Dr James Appleyard criticises air-purifiers - 6/4/2004

Smoking ban
Air-purifying systems do not work, says doctor
Cynthia Busuttil

World Medical Association president James Appleyard said air-cleaning systems are not 100 per cent effective in removing the harm caused by second-hand smoke and in fact promote a false sense of security.

The president of the World Medical Association yesterday described the introduction of air-purifying systems instead of a total ban on smoking in public places as a "con trick" - a dishonest way of misleading people.

"Air-cleaning systems remove some of the dangerous substances, but not all, and harmful substances are still in the air," James Appleyard said.

Speaking to The Times, Dr Appleyard stressed that most second-hand smoke is invisible and odourless. The smoke contains around 4,000 different substances, 50 of which are toxic and have been known to cause cancer.

"There is no safe level below which no adverse effects can be seen," he said.

Conventional ventilation and air-cleaning systems, he said, were expensive and did not provide effective protection because only the visible particulate matter and not the harmful gases were filtered. "This gives a false impression of safety."

Dr Appleyard explained that if people cannot smell or see the smoke, they might think that the area was safe, and that, he said, was "deceitful".

"Introducing air purifiers is a con trick. It is dishonest to mislead the population by making them believe that there are no hazardous substances in the air," he said.

A publication by the British Medical Association - Towards Smoke-free Public Places - says conventional ventilation systems commonly involve the partial dilution and re-circulation of filtered air. It says the systems are "inadequate in offering protection from the harmful effects of second-hand smoke".

"Positive output ventilation", where air is exhausted from an enclosed space at a rate that completely replaces the air in the room, may reduce the risk but not eliminate it.

Dr Appleyard said that for an area to be completely safe, it has to be totally isolated since smoke can waft across from smoking areas to non-smoking ones.

"It is crazy to try and introduce something which you know does not work, at an enormous expense. And it is worse to give the impression that they are actually the answer," said Dr Appleyard, who was in Malta at the invitation of the Medical Association of Malta to deliver a speech about children.

He said a large study in the United States showed that nearly half of non-smokers who claimed not to have been exposed to second hand smoke, had metabolites of nicotine from cigarettes in their blood.

"The health hazards of passive smoking are well known. In adults there is conclusive evidence that passive smoking causes lung cancer, coronary heart disease and exacerbates asthma attacks. There is also substantial evidence that it causes strokes," he said, adding that one study found that the risk was doubled among non-smokers married to a smoker.

Meanwhile, in children, there is conclusive evidence that passive smoking causes cot death, ear and respiratory infections, and it is likely to be associated with premature births and low birth weight infants when the expectant mother is exposed to a smoking environment.

A legal notice banning smoke from public places, with the exception of bars and restaurants, came into force yesterday.

After coming under pressure from the Chamber of Small and Medium Enterprises, the government granted establishments measuring over 60 square metres up to six months to come in line with the regulations. And establishments under 60 square metres have been given until April next year to install the air purification equipment according to the criteria established by the Malta Standards Authority (MSA).

Dr Appleyard said smoking at the workplace was of particular concern, and added that workers in restaurants were exposed to about twice as much cigarette smoke as office workers, and bar workers up to six times.

He said the economic costs to the employer come from increased time off work through illness and reduced productivity. Employers also have to bear the indirect costs of higher maintenance, cleaning costs, greater risk of fire damage, explosion and accidents, and higher fire insurance premiums.

"I encourage the government not to delay introducing this regulation," he said, adding that although behaviour will not change immediately, a positive change will take place over time.

The association president said the government was one of the first to ratify the Framework Convention on Tobacco Control, when other governments were put off by the industry. He said Britain had not been strong enough so far to introduce the necessary measures on behalf of its population, and on behalf of its children.

He said smoke-free public places in Malta would be a selling point for tourists.

"Malta will become the place of choice, and can be promoted as such. I don't think the number of tourists visiting Malta will decrease, but in fact other tourists can be attracted because people will feel safer," he said.

If a smoking ban were introduced and respected, there would be long-term positive effects: "The sooner it is implemented, the better. There is no excuse for delay."

A number of papers question the harm of second-hand smoke. Asked about this, Dr Appleyard asked who could be trusted - the industry or medical people.

"Do you trust the industry which sells this product, or physicians? The smoking lobby raises doubts about the whole issue, and this terrifies people," he said. Tobacco manufacturers, he said, spend 11.3 million annually to promote their products.

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