Velvet Glove, Iron Fist is a fast-paced critique of the late twentieth- and early twenty-first-century public health focus on lifestyle behaviours. The book centres on smoking, which Snowdon, in common with anti-smoking activists, sees as the blueprint for increased regulation of individual health behaviour for the common good. Snowdon traces the history of anti-smoking campaigns from the early seventeenth century through to the present day, via campaigners such as Lucy Page Gaston in early twentieth-century USA and the National Socialist regime in 1930s and early 1940s Germany. Rather than making the simplistic argument that current regulations on smoking exceed anything the Nazis hoped to implement (although he makes this point), Snowdon's aim is to unveil the financial interests which have grown around the tobacco control movement and the spurious epidemiology used to back up some of its claims, particularly in relation to passive smoking and ‘third-hand smoke’ (that is, the residual nicotine that remains on surfaces after a cigarette has been smoked).
Much of the material in Snowdon's early chapters is re-worked from existing historical accounts of smoking, but he presents the material in an interesting and accessible manner. The more substantive part of Snowdon's argument comes in the later chapters, where he follows the development of the tobacco control movement from local initiatives to its global position today, a development which has gathered pace in the last decade and a half. In 1994, leaked documents acknowledging that the tobacco industry had been aware of the addictive nature of cigarettes and ‘had deliberately misled the public for decades’ (p. 191) undermined the notion of the smoker's right to choose. At the same time, concerns about passive smoking legitimated moving the debate beyond individual rights towards a raft of measures justified as within the public interest, such as increased taxation and restrictions on smoking in public places. These measures went beyond previous approaches, such as educating and informing the public about the dangers of smoking, to health and offering advice on how to quit.
This shift in the direction of anti-smoking campaigns has been chronicled elsewhere, most notably by historian Virginia Berridge (Marketing Health, Oxford University Press, 2007). However, Snowdon argues that the case against passive smoking was (and crucially for his argument, remains) scientifically unfounded, epidemiologically dubious and manifestly overstated. He seeks to call the tobacco control movement to account for unsubstantiated statements such as ‘[j]ust thirty seconds of exposure [to smoke] can make coronary heart function indistinguishable from smokers’ (Snowdon's emphasis; p. 332). He cites comments from Sir Richard Doll, one of the epidemiologists who established the causal connection between smoking and lung cancer, that ‘the effects of other people smoking in my presence is [sic] so small it doesn't worry me’. But such views went against the tide: Doll was obliged to later state he had been speaking in a personal capacity (p. 248).
While Snowdon is correct to highlight questionable tactics which go beyond sound public health, and to highlight the dangers to individual liberties which arise from those tactics being applied to other lifestyle behaviours, he undermines his case by downplaying the risks of smoking to individual health. He states that ‘some people might become addicted and some of those might then become ill and die’ (emphasis in original, p. 323), a statement which flies in the face of medical evidence.* ‘Will’ would surely be more appropriate. Similarly, to dismiss concerns about excessive alcohol consumption as ‘panic’ fails to take into account the very real social, as well as medical, harm caused by alcoholism.** Snowdon's attack on the health inequalities agenda (pp. 296–300) ignores the differences in longevity and mortality experienced in different social groups within the developed world. Further, although there is a detailed summary of the epidemiological evidence relating to passive smoking, there is a frustrating lack of referencing in other parts of the book. Regarding passive smoking, Snowdon by-passes the influence of Roy Castle in the UK context, a popular musician and television personality who died of lung cancer in the early 1990s despite being a non-smoker, and did much to bring the subject to public attention.
These criticisms notwithstanding, Velvet Fist, Iron Glove is an enjoyable read which surely proves that smoking has not lost its ability to provoke debate and reaction in over four centuries. It remains to be seen whether the pendulum will continue to swing towards prohibition, or whether smokers will enjoy a renaissance.
* 'Will' would probably have been a better choice of word, although in the context of the paragraph (which is about degrees of risk from cholera to gambling), it makes more sense. On the whole, I don't think the book downplays the risks of smoking at all.
** Alcoholism is always with us. Panics aren't. The hysteria about 24 hour drinking and 'binge-drinking' can fairly be described as a moral panic - see, for example, this study.