Smoking May Now Be Considered An Established Risk Factor For ALS

While previous studies have indicated a "probable" connection between smoking and ALS, a new study published in the Nov. 17, 2009 issue of Neurology®, the medical journal of the American Academy of Neurology, states that smoking may now be considered an "established" risk factor for Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease.

The findings come from Baystate Medical Center neurologist Dr. Carmel Armon, an ALS researcher and neuroepidemiologist, who came to this conclusion using evidence-based methods to perform a rigorous analysis of studies examining the link between smoking and developing ALS -- a fatal neurodegenerative disease affecting the motor nerves and the voluntary muscles.

"Application of evidence-based methods separates better-designed studies from studies with limitations that may not be relied on. The better-designed studies show consistently that smoking increases the risk of developing ALS, with some findings suggesting that smoking may be implicated directly in causing the disease," said Dr. Armon, a professor of neurology at Tufts University School of Medicine and chief of neurology at Baystate Medical Center in Springfield. He is also a fellow of the American Academy of Neurology.

According to Dr. Armon, identifying smoking as an established risk factor for ALS has three implications.

"First and foremost the findings provide a link between the environment and the occurrence of ALS, where none had been previously identified with this level of certainty," said Dr. Armon.

"Additional implications are that since smoking has no redeeming features, avoidance of smoking may reduce the occurrence of ALS in the future, and since some of the mechanisms by which smoking causes other diseases in humans are understood fairly well, recognizing its role in the occurrence of ALS may help pinpoint the biological processes that initiate the disease," added the researcher.

The Baystate Medical Center neurologist noted that focusing on processes at initiation of sporadic ALS, and close to it, may provide new avenues to treatment to stop its progression.

"This has been realized in some animal models of familial ALS, but not in humans. The hope that these concepts may apply to sporadic disease and change its outlook in the future is supported by establishing the association of smoking with ALS occurrence," concluded Dr. Armon.

ALS takes the lives of half of those affected within three years of onset of weakness, with less than five percent surviving more than 10 years. Some 90-95 percent of cases appear to occur at random ("sporadic cases'), with 5-10 percent of cases having an affected blood relative ("familial cases"). An altered gene, several of which have been identified, is implicated in causing familial ALS. Prior to this report, no external factors have been implicated with this level of confidence as contributing to the occurrence of sporadic ALS.

Smoking VS UK Landlord

Smoke row landlord loses licence

Hamish Howitt has continued to allow smoking in his bar

A landlord who has run up thousands of pounds in fines over his refusal to ban smoking on his premises has lost his licence in a High Court ruling.

Hamish Howitt, of Del-boy's Sports bar in Blackpool, allowed smoking in the bar after the ban in England in 2007.

Judge Denyer, sitting at London's High Court, ruled he was obliged to treat smoking in his bar as a crime and try to prevent it.

Later Mr Howitt said he would close the bar, adding: "I am devastated."

He also said he would also attempt to take his case to the House of Lords.

In April Mr Howitt won an appeal case against Blackpool Council's decision to remove his licence for Del-boy's.

Non-smoker

The authority took the case to the High Court.

Mr Howitt, 57, was described by the judge as "an avowed opponent of the smoking ban - he believes it is a gross interference with individual liberty and property rights".

The judge added: "It may be others agree with him. In any event he has allowed people to smoke in his pub."

Mr Howitt has given up cigarettes but clocked up £28,000 in fines from 32 convictions fighting for the freedom of others to continue the habit.

The bar owner argued that, for there to be a breach of his licence, there had to be "disorder", as well as crime.

But Deputy High Court Judge Denyer rejected his argument, saying "permitting smoking in a place where smoking is barred is a criminal offence - and therefore simply as a matter of definition it is a crime."

The ban, which was introduced in England on 1 July 2007, forbids smokers from lighting up in enclosed public places.

Jakarta Indonesia Ban Smoking

Smoking ban sweep picks up 20 puffers

The Jakarta Post , Jakarta | Wed, 11/19/2008 12:04 PM | Jakarta

ANTI-SMOKING WATCHDOG: An official from Jakarta's Environmental Agency signs a document at the Victoria Building in South Jakarta on Wednesday stating the building complies with the city's anti-smoking rules. City officials spot-checked some office buildings to make sure they were in compliance with the city's anti-smoking bylaw. JP/Ricky Yudhistira

The City Environmental Management Agency (BPLDH) has arrested 20 people found smoking in smoking-restricted areas at the Blok M bus terminal and at nearby offices during a sweep to enforce the smoking ban on Wednesday.

Picking up offenders was an effective way to control smokers at the terminal, said A. Wani Zaroni, deputy chief of the Blok M terminal management.

"Before (the smokers) wouldn't even budge when our officers reprimanded them, but with this initiative generating public awareness, we hope people will finally realize the importance of not smoking in restricted areas," he said, as quoted in kompas.com.

South Jakarta BPLDH head Joni Tagor said recent public sweeps were pre-judicial in nature, meaning offenders would only be issued a warning.

"As far as real sanctions go, we'll start applying sanctions from December 2008 onward. Right now we're just trying to raise public awareness," he said.

The city of Jakarta plans to revive its long-abandoned ban on smoking in public places with a series of enforcement actions from Nov. 17 to Nov. 27.

The restrictions on smoking were first introduced in February 2006. Violators could face a six-month jail term or a fine of up to Rp 50 million (US$4,100).

Members of civil society groups are expected to join in the randomly scheduled sweeps.

Stephen Smith: Smoking ban tied to a gain in lives

Fatal heart attacks drop in Massachusetts

By Stephen Smith Globe Staff / November 12, 2008

Nearly 600 fewer Massachusetts residents have died from heart attacks each year since legislators banned smoking in virtually all restaurants, bars, and other workplaces four years ago, according to a report to be released today that provides some of the strongest evidence yet that such laws save lives.

The study, conducted by the state Department of Public Health and the Harvard School of Public Health, shows that a steep decline in heart attack deaths started as Boston and most of its neighbors adopted bans. Enforcement of the statewide law beginning in mid-2004 coincided with a further reduction, the study found. From 2003 to 2006, heart attack deaths in Massachusetts plummeted 30 percent, significantly accelerating what had been a more modest long-term decline.

The report, obtained in advance by the Globe, found that the number of heart attacks began dropping in communities with strong antismoking laws years before the 2004 statewide law and that similar reductions were achieved in other cities and towns only after the state ban. By the end of 2006, the rate of decline in all cities and towns had nearly converged. The authors said this pattern showed that advances in treatment of heart attacks were not responsible for the smaller number of deaths.

"This is the strongest study yet done of the effect of smoking bans on heart attacks," said Dr. Michael Siegel, a Boston University School of Public Health specialist in tobacco control who has been a critic of some antismoking laws and of previous research conducted by the state and Harvard. "You can no longer argue that these declines would have occurred simply due to medical treatment."

The health benefits of smoking bans have long stirred controversy between advocates and opponents of workplace tobacco laws. While health officials including the US surgeon general have concluded that secondhand smoke is responsible for thousands of deaths annually from heart disease and lung cancer, the tobacco industry and some in the hospitality industry have suggested that the dangers of secondhand smoke are overstated and that there is little evidence that bans prevent deaths.

The study, scheduled to be presented this morning to the state Public Health Council, appears destined to bolster the case of Boston health authorities who have already given preliminary approval to a sweeping strengthening of their tobacco control laws. The toughened Boston regulations would quickly eliminate cigarette sales at drug stores and on college campuses and would shutter swank cigar salons and hookah bars within five years.

The Boston Public Health Commission was supposed to consider final approval of the measures tomorrow, but that vote has been postponed until December, because the board wants to review hundreds of comments that have flowed in, said Barbara Ferrer, executive director of the commission.

The state's report should prove to critics that her agency is not acting capriciously, Ferrer said. "The Board of Health isn't just acting because it likes to regulate. It's acting because there's so much evidence about the importance of reducing tobacco smoke."

Brandon Salomon, an owner of the Back Bay stogie bar Cigar Masters, said he was unpersuaded by the state's research, describing it as skewed science.

"The decrease in heart attacks could be the fact that people have stopped eating carbs so much and are exercising more," Salomon said.

Much of the evidence about the damage wrought by smoking has focused on lung tumors, the leading cause of cancer deaths in the nation. But cancer takes years to develop, so smoking bans would not be expected to diminish cancer rates for a long time. An expanding body of scientific evidence shows, however, that even fleeting encounters with cigarette smoke can damage the cardiovascular system of nonsmokers.

In one California study published earlier this year, young adults who did not smoke were exposed to secondhand smoke for 30 minutes in amounts meant to mimic what happens in a restaurant or bar. The researchers discovered that even that amount of exposure damaged the lining of blood vessels and disarmed the body's natural ability to repair such damage.

Cigarette smoke can also cause clots to form or spark a cascade of biological events that causes chunks of fat lining artery walls to shear off, which can result in a heart attack.

"You know all the press that this new study on statins got the other day?" said tobacco researcher Stanton Glantz of the University of California at San Francisco, referring to Boston researchers' finding that anticholesterol drugs substantially reduce heart attacks and strokes even in patients with normal cholesterol levels. "This is a much bigger deal. And it's free."

A spokesman for the nation's largest cigarette maker, Philip Morris USA, said the company's website points out that public health officials have shown that secondhand smoke causes heart disease in nonsmokers.

"We agree that people should be able to avoid being around secondhand smoke, particularly in places where they must go," said company spokesman Bill Phelps.

Led by Tom Land, director of surveillance and evaluation for the Massachusetts Tobacco Control Program, the researchers hunted for signs the reduction might be due to a factor other than tobacco laws.

They considered, for instance, whether there had been an improvement in how heart attack victims were transported to hospitals. They could find nothing that swayed them from their conclusion that there was an indisputable relationship between the smoking ban and fewer heart attack deaths.

That belief was strengthened when they looked at what happened in communities that had either no job-site smoking law before the state ban or a weak law. Heart attack deaths dropped nearly 20 percent in those cities and towns during the first 17 months of the law. In municipalities that had longstanding regulations - and, thus, had seen a steadier decline - the reduction was more modest.

By comparing communities that adopted early smoking bans with those that did not, the researchers were able to estimate that an average of 577 fewer people have died annually from heart attacks because of the law.

"People have assumed that the only benefit we will be able to measure of a smoking ban is long-term benefits," said John Auerbach, the state public health commissioner. "This study demonstrates a real connection between smoking bans and short-term improvement in health outcomes."

Stephen Smith can be reached at stsmith@globe.com.

© Copyright 2008 Globe Newspaper Company.

India Bans Smoking in Many Public Places

By Anjana Pasricha New Delhi 02 October 2008

India has become the latest country to ban smoking in most public places, starting Thursday. From New Delhi, Anjana Pasricha reports on the government's efforts to stub out smoking, which kills an estimated one million people in the country, every year.

Man smokes in Mumbai

Prakash sells cigarettes at a popular roadside stall, near a movie theater and a high school in Delhi. He is confident the ban on smoking in public places will not impact his sales.

He says, if authorities are strict, his sales might plummet. However, he feels most people are neither scared nor bothered about the new rules.

Health ministry officials think otherwise. They are optimistic that the ban will help cut down smoking among the country's estimated 250 million tobacco users. Most of them are men.

An earlier drive against smoking in public made little impact. The new ban, which came into effect Thursday, is more sweeping. The places where lighting up is prohibited include hotels, restaurants, schools, pubs, offices, night clubs, hospitals, airports and bus stops.

The government has directed these establishments to appoint anti-smoking officers who will be accountable, if people smoke on their premises. Those caught violating the ban can be fined up to five dollars.

Health Minister Anbumani Ramadoss says smoking curbs are needed in a country where more than half the population is under 30.

"Although it is fantastic to be in a youthful country, we need to protect this very valuable resource from the harmful effects of tobacco," Ramadoss said.

However, most people feel that enforcing the ban may not be easy in a country where many rules are routinely violated.

A middle-aged smoker puffs away in a marketplace and doubts whether the ban will help him cut down smoking.

"Not much of it. Only thing is you will have to see where you are, that is all," the smoker said.

But the government hopes that the ban will slowly make a difference, as it has in several countries, where curbs on smoking in public places have been imposed in recent years.

Smokers in India are apparently more vulnerable to tobacco-related diseases than those in other countries. A study earlier this year (published in New England Journal of Medicine) found that two-thirds of all smoking-related deaths in India occur relatively early - between the ages of 30 and 69.

The ban came into effect after the Supreme Court rejected a plea by cigarette giant Indian Tobacco Company and hotel interests for a delay.