Should all smoking in cars be banned? The British Medical Association certainly thinks so, and it can only be a matter of time before such a proposal begins to resonate wherever hazard-thwarting regulation is held sacred by government (I’m looking at you, California). But before we answer this question, let me engage in some throat clearing.
I can still recall that particularly sickly feeling of being on the road to hell in a car with two smoking parents, windows sealed tight, heater on. It was ghastly. Worse, I went undiagnosed for years with allergy-related asthma, which turned summer bouts of hay fever into operatic renditions of emphysema; if you have ever spent nights whistling through a lung-bursting wheeze, you will likely appreciate the consequences of smoking in a way that no “scare ’em with photos of rotting lungs” advertising campaign can ever hope to achieve.
So, as someone who has never even tried a cigarette, I can only prostrate myself in gratitude at the public efforts to keep other people’s fumes from my life. They have made my world better and have sensitized many smokers to the public consequences of their habits.
But having said this, there’s a really, truly, special kind of dumb about trying to ban all smoking in cars (and not just when kids are present). It lies not so much with the impracticality of enforcement (the police have a hard enough time catching drunk drivers and cellphone users), but with the British Medical Association’s scientific justification for it.
In short, the association did what too many professional health organizations seem inclined to do when they want to save people from themselves: They resorted to spin. Smoking in a car produced 23 times more toxins than a smoke-filled bar, the association announced in a press release. Except it didn’t, because the number was made up.
Cue a correction from the BMA, which now claimed a smoky car contained 11 times more toxins than a smoky bar. But as skeptical columnists and bloggers pointed out, this wasn’t exactly true either, because the claim depended on the car being stationary with the windows closed and the ventilation off. Move, roll down the windows, turn the ventilation on and the levels of smoke went down dramatically. Plus the levels of smoke in smoky bars varied so widely in the research literature that almost any comparison could be true.
By now, the mandarins of the association were looking more like used-car salesmen than medical experts. Which makes you wonder, why make something like this up?
It’s an interesting question because this peculiar malady doesn’t just afflict the BMA. Take one of my all-time favorite demands from the American Academy of Pediatrics, that the food industry redesign hot dogs.
One threshold test for a public health intervention should be, I believe, ease of implementation. No miracles, in other words, and no dictatorship. So how do you redesign a hot dog without it turning into a patty? A redesigned hot dog is no longer a hot dog — and that’s a high semantic mountain to climb for 300 million Americans, baseball-loving or not.
So before embarking on this Everest of interventions, there should be alarmingly compelling reasons for doing so, shouldn’t there? Of course, there weren’t. The academy had massaged the data to make this “underappreciated risk” feel very, very appreciated indeed. But according to data collected from a representative sample of pediatric emergency rooms, 1.6 kids die from choking on a hot dog each year in the U.S. — which is roughly the number of deaths incurred by kids from falling televisions. Yes, this is tragic. But please don’t tell me we need to redesign televisions.
Or consider the 2006 survey by the American Medical Association, which claimed that “sizable numbers” of girls had multiple sex partners and blacked out and vomited while on spring break. Really? No. Those “sizable numbers” came from an Internet survey in which 73 percent of respondents had never been on spring break.
You would think unimpeachable science would be the sine qua non of medical persuasion. Yet, as these examples show, when it comes to saving the public, medical associations seem to blithely abandon science in hugely self-destructive ways. It’s as if no one bothered to ask, “Hold on, how could we be torn apart and made to look like total fools by saying this?”
Simple arrogance? Perhaps. Political agendas? Possibly. But a more intriguing explanation emerges from “The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life,” the latest book from the hugely entertaining anthropologist and evolutionary biologist Robert L. Trivers. The problem, it seems, is social.
Physics, says Trivers, is the most solid and sophisticated of the sciences as it is the least dependent on social interaction or social content. Or to put it more snarkily, its general lack of relevance to anything guarantees a high level of rigor.
On the other hand, the more relevant the science to everyday life, the more it risks being deformed by that social interaction through deceit and self-deception. It’s a theory that seems especially applicable to public health, where survival of the weakest depends on the social success of the science. It’s a painful irony that the more doctors care, the more careless they tend to be about the science.
I can still recall that particularly sickly feeling of being on the road to hell in a car with two smoking parents, windows sealed tight, heater on. It was ghastly. Worse, I went undiagnosed for years with allergy-related asthma, which turned summer bouts of hay fever into operatic renditions of emphysema; if you have ever spent nights whistling through a lung-bursting wheeze, you will likely appreciate the consequences of smoking in a way that no “scare ’em with photos of rotting lungs” advertising campaign can ever hope to achieve.
So, as someone who has never even tried a cigarette, I can only prostrate myself in gratitude at the public efforts to keep other people’s fumes from my life. They have made my world better and have sensitized many smokers to the public consequences of their habits.
But having said this, there’s a really, truly, special kind of dumb about trying to ban all smoking in cars (and not just when kids are present). It lies not so much with the impracticality of enforcement (the police have a hard enough time catching drunk drivers and cellphone users), but with the British Medical Association’s scientific justification for it.
In short, the association did what too many professional health organizations seem inclined to do when they want to save people from themselves: They resorted to spin. Smoking in a car produced 23 times more toxins than a smoke-filled bar, the association announced in a press release. Except it didn’t, because the number was made up.
Cue a correction from the BMA, which now claimed a smoky car contained 11 times more toxins than a smoky bar. But as skeptical columnists and bloggers pointed out, this wasn’t exactly true either, because the claim depended on the car being stationary with the windows closed and the ventilation off. Move, roll down the windows, turn the ventilation on and the levels of smoke went down dramatically. Plus the levels of smoke in smoky bars varied so widely in the research literature that almost any comparison could be true.
By now, the mandarins of the association were looking more like used-car salesmen than medical experts. Which makes you wonder, why make something like this up?
It’s an interesting question because this peculiar malady doesn’t just afflict the BMA. Take one of my all-time favorite demands from the American Academy of Pediatrics, that the food industry redesign hot dogs.
One threshold test for a public health intervention should be, I believe, ease of implementation. No miracles, in other words, and no dictatorship. So how do you redesign a hot dog without it turning into a patty? A redesigned hot dog is no longer a hot dog — and that’s a high semantic mountain to climb for 300 million Americans, baseball-loving or not.
So before embarking on this Everest of interventions, there should be alarmingly compelling reasons for doing so, shouldn’t there? Of course, there weren’t. The academy had massaged the data to make this “underappreciated risk” feel very, very appreciated indeed. But according to data collected from a representative sample of pediatric emergency rooms, 1.6 kids die from choking on a hot dog each year in the U.S. — which is roughly the number of deaths incurred by kids from falling televisions. Yes, this is tragic. But please don’t tell me we need to redesign televisions.
Or consider the 2006 survey by the American Medical Association, which claimed that “sizable numbers” of girls had multiple sex partners and blacked out and vomited while on spring break. Really? No. Those “sizable numbers” came from an Internet survey in which 73 percent of respondents had never been on spring break.
You would think unimpeachable science would be the sine qua non of medical persuasion. Yet, as these examples show, when it comes to saving the public, medical associations seem to blithely abandon science in hugely self-destructive ways. It’s as if no one bothered to ask, “Hold on, how could we be torn apart and made to look like total fools by saying this?”
Simple arrogance? Perhaps. Political agendas? Possibly. But a more intriguing explanation emerges from “The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life,” the latest book from the hugely entertaining anthropologist and evolutionary biologist Robert L. Trivers. The problem, it seems, is social.
Physics, says Trivers, is the most solid and sophisticated of the sciences as it is the least dependent on social interaction or social content. Or to put it more snarkily, its general lack of relevance to anything guarantees a high level of rigor.
On the other hand, the more relevant the science to everyday life, the more it risks being deformed by that social interaction through deceit and self-deception. It’s a theory that seems especially applicable to public health, where survival of the weakest depends on the social success of the science. It’s a painful irony that the more doctors care, the more careless they tend to be about the science.
