Tuesday, 19 September 2017

Europuppets still thriving

I'm off on holiday for a week so I shall leave you with this, from a recent 'public health' conference organised by the European Public Health Alliance.

As I have shown many times, we already do. Take the EPHA, for example, which is overwhelmingly funded by the unwitting taxpayer.

'Following the guidelines of the EU Civil Society Contact Group and Alliance for Lobbying Transparency and Ethics Regulation in the EU, EPHA has calculated that it spent an estimated €300,000 in 2013 on activities carried out with the objective of influencing the policy formulation and decision making processes of the European Institutions.'

You won't be surprised to hear that 'public interest lobbying' means campaigning for more taxes, more bans and higher prices.

It's bad enough that these vile people are fighting to make us poorer and restrict our freedom but knowing that they're doing it on our dime is too much.

Monday, 18 September 2017

Glantz's 'expanding tobacco epidemic'

From Stan Glantz's wacky blog...

More evidence that the US permissive policy environment for e-cigs is expanding the tobacco epidemic

Hong-Jun Cho, Lauren Dutra, and I recently published “Differences in adolescent e-cigarette and cigarette prevalence in two policy environments: South Korea and the United States” in Nicotine and Tobacco Research. This paper compares changes in e-cigarette and cigarette use in South Korea and the United States between 2011 and 2015. Korea has maintained restrictive policies on e-cigarettes whereas the US has left them essentially unregulated (a situation that the FDA will continue until at least 2022).

We found that In Korea adolescent e-cigarette use remained stable at a low level, whereas in the United States e-cigarette use increased. Most important, combined e-cigarette plus cigarette use declined in Korea whereas it increased in the US. The restrictive policies in Korea likely contributed to lower overall tobacco product use. These results are evidence against the claims that the availability of e-cigarettes is preventing youth from taking up cigarettes. They also add to the case that a permissive e-cigarette policy environment is making the overall nicotine/tobacco epidemic worse.

Wow, really?! Vaping is expanding the 'tobacco epidemic' among youngsters in the US?

*reads the study*

Cigarette prevalence (past 30 day) decreased in Korea from 12.1% (11.6–12.7) to 7.8% (CI: 7.3–8.3) and in the United States from 11.1% (9.5–12.6) to 6.1% (5.1–7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in Korea from 13.2% (12.7–13.8) to 8.5% (8.0–9.1) but increased in the United States from 11.3% (9.7–12.9) to 14.0% (12.4–15.7).

It turns out that South Korea only has 'lower overall tobacco product use' if you pretend that e-cigarettes are tobacco products. The 'increase' in tobacco product use in the US also only exists if you make the same mad assumption.

Back on Planet Earth, the adolescent smoking rate in South Korea remains higher than in the US. The rate has dropped sharply among American youth since vaping became popular. It has dropped less sharply in South Korea.

So it's more pitiful junk science from Glantz and co. As you were.

Tuesday, 12 September 2017

Last Orders - new episode

After a long break, Tom Slater and I are back with a new Last Orders podcast discussing all things nanny state. Our special guest is Claire Fox and we discuss the plastic bag tax, loony anti-obesity proposals and ten years of the smoking ban.

Listen here.

And if you're in a podcasty frame of mind, you can listen to me take on anti-sugar fanatic Graham MacGregor in this week's Spectator podcast.

Thursday, 7 September 2017

A shoddy attempt to turn Big Alcohol into Big Tobacco

If you were involved in the revision of the UK's alcohol guidelines, you are the last person in the world who should be criticising others for misrepresenting evidence. As I've explained before, the benefits of moderate drinking were subjected to the full 'merchants of doubt' treatment by the Chief Medical Officer's guidelines committee. They blatantly cherry-picked the evidence, relying heavily on the work of one sceptic (Tim Stockwell) while raising a bunch of zombie arguments that have long since been debunked in the literature.

But 'public health' knows no shame and so Mark Petticrew, the activist-academic who helped lead the evidence review - and who told his colleagues what the conclusion was going to be before it had got started - has popped up today with a diatribe dressed as a study, claiming that the drinks industry 'appears to be engaged in the extensive misrepresentation of evidence about the alcohol-related risk of cancer.' 

His evidence for this comes from the tried and tested quack methodology of doing a Google search and, er, misrepresenting the evidence. Written with three colleagues - although I'll just say 'Petticrew' in this blog post for brevity - he breaks the industry's alleged misrepresentations into several categories.

He starts with what turns out to be his strongest evidence. Under 'Denying, disputing or selectively omitting the relationship between alcohol consumption and cancer', he quotes the International Alliance for Responsible Drinking (IARD) and some Canadian organisation who say:

‘Recent research suggests that light to moderate drinking is not significantly associated with an increased risk for total cancer in either men or women.’  International Alliance for Responsible Drinking

'Some studies show a link between alcohol and breast cancer among both pre-menopausal and post-menopausal women. However, no causal relationship has been shown between moderate drinking and breast cancer.’ Éduc’alcool (Quebec)

The first of these quotes, from IARD, cites a BMJ study from 2015. The study actually does show an increase in total cancer risk from moderate drinking for women, but not for men. The IARD quote is badly worded, at best, and is all the stranger because they go on to explain the results of the study correctly in the sentences that follow (Petticrew doesn't quote that bit). The risks are extremely low, amounting to an increased risk of between two to four per cent, but they are not completely absent.

However, there is evidence from other sources that moderate and light drinkers do not have a higher cancer risk. Only last month a large American cohort study found that overall cancer risk was 0.89 (0.82-0.97) for light drinkers and 0.95 (0.85-1.05) for moderate drinkers. This means that light drinkers were significantly less likely to die from cancer in the study period. Nevertheless, the source used by IARD does not accurately reflect the statement quoted by Petticrew so it's 1-0 to him.

The second quote depends on what evidence you consider sufficient for a 'causal relationship'. Epidemiology famously cannot prove causation, but most authorities consider the statistical association to be good enough to infer it in this instance. On that basis, the Quebec organisation could be said to be 'disputing' the evidence, albeit no more than Petticrew and his chums have been disputing the much greater weight of evidence about the benefits of moderate drinking.

This is as good as the study gets as an exposé of industry 'denial'. Everything else in it is drivel, as we shall see. For the most part, Petticrew excoriates the industry for saying things that are patently true.

Under 'Distortion: mentioning some risk of cancer, but obscuring, misrepresenting or obfuscating the nature or size of that risk', he writes

It is commonly stated by these organisations (12/20 SAPROs) that the risk of some common cancers only exists for ‘heavy’, ‘excessive’ or ‘binge’ drinking. For example,

‘Cancer risk associated with the consumption of alcohol is related to patterns of drinking, particularly heavy drinking over extended periods of time.’ Australia, Drinkwise

In what universe is this stating that risk 'only' exists for heavy drinkers? If Drinkwise had meant to say that, they would have done so. As it is, the use of the word 'particularly' clearly implies that there is risk, albeit less risk, for non-heavy drinkers.

Similar statements also appear on the IARD website, such as ‘In general, alcohol-associated cancers have been linked with heavy drinking’ [27].

The scientific evidence suggests that such statements are misleading (Table S1), because the increased risk of some common cancers, such as breast, oesophageal, laryngeal, mouth and throat cancers and cancers of the upper aerodigestive tract, starts at low levels of consumption, even though it is low at those low levels [7,8] (see also Table S3).

Like the Drinkwise quote above, the IARD statement is true. Cancer risk is clearly related to patterns of consumption and heavy drinkers have a greater risk than light drinkers. IARD's report Drinking and Cancer provides five academic references to support this.

It is an indisputable facts that some cancers, such as liver cancer and possibly pancreatic cancer, are only associated with alcohol if you're a heavy drinker. For those cancers which are linked to moderate consumption, risk is significantly greater for heavy drinkers. Neither of the sources quoted above suggest otherwise, and the IARD document explicitly discusses the cancers that are - or might be - linked to light/moderate consumption.

It should also be noted that in the press release for this 'study', Petticrew says:

'It's important to highlight that if people drink within the recommended guidelines they shouldn't be too concerned when it comes to cancer.'

If IARD had said that, he would doubtless condemn them for downplaying the risks or being 'misleading'.

He continues:

Other industry claims (from three organisations) relate to disputation of the mechanisms, or involve claims about the consistency of the evidence, as in these examples:

‘Recent studies indicate a dose-response relationship between alcohol consumption and breast cancer, although this relationship was not evident in some past studies.’ IARD [27].

‘All the studies show that the knowledge about the causes of breast cancer is still very incomplete and as scientists from the National Institute on Alcohol Abuse and Alcoholism in the USA recently pointed out, some other (possible confounding) factors have not been considered in the research relating the consumption of alcoholic beverages to breast cancer.’ Wine Information Council [28].

This is also a feature of SABMiller materials:

‘The mechanism by which alcohol consumption may cause breast cancer is not fully known.... The relationship... is undergoing vigorous research... If and how these two factors may interact and affect risk is not completely known.’

All of these are uncontroversial statements of fact and plenty of non-industry sources echo them.

Here is the American Cancer Society, for example:

Exactly how alcohol affects cancer risk isn’t completely understood. In fact, there might be several different ways it can raise risk, and this might depend on the type of cancer.

And here is Cancer Research UK:

According to Dr Ketan Patel, a Cancer Research UK expert on how alcohol causes cancer: “We don’t really know. We don’t fully understand why alcohol causes some cancers and not others.”

Petticrew says that statements like this are examples of the industry tactic of 'Claiming or implying that, as knowledge of the mechanism is incomplete, the evidence of a causal relationship is not trustworthy'. That's rich coming from him. The alcohol guidelines review repeatedly cast doubt on the benefits of moderate drinking by falsely claiming that there is a 'lack of well evidenced biological processes that could explain the effect' and then presenting this as proof that the benefits do not exist at all.

Petticrew pulls exactly the same trick in his little polemic when discussing non-Hodgkin lymphoma which has been inversely associated with alcohol consumption. Keen to dismiss any benefits from drinking, he quotes an authority saying that 'there is no immediately obvious mode of action that could explain the association.'

But there is a difference between what Petticrew does and what the industry and cancer charities quoted above are doing. They explicitly state that the risks are real but that the causal mechanisms are not fully understood. Petticrew, by contrast, is claiming or implying that, as knowledge of the mechanism is incomplete, the evidence of a causal relationship is not trustworthy.

Petticrew then mentions the Portman Group...

The Portman Group’s response to the consultation on the revised UK guidelines (issued in 2016) includes a section in which the evidence is disputed, referring to protective effects. It refers to the ‘increased risk of a small number of cancer types’ and states: ‘Different levels of alcohol consumption have a range of effects on cancer risk including no impact on the majority of cancers, and in some cases, an inverse relationship.’ [11]. As well as misrepresenting the evidence, this statement is misleading as it confuses the number of different ‘types’ of cancer, with the risk of specific cancers.

Again, everything the Portman Group says here is true. The press release that accompanies Petticrew's article correctly notes that alcohol 'accounts for about 4% of new cancer cases annually in the UK.' There are more than 100 different types of cancer and IARC has established that alcohol consumption could cause seven of them: 'cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver (hepatocellular carcinoma) and female breast.' They also noted that 'an association has been observed between alcohol consumption and cancer of the pancreas'. But that's it.

It is reasonable to describe seven out of 100 as a 'small number' and it is indisputable that alcohol has 'no impact on the majority of cancers'.

It is also true that an inverse relationship between alcohol consumption and a few forms of cancer, including renal cancer and non-Hodgkin lymphoma, has been repeatedly found in epidemiological studies. Petticrew asserts that there is a 'lack of evidence for protective effects of alcohol consumption on cancer'. An unbiased reader who reads the meta-analyses (see links in previous sentence) might conclude that he sets the bar of proof higher for evidence that shows benefits than for evidence that shows harm.

The Portman Group is neither 'misrepresenting' nor 'disputing' the evidence. Petticrew chooses not to quote from page 20 of Portman's consultation response in which they explicitly say:

'The relationship between alcohol consumption and increased risk of certain cancers is clear and we believe it is important consumers are aware of this.' 

Moreover, the sentence immediately before the one Petticrew quotes (beginning 'Different levels...') says:

'We fully accept the evidence on the links between alcohol and certain types of cancer.'

Under 'Distraction: focussing discussion away from the independent effects of alcohol in increasing the risk of common cancers', Petticrew cites the following examples of the industry saying things that are 'potentially misleading':

‘Not all heavy drinkers get cancer, as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health.’ Australia: Drinkwise [26].

‘Alcohol has been identified as a known human carcinogen by IARC, along with over 1,000 others, including solvents and chemical compounds, certain drugs, viral infection, solar radiation from exposure to sunlight, and processed meat.’ IARD [27].

‘For example, the fact that you are female is a risk factor in developing breast cancer. We also know breast cancer is age-related so you’re more likely to develop it as you get older and that you’re more prone to breast cancer if it is part of your family history. These are all factors beyond our control. We also know that risk is related to the ‘hormone environment’ that women experience during the course of early pregnancy, child birth and breastfeeding which all exert a protective effect.’ Drinkaware, UK [32].

These are mundane statements of fact. It seems that Petticrew won't be happy until the alcohol industry's only health message is 'IF YOU DRINK, YOU'LL DIE!!! GET AWAY!!!'

In fact, these 'industry messages' are not very different from that of the Committee on Carcinogenicity, who say:

Drinking alcohol has been shown to increase the risk (or chance) of getting some types of cancer. This does not mean that everyone who drinks alcohol will get cancer, but studies have shown that some cancers are more common in people who drink more alcohol.

The Drinkaware discussion of breast cancer is similar to what you will find on Cancer Research's webpage about breast cancer. Although Petticrew doesn't mention it, the quote he uses is from Professor Paul Wallace, an epidemiologist with an impressive CV in alcohol research, who is Drinkaware's Chief Medical Advisor. The full quote runs as follows:

Professor Wallace says it’s important to put this risk into context. There are many other factors which increase the risk of developing breast cancer. “I often sit down with my patients and explain that there are certain factors we can do nothing about,” he says. “For example, the fact that you are female is a risk factor in developing breast cancer. We also know breast cancer is age-related so you’re more likely to develop it as you get older and that you’re more prone to breast cancer if it is part of your family history. These are all factors beyond our control."

There is a lot that Petticrew could have quoted from that Drinkaware webpage but didn't, presumably because it wouldn't fit his narrative of an industry cover up. For example:

When asked to name the main health effects of drinking too much alcohol, many people will first say liver disease. Others will mention heart disease. Some will name mental health issues. Cancers are often low down on the list.

But they shouldn’t be – especially breast cancer.

It is clear from a number of large scale studies that there is a link between alcohol consumption and cancer. Globally, one in five (21.6%) of all alcohol-related deaths are due to cancer. Breast cancer is the most common cancer among women and second only to lung cancer as a cause of cancer death in women.

Professor Paul Wallace, Drinkaware’s Chief Medical Advisor, believes that more people should know that alcohol can increase women’s risk of getting breast cancer.

I challenge any reasonable person to read this - or, indeed, any Drinkaware literature - and claim that the organisation is trying to downplay or deny the risks of drinking. I was on a Drinkaware panel once. They are basically a temperance group. Only a lunatic could think otherwise.

Petticrew says that there are 'two particularly frequent areas of misinformation', namely breast cancer and colorectal cancer. As evidence, he goes back to the Portman Group...

The Portman Group’s response to the UK guidelines includes a section on breast cancer, in which the evidence is disputed. For example, it states that ‘studies associating moderate alcohol consumption are contradictory’.

Is the evidence 'disputed' by the Portman Group? No, it is not. Here is what the Portman Group actually said in their consultation response:

A percentage (6%) of all breast cancer cases in the UK is attributable to alcohol - the links between alcohol consumption and breast cancer are clear and it is right that consumers are made aware of the risks.

As for the studies being 'contradictory', there is some truth in this, but it is not the Portman Group saying it. The Portman Group were only quoting some (reputable) scientists who said:

'Since studies associating moderate alcohol consumption and breast cancer are contradictory, a woman and her physician should weigh the risks and benefits of moderate alcohol consumption.'

Petticrew misquotes this and wrongly attributes it to Portman, which is sloppy at best. In fact, the point being made by the Portman Group is that risks should be explained in a meaningful way. This is not controversial. Cancer Research UK have made an effort to explain breast cancer risk in absolute, rather than relative, terms. John Holmes made a similar point in a journal article this week.

Nevertheless, Petticrew repeats his false claim about Portman disputing the evidence, saying:

...in disputing the evidence on increased breast cancer risk, the Portman Group document does not reference the IARC reviews, other systematic reviews, nor the Committee on Carcinogenicity review.

Not only is the initial claim a lie, but the claim about references is also a lie. The Portman Group document cites the Committee on Carcinogenicity reports several times and uses it as a source for a table which shows 60,000 breast cancer cases a year, of which Portman says alcohol causes 3,600 (see below).

This is a strange way of 'disputing the evidence'.

What is the point of all this flim-flam? Regular readers will have probably guessed. It's all part of creating a narrative of alcohol being the new tobacco and Big Booze being the new Big Tobacco. And he's good the headlines he wanted.

If you want to know why a 'public health' study has been written you have to head straight to the 'discussion' section where it all comes out...

The most obvious parallel is with the global tobacco industry’s decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and CSR activities to mislead the public.

...These findings therefore have significant implications. They provide evidence that the AI [alcohol industry], like the tobacco industry, misleads the public and policy-makers about the cancer risks of their products. Our findings are also a reminder of the risk which accompanies giving to the AI the responsibility of informing the public about alcohol and health.

...some public health bodies, academics and practitioners liaise with the industry bodies included in this study, for example by acting as advisors or trustees, or by collaborating with them in implementation activities. Despite their undoubtedly good intentions, we suggest that it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms.

The AI, unlike the tobacco industry, still has significant access in many countries to government health departments. It is also active in the international policy arena, with, for example, partner or stakeholder status at World Health Organization and United Nations meetings relevant to alcohol, on occasions when the tobacco industry is excluded. This study shows that the AI uses similar tactics to the tobacco industry, to the same ends: to protect its profits, to the detriment of public health.

There you have it. Petticrew is none-too-subtly telling academics to back away from the alcohol industry if they want to keep their reputations intact in the coming war on drink. He is also sending a signal to politicians that industry always lies while anti-alcohol campaigners, such as himself, are trustworthy. And he is telling governments to lock drinks companies out of the political process as has happened with tobacco under the Framework Convention on Tobacco Control.

Petticrew gets to this conclusion by saying things that are not true and denying things that are true. His study uses sleight of hand, evasion and downright misrepresentation to create a false narrative that falls apart as soon as you look at the primary sources. He does precisely what he accuses the industry of doing: selectively quoting from research in order to mislead, lying by omission, and making claims that cannot be supported by the weight of evidence.

For all of Petticrew's bluster, the drinks industry is dominated by massive, blue-chip companies with who would get sued if they lied about the harms of drinking. 'Public health' academics have no such incentive to stay honest.

Not for the first time, Petticrew has started with a conclusion and scrambled around for evidence to support it. When he failed to find any evidence, he wrote what he was going to write anyway. If the 'public health' movement had any integrity, the man would be a pariah.

Spectator - obesity edition

I've got an article in tomorrow's Spectator about the government's doomed attempts to control people's waistlines. It's online now...

James Cracknell, the athlete turned anti-obesity campaigner, was the subject of sniggering and derision in April when he said that North Korea and Cuba had got a ‘handle on obesity’. With impressive understatement, he attributed this to both countries being ‘quite controlling on behavioural trends’. It was a bad point poorly made, but in a roundabout way he drew attention to the major obstacles faced by those who want to reduce obesity rates in the rest of the world: freedom and affluence.

Do read it all and also have a listen to the Spectator podcast in which I debate the issue with Graham MacGregor (Action on Sugar/Salt) and Francesco Rubino (KCL).

Wednesday, 6 September 2017

Spanish smoking ban miracle

It is with a heavy heart that I must inform you that someone's written another yet smoking ban miracle study.

This time it comes from Spain where a partial ban was introduced in 2006 followed by a 'comprehensive' ban in 2011. The authors look at these two dates and study two types of hospital admission (for asthma and COPD), thereby giving themselves four bites of the cherry to find a correlation.

They pooled a bunch of hospitals together and came up with this mess of inconsistent and contradictory results:

Can you see clear evidence of hospital admissions falling after either of the bans? Neither can I, but the authors claim that the following findings emerged:

The partial smoking ban was associated with a strong significant pooled immediate decline of 14.7% in COPD-related admission rates...



There was no subsequent effect of the comprehensive ban on COPD-related admission rates...


But for asthma, it was the other way round...

Asthma-related admission rates increased by 12.1% immediately after the partial ban...


...but decreased by 7.4% after the comprehensive ban.


This is pretty much the definition of a mixed result. Can you guess how it was written up in the abstract?

The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men. 

If you guessed they would ignore the null and negative findings and focus only on the positive findings then give yourself a pat on the back. You know them too well.

Let's try to get our heads around this, shall we? The underlying assumption here is that smoking bans reduce hospital admissions by reducing exposure to secondhand smoke. If so, it seems that the partial ban was so successful in reducing secondhand smoke exposure that it reduced COPD admissions by 14.7 per cent. This is pretty bloody impressive when you consider that COPD is a chronic disease that takes decades to develop and which mostly affects smokers.

But despite the miraculous effect on COPD, the partial ban had the weird effect of increasing admissions for asthma by 12 per cent, although you can see from the graph above that there were about the same number of admissions after the 2011 ban as there had been in 2003 when there was no ban of any kind. And when it came to the comprehensive ban, asthma rates fell but COPD rates didn't.

Does any of this seem plausible? Does it make a lick of sense? I would suggest not.

It is sheer garbage. Manifestly so. The best result these jokers can produce is a fall in COPD admissions during a partial ban. That ban must have done a hell of a job of reducing secondhand smoke exposure, huh?

Well, no. Not according to the authors of the Tobacco Control Scale who celebrated the introduction of 2011's comprehensive ban by saying:

The 2005 so-called Spanish model (weak smokefree legislation in bars and restaurants), praised by the tobacco industry, is finally dead. In 2010 Spain adopted far reaching and comprehensive legislation on smokefree bars and restaurants.

The same authors had previously described the 2006 ban as 'weak and ineffective, and a study of it published in 2009 concluded that:

Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels.

And yet this 'weak and ineffective' legislation had a massive effect on COPD admissions whereas the 'comprehensive legislation' five years later did diddly-squat. The miracle becomes more confusing when you consider that the ban which reduced COPD admissions somehow increased the number of asthma admissions.

This data-dredging bilge makes no sense on any level. Even if you accept the authors' prior beliefs about secondhand smoke, it defies all logic. The authors don't even attempt to explain the contradictions and yet this utter drivel got published in a peer-reviewed journal, just like all its ludicrous predecessors got published in peer-reviewed journals. It is beyond a joke.

Tuesday, 5 September 2017

Did the smoking ban make the number of childhood chest infections plummet?

From The Herald...

Smoking ban sees child chest infections plummet

Really? I may be jaded from years of bitter experience but I suspect that this claim is going to turn out to be bullshit.

Children needing hospital treatment due to chest infections may have dropped by as much as a fifth since anti-smoking laws were introduced, research suggests.

A study led by the University of Edinburgh and the Erasmus University Medical Centre in the Netherlands combined data from 41 papers in countries where tobacco control policies have been introduced.

The figures suggest rates of children requiring hospital care for severe chest infections have dropped by more than 18% since bans were introduced.

OK, so it's a meta-analysis and, as the BMJ says, it's looking at admissions for lower respiratory infections.

Hospital admissions of children with lower respiratory tract infections have fallen by 18.5% since the public smoking ban and 9.8% fewer children have attended hospital for severe asthma exacerbations, research published in the Lancet Public Health shows.

The BMJ implies that the findings are specific to Britain whereas they are sourced from various junk studies from various countries, but what applies to one country should apply to all and claims have been made in the past about childhood hospital admissions for lower respiratory infections falling by 13.8 per cent in England after the smoking ban was introduced.

So let's see if it's true shall we? Here's something you can do at home. It's called 'fact checking' and at one time journalists were rumoured to have done it.

Here is the NHS database of hospital admissions.

There you will find 'Emergency admissions for children with lower respiratory tract infections (LRTIs)'.

Click on that and you will get a spreadsheet showing the number of admissions in each financial year for the whole of England between 2003/04 and 2015/16. You can also get the standardised ratio figures.

Chart them on a graph and you will see this. Note that the smoking ban started in 2007.

As I suspected, then, it's bullshit.