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July 18th, 2009:

Turkey smoke ban extends to bars

BBC News

Turkey has extended an existing ban on smoking in public places to all bars, cafes and restaurants.

The ban has come into force despite opposition from some bar and cafe owners who fear losing business.

It comes after the government banned smoking from most enclosed public spaces in May last year in an effort to improve the nation’s health.

Turkey has more than 20 million smokers but polls suggest 95% of people support the ban.

“We are working to protect our future, to save our youth,” said Health Minister Recep Akdag.

Anyone caught lighting up in a designated smoke-free area faces a fine of 69 liras ($45:£28) while bar owners who fail to enforce the ban could be fined from 560 liras for a first offence (US$ 366) up to 5,600 liras (US$ 3,660).

Local authorities have hired thousands of extra staff to track down smokers and impose the fines.

Many people in Istanbul said they thought the ban was a good move.

“We were being destroyed in the places where you were allowed to smoke inside,” said Istanbul cafe patron Hanife Demirm.

“I was choosing the non-smoking places automatically, but after the ban is extended I will not need to be selective. I’ll be very comfortable in every place that I go,” he told the AP news agency.

‘Unnecessary stress’

But the BBC’s David O’Byrne in Istanbul says many Turkish people see the ban as an erosion of their democratic rights and have called for bars to be able to apply for a smoking licence.

Some cafe owners have also said they were concerned the ban would drive away customers.

“They will simply leave and never come back, or we would get in trouble for letting them smoke,” said Istanbul cafe owner Selahattin Nar.

“Then both we and they would be filled with unnecessary stresses. In the end they will not be able to relax and we will have to shut down.”

But Mr Akdag said there was no reason for cafe and bar owners to be worried about a drop in trade.

“The public supports a smoke-free environment and the only ones to suffer will be the cigarette producers and sellers,” he said.

A no smoking rule has been in place for the past 15 months in government offices, workplaces, shopping malls, schools and hospitals.

All forms of public transport, including trains, taxis and ferries, are also affected but there are exemptions for special zones in psychiatric hospitals and prisons.

Story from BBC NEWS:

Published: 2009/07/18 23:42:21 GMT



CTA, Jim: we need many more Tobacco Control Inspectors and the onus placed on licensees to enforce the smoking ban here in Hong Kong

the officers could be empowered to issue littering tickets also

IN MY VIEW: Effectiveness of Nicotine Replacement Therapy Needs to Be Re-Examined

In light of yesterday’s revelation (post #1; post #2) concerning the failure of the blinding in nicotine replacement therapy (NRT) trials, and also in light of the way in which financial conflicts of interest with pharmaceutical companies have resulted in bias in the reporting of the results of these studies, I think it is time for a re-examination of the effectiveness of NRT and its role as part of a national smoking cessation promotion strategy.

The current recommendation that NRT or other pharmaceutical agents be used with every smoker who wishes to quit is plagued by a number of serious problems:

1. The panel making this recommendation was heavily conflicted. Its chair and seven members had financial conflicts of interest with pharmaceutical companies that manufacture smoking cessation drugs.

2. The presentation of information to physicians on drug treatment for smoking cessation has been found to bebiased, presumably because of these financial conflicts of interest.

3. The conclusions of a number of the individual studies of NRT therapy appear to be biased, also presumably on account of financial conflicts of interest. See also this post.

4. Reporting of the financial conflicts of interest in smoking cessation drug studies has been inadequate, making it even more difficult to uncover the role of bias in the reporting and review of this literature.

5. The use of NRT therapy during pregnancy has been specifically challenged.

6. Population-based studies indicate that cold turkey cessation, not the use of NRT, is the most effective method for smoking cessation.

7. A number of recent studies indicate that spontaneous quit attempts, usually conducted without the assistance of NRT, are more effective than planned quit attempts which commonly use NRT.

8. Smoking cessation treatment providers have an odd dislike of electronic cigarettes, suggesting that financial conflicts of interest are playing a major role in skewing the thinking on the issue of national smoking cessation strategy.

9. Blinding failure in NRT clinical trials is a serious concern and has not yet been adequately addressed. As a result, the conclusions of the existing literature have been thrown into doubt. See the following posts for more on this issue: post 1; post 2; post 3.

Blinding failure is a serious concern because when subjects enter into a clinical trial with the thought/hope that they are going to receive nicotine replacement and then they realize they are getting a dud, they may well become very disappointed and discouraged right away. Relapse is very likely under such circumstances. This immediately lowers the continuous abstinence rates in the placebo group. There may be some recovery but it is unlikely that this initial effect can be overcome.

10. Failure to compare NRT to cold turkey quitting: In order to credibly claim that NRT is effective, one needs to compare NRT not to placebo, but to cold turkey quitting.

The Rest of the Story

In light of these 10 problems, I believe that it is time for a serious re-examination of both the effectiveness of nicotine replacement therapy and the role of NRT as part of a national strategy for the promotion of smoking cessation.

Most importantly, this re-examination needs to be conducted by unconflicted researchers who do not have financial interests in pharmaceutical companies which stand to benefit from the recommended use of nicotine replacement products.

Unfortunately, the tobacco control field has become so intertwined with pharmaceutical company money — even its national and international conferences are now sponsored by Big Pharma — that I see little possibility for such an unconflicted re-examination of this issue to take place.

Stop trying to please everyone


Some pedestrians have apparently complained about Hong Kong’s designated smoking areas. This seems to indicate an increasingly draconian approach to public health. I am not a smoker and few of my friends smoke. The law to ban smoking has tried to appease smokers and the non-smoking members of the community. But the result has been that neither group is happy.

The way the government promoted the ban has led some non-smokers to expect a smoke-free city. Now people converge at public places to light up, locations where there are smokers and non-smokers, such as elevated walkways, outside shopping malls, bus stops, taxi stands and pavements.

Before the law was enacted you would normally see smokers in restaurants, bars and karaokes, where they were not so much of an eyesore. You might see one or two people puffing on cigarettes at outside locations. Now you see groups of up to a dozen. We are not less exposed to second-hand smoke than we were before the ban came into force. There is ill-feeling between the two groups.

The smokers feel cornered and vilified. The non-smokers are annoyed that people are lighting up outside in areas where there should be fresh air. When will the government stop trying to please all parties when it launches campaigns to publicise new policies?

Virginia Yue, Tsuen Wan