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Smoking ban for N.C. Bars and Restaurants

The bill approved Wednesday falls short of how it began: a total and sweeping ban on smoking in all public places. But the House's original bill left a wide loophole for bars, an exemption that worried restaurant owners who feared bars would steal late-night customers.

via House approves smoking ban for N.C. – Politics – News & Observer.

The bill (soon to become law) still contains the giant “private club” loophole I had mentioned earlier, so, 1.5 cheers. And strange exemption for cigar bars (where smoke is emitted), but not for hookah bars (where water filters quite a bit of the smoke).

Critically, as Laura Leslie pointed out, the law will allow local health officials to go above and beyond state law. So, a floor was established, not a ceiling, which is good. They were previously forbidden to enact any smoking bans. Now Chapel Hill/Carrboro can do what it has been wanting to do for years and finally kill smoking in all public places.

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  • Alcohol Retail Privatization and Health

    I had a conversation recently about alcohol retail store privatization where I mentioned that there is quite a bit of research linking privatization of previously public sector alcohol retail outlets and increased incidence of adverse events, especially in alcohol dependent people. Since I’ve forgotten who it was I had this conversation with, here are three studies on this issue, dear conversation partner:

    From British Columbia, where a 2002 decision by a new BC Liberal government to greatly expand private liquor stores was studied. Here’s a link to the full study ($$) and the press release is below:

    http://communications.uvic.ca/releases/release.php?display=release&id=1193

    Excerpting from the study abstract:

    Findings  The total number of liquor stores per 1000 residents was associated significantly and positively with population rates of alcohol-related death (P < 0.01). A conservative estimate is that rates of alcohol-related death increased by 3.25% for each 20% increase in private store density. The percentage of liquor stores in private ownership was also associated independently with local rates of alcohol-related death after controlling for overall liquor store density (P < 0.05). Alternative models confirmed significant relationships between changes in private store density and mortality over time.

    Conclusions  The rapidly rising densities of private liquor stores in British Columbia from 2003 to 2008 was associated with a significant local-area increase in rates of alcohol-related death.

    From Alberta: A study linking greater alcohol privatization with increased alcohol related suicides.

    We examine the impact of privatization of retail sale of alcohol in Alberta, Canada, between 1985 and 1995 on mortality rates from suicide. Privatization took place in three stages: The opening of privately owned wine stores in 1985, the opening of privately owned cold beer stores and the selling of spirits and wine in hotels in the rural area in 1989–90, and finally privatization of all liquor stores in 1994. Interrupted time series analysis with Auto Regressive Integrated Moving Average (ARIMA) modeling was applied to male and female suicide rates to assess the impact of the three stages of privatization. The analyses demonstrated that most of the privatization events resulted in either temporary or permanent increases in suicide mortality rates. Other alcohol-related factors, including consumption levels and Alcoholics Anonymous (AA) membership rates, also affected suicide mortality rates. These analyses suggest that privatization in Alberta has acted to increase suicide mortality rates in that province.

    Here’s a fairly comprehensive review of 17 studies, which was conducted by the American Centres for Disease Control (CDC).

     

    EVIDENCE SYNTHESIS:

    A total of 17 studies assessed the impact of privatizing retail alcohol sales on the per capita alcohol consumption, a well-established proxy for excessive alcohol consumption; 9 of these studies also examined the effects of privatization on the per capita consumption of alcoholic beverages that were not privatized. One cohort study in Finland assessed the impact of privatizing the sales of medium-strength beer (MSB) on self-reported alcohol consumption. One study in Sweden assessed the impact of re-monopolizing the sale of MSB on alcohol-related harms. Across the 17 studies, there was a 44.4% median increase in the per capita sales of privatized beverages in locations that privatized retail alcohol sales (interquartile interval: 4.5% to 122.5%). During the same time period, sales of nonprivatized alcoholic beverages decreased by a median of 2.2% (interquartile interval: -6.6% to -0.1%). Privatizing the sale of MSB in Finland was associated with a mean increase in alcohol consumption of 1.7 liters of pure alcohol per person per year. Re-monopolization of the sale of MSB in Sweden was associated with a general reduction in alcohol-related harms.

    CONCLUSIONS:

    According to Community Guide rules of evidence, there is strong evidence that privatization of retail alcohol sales leads to increases in excessive alcohol consumption.

    This Mothers against Drunken Driving (MADD) document has a comprehensive bibliography, so does the Canadian Centre for Addiction and Mental Health.

    I would characterize myself as part of the majority of people who believe their alcohol consumption is well under control, and as a consequence, does not mind the proliferation of liquor stores open till late, on Sundays, and running promotions. But as a public health issue, the huge costs of alcohol consumption are well known and extensively studied. It is surprising that jurisdictions rush headlong into liquor privatization when this kind of literature showing clear correlation (and good causal relations) between increased retail privatization and adverse outcomes for vulnerable populations is out there.

    References

    1. Stockwell, Tim, Jinhui Zhao, Scott Macdonald, Kate Vallance, Paul Gruenewald, William Ponicki, Harold Holder, and Andrew Treno. “Impact on Alcohol-related Mortality of a Rapid Rise in the Density of Private Liquor Outlets in British Columbia: a Local Area Multi-level Analysis.” Addiction 106, no. 4 (2011): 768–776.
    2. Zalcman, Rosely Flam, and Robert E. Mann. “Effects of Privatization of Alcohol Sales in Alberta on Suicide Mortality Rates, The.” Contemporary Drug Problems 34 (2007): 589.
    3. Hahn, Robert A., Jennifer Cook Middleton, Randy Elder, Robert Brewer, Jonathan Fielding, Timothy S. Naimi, Traci L. Toomey, Sajal Chattopadhyay, Briana Lawrence, and Carla Alexia Campbell. “Effects of Alcohol Retail Privatization on Excessive Alcohol Consumption and Related Harms: A Community Guide Systematic Review.” American Journal of Preventive Medicine 42, no. 4 (April 2012): 418–427.
    4. Provincial Liquor Boards: Meeting the Best Interests of Canadians. Mothers Against Drunken Driving (MADD), 2012.
    5. Alcohol Retail Monopolies and Privatization of Retail Sales. Centre for Addiction  and Mental Health, 2010.
    Wine image from public domain used under a creative commons licence.
  • |

    NC Smoking ban now inevitable?

    Well, it has taken less than a decade (I am a pessimist), but looks like smoking in bars and restaurants may finally be over and done with in my old home state of NC.

    Note that there is currently a HUGE loophole in the senate version of the bill, it permits smoking in “private clubs”. Many bars in NC designate themselves as “private clubs” to circumvent prohibition era (or thereabouts) laws that mandate liquor serving establishments to get a certain percentage of their revenue from food. So, my favourite Chapel Hill drinking establishment, The Dead Mule (no website, sorry!) is supposedly a “private club” – You supposedly pay a one time membership fee (usually less than 5 bucks), and are supposed to “sign in” any members and guests. This was all a farce anyway, and the Mule got extremely smoky, it was quite disgusting after a while.

    One hopes that the final bill will make the ban universal. Bans like this work best when they don’t favour one group of establishments over the other for no real reason. The people who work at the Dead Mule are equally entitled to clean air.

    1.5 cautious cheers, let’s see what happens in the end…

    The state Senate voted Thursday to ban smoking in bars and restaurants in North Carolina. It set the stage for what would be a historic prohibition of a product that created thousands of jobs, built Duke and Wake Forest universities and has long been an integral part of the culture in the nation's top tobacco-producing state.

    House members passed a tougher version last month, meaning that lawmakers will still have to work out a compromise, assuming the Senate passes the measure in a second vote on Monday. The bill passed Thursday by an eight-vote margin, 26-18, so that seems likely.

    via State Senate OKs smoking ban – Politics – News & Observer.

  • | |

    Indian firms push down global vaccine prices – Lessons for Canada

    Cheaper vaccines from India are forcing global giants to slash prices. GSK announced its rotavirus vaccines at $2.50 per dose — or $5 to fully immunise a child — in response to a current tender administered by UNICEF.The offer is a 67% reduction in the current lowest available public price.

    Hindustan Times

    This is good news for many reasons. Preventable diseases kill over a million people every year, and one of the biggest factors in getting vaccinated is cost. India’s healthcare spending was estimated at US$ 40 billion in 2008, going up to 300+ billion in 2023. Forty billion is less than $40 per person, so saving 7-8 dollars on vaccinations alone for every one of the 26 million children born every year is a huge deal.

    Development costs of vaccines and drugs are high and success is often uncertain. Pharmaceutical companies have used this to justify government enforced monopolies and per dose prices that are sometimes a 1000 times higher than the incremental cost of production. While this makes for good profits, it means severe lack of access in India, many African countries, and many excess deaths that could have been prevented. For years, India had what was called a process patent, not a product patent, which meant that if you could make a drug with a slightly different process, it would not get patent protection any more. How did this help India?

    1. Affordable drugs – Indian companies could make and sell drugs at a fraction of the cost without paying for drug development.
    2. Pharmaceutical Industry – This enabled the industry to grow and mature.

    Of course, this also meant that India was considered an outlaw, and Indian pharmaceutical industry came under great pressure from the WTO to tighten patent laws, which it did. At the time, the concern (rightly) was that tightening patent restrictions would harm India’s pharmaceutical industry and reduce access to drugs. Has this come to pass? In some ways, yes. But the Indian pharmaceutical industry has also matured, and with government help, has been able to do its own development, clinical trials and production (which it was always good at). The focus on tropical diseases like rotavirus also means that US, European Companies, which have since moved away to treating chronic conditions like high cholesterol, erectile dysfunction, etc., have much more competition in the tropical diseases area and cannot charge premium prices to poor people any more.

    So dear Canada, while you are negotiating with Europe about “free trade”, and trying to give European companies much greater patent protection for their drugs, know that this will very surely raise costs in the short term. Two important questions:

    1. Will Canada’s drug companies benefit?
    2. Will Canada’s consumers benefit?

    Um, let’s take a look at Canada’s top 10 in 2009:

     

    Rank Leading Companies Country Market Share (%)
    1 Pfizer US 13.4
    2 Apotex Canada 7
    3 AstraZeneca UK 6.6
    9 Merck US 6
    4 Johnson & Johnson US 5.3
    6 Novopharm (Teva) Israel 4.2
    7 Novartis Switzerland 4
    5 GlaxoSmithKline UK 4
    8 Abbott US 3.9
    10 Roche Switzerland 3.1
    Source: IMS Health

    There is one Canadian company in the top 10, and four European companies. Our pharmaceutical industry is not well positioned to be independent, or work to reduce Canadian drug prices, especially if laws strengthening patent protections for European companies come into effect. This will serve to weaken Apotex, and Canada does not have a big independent pharmaceutical company network born out of years of “isolation” to take advantage of any competition, or competitive advantages. So, while patent “reform” seems to not have hurt Indian industry as much as feared, it sure will hurt Canadian consumers.

     

  • | |

    High fructose corn syrup makes you fat

    This well designed and well executed study provides rather conclusive proof that High Fructose Corn Syrup, the sweetener most commonly used in North America, makes you gain weight in a way not explained by calories alone. These rats gained more weight on HFCS compared to a sucrose (regular sugar) diet even though they were fed the same calories. The effect was seen in the short term and in the long term, and abdominal fat increased the most. Gut fat, if you did not know is related to the infamous metabolic syndrome, causing diabetes, hypertension, coronary disease, etc.

    High-fructose corn syrup (HFCS) accounts for as much as 40% of caloric sweeteners used in the United States. Some studies have shown that short-term access to HFCS can cause increased body weight, but the findings are mixed. The current study examined both short- and long-term effects of HFCS on body weight, body fat, and circulating triglycerides. In Experiment 1, male Sprague–Dawley rats were maintained for short term (8 weeks) on (1) 12 h/day of 8% HFCS, (2) 12 h/day 10% sucrose, (3) 24 h/day HFCS, all with ad libitum rodent chow, or (4) ad libitum chow alone. Rats with 12-h access to HFCS gained significantly more body weight than animals given equal access to 10% sucrose, even though they consumed the same number of total calories, but fewer calories from HFCS than sucrose. In Experiment 2, the long-term effects of HFCS on body weight and obesogenic parameters, as well as gender differences, were explored. Over the course of 6 or 7 months, both male and female rats with access to HFCS gained significantly more body weight than control groups. This increase in body weight with HFCS was accompanied by an increase in adipose fat, notably in the abdominal region, and elevated circulating triglyceride levels. Translated to humans, these results suggest that excessive consumption of HFCS may contribute to the incidence of obesity.

    Miriam E. Bocarsly, Elyse S. Powell, Nicole M. Avena, Bartley G. Hoebel. High-fructose corn syrup causes characteristic of obesity in rats: Increased body weight, body fat and triglyceride levels. Pharmacology Biochemistry and Behavior, 2010; DOI: 10.1016/j.pbb.2010.02.012

    For a more layman friendly summary of the article, read the sciencedaily release.

    Do reconsider your food habits to avoid HFCS. Note that this whole corn syrup boondongle is made possible by the US government’s insistence on providing billion dollar subsidies to its farmers to grow corn while imposing tariffs on cane sugar from the tropics to make it less attractive. Free trade, my A$$.

    Thanks to Tom Laskawy at grist for the blog post.

  • |

    Dole Begone

    Facing a close re-election race in North Carolina, Sen. Elizabeth Dole (R) recently released an ad attacking her opponent Kay Hagan, falsely accusing her of being “Godless.” The end of the ad shows a photo of Hagan while a woman yells, “There is no God!” Watch it:

    via Think Progress » Elizabeth Dole ad falsely suggests opponent Kay Hagan is ‘Godless.’

    Dear fellow Tar Heels:

    Please give this inept, ineffectual, incompetent excuse for a senator the retirement she so richly deserves.

    Sincerely,

    The Olive Ridley Crawl

    Of course, she yelled “Godless” in my face, I’d say, “Yeah”!! But as we know, atheists are not very popular…

  • |

    Canada to stop asbestos mining and stop defending it.

    Canada’s long and sorry saga of exporting death (asbestos) and defending it loudly and proudly in international fora is over and I needed to mark this happy day on the blog. The newly elected provincial government in Quebec, the Parti Quebecois have followed through on their campaign promise to finally end this small “industry” employing a few workers. Canada will no longer produce asbestos, or fight the listing of asbestos as a toxic substance.

    It is going to take $50 million in government funds, a fraction of the cost of one fighter jet, to transition the workers away (if they get the money, not the mine owners). That’s it, why were we exporting death to India and other countries for this, I don’t know.

    Canada’s many conservative and liberal governments fought hard for years to preserve the industry, using techniques lifted from tobacco propaganda, or today’s climate change challenges. I leave you with the ruling Canadian government’s response: Finely tuned to appeal to everyone who likes mesothelioma, cancer and death.

    “Mrs. Marois’s decision to prohibit chrysotile mining in Quebec will have a negative impact on the future prosperity of the area,” (Industry Minister) Mr. Paradis said in a statement.

    That about sums it up. But, it is a good day for public health, nevertheless.

    Citing PQ pressure, Canada to cease defending asbestos mining – The Globe and Mail.

    Featured image courtesy wikipedia used under a Creative Commons license (a micrograph of asbestos fibres causing lesions in the lung).