The Norwegian Health Department celebrated the new year with a distasteful and patronizing media campaign against smoking, borrowing a concept from the evil Australians. Now, they're happy to announce, the results are in. It worked.

Gruesome photos showing everything from damaged lungs to human brains hit by a stroke had its desired effect on Norwegians. Officials said Monday that as many as 100,000 smokers kicked the habit after the public health department's shock campaign last winter. [..]

Cigarette sales have fallen 4.5 percent since the graphic photos showed up in newspapers and other advertising outlets. State statistics indicate that just 26 percent of Norwegians now smoke, down from 30 percent at the beginning of the year.

Daily smoking among 16- to 19-year-olds fell from 34.8 percent to 31.9 percent, while daily smoking among 35- to 55-year-olds fell from 53 percent of the population to 46.9 percent, according to health ministry data.

Okay, let's dissect these claims. The 100 000 figure is not mentioned in the official press release, and is probably derived from the claim that the share of regular smokers of the population (age 16-74, 3,3 mill people) has fallen from 30% to 26%, which would correspond to a reduction of 132 000 people. These figures again are from a recent report from the Central Bureau of Statistics (SSB). Take a look at this graph over regular smokers from March 2000 to March 2003. There is indeed a fall in Q1 '03, but you will notice that the graph is fluctuating rather heavily, with regular jumps and falls of several percentage points. There does appear to be a long-term decreasing trend here, (though it's hard to be sure from a three-year period), and the fall this year seems to me more likely a part of this trend, than a result of a single campaign. At least it would be difficult to separate the two factors.

And then there's the following qualification to SSB's data, (my emphasis):

Numbers from the first quarter this year could be a sign that the trend of the last two years of a reduction in the number of daily smokers has strengthened. This, however, is not necessarily correct. For one thing, there's uncertainty connected to the quarter numbers. We often use confidence intervals as a measure of the uncertainty of a number. This mens that we, with 95% certainty, can say that the actual number for quarter 1 2003 is within this interval. For the share of daily smokers in quarter 1 2003, this interval stretches from 28.9% to 22.9%, (and the uncertainty for previous quarters is equally large.) In addition, we observe large fluctuations in the number of smokers every year on a quarter to quarter basis. The last couple of years, there has always been an increase in the number of smokers in the fall.

Even though the numbers for quarter 1, 2003, are the lowest we have ever had, one must wait until the full data for the year are available before one can say anything about whether this is true for the whole year. In March 2004, we will know more about how the habits of Norwegian smokers developed throughout 2003.

In other words: The share of average smokers may, within the confidence intervals SSB operate with, have fallen from 32.6% to 22.9%, but it may just as well have increased from 26.6% to 28.9%! So we don't know if there were a statistically significant decrease, and if there were, we don't know why, whether it was part of the trend or a result of the anti-smoking campaign.

And then there's the other claim, that regular smoking has fallen among 16-19 year olds and 35-55 year olds. Unfortunately, these figures are bogus as well. The source for this is the Social and Health Directorate's press release, which states:

There was registered a decrease in the share of smokers of fully six percentage points in the age group 35-55. In the age group 16-19 the decrease was 3 percentage points.

But if you read the report that accompanies the press release, on the Directorate's own website, which summarizes several investigations on the effect of the campaign, you see that they left out an important qualifier to the data:

With the available sample size, however, the decrease was not statistically significant.

Oh, I see. You just omitted it, did you? Not statistically significant. In other words, the numbers are meaningless, and the claim nothing less than a lie.

So what, exactly, do we know? I can't argue with the reduction in cigarette sales, nor with the claim in the report that the campaign was noticed, (it was hard not to!) The report also claims a statistically significant increase in the number of people who has quit smoking in Q1, although it doesn't mention how many. But again, as with the SSB figures, there's no way to know why, (trend or campaign), or how permanent this is.

One thing we can know for sure: There'll be more Boschian campaigns like this. And they'll all be proven successes - whether the numbers support it or not.

Bjorn: I take it you're a smoker. You should quit. It's bad for you.

Your pro-smoking comments, I suspect, resonate better with Europeans than with Americans.

Strange. America is the country supposedly not socially concerned about bad social habits.

Markku: Not a smoker, never been, never will be. Even if we could agree that campaigning against smoking, through advertising and taxation, is a government responsibility, why should we tolerate lies and distortion of numbers?

If I can't trust the Norwegian health department to tell me the truth about something as simple as the number of smokers in Norway, how can I expect it to tell me the truth about the dangers of smoking? If a good cause justifies lying in one area, perhaps it justifies lying in others as well.

Here, Bjorn has offered us an interesting insight into the use (and misuse) of statistics.

But what strikes me as more interesting than Bjorn's analysis is the comment of Markku. Markku doesn't rebut what Bjorn has written: rather, he seems to rebuke Bjorn for obviously being on the wrong side of a social disputation. In other words, Bjorn is (or so Markku seems suggests) politically incorrect.

Poor show, Markku. (Btw, I'm an ex-smoker from the biggest tobacco-growing state in the US.)

Not to denegrate the contribution of valiant Aussies in the campaign to eradicate smoking tobacco, but I can give two examples from Canada:

1. Package #1 (which I just emptied): "WARNING each year, the equivalent of a small city dies from tobacco use." "Estimated deaths in Canada, 1996: Murders 510; Alcohol 1900; Car Accidents 2900; Suicides 3900; Tobacco 45,000." (the estimated death tolls are also illustrated by a barchart).

2. Package #2 (which I just opened): "CIGARETTES ARE A HEARTBREAKER. Tobacco use can result in the hardening of arteries in your heart. Clogged arteries cause heart attacks and can cause death." Accompanied by a photo of a heart, showing damaged muscle due to clogged artery.

This campaign has been in operation for several years now. Their best example shows a cigarette (60-70% smoked/ long ash) bent in a semi-circle. The accompanying blurb touts the possibility that smoking causes impotence.

Given the imprecision of the graphic data shown, I am unpersuaded of the exact consequences my 'filthy habit' will have, nor of its influence in my thus-far delayed but evidentially imminent death.

What could be interesting would be a study examining the influence of 'campfires' on death rates of persons living prior to the 'modern age'. Having breathed deeply in the smoke of fires built of coniferous woods, might I be facing a 'double whammy'?

Cheers

Okay, okay. I guess I'll have to be dragged into this one. Can't let accusations of a poor show go by just like that.

Bjorn: I'm glad that you're not a smoker, and I have no issue with your basic premise that the Norwegian state & media are putting a spin on statistical figures that can be read any number of ways. I applaud the work of all bloggers that catch the powers-that-be in media and government in their acts of dishonesty and distortion.

George Peery: My arguments have nothing to do with being politically correct, as much as medically correct, and how that affects my bank account. For years I really didn't take much of a stand on the smoking issues; I've even enjoyed a good cigar every once in a while, especially when it goes with a good scotch. But then, when the anti-smoking people got clever and started to measure the medical costs incurred through smoking, and how much my personal health insurance bills went up due to the fact that people smoked...

I love the American way: in European social welfare states, people know that the state is obligated to take care of them forever, no matter what. So Europeans are quite lax when it comes to engaging in bad habits. In America, people have to pay for their own health insurance. We see, personally, the costs incurred every time we issue a payment out of our bank accounts. Eventually the market wises up, and starts asking pertinent questions about societal medical costs. Large, non-tobacco corporations - those who offer group health insurance coverage for their tens of thousands of workers, - have led the way, actually, in stressing the harmful effects of smoking, as rising insurance costs directly affects their bottomlines. It happens all the time over here, less seldom in Europe.

It was a stroke of genius for the individual state district attorneys here in the US to band together to form a class-action suit to sue the tobacco corps en masse a number of years ago. Their argument? The tobacco corps owe back losses incurred by insurance companies due to smoking-related illnesses. That is a model worthwhile for Europeans to study, instead of relying on the state to pass regulations on individual behavior (though that's happening here, too, but with less resistance than in Europe). The tobacco corps are definitely on the defensive domestically, to the point that they're now concentrating in getting people hooked abroad, especially in Asia. (It behooves the Asians to wise up to the process).

Though I am pro-business, all the way, that does not mean that we should not react when some corporations engage in socially harmful business practices, especially when those practices wind up affecting our personal bottomlines. The best way to strike back is the American way: sue their pants off, hit 'em where it hurts: in their bottomline. The best motivation for that is not because it is the moral thing to do, but because we can gain from it monetarily. The state acts as a referee in the dispute, rather than a parental organ engaged in societal guidance. Ultimately, the corps wind up having to listen to the marketplace, rather than the state, as the marketplace will always be more important than the state could ever be.

Markku,

I don't agree that hitting corporations through courts is necessarily a better option. Courts are one step away in democratic accountability. If tobacco companies should be penalised, it should be done through democratically elected parliaments, not through courts interpreting legislation beyond what it was originally intended for.

Using the courts is IMO bypassing democratic accountability. That is even more true under case law, where courts to a large degree make their own laws, again without democratic control. Lawmaking is IMO the task of the legislative branch. If parliament/congress does not have the will or balls to enact laws against tobacco, so be it. That is ultimately up to the voters.

We've already seen the tobacco cases evolve into ridiculous suits against fast food companies. Where is it going to end? Car manufacturers? I see it as very business-unfriendly, creating a climate of fear that undermines business decisions and predictability.

Another issue: the whole legal profession has an interest in making the world as sue-crazy as possible (up to the point of suing lawyers). Leaving it all to judges, who may later become lawyers, or who have collegues who are, is rather risky.

Lawyers do deserve their reputation as bottom-feeding scum suckers, but even such lowlife are an important part of the economic food-chain. The bigger danger by far is government regulation of businesses.

In American business-life, the threat of lawsuits is the way societal regulation is achieved. In Europe, societal regulation is achieved through imposition from the state above. The European system results in a bloated state bureaucracy that has a self-interest in sustaining its pre-eminence.

In America, societal regulation through the threat of lawsuits results in the creation of an industry, in effect, that is completely in private hands. No regulating bureaucracy is needed: a private industry composed of lawyers will take care of that.

Spurious lawsuits against fast food companies, as ridiculous as they sound, do have an ameliorating effect: McDonald's has recently introduced (at least in the US) low-calorie salads as one of its offerings. Though the lawsuit probably had nothing to do with it, McDonald did respond to the preception that their industry is responsible for the growth of obesity in the US.

As for car manufacturers, lawsuits are directly responsible for the institution of safety standards in the US. What is most interesting about these standards is that car manufacturers have voluntarily complied to many standards that are not even legislated. Thus the onus is not on the state to think up on taxpayers' time all the possible safety precautions required: the onus is on the manufacturers (and insurance companies) to make sure that an opposing party's lawyer cannot think of some angle to use against them.

The American way leads to less barriers of entry for businesses, though with one eye always peering for the threat of lawsuits. The European entrepreneur, on the other hand, is confronted with a massive amount of regulations even before day one of the first day of business. The European welfare state gives lip service to "supporting" the entrepreneur, but as soon as the entrepreneur puts up his capital, he is hit with a barrage of regulations designed to "protect" workers and consumers, when instead they should let entrepreneurs be regulated by the market place - the threat of lawsuits being an important component of that market place.

No wonder so few new businesses prop up in Europe, compared to America.

Markku,

I don't see the logic of your argument. The laws interpreted by the courts are created by parliaments, which answer to voters. The "markets" don't regulate themselves, they need a legal framework.

Ultimately, punishments for violating laws go through the court systems in both cases. The only difference is who has the power to micro-regulate: elected officials who at least answer to voters or appointed judges and randomly selected juries that answer to nobody.

Interesting, after I wrote the previous entry I found that Glenn Reynolds just made a similar argument, but put it far better than I can, at http://www.instapundit.com/archives/010247.php#010247

"The real problem, in my opinion, isn't garden-variety frivolous lawsuits, but the use of the tort system to end-run the regulatory process, as in tobacco -- and as has been attempted with firearms and fast food. Doing that is an effort by people in the government to subcontract the legislation process to private interests, without democratic safeguards. I think it is unfortunate that people have been distracted from this concern by bogus stories of slip-and-fall chicanery."

Reynolds is, as you probably know, a law professor teaching constitutional law. He can hardly be accused of being anti-American.

The first thing this use of statistics reminded me of was recent UK government crowing over a fall in arrests for burglary over the past year. Not mentioned is that a bit more than a year ago London (and some other) police were directed not to respond to burglar alarms, nor to 999 emergency calls about breaking-and-entering unless the caller said guns were seen.

As to the smoking thing, despite claims a definite link between smoking and cancer had been established by 1962 when as a high-school student I was shown a film documenting laboratory proofs. It affected me so badly I had a cigarette between classes to calm my nerves... So while I may object to the graphic nature of some anti-smoking ads I do not object to thhem entirely.

But the point, as Bjorn states, is that the statistics used are distorted (when not simply pulled out of the air). Some of them could be used, unchanged, to encourage smoking as a way of reducing medical costs since we smokers are supposed to die so much sooner than non-smokers.

It gets worse in the realm of second-hand or "Environmental Tobacco Smoke" bigotry. As I said above, smoking (and to a lesser extent 'smokeless' or chewed tobacco) has been known for several decades as having a link to cancer. But there is not, as of last month, a single published and verified study showing such a link with ETS.

Now, I agree that ETS is objectionable: I even find it so myself (I smoke about a pack per day) at times. So if the owners/lessors/renters of a building (except my apartment, please) want to ban smoking inside, I'll go with it. But when the government starts to ban smoking in private places, outdoors in parks, and semi-public places such as pubs I object. The only one I have seen that I could agree with was in a Far East city, which banned smoking while walking - but because of the danger of ashes or burning coals landing on clothes or in children's eyes, not because of the smoke, and you can smoke if you stand in one place.

Hmm, I got a bit wordy, sorry.

"But when the government starts to ban smoking in private places, outdoors in parks, and semi-public places such as pubs I object. The only one I have seen that I could agree with was in a Far East city, which banned smoking while walking -"

Ever heard of the dangers of passive smokers? People who don't wish to pollute their lungs with filth, shouldn't have to incurr poor health.

I'm a great believer in civil
liberties, but I don't belive anyone has
the right to poison someone else. A
cigarette is a little toxic waste dump on
fire. Stan Glantz (The Independent, 2001)

http://www.cancersa.org.au/i-cms?page=1.6.36.368.188

"But there is not, as of last month, a single published and verified study showing such a link with ETS."

The information on the above website, tends to disagree with you. Besides, if the carcinogens
are doing your body damage when you breath them in, do you really believe that the carcinogens
which other people breath in from your second hand smoke (with many of the same chemicals included) is some how nonharmful???

The Full report can be found here:

http://www.health.gov.au/nhmrc/advice/nhmrc/foreword.htm

Conclusions of the 1997 NHMRC report The health effects of passive smoking

This extensive Australian review of the scientific evidence linking passive smoking to many diseases, including asthma in children, lower respiratory tract illness, lung cancer, and major coronary conditions and other illnesses. As very little Australian data exists describing exposure to environmental tobacco smoke outside the home, it estimates the risk of illness from exposure to ETS at home for people who have never smoked.

This report concludes that:

An estimated 13% of lower respiratory illness in children under 18 months (about 16,300 cases per year) is due to passive smoking

Children exposed to ETS are about 40% more likely to suffer from asthmatic symptoms than those not exposed

About 8% of new cases of childhood asthma is attributable to passive smoking (about 46,500 children per year)

It is estimated that the risk of heart attack or death from coronary heart disease is about 24% higher in people who never smoke but who live with a smoker, compared to unexposed people who never smoke

It is estimated that people who never smoke and live with a smoker have a 30% increase in the risk of developing lung cancer compared to people who never smoke and live with a non-smoker (leading to about 12 new cases of lung cancer and 11 deaths from lung cancer per year in people who never smoke)

Passive smoking contributes significantly to the risk of sudden infant death syndrome.

Most important are reports from the:

International Agency for Research on Cancer (a branch of the World Health Organisation) (1985)

US Surgeon General (1986)

Australia's National Health and Medical Research Council (1986)

Independent Scientific Committee on Smoking and
Health from the United Kingdom (1988)

US Environmental Protection Agency* (1992)

Royal College of Physicians of London (1992)

National Health and Medical Research Council in Australia (1997) a new report* reviewing the scientific research into passive smoking - see conclusions below

UK government's Scientific Committee on Tobacco and Health report* (1998) on the impact of passive smoking

International Consultation on Environmental Tobacco Smoke (ETS) and Child Health May (1999)

So you're "right" absolutely no reports into ETS causing physical harm.

Continue burying your heads in the sand.

No cigar on those. I can add the more recent http://www.chestnet.org/about/press/archives/release01/september/september01_1.php
which gives the results of a study that ETS increases the probability of asthma. A typical study, "Among never-smokers with childhood exposure to ETS, the prevalence of physician diagnosed asthma was 7.6% versus 5.9% among non-exposed." The difference, even discounting that the study was a survey rather than an actual medical study, is well under the size accepted outside the peculiar field of epidemiology. See junkscience.com.

I do, as it happens, know of one ETS-Asthma study which may actually turn out to be useful if verified. It was designed to show a link (not a good approach, but typical) with actual case histories and medical exams over several years and failed to exceed the type of figures shown above - BUT they noticed that if both parents had asthma the children had greatly (5% if neither parent had asthma but child did vs 37% if both did, regardless of ETS) increased. The researchers suspect gene-linkage, which may be of great value.

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