Cardiovascular cases involving occupational risks are complicated causation proof issues in workers' compensation cases. The association of the work exposure and/or effort is usually a challenging proof battle where literature and medical experts are caught in a contentious duel.
Showing posts with label smoking. Show all posts
Showing posts with label smoking. Show all posts
Sunday, November 13, 2016
Monday, January 20, 2014
Smoking Is Worse Than You Imagined
The latest surgeon general’s report on the health effects of smoking — issued at the 50th anniversary of the pathbreaking 1964 report — offers astonishing new evidence of just how much harm tobacco is causing. Despite the many gains in reducing risks over the past half-century, researchers keep finding new and insidious ways in which smoking is harming the smokers themselves and nonsmokers who breathe in toxic fumes.
The report, issued last Friday, finds that cigarette smoking kills even more Americans than previously estimated (about 480,000 a year, up from 443,000), and is a cause, though not necessarily the major cause, of even more diseases than previously recognized, including liver and colorectal cancers. These add to the long list of other cancers caused by smoking, as well as rheumatoid arthritis and other ailments. The report newly identifies exposure to secondhand smoke as a cause of strokes.
The report estimates that smoking costs the United States between $289 billion and $333 billion a year for medical care and lost productivity, well above the previous estimate of $193 billion.
Most shocking, the report finds that today’s smokers have a much higher risk for lung cancer and chronic obstructive pulmonary disease than smokers in 1964, despite smoking fewer cigarettes.
It reports that the risk of developing adenocarcinoma of the lung, the most common type of lung cancer, has increased substantially over the past several decades because of...
[Click here to see the rest of this post]
Related articles
The 50-year war on smoking (workers-compensation.blogspot.com)
Asbestos and Cigarettes (workers-compensation.blogspot.com)
Deal reached on tobacco firm corrective statements (workers-compensation.blogspot.com)
Cancer deaths rise to 8.2 million, breast cancer sharply up (workers-compensation.blogspot.com)
Global cancer burden rises to 14.1 million new cases in 2012: Marked increase in breast cancers must be addressed (workers-compensation.blogspot.com)
Why Everyone Seems to Have Cancer (workers-compensation.blogspot.com)
The report, issued last Friday, finds that cigarette smoking kills even more Americans than previously estimated (about 480,000 a year, up from 443,000), and is a cause, though not necessarily the major cause, of even more diseases than previously recognized, including liver and colorectal cancers. These add to the long list of other cancers caused by smoking, as well as rheumatoid arthritis and other ailments. The report newly identifies exposure to secondhand smoke as a cause of strokes.
The report estimates that smoking costs the United States between $289 billion and $333 billion a year for medical care and lost productivity, well above the previous estimate of $193 billion.
Most shocking, the report finds that today’s smokers have a much higher risk for lung cancer and chronic obstructive pulmonary disease than smokers in 1964, despite smoking fewer cigarettes.
It reports that the risk of developing adenocarcinoma of the lung, the most common type of lung cancer, has increased substantially over the past several decades because of...
[Click here to see the rest of this post]
Related articles
The 50-year war on smoking (workers-compensation.blogspot.com)
Asbestos and Cigarettes (workers-compensation.blogspot.com)
Deal reached on tobacco firm corrective statements (workers-compensation.blogspot.com)
Cancer deaths rise to 8.2 million, breast cancer sharply up (workers-compensation.blogspot.com)
Global cancer burden rises to 14.1 million new cases in 2012: Marked increase in breast cancers must be addressed (workers-compensation.blogspot.com)
Why Everyone Seems to Have Cancer (workers-compensation.blogspot.com)
Friday, August 23, 2013
Why Is Obama Caving on Tobacco?
LAST year I endorsed President Obama for re-election largely because of his commitment to putting science and public health before politics. But now the Obama administration appears to be on the verge of bowing to pressure from a powerful special-interest group, the tobacco industry, in a move that would be a colossal public health mistake and potentially contribute to the deaths of tens of millions of people around the world.
Although the president’s signature domestic issue has been health-care reform, his legacy on public health will be severely tarnished — at a terrible cost to the poor in the developing world — unless his administration reverses course on this issue.
Today in Bandar Seri Begawan, Brunei, representatives from the United States and 11 other nations begin the latest round of negotiations over the Trans-Pacific Partnership, a multinational trade agreement. The pact is intended to lower tariffs and other barriers to commerce, a vitally important economic goal. But if it is achieved at the expense of people’s health, the United States and countries around the world will be worse off for it.
Wednesday, August 14, 2013
Anti-Smoking Battle Moves Outdoors
First it was bars, restaurants and office buildings. Now the front lines of the "No Smoking" battle have moved outdoors.
City parks, public beaches, college campuses and other outdoor venues across the country are putting up signs telling smokers they can't light up. Outdoor smoking bans have nearly doubled in the last five years, with the tally now at nearly 2,600 and more are in the works.
But some experts question the main rationale for the bans, saying there's not good medical evidence that cigarette smoke outdoors can harm the health of children and other passers-by.
Whether it is a long-term health issue for a lot of people "is still up in the air," said Neil Klepeis, a Stanford University researcher whose work is cited by advocates of outdoor bans.
Ronald Bayer, a Columbia University professor, put it in even starker terms.
"The evidence of a risk to people in open-air settings is flimsy," he said.
There are hundreds of studies linking indoor secondhand smoke to health problems like heart disease. That research has bolstered city laws and workplace rules that now impose smoking bans in nearly half of the nation's bars, restaurants and workplaces.
City parks, public beaches, college campuses and other outdoor venues across the country are putting up signs telling smokers they can't light up. Outdoor smoking bans have nearly doubled in the last five years, with the tally now at nearly 2,600 and more are in the works.
But some experts question the main rationale for the bans, saying there's not good medical evidence that cigarette smoke outdoors can harm the health of children and other passers-by.
Whether it is a long-term health issue for a lot of people "is still up in the air," said Neil Klepeis, a Stanford University researcher whose work is cited by advocates of outdoor bans.
Ronald Bayer, a Columbia University professor, put it in even starker terms.
"The evidence of a risk to people in open-air settings is flimsy," he said.
There are hundreds of studies linking indoor secondhand smoke to health problems like heart disease. That research has bolstered city laws and workplace rules that now impose smoking bans in nearly half of the nation's bars, restaurants and workplaces.
Friday, August 2, 2013
Largest Study to Date Finds State Smoke-Free Laws Would Not Hurt Restaurant and Bar Business
Smoking is a major cause of disease and workers' compensation claims. Tobacco usage in restaurants and bars is a danger to both the employees and the guests. Banned in some jurisdictions, this study confirms that prohibiting smoking in restaurants and bars is not an economic detriment to businesses. Today's post was shared by RWJF PublicHealth and comes from www.cdcfoundation.org
A study conducted by RTI International in nine states concludes that statewide smoke-free laws would not be expected to have an adverse economic impact on restaurants and bars in these states. The study, which was supported by the CDC Foundation, was released today in the journal Preventing Chronic Disease.
The findings of the new analysis are consistent with the results of previous peer-reviewed studies. However, this study (www.cdc.gov/pcd/issues/2013/12_0327.htm) is unique in that it is the largest of its kind, aggregating all the available data from local jurisdictions in the studied states.
The findings of the new analysis are consistent with the results of previous peer-reviewed studies. However, this study (www.cdc.gov/pcd/issues/2013/12_0327.htm) is unique in that it is the largest of its kind, aggregating all the available data from local jurisdictions in the studied states.
Sunday, June 2, 2013
The Global Adult Tobacco Survey: Saving Lives From Tobacco Related Diseases
Antismoking mass media campaigns can help reduce the prevalence of smoking by discouraging young persons from initiating smoking and by encouraging current smokers to quit (1,2). Smoking cessation is a multistage process; intention to quit smoking precedes quit attempts (3).
To assess whether awareness of anti-cigarette smoking information in four mass media channels (television, radio, billboards, and newspapers or magazines) was significantly associated with a current cigarette smoker's intention to quit, CDC analyzed data from 17 countries that participated in the Global Adult Tobacco Survey (GATS). Logistic regression was used to analyze the relationship between awareness of antismoking messages and intent to quit smoking; odds ratios were adjusted to control for demographic factors, awareness of warning labels on cigarette packages, and awareness of tobacco advertisements.
In nine of 17 countries, intent to quit was significantly associated with awareness of antismoking messages in a single media channel versus no awareness, with adjusted odds ratios ranging from 1.3 to 1.9. In 14 countries, intent to quit was significantly associated with awareness of messages in multiple channels versus no awareness, with adjusted odds ratios ranging from 1.5 to 3.2. Antismoking information in mass media channels can help reduce tobacco consumption by encouraging smokers to contemplate quitting and might be more effective when presented in multiple channels.
In nine of 17 countries, intent to quit was significantly associated with awareness of antismoking messages in a single media channel versus no awareness, with adjusted odds ratios ranging from 1.3 to 1.9. In 14 countries, intent to quit was significantly associated with awareness of messages in multiple channels versus no awareness, with adjusted odds ratios ranging from 1.5 to 3.2. Antismoking information in mass media channels can help reduce tobacco consumption by encouraging smokers to contemplate quitting and might be more effective when presented in multiple channels.
Wednesday, March 27, 2013
Should Employers Hire Smokers?
Workers' Compensation claims seem to increase with both complexity and severity when a worker is a smoker and suffers an occupational exposure. The class case is the synergistic effect that smoking has with some carcinogenic substance such as asbestos.
The ethical implications are reviewed this week in the New England Journal of Medicine
where the authors seem to take the position that smokers should not be punished, but rather reformed.
"Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International. We agree with those polled, believing that categorically refusing to hire smokers is unethical: it results in a failure to care for people, places an additional burden on already-disadvantaged populations, and preempts interventions that more effectively promote smoking cessation."
The ethical implications are reviewed this week in the New England Journal of Medicine
"Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International. We agree with those polled, believing that categorically refusing to hire smokers is unethical: it results in a failure to care for people, places an additional burden on already-disadvantaged populations, and preempts interventions that more effectively promote smoking cessation."
Tuesday, November 20, 2012
Five US Airports that Put Employees and Passengers At Risk For Environmental Tobacco Smoke
 |
| Secondhand Smoke Is Deadly |
Average air pollution levels from secondhand smoke directly outside designated smoking areas in airports are five times higher than levels in smoke-free airports, according to a study by the Centers for Disease Control and Prevention. The study conducted in five large hub U.S. airports also showed that air pollution levels inside designated smoking areas were 23 times higher than levels in smoke-free airports. In the study, designated smoking areas in airports included restaurants, bars, and ventilated smoking rooms.
Five of the 29 largest airports in the United States allow smoking in designated areas that are accessible to the public. The airports that allow smoking include Hartsfield-Jackson Atlanta International Airport, Washington Dulles International Airport, McCarran International Airport in Las Vegas, Denver International Airport, and Salt Lake City International Airport. More than 110 million passenger boardings—about 15 percent of all U.S. air travel—occurred at these five airports last year.
"The findings in today’s report further confirm that ventilated smoking rooms and designated smoking areas are not effective," said Tim McAfee, M.D., M.P.H., director of CDC’s Office on Smoking and Health. "Prohibiting smoking in all indoor areas is the only effective way to fully eliminate exposure to secondhand smoke."
A 2006 Surgeon General’s Report concluded that there is no risk-free level of exposure to secondhand smoke. Although smoking was banned on all U.S. domestic and international commercial airline flights through a series of federal laws adopted from 1987 to 2000, no federal policy requires airports to be smoke-free.
"Instead of going entirely smoke-free, five airports continue to allow smoking in restaurants, bars or ventilated smoking rooms. However, research shows that separating smokers from nonsmokers, cleaning the air and ventilating buildings cannot fully eliminate secondhand smoke exposure," said Brian King, Ph.D., an epidemiologist with CDC’s Office on Smoking and Health and co-author of the report. "People who spend time in, pass by, clean, or work near these rooms are at risk of exposure to secondhand smoke."
Secondhand smoke causes heart disease and lung cancer in nonsmoking adults and is a known cause of sudden infant death syndrome or SIDS, respiratory problems, ear infections, and asthma attacks in infants and children. Even brief exposure to secondhand smoke can trigger acute cardiac events such as heart attack. Cigarette use kills an estimated 443,000 Americans each year, including 46,000 heart disease deaths and 3,400 lung cancer deaths among nonsmokers from exposure to secondhand smoke.
For an online version of this MMWR report, visit http://www.cdc.gov/mmwr. For quitting assistance, call 1-800-QUIT-NOW (1-800-784-8669) or visit www.smokefree.gov
. Also, visit www.BeTobaccoFree.gov for information on quitting and preventing children from using tobacco. For real stories of people who have quit successfully, visit http://www.cdc.gov/tips. For state-specific tobacco-related data, visit CDC's State Tobacco Activities Tracking and Evaluation System at http://www.cdc.gov/tobacco/statesystem.Read More About "Secondhand" Environmental Smoke
Apr 23, 2011
"Secondhand smoke (SHS) exposure causes lung cancer and cardiovascular and respiratory diseases in nonsmoking adults and children, resulting in an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths ...
Feb 20, 2008
An Atlantic City NJ casino card dealer employed at the Claridge Hotel who was exposed to second hand tobacco smoke was awarded workers' compensation benefits. NJ Judge Cosmo Giovinazzi award $150,00 for lost ...
Nov 14, 2012
"Secondhand smoke (SHS) exposure causes lung cancer and cardiovascular and respiratory diseases in nonsmoking adults and children, resulting in an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths .
Oct 06, 2011
Lubick (2011) discussed the global health burden of secondhand smoke, and Burton (2011)emphasized a new and alarming consequence of smoking in indoor environments—“thirdhand smoke”—a term first coined in 2006 ...
Wednesday, November 14, 2012
The Great American Smoke-out - November 15, 2012
Read more about smoking and workers' compensation
Oct 06, 2011
"Passive smoking exposure is a topic of great concern for public health because of its well-known adverse effects on human health (International Agency for Research on Cancer 2004). Two news articles on this topic were ...
Apr 23, 2011
"Secondhand smoke (SHS) exposure causes lung cancer and cardiovascular and respiratory diseases in nonsmoking adults and children, resulting in an estimated 46,000 heart disease deaths and 3,400 lung cancer deaths ...
Jul 11, 2009
In many jurisdictions firefighters are allowed a presumption under the law that their pulmonary disability is causally related to their employment under workers' compensation. Now firefighters hired after January 1, 2010 in St.
Nov 18, 2009
For decades, the addictive habit of smoking has been treated as a non-compensable cause and a pre-existing condition. See The Health Consequences of Smoking: Cancer and Chronic Lung Disease in the Workplace: A ...
Wednesday, February 20, 2008
Casino Employee in NJ Wins Cancer Suit for Second-Hand Smoke Forecasting a New Wave in Litigation
An Atlantic City NJ casino card dealer employed at the Claridge Hotel who was exposed to second hand tobacco smoke was awarded workers' compensation benefits. NJ Judge Cosmo Giovinazzi awarded $150,00 for lost wages and medical benefits to a card dealer holding that second-hand tobacco smoke materially contributed to the employee's lung cancer.
Environmental tobacco smoke has long been associated with lung cancer. A survey of London casino workers indicated that most wanted their environments should be smoke-free. A recently published study by researchers at the University of Nevada revealed that casino floor workers are exposed to four times more tobacco smoke tham amy other workers increasing their risk of cradiovascular disease and lung cancer. Ventilation does not eliminate the poisonous toxins and chimcal components of secondhand smoking.
In The History of the War on Cancer , authored by Devra Davis, in a recent speech broadcast on Book-TV, expresses the urgent need for the removal of carcinogens, inluding tobacco, from the workplace and indicates the need to eliminate the causes.
The Surgeon General of the United States has stated two major observations:
"For the majority of American workers who smoke, cigarette smoking represents a greater cause of death and disability than their work environment." U.S. Department of Health and Human Service. The Health Consequences of Smoking. A Report of the Surgeon General, U.S. Department of Health and Human Services, Public Health Service, 1985 at p. 11.
"In those worksites where well-established disease outcomes occur, smoking control and reduction in exposure to hazardous agents are effective, compatible, and occasionally synergistic approaches to the reduction of disease for the individual worker ..." However, "asbestos exposure can increase the risk of developing lung cancer in both cigarette smokers and non-smokers." Id. at p. 13.
"Cigarette smoking is a major cause of cancer of the lung, larynx, oral cavity, and esophagus and is a contributory factor for cancer of the kidney, urinary bladder, and pancreas. These cancers will cause 278,700 of the estimated 910,000 new cancer cases in the United States during 1985 (ACS 1985), or 30.6 percent of the cancers occurring in the United States other than skin cancer. Exposures to agents in the workplace other than cigarette smoke will also cause some of these new cancers, and a number of cancers will result from the combined effects of cigarette smoking and carcinogenic exposures in the workplace." Id. at p. 101.
Approximately 30 percent of indoor workers in the United States are not covered by smoke-free workplace policies. Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide. Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC). The National Institute for Occupational Safety and Health has concluded the secondhand smoke is an occupational carcinogen.
Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.
Conventional air cleaning systems can remove large particles, but not the smaller particles or gases found in secondhand smoke. Routine operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the preeminent U.S. body on ventilation issues, has concluded that ventilation technology cannot be relied on to control health risks from secondhand smoke exposure. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
Already an area of new litigation is that of Suing the Smoker Next Door. Ironically, in a lawsuit against their neighbors, tenants allege that the common hallways of their NY apartment building smell like "a Las Vegas casino," jeopardizing the health of those who live and work in building.
Workers' Compensation has been the genius of many lawsuits and one could easily predict that a new wave of litigation will be third-party civl actions generated against building property owners and those who are responsible to maintain the premises including: management companies, co-op and condominium associations.
Environmental tobacco smoke has long been associated with lung cancer. A survey of London casino workers indicated that most wanted their environments should be smoke-free. A recently published study by researchers at the University of Nevada revealed that casino floor workers are exposed to four times more tobacco smoke tham amy other workers increasing their risk of cradiovascular disease and lung cancer. Ventilation does not eliminate the poisonous toxins and chimcal components of secondhand smoking.
In The History of the War on Cancer , authored by Devra Davis, in a recent speech broadcast on Book-TV, expresses the urgent need for the removal of carcinogens, inluding tobacco, from the workplace and indicates the need to eliminate the causes.
The Surgeon General of the United States has stated two major observations:
"For the majority of American workers who smoke, cigarette smoking represents a greater cause of death and disability than their work environment." U.S. Department of Health and Human Service. The Health Consequences of Smoking. A Report of the Surgeon General, U.S. Department of Health and Human Services, Public Health Service, 1985 at p. 11.
"In those worksites where well-established disease outcomes occur, smoking control and reduction in exposure to hazardous agents are effective, compatible, and occasionally synergistic approaches to the reduction of disease for the individual worker ..." However, "asbestos exposure can increase the risk of developing lung cancer in both cigarette smokers and non-smokers." Id. at p. 13.
"Cigarette smoking is a major cause of cancer of the lung, larynx, oral cavity, and esophagus and is a contributory factor for cancer of the kidney, urinary bladder, and pancreas. These cancers will cause 278,700 of the estimated 910,000 new cancer cases in the United States during 1985 (ACS 1985), or 30.6 percent of the cancers occurring in the United States other than skin cancer. Exposures to agents in the workplace other than cigarette smoke will also cause some of these new cancers, and a number of cancers will result from the combined effects of cigarette smoking and carcinogenic exposures in the workplace." Id. at p. 101.
Approximately 30 percent of indoor workers in the United States are not covered by smoke-free workplace policies. Secondhand smoke exposure causes disease and premature death in children and adults who do not smoke. Exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer.
Secondhand smoke contains hundreds of chemicals known to be toxic or carcinogenic (cancer-causing), including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide. Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer (IARC). The National Institute for Occupational Safety and Health has concluded the secondhand smoke is an occupational carcinogen.
Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposures of nonsmokers to secondhand smoke.
Conventional air cleaning systems can remove large particles, but not the smaller particles or gases found in secondhand smoke. Routine operation of a heating, ventilating, and air conditioning system can distribute secondhand smoke throughout a building. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), the preeminent U.S. body on ventilation issues, has concluded that ventilation technology cannot be relied on to control health risks from secondhand smoke exposure. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.
Already an area of new litigation is that of Suing the Smoker Next Door. Ironically, in a lawsuit against their neighbors, tenants allege that the common hallways of their NY apartment building smell like "a Las Vegas casino," jeopardizing the health of those who live and work in building.
Workers' Compensation has been the genius of many lawsuits and one could easily predict that a new wave of litigation will be third-party civl actions generated against building property owners and those who are responsible to maintain the premises including: management companies, co-op and condominium associations.
Sunday, October 14, 2007
Workers' Compensation, "'The Dead Elephant' in the Room"
Joining a loud and vocal majority, Peter Rousmanie, a writer for the periodical, Risk and Insurance, has authored a series of 4 articles on the failing workers’ compensation system.
In a series initially focusing on the World Trade Disaster he has shifted his focus in the first two articles from merely the 911 tragedy to the entire system calling workers’ compensation, “”The Dead Elephant’ In the Room.”
World Trade Center In-Depth Series (Part 1): Up in Smoke
World Trade Center In-Depth Series (Part 2): The Disease Within
World Trade Center In-Depth Series (Part 3): Peeling a Sour Apple
In a series initially focusing on the World Trade Disaster he has shifted his focus in the first two articles from merely the 911 tragedy to the entire system calling workers’ compensation, “”The Dead Elephant’ In the Room.”
World Trade Center In-Depth Series (Part 1): Up in Smoke
World Trade Center In-Depth Series (Part 2): The Disease Within
World Trade Center In-Depth Series (Part 3): Peeling a Sour Apple
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