Wind turbine noise
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1527 (Published 08 March 2012) Cite this as: BMJ 2012;344:e1527
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An original research proposal: Effects of noise on sleep and their potential repercussion on cardiac patients in hospital settings
Dr.Tanu Pramanik BSc. MA (Sociology) DSc (Clin.Psychology) Lecturer & Research Supervisor,Allianze University College of Medical Sciences, 13200-Penang, Malaysia.
E-mail: tanu@allianzeunicollege.edu.my
The author of the current editorial “Wind turbine noises” deserves sincere applause for his firm statement- “we are firm in our assertion that the evidence for harm at distances and noise levels permitted under current regulations in most jurisdictions is such that regulators should take notice and initiate research (1).
Clinical Psychology:
Many clinical psychologists and sleep medicine experts consider that normal sleep should be regarded as one of the basic human rights, because chronic sleep disturbance due to any kind of noise pollution is a well-documented cause of several psychosomatic disorders. Sleep patterns are particularly susceptible to noise for a number of reasons. First, our brains are able to process incoming acoustic stimuli even while asleep. Second, the noise levels that effect sleep are much lower than those required to impair hearing.
The World Health Organization guidelines say that for a good sleep, sound level should not exceed 30 dB(A) for continuous background noise, and 45 dB(A) for individual noise events.(2)
During sleep, the sound levels that cause noise-induced stress reactions are much lower than in the active phase. Furthermore, a shift worker in a wind turbine firm or in an airport may sleep during relatively high noise levels but still shows autonomic responses, such as increased heart rate.
The effect of noise on sleep, however, not only depends on the acoustical parameters of noise but also on the individual as there is large variance in the experience of a person with a particular noise. Personal characteristics such as personality traits, diurnal type, age and self-estimated sensitivity to noise are important individual factors.(3)
In one study, rats were exposed to environmental noise for 9 days. Results showed that this chronic exposure continually restricted the amount of slow wave sleep (SWS).(4)
These autonomic responses to noise during sleep can be obtained for much lower peak noise intensities as during wake states. These effects, mainly involving increased heart rate and vasoconstriction, have been found to habituate over successive noise-exposed nights as opposed to long exposure times. This could indicate an effect on cardiovascular response over the long term exposure.(5)
Sleep Medicine:
Current understanding, however, indicates that sleep has important physiologic restorative functions. An improved understanding of physiologic activities during normal sleep has shed light on the important cardiovascular, neuroendocrine, immunologic and behavioral/cognitive changes associated with disturbed sleep.
Chronic exposure to an environmental noise (EN) induces sleep disturbances but is not fully known what impact these disturbances have on humans.
However, we appreciate the author’s comment that “there is not a single published study showing lack of adverse effects of noise on sleep and health”.
Therefore, we designed current research proposal with an objective to study noise induced repercussions on cardiac patients in a hospital setting. During our study, we will use EEG, EKG, polysomnogram and other monitoring systems for the patients selected under stringent criteria set by the clinical research committee and University ethical committee.
Psychosomatic medicine:
During sleep, heart rate is related to changes in the parasympathetic-sympathetic balance with an increase in sympathetic tone associated with activation and with electroencephalogram (EEG) arousal. Catecholamine levels and sympathetic activity decrease during sleep.
So, as one might assume that decreased sleep is associated with increased sympathetic activity and as a result increased blood pressure and heart rate. This association has been observed not only with sleep deprivation but also with regard to sleep disruption. Brief awakenings from sleep for only a few seconds are associated with temporary elevation in blood pressure and heart rate that results from an autonomic reflex.(6)
One study reports heart rate acceleration with auditory stimulation during sleep even when no EEG arousal was observed. These findings thus question whether activation of the autonomic nervous system night after night without visual EEG arousal or alpha-alpha-beta EEG changes of shorter duration could have long-term detrimental effects on the cardiovascular system. By contrast, the results suggest that brain stem activation can lead to autonomic nervous system response without creating objective consequences on specific tests of psychomotor vigilance during the following day.(7)
Studies report that total and partial sleep deprivation cause changes in mood and cognition such as increased sleepiness, fatigue, irritability and an overall decrease in concentration.(8) Other effects of sleep deprivation include longer reaction times, poor short-term memory, reduced motivation, distractibility and poor performance.(9)
Environmental factors, such as work pressure, lifestyle choices and noise are major causes of sleep disturbance. Because sleep is a crucial physiological recuperative state, sleep disorders are known cause of many negative health effects. Such effects include, but are not limited to, cardiovascular problems, neuroendocrine abnormalities and changes in cognition, mood and memory. The causal relationships between noise exposure, effects on sleep, and contribution to health disturbances, both behavioral and physical, are not firmly established yet. Our research may reveal adequate experimental data to substantiate general opinion about noise induced repercussions on human health.
Legal medicine:
Last but not the least, wind turbine noise may amount to what the common law regards as a nuisance, and entitle a person to take proceedings in the courts. If the court is satisfied that the noise complained of constitutes a nuisance, honorable court can order the person responsible to stop or remove the nuisance. It can also order compensation to be paid. Statute law also deals with nuisances. The Health Act 1958 (Vic) ("Health Act") expressly provides that a nuisance includes any noise which is or is liable to be dangerous to health or noxious, annoying or injurious to personal comfort.(10)
References:
1. Christopher D Hanning, and Alun Evans, Editorial:Wind turbine noise BMJ 2012; 344 doi: 10.1136/bmj.e1527 (Published 8 March 2012) : BMJ 2012;344:e1527
2. Berglund B, Lindvall T, Schwela DH. Guidelines for Community Noise. World Health Organization 1999. Available from: http://www.who.int/docstore/peh/noise/guidelines2.html . [Accessed on 2010 March 28].
3. Muzet A, Weber LD, Di Nisi J, Ehrhart J. Comparison of cardiovascular reactivity to noise during waking and sleep. National Center for Scientific Research Center for Bioclimatic studies. Convention No 82243, 1985.
4. Ohrstrom E, Bjorkman M. Effects of noise-disturbed sleep- a laboratory study on habituation and subjective noise sensitivity. J Sound Vib 1988;122:277-90.
5. Muzet A, Ehrhart J, Eschenlauer R, Lienhard JP. Habituation and age differences of cardiovascular responses to noise during sleep. In Sleep 1980;212-5.
6. Sforza E, Chapotot F, Lavoie S, Roche F, Pigeau R, Buguet A. Heart rate activation during spontaneous arousals from sleep: Effect of sleep deprivation. Clin Neurophysiol 2004;115:2442-51.
7. Guilleminault C, Abad VC, Philip P, Stoohs R. The effect of CNS activation versus EEG arousal during sleep on heart rate response and daytime tests. Clin Neurophysiol 2006;117:731-9.
8. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5h per night. Sleep 1997;20:267-77.
9. Bonnet MH, Arand DL. Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev 2003;7:297-310
10. file:///C:/Users/Toshiba/Desktop/TanuPhD/Legal%20sleep.htm
Competing interests: The continuous moral support of Prof. Dato 'Dr. Zainuddin Md Wazir, President, Allianze University College of Medical Sciences, Malaysia, is cordially acknowledged.
I live within approximately 1 km of five GE 1.5 MW turbines. I sleep very well at night and have had no change in my health since they were commissioned much earlier in the year.
Outside my residence, I can hear one or more of the turbines when the wind is of a certain strength and from a certain direction and it is the form of the well documented "swoosh". I have never felt or observed any LFN effects.
Some will say that I'm just not sensitive to the sounds being emitted by the turbines; and that a significant part of the population are hyper-sensitive to those sounds.
However, I don't understand why none of the many hundred host landowners and wind turbine workers in my province (Ontario) exhibit any adverse effects. When you include host landowner families, the cohort probably approaches 1000. None of them complain of any symptoms and, when informally questioned, none of them report any symptoms.
Having had considerable experience in the wind industry, I know that these people are not subject to gag orders.
Occasionally, I'm sure that a turbine can be incorrectly placed and cause real annoyance. At that point, it is up to the developer to either bring the turbine into compliance or to reach a settlement with the resident.
In Ontario, with its 550m minimum setback, incorrect placement is a very rare event.
Competing interests: Former wind developer, now retired
We thank Mr Barnard for his interest in our editorial and for at least appearing to agree with us that wind turbine noise causes annoyance.
Unfortunately, his ideas for "low cost solutions" will not be effective in reducing either "annoyance" or sleep disturbance. He seems incapable of recognising that, in this context, the term “annoyance” is used to denote a level of stress leading to harm, not just a mild irritation. Noise is universally recognised as a major public health problem causing not just sleep disruption with all its consequent effects including increases in blood pressure and myocardial infarction. The only effective measures are to reduce noise emission at source and/or attenuate the noise before it arrives at the receptor. For higher frequency noise, improved sound insulation of properties may be effective but the low frequency and infrasound emitted by wind turbines is not well attenuated and noise levels within a building may be higher than those outside. They can even be worse with the windows shut. Sadly therefore, Mr Barnard’s suggestions of thick blinds and closed windows will not be effective. Closed windows in summer either make the bedroom over warm or bring the need for air conditioning, neither of which may be conducive to good sleep.
Wind developers rely on increases in background noise with increased wind speed to mask turbine noise. Because of the low frequency content and impulsive nature of wind turbine noise, it is not masked by ambient noise and is audible 10-15dB below background. A white noise generator does not emit low frequency sound and therefore is useless in this range. If it is employed at sufficient intensities to mask other wind turbine noise frequencies, it will also impair sleep as is confirmed by a recent news report1.
Earplugs are uncomfortable, only suitable for short term use and would not be effective against low frequency and infra sound. Cognitive behavioural techniques have been suggested as a means of dealing with low frequency noise annoyance but are only effective when the source can not be identified (the hum). Wind turbines are all too obvious a source of noise.
All of Mr Barnard’s suggested measures would cause either distress or expense to those who find wind turbine noise thrust upon them. When secondhand smoke in public buildings was shown to inflict harm on non-smokers, the solution was to remove the source. No one, instead, seriously suggested impinging on the rights of non-smokers by forcing them to purchase respirators or nosegays to hide the smell. Factories are not permitted with noise emissions which are certain to impair the sleep of local inhabitants., We know of no good reason why wind turbines should not be subject to the same regulation. It is simply not good enough to exhort people to close their windows and wear ear plugs.
All governments seek to limit noise from all sources and we see no reason why wind energy should be exempt. We make no judgement about the value or otherwise of this form of electricity generation. If governments decree that the need to implement wind energy is so urgent that public health constraints can be overridden then appropriate compensation for those harmed must be put in place. We have no “agenda” save a desire to see that this public health problem is properly investigated and appropriate setback distances determined.
1. Fairfield residents given noise generators to drown out sound of windmills. Jul 16, 2012. http://www.wktv.com/news/local/Fairfield-residents-given-noise-generator...
Competing interests: None beyond those given with the editorial
It is heartening to see the work of Chris Hanning recognised by the medical fraternity. The emissions from wind turbines are a real concern for the health of people who are forced to live near them.
The ill effects , described , have been positively identified by many, many epidemiologists, neurologists and other health professionals but sadly not by the UK Government which continues to promote the cause of the Wind Energy developers. The only logical conclusion being that the Government is more concerned with the profits of the energy companies than it is with the health of the Nation.
The UK Government is a signatory to the Rio Declaration which requires the Precautionary Principle to be invoked where there is uncertainty about the safety and well being of human kind, animals and plant life. Compliance with this legal duty would mean the prohibition of wind turbines near to peoples dwellings and the introduction of a 2km buffer zone until such time as the scientific evidence confirms there is no risk to human health.
Many cases of people feeling ill near to wind turbines and of people leaving their homes because they can not tolerate the adverse effects are well documented.
It is time the UK Government took this matter seriously, stopped all windfarm planning applications and approvals within2 km of peoples house, employed properly qualified and experienced scientists in the field of medicine to fully investigate this matter rather than relying on acoustic experts employed by the wind industry and to re write the ETSUR97 noise regulations so that they protect the people rather than empower the energy companies.
Competing interests: No competing interests
Writing as someone who used to live 1km from a windfarm, and whose career has been involved in some way or other with public health. I make the following observations. We welcomed the wind farm, why would e not? We could not see the turbines from our home. We thought them to be admirable structures, a significant engineering achievement, and graceful in operation. We were completely and wholly unprepared for the noise and sleep deprivation that we immediately suffered from. None of my family have had problems sleeping before, but we did then, and being suddenly awoken in the early hours and being unable to get back to sleep night after night is very unpleasant, and rapidly makes normal day to day living almost impossible. It is well documented, and within the public domain that we tried (as other respondents have suggested) ear plugs, white noise machines, fans and medication. Nothing worked. Once we stopped sleeping at home, we were able to sleep normally again. We can sleep next to motorways, industrial sites, strain stations and airports – but this was something else altogether. You do not habituate to it.
Noise is of course a physical “presence”, and given that science is still discovering more and more about how the body “hears” and interprets sounds, my feeling is that we are; A) not measuring what is actually being emitted that impacts on human bodies and B) not perhaps yet able to scientifically understand the impact of whatever “frequency” (if that is what it is) has on the human body. There is, in my opinion, much yet to be learnt and understood about sound waves and their impacts. There is much to be aid for not dismissing something as being of little or no relevance just because you cant see it, not seeing it, doesn’t mean it doesn’t exist.
Competing interests: Recent neighbour of a wind farm. Took allegations of a private nuisance to the High Court in July 2011. Case settled out of court before noise evidence was heard in December 2011. No longer a wind farm neighbour
While Simon Chapman does an excellent job of rebutting the primary arguments of this article, if we were to take it at face value from a public health policy, what would suggested interventions be?
As the authors assert that this is a matter of annoying noise causing sleep disturbance, then surely they will be interested in low-cost, effective noise annoyance reduction measures.
For example, a white noise generator can be purchase for less than $30USD. This provides masking noise which would eliminate any impact from nearby wind turbines.
Similarly, comfortable foam earplugs would also be reasonable interventions. These can be purchased in bulk for cents per ear plug.
There are many stress reduction and annoyance distraction techniques available with the click of a button on the internet. Most of these can be studied and practiced free of charge by anyone interested in dealing with ultimately trivial annoyances that they are over-focussing upon.
Finally, closing windows and installing quilted blinds would not only significantly decrease noise, but would also decrease light, improving sleep as well.
The quilted blinds are the only expensive alternative in the above interventions.
All of these techniques are in use today in households around the world to deal with traffic noise, sirens, airplane noise, noisy neighbours, nearby industrial works, streetcars and dawn tractor startups. Urban and rural dwellers depend on them to ensure a comfortable and uninterrupted sleep.
By comparison, increasing setbacks of wind turbines by hundreds of meters, which their numbers suggest, would cause a significant reduction in possible sites for this clean and economical form of energy, cause an increase in distant wind turbines with associated higher costs, causing an overall increase of electricity costs and secondary health impacts to all consumers.
That the authors' only suggested intervention is greater setbacks for wind turbines betrays their agenda. Their solution is vastly out of proportion to the problem.
Competing interests: No competing interests
Authors’ reply
The weakness of Professor Chapman’s objections are evident from the tone of his response and his extensive use of ad hominen attacks, straw men and appeals to authority. He describes us as having “histories of anti-windfarm activity” as if that automatically rendered our opinions invalid. Neither of us have campaigned against windfarms in general, only against wind turbines being placed too close to human habitation, a public health objective which should have met with Prof Chapman’s approval. As Prof Chapman is a member of the Climate and Health Alliance, an advocacy group that campaigns for renewable energy, and could fairly be described as having a history of pro-windfarm activity, by his logic his opinions should be treated with equal scepticism.
Our editorial was careful to concentrate on sleep disturbance as the outcome measure for the adverse effects of wind turbine noise as we believe it is less susceptible to psychological effects than “annoyance”. We made no mention of “wind turbine syndrome” or any of the other symptoms that have been attributed to wind turbine noise. Professor Chapman’s assertions that complaints of ill-health from wind turbine noise are the product of mass hysteria are just that, assertions. There is no objective evidence to support them. There is clear evidence of causality and obvious mechanisms for wind turbine noise to disturb sleep rendering these assertions highly unlikely.
Prof Chapman makes much of his list of 17 reviews. Closer inspection shows that at least five were written before most of the studies cited in our editorial were published. One is in draft form and thus can not be relied upon, one reviewed the potential contribution of low frequency noise to annoyance and the rest were authored either by those with close associations with the wind industry or government departments committed to implementing wind energy and are thus hardly independent. We contend that the onus of proving safety falls on those introducing new forms of environmental pollution, including noise pollution, not on those exposed to the pollutant. A major principle of public health medicine is prevention. The reviews cited by Prof Chapman stand these principles on their heads.
We are not alone in calling for a review of current guidance for wind turbine noise and independent research. A review written by one of us (Hanning, 2011) contains a referenced list of 11 physicians and acousticians who have recommended greater setbacks and lesser noise levels than those currently permitted. An Environmental Review Tribunal in Ontario held in 2011 took oral and written evidence from over 20 experts including several contributors to Prof Chapman’s list and concluded: “… the debate should not be simplified to one about whether wind turbines can cause harm to humans. The evidence presented to the Tribunal demonstrates that they can, if facilities are placed too close to residents. The debate has now evolved to one of degree.” (Case Nos. 10-121 and 10-122. p 207). The Tribunal called also for more research as do we.
We are firm in our assertion that the evidence for harm at distances and noise levels permitted under current regulations in most jurisdictions is such that regulators should take notice and initiate research. If wind turbines are as benign as Prof Chapman asserts he should have no objection to research being undertaken. After all, there is not a single published study showing a lack of adverse effects on sleep and health.
CD Hanning and Alun Evans
15th March 2012
Competing interests: None beyond those given in the editorial
Hanning and Evans, two writers who declare histories of anti-windfarm activity, say that “a large body of evidence” now exists that wind turbines disturb sleep and impair health within permissible distances from housing[1]. They are correct in saying that a large body of relevant evidence exists, but wildly incorrect in their interpretation of its conclusions. I have located no less than 17 reviews of the evidence on whether wind turbines and infrasound cause health problems, nearly all which satisfy the fully “independent” provenance being called for [2]. Predictably, none are referenced in the editorial.
As will be seen, all of these reviews make strong statements that the evidence is very poor that wind turbines in themselves cause problems. What these reviews conclude is that :
• A small minority of exposed people claim to be adversely affected by wind turbines
• Negative attitudes to wind turbines are more predictive of reported adverse health effects and annoyance than are objective measures of actual exposure
• Being able to see wind turbines is similarly predictive of annoyance
• Deriving income from hosting wind turbines on one’s land may have a “protective effect” against annoyance and health symptoms. Here, it is important to note that claims made by anti-wind farm groups that turbine hosts sign “gag” clauses which prevent them from complaining, are contestable. I have obtained contracts from different Australian firms and none say anything about “gags”. Also, no contract would ever preclude a citizen from pursuing a claim of negligence in common law.
I have also compiled an ever-growing list[3] – currently standing at 63 – of symptoms and diseases in humans, animals and even earthworms, that people opposed to wind farms have publicly attributed to exposure. The diffuse and sometimes bizarre nature of many of these claims, considered alongside the complete absence of even a single mention of “wind turbine syndrome” in PubMed suggests that this is a phenomenon which is a prime candidate for being considered a contemporary example of psychogenic illness[4,5]. I know of no agent that even causes even a small fraction of all the symptoms and diseases said in these websites to be caused by wind turbines.
In their editorial [1] Hanning and Evans cite three papers from a non-indexed journal, the Bulletin of Science, Technology and Society which in August 2011 published an issue dedicated to papers opposed to wind farms. The journal was indexed between 1981-1995 by the Web of Science, but after 1995 indexing ceased, generally a sign that indexing services regard a journal as having fallen below an acceptable scientific standard.
The eight papers in the special Bulletin issue were written by 12 authors. Of these, 7 had given papers at the “First International Symposium: The Global Wind Industry and Adverse Health Effects: Loss of Social Justice?” The conference was an overtly anti-wind farm meeting.
A paper by Krough [6] provides an indication of the abject quality of the papers in that issue. The paper contains no methods section, so fails to conform to the most basic requirement of scientific reporting: that it contain details of how the research reported was undertaken. Instead, the author says that she “began investigating reports of adverse health effects made by individuals living in the environs” of wind turbines in Ontario, Canada for “more than two years”. Instead of describing any research, the author has written a paper which mixes up statements somehow apparently made to her by informants about negative effects of exposure to turbines with similar examples from other parts of the world, from websites and submission to enquiries. We are told nothing about the process by which her informants were interviewed, how they were selected and whether her “study” was approved by any institutional research ethics committee. There is not a single example of any informant reporting anything but adverse effects of exposure to windfarms, when it is widely acknowledged that a large majority of those so exposed report no adverse effects nor complain about turbines.
Hanning and Evans refer to Carl V Philips as an expert epidemiologist. Web of Science shows Philips has published just 10 cited papers (total cites 251). Philips today runs a private “Institute”, the Populi Health Institute, apparently consisting only of him. He testifies on behalf of complainants about wind farms.
Within hours of the BMJ publishing this peer reviewed editorial, I was being sent gloating emails by anti-wind farm activists, jubilant that a prestigious journal had published the editorial. In this instance, the BMJ needs to look at the adequacy of its peer review process.
References
1. Hanning CP, Evans A. Wind turbine noise. BMJ 2012;344:e1527 doi: 10.1136/bmj.e1527 (Published 8 March 2012)
2. Chapman S, Simonetti T. Summary of main conclusions reached in 17 reviews of the research literature on wind farms and health. School of Public Health, University of Sydney. 30 Jan 2012
http://tobacco.health.usyd.edu.au/assets/pdfs/WindHealthReviews.docx
3. Chapman S, Simonetti T. Is there anything not caused by wind farms? A list of diseases and symptoms in humans and animals said to be caused by wind turbines. School of Public Health, University of Sydney. http://tobacco.health.usyd.edu.au/assets/pdfs/WindfarmDiseases.docx
4. Bartholomew RE, Wessely S. Protean nature of mass sociogenic illness: From possessed nuns to chemical and biological terrorism fears. Br J Psychiatry 2002 180: 300-306.
5. Boss LP. Epidemic hysteria: a review of the published literature. Epidem Reviews 1997;19:233-243.
6. Krogh CME. Industrial wind turbine development and loss of social justice. Bull Science, Technol and Society 2011;31:321-333.
Competing interests: SC is a member of the Climate and Health Alliance, Australia and has often publicly questioned the legitimacy of "wind turbine syndrome". He had never received support of any sort from the wind industry or agents acting on its behalf.
Re: Wind turbine noise
Ladies and gentlemen sorry to get to the debate 2 years late, but I hope you find my contribution worthy. (1)
When it comes to psychogenic illness, it seems unlikely it is an illness that affects animals. This paper was published in 2013 from Poland, if I may quote. (2)
"The study consisted of 40 individuals of 5-week-old domestic geese Anser anser f domestica, divided into 2 equal groups. The first experimental gaggle (I) remained within 50 m from turbine and the second one (II) within 500 m. During the 12 weeks of the study, noise measurements were also taken. Weight gain and the concentration of cortisol in blood were assessed and significant differences in both cases were found.
Geese from gaggle I gained less weight and had a higher concentration of cortisol in blood, compared to individuals from gaggle II. Lower activity and some disturbing changes in behavior of animals from group I were noted. Results of the study suggest a negative effect of the immediate vicinity of a wind turbine on the stress parameters of geese and their productivity."
In Portugal a study from Portugal suggested that foals born near wind turbines developed Equine Flexural Limb Deformities.
Also "Biologist Dr. Lynne Knuth, in a letter to the Public Service Commission of Wisconsin, testified as follows: “The problems with animal reproduction reported in the wind farms in Wisconsin are lack of egg production, problems calving, spontaneous abortion (embryonic mortality), stillbirth, miscarriage and teratogenic effects:
In chickens: Crossed beaks, missing eyeballs, deformities of the skull (sunken eyes), joints of feet/legs bent at odd angles.
In cattle: missing eyes and tails (updated Excerpts from the Final Report of the Township of Lincoln Wind Turbine Moratorium Committee)."" (4)
There is more here. (5)
In conclusion it is possible in humans wind farm illnesses could be psychogenic. In animals it maybe a bridge too far.
1. http://www.bmj.com/content/344/bmj.e1527
2. http://www.ncbi.nlm.nih.gov/pubmed/24597302
3. https://www.repository.utl.pt/bitstream/10400.5/4847/1/Deforma%C3%A7ao%2...
4. file:///C:/Users/DaveA/Downloads/viewdoc.htm
5. http://canadafreepress.com/index.php/article/62126
Competing interests: Freedom2Choose (F2C) are mainly known as a smoker's rights group. I and our organisation have never received money, expenses or grace and favour from tobacco companies or agents. However I have been paid and remunerated by Pfizer who make smoking cessation drugs.