Smoking in cars: the BMA’s dodgy dossier

In support of a resolution passed at its annual conference, the British Medical Association (BMA) has published a briefing arguing for a complete ban on smoking in private vehicles. Quite apart from the dubious quality of the evidence on which this demand is made, the briefing is just the latest illustration of how moralistic demands are dressed up in the language of science these days.

The case put forward by Smoking in Vehicles is that because cars are confined spaces, smoking there exposes non-smokers to high concentrations of chemicals that are dangerous, particularly to children. Smoking, it is suggested, is also a distraction that increases the risk of traffic accidents. The briefing goes on to assert that public opinion is favourable to smoking bans, that such a ban would only be an extension of rules that are already in place, and that Britain should really get with the programme because other countries have started to impose bans in cars already.

Like Tony Blair’s ‘dodgy dossier’ in 2002, used to justify the Iraq War, the BMA briefing is a resolutely political document, using tendentious claims and junk science to support authoritarian political outcomes.

It is certainly true that active smoking increases a person’s risk of lung cancer and respiratory disease, and is associated with higher risks of other diseases, too. But the prohibitionists have yet to convince many people that smokers shouldn’t have the right to enjoy their own poisons when they are the only ones being harmed. So anti-smoking campaigners have instead floated the idea that smoking causes harm to other people – ‘passive smokers’ – who breathe in smoke involuntarily. The trouble is that while this might sound plausible, the evidence suggests that ‘passive smoke’ poses either a very small risk or no risk at all.

Still, that won’t stop our health guardians from using very flimsy evidence to persuade politicians to reduce smokers’ freedoms. Having successfully achieved a ban on smoking in ‘public’ places (many of which, like pubs, are actually private property), campaigners want to encroach on private spaces, too. While banning smoking at home would be a step too far right now, the current thin end of the wedge is the private car – and specifically, the effect that smoking in cars supposedly has on children’s still-developing bodies.

To illustrate the alleged dangers, the BMA briefing argues that living with a smoker increases the risk for a child of ‘cot death’, lower respiratory tract infection, asthma, middle-ear disease and bacterial meningitis. Actually, these are associations not proven causation, but that doesn’t stop the briefing from treating them as confirmed smoking-caused dangers nonetheless.

Then we get into some really dodgy territory. First of all, the BMA briefing simply asserts as fact that children are routinely exposed to smoke in cars. ‘In England, an estimated 30 per cent of smokers smoke in their vehicles and over half of journeys made by children aged 16 and under are by private vehicle. It is likely that private vehicles are a significant source of exposure to SHS [secondhand smoke] in children.’ But the final sentence is a non-sequitur. As a study in Tobacco Control in 2007 noted, there is ‘a marked secular trend towards smoke-free homes, even when parents themselves are smokers’. In other words, a sizeable proportion of parents won’t smoke in front of their kids already.

Later on, the BMA briefing states: ‘A study by the British Lung Foundation (BLF) showed that more than half (51 per cent) of eight- to 15-year-olds have been exposed to cigarette smoke when confined in a vehicle.’ The ‘study’ is a press release based on a survey of 1,000 children. Still, as Blair found when groping for evidence that Saddam had ‘weapons of mass destruction’, you aggrandise any evidence you can get, no matter how ropey it is.

Then comes a factoid which has no place in a serious document about smoking. ‘Further studies demonstrate that the concentration of toxins in a smoke-filled vehicle is 23 times greater than that of a smoky bar, even under realistic ventilation conditions’, the BMA claims. Yet as an article in the Canadian Medical Association Journal has previously argued: ‘We recommend that researchers and organisations stop using the 23 times more toxic factoid because there appears to be no evidence for it in the scientific literature.’ It is not a fact; it’s a Chinese whisper repeated endlessly by anti-smoking campaigners.

Indeed, that alleged factoid contradicts a study actually used as a reference for it, from the American Journal for Preventative Medicine, which did some measurements of just how smoky a car gets. The study found particulate (ie, fine soot) concentrations of 272 micrograms (millionths of a gram) per cubic metre of air in a car with closed windows and 51 micrograms per cubic metre with open windows. As a comparison, the figures for bars were either similar (206 micrograms on average in smoking bars in Massachusetts) or considerably higher (412 micrograms in smoking bars in New York state).

In other words, if you do what the vast majority of smokers do in a car and open the window when you light up, then the already-minute quantities of particulates plummet to levels way below those in smoky bars and drop even further once the cigarette is put out.

Yet on the basis of this single page of wispy-as-smoke evidence, the BMA suggests that all smoking in private vehicles should be banned. Anti-smoking campaigners are nothing if not brazen.

The reality is that the demand for prohibition has got nothing to do with scientific evidence and everything to do with moralising. The briefing reminds us of the ‘BMA’s desire for UK governments to achieve a tobacco-free society by 2035’. Essentially, the BMA’s hierarchy detests the idea that you or I might choose to engage in a pleasurable activity that could possibly shorten our lives. These petty puritans believe it is their God-given right to tell us how to live – and the corridors of power are increasingly stacked with politicians and bureaucrats that share this sentiment.

Now, there is a moral argument to be had about smoking in cars. You might very reasonably argue that in such a confined space, it is a bit anti-social to smoke in front of others, at least in a manner that would cause them irritation. Most people resolve this through compromise between one person’s desire to smoke and another person’s desire for fresh air.

But the moral argument about our habits just doesn’t work today. We’ve been told for years that we’ve all got to make our own choices about the world and that there’s no such thing as hard-and-fast morality anymore. That might seem like a good thing. After all, who wants some higher authority determining how they should live their lives? But unfortunately, the old moral campaigns to shift our behaviour have been replaced by new pseudoscientific campaigns to re-engineer us, as typified by the BMA’s war on smoking. how I live my life.

The moraliser-in-chief is the BMA’s head of science and ethics, Vivienne Nathanson, a veritable Mary Whitehouse for the twenty-first century. The only difference is that Nathanson wants to ban smoke (and drink) rather than smut. In fact, if anything, Nathanson is even worse than Mrs Whitehouse. As Tim Black notes elsewhere on spiked: ‘The nakedly moralising Mary Whitehouse was as nothing compared to the new Priesthood of Experts, who hide their distaste for the public behind… “evidence-based recommendations for policy”.’

Hopefully, enough of our elected representatives will see through this naked piece of propaganda and have nothing to do with it or the law it purports to justify. But then again, many of our MPs voted to invade Iraq on the basis of that other ‘dodgy dossier’ – and that didn’t end well, did it?

Rob Lyons is deputy editor of spiked. His new book, Panic on a Plate: How Society Developed an Eating Disorder, is published by Societas. (Buy this book from Amazon (UK).) Read his blog here.