certainly don’t defend or condone parents who light up in a car with children present, not because I think it’s a serious health risk to them but because I think it’s incredibly inconsiderate to children who don’t really have a say in the matter. And I think that one should, if you have very small children, err on the side of caution, or err on the side of courtesy. But the BMA wants to go beyond that. They want to introduce a complete ban on smoking in all private vehicles. And I think that Paul is right – not to bring up the Nazi analogy or reference, which I wouldn’t use myself – but he is right to point out that we are now talking about private vehicles and the next logical step will be to try to ban smoking in another private space, which is of course the home. And people are denying it all over the place today. The BMA are saying Oh no no no, that’s not our intention.
NC: Do you think that is their agenda?
SC: Of course it is. Undoubtedly. Because 5 years ago they weren’t talking about banning smoking in cars. The fact is it’s common sense that smoking in a very small enclosed space is a potentially higher risk than smoking in a large office or a large pub, so why weren’t they calling for a ban on smoking in cars 15 years ago? The reality is that they never actually produced hard evidence that there’s a serious health risk. It’s only now when they feel that they’re pushing at an open door that they can move in to private spaces
Paul: How do we police it?
NC: How do we police it, Deborah Arnott?
DA: I think the issue of enforcement is a really important one, which is why the all party parliamentary group on smoking and health, which ASH provides the secretariat for, brought out a report today and has written to the secretary of state to ask for a public consultation around this. The fact of the matter is that the smokefree laws in public places were around health of workers and rights of workers, and what we’ve seen is a massive decline in exposure of adults to secondhand smoke, but children and people…
Paul: You’re not answering the question.
DA: I am. But that’s absolutely right. You police it because it’s got popular support. You can’t impose.. The smokefree laws, 98% compliance from day one, massive public support which grew particularly among smokers after the legislation came into force. The reason was that there’d been a big public debate and consultation, and people understood why the laws were coming in and supported them. Now, that’s what you need..

There was no big public debate. It was one of the things that shocked me at the time, that the ban wasn’t debated in public, on TV, on radio. It was one reason why I subsequently got rid of my TV set. Nor was there “massive public support”. Not in the pubs I knew. Least of all among smokers. There was instead resignation.

NC: Do you think people will understand why they are not allowed to smoke on their own, in their own car, in their own space, at their own risk? Do you think people will go with that and think: that’s reasonable.
DA: I think we need to see what happens when people actually understand all the evidence. And even if you’re on your own in your car it’s already in the highway code that driving while smoking is not safe, but there’s no law against it. Actually the evidence shows that it’s more dangerous than using a mobile phone.
SC: What absolute rubbish, Deborah. For goodness sake. There have been international surveys into this on the issue of smoking as a distraction, and smoking comes down at about number 9 or 10. There are far more distracting..
DA: That’s not the evidence produced by the chartered institute of environmental health for the all party parliamentary group inquiry. So look at the evidence.
NC: I bet listening to this in a car is more distracting than having a cigarette.
DA: I do hope not.
Stephen: When is not going to be right to be able to breathe fresh air? It’s really getting ridiculous.
NC: Fresh air bans. 1930s Nazi Germany. That’s getting ridiculous.
Stephen: Hitler was the first leader to have a smoking ban in their country
NC: Yeah, he banned hunting and he’s a vegetarian. False logic.
Stephen: Number two, there are more carcinogens that come out of a car exhaust than come out of cigarette…<snip> .. Deborah Arnott is doing this simply because they are getting well paid to promote this antismoking ban. I don’t get paid. I do it from the heart. Deborah Arnott does it because she’s getting.. I’d like to ask Deborah Arnott how much money she gets paid.
NC: Who pays you Deborah? Pharmaceutical giants?
DA: You can see we are a charity. Look on our website, you can see our annual review, and our report and accounts. We are funded by the Department of Health and Cancer Research UK…

I thought it was interesting how several of the callers raised the spectre of the Nazis or the Stasis, and how Nicky Campbell laughed, and Simon Clark said he wouldn’t have mentioned it. And yet, the callers, as far as I was concerned, seemed rather more knowing than the participants in the studio.

Caller James in Dalston: I grew up in a house and my father smoked a pipe, and used to smoke and fill it while he drove, and it quite often dropped in his lap while it was alight. And consequently I’m very antismoking from that as a child. And I have a feeling that I have to suffer from odd breathing problems That sort of sensistized me towards it. My son was a heavy smoker, and not just of tobacco. He smoked other things as well. He like Steve Jobs ended up with pancreatic cancer. And it killed him at just 37. I lost his mother to cancer. That was nothing to do with that, that was cancer of the heart which was very rare. Because of that I then had a stroke. Basically I could have coped with one death, but to cope with two is just ridiculous. I’m very antismoking. Now I’m living in London again because I can’t drive.
NC: Do you think these people need saving from themselves?
James: I know, exactly. Things that annoy me now are like people smoking at bus stops, because I’m obviously very sensitive to cigarette smoke.
NC: Do you have a word?
James: I went on holiday in Greece, and had to come home because everybody was smoking.
NC: When people are smoking at a bus stop, do you have a word?
James: Yes I do, and somebody threatened to hit me.
NC: Tell me what happened.
James: I might be 64 but I’ll give everything I can.
NC: What happened?
James: He said it’s legal to do it. He was a bus driver just getting on, because they swap bus drivers round where I live. I also think you know how we have a large amount of youth unemployment. Employers can pick and choose, and some of them say: we don’t employ smokers. It’s a cause of high youth unemployment, that a lot of youths seem to smoke…

Smoking causes unemployment?

The next caller, a non-smoker, was almost beside himself with rage. He was almost shouting the whole time.

Caller Simon: I just go back to the old days. I grew up in the sixties. We used to travel around. Both my parents used to light up in the front of the car. My brother and I would sit in the back. Neither of us suffered in the long term. I’m not a smoker. I don’t suffer from asthma. I think that most adults realise that these days we are very aware if you travel around with the windows closed and you smoke we are very aware it’s harmful for children. We don’t need to be dictated to by a bully state. Legislation used to make us live in a certain way, it’s the tactics of the Stasi government..
NC: We’ve had the Nazis. We’ve got the Stasi now. We’re moving east.
Simon: This is the point. We must stop eating fatty foods. You cannot smoke. You mustn’t put your rubbish in the wrong bin. Please don’t go into the sun without your cream, it’s irresponsible.
NC: I just wonder whether those who lived under the Stasi, and lived under the Nazis, might put this in some perspective. But you make a point. Do you want to come back on here, Deborah?
DA: I think that Simon raises important issues, but actually..
NC: Freedom.
DA: ..but actually we always balance freedom and the rights of individuals and the rights of society and the rights of children and that’s a continuous debate and it’s a debate that society has about what they think is appropriate. We had..
Simon: Is your concern with the health of children being in a car when people are smoking?
DA: My concern is broader than that. And I think the BMA and the Royal College of Physicians both put forward their case that they’re concerned not just about children but about adults too. And I made this point slightly earlier, when the smokefree laws in public places came in the number of heart attacks went down, and that’s been found in Scotland, England, everywhere in the world that those laws have been brought in. Because if you have pre-existing heart disease, then actually exposure to secondhand smoke has an immediate risk of stimulating a heart attack. The levels of concentration in cars are very high. So I want that public debate about the harm to children, the harm to adults, and what is the appropriate way forward. It’s only going to be enforceable if people support it. That’s why pubs and bars, when they went smokefree, compliance was 98% from day one, because people had come to a decision following years of public debate that was the right thing to do.
Simon: I asked the pupils in my classes: how many of you now see people regularly smoking? They all put their hands up. Do you knw why? Becauseyears ago, when they could sit in a pub and smoke, children didn’t see adults smoking. Now you see them down every high street.
NC: Friend of mine was telling me had a friend over from Eastern Europe when the ban had just been imposed and in London people were standing outside smoking, and he said, “My goodness, the prostitutes here are so well dressed!”
Simon: (laughs uproariously)
Caller Theresa: May I come back on this argument that people keep using about when we grew up our parents smoked. My parents smoked. My mum was a headmistress, highly intelligent person, but they didn’t know any different. People know different now. I’m sure there’s loads of people who’ve got asthma-related illnesses because their parents smoked. My mum smoked when she was pregnant with myself and my three sisters. Knew nothing about it. But it’s a fact now that if you smoke when you’re pregnant you have a smaller baby. So just because my mum smoked, does that make it okay for my children to smoke when they’re pregnant. No. Because you know better.
Simon: Most adults don’t smoke around their children in cars.
Theresa: You’re coming back with this dialogue. You don’t know that. You’re stating facts that you don’t know…

30:30 Caller Craig (smoker): …Would it not make more sense to just have one consultation on a total ban of sales of cigarettes, tobacco. What’s going to happen then?
DA: Well, ASH doesn’t support a total ban on the sales of cigarettes.
NC: You’d love it though… Kevin Keegan style.
DA: No, no, seriously. If you think this is something that still one in five adults smoke. If you try to impose a total ban, it’s just not feasible.
NC: You’re creeping towards it. It’s being done by stealth, isn’t it? Gradually…You’re evolving towards that position… You have a dream.
DA: Well, we want to reduce the harm caused by tobacco. Our aim in life is not just to get rid of smoking, it’s to actually reduce the harm caused by tobacco, so we’re trying to make sure..
NC: Ah, your aim in life is to get rid of smoking.
DA: Our aim in life is to reduce the harm caused by tobacco
NC: You just said your aim in life is to get rid of smoking.
DA: No, I said it was to reduce the harm caused by smoking.
NC: I’m sure you said to get rid of smoking. Those are your words.
DA: Well, if.. people will give up smoking then that’s fantastic. But it’s a legal activity, if smokers want to carry on smoking, then that’s their right.
Caller Craig: So what happens if a total ban of smoking does end up coming in, which to me that’s what your group, the BMA, are trying to do.
NC: She’s not the BMA. She’s ASH.
Caller Craig: ASH and the BMA, right across the medical profession, that’s what they’d love to happen is a total ban on cigarettes. What’s going to happen then? Where’s all the money going to come from?
NC: That’s the question, and we’ll address that. Quick answer.
DA: People pay tax on different things. If you’re not spending the money on cigarettes, which just goes up in smoke, you’ll spend the money on other things.

41:45 NC: Anne in Paddington… Anne, you are a doctor I do believe.
Caller Anne: I am, and I work in oncology. I’m a consultant oncologist. I’m a member of the Royal College of Pathologists, the Royal College of Physicians, Royal Society of Medicine, and I belong to the BMA.
NC: And the BMA are calling for a ban on smoking in cars even if you’re on your own. Do they represent you in that respect?
Caller Anne: No they do not! I think it’s a step too far. I think we’re going to bring the whole campaign into disrepute. People in cars on their own are adults. They know the risks. We have so much information out there about smoking. If we push this one, I think we might be undoing the good we’ve done already.
NC: Counterproductive?
Caller Anne: Counterproductive. And there are some things about smoking that are not all bad.
NC: Oh?
Caller Anne: Yes. I’ve observed throughout my long career in oncology that stress – chronic unresolved stress – can help – it’s only a factor, just as smoking is only a factor – in producing cancer. All cancers are multifactorial. But stress is a big – and we know this now – is a big immuno-suppressant, and the one thing that people reach for when they’re stressed, if they’re a smoker, is a cigarette. So this is a much more nuanced and complex argument than this current..
NC: So smoking can reduce stress, which can reduce the risk of cancer, says a doctor of oncology.
Caller Anne: It’s only a factor. It’s only a factor.
NC: Doctor’s orders. Anne, a doctor once told me this. I must say I went for one of those insurance check-ups. Went to a posh doctor I was sent by the insurance company in Harley street. They said, “How many do you smoke?” and I went “5 a day,”. And she said, “Given your profession, it’s a stressful profession, ” – I said, “Darling, tell me about it,” – “It’s a stressful profession. I wouldn’t bother giving up. It probably reduces your stress.” I did give up. I was flaunting the cigarettes in the office saying, “Doctor’s orders!”
Caller Anne: Yes. Some of us do. And we are all squashed and never have our voice heard. My own mother is 85. And I saw when I was in the sixties and seventies I saw her smoking , and I wanted her to stop, I wanted her to stop. But when I became a doctor, and made my observations, and saw how much it busted stress in my mother I backed off. And here she is still today at 85, and very healthy, and I’m very lucky.
NC: Miranda Watson, what do you think of what you’re hearing? Miranda Watson from the British Lung Foundation.
Miranda Watson: I’d say that the weight of evidence showing the impact of smoking on your health is pretty overwhelming.
NC: Multifactorial, though, and nuanced…
Miranda Watson: The British Lung Foundation, just going back to the broader topic, are particularly worried about children in relation to smoking in cars. And when you look at children and the impact of passive smoking on children, particularly in the car when they’re strapped in, and they’ve got no way of getting out, even if the window is open, the effect of smoking on their health is really significant.
Caller Anne: But I don’t know anybody who smokes in the car, do you, with children.
Miranda Watson: It’s interesting. That came up earlier on, when Simon said that most adults don’t smoke in their cars. But actually there are a couple of factors to raise here. One, the BMA in its report today showed that a third of smokers actually do smoke in the car. So that evidence is already there. We at the BLF also asked children to tell us how.. whether they had been exposed at all to cigarette smoking in the car. Even I was astonished by how many: 51% of children said they had been exposed while they had been in a car.
Caller Anne:  I was exposed in the womb. And I do think it’s gone too far. I think if you back off now, you will consolidate the good you’ve already done. I think this is going a step too far and may bring your whole campaign into disrepute. Because it is getting far too into the Englishman’s home. A car is an extension of an Englishman’s home and has always been his castle. If we go too far, we are going to undo the good we’ve already done. Let us stop here.
Miranda Watson: The British Lung Foundation is not talking about the English man. We’re talking about the child here. The child that doesn’t have any choice.
NC: Would you support a ban on smoking in cars with children, Anne?
Caller Anne: Well, I just think the whole thing is going too far now. And you know there’s some brilliant technology, if we backed off and allowed the scientists do the marvellous things they do with air filtration, we could probably have a smoking room in every hospital where the nurses could go to smoke. Because they’re in a stressful profession, I can tell you. It’s at least half of the nurses that smoke. So we could have a smoking room for the nurses.
NC: Do you smoke?
Caller Anne: I don’t smoke. No, I don’t smoke.
NC: Too dangerous.
Caller Anne: No. Actually, to be quite honest..
NC: You’re an oncologist.
Caller Anne: I’m an oncologist. But the thing is that I know lung cancer requires, I think, it’s human papilloma virus as well as the immune reduction. All cancer is multifactorial. So this explains why we still have lung cancer in people who do not smoke. However, I also think we need to be reasonable, and I think all offices should have a smoking room, and you’re not going to tell me there’s not the technology to fast-filter the air and make there hardly any smoke or nicotine or whatever in the air. We are such clever people, I’m sure we could do this. You could have a smoking room in the pub, similarly fitted with hi-tech air filtration, and then we wouldn’t have so many pubs closing. There so many knock-on bad effects for society as a whole by getting rather obsessive about smoking.

Anyway, I’m a bit knackered after spending hours transcribing it. It’s really no surprise that Deborah Arnott wants to “get rid” of smoking. Everyone knows that’s what she wants to do. The only surprise is that it slipped out. She usually speaks very carefully. I think she must memorize quite a lot of what she says. And she speaks in a low voice (like Thatcher used to do), and never loses her cool.

What was more interesting, in many ways, was what the consultant oncologist had to say. She spoke surprisingly good sense. I thought it was very interesting that she mentioned HPV, although in the context of cancer being “multifactorial”. I just wondered what she was doing phoning Radio 5. Was that the only way she could make her voice heard? For it would seem to pass unheard in all the august bodies of which she is a member.

The only point on which I found myself in disagreement was with her repeated insistence that “If we go too far, we are going to undo the good we’ve already done” – because they have long since gone too far, and undone whatever good they might once have done.

P.S.  BMA retracts claim about smoking in cars also Telegraph Brendan O’neill

P.S. Updated with more transcript (Anne + Miranda Watson)