Patrick Basham’s paper on tobacco displays doesn’t add up

Smoking causes a quarter of all cancer deaths

Tobacco is responsible for more than a quarter of cancer deaths. Over the last year, we’ve been campaigning hard to get displays of tobacco products removed from shops – a campaign that’s had overwhelming backing from our supporters and the wider public.

The matter was debated at length in Westminster as part of the 2009 Health Bill, and MPs voted for this to become law earlier this year. But the new Government has not yet implemented the regulations.

Removing this so-called ‘point of sale’ advertising from shops should reduce teenage smoking rates – a policy backed up by a large amount of world-class research in respected peer-reviewed journals.

So we were surprised to see a new report appear recently, claiming that covering up tobacco displays in shops could actually increase youth smoking rates – and even tobacco smuggling. This report has been seized on by groups who want to encourage the government not to bring in the regulations outlined in the Health Act.

But on closer inspection, the report is riddled with problems – including the failure of the author to declare his long-standing links with the tobacco industry. The World Health Organisation says the tobacco industry has a “long history of using seemingly independent ‘front groups’ to advance its case.”

The evidence

Researchers have demonstrated that the more children see tobacco displays the more likely they are to take up smoking. Many of these studies are summarised in a literature review produced by the Cancer Research UK-funded Centre for Tobacco Control Research. Also noteworthy are two other publications from a group in New Zealand – one published in Tobacco Control, another in Nicotine and Tobacco Research.

In summary, this evidence shows that, by being placed with sweets and crisps by the counter, tobacco displays make smoking seem normal. And their brightly lit, colourful displays show off rows of cigarette brands like huge adverts, earning them the industry nickname ‘powerwalls’.

The counter-claims

In his new paper “Canada’s ruinous tobacco display ban: economic and public health lessons”, Patrick Basham – director of the Democracy Institute in the US –  claims that when Canada removed tobacco displays, youth smoking and tobacco smuggling went up, and there were “devastating” effects on small shops.

However, his paper has a number of weaknesses that mean that he struggles to substantiate these claims. And the view he presents is not particularly balanced.

A key issue is that, as detailed in ASH’s report “The smoke-filled room: How big tobacco influences health policy in the UK” (2010), Basham has long-standing links with the tobacco industry, receiving funding from them and attacking government regulation of tobacco.

Yet he does not declare these links in his paper.

But more tellingly, Patrick Basham’s paper has not been through “peer review”, the process whereby researchers review each other’s work before it is published to ensure that the research is rigorous and of high quality. Nor does Basham’s paper make much reference to the large amount of evidence in favour of removing tobacco displays.

In fact, he only quotes one source from a peer-reviewed journal, which he fundamentally misrepresents, as we’ll see below.

Contradictions

Basham’s paper also contradicts itself. For example it says that one kind of data – ‘year-on-year cross-sectional data’ – are “highly unreliable” (p.12) in the context of Iceland, but uses the same kind of data from Canada to support his claims (p.6).

The paper also says that in Canada there was no link between the price of tobacco, the introduction of the display ban and the subsequent drop in tobacco consumption (p.8). However, when it talks about the issue in Iceland, price is stated as a possible reason for the fall in smoking rates among Icelandic teenagers (p.12).

Another issue we have is that the paper ignores the key argument for removing displays of tobacco in shops, namely that it is a form of advertising, as we say in our most recent briefing to Parliamentarians.

Insufficient data

He also has insufficient data for his claims, and makes assertions with no evidence to back them up. A particularly striking example of this is the discussion of Iceland’s experience in removing tobacco displays.

According to Basham, in 2000 (a year before the display ban was introduced) the ‘prevalence rate’ for youth smoking was 14.4 per cent. After the ban it had risen to 15.5 per cent (pp13-14). However, these numbers are drawn from two separate surveys that were carried out in completely different ways – their results are not comparable.

Moreover, his pre-ban figure of 14.4 per cent is for ‘daily smokers’ while his figure from the 2006 survey (published here in BMC Public Health) is ‘daily’ and ‘occasional’ smokers added together. The 2006 survey’s figure for daily smokers is 8.8 per cent and for occasional smokers it is 6.7 per cent. Even if these surveys were comparable, which they are not, they would have shown the opposite effect to what the paper claims.

The paper also makes claims about the effect on convenience stores in Canada from a source which Patrick Basham fails to properly cite as being linked to the tobacco industry.

It says cigarette smuggling increased as a result of the display ban. Tellingly though, the Canadian authorities don’t mention this in their 2008 Contraband Tobacco Enforcement Strategy. This document lists the main causes of tobacco smuggling, such as pricing and organised crime, but does not cite the removal of point of sale displays as a factor.

Together these problems mean his claims that display bans have increased smuggling or harmed small shops lack real substance.

Not peer-reviewed

As we mentioned above, the various problems with Basham’s paper show the value of peer review, which would likely have picked up its weaknesses. Being peer-reviewed would also necessitate the author’s declaring any competing interests.

Regrettably, Basham’s flawed arguments have been used by those who favour the continued display of tobacco in shops, endangering an important public health measure.

If you would like to read more about why we support removing tobacco displays in shops, we’ve worked with partners such as the British Medical Association, Action on Smoking and Health, the British Heart Foundation and the Royal College of Physicians to put together a briefing outlining the evidence for the measures in the Health Act 2009.

We’ve also written a longer, detailed rebuttal of Basham’s paper.

Robin