Where There’s Smoke, There’s Fire

The article we published recently, Smoking Bans Reduce Heart Attacks: Lying By Omission, was posted for discussion on LinkedIn. Since the discussion and comments are only viewable to members of the Cornell network, we cannot address any issues which are being raised directly on LinkedIn.

A member of the network forwarded some of the comments to us and we will address them here. Please take a moment to register and comment on our site if you would like to join in the discussion. We are willing to answer your questions but we have to know the questions exist in the first place.

Since a few commenters made multiple points and because there is overlap on some of the issues raised, we will first post the comments in full and then address the individual points.

Vernon C.:

Do you deny that smoking causes heart and lung disease? Do you deny that we, as a society, pay higher health insurance premiums when there is a higher incidence of disease? Then why is it questionable for society to limit smoking by any method it chooses in order to reduce our costs?

Bonnie F.:

The article is focusing on the smoking issue and the specific way in which scientific data about secondhand smoke has been manipulated to promote indoor smoking bans. The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.

Steve K.:

And this makes the public officials different from the ‘I had no idea nicotine was addictive’ Tobacco CEOs in WHAT way? Secondhand smoke is DISGUSTING. I do not CARE what the science says, it is DISGUSTING, and I have absolutely no problem with smoking being banned EVERYWHERE.It is also a public health risk, and if the health issues are not enough for you, look at the fire statistics. The only likely supporters of smoking are people in the tobacco business and firefighters – depending on whose numbers you want to use, tobacco is responsible for 40% to 80% of house fires.. which keeps them employed.

Mark C.:

A implies B, and I believe B, so A must be true. This fallacy is the foundation of public support for bogus science. People like the conclusions so they accept any rationale that comes their way. They really don’t care if the science is bogus, so long as the conclusion is what they want to hear.

But, just because A is bogus, doesn’t mean B is false. Matter of fact it is easier to get bogus A’s accepted when B is true.

Eric S.:

Hi there. Tobacco is a known carcinogen. I would anticipate that, since the smoking bans have only recently gone into effect, it’s a bit soon to be able to trace benefits to reduction in disease from second hand smoke. Are you aware of any studies that measure the reduction in carcinogenic material that occurs by retention/conversion in the smoker’s lungs and blood stream?

Please be careful about charging fraud in the discussion of the health effects of tobacco ingestion (smoke, chew, etc.) when the obscene fraud practiced by the tobacco companies and their allied state representatives has been well documented.

Marc M.:

>>The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.<<

I don’t even know where to start with this comment, but let me start by saying I live in Texas, a state well known for folks with fundamentalist agenda’s lying to the public about science to get laws passed, albeit in quite a different manner than you might be thinking. That said, Mark makes an excellent point that notwithstanding the possible misinterpretation of allegedly bogus science (where the general scientific consensus is fairly consistent in favor of anti-smoking activists, however), there is still an extremely strong case in favor of indoor smoking bans on just the yuck factor, amongst other reasons.

And it is interesting that the 3 Monkeys also repeat the mantra about the alleged economic catastrophe that would occur with indoor smoking bans, which has repeatedly been show to be bogus (including in several places here in Texas!).

And Steve, firefighters are never in favor of things that actually start fires. I wold rather take my training and sit on my rear in the fire station than make a fire – fires are tragedies in terms of both potential for lives lost AND for the loss of personal history and memories when it is damaged by smoke, water and fire.

Steve K.:

Re: Fire prevention – what I was trying to convey is that I have never heard of a fire department advocating a ban on indoor or unenclosed flame sources. (maybe someone has done so, but I have not heard of it) There must be commerical fire suppression systems that could be installed over gas stoves. Beyond that, ban all unenclosed flame sources, and if a fire is found to have been started by an unenclosed flame source, send the person responsible a bill for the full cost of fighting the fire.
Fires started by cigarettes are NOT accidents, they are acts of stupidity. Why should firefighters have to risk their lives to put out such fires? How many fewer firefighters would a community need if cigarettes were simply banned?

Marc M.:

Steve, you were on the hill about the same time (OK, a few years earlier, but not much) as I was – don’t you remember the ban of candles in campus residence halls? And that was back in the 80’s.

Gas stoves are relatively contained flames and there are codes which govern the installation of such objects – only in commercial occupancies are there rules requiring fire suppression systems. These codes are promulgated for fire prevention reasons and supported by the fire service through the NFPA and other organizations.

Re: fires started by cigarettes – the problem with a fire is that you don’t always know what caused the fire before you put it out – often you don’t know what started it. They get put out, then we determine cause. But there would probably be little decrease in the number of firefighters required because staffing and deployment patterns are governed by time and distance more than by actual numbers of events. Plus, most fire departments now are actually EMS delivery system that provide fire suppression as an ancillary service, so decreases in numbers would impact those services more than the fire suppression services.

And no doubt fires caused by cigarettes are acts of stupidity (or drunkenness, actually, but that may be the same thing).

Here is a distillation of the points raised above, and the answers:

• Tobacco smoking is a major cause of house fires and indoor smoking even at home should be banned.

Factually incorrect. According to the CDC and the NFPA, cooking fires are the number one cause (40%) of house fires. However, it is worth noting that although under 12% of fires (4% of fires originate in the living room, family room, or den; 8% in the bedroom) can be attributed to smoking, it is responsible for more (25%) of the fatalities.

It seems likely that many of the people who were involved in fatal fires with smoking as a cause were impaired by alcohol at the time. By logical extension, we should advocate a ban on drinking alcohol at home. We are sure an intrepid researcher can unearth a strong connection between drinking at home and all sorts of preventable physical and property damage.

We pay for the fire department through taxes and we are required by law to have fire insurance. On on unrelated note, health insurance should be like fire insurance – covering catastrophes, not routine medical expenses.

• Big Tobacco lied about the extent of the dangers associated with their products, therefore claiming that there is fraud involved in research supporting indoor smoking bans is probably a lie supported by Big Tobacco.

Even if Big Tobacco were directly funding research showing how data is being manipulated to support indoor smoking bans, it in no way changes the fact that data is being manipulated. Aside from the lack of direct funding from Big Tobacco, those sources arguing for an examination of the underlying research have been proven right by the original research.

The primary justification for curtailing the freedom of businesses to choose to allow their customers to smoke indoors and for customers to choose to support such businesses is based on the health risks posed to the employees by the secondhand smoke. According to the Surgeon General’s report the actual correlation between secondhand smoke (aka ETS, Environmental Tobacco Smoke) and things like cardiovascular disease, ischemic heart disease, and arrhythmic heart failure or coronary arrest mortality is low enough to be attributable to statistical noise.

Here’s a bit of perspective: the highest risk ratio is for cardiovascular disease, at 1.25. The risk ratio of dying from a traffic accident (for women) on Friday the 13th is 1.38 according to research published in the American Journal of Psychiatry. Therefore it is safe to bet that traffic will be light on November 13th, 2009 because all our female readers will have opted to take the bus or train to work instead.

• Many people simply find tobacco “yucky” and therefore it should be banned anywhere it may come into contact with others. Also, smoking is really bad for you.
  

Smoking tobacco is bad for you and there is no great controversy in saying so. However, it is not the issue we are dealing with here. To reiterate: the issue is that the science shows no ill effects from secondhand smoke, therefore the justification for banning smoking indoors in the name of protecting employees is nonexistent.

The “yucky” argument is flat out childish and sophomoric. Try to defend against it when used as an argument against something you like, which other people abhor.

• People making out on TV is “yucky” and against my religious values, therefore it should be banned from being broadcast.

There is no law forcing anyone to own a television, watch particular shows, or derive spiritual sustenance from it. Turn it off, change the channel, or don’t buy a TV in the first place since broadcasters are providing their audience with what they want. You can affect change by not being part of the audience.

• Small dog breeds are ankle biting terrorists and should be banned. They are a menace to everyone with ankles, and creating something called a “dog” which can get its butt whooped by a 10 lb. house cat is an affront to the basic dignity afforded to every living creature.

No law forces anyone to buy a small dog or hang out at the dog park. In the rare instance you are bitten by one, call the police and file a report.

Now we would like you to imagine that an individual with such a view was in a position of power – say as mayor of Big Major City – and used some shady statistics to justify banning certain breeds of small dogs. Due to the importance of Big Major City, many other cities followed suit and banned those breeds as well. Then a report is issued citing selected cities in which banning those small dogs improved quality of life. In fact, the report is so positive that the mayor of Big Major City and others begin pushing to expand on the success of the original ban by extending it to include all dogs.

All that, because some nutter thinks dogs are “yucky”.

• The reports indicating an economic decline after smoking bans were put into effect are false and misleading.

We came across research which clearly showed an economic decline as a result of indoor smoking bans. To argue otherwise you must show a flaw in the research or provide some other source of data to back up that claim.

Absent a smoking ban, how can someone who finds secondhand smoke “yucky” go about creating change? By choosing with whom you do business. Whether it is a restaurant, bar, or bowling alley, by choosing to direct your business to places with a smoke free environment your actions are causing them to be more successful and thereby encouraging more of that type of business.

The fact that many nightlife places were environments which encouraged smoking shows that the majority of people voted with their hard earned money to keep those places thriving. It means that many of the people who participated in nightlife either liked having a cigarette with their drink or did not mind that others did. To argue that bars and clubs did not suffer economically after smoking bans were put into effect is to ignore the huge support they were receiving from locals and to ignore that people respond to incentives. Furthermore, if only a small percentage of nightlife participants are non-smokers and/or cannot tolerate secondhand smoke, where are all the extra people coming from to replace the smokers who choose to stay at home?

Freedom is what is at stake here. Smoking is dangerous and bad for you, but so are many other things. The indoor smoking bans in effect are the result of the minority imposing their views and beliefs on the majority by lying. The economics show that the majority of the public impacted by ban were against it.

Exit question: If the indoor smoking ban cannot be justified based on science, are supporters of the ban essentially guilty of “we’re just trying to do what’s best for you” paternalism? If that is true, what can citizens do to prevent something like this from happening in the future?

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Why Health Insurance Should Be Like Fire Insurance

Steven Perlstein has a good article in The Washington Post explaining some of the problems with health insurance as it exists today.

There is a part of health insurance that is meant to protect us from unpredictable or unavoidable “catastrophes,” such as getting cancer or having a heart attack. But there is also a part of health insurance that covers fairly predictable and routine medical expenses — the annual physical, a kid’s ear infection or a colonoscopy for a 55-year-old. In those cases, health insurance is not so much protection from catastrophe as it is a mechanism to “prepay” what is likely to be the bill for your own care.

Simply giving people more insurance without addressing the fundamental issues in the existing system is precisely the reason we feel Congress is not serious about reforming healthcare.

Here are a few other interesting points he discusses:

Then there are those who are demanding that Medicare pay more to doctors and hospitals in areas with high medical costs. In reality, this is nothing more than requiring the rest of us to subsidize the inefficient lifestyles and cost structures in rural communities and big cities.

Those who want to prohibit insurance companies from charging higher premiums to people who smoke, drink heavily, abuse drugs or have unhealthy diets apparently take the position that these behaviors should be subsidized by those who take better care of their health.

And those who rail against limits to end-of-life care are effectively saying that patients willing to follow the best medical evidence about what works and what is cost-effective should be required to subsidize those who don’t.

In a free country, people have the right to decide what to buy, where to live, what to eat and drink, and how much medical care to buy. They’re even free to negotiate for health benefits instead of wage increases. What they don’t have is the right to expect that everyone else should pay for their choices through higher taxes and higher health insurance premiums.

People respond to incentives. If regular, planned treatment continues to get covered by insurance (like using insurance to pay for groceries) then prices will remain high, unevenly distributed and opaque. If there is no penalty for making poor choices, then poor choices will abound.

Go read the whole thing.

Over a year ago Bill Whittle wrote an excellent essay which explains why government healthcare (especially in guise of the “public option”) is a terrible blow against freedom.

There’s a scene in Bowling For Columbine where Michael Moore interviews a typically decent and friendly Canadian as he emerges from a health clinic. The poor fellow had, as I recall, some serious injury, and Mssr. Moore wanted to know what it had cost him for treatment.

The man couldn’t reply. They hadn’t charged him. This took Michael Moore’s carefully rehearsed breath away! No charge? You mean, you got that medical attention for free?

That’s right, eh.

Cut to beatific look on directors face, as if he had just been handed a clean plate at a Shoney’s Breakfast Bar.

Folks, Canadians are great people. They are not a stupid people. So can we not, please, not ever again, call this Free Health Care? It is Pre-paid Health Care. That Canadian fellow paid for that treatment every week, for the past twenty years. It was taken out of every paycheck he made. He paid for that medical care, and much, much more. He paid for it whether he needed it or not. And he not only paid for the doctor, he paid for the bureaucrats and administrators in the National Health Service or whatever it’s called. It was not free. It was paid for. Whether he needed it or not. When he has fully recovered, years from now, he will still be paying for it. Every week, from every check. That car or vacation he couldn’t afford, got eaten up by health care he paid for but did not need.

So the question is, who better decides what kind of health care you and your family need: you, or Hillary Clinton? I understand that not all poor people can afford health insurance. Again, being a decent sort of fellow beneath my strikingly handsome exterior, I don’t mind paying a little extra for Medicare for people who need help. I can even live with my insurance rates being higher to cover the cost of caring for the uninsured at the Emergency Room.

But! What I most assuredly DO NOT need is for someone taking my money to give me a health care system I do not need or want. As my all-time idol P.J. O’Rourke once said, if you think health care is expensive now, just wait till you see what it costs when it’s free.

This is a great example of the seduction of the state, because “Free Health Care” sounds like a great deal. It’s Caring! It’s Healthy! And it’s Free!

It’s not free. And not only do I object to being told what I need and don’t need, I also object to the idea that some dim-witted Student Council dork thinks he knows what’s better for me than I do.

P.J. Again: if you think that Public is an altar to worship at, put the word “public” in front of these words and tell me how you feel: Restroom. Swimming pool. Transportation. Here’s another: Take the words Decision, Officer, Appointment, and then add the word “political” to the front end and watch them drop in value.

So, look around. Look at how people feel about government, and ask yourself, does this or that person think of themselves as an adult or as a helpless child? Freedom is not for children. Freedom means responsibility. It means making tough decisions yourself. Freedom is not government. Almost all government is the enemy of freedom; the bigger the government, the more powerful the enemy.

This is an excerpt from a longer essay which makes several other worthwhile points, so go read the whole thing.

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Cancer Surgery Breakthrough: Electrosurgery + Mass Spectrometry = Real Time Tumor Identification

If you have never heard of electrosurgery before, here is some background information:

Electrosurgery is the application of a high-frequency electric current to biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue. […] Its benefits include the ability to make precise cuts with limited blood loss. Electrosurgical devices are frequently used during surgical operations helping to prevent blood loss in hospital operating rooms or in outpatient procedures.

In electrosurgical procedures, the tissue is heated by an electric current. Although electrical devices may be used for the cauterization of tissue in some applications, electrosurgery is usually used to refer to a quite different method than electrocautery. The latter uses heat conduction from a probe heated by a direct current (much in the manner of a soldering iron), whereas electrosurgery uses alternating current to directly heat the tissue itself.

The main reason surgeons use electrosurgical tools is to minimize blood loss. A team of German and Hungarian researchers decided to adapt one such electroscalpel by attaching a pump to suck up tiny particles of tissue which get vaporized during cutting.

In electrosurgery, tissue is locally exposed to high-frequency electrical current in order to guide a cut, remove tissue, or halt bleeding. The tissue being treated becomes very hot and is partially vaporized. The electrical current also generates electrically charged molecules during the vaporization. The team of scientists from the University of Giessen, the Budapest firm Massprom, Semmelweis University, and the National Research Institute for Radiobiology and Radiohygiene, also in Budapest, made use of this process for their new method called rapid evaporation ionization mass spectrometry, or REIMS. They equipped an electrosurgical instrument with a special pump that sucks the vaporized cell components up through a tube and introduces the charged molecules into a mass spectrometer.

Once it was shown that obtaining the tissue was feasible, they were fortunate to discover that the different types of tissue are rapidly and easily distinguished by a mass spectrometer.

It turns out that mainly lipids, the components of cell membranes, are registered by the mass spectrometer. “Different tissue types demonstrate characteristic differences in their lipid composition,” explains Takáts. “Tumor tissue also differs from healthy tissue.” The scientists were able to develop a special algorithm to unambiguously identify and differentiate between types of tissue.

“Tissue analysis with REIMS, including data analysis, requires only fractions of a second,” according to Takáts. “During an operation, the surgeon thus received virtually real-time information about the nature of the tissue as he was cutting it.” This opens new vistas for cancer surgery in particular: the method helps to precisely localize the tumor during surgery and to delimit it from the surrounding healthy tissue. REIMS also provides information about whether the carcinoma is in an early or advanced stage.

We hope this technique becomes widely available as soon as possible.

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Ogling Breasts Increases Men’s Lifespans

What a terrific piece of news from the scientific community:

Ogling over women’s breasts is good for a man’s health and can add years to his life, medical experts have discovered. According to the New England Journal of Medicine, “Just 10 minutes of staring at the charms of a well-endowed female is roughly equivalent to a 30-minute aerobics work-out” declared gerontologist Dr. Karen Weatherby.

Dr. Weatherby and fellow researchers at three hospitals in Frankfurt, Germany, reached the startling conclusion after comparing the health of 200 male outpatients – half of whom were instructed to look at busty females daily, the other half told to refrain from doing so. The study revealed that after five years, the chest-watchers had lower blood pressure, slower resting pulse rates and fewer instances of coronary artery disease.

“Sexual excitement gets the heart pumping and improves blood circulation,” explains Dr. Weatherby. “There’s no question: Gazing at breasts makes men healthier.” “Our study indicates that engaging in this activity a few minutes daily cuts the risk of stroke and heart attack in half. We believe that by doing so consistently, the average man can extend his life four to five years.”

File this one in the “too good to be true department”.

If the story smacks of tabloid journalism, it’s because that’s precisely what it is. The text began circulating in March or April 2000, mere weeks after a very similar article appeared in the consistently misinformative Weekly World News — nor is this the first time we’ve run into baseless Internet rumors traceable to precisely that source.

It goes without saying (I hope) that it’s unwise to take medical advice from supermarket tabloids, still less from forwarded emails. Males who wish to increase their lifespans ought to consider practicing common sense as an alternative — it’s more likely to achieve the desired result than any amount of public breast ogling.

Sorry fellas, but you will not be able to justify staring based on “some scientific research you read somewhere”. Instead, take the high road and blame Leslie Bennetts style nagging for your wandering eyes – but don’t forget to look your best otherwise you won’t be able to turn her off. If you are concerned about your health don’t forget that video games are good for the heart and for the mind.

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Videos: Evolution and Skewed Views Of Science

QaliaSoup has a great video which addresses some misconceptions and explains some of the basics of evolution.

See the evolution video on YouTube here.

If you enjoyed that one we think you will also enjoy one of their other videos, Skewed views of science.

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Video Games: Good For The Heart & Body

Parents would greatly prefer if their children engaged in plenty of outdoor exercise. Unfortunately for some parents, their children actually lead almost completely sedentary lives. Those children are at a high risk for health complications, especially if a lack of exercise is combined with poor dietary choices.

Even if you are fortunate and have children who are physically active there are still reasons to moderate their activities during their time in front of the television. There are real skills which can be gained from interactive media, beneficial to boys and girls alike, which they simply will not gain from hours of passive television consumption.

An active video game system like the Nintendo Wii can be beneficial to kids who otherwise get no exercise at all, according to recent research published in Pediatrics.

Scientists at the University of Oklahoma Health Sciences Center found that playing active video games like the Wii can be an effective substitute for moderate exercise.   No one is saying children should stop playing outside or doing real exercise but active video games can be a suitable alternative at times.  Basically, if an obese child is going to sit around and play video games instead of exercising, something is better than nothing.

Here are the detailed finding of the research:

• Children use similar amounts of energy playing Wii boxing, doing DDR at Level 2 and walking 2.6 mph. They burned about three times as many calories doing these activities as they did while watching television, about 3 calories a minute playing the games compared with 1 calorie a minute lounging in front of the TV.
• Kids used about two to 2½ times more energy playing Wii bowling and doing the beginner level of DDR as they did watching TV. They burned 2 to 2½ calories a minute during the activity.
• Boys used more energy than girls when playing DDR and bowling, but both boys and girls used about the same amount of energy walking and playing Wii boxing.

DDR2 is referring to the game Dance Dance Revolution 2. Boxing, tennis, and bowling are part of Wii Sports, the game that comes bundled with a new Wii. There are other fun fitness related games from Nintendo, such as Wii Sports Resort and the Wii Fit (which has games incorporating a unique balancing board).

Amazon.com has a special notice up:

Celebrate Sunday’s Wii Price Drop with Savings
If you are considering a Wii, you might like to know that the price of the Wii console will drop to just $199.99 starting at 12 AM PST, Sunday, September 27, 2009. Come back when it does and celebrate your purchase with surprise savings on some of our best games and accessories for Wii!

We recommend marking your calendar.

UPDATE: The notice is no longer up at Amazon, but the discounted price of $199.99 is still in effect.

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Smoking Bans Reduce Heart Attacks: Lying By Omission

Two studies were recently published which showed a correlation between a community adopting a smoking ban and a subsequent reduction in heart attack rates. The results are based on aggregated data from several other studies. Unfortunately, we do not have access to the original reports so we cannot question their methodology directly.

Report #1:

The research — which incorporated data from a total of 24 studies of smoking bans across the country — found at least a 17 percent reduction in heart attacks one year after the bans had been enacted.

Report #2:

The other study, published in the Sept. 21 issue of Circulation, found a 17 percent drop in heart attack rates after one year and about a 36 percent drop three years after smoking restrictions had been enacted.

It incorporated data from 13 studies in the United States, Canada and Europe. Meyers’s research effort analyzed data from 11 studies of 10 public smoking bans in the same geographic regions.

We will examine the motivation for presenting the public with false information by exposing the agenda behind it later. First, we will take a close look at how this type of fraud occurs.

The crime in this case is one of omission. Both studies show impressive results based on data from multiple sources. One of these reports used data from 24 other studies and the other used 13. How many studies have been left out which don’t support their conclusions?

It would be very inconvenient for the authors and proponents of these studies if some communities experienced an increase in heart attacks after a smoking ban was put into effect, and they conveniently left those out of their research. The most conclusive study would be one which examined the data on a national level.

In fact, such a study exists and was published a few months ago.

A new study by researchers from the RAND Corporation, Congressional Budget Office, University of Wisconsin, and Stanford University is the first to examine the relationship between smoking bans and heart attack admissions and mortality trends in the entire nation, using national data. All previous U.S. studies only examined one particular city. In contrast, this study examined data from the Nationwide Inpatient Survey (NIS), which is nationally representative and includes 20% of all non-federal hospital discharges in the United States. The study has been published as Working Paper 14789 of the National Bureau of Economic Research Working Paper Series.

The study came to a completely different conclusion than the ones recently published.

The most important finding of this study is that there are just as many smoking ban communities in which heart attack admissions and mortality have increased in comparison with control communities as there are smoking ban communities in which heart attacks have decreased relative to control communities. The mean difference was found to be zero.

Thus, the study not only fails to find a short-term effect of smoking bans on heart attacks, but it also explains the positive findings of previous studies. What appears to be going on is what is referred to as publication bias.

Another major problem with studies being touted by the media and pushed by anti-tobacco activists is the level of harm attributed to second hand smoke.

Epidemiologists use “relative risk” (RR or Risk Ratio and informally including the similar Odds Ratio computation) as a means for measuring the severity of risk. The U.S. Surgeon General stated the relative risk for secondhand smoke is between 1.20 to 1.30. This is far below the minimum level at which any meaningful risk might be indicated. Both the World Health Organization and the National Cancer Institute have clearly stated that RRs below 2.0 are too low to be relied upon. The same is true of the federal Reference Manual on Scientific Evidence and textbooks such as Breslow and Day’s Statistical Methods in Cancer Research. A report by the independent health consulting firm Littlewood & Fennell characterizes RRs below 2.0 as “dancing on the tiny pinhead of statistical insignificance.”

The Surgeon General’s report went out of its way to make a claim which ran counter to the evidence. It had to be explicitly pointed out after the report’s publication that there is no justification for banning indoor smoking.

The 1992 report Revised Comments on the 1986 Surgeon General’s Report…EPA…and NIOSH states: “Risk estimates below 2.0 or 3.0 are described as ‘weak’ and thus any conclusions drawn from them are unreliable.” The summary of this 47-page document concludes: “…these reports [Surgeon General’s, EPA, and NIOSH] do not provide a defensible basis for regulation of smoking in the workplace.” Comments in the report are supported by 113 references in the scientific literature.

Even with that censure, the Surgeon General’s office continues to be promote nonsense for the anti-tobacco crusade. It is shameful for a governmental organization to promote political agendas using scare tactics which run counter to the scientific data.

The 2006 SG’s report claims 46,000 deaths annually due to heart disease from secondhand smoke. But the American Heart Association website lists the following RRs for ETS: 1.25 for Cardiovascular disease, 1.18 for ischemic heart disease, and 1.13 for arrhythmic heart failure or coronary arrest mortality. None of these suggests credible risk. Death estimates are derived from relative risk. If a RR is meaningless, so are the estimates of deaths based upon it. So the big scary estimate of 46,000 deaths has no validity. It is simply a phony number put out to scare people and panic them into political action. If such death estimates were valid, the new study would not have found that smoking bans have zero effect on heart attack mortality.

The EPA (Environmental Protection Agency) also helped to promote this madness. The Surgeon General’s report relied on data from a 1992 EPA study, which concluded that 3,000 deaths per year are attributable to secondhand smoke.

The U.S. House of Representatives then held a Congressional Investigation of EPA’s findings. It concluded: “EPA could reach that conclusion [3,000 lung cancer deaths] only by ignoring or discounting major studies, and deviating from generally accepted scientific standards.” Further, it found EPA guilty of “conscious misuse of science and the scientific process to achieve a political agenda that could not otherwise be justified.” It also stated: “The agency [EPA] has deliberately abused and manipulated scientific data in order to reach a predetermined, politically motivated result.” (emphasis added.) Over the next seven years, five similar studies (meta-analyses) of secondhand tobacco smoke were performed by other researchers who, unlike EPA, followed correct scientific standards. The RRs of these studies showed a range of 0.98 to 1.03 and an average RR of 1.01, compared to EPA’s RR of 1.19. Levois and Layard performed a meta-analysis of all the original studies utilized by EPA and came up with a RR of 1.00. Furthermore, these studies all had the standard 95% confidence level. The EPA study did not qualify for that. Instead, EPA used a degraded confidence level of only 90 percent, thus doubling the likelihood that its results were mere chance.

The motivation behind this shady business comes from several fronts. The strongest force are the absolutists, the prohibitionists, the fundamentalists who would like tobacco to be eliminated from the face of the Earth. Some of them become politicians and work towards achieving that goal incrementally. Their motivation is “the ends justify the means”. Others are the media and do-gooders who are not intelligent enough or simply too lazy and ignorant to examine the background science and automatically assume people they look up to are working in everyone’s best interests.

A steep price is paid for this stupidity. First, indoor smoking bans cause economic losses. Second, they promote the kind of “save me from myself” paternalism which is a way of expanding the power of government in the name of helping people who cannot handle the responsibility that comes with freedom. There are eerie similarities between those who wish to ban tobacco and the prohibitionist war on drugs.

In case it was not clear until this point, smoking is bad for you, and you should use whatever means necessary to quit. However, it is a legal product and adults should be allowed to enjoy it even without big government nanny approbation. The danger from tyranny is far greater than the dangers of indoor smoking.

Exit question: If the general public knew how much of the science being used to push for banning tobacco was nonsense, would such legislation continue to receive support?

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UPDATE: The answers to a few critiques raised by this article can be found here: Where There’s Smoke, There’s Fire.

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Doctors vs Veterinarians (vs Big Government)

Eric at Classical Values brings up an interesting point – veterinary care is a pretty good example of the free market at work in a healthcare system.

Under our “system” of veterinary health care, there’s generally little or no wait, they’re invariably friendly (because you could always grab your dog or cat and take it to another vet), and as to the prices?

He gives a personal example involving a visit to the vet for his dog which actually cost $950, whereas a comparable operation on a person would likely cost upwards of $20,000. It is possible to quibble about the details, but undoubtedly the same operation on person would cost many times more.

Differences in liability insurance is part of it. Bear in mind that it is more difficult to get into veterinary school than medical school.

It strikes me that there is a giant, overarching difference between veterinary care and regular medical care, and that is that the former is barely regulated by the government, while the latter is so regulated that even now — without socialized health care — many doctors feel as if they spent most of their time being bureaucrats. Is that it? I’m sure my vet kept records for Puff, but I’d be willing to bet they consisted of little more than a couple of paragraphs summarizing the diagnosis, the procedure, and his recovery. And I’d also be willing to bet that for the same procedure on a boy, if all of the records were all printed out they’d be a stack of documents inches thick.

The bureaucracy adds to the costs in many different ways, from ordering unnecessary tests to increased personnel costs merely to deal with mountains of paperwork. The lack of tort reform with regards to medical malpractice insurance is also responsible for a large portion of the higher costs.

While I realize technology has added many tools to the medical arsenal since the 1940s, the same tools have been added to the veterinary arsenal, so that can’t be all there is to it. I have not seen any vet bills from the 1940s, but I am sure that a cursory examination would reveal that the rate of increase has risen in a normal manner that we would expect, while the rate of increase for human medical care has skyrocketed. (Of course, in those days, far fewer people had health insurance. Might the “blank check” from the big pocket have something to do with it?)

Should we allow vets to treat humans? Why not? If a woman can consent to an abortion, why can’t I consent to having a veterinarian cut a tennis ball out of my intestines?

Why can’t we be consenting adults?

As long as members of Congress remain cozy with trial lawyers, tort reform will not be implemented. Please note that simple things can be written into law which would have an effect on the system without drastically overhauling it in the worst way possible. For example, when we hear that there are potentially billions of dollars being wasted in Medicare/Medicaid programs, why wouldn’t that get taken care of immediately and independently of any healthcare reform bill?

There are viable solutions. Unfortunately recent current events such as the problems with ACORN[1] and the NEA[2] only further the notion in most citizens minds that more government is very clearly not the answer.

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[1] In case you’ve been living under a rock, ACORN is under fire for promoting child prostitution. They’ve received millions of federal dollars.

• ACORN Prostitution Investigation Undercover Video: Baltimore
• Washington, D.C.
• New York, NY
• San Bernardino, CA
• San Diego, CA

[2] The NEA is in trouble, having been caught allowing the White House to push a partisan agenda during a conference call, which is very likely against the law.

• Full NEA Conference Call Transcript and Audio
• “This Is Only The Beginning.”
• ‘Artists’ As Servants Of Power
• NEA Conference Call Broke Laws

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Video Games: Good For The Brain

Sinking blocks and clearing lines in Tetris may pay off with more than just a high score. Playing the classic shape-fitting computer game, which celebrates its 25th anniversary this year, for just three months may boost the size and efficiency of parts of the brain, a study published September 1 in BMC Research Notes finds.

Who knew playing Tetris for hours had a positive effect? (Hint: not your mom.)

When researchers wanted to test this theory out, they recruited young girls because boys tend to already have extensive video game playing experience, which may have affected the results.

Brain scans revealed that certain regions of gray matter — an information-processing mix of brain cells and capillaries — grew thicker in 15 adolescent girls who had played Tetris for three months. On average, these participants played for just 1.5 hours per week.

Although parts of the brain became bigger, other parts became less active.

Surprisingly, the brain regions that got bigger over the three months of Tetris play were not the same regions that showed a drop in activity, ruling out the simple explanation that as brain regions get bigger, they become more efficient.

The most important question from this study remains unanswered – is it good for you?

Haier and colleagues don’t know whether these Tetris-induced brain changes have any real benefits in tasks like memory, spatial reasoning and problem-solving ability. “We know Tetris changes the brain,” Haier says. “We don’t know if it’s good for you.”

On a related note, research has shown that women who play video games can improve their spatial skills.

“Our first experiment discovered a previously unknown sex difference in spatial attention,” said Jing Feng, a psychology doctoral student and lead author of the study. “On average, women are not quite as good at rapidly switching attention among different objects and this may be one reason why women do not do as well on spatial tasks. But more important than finding that difference, our second experiment showed that both men and women can improve their spatial skills by playing a video game and that the women catch up to the men,” Feng added. “Moreover, the improved performance of both sexes was maintained when we assessed them again after five months.”

It is important research with non-trivial applications in the field of education. One of the reasons why men rather than women are drawn to games which improve spatial skills is because those games tend to be violent 3D action shooter type games, like Halo 3, which are simply not as appealing to women. Unfortunately, playing The Sims or other games which require strategizing and deep thinking will do nothing for enhancing spatial intelligence in particular.

“One important application of this research could be in helping to attract more women to the mathematical sciences and engineering. Since spatial skills play an important role in these professions, bringing the spatial skills of young women up to the level of their male counterparts could help to change the gender balance in these fields that are so important to our economic health,” Spence added.

Spatial intelligence is not the only target for improvement. What if it were possible to boost fluid intelligence by training with a video game? Ed Yong points out that the latest research indicates it is possible, if done correctly.

There are products available on the market now such as Brain Age, Brain Age 2 and Big Brain Academy which will improve your abilities at certain specific tasks. However, improving at a specific task does not necessarily translate into an enhancement of overall fluid intelligence.

Nonetheless, Susanne Jaeggi from the University of Michigan has developed a training programme involving a challenging memory task, which does appears to improve overall fluid intelligence. The trainees do better in intelligence tests that have nothing to do with the training task itself and the more training they receive, the higher their scores.

Here’s how the actual training test worked:

Jaeggi recruited 70 young students and set half of them on a challenging training regime, involving the so-called “n-back task”. These trainees watched a series of screens where a white square appeared in various positions on a black background. Each screen appeared for half a second, with a 2.5 second gap before the next one flashed up. While this happened, the trainees also heard a series of letters that were read out at the same rate.

At first, their job was to say if either the screen or the letter matched those that popped up two cycles ago but the number of cycles increased or decreased depending on how good the students were at the task. Boffins had to compare the current pair with those many cycles ago, while dunces only had to remember fairly recent ones. The students sat through about half an hour of training a day for either 8, 12, 17 or 19 days, and were tested on their fluid intelligence before and after the regimen using the German Bochumer-Matrizen Test.

Those who participated for longer had better scores on a fluid intelligence test. The benefits extended to those who were initially low performers, not just the brilliant participants. Many training regimes have been designed to do precisely what was accomplished here, so what made this one successful where others have failed?

Jaeggi thinks that this task worked where others have failed because it remained challenging. The students were never allowed to get comfortable with the task – as soon as they improved, it became accordingly more difficult. Faced with the combination of two info streams and shifting difficulty levels, they couldn’t develop simple strategies or switch to autopilot. The task was also very challenging. To succeed in it, students had to remember old items, constantly update the memories they were keeping, block out irrelevant ones, and manage two tasks at the same time using both sound and sight.

Ed Yong ends with some related questions:

How exactly does the training programme lead to better fluid intelligence? At what point will the benefits of extra training start to level off? And how long will it take for the programme’s effects to wear off, it they ever do? The answers to these questions will help to decide if the findings are indeed “highly relevant to applications in education” as the authors claim.

And speaking of education, perhaps readers who are more familiar with the literature on intelligence can enlighten me on this: Jaeggi claims that fluid intelligence is fairly unchangeable in the face of education, which seems quite shocking. That would imply that our education system improves our knowledge and skills, but not our innate ability to solve problems or draw inferences. Is that really the case?

Try your hand at a free dual n-back style memory and intelligence training test here.

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Early Risers Crash Faster Than Night Owls

“Early to bed and early to rise makes a man healthy, wealthy and wise.” –Benjamin Franklin

Some people are “morning people”, functioning a little too well in the early a.m. hours, while others are “lazy” and can’t get anything done before the crack of noon. When we fast forward the clock a bit to midnight or later, the morning people are out cold, whereas those lazy individuals are just getting revved up.

In a new study researchers Christina Schmidt and Philippe Peigneux, both at the University of Liège in Belgium, and their colleagues first asked 16 extreme early risers and 15 extreme night owls to spend a week following their natural sleep schedule. Then subjects spent two nights in a sleep lab, where they again followed their preferred sleep patterns and underwent cognitive testing twice daily while in a functional MRI scanner.

It is tempting to assign the blame for these differences on mere habit, but what if there is an underlying biological explanation? Perhaps there are other subtleties at play here as well.

An hour and a half after waking, early birds and night owls were equally alert and showed no difference in attention-related brain activity. But after being awake for 10 and a half hours, night owls had grown more alert, performing better on a reaction-time task requiring sustained attention and showing increased activity in brain areas linked to attention. More important, these regions included the suprachiasmatic area, which is home to the body’s circadian clock. This area sends signals to boost alertness as the pressure to sleep mounts. Unlike night owls, early risers didn’t get this late-day lift. Peigneux says faster activation of sleep pressure appears to prevent early birds from fully benefiting from the circadian signal, as evening types do.

An early riser who wakes up at 5 a.m. will not crash at 3 in the afternoon. However, their brains are not as alert in the late afternoon compared to a night owl who wakes up at noon, and is then tested past 10 p.m. The main difference is that night owls will maintain a high level of attention for longer periods of time, not just different periods of time.

Are night owls taking advantage of a circadian signal, or have they somehow pushed the brain’s equivalent of a snooze button, delaying the chemical reaction which causes the “need to sleep right now” pressure?

We would like to see a version of this study done with those individuals who naturally need 25% less sleep than normal.

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Do Antioxidants Boost Cancer Cells & Hinder Exercise?

A characterization of cancerous cells is their ability to metastasize and show up in areas where they do not belong. When a normal cell becomes detached from its environment, a process called apoptosis (cellular self destruction) is triggered.

The genes which would be activated in a normal cell to trigger apoptosis may be damaged and non-functional in a cancerous cell, thereby allowing it to survive the initial detachment from its environment. However, even if apoptosis is not triggered, the cell should die of starvation because it is cut off from its supply of nutrients.

A group at Harvard published a study examining cellular detachment and found some surprising results. From Derek Lowe:

So far, so good – this all fits in well with what we already know about tumor cells. But this study found that there was another way to keep detached cells from dying: give them antioxidants. (They used either N-acetylcysteine or a water-soluble Vitamin E derivative). It appears that oxidative stress is one thing that’s helping to kill off wandering cells. On top of this effect, reactive oxygen species also seem to be inhibiting another possible energy source, fatty acid oxidation. Take away the reactive oxygen species, and the cells are suddenly under less pressure and have access to a new food source.

Clearly, there are serious implications to this research. Right now all we have are more questions and not enough answers.

This looks like a very strong paper to me; there’s a lot of work in it and a lot of information. Taken together, these results suggest a number of immediate questions. Is there something that shuts down normal glucose uptake when a cell is detached, and is this another general cell-suicide mechanism? How exactly does oxidative stress keep these cells from using their fatty acid oxidation pathway? (And how does that relate to normally positioned cells, in which fatty acid oxidation is actually supposed to kick in when glucose supplies go down?)

The biggest questions, though, are the most immediate: first, does it make any sense at all to give antioxidants to cancer patients? Right now, I’d very much have to wonder. And second, could taking antioxidants actually have a long-term cancer-promoting effect under normal conditions? I’d very much like to know that one, and so would a lot of other people.

After this and that exercise study, I’m honestly starting to think that oxidative stress has been getting an undeserved bad press over the years. Have we had things totally turned around?

The exercise study referred to examines whether antioxidants combined with exercise is a formula for failure. After exercising, the body tries to increase the number of mitochondria and it does so by signaling with reactive oxygen species (ROS).

Of course, ROS are also implicated in many theories of aging and cellular damage, which is why cells have several systems to try to soak these things up. That’s exactly why people take antioxidants, vitamin C and vitamin E especially. So. . .what if you take those while you’re exercising?

Once again, the law of unintended consequences rears its ugly head.

And as it turns out, antioxidant supplements appear to cancel out many of the beneficial effects of exercise. Soaking up those transient bursts of reactive oxygen species keeps them from signaling. Looked at the other way, oxidative stress could be a key to preventing type II diabetes. Glucose uptake and insulin sensitivity aren’t affected by exercise if you’re taking supplementary amounts of vitamins C and E, and this effect is seen all the way down to molecular markers such as the PPAR coactivator proteins PGC1 alpha and beta. In fact, this paper seems to constitute strong evidence that ROS are the key mediators for the effects of exercise, and that this process is mediated through PGC1 and PPAR-gamma.

Taking supplemental antioxidants may unnecessary because the body produces enough of its own.

Interestingly, exercise also increases the body’s endogenous antioxidant systems – superoxide dismutase and so on. These are some of the gene targets of PPAR-gamma, suggesting that these are downstream effects. Taking antioxidant supplements kept these from going up, too.

In conclusion, antioxidant supplements will hinder the some of the benefits gained from exercise and likely helps cancerous cells survive and spread around.

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Boost Your Baby’s IQ

Breastfeeding has been shown to be beneficial to babies because of the immune system boost they get from mom. Breast milk also has an essential fatty acid called docosahexaenoic acid (DHA) which may provide infants with a cognitive boost.

Researchers decided to test if supplementing regular formula with DHA would have the same effect that came naturally from breastfeeding.

The researchers studied 229 infants, who received either formula supplemented with DHA or traditional infant formula. The babies were given the different formulas either shortly after birth, after 6 weeks of breastfeeding, or after 4 to 6 months of breastfeeding. When they were 9 months old, they were given a problem-solving test in which they had to complete a sequence of steps to get a rattle.

Babies who were fed formula supplemented with DHA were more likely to get the rattle and showed more intentional behaviors that allowed them to get the rattle.

More studies need to be conducted to confirm these effects.

“Currently, there is no clear consensus on whether infant formula should be supplemented with DHA,” notes lead author James R. Drover, a former postdoctoral fellow at the Retina Foundation of the Southwest who is now assistant professor of psychology at Memorial University in Canada.

“However, our results clearly suggest that feeding infants formula supplemented with high concentrations of DHA provides beneficial effects on cognitive development. Furthermore, because infants who display superior performance on the means-end problem-solving task tend to have superior IQ and vocabulary later in childhood, it’s possible that the beneficial effects of DHA extend well beyond infancy.”

This is not the first time DHA has been in the news. A news report from 2002 showed that the FDA approved its inclusion in formula, although evidence that it had a positive effect was scant at the time. Other factors, including the average age of a breastfeeding mother and socioeconomic status could have influenced results.

No doubt all this is why experts at the American Council on Science and Health, including the former chairman of the American Academy of Pediatrics Committee on Nutrition, concluded in a recent report that, “the addition of DHA and AA to infant formulas is not warranted at this time.”

In light of this new study, is paying a premium for enhanced baby formula worth it?

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Pfizer’s Whistleblowers

The problems at Pfizer which led to the record $2.3 billion settlement were revealed by whistleblowers. Unfortunately, it was not just individual sales representatives who were pushing for sales based on off label uses. Sales managers, who have the responsibility of noticing and preventing these abuses, were the ones pushing for these sales to earn bigger bonuses.

One of the sales reps was Stefan Kruszewski, a psychiatrist. He did not merely disagree with the promotion of unapproved off-label usage of Geodon (an anti-psychotic drug), but actively went and researched it.

Kruszewski didn’t just say no. He went and checked the research and saw Geodon could have serious cardiac side effects not mentioned by the salesmen, who boasted of its relative safety, according to his lawyer, Brian Kenney. And he noticed that Pfizer was paying his peers to promote the drug to other psychiatrists.

He got a lawyer who specializes in these kinds of cases, and they presented their information to the government. Several years earlier, John Kopchinski (also a sales rep) did not fare as well. He joined with Kruszewski and also presented his information to the government.

So did John Kopchinski, who sold Pfizer’s arthritis drug Bextra but not as aggressively as the bosses wanted. They told the sales force to pitch it for post-surgical pain, acute pain, migraines and a host of other conditions for which the drug had been rejected by the U.S. Food and Drug Administration, says Kopchinski’s lawyer, Erika Kelton.

Nor would he advise doctors to boost the recommended dosage to two, four, even eight times the amount approved, though other salespeople did.

“The sales managers were having us do what was blatantly illegal,” Kopchinski told the BBC. Those who did were rewarded financially. He refused, was fired and spent the next six years depleting his retirement funds.

There are a total of 6 whistleblowers, and the awards they are getting range from $2.3 million to $51 million.

Pfizer may really be working hard behind the scenes to make sure all their divisions, subsidiaries, and related sales teams comply with the law, but this is not the first time something like this has happened.

To resolve claims it promoted off-label uses of Neurontin, an anti-seizure drug, Warner-Lambert, owned by Pfizer, paid $430 million in 2004, and Pfizer said it would institute a compliance program.

There’s a systemic problem going on, because the Pharmacia & Upjohn Co. division involved in this most recent case were involved in the same type of off-label promotion nonsense before.

Three years later, Pfizer’s Pharmacia & Upjohn Co. divisions agreed to pay almost $35 million to settle charges related to the human-growth hormone Genotropin. Among the allegations was that the drug was being promoted as an anti- aging treatment.

That same subsidiary has again pleaded guilty, this time as part of the overall settlement with Pfizer for its promotion of Bextra.

Part of Pfizer’s growth strategy involves acquiring other companies. These companies may bring with them an ingrained corrupt corporate culture which takes some time to purge. It is important to note the difference between a company promoting a safe off-label use for a drug, versus an off-label use specifically prohibited by the FDA because of the problems it causes.

We are still hesitant to label Pfizer as evil because killing customers is not a good corporate strategy, what with the big fines and bad publicity eating into profits. Big Tobacco is not a good counter example because none of their products are safe for use, on-label, off-label, or otherwise. They do a lot of good, and huge companies like it will run into the “left hand doesn’t know what the right hand is doing” problems at one point or another. However, although Pfizer can technically blame the Parmacia & Upjohn subsidiary here, it is imperative they have a thorough internal review and toughened compliance system put in place before they even consider any new acquisitions.

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Drug Prohibition Is A Failure

The politics and policies of drug prohibition are a failure primarily because they are not effective in actually prohibiting people from obtaining and using drugs, and also because the evidence supporting those policies are weak.

Here are a few rebuttals to the main arguments used in favor of prohibition.

Argument 1: The fact that drugs are illegal keeps many people from trying them, and out of harm’s way. Legalization now would contribute to many more people using drugs.

In the UK, as in many countries, the real clampdown on drugs started in the late 1960s, yet government statistics show that the number of heroin or cocaine addicts seen by the health service has grown ever since – from around 1000 people per year then, to 100,000 today. It is a pattern that has been repeated the world over.

Argument 2: If current policies are not successful at prohibition, stricter policies should be enacted.

A second approach to the question is to look at whether fewer people use drugs in countries with stricter drug laws. In 2008, the World Health Organization looked at 17 countries and found no such correlation. The US, despite its punitive drug policies, has one of the highest levels of drug use in the world (PLoS Medicine, vol 5, p e141).

Argument 3: A halfway approach, which would decriminalize possession of drugs, is doomed to fail since the lack of effective punishment will encourage more people to try drugs.

While dealing remains illegal in Portugal, personal use of all drugs has been decriminalised. The result? Drug use has stayed roughly constant, but ill health and deaths from drug taking have fallen. “Judged by virtually every metric, the Portuguese decriminalisation framework has been a resounding success,” states a recent report by the Cato Institute, a libertarian think tank based in Washington DC.

The Law Of Unintended Consequences comes into play as a result of prohibitionist policies. Black market items are generally very profitable, and young people may get sucked in with dreams of fast cash. Ironically, prohibition is often sold as being “for the children”.

Most drug trafficking happens through large criminal enterprises, which are also involved in murder, corruption, and kidnapping. Nearly 4,000 people have been killed this year (so far) in Mexico’s drug wars.

So what’s the alternative? There are several models for the legal provision of recreational drugs. They include prescription by doctors, consumption at licensed premises or even sale on a similar basis to alcohol and tobacco, with health warnings and age limits. If this prospect appals you, consider the fact that in the US today, many teenagers say they find it easier to buy cannabis than beer.

Accusations of evidence suppression happen everywhere, from Big Tobacco to Big Pharma, and it is rightly shocking when lives are at stake. Why are citizens willing to elect and re-elect politicians who enact policies running contrary to evidence sometimes composed by Big Government itself? Aren’t lives at stake here too?

In 1944, Mayor LaGuardia commissioned a report which was titled “The Marihuana Problem in the City of New York”. The report was written up by the New York Academy of Medicine.

This study is viewed by many experts as the best study of any drug viewed in its social, medical, and legal context. The committee covered thousands of years of the history of marijuana and also made a detailed examination of conditions In New York City. Among its conclusions: “The practice of smoking marihuana does not lead to addiction in the medical sense of the word.” And: “The use of marihuana does not lead to morphine or heroin or cocaine addiction, and no effort is made to create a market for those narcotics by stimulating the practice of marihuana smoking.” Finally: “The publicity concerning the catastrophic effects of marihuana smoking in New York City is unfounded.”

A primer on the issues at play here and a must read is The Consumers Union Report on Licit and Illicit Drugs, by Edward M. Brecher and the Editors of Consumer Reports Magazine.

The recommendations in this report included:

Stop emphasizing measures designed to keep drugs away from people.

Stop increasing the damage done by drugs.

Stop misclassifying drugs.

Stop viewing the drug problem as primarily a national problem, to be solved on a national scale.

Stop pursuing the goal of stamping out illicit drug use.

Consumers Union recommends the immediate repeal of all federal laws governing the growing, processing, transportation, sale, possession, and use of marijuana.

Consumers Union recommends that each of the fifty states similarly repeal its existing marijuana laws and pass new laws legalizing the cultivation, processing, and orderly marketing of marijuana-subject to appropriate regulations.

Consumers Union recommends that state and federal taxes on marijuana be kept moderate, and that tax proceeds be devoted primarily to drug research, drug education, and other measures specifically designed to minimize the damage done by alcohol, nicotine, marijuana. heroin, and other drugs.

Consumers Union recommends an immediate end to imprisonment as a punishment for marijuana possession and for furnishing marijuana to friends.*

Consumers Union recommends, pending legalization of marijuana, that marijuana possession and sharing be immediately made civil violations rather than criminal acts.

Consumers Union recommends that those now serving prison terms for possession of or sharing marijuana be set free, and that such marijuana offenses be expunged from all legal records.

There are many more major studies of drugs and drug policy like the above two available for free from the Schaffer Library of Drug Policy.

Unfortunately, the idea that banning drugs is the best way to protect vulnerable people – especially children – has acquired a strong emotional grip, one that politicians are happy to exploit. For many decades, laws and public policy have flown in the face of the evidence. Far from protecting us, this approach has made the world a much more dangerous place than it need be.

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Life Begins At 100

There are more people alive today above the age of 100, called centenarians, than ever before. The curious part of this tale is how healthy many of them are relative to their compatriots who did not live as long.

It is becoming clear that people who break through the 90-plus barrier represent a physical elite, markedly different from the elderly who typically die younger than them. Far from gaining a longer burden of disability, their extra years are often healthy ones. They have a remarkable ability to live through, delay or entirely escape a host of diseases that kill off most of their peers. Supercentenarians – people aged 110 or over – are even better examples of ageing gracefully.

Healthy is relative term for someone that old. In fact, very few people who live to be 100 are able to avoid certain chronic conditions entirely. Centenarians are divided into 3 categories regarding their health: delayers, survivors, and escapers.

Not all of the oldest old survive by delaying illness or disability, though – many soldier through it. Jessica Evert of Ohio State University in Columbus examined the medical histories of over 400 centenarians (The Journals of Gerontology Series A, vol 58, p 232). She found that those who achieve extreme longevity tend to fall into three categories. About 40 per cent were “delayers”, who avoided chronic diseases until after the age of 80. This “compression of morbidity”, where chronic illness and disability are squeezed into ever-shorter periods at the end of life, is a recent trend among ageing populations. Another 40 per cent were “survivors”, who suffered from chronic diseases before the age of 80 but lived longer to tell the tale. The final 20 per cent were “escapers”, who hit their century with no sign of the most common chronic diseases, including heart disease, cancer, diabetes, hypertension and stroke. Intriguingly, one-third of male centenarians were in this category, compared with only 15 per cent of women (see “Two paths to 100”).

There is conclusive evidence pointing to genetics as a contributing factor in such extreme longevity. Precisely how much is still being debated. Environmental factors like exercise and diet should not be dismissed even if some centenarian reports smoking 60 cigarettes a day for decades.

Scientists are working hard to uncover whatever genetic secrets are responsible for a long healthy life. Very little has been found to date.

Until recently, the only exception was ApoE, and in particular a variant of this gene known as e4, which bestows carriers with a much higher than average risk of developing Alzheimer’s and heart disease. Across the world, this unfortunate version of ApoE is about half as common in centenarians as in younger adults. Last year, a second promising candidate emerged – a variant of a gene called FOXO3A. At the University of Hawaii, a team led by Bradley Willcox, Craig’s identical twin, found that people who carried two copies of a particular form of the gene were almost three times as likely to make it to 100 than those without the variation, and also tended to start their journey into old age with better health and lower levels of stroke, heart disease and cancer (Proceedings of the National Academy of Sciences, vol 105, p 37). “There are so many false positives in this field that FOXO3A is very exciting,” says Bradley Willcox.

FOXO3A is involved in several signalling pathways that are conserved across animal species. It controls the insulin/IGF-1 pathway, which influences how our bodies process food. It also controls genes that protect cells from highly reactive oxygen radicals – molecules often thought to drive human ageing through the cumulative damage they wreak on DNA. FOXO3A could even protect against cancer by encouraging apoptosis, whereby compromised cells commit suicide. The variant of FOXO3A associated with longevity is much more prevalent in 100-year-olds even than in 95-year-olds, which clearly demonstrates the value of studying the centenarian genome.

As was discussed earlier in regards to Alzheimer’s disease, it is interesting to note that men who survive to be 100 are in better shape than women.

Men, meanwhile, have the double disadvantage of being both more prone to risky behaviours throughout their lives and more likely to succumb to chronic illnesses as they age. This means that men who do make it to their century must depend more on genetic trump cards to see them through.

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