# Sloppy science taints Dlamini-Zuma’s tobacco court defence

- Link: https://dearsouthafrica.co.za/2020/06/09/sloppy-science-taints-dlamini-zumas-tobacco-court-defence/
- Published: 2020-06-09T17:04:59+02:00
- Author: dearSA

![](https://cdn.dearsouthafrica.co.za/wp-content/uploads/2020/06/20191030/Screenshot-
2020-06-09T170155.039.png "Screenshot - 2020-06-09T170155.039")

The government believes that banning cigarettes will force people to quit; that 
95% of smokers do so successfully without help; and that smoking cigarettes makes
contracting Covid-19 more likely.

These claims are part of the “scientific” reasons for banning tobacco contained 
in the government’s court papers. The trouble is, they’re simply not true.

The government and minister of co-operative governance & traditional affairs Nkosazana
Dlamini Zuma were forced to provide reasons for the ban on tobacco sales by the 
Fair Trade Independent Tobacco Association (Fita), which has challenged the ban 
in court. The case starts this morning, in the judge’s chambers, and in court tomorrow.

In a supplementary affidavit provided for Fita, psychiatrist Mike West, who specialises
in treating people with addictions, dismantles the government’s arguments.

West says people trying to stop smoking need support or licensed medication, and
that the data shows that people “under significant stress” are twice as likely to
fail in their quit attempts. (West was not paid for his work.)

But his analysis exposes how the government’s arguments include flawed estimates
of how many SA smokers will get Covid-19, incorrect study references, false claims,
outdated science from the 1990s, and studies cherry-picked to show the negative 
effects of smoking on Covid-19.

In its opening argument, the government claims smoking tobacco increases the risk
of contracting the coronavirus. “The evidence is that the use of tobacco increases…
the risks of transmission,” it says.

However, the World Health Organisation (WHO) itself says there is “no evidence” 
to show this. Instead, the WHO’s scientific brief on Covid-19 and smoking says the
risk of smokers getting the disease, or of being more susceptible to landing up 
in hospital, has not been investigated. “There are currently no peer-reviewed studies
that have evaluated the risk of SARS-CoV-2 infection among smokers,” it states.

One claim made by the government is that smokers are more likely to get Covid-19
because they move their hands to their mouths more often. West responds that anyone
who eats also puts their hands near their mouths, and no evidence exists that repetitive
hand-to-mouth actions are linked to more Covid-19 infections.

Elsewhere, the government references Asian studies that did indeed find worse outcomes
among hospitalised smokers with Covid-19. West took the time to match the government’s
scientific references and twice it quotes the wrong study to back up its claims.
He fixes its citations.

One study done in China by Fei Zhou and printed in The Lancet, which the government
cites, showed that there was no difference between the rates of death of smokers
or nonsmokers. However, the government doesn’t quote that conclusion.

The government also argues that the lockdown has caused 88% of people to quit smoking,
based on data from the Human Sciences Research Council (HSRC). However, a study 
done by University of Cape Town (UCT) researchers found that 90% of smokers surveyed
obtained tobacco anyway during the lockdown, but on the black market.

The government says in its court papers that 95% of people who stop smoking don’t
need any assistance, pharmaceutical or otherwise; this claim is based on a book 
it says was written in 2012.

However, West found that the book was actually written in 1990, when little medication
to stop quitting was available.

“The author states that 95% of smokers who successfully quit have done so on their
own without any support. It is worth noting that in 1990, the only available supports
were counselling and nicotine gum, the latter of which is not often successful when
used in isolation,” he says.

West says the known interventions to help people stop smoking were developed after
the book was written.

“Nicotine patches were only introduced in the 1990s, and the medications bupropion
and varenicline only received approval in 1997 and 2006, respectively … It is no
wonder that 95% of patients quit without support — there simply wasn’t any support
available in 1990,” he says.

Elsewhere, the government’s statistics seem shaky. It quotes the HSRC as saying 
that 1% of SA’s 8-million smokers will get Covid-19, which amounts to 80,000 people.
Of these, it says, 10% – or 8,000 people – will need intensive care treatment. However,
the HSRC provided no study to corroborate these numbers.

West says: “On further enquiry with Priscilla Reddy from the HSRC, I was informed[
those] figures were, ‘conservative estimates that were guided by prevalence and 
infection rate studies such as the seroprevalence studies conducted in several countries
and districts’”.

He says Reddy “did not elect to share or reference any of these studies”.

Yet those HSRC numbers contradict other models. For example, the SA Covid-19 Modelling
Consortium estimates that about 4% of symptomatic patients will require intensive
care — not 10%.

Another argument made by the government is that banning cigarettes will reduce people
sharing cigarettes – or “zol” – and thus sharing saliva. But if cigarettes on the
black market are 90% more expensive, as the UCT study found, the likelihood of people
sharing a smoke actually increases.

There were other noticeable errors in the government’s court papers. For example,
it claims Israel banned cigarette sales during Covid-19 (it didn’t) and that SA 
has 4,000 ventilators (it doesn’t).

One area where West concedes there is some evidence is that smokers who do end up
in hospital are more ill and are more likely to need a ventilator, as seen in Chinese
studies.

But even here, the WHO cautions that the evidence is of poor quality, since the 
studies didn’t look to see if smokers who needed intensive care were also overweight,
older, male or with uncontrolled diabetes – all known risk factors for Covid-19 
complications.

West says the same: “The literature referenced in the response in support of these
statements is either nonexistent, or of low to very low quality.”

He then explains that studies on smokers in intensive care are limited: “Some studies
do not differentiate between current and past smokers, none of the data sets stratify
smokers according to pack-year-history (a measure of quantity in duration of smoking).”

This matters, since newer studies appear to show that current smokers are less likely
to die than former smokers from Covid-19, though no one knows whether or not this
is just an anomaly.

Much of the government’s argument details the harm of tobacco and severely increased
risk of lung cancer, heart disease, and low birth weight of babies born to smoking
moms. This is not disputed by Fita.

But it is not clear what curbing these side effects of smoking have to do with controlling
the spread of Covid-19 specifically.

While smoking is obviously bad for people, and it can lead to worse outcomes if 
smokers land in hospital with severe Covid-19, the government’s court documents 
appear to be a haze of outdated science, sloppy references and leaps of logic in
contradiction to the WHO.

Article by [Financial Mail](https://www.businesslive.co.za/fm/features/2020-06-09-sloppy-science-taints-dlamini-zumas-tobacco-court-defence/)